She felt a pain in her sinuses and sought a quick resolution.

Covid-19 couldn’t be ruled out, so rather than risk passing on an unknown infection to others in a waiting room, the New Yorker booked a telehealth visit through her usual health system, Mount Sinai — a perennial on best-hospitals lists.

That proved an expensive decision. She remembers the visit as taking barely any time. The doctor decided it was likely a sinus infection, not covid, and prescribed her fluticasone, a nasal spray that relieves congestion, and an antibiotic, Keflex. (The Centers for Disease Control and Prevention says antibiotics “are not needed for many sinus infections, but your doctor can decide if you need” one.)

Then the bill came.

The Patient: Elyse Greenblatt, now 38, had insurance coverage through Empire BlueCross BlueShield, a New York-based insurer.

Medical Services: A telehealth urgent care visit through Mount Sinai’s personal record app. Greenblatt was connected with an urgent care doctor through the luck of the draw. She was diagnosed with sinusitis, prescribed an antibiotic and Flonase, and told to come back if there was no improvement.

All this meant a big bill. The insurer said the telehealth visit was deemed an out-of-network service — a charge Greenblatt said the digital service didn’t do a great job of warning her about. It came as a surprise. “In my mind, if all my doctors are ‘in-insurance,’ why would they pair me with someone who was ‘out-of-insurance’?” she asked. And the hospital system tried its best to make contesting the charge difficult, she said.

Service Provider: The doctor was affiliated with Mount Sinai’s health system, though where the bill came from was unclear: Was it from one of the system’s hospitals or another unit?

Total Bill: $660 for what was billed as a 45- to 59-minute visit. The insurer paid nothing, ruling it out of network.

What Gives: The bill was puzzling on multiple levels. Most notably: How could this be an out-of-network service? Generally, urgent care visits delivered via video are a competitive part of the health care economy, and they’re not typically terribly expensive.

Mount Sinai’s telehealth booking process is at pains to assure bookers they’re getting a low price. After receiving the bill, Greenblatt went back to the app to recreate her steps — and she took a screenshot of one particular part of the app: the details. She got an estimated wait time of 10 minutes, for a cost of $60. “Cost may be less based on insurance,” the app said; this information, Mount Sinai spokesperson Lucia Lee said, is “for the patient’s benefit,” and the “cost may differ depending on the patient’s insurance.”

A $60 fee would be in line with, if not a bit cheaper than, many other telehealth services. Doctor on Demand, for example, offers visits from a clinician for $79 for a 15-minute visit, assuming the customer’s insurance doesn’t cover it. Amazon’s new clinic service, offering telehealth care for a wide range of conditions, advertises that charges start at $30 for a sinus infection.

The Health Care Cost Institute, an organization that analyzes health care claims data, told KFF Health News its data shows an urgent care telehealth visit runs, on average, $120 in total costs — but only $14 in out-of-pocket charges.

So how did this visit end up costing astronomically so much more than the average? After all, one of the selling points of telemedicine is not only convenience but cost savings.

First, there was the length of the visit. The doctor’s bill described it as moderately lengthy. But Greenblatt recalled the visit as simple and straightforward; she described her symptoms and got an antibiotic prescription — not a moderately complex visit requiring the better part of an hour to resolve.

The choice of description is a somewhat wonky part of health care billing that plays a big part in how expensive care can get. The more complex the case, and the longer it takes to diagnose and treat, the more providers can charge patients and insurers.

Greenblatt’s doctor billed her at a moderate level of care — curious, given her memory of the visit as quick, almost perfunctory. “I think it was five minutes,” she recalled. “I said it was a sinus infection; she told me I was right. ‘Take some meds, you’ll be fine.’”

Ishani Ganguli, a doctor at Brigham and Women’s Hospital in Boston who studies telehealth, said she didn’t know the exact circumstances of care but was “a bit surprised that it was not billed at a lower level” if it was indeed a quick visit.

That leaves the out-of-network aspect of the bill, allowing the insurer to pay nothing for the care. (Stephanie DuBois, a spokesperson for Empire BlueCross BlueShield, Greenblatt’s insurer, said the payer covers virtual visits through two services, or through in-network doctors. The Mount Sinai doctor fit neither criteria.) Still, why did Mount Sinai, Greenblatt’s usual health care system, assign her an out-of-network doctor?

“If one gets their care from the Mount Sinai system and the care is within network, I don’t think it is reasonable for the patients to expect or understand that one of the Mount Sinai clinicians is suddenly going to be out of network,” said Ateev Mehrotra, a hospitalist and telehealth researcher at Beth Israel Deaconess Medical Center.

It struck the doctors specializing in telehealth research whom KFF Health News consulted as an unusual situation, especially since the doctor who provided the care was employed by the prestigious health system.

The doctor in question may have been in network for no insurers whatsoever: A review of the doctor’s Mount Sinai profile page — archived in November 2022 — does not list any accepted insurance. (That’s in contrast to other doctors in the system.)

Lee, Mount Sinai’s spokesperson, said the doctor did take at least some insurance. When asked about the doctor’s webpage not showing any accepted plans, she responded the site “instructs patients to contact her office for the most up-to-date information.”

Attempting to solve this billing puzzle turned into a major league headache for Greenblatt. Deepening the mystery: After calling Mount Sinai’s billing department, she was told the case had been routed to disputes and marked as “urgent.”

But the doctor’s office would seemingly not respond. “In most other professions, you can’t just ignore a message for a year,” she observed.

The bill would disappear on her patient portal, then come back again. Another call revealed a new twist: She was told by a staffer that she’d signed a form consenting to the out-of-network charge. But “when I asked to get a copy of the form I signed, she asked if she could fax it,” Greenblatt said. Greenblatt said no. The billing department then asked whether they could put the form in her patient portal, for which Greenblatt gave permission. No form materialized.

When KFF Health News asked Mount Sinai about the case in mid-October of this year, Lee, the system’s spokesperson, forwarded a copy of the three-page form — which Greenblatt didn’t remember signing. Lee said the forms are presented as part of the flow of the check-in process and “intended to be obvious to the patient as required by law.” Lee said on average, a patient signs two to four forms before checking into the visit.

But, according to the time stamp on the forms, Greenblatt’s visit concluded before she signed. Lee said it is “not standard” to sign forms after the visit has concluded, and said that once informed, patients “may contact the office and reschedule with an ‘in-network provider.’”

“If it was provided after the service was rendered, that is an exception and situational,” she concluded.

The business with the forms — their timing and their obviousness — is potentially a vital distinction. In December 2020, Congress enacted the No Surprises Act, designed to crack down on so-called surprise medical bills that arise when patients think their care is covered by insurance but actually isn’t. Allie Shalom, a lawyer with Foley & Lardner, said the law requires notice to be given to patients, and consent obtained in advance.

But the legislation provides an exception. It applies only to hospitals, hospital outpatient facilities, critical access hospitals, and ambulatory surgery centers. Greenblatt’s medical bill variously presents her visit as “Office/Outpatient” or “Episodic Telehealth,” making it hard to “tell the exact entity that provided the services,” Shalom said.

That, in turn, makes its status under the No Surprises Act unclear. The rules apply when an out-of-network provider charges a patient for care received at an in-network facility. But Shalom couldn’t be sure what entity charged Greenblatt, and, therefore, whether that entity was in network.

As for Mount Sinai, Lee said asking for consent post-visit does not comply with the No Surprises Act, though she said the system needed more time to research whether Greenblatt was billed by the hospital or another entity.

The Resolution: Greenblatt’s bill is unpaid and unresolved.

The Takeaway: Unfortunately, patients need to be on guard to protect their wallets.

If you want to be a smart shopper, consider timing the length of your visit. The “Bill of the Month” team regularly receives submissions from patients who were billed for a visit significantly longer than what took place. You shouldn’t, for example, be charged for time sitting in a virtual waiting room.

Most important, even when you seek care at an in-network hospital, whose doctors are typically in network, always ask if a particular physician you’ve not seen before is in your network. Many practices and hospitals offer providers in both categories (even if that logically feels unfair to patients). Providers are supposed to inform you that the care being rendered is out of network. But that “informed consent” is often buried in a pile of consent forms that you auto-sign, in rapid fire. And the language is often a blanket statement, such as “I understand that some of my care may be provided by caregivers not in my insurance network” or “I agree to pay for services not covered by my insurance.”

To a patient trying to quickly book care, that may not feel like “informed consent” at all.

“It’s problematic to expect patients to read the fine print, especially when they feel unwell,” Ganguli said.

Emily Siner reported the audio story.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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.

USE OUR CONTENT

This story can be republished for free (details).

On the campaign trail to win another term in the White House, though, he also has knocked the use of those very vaccines. In October, for example, he unleashed a barrage of social media attacks on Ron DeSantis’ pandemic record by reposting claims that the Florida governor — who is running against him in the Republican presidential primaries — was too active in vaccinating Sunshine State residents.

In a further twist, Trump simultaneously circulated an MSNBC article suggesting DeSantis wasn’t vaccinating his constituents enough.

Trump’s tap dance — touting Operation Warp Speed’s success at developing vaccines while criticizing vaccine use — is emblematic of how pandemic politics are intensifying broader vaccine politics. Republican presidential candidates currently trailing the former president in polls are contorting their messaging to court the party’s vaccine-skeptical voters. No one embraces, without qualification, the utility of a public health measure that has saved millions of lives.

