Robert F. Kennedy Jr., President Trump’s pick to head the U.S. Department of Health and Human Services (HHS), was grilled by Democratic senators during his confirmation hearing on Jan. 29 and Jan. 30, who confronted him with conspiratorial and conflicting statements he has made about COVID-19. Attempting to understand how Kennedy would square his past questioning of the safety of vaccines, Sen. Bernie Sanders asked him if he believed that the COVID-19 vaccine was successful in saving millions of lives. "I don't know," Kennedy said. "We don't have a good surveillance system." In reality, both the U.S. Centers of Disease Control and Prevention and the U.S. Food and Drug Administration have several systems to collect and track side effects and adverse events of vaccines. And many studies have consistently shown that COVID-19 vaccines dramatically reduce people's risk of hospitalization and death from the disease. Enterprises eye China’s huge consumer market Branded Content Enterprises eye China’s huge consumer market By China Daily Here's what to know about Kennedy's positions on COVID-19, and why some experts and lawmakers are concerned about him leading the U.S.'s response to a next potential pandemic. Kennedy's racial and ethnic claims about COVID-19 Kennedy has held some controversial and unsubstantiated views on COVID-19 and ethnicity. According to a 2023 video shared by the New York Post, when Kennedy was a presidential candidate, he said at a private dinner in New York City, “There is an argument that [COVID-19] is ethnically targeted. COVID-19 attacks certain races disproportionately. COVID-19 is targeted to attack Caucasians and Black people. The people who are most immune are Ashkenazi Jews and Chinese.” After being accused of being anti-Semitic, Kennedy wrote on X that the Post story was "mistaken," and that “I have never, ever suggested that the COVID-19 virus was targeted to spare Jews. I do not believe and never implied that the ethnic effect was deliberately engineered.” Senators brought up the statement at the hearing. "I didn't say it was deliberately targeted," Kennedy said again. What science says about COVID-19 and race Government health data on hospitalizations and deaths from COVID-19 indicate that at times during the pandemic, the virus affected Blacks and Hispanics disproportionately. But that data also showed that the reason for the imbalance was not due to any biologic factors related to race, but to a slew of social factors. During the pandemic, people in these demographic groups tended to have a higher risk of exposure to the virus because they were more likely to work essential jobs that could not be done at home, a greater likelihood of living in larger households where infections can spread quickly, more limited access to health care and vaccines, and higher rates of underlying chronic conditions such as asthma, diabetes and heart disease, which can make them more vulnerable to serious illness from COVID-19. Read More: What to Know About Spasmodic Dysphonia, the Condition That Affects RFK Jr.’s Voice Much of the disproportionate impact of COVID-19 “reflect inequities that arise due to structural racism and not race,” says Samantha Artiga, vice president and director of the racial equity and health policy program at KFF who has published an analysis of COVID-19 trends by race and ethnicity. “The idea of biological differences by race has been disproven," she says. "Historically, it’s been used for an array of abuses and mistreatment of people of color.” Kennedy’s 2023 comments about COVID-19 “capitalize on confusion and mistrust in the public to push his own agenda of natural medicine and demonizing the medical industry,” says Dr. Eric Burnett, assistant professor of medicine at Columbia University. “He just wants to burn everything down and then not provide real solutions for how to fix the problems he talks about.” RFK Jr.'s opposition to COVID-19 vaccines Kennedy, who is known for his anti-vaccine views, has been a vocal critic of the government’s response to COVID-19, including the lockdowns and vaccine and mask mandates, which he once compared to Nazi practices in concentration camps. “Even in Hitler Germany, you could…cross the Alps into Switzerland. You could hide in an attic, like Anne Frank did,” he said at a rally protesting vaccine mandates in Washington, DC in 2022. (After his remarks were widely condemned, Kennedy apologized.) His opposition to the vaccine also came up in the hearing several times, including when he said that "COVID vaccines are inappropriate for six year old children who basically have a zero risk COVID." That's not supported by data from the U.S. Centers for Disease Control and Prevention (CDC), which show that young children can and do develop infections. Read More: RFK Jr. Says He’ll Follow Trump’s Lead on Abortion Kennedy has called himself an advocate for “medical freedom” and “bodily autonomy,” supporting the idea that people should be able to chose for themselves whether they get vaccinated, based on having informed data. But the evidence he espouses is “his evidence, evidence that supports whatever his current theory is,” says Dr. Gregory Poland, president of Atria Research Institute, which provides personalized health care. “Part of the problem is that these are appalling errors in communication and result from not being a scientist and not being trained scientifically. You use words and phrases that sound right, like evidence-based medicine, but evidence-based medicine is completely based on the scientific method which he evidently rejects.” As head of HHS, Kennedy would also have considerable power to influence vaccine policy in innumerable ways, including through CDC committees that recommend vaccine policy for everything from childhood vaccinations to the yearly flu and COVID-19 shots, and at the U.S. Food and Drug Administration, which reviews and approves vaccines as safe and efficacious. Concern over how Kennedy would lead during another pandemic Senators pressed Kennedy on his past statements about COVID-19 as a window into how an HHS under his leadership would respond to a new pandemic—a thought that troubles Burnett. "The guardrails are gone" in President Trump's second term, he says. "Medical experts, people who are familiar with pandemics and have worked on them before: they just aren’t going to be there. I think it will be more difficult for the American people to weather that storm.” The concern isn't purely hypothetical; as cases of bird flu continue to rise among farm animals, public health experts are carefully monitoring the virus’ potential shift to spreading among people. "I intend to devote the appropriate resources to preventing pandemics," Kennedy said during the hearing when questioned about bird flu. "That's a central part of my job." Read More: RFK Jr. Denied He Is Anti-Vaccine During His Confirmation Hearing. Here’s His Record Yet the Trump Administration has already taken steps to weaken the government's ability to respond to a pandemic. Just days after taking office, Trump signed an executive order withdrawing the U.S. from the World Health Organization (WHO); days later, public health officials were told to immediately cease working with the WHO. The Administration also froze federal health communications until further notice—including stopping publication of the CDC’s weekly MMWR report, which details the latest outbreaks of diseases like bird flu and keeps physicians and public-health experts informed about emerging threats. “You and I as private citizens have no way to gather, collate, and synthesize data from across the U.S., much less from across the world,” says Poland. “We are dependent on the government to do that for us. But what happens when that government won’t, or can’t, or manipulates that kind of information? That’s a world of hurt.”

The tide has largely turned against alcohol. Drinking, at least in moderation, was once seen as a harmless—or even healthy—indulgence that could strengthen your heart and even lengthen your lifespan. But in many scientific circles, consuming virtually any amount of alcohol is now seen as toxic. On Jan. 3, outgoing Surgeon General Vivek Murthy released an advisory warning that alcohol consumption raises the risk of at least seven types of cancer. Shortly afterward, a second federal report warned that people who consume more than nine drinks per week have a one in 100 chance of dying from their habit, due to alcohol’s links to a range of health problems. Increasingly, reports like these conclude there is no safe level of drinking. Even moderate consumption—no more than one alcoholic beverage per day for women, and no more than two per day for men—comes with dangers, and the situation snowballs the more a person sips. But alcohol is an ancient and natural beverage, made by fermenting grains, fruits, or vegetables—all of which are part of a balanced diet in their original forms. So what’s so bad about booze, exactly? It creates a toxic byproduct After you drink any kind of booze—vodka, wine, sake, you name it—enzymes in your body get to work metabolizing the alcohol (chemically known as ethanol) in your system. Most of this process happens in the liver. Ethanol breaks down into a byproduct called acetaldehyde, and that’s where the trouble begins, says Dr. Eden Bernstein, an assistant professor and internal-medicine physician at the University of Colorado School of Medicine. “If I were to point to one thing that alcohol does that’s harmful to the body,” Bernstein says, “it would relate to the production of acetaldehyde.” Acetaldehyde is “very toxic to a lot of different tissues,” says Dr. Sarah Wakeman, senior medical director for substance-use disorder at Mass General Brigham. It can damage body parts that are directly involved in alcohol metabolism, such as the liver, pancreas, and brain, as well as DNA itself. Exposure to acetaldehyde can result in DNA damage and mutations that lead to cancer, Bernstein explains. Alcohol-in-the-body Lon Tweeten for TIME; Getty Images Plenty of factors influence how damaging acetaldehyde is to the body, Wakeman says. The most obvious is the amount of alcohol consumed; a heavy drinker will be exposed to more acetaldehyde than a light drinker, leading to more damage. But even two people who drink the same amount may be affected differently, depending on their genes and other risk factors. After ethanol becomes acetaldehyde, it continues breaking down into non-toxic byproducts. But some people’s enzymes work more slowly than others, which leaves them exposed to acetaldehyde and its toxic effects longer, Wakeman says. Damage can also compound if someone has multiple risky habits, like drinking heavily and smoking cigarettes, she adds. Alcohol creates inflammation Drinking alcohol also leads to inflammation in the body. This, too, happens when booze is metabolized. The process creates what’s known as oxidative stress, or an imbalance between different types of molecules that results in inflammation. Alcohol also disrupts the colonies of microbes that live in your mouth, intestines, and gut, Bernstein explains, which can lead to overgrowth of “bad” bacteria. Booze can also damage intestinal cells, allowing pathogens that are normally confined to the GI tract to travel throughout the bloodstream. These effects can result in inflammation-causing immune responses. Read More: 9 Things You Should Do for Your Brain Health Every Day, According to Neurologists “Inflammation can really be an enemy,” Wakeman says. “It can lead to tissue changes over time that can increase the risk for cancer” and other health problems, such as liver scarring known as cirrhosis. Among very heavy drinkers, alcohol metabolism and the resulting inflammation may even contribute to serious brain damage, possibly including shrinkage of the brain or alcohol-induced dementia, Wakeman says. Drinking may affect hormones Drinking-related cancers are typically seen in parts of the body that alcohol directly touches: the mouth, throat, stomach, and so on. But there’s also a “unique relationship around breast cancer risk and alcohol use,” Wakeman says. Read More: Some Early Forms of Breast Cancer May Not Need Treatment Drinking alcohol seems to change the way the body metabolizes estrogen, leading to higher levels of the hormone. This may translate to an increased risk of estrogen-related breast cancers. Researchers are still learning about exactly how alcohol affects hormones, according to the recent Surgeon General report. Alcohol and injury In addition to the complex domino effect that alcohol sets off inside the body, intoxication has “direct effects on health through people falling and crashing cars and getting in all kinds of other accidents,” says William Kerr, scientific director of the Alcohol Research Group at the Public Health Institute in California. More than 30% of alcohol-related deaths recorded in the U.S. from 2020 to 2021 were due to acute issues including accidents and injuries. What about those heart benefits? For a long time, researchers thought moderate drinking—that nightly glass of red wine—improved heart health, and some studies continue to suggest that. In contrast to other recent reports on alcohol, a December 2024 report by the National Academies of Sciences, Engineering, and Medicine concluded with “moderate certainty” that moderate drinking is associated with a lower risk of dying from any cause, including cardiovascular disease, compared to never drinking. (It also found, however, that moderate drinking likely raises the risk of some cancers.) But many researchers now believe that design flaws in older studies falsely inflated the cardiovascular benefits of drinking. In some studies that correct for those flaws, booze’s apparent health benefits disappear. “Contrary to popular opinion, alcohol is not good for the heart,” the World Heart Foundation wrote in a 2022 policy brief. Drinking in excess is, in fact, linked to high blood pressure, abnormal heart rhythms, and sometimes even heart failure, according to American Heart Association researchers. Read More: How Stress Affects Your Heart Health Scientists are still learning about the true relationship between drinking and heart health, Wakeman says. But given all of the other known risks, it’s safe to say that “drinking is not a health-promoting activity,” Wakeman says. “No one should fool themselves into thinking that they are starting to drink for their health.” Does that mean everyone should quit drinking immediately? Not necessarily. Like other potential health hazards—such as spending time in the sun or eating not-so-nutritious foods—moderate or light drinking can fit into an otherwise healthy lifestyle, Wakeman says. “It’s not this binary, all or nothing” issue, she says. Ultimately, people must make their own decisions based on their personal risk factors and tolerances, ideally with the help of a trusted health professional.

The flu is always a nasty foe—and it’s particularly vicious this year. According to the U.S. Centers for Disease Control and Prevention (CDC), there have been at least 12 million flu infections since the fall in the U.S., leading to 160,000 hospitalizations and 6,600 deaths. Dr. Mahesh Polavarapu, medical director of emergency medicine at NewYork-Presbyterian Westchester, has mostly seen influenza A this year, a strain that causes more serious illness than influenza B. “If you’re getting flu-like symptoms, and you’re like, ‘This feels worse than before,’ you're not wrong,” he says. “It’s pretty harsh this year.” Fortunately, there are ways to alleviate at least some of the misery of the flu (besides, of course, getting your annual flu shot before you get sick). Doctors often prescribe Tamiflu, an antiviral that can treat both influenza A and B. Here’s what to know about how it works—and whether it might be right for you. How does Tamiflu work? Most people have flu symptoms for three to seven days. Tamiflu can shorten that by about 24 hours by blocking the virus from replicating in your body. “It’s basically stopping the virus from multiplying or shedding any more than it already has,” Polavarapu says. (Antibiotics, which treat bacterial infections, don’t work against a viral infection like the flu.) Grottoes bear the enduring touch of Tang Branded Content Grottoes bear the enduring touch of Tang By China Daily Read More: When Should I Go to the Doctor With Cold Symptoms? Tamiflu starts working after the first dose, and within a day or two, it will have built up in your body enough to make a noticeable difference. But timing is crucial—you need to start taking it within 48 hours of symptom onset. “I tell patients to consider it a way to reduce the duration of their symptoms by hopefully a day,” Polavarapu says.Tamiflu (sold under the generic name oseltamivir) can be prescribed as a pill or in liquid form, and most people take 75 mg twice a day for five days, he adds. Who might benefit from taking Tamiflu? You’re most likely to benefit from Tamiflu if you have risk factors that predispose you to serious influenza infection. That includes being 65 or older, under 2, pregnant, or immunocompromised, or having a chronic condition like diabetes, heart disease, or asthma. Research suggests that starting Tamiflu within two days of developing symptoms can reduce the risk of death from a serious case of the flu; it also lowers ICU admission rates among hospitalized adults. Tamiflu is also available to people outside of these higher risk groups. It can be taken by anyone else who’s at least 2 weeks old and who’s had flu symptoms for no more than two days. Is it really worth it just to feel better one day sooner? “Flu makes you feel very crummy, and so a day less is certainly better than a day more,” says Dr. Helen Chu, a professor of medicine, allergy, and infectious diseases at the University of