Like Trump, even the more establishment candidates can’t seem to avoid embracing the anti-vaccine leanings of the party’s base. Take Nikki Haley, who formerly served as governor of South Carolina and ambassador to the United Nations and has been rising in the polls. In the waning days of the Trump administration, she was pro-vaccine. But by the end of November 2021, in an interview with the Christian Broadcasting Network, she repeated dubious anti-vaccine claims: for instance, that the vaccine could undermine a woman’s fertility. (Studies consistently show no effect.)

The GOP has gained the allegiance of “a minority of people who feel very strongly about the safety of vaccines,” Robert Blendon, a Harvard professor of public health, told California Healthline. Presidential candidates are trying to use this sensibility as “a cultural issue” to signal distrust in scientists, other experts, and government authority in general, he said.

The resulting dynamic carries the risk of reaching beyond the current election cycle to affect public health policy in years to come, leading to lower rates among schoolchildren and seniors of vaccinations that protect them from measles, shingles, and HPV. Even as candidates try to weaponize this rhetoric, they’ve had little luck in changing the former president’s front-runner status.

A recent KFF survey of adults about their plans to get vaccinated against the flu, respiratory syncytial virus, known as RSV, and covid found that partisanship remains a key predictor of how people view vaccines. Confidence in the safety of the updated covid vaccines split sharply along party lines, with more than 8 in 10 Democrats saying they trust the new shots, compared with 1 in 3 Republicans.

But unease about covid or the vaccines is not Republican primary voters’ top issue — Blendon said concerns around the border, crime, and inflation are — and it’s not clear vaccine-focused attacks hurt Trump.

“I didn’t like his response to covid,” says an Iowa business owner featured in a critical ad from a well-funded political action committee that questioned Trump’s handling of the pandemic. “I thought he probably got led a little bit by the bureaucrats,” he says, hitting Trump on his bragging about the development of the vaccine and contrasting Trump unfavorably with certain governors the man in the ad thought performed better against covid. (Images of DeSantis, otherwise unnamed, flash by.)

The result? The ad “produced a backlash” and, when audience-tested with focus groups, improved the former president’s support, according to a memo summarizing the political action committee’s attempts to dent the front-runner.

Candidates nonetheless are trying to make hay, acknowledged Joe Grogan, who led the Domestic Policy Council during the Trump administration. But “I think people have a lot of other targets for ire about the pandemic.”

“Trump is not at the top of the list for Republican primary voters,” Grogan said. “He’s not on Page 2. Or 3, or 4. It begins with the media, the public health bureaucracy, or Big Tech companies.”

Voters have strong, yet divided and sometimes inconsistent, opinions. Some, like Joshua Sharff, 48, of Chesapeake, Virginia, are opposed to the covid vaccines and to candidates who support the shots as safe and effective. Sharff describes himself as a conservative voter who intends to support the Republican nominee for president. Though he’s vaccinated, he said, “If you’re a governor or a president and you tell me that I have to take a vaccine that has not been tried, that has not been tested, and ignores the science, that’s a problem for me. You’re taking away my freedoms as an American citizen.”

These positions have led Sharff away from Trump — and toward DeSantis, who has promoted anti-vaccine and anti-public health positions in his quest for the nomination.

Trump “pushed the vaccine very hard and recently came out, when he began to get pushback on it, that it was somebody else’s fault,” Sharff said. “That’s not true.”

Other Republican voters said the vaccine is not key to their vote.

“It will not sway my vote one way or another,” said Kimberly Hunt, 59, of Melville, Tennessee.

In chasing these voters, some candidates are distancing themselves from initial, pro-vaccine positions to embrace outspoken views against the shot. Vivek Ramaswamy, a biotech entrepreneur, started out as a vaccine cheerleader. But then he flipped, coming out against vaccine mandates and saying this summer that he regretted getting vaccinated. (His wife, a doctor, said she had no regrets.)

The most vocal of all is DeSantis.

Appearing on the right-leaning “PBD Podcast” on Oct. 30, DeSantis attacked Trump and “the corrupt medical swamp in D.C.” for overselling a vaccine that, despite the initial federal guidance, could not prevent infection or transmission of covid. The Centers for Disease Control and Prevention recommends the vaccine for anyone 6 months and older to protect against serious illness.

Though he initially encouraged people to get vaccinated in early 2021, DeSantis pivoted months later, banning vaccine passports for businesses and government entities, and later approving legislation prohibiting vaccine mandates in the state. That fall, he also appointed a new Florida surgeon general, physician Joseph Ladapo, whose guidance on covid vaccines contradicts CDC recommendations. DeSantis formed a Public Health Integrity Committee to assess, and generally dispute, federal health recommendations.

When the CDC released new vaccine guidance in September, Florida responded with its own advisory casting doubt on the safety of the boosters.

This anti-vaccine positioning hasn’t helped DeSantis. He has been losing support nationally and is generally polling third behind Haley and Trump in New Hampshire, a key early primary state. He headlined a “medical freedom” town hall in Manchester on Nov. 1 with Ladapo as a special guest.

Among the candidates remaining, DeSantis may be the most famous convert to the politics of anti-vaccination, but, with this subject, Haley has more experience.

In the 2021 CBN interview, she said “mandates are not what America does.” But the forceful declaration is merely the end of an ambivalent record, and, for critics, demonstrates her willingness to get in sync with the demands of the GOP base. As a state legislator, she supported 2007 legislation that included a mandate for HPV vaccines before voting against it; and later, as governor, she vetoed an effort to promote those vaccinations.

Bakari Sellers — now a commentator on CNN, but at the time a lawmaker who spearheaded that bill — told California Healthline, “That’s the biggest Nikki Haley issue that there is: She kind of has her finger in the air.”

The issue of vaccines may affect the general election: Even as Trump defends his vaccine record, it’s nevertheless clear he has support from the anti-vaccine crowd. An analysis by Politico, for example, found overlap among donors to independent presidential candidate Robert F. Kennedy Jr., who is staunchly opposed to vaccines, and Trump.

The willingness among politicians to assail what’s traditionally looked on as a foundational achievement of public health is likely to lead to turbulence for doctors themselves. Allison Ferris, a primary care physician and an associate professor at Florida Atlantic University, said people should be listening to their doctors and not to presidential candidates about whether to take the new covid vaccines. But that message is hard to deliver in the current climate.

“It is a tricky position to be in,” said Ferris, who co-authored recently released guidance advising doctors to counsel patients that frequent covid vaccination will likely become a necessity.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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.

USE OUR CONTENT

This story can be republished for free (details).

Sin embargo, en la campaña electoral para conseguir otro mandato en la Casa Blanca, Trump ha criticado el uso de esas mismas vacunas.

En octubre, por ejemplo, desató una ola de ataques contra Ron DeSantis en las redes sociales al postear afirmaciones relacionadas con la estrategia del gobernador de Florida durante la pandemia. Trump acusó a DeSantis, quien compite contra él para representar al partido republicano en las elecciones presidenciales de 2024, de ser demasiado activo a favor de la vacunación en su estado. 

Y, en un giro inesperado, Trump hizo circular simultáneamente un artículo de MSNBC sugiriendo que DeSantis no estaba vacunando lo suficiente a los residentes de la Florida.

Los vaivenes de Trump, que promociona el éxito de la “Operación Warp Speed” en el desarrollo de vacunas y al mismo tiempo critica su uso, es emblemático de cómo la politización de la pandemia sigue influenciando el discurso alrededor de las vacunas.

Los otros aspirantes republicanos a la presidencia también usan el argumento de las vacunas para cortejar a los votantes, aunque hayan salvado millones de vidas.

Al igual que Trump, incluso los candidatos más conservadores no han podido eludir las tendencias antivacunas de la base del partido. Nikki Haley, ex gobernadora de Carolina del Sur y ex embajadora de Estados Unidos ante las Naciones Unidas, que ha estado subiendo en las encuestas, estaba a favor de las vacunas en los últimos días del gobierno de Trump.

Pero a fines de noviembre de 2021, en una entrevista con Christian Broadcasting Network, repitió falsas afirmaciones, por ejemplo que las vacunas podrían impactar en la fertilidad de las mujeres. (Estudios científicos no han demostrado ningún efecto).

El partido republicano se ha ganado la lealtad de “una minoría con opiniones fuertes acerca de la seguridad de las vacunas”, dijo a JFF Health News Robert Blendon, profesor de salud pública de la Universidad de Harvard. Los candidatos presidenciales están usando esta postura como “una cuestión cultural” para señalar la desconfianza en los científicos, otros expertos y la autoridad gubernamental en general, agregó.

La dinámica resultante podría impactar más allá del ciclo electoral, y afectar la política de salud pública en los próximos años. Esto derivaría en tasas de vacunación más bajas para enfermedades como el sarampión, el herpes zóster y el VPH entre los niños en edad escolar y las personas mayores.

Pero incluso cuando los candidatos intentan manipular este discurso, no han podido superar al ex presidente.

Según una encuesta reciente de KFF que preguntó a adultos si se iban a vacunar contra la gripe, el virus respiratorio sincitial (conocido como RSV) y covid, el partidismo siguió siendo un predictor clave de cómo la gente ve las vacunas.

La confianza en la seguridad de las vacunas actualizadas de covid se divide en líneas partidistas: más de 8 de cada 10 demócratas dicen que confían en las nuevas vacunas, en comparación con 1 de cada 3 republicanos.