Washington. “But it’s not like a dramatic difference, so I understand why people have reservations about it.” Read More: The Supplements Doctors Actually Think You Should Take Whether it’s right for you comes down to your own priorities. “You have to weigh your pros and cons,” she says. “You have to go pick up the medicine”—an inconvenient task when you’re sick—“and it can make people nauseated.” Yet there’s another, often significant benefit to keep in mind: Tamiflu can be a way to help keep your family members safe. Does Tamiflu make you less contagious? You can still spread the flu to other people while you’re on Tamiflu, Chu says. Scientists aren’t sure exactly how much less contagious it makes you. However, research suggests that the antiviral helps prevent household outbreaks. In one study, it reduced secondary infections among people who lived in the same house by 50% if those who weren’t sick yet started Tamiflu within 24 hours. “You can use it to stop transmission,” Chu says. “If someone in your house has the flu, that person can take it for treatment, but you can also take it to prevent yourself from acquiring the infection.” Can you take Tamiflu to prevent getting the flu? If you haven’t been exposed to the flu and you’re simply desperate to avoid catching it, it doesn’t make sense to take Tamiflu. Your doctor won’t prescribe it for that reason—it’s not like a vitamin you might take in hopes of bolstering immune health. “It's not a preventive measure,” Polavarapu says. However, if you have been exposed to the flu—especially by someone in your household—many doctors will consider prescribing a prophylactic dose to lower your chance of infection. Read More: Is Zinc Good for Colds? Keep in mind, however, that Tamiflu isn’t a guaranteed way to stay healthy, so you still need to practice other healthy behaviors when flu is in your house: washing your hands frequently, wearing a face mask, cleaning high-touch surfaces like doorknobs and light switches. And for family members with the flu, don’t go out unless you absolutely need to: The CDC recommends staying home until your symptoms have been improving and you haven't had a fever for at least 24 hours. How do I know if I need Tamiflu? Thanks to the rise of at-home tests, it’s now easy to confirm whether you have the flu without even leaving your house. “The way the flu works, unlike some other viruses, is that it really hits you like a truck,” Chu says. “You're feeling fine, and then suddenly you just need to crash.” If you’re overcome with the urge to climb into bed, and your entire body hurts, it’s time to test, she says. If it turns out you do in fact have the flu, call your doctor and ask about Tamiflu. “The earlier you start it, the better,” she adds—so don’t spend too much time vacillating about the decision. When is it too late to take Tamiflu? The gold standard is to start Tamiflu within two days of symptom onset; if you’ve been sick longer than that, your doctor probably won’t prescribe it for you. But there are some exceptions. If you’re immunocompromised or so sick that you’re hospitalized with the flu, “then we start it any time,” Chu says. “Most people clear the virus very quickly, but people who have suppressed immune systems are shedding it for much longer, so you can start Tamiflu later on.” Can kids take Tamiflu? Yes—but at a slightly smaller dose than teens and adults. Children who are 2 weeks to 12 years old take a twice-daily dose based on their weight. As the CDC notes, taking Tamiflu curbs the incidence of ear infections in kids with the flu, and may also reduce more serious complications like pneumonia and hospitalization. Read More: What to Do If Your Doctor Doesn’t Take Your Symptoms Seriously Does Tamiflu have any side effects? Tamiflu is “a safe medication,” Polavarapu says, with a track record spanning more than two decades. It was approved by the U.S. Food and Drug Administration in 1999, and the generic version, oseltamivir phosphate, was approved in 2016. Still, like most medications, there’s a risk of side effects. You might feel nauseous and even vomit if you take Tamiflu. Diarrhea is also possible, though less common. “Essentially what I tell patients is that the medicine itself can make you feel kind of crummy, particularly the nausea,” Polavarapu says. Sometimes, if a patient doesn’t tolerate it well, he prescribes anti-nausea medication alongside it. Ideally, he says, treating one set of symptoms won’t cause another set to pop up, but it’s smart to be aware what kind of side effects are possible. “Medications like antivirals aren’t always the answer,” he says. “They’re an answer in a specific time duration,” and for certain people, but they’re not a magic, flu-dissipating bullet—and whether they’re right for you depends on your own unique circumstances.

Robert F. Kennedy Jr. will face questioning by Senators from both parties on Wednesday and Thursday, in one of the most anticipated confirmation hearings for President Donald Trump’s Administration. If confirmed by the Senate, Kennedy would head the Department of Health and Human Services (HHS), which oversees many of the country’s health agencies, from the Food and Drug Administration (FDA) to the Centers for Disease Control and Prevention (CDC). His nomination is already stirring fierce debate on both sides of the political aisle. Kennedy, 71, is one of Trump’s more controversial Cabinet nominees. Known for his anti-vaccine views, Kennedy has sparked backlash and outrage from the science and medical communities for spreading disinformation. In addition to repeating the debunked claim that vaccines cause autism—despite years of research proving that vaccines are both safe and effective—he has also accused the FDA of “aggressive suppression” of raw milk (the FDA warns that raw milk can have harmful bacteria, such as E. coli and listeria, that can lead to illness and even death). Kennedy has also said he would stop the safe and years-long practice of adding fluoride to the water supply, which, while done to protect oral health, Kennedy claims is tied to issues like IQ loss and bone cancer. Perhaps one area where Kennedy may be able to find bipartisan support is on his goals for food and nutrition. Kennedy, who initially ran as an independent in the 2024 presidential election before endorsing Trump, has promoted a plan to “Make America Healthy Again,” promising to “ban the hundreds of food additives and chemicals that other countries have already prohibited” and saying that he would “change regulations, research topics, and subsidies to reduce the dominance of ultra-processed food.” But while some health experts have been encouraged by Kennedy’s pledge to address this issue, most are alarmed and appalled that Kennedy is being considered to lead HHS. “We shouldn’t even be having this discussion,” says Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who has served on CDC and FDA vaccine advisory committees. “So how do I hope [the hearing] goes? The way I hope this goes is that he was never considered.” Kennedy can only afford to lose three Senate Republican votes if Democrats unanimously oppose his nomination. It’s currently unclear whether any Republicans will vote against him. TIME spoke with public health experts and lawmakers about the biggest issues likely to arise in the hearings this week. Vaccines and viruses Public health experts agree that Kennedy’s false claims about vaccines will be a major focus of the hearings. While Kennedy has said that he and the Trump Administration wouldn’t remove vaccines from the market, he has, for years, spread misinformation about them. In addition to promoting the debunked claim that vaccines are linked to autism, Kennedy falsely labeled the COVID-19 vaccine “the deadliest vaccine ever made,” even though data has proven and health experts have said that COVID-19 vaccines are both safe and effective. In 2021, he filed a petition with the FDA, requesting that the agency revoke its emergency-use authorizations for the COVID-19 vaccines. “The hospitals were overwhelmed with that virus," Offit says. “Our ICU was flooded, and here this man stands up and says, ‘I think that you should remove your authorization for the COVID-19 vaccine.’ I mean, that [vaccine] was a godsend. That was our way out of this pandemic.” “Let’s imagine that there was a bird flu pandemic—how would he handle that? Since he doesn’t believe in vaccines, which, by the way, is not a belief system—it’s an evidence-based system,” Offit says. Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law, says he hopes the Senate committees “dig down” on vaccinations—not just asking Kennedy if he would ban certain vaccines, but more specific questions, like: would Kennedy appoint scientists with vaccine research expertise to the CDC vaccine advisory committee? Would he follow or undermine CDC recommendations for childhood vaccination schedules? When he says that he wants to make vaccine research more transparent, what would that look like? Read More: What Donald Trump’s Win Could Mean for Vaccines Kennedy has also suggested that AIDS may not be caused by HIV, despite overwhelming scientific evidence establishing the link between the two. Food and nutrition Kennedy has gained some support for his stance on food and nutrition. Dr. Dariush Mozaffarian, a cardiologist and director of the Food Is Medicine Institute at Tufts University, acknowledges Kennedy’s controversial statements on vaccines and fluoride in water, but says he hopes that Kennedy’s more contentious comments “may have been partially [or] purposefully inflammatory to raise attention,” and hopes that Kennedy will follow “the evidence and the science” and focus on the issue of nutrition. “There’s broad consensus across the country, across the political spectrum, that our food is making us sick, and that we haven’t been paying nearly enough attention to this,” Mozaffarian says. “RFK Jr. has appropriately highlighted this is a true national crisis requiring urgent attention.” Gostin also anticipates