Pero la inquietud por covid o las vacunas no es la principal preocupación de los votantes en las elecciones primarias presidenciales. Blendon dice que la situación en la frontera con México, el crimen y la inflación son temas más presentes, y no está claro que los ataques enfocados en las vacunas perjudiquen a Trump.

“No me gustó su respuesta al covid”, dice el propietario de un negocio de Iowa en un anuncio crítico publicado por un comité de acción política bien financiado que cuestionó el manejo de la pandemia por parte de Trump. “Pensé que seguramente se dejó guiar por los burócratas”, agrega el hombre, al tiempo que critica a Trump por hacer alarde del desarrollo de la vacuna y lo compara desfavorablemente con ciertos gobernadores que en su opinión se desempeñaron mejor contra el covid. (Aunque no se lo menciona por nombre, el anuncio invoca imágenes de DeSantis).

¿El resultado? El anuncio produjo “una respuesta negativa”, y en un sondeo con grupos de enfoque, aumentó el respaldo al ex presidente, según un memorando que resume los intentos del comité de acción política de frenar el avance de Trump.

Los votantes tienen opiniones fuertes pero divididas y a veces inconsistentes. Algunos, como Joshua Sharff, que tiene 48 años y vive en Chesapeake, Virginia, se oponen a las vacunas contra covid y a los candidatos que las califican como seguras y eficaces.

Sharff se describe a sí mismo como un votante conservador que va a apoyar al candidato republicano. Aunque está vacunado, dijo: “Si eres gobernador o presidente y me dices que tengo que ponerme una vacuna que no ha sido probada y que ignora la ciencia, eso es un problema para mí. Me estás quitando mis libertades como ciudadano estadounidense”.

Esto ha alejado a Sharff de Trump y lo ha acercado a DeSantis, que ha promovido posturas antivacunas y anti-salud pública en su campaña para la nominación. Trump “impulsó mucho la vacuna, y cuando empezó a recibir críticas por eso, dijo que fue culpa de otra persona”, dijo Sharff. “Eso no es cierto.”

Para otros votantes republicanos, la vacuna no es un factor clave. “No influirá en la dirección de mi voto”, dijo Kimberly Hunt, que tiene 59 años y vive en Melville, Tennessee.

Para tratar de atraer a estos votantes, algunos candidatos se están distanciando de sus posturas iniciales a favor de las vacunas y adoptan abiertamente la postura opuesta. Vivek Ramaswamy, un empresario de biotecnología, comenzó como un fuerte defensor de las vacunas. Pero luego dio un giro y se manifestó en contra de los mandatos de vacunación, diciendo este verano que se arrepentía de haberse vacunado. (Su esposa que es doctora dijo que no se arrepentía).

El más expresivo de todos es DeSantis.

En su aparición en el programa de derecha “PBD Podcast” el 30 de octubre, DeSantis atacó a Trump y “el pantano médico corrupto de Washington, DC” por promover excesivamente una vacuna que, a pesar de las pautas iniciales del gobierno federal, no previene la infección o la transmisión del covid. Los Centros para el Control y Prevención de Enfermedades (CDC) recomiendan la vacuna para todas las personas de 6 meses en adelante para protegerse contra síntomas graves.

Aunque al principio de 2021 alentó a la gente a vacunarse, DeSantis dio un giro meses después, aprobando una ley que prohibió los mandatos de vacunas en el estado. Ese otoño, también nombró a un nuevo cirujano general de Florida, el doctor Joseph Ladapo, cuyas recomendaciones con respecto a las vacunas contra covid contradicen las de los CDC. DeSantis estableció un Comité de Integridad de Salud Pública para evaluar y, en general, cuestionar las pautas de salud federales.

En septiembre, cuando los CDC publicaron recomendaciones actualizadas para las vacunas, Florida respondió con su propio aviso, arrojando dudas sobre la seguridad de los nuevos refuerzos contra covid.

Este posicionamiento antivacunas no ha ayudado a DeSantis. Ha perdido apoyo a nivel nacional y ocupa el tercer lugar en las encuestas, por debajo de Haley y Trump, en New Hampshire, un estado clave para las primarias. DeSantis encabezó una asamblea pública sobre “libertad médica” en Manchester el 1 de noviembre, con Ladapo como invitado especial.

Entre los candidatos restantes, DeSantis puede ser el converso más famoso a la política antivacunas, pero Haley tiene más experiencia en el tema.

En la entrevista con Christian Broadcasting Network en 2021, dijo que “los Estados Unidos no hacen mandatos de vacunas”. Pero esta contundente declaración llega después de una larga trayectoria de posturas ambivalentes y, para los críticos, demuestra su disposición a adaptarse a las demandas de la base republicana. Como legisladora estatal, Haley apoyó una ley de 2007 que incluía el mandato de vacunar contra el VPH pero después votó en contra. Luego, como gobernadora, vetó un esfuerzo para promover esa misma vacuna.

Bakari Sellers, un ex-legislador que encabezó ese proyecto de ley y que ahora es comentarista de CNN, dijo a KFF Health News: “Ese es el mayor problema de Nikki Haley, que siempre sigue la corriente”.

La cuestión de las vacunas podría afectar las elecciones generales: aunque Trump defiende su narrativa sobre las vacunas, está claro que cuenta con el apoyo de los antivaxx. Según un análisis de Politico, por ejemplo, Trump comparte donantes con el candidato presidencial independiente Robert F. Kennedy Jr., que se opone firmemente a las vacunas.

El hecho de que los políticos estén dispuestos a atacar algo que tradicionalmente se consideró un logro fundamental de la salud pública probablemente genere problemas para los profesionales médicos. Allison Ferris, doctora de atención primaria y profesora asociada de Florida Atlantic University, dijo que la gente debería escuchar a sus doctores y no a los candidatos presidenciales al momento de decidir si recibir las vacunas contra covid. Pero ese mensaje es difícil de transmitir en el clima político actual.

“Es una posición difícil”, dijo Ferris, coautora de una guía reciente para profesionales de salud sobre las nuevas vacunas. Ferris aconseja que los doctores le comuniquen a sus pacientes que la vacunación frecuente contra covid probablemente se convertirá en una necesidad.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo. 

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.

USE OUR CONTENT

This story can be republished for free (details).

The messaging was likely a shock in Washington. The graffiti reflects part of a surprising segment of the ideological spectrum: anti-abortion using the language of the radical left.

One group on the vanguard of an increasingly confrontational anti-abortion movement is Progressive Anti-Abortion Uprising, which operates mostly in the nation’s capital. They ’ve embraced all types of media and a good dose of misinformation to communicate a smashmouth message. One member of the group, Caroline Smith, boasted that they want to make people “uncomfortable.” Their activities have also gotten several members convicted of trespassing and obstructing abortion clinics.

Demonstrations like these, which involve rowdy, obstructive protests livestreamed over the internet, have gotten more scrutiny, especially since the Supreme Court overturned the constitutional right to abortion. Since the beginning of the Biden administration, the Department of Justice has used the Freedom of Access to Clinic Entrances Act to protect access to abortion clinics. As of June, it had pursued FACE Act cases against 48 defendants nationwide, with allegations ranging from shooting pellet guns into facilities to simply locking the gates with super glue.

Graffiti also is part of PAAU’s strategy, with the group’s social media providing instruction on “decorating public space,” celebrating defacement as “culture jamming.” (The group’s founder, Terrisa Bukovinac, told KFF Health News in an interview that she did not “know anything about the specifics” about whether PAAU had done any anti-abortion graffitiing in Washington this summer.) The group’s no-holds-barred strategies include livestreamed protests with combative counterprotesters and passersby.

In recent years, the group and its allies have been featured in livestreamed videos, some of which show protesters shouting combustible, misleading claims that have been rejected by medical experts and others. These livestreams include bystanders, patients, clinicians, and abortion rights activists, who, once they are on the livestream, risk becoming the subject of online attack, whether they are associated with the abortion clinic or not.

“It’s a vector for doxxing and honestly would be foolish to think it’s anything other than an aggression tactic,” said Daly Barnett of the Electronic Frontier Foundation, a digital rights group, speaking generally of livestreams and other social media about protests at abortion clinics. Doxxing describes a form of online attack in which someone’s personal information is made public without permission.

PAAU’s Bukovinac left a San Francisco anti-abortion organization in 2021 to help create this unorthodox group. She and some of her colleagues wanted to find “a space for themselves” on the ideological spectrum. The group’s website boasts of “progressive feminist values of equality” and members’ willingness to put their bodies “in between the oppressor and the oppressed.” But the use of graphic anti-abortion rhetoric drew a cold reception from what Bukovinac called the “leftist” part of the pro-life movement.

A Curious Fit

Despite its otherwise progressive verbiage on inclusion and gay rights, the group mixes quite naturally into the right. Bukovinac, for instance, is a faculty member at the Leadership Institute, a conservative training group endorsed by the likes of Rep. Jim Jordan (R-Ohio). She also attended a Heritage Foundation gala at which Tucker Carlson spoke.

She blames liberals for this strange company. “It should be embarrassing that I have to rely on Christofascists to end a genocide,” she said.

Politically, it’s a dissonant fit, too. Despite having made clear to documentarians that she didn’t vote in the 2020 election, she recently declared a Democratic presidential run. In her view, that’s because anti-abortion Democrats are underrepresented. Citing data of unspecified provenance, she claimed in an interview that a quarter of Democrats identify as pro-life, and that a majority say they want more restrictions on abortion. She said she intends to show graphic anti-abortion television ads as part of her campaign.