that Kennedy’s comments on food will come up during the hearings, but says he hopes that Senators drill in on their line of questioning. “For me, again, I would ask the hard questions. It’s easy to say, ‘Well, I want to take out toxins and dyes from food,’” Gostin says. “What policies does he really want to put forward, and what is he prepared to do to fight for them?” Read More: The Power RFK Jr. Would Have Over Food Income and debt Kennedy’s financial disclosures could also be a point of discussion during his confirmation hearing before the Senate Finance Committee. Recent financial disclosure forms filed with the U.S. Office of Government Ethics reveal that he reported up to $1.2 million in credit card debt, along with mortgages that could total up to $10.5 million. Kennedy's income, however, paints a different picture. Over the past two years, he reported earnings exceeding $12 million, with a significant portion of that coming from his law firm, Kennedy & Madonna LLP, which recently rebranded to Madonna & Madonna LLP. Despite his mounting liabilities, he continued to earn substantial income from referral fees, including nearly $9 million from legal cases. His ongoing involvement in the law firm, particularly cases involving vaccine manufacturers, has prompted Kennedy to vow to sever ties with the firm if confirmed to avoid potential conflicts of interest. What are lawmakers saying? Kennedy’s path to HHS rests with the Republican-controlled Senate, which holds a razor-thin majority. Senators from both parties have been vocal about their concerns, focusing on his past views on vaccines, food safety, and abortion. Some Republicans are demanding that Kennedy clarify his past support for abortion rights, given that he would play a key role in shaping the Trump Administration’s abortion policies if confirmed. Former Vice President Mike Pence, a staunch opponent of abortion, is lobbying against Kennedy’s nomination. Kennedy, like Trump, has flip-flopped on the issue, previously saying he would support a federal ban on abortion after the first trimester of pregnancy, before backtracking and saying that abortion should be legal up until a certain point. Read More: The Powers Trump’s Nominees Will Have Over Abortion Meanwhile, Democrats have questioned Kennedy’s qualifications for the role based on his past statements and unorthodox view of medicine. Democratic lawmakers told TIME that Kennedy’s position on vaccines is a dealbreaker. Asked if anything could change his mind on Kennedy’s nomination, Democratic Sen. Richard Blumenthal of Connecticut, said: “Well, if he were to say I was totally misguided and mistaken on my criticism of vaccines.” Senate Minority Leader Chuck Schumer said on Tuesday that he “cannot recall a nominee more dangerous to the health of Americans than Mr. Kennedy.” “He is neither a doctor, neuroscientist nor a public health expert, nor a policy expert of any kind,” he said. “When I met with him, he would not answer many questions directly, saying he would defer to the president, who also is hardly a leader… Nobody should believe this 11th hour conversion of Mr. Kennedy on vaccines.” Several Democrats declined to say how they will vote on Kennedy. Sen. Bernie Sanders, an independent who previously said he agreed with some of Kennedy’s positions on food policy—particularly his criticism of how the food industry prioritizes profits over public health—told reporters Monday that he will be tracking the hearings closely this week and confirmed that he spoke with Kennedy about his past debunked claim that vaccines can cause autism. What are public health experts saying? Gostin hopes that, in addition to asking Kennedy about his controversial statements, Senators also question him about the Trump Administration’s decision to pull the U.S. out of the World Health Organization, which has drawn sharp criticism from public health experts. Senators may question Kennedy about abortion but Gostin says any line of questioning on the issue will likely be “predictable,” since he expects that Kennedy will repeat Trump’s view that abortion policy should be left up to the states. While some public health experts are uneasy about how the hearings will go, they hope that Senators across the aisle will grill Kennedy on his controversial claims. “For me, the headline should be: do you believe in science, and will HHS policies and guidelines be based on evidence and solely scientific evidence?” Gostin says. “And then secondarily, just under that is: will you rely on career scientists at U.S. public health agencies? Will you rely on their judgment and their research?” “This is the head of HHS—we shouldn’t have to force the head of HHS to embrace science and evidence and the public health mission of the agency,” Gostin says.

When Robert F. Kennedy Jr. starts the first of two days of confirmation hearings on Wednesday, it won’t be just a big moment for the former environmental lawyer and presidential candidate. It will also be a breakthrough event for the once-fringe anti-vaccine movement, as Senators weigh allowing one of its most high-profile boosters to head the nation’s top health agency. Vaccines prevent tens of thousands of deaths and millions of cases of disease each year, according to the Centers for Disease Control and Prevention. Medical experts are concerned that those gains are in jeopardy. The percentage of Americans who consider childhood vaccines important has declined in the past two decades. According to polling from Gallup released last year, about 40% of Americans say it is extremely important for parents to have their children vaccinated. That is down from 58% in 2019 and 64% in 2001. For decades, Kennedy has been one of the most well-known anti-vaxers in the country, helping spread doubts about their safety in the face of decades of medical data that shows they have saved lives and improved public health. He has also helped legal efforts to tear down vaccine mandates. After a 2015 measles outbreak at Disneyland in Anaheim, Calif. showed that a large number of infected patients hadn’t been vaccinated, Kennedy helped lobby to block several state efforts to close loopholes in vaccine requirements. In 2019, Kennedy helped spread anti-vaccine sentiment in Samoa as the Pacific Island nation was in the midst of a deadly measles epidemic. Kennedy will appear before the Senate Finance Committee on Wednesday and the health committee on Thursday. Whether or not he is confirmed, those high-profile hearings could amount to an advertisement for the anti-vax movement, some fear. Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention and the current president and CEO of the health nonprofit Resolve to Save Lives, warns against the dangers of feeding anti-vax sentiment, which he describes as “a matter of life and death.” Branded Content XPRIZE at the 2025 TIME100 Summit: Making the Impossible, Possible By XPRIZE “Undermining confidence in vaccines undermines the health and safety of children and all Americans,” Frieden says. “False and misleading claims about vaccines also divert energy and attention from figuring out what really causes chronic illnesses such as autism.” Trump told voters during the campaign that he would let Kennedy “go wild” on health care. While Kennedy has in recent months talked often about a desire to target ultraprocessed foods, many of his supporters expect him to make major changes to the course of U.S. vaccine policy. Kennedy’s allies have encouraged him to dismantle the government’s panel on vaccine safety and recommendations, called the Advisory Committee on Immunization Practices. If confirmed as HHS secretary, Kennedy would be able to stack the panel with vaccine skeptics. Read more: Trump Draws False Link Between Vaccines and Autism in TIME Interview Advocates who have been working to undermine public faith in childhood vaccine requirements for decades have been giddy to find themselves welcomed into Donald Trump’s revamped Republican Party. They even had their own ball last week during Trump’s inauguration festivities. The MAHA Inaugural Ball, using the acronym for Make American Healthy Again, was sponsored by MAHA Action, the political action committee Kennedy started last year after suspending his own fledgling presidential bid and endorsing Trump. Del Bigtree, the founder of the Informed Consent Action Network that promotes allowing parents to opt out of childhood vaccine requirements, described the ball as an “amazing moment” during a broadcast of his online show The HighWire. Bigtree was also a former spokesman for Kennedy’s presidential campaign. “Media covered it, there was Vogue articles and Fox and so many different reporters covered the MAHA ball, very very exciting, and all the who’s who of holistic health and fitness and wellness and nutrition, all in one building—many of the O.G.s of the vaccine risk-awareness movement.” Anti-Vaccine Demonstration On The National Robert F. Kennedy Jr., speaks during an anti-vaccine mandate rally at the Lincoln Memorial in Washington, D.C., on Jan. 23, 2022. Eric Lee—Bloomberg via Getty Images In his testimony before his Senate hearing on Wednesday, Kennedy plans to say he’s not “anti-vaccine or anti-industry” and that he’s “pro-safety,” according to Bloomberg News. That is an abrupt shift from his years of public skepticism and advancing the debunked claim that the measles vaccine is linked to autism and the false idea that the polio vaccine is more deadly than polio itself. Kennedy is all but certain to face questioning at his hearings from multiple long-time vaccine supporters, including Republican Senator Bill Cassidy, a medical doctor who has promoted vaccines in his home state of Louisiana. Cassidy will have the chance to question Kennedy both days, as he is chairman of the Senate health committee and sits on the finance committee. It is unclear how much Cassidy will focus on vaccines during his questioning, but he said on Fox News Sunday earlier this month that Kennedy was “wrong” on vaccinations.