Her campaign is an escalation of the group’s all-media tactics, which include livestreaming videos across the internet, accessible far and wide.

One livestream documented a 2020 blockade of a Washington, D.C., abortion clinic. It became a right-wing cause célèbre after several activists, including Lauren Handy, PAAU’s director of activism, entered the clinic, injuring a person while blockading the rooms, and livestreamed the whole thing — later earning an arrest, indictment, and conviction under the FACE Act. Right now, five of the 10, including Handy, are appealing; defense counsel Martin Cannon says it’s “likely” a total of nine will appeal after sentencing. In March 2022, police found the remains of five fetuses in Handy’s house, which she said came from the clinic via a medical waste driver. The transport company disputed her account.

The group has enlisted multiple anti-abortion members of Congress, who have pressed their case — about the fairness of the prosecutions — to the Department of Justice and Washington city officials. More broadly, some congressional Republicans are gearing up to repeal the FACE Act. Former GOP presidential candidate Sen. Tim Scott (R-S.C.) even complained during the first primary debate that prosecutors were pursuing anti-abortion activists.

Whatever their appeals to the right wing, the group and their allies are careful to appeal to the left too. Before their October 2020 blockade in Washington, organizers planned to present an aggressive — yet also multicultural, progressive — image, according to prosecutors’ filings in federal district court, on the FACE Act charges. “The idea of deliberately breaking the law is sexy,” advised Jonathan Darnel, an evangelical Christian activist, about their language advertising the event. Later another activist counseled making the language seem “more woke,” according to text messages obtained by the government and provided in a trial brief.

Livestreams: A Digital Megaphone

In real time, the nearly three-hour livestreamed videos had a more Christian, conservative bent, with protesters blockading and subsequently getting arrested and featuring speakers extolling religious themes and praising “anti-abortion, anti-Sodomite” activists. An internet broadcast like this “presents the potential for martyrdom,” said Mackenzie Quick, an assistant professor at Flagler College who has studied the rhetoric of anti-abortion movements. She thinks such streams might emerge as a common tactic for activists.

In the livestreamed videos, the protesters made typical anti-abortion claims in on-camera appearances, like that a fetus can feel pain at 12 weeks’ gestation, which the American College of Obstetricians and Gynecologists rejects.

The livestreams also employ a take-no-prisoners approach to identifying — or misidentifying — people who, whether intentionally or not, become part of the video. “This may be the abortionist,” Darnel said in the halls of the abortion clinic, of one potential target of the protest who walked in view of the camera. Then an offscreen speaker is heard telling him the person was an FBI agent.

At another point, Darnel speculated on the livestreamed video whether someone — it was unclear whom he was referring to — was a well-known, Washington, D.C.-based abortion rights activist. Then he changed his mind: “Oh wait, we don’t know — we don’t know who she is,” he said.

Darnel summarily dismissed any potential concerns with his behavior. In a message to KFF Health News, he asked, given his opposition to abortion, why would he “be concerned with the privacy of the murderers or the corrupted police who sought to protect those murderers?” Days later, asked about a different subject, he added that these concerns are raised only against anti-abortion protesters.

It’s not illegal in Washington, D.C., to film people in public without their consent, but the progressive anti-abortion types are “very media-oriented and they’re very noisy and aggressive,” said Megan S., who helps run a volunteer group that escorts patients to appointments. She and other clinic escort volunteers are very aware of the risks of being identifiable. (Megan S. withheld her last name to protect herself from such risks.)

Exposing or potentially misrepresenting identities became a thorny point during the trial on the October 2020 obstruction, at which both Darnel and Handy were defendants.

The proceedings were marked by multiple clashes pitting expression and publicity against protecting courtroom deliberations.

Some pro-life activists, who Bukovinac maintained were unaffiliated with the progressives, protested outside the courthouse when jury selection began.

Once the trial began, the conflicts continued, with the judge raising concerns that activists’ audible comments constituted witness tampering, Bukovinac said. The trial record showed the judge ultimately granted requests from prosecutors to shield witnesses’ identities and restrict the dissemination of discovery material to only the defense team members.

The defense also attempted to introduce photos and videos of fetuses and a video of the clinic’s doctor purportedly describing what he does to fetuses post-abortion, which counsel claimed would justify Handy’s belief that fetuses were born alive before being killed. But the judge ruled that the photos were “particularly incendiary.” She wrote that the defendants planned to mischaracterize the video, which she said was “propaganda.”

The case is set to get tested in the appeals court, where some anti-abortion advocates see an opportunity to undo the FACE Act, which was designed to regulate these made-for-social-media protests that have become a signature of PAAU.

That’s the hope of Cannon, senior counsel at the Thomas More Society, an anti-abortion public interest law firm representing one of the defendants. The law is questionably constitutional, despite its nearly 30-year history, he said. “We’re not tilting at windmills.”

If the courts won’t end the law, the activists’ next best hope may be their congressional allies. The Progressive Anti-Abortion Uprising has rebranded one of its social media accounts previously devoted to providing trial updates “#RepealFACE.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

The confusion about what’s true — and who’s telling the truth — is of critical importance to public health, experts in political science said. “Misinformation leads to lives being lost and health problems not being resolved,” Bob Blendon, a professor emeritus of public health at Harvard, said in an interview. Blendon was not associated with the survey.

Such misinformed beliefs are strongly held by only a sliver of the population, according to a KFF poll out today. Nearly a third of the 2,007 respondents said the dewormer ivermectin was definitely or probably an effective treatment for Covid-19. (It’s not: Numerous randomized controlled trials have found otherwise.) A mere 22% thought ivermectin was definitely ineffective.

A fifth thought it was definitely or probably true that the covid-19 vaccine had killed more people than the virus itself. (Multiple studies, examining different data sets, have found lower death rates among recipients of the vaccine than among those who didn’t get the shot.)

But nearly half, 47%, thought that claim was definitely false.

Nevertheless, said Brendan Nyhan, a professor of government at Dartmouth College who has spent years studying the transmission of false information, the prevalence of vaccine misinformation is “alarming.” And, while not necessarily resulting entirely from misinformation, 30% of respondents thought parents should not be required to vaccinate their children against measles, mumps, and rubella.

More than a third of respondents also thought using birth control such as intrauterine devices made it harder for most women to get pregnant once they stopped.

For Lunna Lopes, a senior survey analyst at KFF and one of the poll’s authors, the results show wide exposure, but limited uptake, of false claims. “A lot of people have heard about these health misinformation claims. Just because they’re exposed to it doesn’t mean they’re buying into it,” she said. Still, the din of misinformation might leave the populace unsure what to believe. “You might be less trusting, and less likely to outright reject false information.”

The limited embrace of outright misinformation may be cold comfort for public health advocates. The study also found only grudging trust, at best, for media sources of all kinds and the federal government. The limited trust the survey recorded is colored by wide partisan gaps, noted Nyhan.

Respondents did not have “a lot” of trust in the information relayed by any news media institution. Just over a quarter had this high level of trust for local TV news stations. And that was the highest mark of the institutions tested, which ran the ideological and stylistic gamut from MSNBC to The New York Times to Fox News and Newsmax. More people had “a little” trust in each of these institutions.

For Blendon, however, the mild support is a problem. It suggests that “we are short” of trusted sources of news about health.

Journalists and editors, he said, should consider there’s “something about the way you’re presenting information that’s not seen as credible by viewers.” Seventy percent of respondents said the news media wasn’t doing enough to limit the spread of health misinformation.

The public conversation tends to focus on the often extreme declarations and wild claims featured on social media and on both corporate and government attempts to regulate the medium, Blendon noted. Sixty-nine percent of respondents said social media companies were not doing enough to limit the spread of false or inaccurate information.

But the poll shows that while the public tunes into social media quite frequently, they have very little faith in the health information they see there. No social media outlet enjoyed a double-digit percentage of respondents saying they had “a lot” of trust in it.

Even so, said Lopes, a significant slice of the public — about a quarter — turn to these platforms for health information and advice. “That stood out to us,” she said. Latinos and the young are especially likely to use the forums.

The picture is similarly bleak for official institutions. Around a quarter of respondents had “a great deal” of trust in the Centers for Disease Control and Prevention’s recommendations. That response rate dropped to a fifth when it came to the Food and Drug Administration. The Biden administration, Donald Trump, and state and local public health officials lagged behind.

Those findings, combined with the partisan gaps in trust, were especially discouraging for Nyhan. “They will be essential sources of information in future pandemics despite their errors and misjudgments during the pandemic,” he said of public health institutions.

By far the most highly trusted source of health information? One’s own doctor. Forty-eight percent of respondents had a great deal of trust in their recommendations.

The survey, the KFF Health Misinformation Tracking Poll Pilot, was conducted May 23 through June 12, online and by telephone among a nationally representative sample of U.S. adults in English and Spanish.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

The problem has gotten particularly acute with a recent wave of misinformation. And when Francis Collins led the National Institutes of Health, the world’s premier medical research agency, he thought he had a solution: to study health communications broadly. “We basically have seen the accurate medical information overtaken, all too often, by the inaccurate conspiracies and false information on social media. It’s a whole other world out there,” he said in 2021 as part of a farewell media tour.

“I do think we need to understand better how — in the current climate — people make decisions,” he concluded.

But Collins’ hopes appear dashed. In a sudden reversal, the NIH’s acting director, Larry Tabak, has paused — some say killed — the planned initiative, Advancing Health Communication Science and Practice. Its advocates fear the agency has, for political reasons, censored itself — and the science that would’ve sprung out of this funding stream.

The agency has offered shifting and inconsistent explanations, sometimes outright contradicting itself in the space of days. Sources familiar with the project insist that whatever the agency’s official story, it has acted unusually, contrary to its normal procedures in deciding what science to fund.

The officials, both in and outside of NIH, believe the agency is acting in response to political pressures over misinformation and is effectively censoring itself. Efforts to study or push back on inaccurate information have become contentious. The Republican-controlled House of Representatives repeatedly has plunged into the issue by investigating social media firms and government agencies for their efforts to regulate online speech. They’ve even targeted academics who merely study information flows online. Meanwhile, in July, a federal court in Louisiana issued a decision on a long-simmering lawsuit brought by a group of Republican attorneys general and anti-vaccine groups to block government officials from communicating with social media companies, with certain exceptions for national security and criminal matters. That ruling has since been stayed.

Even though the NIH has had to navigate political rapids for decades, including enduring controversy over stem cell research and surveys on the sexual behavior of teens, this is a particularly fraught moment. “It is caught up in a larger debate about who gets to decide what is truthful information these days,” said Alta Charo, a professor emerita of law and bioethics at the University of Wisconsin-Madison who has advised the NIH in the past.

For researchers interested in the topic, however, it’s a major loss. The program was deemed potentially so important that it would be supported through the agency’s Common Fund: a designation for high-priority programs that cut across normal institutional boundaries. In theory, it would study how health communication works, not merely at an individual doctor-to-patient level, but also how mass communication affects Americans’ health. Researchers could examine how, for example, testimonials affect patients’ use of vaccines or other therapies.

Serious money was on the table. The agency was prepared to spend more than $150 million over five years on the endeavor.

For researchers, it’s a necessary complement to the agency’s pioneering work in basic research. The NIH has “done a remarkable job discovering the way cells communicate with each other,” said Dean Schillinger, a researcher at the University of California-San Francisco. “When it comes to how people communicate to each other — doctors to patients, or doctors with each other — the NIH has been missing in action.” Now, he said, the tentative efforts to reverse that are met with a “chilling effect.” (Schillinger co-authored an opinion piece in JAMA on these developments.)

After favorable reports from an agency’s advisory body last fall, advocates were anticipating more encouraging developments. Indeed, the NIH’s budget had touted the concept as recently as March. And participants expected the grant application process would begin toward the end of the year.

Instead, researchers have heard nothing through official channels. “Investigators have been asking, ‘What’s the plan?’” said Schillinger. Officially, “it’s been the sound of silence, really.”

That has been a puzzling anticlimax for a program that seemed to have all the momentum. “Given the urgency of misinformation, you would expect — within a year — a formal announcement,” said Bruce Y. Lee, the executive director of the City University of New York’s Center for Advanced Technology and Communication in Health.

Advocates and sources involved with the process had been pleased with its progress leading up to Tabak’s sudden reversal. After Collins publicly floated the concept in late 2021, the agency took some public steps while defining the project, including holding a workshop in May 2022, keynoted by Collins.

Later that year, the project’s leaders presented the concept to the agency’s Council of Councils, a group of outside researchers who provide feedback on policy initiatives and projects. It got a warm reception.

Edith Mitchell, an oncologist at Thomas Jefferson University Hospital in Philadelphia, said the agency had a “major task, but one that is much needed, one that is innovative.” The council gave the proposal a 19-1 seal of approval.

Researchers were happy. “As far as I was concerned, this program had been funded, accepted, and approved,” Schillinger said. (The agency says that it is “not unusual” for programs not to move forward but that it does not track how frequently programs get affirmative votes from the council and later don’t move forward.)

That smooth sailing continued into the new year. In March, the program was mentioned in the NIH budget as one of the agency’s potential projects for the coming years. Then, say sources in NIH and elsewhere in government, came Tabak’s sudden decision in April, which was not communicated to some researchers until June.

Early that month, Schillinger said, he received a call from an NIH official saying, “The program has been killed.” Program officers were reaching out to academics who had made prior inquiries about the initiative and potential research efforts that could garner grants. Schillinger said researchers were told, “You’re not getting an email” from the agency.

A former White House staffer and two current NIH officials — who were granted anonymity because they didn’t have permission to speak on sensitive matters — said the decision, which came as researchers and agency officials were preparing to open grant applications in the last quarter of the year, was made by Tabak. California Healthline asked Tabak for an interview but instead got an answer from agency spokespeople.

The agency disputes any final decision about this research funding that has been made. Spokesperson Amanda Fine told California Healthline the project was “still in concept phase” and is “being paused to consider its scope and aims.”

But the agency lists the health communications proposal on the “former programs” part of its website, and sources inside and outside of government disagree with this company line. They point to political fears on NIH’s part as driving the change, which reflects the growing political controversy over studying anything related to misinformation, even though the proposal was set up to examine health communications broadly, not solely misinformation.

A hint of this reasoning is contained in the rest of Fine’s statement, which notes the “regulatory and legal landscape around communication platforms.” When pressed, the agency later cited unnamed “lawsuits.”

That’s likely a reference to the Louisiana case, which was decided weeks after the agency decided to pause or kill the Common Fund initiative.

Fine later offered a new explanation: budgetary concerns. “We must also balance priorities in view of the current budgetary projections for fiscal years 2024 and 2025,” she wrote.

That explanation wasn’t part of a June 6 note on the program page, and one NIH official confirmed it wasn’t part of previous discussions. When pressed further about the agency’s budgetary position — which analysts with TD Cowen’s Washington Research Group think will be flat — spokesperson Emily Ritter said, “The NIH does not have a budget projection.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

“I would describe this year as hand-to-hand combat. Really, every day,” he said at an academic conference at Stanford in April. It’s a sentiment the FDA commissioner has expressed often.

What’s been getting Califf’s goat? Misinformation, which gets part of the blame for Americans’ stagnating life expectancy. To Califf, the country that invents many of the most advanced drugs and devices is terrible at using those technologies well. And one reason for that is Americans’ misinformed choices, he has suggested. Many don’t use statins, vaccines, or covid-19 therapies. Many choose to smoke cigarettes and eat the wrong food.

Califf and the FDA are fighting misinformation head-on. “The misinformation machine is really causing a lot of death,” he said, in an apparent ad-lib, this spring in a speech at Tufts University. The pandemic, he told KFF Health News, helped “crystallize” his need to tackle misinformation. It was a “blatant case,” in which multiple studies gave evidence about very effective therapeutics against covid. “And a lot of people chose not to do it.” There were “large-scale purveyors of misinformation,” he said, poisoning the well.

Occasionally, though, Califf and the FDA have added to the cacophony of misinformation. And sometimes their misinformation is about misinformation.

Califf hasn’t been able to consistently estimate misinformation’s public health toll. Last June, he said it was the “leading cause of meaningful life-years lost.” In the fall, he told a conference: “I’ve been going around saying that misinformation is the most common cause of death in the United States.” He continued, “There is no way to prove that, but I do believe that it is.”

At other times, as in April, he has called the problem the nation’s “leading cause” of premature death. “I’ll keep working on this to try and get it right,” he said. Later, in May, he said, “Many Americans die or experience serious illness every year due to bad choices driven by false or misleading information.”

Americans’ health is indeed in dire straits. The Centers for Disease Control and Prevention noted the country’s life expectancy has dropped two years in a row — it’s at 76.1 years as of 2021 — a dismal capper to four decades of lagging gains. Countries such as Slovenia, Greece, and Costa Rica outrank the U.S. Their newborn citizens are expected to live more than 80 years, according to the Organization for Economic Co-operation and Development.

Several factors are at the root of those differences. But Americans’ choices, often informed by bad or misleading data, political jeremiads, or profit-seeking advertising, are among the causes. For instance, one 2023 paper estimated that undervaccination against covid — caused in part by misinformation — costs as much as $300 million per day, accounting for both the costs of health care and economic costs, like missed work.

Outside experts are sympathetic. Misinformation is a “huge problem for public health,” said Joshua Sharfstein, a Johns Hopkins University public health professor and former FDA principal deputy commissioner. Having a strategy to combat it is crucial. But, he cautioned, “that’s the easiest part of this.”

The agency, which regulates products that consumers spend 20 cents of each dollar on per year, is putting more muscle behind the effort. It’s begun mentioning the subject of misinformation in its procurement requests, like one discussing the need to monitor social media for misinformation related to cannabis.

The agency launched a “Rumor Control” page seeking to debunk persistent confusion. It also expects to get a report from the Reagan-Udall Foundation, a not-for-profit organization created by Congress to advise the FDA. Califf has said he thinks better regulation — and more authority for the agency — would help.

Califf has noted small victories. Ivermectin, once touted as a covid wonder drug, “eventually” became one such win. But, then again, its use is “not completely gone,” he said. And, despite winning individual battles, his optimism is muted: “I’d say right now the trend in the war is in a negative direction.”

Some of those battles have been quite small, even marginal.

And it’s difficult to know what to take on or respond to, Califf said. “I think we’re just in the early days of being able to do that,” he told KFF Health News. “It’s very hard to be scientific,” he said.

Take the agency’s experience last fall with “NyQuil chicken” — a purportedly viral cooking trend in which users roasted their birds in the over-the-counter cold medicine on social media platforms like TikTok.