One of the many indignities of being a patient is that you won’t always be taken seriously. Perhaps the most frustrating—and startlingly common—experience is being told your medical symptoms, which have nothing to do with mental health, are anxiety. Steph Fowler can tick off a long list of conditions she was initially told were anxiety or otherwise all in her head: endometriosis, a stomach infection from H.pylori, insomnia, and mast cell activation syndrome. She was sent for a full neuropsychiatric evaluation before her doctors eventually diagnosed her with Long COVID. Figuring out what was really going on “is such a mixed bag,” she says. “It’s a combination of relief that somebody knows I'm not making it up, and that I can trust myself. Anger and frustration also come in, plus the grief of knowing it could have been different.” Fowler, 43, a therapist in Chicago, has now shifted her practice to supporting clients who live with chronic and misunderstood illnesses, often helping them advocate for themselves when dealing with doctors who dismiss their symptoms as anxiety. “It’s been alarming to discover how common this is,” she says. We asked experts what to do if a doctor doesn’t take your symptoms seriously and instead dismisses them as anxiety. Bring someone to appointments with you It’s helpful to have someone with you, Fowler says, especially if you tend to get nervous or have a lot of symptoms to remember. A friend “can help jog your memory, but also give outside validation and input about what they've seen happening,” she says. Some research suggests that physicians sometimes treat female patients differently than they do males; anecdotally, Fowler has found that if you bring a man to your appointment, “they might listen more,” she says. “I’ve unfortunately felt this and experienced this, and I know clients who have experienced this, too.” Read More: 8 Symptoms Doctors Often Dismiss As Anxiety Track your symptoms Lots of apps—like Bearable and Visible—allow you to digitally track health symptoms like mood and migraines. The more information you can supply your doctor with, the better, Fowler says. Or you can simply use a pen and paper, writing down what you’re experiencing, the exact date and time, any potential triggers (like what you ate beforehand), and how long it lasted. "It's an unfortunately necessary use of energy and capacity—which, if you're sick, is limited,” she acknowledges. “But it can really help make your case and see trends over time.” Describe your symptoms clearly Good health care hinges on strong communication. Before talking to your doctor, spend time planning the best way to paint a vivid, accurate description of your symptoms, suggests Dr. Robert Gee, assistant dean of student affairs and a behavioral sciences professor at Ross University School of Medicine. “I’m short of breath even when I feel calm,” for example, tells a different story than “I feel anxious sometimes,” he says. Make sure you mention where you feel pain, what medications you're taking, any associated symptoms, and whether anything exacerbates or relieves what you're experiencing. Be prepared, too, to rate how severe your symptoms are on a scale of 1 to 10. Encourage your providers to collaborate Ideally, your provider will practice “collaborative care,” which means specialists like a psychiatrist or social worker are embedded within the primary care unit. That kind of integration can help ensure physical symptoms aren’t mistaken as mental-health symptoms, says Dr. Monika Roots, co-founder and president of Bend Health, which provides pediatric mental-health care. “They’re helping that pediatrician or family physician or internal medicine doctor think through, ‘Hey, have you looked at this lab, have you looked at that vital sign?” Read More: Long Dismissed, Chronic Lyme Disease Is Finally Getting Its Moment If you’re not able to go to a collaborative-care practice, you can still ask different doctors to communicate with each other. For example, Roots say, you could ask your primary care doctor: “Could you talk to the psychiatrist I'm also seeing?” Or ask your psychiatrist: “Could you talk to my primary care physician?” Doing so encourages collaboration, she says, and helps ensure doctors are comparing notes and making sure they don't miss an important diagnosis. Ask specific questions You can help your doctor feel like you’re part of the team, Gee says. He suggests phrasing a request for additional workups like this: “Could we do a few extra tests just to rule things out? It would really help to put my mind at ease.” If your doctor continues to brush off your symptoms as being all in your head, Fowler recommends responding like this: “If it’s not anxiety, what else could it be? And how are you ruling this out?” If your doctor still isn’t willing to run tests, ask them what symptoms—or duration of symptoms—would indicate they would be necessary. Doing so “helps the doctor show their work to the patient,” she says. “It helps make apparent why it is that they're not thinking this is a heart attack or a stroke or any of the big scary things people might be concerned about.” Ask your doctor to document that they opted not to pursue further testing If you believe you need additional testing, and it’s not happening, tell your clinician you’d like that marked in your chart. “It’s a paper trail,” Fowler says. “It also causes doctors to slow down and consider that this is documented.” Upon reflection, they may decide to pursue more tests after all. Appeal to your doctor’s human side Fowler has found it can be helpful to ask: “If you had a loved one with these symptoms, what would your next steps be?” The question often spurs doctors to consider the situation with genuine patience and care. That way, “It’s not just the patient they’re seeing at 12:35 before their lunch break,” she says. “If it's somebody they care about, they're more likely to be engaged.”

Since COVID-19 first took off, political leaders, infectious disease specialists, and the lay public have debated its origins. Eventually, two hypotheses emerged: Either the virus crossed over from animals to humans in a wet market in Wuhan—the city in which the disease first appeared—or it leaked from a Chinese lab, likely the Wuhan Institute of Virology. The truth is still unknown. But on Jan. 25, 2025, the Central Intelligence Agency (CIA) weighed in, saying in a statement to reporters that the virus is “more likely” to have come from a lab than a natural reservoir like a bat or other animal at the wet market. The conclusion did not come from new evidence—merely a fresh look at existing data—and the agency has “low confidence” in the findings, suggesting the analysis is based on incomplete data. Accordingly, the CIA said it would “continue to evaluate any available credible new intelligence reporting or open source information that could change CIA’s assessment.” Such hedging notwithstanding, the announcement came as a thunderclap to China, which has long insisted that the Wuhan lab was not responsible. In response to the CIA’s new determination, the Chinese government doubled down on that position. “Origins-tracing is a matter of science and any judgement on it should be made in a science-based spirit and by scientists. It is extremely unlikely that the pandemic was caused by a lab leak,” said foreign ministry spokeswoman Mao Ning at a press conference. “The U.S. needs to stop politicizing and weaponizing origins-tracing at once, and stop scapegoating others.” The political backdrop Only one day before the CIA’s statement, the agency’s just-sworn-in director, John Ratcliffe, signalled that a new position on the origins of COVID-19 was coming. “One of the things that I’ve talked about a lot is addressing the threat from China on a number of fronts, and that goes back to why a million Americans died and why the Central Intelligence Agency has been sitting on the sidelines for five years in not making an assessment about the origins of COVID,” he said in an interview with Breitbart News. “That’s a day-one thing for me.” Restoring a city’s charm Branded Content Restoring a city’s charm By China Daily That confrontational approach to Beijing is a consistent one for Ratcliffe, who served as Director of National Intelligence during President Donald Trump’s first term. “The lab leak is the only theory supported by science, intelligence, and common sense,” he said in 2023. Read More: The Dire Consequences of Trump Withdrawing America From the WHO The newly announced position stretches across political lines. The finding was reached during the final days of the Biden administration, under then-CIA chief William Burns, according to reporting by the New York Times, and Ratcliffe ordered it declassified and released. A hotly debated question since the start Early in the pandemic, back in 2021, the World Health Organization reached a different conclusion. In collaboration with Chinese epidemiologists,they conducted an extensive review of the likely origins of the COVID-19 virus and saw a natural spillover from an animal host to humans as the likeliest route. A contamination of the food-supply cold chain—with the virus hitching a ride in refrigerated food somewhere in the production and delivery line—was also considered. The lab theory did not gain much traction. “Introduction through a laboratory incident was considered to be an extremely unlikely pathway,” the report concluded. Mao Ning, the foreign ministry spokeswoman, cited that finding at her Jan. 27 press conference, describing it as an “authoritative conclusion reached by the experts of the WHO-China joint mission based on science following their field trips to the lab in Wuhan and in-depth communication with researchers.” But this was hardly the last word. Scientists from the U.S. and elsewhere had no role in that study, and the research occurred while the pandemic was still boiling, with a lot about the virus still unknown. In 2023, the U.S. Department of Energy (DOE) reached a conclusion similar to the CIA’s new one: that a lab leak was responsible for the pandemic, though it could also say so only with “low confidence.” That same year, former FBI Director Christopher Wray echoed the DOE’s conclusion, if somewhat more confidently, telling Fox News, “The FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident in Wuhan." The Chinese foreign ministry hit back then too. “By rehashing the lab-leak theory,” said Mao Ning, “the U.S. will not succeed in discrediting China, and instead, it will only hurt its own credibility.” Widespread disagreement The problem for the lab-leak position is that the U.S. has never had access to the Wuhan lab and has thus been unable to reach a definitive answer for more than five years. Now that the CIA has at last come to a conclusion, not all scientists are sold on what it has reported, seeing the results as thinly scientifically sourced. Read More: Why People Believe Trump and RFK Jr.’s Dangerous and Debunked Claims about Vaccines and Autism “We have at least a half-dozen scientific papers in the best scientific journals, including Cell and Science, which convincingly demonstrate how the SARS-2 virus emerged through zoonotic spillover,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, in an email to TIME. “In contrast, I’ve not seen a single published scientific paper on lab leak…nor even a serious scientific explanation [of] how that would occur given the scientific evidence to date. So I don’t understand how the CIA came to its conclusions.” The debate is more than an academic one. If the virus indeed spilled over in a Wuhan wet market, the resulting seven million deaths worldwide make a strong case for better regulating the way we interact with the ecosystem, such as in outdoor food bazaars. If, instead, the pandemic was the result of what went on in a laboratory, then China, the U.S., and any other country that performs such biological tinkering are gravely in need of more oversight to make these labs safer. As scientists have argued for years, both precautions are necessary—no matter how COVID-19 originated.

Everything is negotiable, as the saying goes—and that includes medical bills. Although many people assume their health care bills are binding, there’s often more wiggle room than one would think. “Never pay any bill right away,” says Caitlin Donovan, a senior director at Patient Advocate Foundation (PAF), a nonprofit that helps patients afford medical care. Prices that are incorrect, unaffordable, or simply higher than you think are fair can often be changed with a little effort. A recent report by the Commonwealth Fund, a health care research organization, found that about 40% of people who challenged an unforeseen medical bill ultimately secured a price reduction or even had their balance forgiven entirely. Erin Duffy, a research scientist at the University of Southern California’s Leonard D. Schaeffer Center for Health Policy and Economics, found an even higher percentage when she surveyed a small group of U.S. consumers who received medical bills they disagreed with or couldn’t afford. About 40% of those people didn’t bother to contest their bills, often thinking it wouldn’t make a difference. But in reality, roughly 75% of those who challenged an unaffordable bill got financial relief, Duffy found. “It’s worth the call,” she says. Making that call, however, can feel uncomfortable. Here’s how to do it. Branded Content XPRIZE at the 2025 TIME100 Summit: Making the Impossible, Possible By XPRIZE Step one: Read the bill carefully “Your first step is to really understand the bill,” says Jeremy Gurewitz, CEO of Solace, a company that connects consumers with health care advocates. Before you pay a cent, read over your bill and its accompanying explanation of benefits (EOB), the document your insurance company sends to summarize how it processed and covered the care you received. Make sure you understand what you’re being charged for and why. Just as important, confirm that nothing is inaccurate, Donovan says. Errors on these documents are very common, she says, and can lead to overpaying. “Any time you get any medical bill in the mail, assume there’s a mistake and it’s your job to find it,” she says. Make sure all of the basics—names, dates, and so on—are right. This may sound silly, but even glaring mistakes happen. “We’ve seen scenarios where people get bills for different people’s names” or for procedures they didn’t have, Gurewitz says. Read More: How to Get Better at Doing Things Alone Next, confirm that the amount on the bill matches the one specified on the EOB, Donovan says. Your EOB should also list the specific services for which you were billed. These billing codes can be hard to parse, but if any of them seem off, call your insurer to clarify. If necessary, you can ask for your bill to be reprocessed with the correct information. It’s also worth confirming that your insurance benefits were applied correctly. Make sure that your insurance was billed at all; that services weren’t processed as out-of-network when they should have been in-network; and that your documents accurately list how much you’ve paid toward your deductible, if you have one. In some cases, you may receive a letter saying that your insurer is denying coverage altogether, which can result in high out-of-pocket expenses. If you believe a denial is wrongful, you may have to appeal the company’s decision. Here’s a guide to doing so. Step two: Do your homework Before making any calls, calculate how much you can comfortably pay right away, as well as how much you can afford to pay over time, Donovan says. Keep those numbers in mind. It’s also helpful to do some research on typical pricing for the services you received, Donovan says. This information isn’t always easy to pin down, since prices can vary widely by geographic area, provider, patient insurance status, and more. But tools like Medicare’s price database can help give you a frame of reference, she says. You can also try to find hospitals or health systems in your area that post their price lists online. Step three: If necessary, enlist others Successful negotiation “really does take some boldness,” Duffy says. “Some people feel a stigma or shyness about picking up the phone and saying, ‘I can’t afford this bill.’” If you know that negotiating isn’t your strong suit—or if you’re dealing with a health issue that’s making you feel lousy—get help. A loved one may be able to handle the call on your behalf, or join you by three-way call or speaker phone. Pick someone who can be “assertive but diplomatic,” Donovan recommends. “The way you’re not going to win is having someone who’s screaming, because you’re trying to convince another person to help you.” Read More: 11 Ways to Respond When Someone Insults a Loved One’s Disability If you don’t have a loved one who is an ace negotiator, you can look into groups like PAF, Solace, and the nonprofit Dollar For, all of which offer patient assistance. You can also request a three-way call with your provider’s billing office and your insurance company if you’re hearing different things from each side, Donovan says. Step four: Ask about financial assistance If your bill is correct but higher than you can afford or think is appropriate, it’s time to negotiate. First, call your provider’s billing department and ask whether they offer financial assistance, since many hospitals and health systems provide free or discounted care to certain patients. Eligibility for these programs can be surprisingly broad, sometimes including people whose incomes put them several times above the federal poverty level. Nonprofit hospital systems tend to have particularly robust charity-care programs, Duffy says. It’s smart to start by asking whether you qualify for financial assistance, Donovan says. They may “say yes, and maybe you end up having no out-of-pocket costs,” she says. But even if they say no, “it preps the conversation. If you’re asking about financial assistance, it’s not going to be a shock to them” if you proceed to other negotiations. Step five: Ask about payment plans or discounts If you’re not eligible for a formal financial-aid program, you still have options. Many health care providers offer payment plans that allow you to pay off your balance in small chunks over time, sometimes without interest. Others may agree to “prompt pay” discounts, accepting a smaller lump sum right away rather than waiting for the full amount. But you might not know about these options unless you ask. Duffy’s research has shown that many hospitals offer payment plans, but far fewer publicly list that information online. Read More: The Surprising Benefits of Talking Out Loud to Yourself Here’s where your previous calculations about how much you can afford to pay will come in handy. “You can say something like, ‘I can’t afford the full price of what you’re charging, even after insurance,'” Donovan says. Then, either suggest a smaller, immediate lump-sum payment, or an amount that you can pay each month for a set amount of time. “They know on some human level that not very many people can afford a, say, $10,000 bill,” Donovan says. “They want to get paid,” even if the payment is less than what they originally charged, “and you should use that to your advantage.” If you feel your bill was improper—if, for example, you were led to believe that a service would be covered by insurance and it wasn’t—you should also mention that to strengthen your case, Gurewitz says. And if you’re really nervous about what to say, AI programs like ChatGPT can help you come up with a script, he notes. Step six: Escalate If negotiating didn’t work, consider ramping up your efforts, Gurewitz says. Advocates at his company have succeeded by sending letters to a health system’s billing department, as well as the organization’s CEO and legal team. If you try that approach yourself, use your letters to “lay out the situation and say, ‘I’m unable to pay this. I feel this payment is inappropriate and excessive. Here’s what I’m able to pay,’” and note that you’re also sending letters to other people within the organization, Gurewitz says. He recommends using certified mail so there’s a trackable paper trail. And in really egregious cases, Gurewitz says, alerting the media can also be effective. Once a journalist starts looking into an astronomical bill, he says, it often disappears.