Califf said his agency’s “skeleton crew” — at least relative to Big Tech giants — had picked up on increasing chatter about the meme.

But independent analyses don’t corroborate the claim. It seems much of the interest in it came only after the FDA called attention to it. The day before the agency’s pronouncement, the TikTok app recorded only five searches on the topic, BuzzFeed News found in an analysis of TikTok data. That tally surged to 7,000 the week after the agency’s declaration. Google Trends, which measures changes in the number of searches, shows a similar pattern: Interest peaked on the search engine in the week after the agency announcement.

Califf also claimed “injuries” occurred to participants “directly” due to the social media trend. Now, he said, “the number of injuries is down,” though he couldn’t say whether the agency’s intervention was the cause.

Again, his assertions have fuzzy underpinnings. It’s not clear what, if any, actual damage the NyQuil chicken fad caused. Poison control centers don’t keep that data, said Maggie Maloney, a spokesperson for America’s Poison Centers. And, after multiple requests, agency spokespeople declined to provide the FDA’s data reflecting increased social media traffic or injuries stemming from the meme.

In countering misinformation, FDA also risks coming off as high-handed. In September 2021, the agency tweeted about purported myths and misinformation on mammograms. Among the myths? That they’re painful. Instead, the agency explained that “everyone’s pain threshold is different” and the breast cancer-screening procedure is more often described as “temporary discomfort.”

Statements like these “erode trust,” said Lisa Fitzpatrick, an infectious diseases physician and currently the CEO of Grapevine Health, a startup trying to improve health literacy in underserved communities. Fitzpatrick has previously served as an official with the District of Columbia’s Medicaid program and with the CDC.

“Who are you to judge what’s painful?” she asked, rhetorically. It’s hard to brand subjective impressions as misinformation.

Califf acknowledged the point. Speaking to 340 million Americans is difficult. With mammograms, the average patient might not have a painful experience — but many might. “Getting across that kind of nuance and public communication, I think, is in its early phases.”

Scrutiny over the agency’s role regarding food and nutrition is also mounting. After independent journalist Helena Bottemiller Evich wrote an article criticizing the agency for relying on voluntary reporting standards for baby formula, Califf tweeted to correct a “bit of misinformation,” saying the agency did not have such authority.

An agency communications specialist made a similar intervention with New York University professor Marion Nestle, referring to a “troubling pattern of articles with erroneous information that then get amplified.” The agency was again seeking to rebut arguments that the agency had erred in not seeking mandatory reporting.

“As I see it, the ‘troubling pattern’ here is FDA’s responses to advocates like me who want to support this agency’s role in making sure food companies in general — and infant formula companies in particular — do not produce unsafe food,” Nestle retorted. Notwithstanding the agency’s protests to Evich and Nestle, the agency had only recently asked for such authority.

Efforts to respond to or regulate misinformation are becoming a political problem.

In July, a federal judge issued a sweeping, yet temporary, injunction — at the instigation of Republican attorneys general, multiple right-wing political groups, and prominent anti-vaccine advocate Robert F. Kennedy Jr.’s Children’s Health Defense — barring federal health officials from contacting social media groups to correct information. A large section of the ruling detailed efforts by a CDC official to push back on suspected misinformation on social media networks.

An appeals court later issued its own temporary ruling — this time countering the original, sweeping order — nevertheless underscoring the extent of pushback on government pushback against misinformation. Califf has consistently played down the government’s ability to solve the problem. “One hundred percent of experts agree, government cannot solve this. We have too much distrust in fundamental institutions,” he said last June.

It’s a remarkable change from his previous tenure leading the agency during the Obama administration. “I would describe the Obama years as genteel, intellectual, and a lot of fun,” he has said. Now, however, Califf is bracing for more misinformation. “It’s just something that I think we have to come to grips with,” he told KFF Health News.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

Over the course of the pandemic, lawsuits came from every direction, questioning public health policies and hospitals’ authority. Petitioners argued for care to be provided in a different way, they questioned mandates on mask and vaccine use, and they attacked restrictions on gatherings.

Historically, “there’s been nothing but a cascade of supportive deference to public health,” said Lawrence Gostin, a professor specializing in public health law at Georgetown University. That changed during the pandemic. “It’s the opposite. It’s been a torrent.”

Even as covid-19 wanes, lawyers representing the health care sector predict their days in court aren’t about to end soon. A group of litigators and media companies, among others, are eyeing policy changes and even some profits from yet more lawsuits.

Because such groups can reach millions of people, public health advocates like Gostin and Brian Castrucci, president of the de Beaumont Foundation, a public health nonprofit, suggest that the result, beyond creating legal setbacks, could spread more misinformation about their work. The imprimatur of a lawsuit, they think, can help spread vaccine skepticism or other anti-public health beliefs, if only through news coverage. “You know, lawsuits have a galvanizing effect,” Gostin said. “They tend to shape public opinion.”

Lawyers are organizing to promote their theories. Late in March, a group of them gathered in Atlanta for a debut Covid Litigation Conference to swap tips on how to build such cases. “Attention, Atlanta lawyers!” proclaimed an ad promoting the event. “Are you ready to be a part of the fastest-growing field of litigation?”

The conference was sponsored in part by the Vaccine Safety Research Foundation, which was established on vaccine-skeptical views. The gathering promised to share legal strategies for suing federal and state public health agencies over covid policies, as well as hospitals and pharmaceutical firms for alleged malfeasance.

It’s the sort of thing that has people like Gostin paying attention. “It’s very worrisome,” he said. Even if lawsuits don’t succeed, it could make hospitals and public health officials gun-shy, he said. At the height of the pandemic, lawyers were successfully forcing hospitals to administer ivermectin to treat covid — despite many gold-standard, randomized, controlled trials demonstrating it wasn’t particularly useful.

The conference was a good way to meet like-minded advocates, explained Steven Warshawsky, a New York lawyer who attended. “There’s networking and an effort to create a legal community that’s knowledgeable,” he said. And colleagues can also “spread the word about different legal angles.” Indeed, panels covered subjects ranging from licensure to hospital negligence, and allegations of vaccine injuries.

The conference was organized by Steve Kirsch, a wealthy San Francisco Bay Area tech executive, who describes himself as a “truth teller” regarding covid vaccines and policies. He has persistently raised questions about masks and vaccines and other standard public health measures. The conference, he said, is meant to help encourage lawyers to further that stance. He said he hopes that “the lawyers are successful in getting large settlements” because “it will incentivize other lawyers” to bring their own suits against pharmaceutical firms and government agencies alike.

He’s been known to tweet about situations in which he, an unmasked person, encountered masked counterparts. For example, during a flight, he offered $100,000 to an airplane seatmate to remove her mask. (He said he did it to test the level — and potential hypocrisy — of people’s attachment to masks.)

Kirsch’s legal entrepreneurism is on full display in his newsletter: Individuals seeking his comments can check boxes if they are lawyers who would represent him in various lawsuits against the federal government on vaccine-related issues.

Visitors can also book his time in 15-minute increments, at $500 a pop; subscriptions to his newsletter — of which he claims “tens of thousands” — are $50 a year. (He says he donates the subscription income.)

The lawyers’ conference attracted speakers well known in the covid litigation world. One, Robert Malone, did early work on messenger RNA and has now grown skeptical over alleged defects in covid vaccines. (They’ve been approved by the FDA after large trials.) Malone and other plaintiffs threatened Twitter last year with a lawsuit seeking to reverse a ban on spreading misinformation. After taking a media tour, he’s now back on the social media network.

For public health officials, it’s not merely the potential outcome of the courts’ rulings but also the publicizing of the theories that poses a risk.

“Even one win, despite countless losses, for some will provide supposed evidence and vindication that questions need to be answered, liability needs to be assigned, or a wrong needs to be righted,” Castrucci told California Healthline. “But the decision of any one trial can’t and shouldn’t supplant the findings of clinical trials enrolling nearly 70,000 Americans.”

“I think this is part of a grander destabilization of public health, through the judicial system,” Castrucci said.

Readers wanting to connect favored theories to courtroom drama through the media have no lack of opportunity. Take The Daily Wire, an online publication featuring conservative political commentator Ben Shapiro. The company was a plaintiff in one federal lawsuit, part of a barrage of successful litigation, challenging the Occupational Safety and Health Administration’s policy of giving large businesses an option of either requiring their employees to get vaccinated or test weekly for covid. The regulation was stymied by the Supreme Court and later withdrawn by the agency.

The lawsuit served a second purpose. It provided a continual, evolving theme for Facebook ads promoting the outlet’s fight — and asking viewers to subscribe, sign petitions, or purchase merchandise. In a November 2021 ad, Shapiro asserted there was “no bigger fan” of vaccines than he. But any pro-vaccine claim was not a centerpiece of future ads, which inveighed against mandates, vaccine passports, and the like. The Daily Wire claimed in February 2022 that it was bringing in $100 million in annual revenue.

The publication made covid messaging, particularly around lawsuits or legal matters, a frequent theme of its advertising. One ad, for example, mentioned how police were enforcing vaccine passports in “certain cities” — it didn’t specify which cities. But the Daily Wire published an article about police checking such passports in Paris, not the United States. The media outlet didn’t respond to multiple requests for comment.

In all, California Healthline found the publication had at least 10 million ad impressions on Meta platforms — Facebook and Instagram — from October 2021 to February 2023 concerning lawsuits, mandates, lab leaks, and other covid-related topics.