When Vanessa Walilko was in her late 20s, she got strep throat—and then she got it again and again. Because she’s allergic to strep bacteria, she says her illness turned into scarlet fever several times within a few months. Soon, she started having heart issues. After spending a day in the sun selling jewelry at an art fair, she nearly passed out. A friend rushed her to the emergency room, where a doctor asked if she had a family history of people dropping dead in their 20s. When Walilko said no, the doctor told her to learn to better manage her stress and sent her home. “I don’t know if I can convey how smug and flippant he was,” recalls Walilko, 41, who lives in Evanston, Ill. “It was unreal—I was so glad my friend was there with me, because I was pretty delirious. I had to check with her: ‘Did I catch all that?’” Walilko knew something was wrong—yet says clinicians continued to brush off her symptoms. After doing internet research, she figured out that her boyfriend was likely a strep carrier, which meant he was harboring strep bacteria in his throat while remaining asymptomatic. Seven different doctors dismissed her theory, she says, before one finally agreed to test Walilko’s boyfriend—who was positive for strep. Read More: What to Do If Your Doctor Doesn’t Take Your Symptoms Seriously Branded Content XPRIZE at the 2025 TIME100 Summit: Making the Impossible, Possible By XPRIZE That unlocked the key to her physical recovery, though the emotional scars lingered. “We should be able to put our faith in doctors,” she says. “If something is cut-and-dried, like a broken bone, a heart attack, or cancer, doctors are like, ‘Great. We have a plan.’ But if it’s something that requires nuance and thinking outside their training, they kind of freak out and dismiss it.” Walilko’s experience isn’t unique: Researchers, clinicians, and patients alike have found that doctors routinely dismiss real medical symptoms that have nothing to do with mental health as anxiety. Across the internet, people have shared viral stories about medical gaslighting, describing the ways that doctors chalked up their symptoms of appendicitis, heart conditions, or even cancer to anxiety. Why do doctors assume it’s anxiety? There are a variety of reasons why this is a common occurrence, says Dr. Robert Gee, assistant dean of student affairs and a behavioral sciences professor at Ross University School of Medicine. Anxiety symptoms overlap with those of other medical issues, which makes it easy for both patients and clinicians to mistake a physical condition for one related to mental health, he points out. And if a patient has a history of anxiety, their provider will typically be even quicker to assume that physical symptoms are a recurrence, rather than a sign of something new. Other research has found that clinicians’ lack of knowledge is partly to blame. Limited time with patients also plays a role. “This is a huge factor for physicians,” Gee says. Some might lean toward an anxiety diagnosis because it seems like the simplest explanation, especially when symptoms are vague—like “I’m so tired all the time”—and when diagnostic tests don’t provide a clear explanation. “It’s complicated,” he says. “Some illnesses begin with mild symptoms that look a lot like anxiety before clearer signs appear.” Read More: When Should I Go to the Doctor With Cold Symptoms? The consequences of a misdiagnosis can be significant. “Patients may suffer longer, without proper treatment, which can make their health worse,” Gee says. “Ironically, being told it’s ‘just anxiety’ can make them even more anxious, since they have to worry that their concerns aren’t being taken seriously.” This loss of trust can dissuade people from seeking further care, he adds. We asked experts which symptoms are most likely to be misdiagnosed as anxiety. Digestive problems Anxiety can cause your stomach to lurch up and down, making you nauseous and leading to cramping, bloating, or diarrhea. But so can food-borne illnesses, gastroesophageal reflux disease (GERD), gallbladder problems, irritable bowel syndrome, peptic ulcers, and any number of other gastrointestinal issues. An endoscopy, stool test, or ultrasound can help pinpoint an accurate diagnosis. So can asking the right questions, says Dr. Monika Roots, a psychiatrist who’s co-founder and president of Bend Health, which provides pediatric mental-health care. Roots often sees kids who have been referred by their pediatrician for anxiety—but who are actually experiencing something else, like a stomach issue. She makes it a point to ask: “Do you feel like this all the time, or only when you’re stressed, like if you have a test at school? Are there specific foods you've noticed that change how your stomach feels? Are you super tired all the time? Are you vomiting?” The answers can help reveal whether something else is being overlooked. If she suspects mental health is not the culprit, she collaborates with the patient’s primary care doctor to ensure the child receives more in-depth testing. A racing heart If your heart is pounding rapidly—more than 100 beats per minute—or feels like it’s fluttering, you very well might be experiencing anxiety. When you’re in a state of high arousal and stress, your fight-or-flight response kicks in, leading to an uptick in heart rate. Yet it’s also possible you’re experiencing a cardiac issue, says Dr. Saima Shikari, a women's health cardiologist at the VCU Health Pauley Heart Center. “It could indicate an arrhythmia or an issue with your thyroid," she says. (People with hyperthyroidism often experience a rapid heartbeat.) Many of Shikari’s patients are women with symptoms of heart disease who were initially misdiagnosed with anxiety. “Unfortunately, a lot of women get told that when they're having palpitations, they're having anxiety,” she says. “If you happen to go to the doctor when you're not having your symptoms at that moment, I can understand how people would say, ‘Well, maybe it isn't coming from your heart.’” That's why it's helpful to track your symptoms, especially by using a wearable. You’ll be able to tell your doctor, “‘This is what my Apple Watch showed,’” she adds. Chest pain Anxiety can make your chest feel tight, like your insides are burning or being squeezed. But chest pain could also indicate a heart attack, or it might be caused by acid reflux, a lung condition, or even asthma, Gee says. Clinicians can use EKGs, chest scans, or tests for acid levels to rule out these conditions—while also checking in on stress levels. Read More: How Stress Affects Your Heart Health “This is something I think clinicians in general struggle with: asking the patient’s perspective," Gee says. “What we want is for patients to tell us, in their own words, what they think might be happening with their chest pain: any alleviating factors, any aggravating factors, any antecedents, any consequences from their various activities, and how it’s impacting them at home and at work and their activities." Fatigue or weakness Feeling tired all the time is one of the most common—and vague—symptoms that patients describe. There’s no single test to determine the root cause of fatigue, which is why doctors often blame it on anxiety or depression. “Fatigue is unfortunately a sign of multiple different things,” Shikari says. “You can have fatigue because you have congestive heart failure, and you're not pumping blood as efficiently as you need to. You can have fatigue because you have an arrhythmia, and your heart is in overdrive. You can have fatigue because your thyroid isn’t working the way that it needs to, so you're really tired. You can have fatigue because you have a GI disorder and you're malabsorbing things and are nutritionally deficient.” Read More: What to Do if You Have Sleep Apnea Relentless fatigue could also indicate diabetes, insomnia, or chronic fatigue syndrome, among other conditions. Ideally, an exam will include a thyroid test, blood sugar check, and sleep study to zero in on what’s really driving it. Shortness of breath If you’ve ever had intense anxiety or a panic attack, you understand what it’s like to feel like you're gasping