Earlier, conservative media groups were happy to contribute by writing amicus briefs in support of certain cases. But there’s now plenty of right-wing voices trying to seize an audience, said A.J. Bauer, an assistant professor of journalism studying conservative media at the University of Alabama. “We’re seeing an oversaturated media space, with a lot of competition,” especially on the right, Bauer said. As such, he said, they need to stand out — even if it means embracing “stunts,” like participating directly in lawsuits.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

And CVS is not the only pharmacy sharing this kind of sensitive data.

We found trackers collecting browsing- and purchase-related data on websites of 12 of the U.S.’ biggest drugstores, including grocery store chains with pharmacies, and sharing the sensitive information with companies like Meta (formerly Facebook); Google, through its advertising and analytics products; and Microsoft, through its search engine, Bing.

The tracking tools, popularly called “pixels,” collect information while a website runs. That information is often sent to social media firms and used to target ads, either to you personally or to groups of people that resemble you in demographics or habits. In previous investigations, The Markup found pixels transmitting information from the Department of Education, prominent hospitals, telehealth startups, and major tax preparation companies.

Pharmacy retailer websites’ pixels send a shopper’s IP address — a sort of mailing address for a person’s computer or household internet — to social media giants and other firms. They also send cookies, a way of storing information in a user’s browser that in this case helps track a user from page to page as the user browses a retailer’s site. Cookies can sometimes also associate individuals on a site with their account on a social media platform. In addition to the IP address and cookies, the pixels often send information about what you’ve clicked or bought, including sensitive items, such as HIV tests.

“HIV testing is the gateway to HIV prevention and treatment services,” said Oni Blackstock, the founder of Health Justice and a former assistant commissioner for the New York City Bureau of HIV/AIDS Prevention and Control, in an interview.

“People living with HIV should have control over whether someone knows their status,” she said.

Many retailers shared other detailed interaction data with advertising platforms as well. Ten of the retailers we examined alerted at least one tech platform when shoppers clicked “add to cart” as they shopped for retail goods, a capacious category that included sensitive products like prenatal vitamins, pregnancy tests, and Plan B emergency contraception.

Supermarket giant Kroger, for instance, informed Meta, Bing, Twitter, Snapchat, and Pinterest when a shopper added Plan B to the cart, and informed Google and Nextdoor, a social media platform on which people from the same neighborhood gather in forums, that a shopper had visited the page for the item. Walmart informed Google’s advertising service when a shopper browsed the page of an HIV test, and Pinterest when that shopper added it to the cart.

A previous investigation from The Markup found that Kroger used loyalty cards to track, analyze, and sell an array of data about customers to advertisers.

Using Chrome DevTools, a tool built into Google’s Chrome browser, The Markup and KFF Health News visited the websites of 12 of the U.S.’ biggest drugstores and examined their network traffic. This monitoring tool allowed us to see what information about shopping habits and, in some cases, prescriptions, were sent to third parties.

Over the course of the investigation, retailers frequently changed their trackers — sometimes activating them, sometimes removing them. Some retailers appeared to be taking steps to limit tracking on sensitive items.

For example, Walgreens’ website prevented some trackers from activating on the pages of some products, which included Plan B and HIV tests. This code didn’t prevent all tracking, though: Walgreens’ site continued sending Pinterest information about those sensitive items a user added to the cart.

Walgreens shared a new policy after learning of The Markup and KFF Health News’ findings. Spokesperson Fraser Engerman said that while the chain already had a “robust privacy program,” it would no longer share browsing data related to reproductive health and HIV testing. Engerman also told us that “Pinterest confirmed that the data will be deleted and that it has not been used for advertising purposes.” Crystal Espinosa, a spokesperson for Pinterest, said the company “can confirm that we will be deleting the data Walgreens requested.”

The Pharmacy vs. the Pharmacy Aisle

In the U.S., drugstores and grocery stores with associated pharmacies are only partially covered by the Health Insurance Portability and Accountability Act, or HIPAA. The prescriptions picked up from the pharmacy counter do have this protection.

But in a separate section, sometimes confusingly called the pharmacy aisle, stores also often sell over-the-counter medications, tests, and other health-related products. Consumers might think such purchases have similar protections to their prescriptions, but HIPAA only covers the pharmacy counter’s clinical operations, such as dispensing prescriptions and answering patients’ questions about medication.

This distinction can be confusing enough inside the brick-and-mortar location of a retailer. But the line can become even harder to make out on a website, which lacks the clarifying delineations of physical space.

What’s more, descriptions about what will happen with retail data are generally in retailers' privacy policies, which can usually be found in a link at the bottom of their webpages. The Markup and KFF Health News found them murky at best, and none of them were specific about the parts of the site that were covered by HIPAA and the parts that weren’t.

In the “Privacy Notice for California Residents” part of its privacy policy, Kroger says it processes “personal information collected and analyzed concerning a consumer’s health.” But, the policy continues, the company does not “sell or share” that information. Other information is sold: According to the policy, in the last 12 months, the company sold or shared “protected classification characteristics” to outside entities like data brokers.

Kroger spokesperson Erin Rolfes said the company strives to be transparent and that, “in many cases, we have provided more information to our customers in our privacy notices than our peers.”

Brokering of general retail data is widespread. Our investigation found, though, that some websites shared sensitive clinical data with third parties even when that information would be protected at a HIPAA-covered pharmacy counter. Users attempting to schedule a vaccine appointment at Rite Aid, for example, must answer a survey first to gauge eligibility.

This investigation found that Rite Aid has sent Facebook responses to questions such as:

• Do you have a neurological disorder such as seizures or other disorders that affect the brain or have had a disorder that resulted from a vaccine?
• Do you have cancer, leukemia, AIDS, or any other immune system problem?
• Are you pregnant or could you become pregnant in the next three months?

The Markup and KFF Health News documented Rite Aid sharing this data with Facebook in December 2022. In February of this year, a proposed class-action lawsuit based on similar findings was filed against the drugstore chain in California, alleging code on Rite Aid’s website sent Facebook the time of an appointment and an identifier for the appointment location, demographic information, and answers to questions about vaccination history and health conditions. Rite Aid has moved to dismiss the suit.

After the lawsuit was filed, The Markup and KFF Health News tested Rite Aid’s website again, and it was no longer sending answers to vaccination questions to Facebook.

Rite Aid isn’t the only company that sent answers to eligibility questionnaires to social media firms. Supermarkets Albertsons, Acme, and Safeway, which are owned by the same parent company, also sent answers to questions in their vaccination intake form — albeit in a format that requires cross-referencing the questionnaire’s source code to reveal the meaning of the data.

Using the Firefox web browser’s Network Monitor tool, and with the help of a patient with an active prescription at Rite Aid, KFF Health News and The Markup also found Rite Aid sending the names of patients’ specific prescriptions to Facebook. Rite Aid kept sharing prescription names even after the company stopped sharing answers to vaccination questions in response to the proposed class action (which did not mention the sharing of prescription information). Rite Aid did not respond to requests for comment, and as of June 23, the pixel was still present and sending the names of prescriptions to Facebook.

Other companies shared data about medications from other parts of their sites. Customers of Sam’s Club and Costco, for example, can search names of prescriptions on each retailer’s website to find the local pharmacy with the cheapest prices. But the two websites also sent the name of the medication the user searched for, along with the user’s IP address, to social media companies.

Many of the retailers The Markup and KFF Health News looked at did not respond to questions or declined to comment, including Costco and Sam’s Club. Albertsons said the company “continually” evaluates its privacy practices. CVS said it was compliant with “applicable laws.”

Kroger’s Rolfes wrote that the company’s “trackers disclose product information, which is not sensitive health information unless one or more inferences are made. Kroger does not make any inferences linking the product information collected or disclosed by trackers to an individual’s health condition.”

A Huge Regulatory Challenge

Pharmacies are just one facet of a huge health care sector. But the industry as a whole has been roiled by disclosures of tracking pixels picking up sensitive clinical data.

After an investigation by The Markup in June 2022 found widespread use of trackers on hospital websites, regulatory and legal attention has homed in on the practice.

In December, the Department of Health and Human Services’ Office for Civil Rights published guidance advising health providers and insurers how pixel trackers’ use can be consistent with HIPAA. “Regulated entities are not permitted to use tracking technologies in a manner that would result in impermissible disclosures” of protected health information to tracking technology or other third-party vendors, according to the official bulletin. If implemented, the guidance would provide a path for the agency to regulate hospitals and other providers and fine those who don’t follow it. In an interview with an industry publication in late April, the director of the Office for Civil Rights said it would be bringing its first enforcement action for pixel use “hopefully soon.”

Lobbying groups are seeking to confine any regulatory fallout: The American Hospital Association, for example, sent a letter on May 22 to the Office for Civil Rights asking that the agency “suspend or amend” its guidance. The office, it claimed, was seeking to protect too much data.

This year the Federal Trade Commission has pursued action against companies like GoodRx, which offers prescription price comparisons, and BetterHelp, which offers online therapy, for alleged misuse of data from questionnaires and searches. The companies settled with the agency.

Health care providers have disclosed to the federal government the potential leakage of nearly 10 million patients’ data to various advertising partners, according to a review by The Markup and KFF Health News of breach notification letters and the Office for Civil Rights’ online database of breaches. That figure could be a low estimate: A new study in the journal Health Affairs found that, as of 2021, almost 99 percent of hospital websites contained tracking technologies.