for air. While shortness of breath is a common mental-health symptom, it can also indicate a respiratory condition like asthma, chest infection, or an array of heart problems, among other potential concerns. “Shortness of breath is what we call an anginal equivalent,” Shikari says. “Some people don’t have chest pain—they have shortness of breath, and that's a sign of having a heart attack. Shortness of breath can also come along with heart failure or an arrhythmia.” That’s why it’s so crucial for doctors to run thorough tests, she says. Migraines or severe headaches Headaches can certainly be stress-related; how many times have you had to pop a Tylenol after a rough day at work? But they “can also signal vascular issues,” says Dr. Sam Setareh, a staff cardiologist at Cedars-Sinai Medical Center and senior clinical researcher at the National Heart Institute. For example, a headache could point to a transient ischemic attack or a condition like epilepsy, multiple sclerosis, or fibromyalgia. Head pain is also associated with sinus problems, vision issues, and high blood pressure—which is why it’s important for doctors to take a detailed history and order tests like an MRI or CT scan, Setareh says. If you suffer from frequent headaches, tracking details like when they start, how long they last, and how severe they get can help your doctor pinpoint the cause. Dizziness or lightheadedness In the throes of anxiety, you might feel like the world is spinning. But vertigo can also point to inner-ear issues, low blood sugar, anemia, or a sudden drop in blood pressure. “There could be a neurological basis or some kind of nerve issue or a syndrome like epilepsy," Gee says. Read More: Long Dismissed, Chronic Lyme Disease Is Finally Getting Its Moment Plus, dizziness is associated with conditions that are traditionally difficult to diagnose, like multiple sclerosis. Ideally, doctors should test your ear function, check your blood pressure, and look into your blood sugar and iron levels, Gee adds. Sweating, flushing, or feeling hot Anxiety can trigger sweating and flushing, especially during panic attacks. But conditions like an overactive thyroid, menopause, or early onset of a serious infection can, too, Gee says. Blood work, including a thyroid test and hormone test, can help doctors figure out the best course of action. So can active listening. “Communication skills are absolutely critical in this,” he says. Gee recommends doctors ask open-ended questions and make it clear that they’re hearing what patients say while remaining nonjudgmental. That can encourage people to share not only the details of their current illness, but also their social history, family history, and past medical history, he says—all of which can be illuminating. “I’m a seasoned clinician, and I myself have to catch myself in making a quick judgment about, ‘Oh, I've seen this before,’” he says. “You have to keep an open mind.”

With respiratory-disease season in full swing and a bird flu outbreak rapidly evolving, the new Trump Administration has ordered federal health agencies to secure White House approval before communicating with the public. “As the new Administration considers its plan for managing the federal policy and public communications processes, it is important that the President’s appointees and designees have the opportunity to review and approve any regulations, guidance documents, and other public documents and communications (including social media),” through Feb. 1, reads a Jan. 21 memo sent by Department of Health and Human Services officials and reviewed by TIME. The Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH) are all housed within HHS. These agencies regularly publish reports, research, and guidance that shape public response to both chronic and acute health threats, ranging from tobacco to infectious and food-borne disease. “CDC is the health warning system of the United States,” says Katelyn Jetelina, an epidemiologist who has been a communications adviser to the CDC but was not speaking on behalf of the agency. Any policy that slows that warning system, she says, could make CDC’s job “incredibly chaotic.” Branded Content XPRIZE at the 2025 TIME100 Summit: Making the Impossible, Possible By XPRIZE Behind the scenes, staff at federal health agencies are scrambling to understand what the directive means for their work, says a person with firsthand knowledge of the discussions, who asked not to be identified due to the political sensitivity of the situation. “They’re gaining clarity in real time,” they say. The directive does not constitute a full freeze on public communication, suggests the Jan. 21 memo, but rather requires pre-publication review of documents, press releases, website updates, social media posts, and other public communications. Such a policy is not totally unprecedented. In 2017, the first Trump Administration issued a similar communications pause for agencies including the Environmental Protection Agency, the Department of Agriculture, and the Department of the Interior. And both the Trump and Biden White Houses vetted communications related to COVID-19 at various points in the pandemic. Mitch Zeller, who was director of the FDA’s Center for Tobacco Products from 2013 to 2022, says it is “not unusual” for an incoming administration to issue a temporary pause on publications. “They want to get up to speed on stuff that would otherwise be coming out before they’ve all even gotten their IDs laminated,” Zeller says. It is less standard—and more concerning—for the White House to request review of scientific documents, he says. During his tenure with the FDA, White House communications staff were “almost never involved” in agency announcements unless it was an “extremely high-profile, once-in-a-decade kind of announcement,” Zeller says. HHS has its own “challenging” system for getting materials approved, Zeller says. Adding an extra layer of review, he says, could create a “bottleneck” in agencies’ communications, which are potentially time-sensitive. Already, the policy has reportedly delayed CDC reports on bird flu, according to the Washington Post. (The memo reviewed by TIME notes that agency personnel can notify HHS executives if they believe a document or communication should be exempt from the policy for reasons including “affect[ing] critical health, safety, environmental, financial, or national security functions of the Department.”) Further, “I don’t trust the incoming administration on issues like this,” says Zeller, who worked at the FDA during the first Trump Administration. “They have come in with an anti-regulatory, anti-science agenda.” Robert F. Kennedy Jr., the vaccine skeptic who Trump has tapped to lead HHS, has repeatedly said he will spearhead dramatic changes within federal health agencies if he is confirmed. (Kennedy's confirmation hearing is unlikely to happen before February, Bloomberg reports.) These changes potentially include clearing out “entire departments” at the FDA, limiting the CDC’s ability to create and disseminate vaccination guidance, and redirecting NIH research funding to topics related to preventive, alternative, and holistic health. A day before the communications memo was circulated, Trump also signed an executive order withdrawing the U.S. from the World Health Organization, a move that experts say makes the U.S. more susceptible to public-health threats. The White House office that handles pandemic preparedness is also expected to dramatically shrink under the Trump Administration. Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law, views the communications directive, however short-lived, as another “assault on American health.” “The White House has no expertise in science and health and medicine,” Gostin says. “Why would I want to know what they think more than I would want to know what a top public-health scientist thinks?” HHS representatives did not respond to TIME’s requests for comment before press time. However, according to the memo, “The President’s appointees intend to review documents and communications expeditiously and return to a more regular process as soon as possible.”