One prominent law firm, BakerHostetler, is defending hospitals in 26 legal actions related to the use of tracking technologies, lawyer Paul Karlsgodt, a partner at the firm, said during a webinar this year. “We’ve seen an absolute eruption of cases,” he said.

Abortion- and pregnancy-related data is particularly sensitive and driving regulatory scrutiny. In the same webinar, Lynn Sessions, also with BakerHostetler, said the California attorney general’s office had made specific investigative requests to one of the firm’s clients about whether the client was sharing reproductive health data.

It’s unclear whether big tech companies have much interest in helping secure health data. Sessions said BakerHostetler had been trying to get Google and Meta to sign so-called business associate agreements. These agreements would bring the companies under the HIPAA regulatory umbrella, at least when handling data on behalf of hospital clients. “Both of them, at least at this juncture, have not been accommodating in doing that,” Sessions said. Google Analytics’ help page for HIPAA instructs customers to “refrain from using Google Analytics in any way that may create obligations under HIPAA for Google.”

Meta says it has tools that attempt to prevent the transfer of sensitive information like health data. In a November 2022 letter to Sen. Mark Warner (D-Va.) obtained by KFF Health News and The Markup, Meta wrote that “the filtering mechanism is designed to prevent that data from being ingested into our ads.” What’s more, the letter noted, the social media giant reaches out to companies transferring potentially sensitive data and asks them to “evaluate their implementation.”

“I remain concerned the company is too passive in allowing individual developers to determine what is considered sensitive health data that should remain private,” Warner told The Markup and KFF Health News.

Meta’s claims in its letter to Warner have been repeatedly questioned. In 2020, the company itself acknowledged to New York state regulators that the filtering system was “not yet operating with complete accuracy.”

To test the filtering system, Sven Carlsson and Sascha Granberg, reporters for SR Ekot in Sweden, set up a dummy pharmacy website in Swedish, which sent fake, but plausible, health data to Facebook to see whether the company’s filtering systems worked as stated. “We weren’t warned” by Facebook, Carlsson said in an interview with KFF Health News and The Markup.

Carlsson and Granberg’s work also found European pharmacies engaged in activities similar to what The Markup and KFF Health News have found. The reporters caught a Swedish state-owned pharmacy sending data to Facebook. And a recent investigation with The Guardian found the U.K.-based pharmacy chain LloydsPharmacy was sending sensitive data — including information about symptoms — to TikTok and Facebook.

In response to questions from KFF Health News and The Markup, Meta spokesperson Emil Vazquez said, “Advertisers should not send sensitive information about people through our Business Tools. Doing so is against our policies and we educate advertisers on properly setting up Business Tools to prevent this from occurring. Our system is designed to filter out potentially sensitive data it is able to detect.”

Meta did not respond to questions about whether it considered any of the information KFF Health News and The Markup found retailers sending to be “sensitive information,” whether any was actually filtered by the system, or whether Meta could provide metrics demonstrating the current accuracy of the system.

In response to our inquiries, Twitter sent a poop emoji, while TikTok and Pinterest said they had policies instructing advertisers not to pass on sensitive information. LinkedIn and Nextdoor did not respond.

Google spokesperson Jackie Berté said the company’s policies “prohibit businesses from using sensitive health information to target and serve ads” and that it worked to prevent such information from being used in advertising, using a “combination of algorithmic and human review” to remedy violations of its policy.

KFF Health News and The Markup presented Google with screenshots of its pixel sending the search company our browsing information when we landed on the retailers’ pages where we could purchase an HIV test and prenatal vitamins, and data showing when we added an HIV test to the cart. In response, Berté said the company had “not uncovered any evidence that the businesses in the screenshots are violating our policies.”

KFF Health News uses the Meta Pixel to collect information. The pixel may be used by third-party websites to measure web traffic and performance data and to target ads on social platforms. KFF Health News collects page usage data from news partners that opt to include our pixel tracker when they republish our articles. This data is not shared with third-party sites or social platforms and users' personally identifiable information is not recorded or tracked, per KFF's privacy policy. The Markup does not use a pixel tracker. You can read its full privacy policy here.

This article was co-published with The Markup, a nonprofit newsroom that investigates how powerful institutions are using technology to change our society. Sign up for The Markup's newsletters.

“Tearing down all these institutions of power. It gives me glee,” said one of his boosters in tech, Chamath Palihapitiya, a garrulous former Facebook executive, nearly two hours into a May episode of the popular “All-In” podcast he co-hosts with other tech luminaries. The person who might help with the demolition was the show’s guest, Kennedy himself.

“Me too,” responded David Sacks, Palihapitiya’s co-host on the podcast, an early investor in Facebook and Uber. Sacks and Palihapitiya said they would host a fundraiser for Kennedy, which, according to the Puck news outlet, was set for June 15.

Kennedy’s newfound friends in Silicon Valley were mostly loud supporters of vaccines early in the pandemic, but they have proven more than willing to let him expound on his anti-vaccine views and conspiracy theories as he promotes his presidential bid. During a two-hour forum on Twitter, hosted by company owner Elon Musk and Sacks, Kennedy raised a range of themes, but returned to the subject he’s become famous for in recent years: his skepticism about vaccines and the pharmaceutical companies that sell them.

Indeed, on the June 5 appearance, he praised Musk for ending “censorship” on his corner of social media. A promoter of conspiracy theories, Kennedy said various forces are keeping him from discussing his safety concerns over vaccines, like Democratic Rep. Adam Schiff (as part of the intelligence apparatus), Big Pharma, and Roger Ailes (who has been dead for six years).

Kennedy argued an influx of direct-to-consumer advertising from pharmaceutical concerns keep media outlets, like Fox News, from featuring his theories about vaccine safety. Fox didn’t respond to a request for comment.

He then said he supported reversing policies that allow direct-to-consumer ads in media. (Kennedy earlier dubbed himself a “free-speech absolutist” and, later, in a discussion about nuclear power, a “free-market absolutist” and even later a “constitutional absolutist.” Legal scholars doubt the courts, on First Amendment grounds, would be receptive to a ban of direct-to-consumer ads.)

Support for Kennedy in the venture capital and tech communities, which have a big financial stake in the advancement of science and generally reject irrational conspiracy theories, is likely limited. Multiple venture capitalists and technologists contacted by KFF Health News expressed puzzlement over what’s driving the embrace from Musk and others.

“I think he is a lower-intellect, Democratic version of Donald Trump, so he attracts libertarian-leaning, anti-‘woke,’ socially liberal folks as a protest vote,” said Robert Nelsen, a biotech investor with Arch Venture Partners. “I think he is a dangerous conspiracy theorist, who has contributed to many deaths with his anti-vaccine lies.”

But the ones with the megaphones are letting Kennedy talk. Jason Calacanis, another co-host of “All-In” and a pal of Musk’s, said late in the podcast he was pleased the conversation didn’t lead with “sensational” topics — like vaccines. Still, during the podcast, Kennedy was given nearly five uninterrupted minutes to describe his views on shots — a long list of alleged safety problems, ranging from allergies, autism, to autoimmune problems, many of which have been discredited by reputable scientists.

David Friedberg, another Silicon Valley executive and guest on the show, suggested there wasn’t “direct evidence” for those problems. “I don’t think it’s solely the vaccines,” Kennedy conceded. After an interlude touching on the role of chemicals, he was back to injuries caused by diphtheria shots.

While Friedberg, a former Google executive and founder of an agriculture startup sold to Monsanto for a reported $1.1 billion, pushed back against Kennedy, he did so deep into the podcast, after the candidate had left. Kennedy’s views — on nuclear power and vaccines — manifest “as conspiracy theories,” he said. “It doesn’t resonate with me,” he continued, as he “likes to have empirical truth be demonstrated.”

The muted pushback is a bit of a reversal. Early in the rollout of covid-19 vaccines, many tech luminaries had been among the most loudly pro-shot individuals. The “All-In” crew was no exception. Sacks once tweeted, “We’ve got to raise the bar for what we expect from government”; Palihapitiya begged administrators to “stop virtue signaling” with vaccination criteria and simply mass-vaccinate instead.

That was then. Sacks recently retweeted a video of Bill Gates questioning the effectiveness of current covid vaccines and defended Kennedy from charges of being anti-vaccination.

Musk himself has sometimes suggested he has qualms with vaccines, tweeting in January, without evidence, that “I’m pro vaccines in general, but there’s a point where the cure/vaccine is potentially worse, if administered to the whole population, than the disease.”

Musk isn’t the only top tech executive to signal interest in Kennedy’s candidacy. Block CEO and Twitter co-founder Jack Dorsey has tweeted Kennedy “can and will” win the presidency.

In some ways, the Valley’s interest in Kennedy — vaccine skepticism and all — has deep roots. Tech culture grew out of Bay Area counterculture. It has historically embraced individualistic theories of health and wellness. While most have conventional views on health, techies have dabbled in “nootropics,” supplements that purportedly boost mental performance, plus fad diets, microdosing psychedelics, and even quests for immortality.

There’s a “deeply held anti-establishment ethos” among many tech leaders, said University of Washington historian Margaret O’Mara. There’s a “suspicion of authority, disdain for gatekeepers and traditionalists, dislike of bureaucracies of all kinds. This too has its roots in the counterculture era, and the 1960s antiwar movement, in particular.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.