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Of all the diseases that the U.S. government announced today that it will no longer recommend vaccines against, rotavirus is by no means the deadliest. Not all children develop substantial symptoms; most of those who do experience a few days of fever, vomiting, and diarrhea, and then get better. In the early 1970s, when no rotavirus vaccines were available and most children could expect to be sickened with the virus at least once by the end of toddlerhood, Paul Offit considered it to be no big deal, relatively speaking. In this country especially, rotavirus “was an illness from which children recovered,” he told me.

That perception shifted abruptly during Offit’s pediatric residency training, when he saw hundreds of severe rotavirus cases admitted to the Children’s Hospital of Pittsburgh each year. Although plenty of children weathered the infection largely without bad symptoms, others vomited so profusely that they struggled to keep down the fluids they desperately needed. Offit can still recall the nine-month-old he treated in the late 1970s who was hospitalized after her mother had struggled to feed her sufficient fluids at home. The infant was so severely dehydrated that Offit and his colleagues couldn’t find a vein in which to insert an IV; as a last resort, they attempted to drill a needle into her bone marrow to hydrate her. “We failed,” Offit told me. “And then I was the one who had to go out to the waiting room to tell this mom of a little girl who had been previously healthy two days earlier that her child had died.”

Within a few years, Offit had partnered with several other scientists and begun to develop a rotavirus vaccine. Their oral immunization, called RotaTeq and delivered as a series of sugar-sweet drops to infants, would ultimately be licensed in 2006. Today, it remains one of the two main rotavirus vaccines available to American children. Offit is now a pediatrician at Children’s Hospital of Philadelphia, where, he told me, “most residents have never seen an inpatient with rotavirus-induced dehydration”—thanks in large part to the country’s deployment of rotavirus vaccines, which reaches about 70 percent of U.S. children each year.

Now, though, the United States’ rotavirus shield stands to fracture. Today, the Trump administration overhauled the nation’s childhood vaccination schedule, shrinking from 17 to 11 the number of diseases it broadly recommends that all American kids should be immunized against. “After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent,” Health Secretary Robert F. Kennedy said in a statement today. Among the vaccines clipped—including immunizations against hepatitis A, meningitis, and influenza—is the rotavirus vaccine, which the administration frames as more of a personal choice, allowable under consultation with a health-care provider but not essential, because the virus poses “almost no risk of either mortality or chronic morbidity.” Experts suspect that vaccination rates will plummet in response. If they do, rates of diarrheal disease are likely to quickly roar back, Virginia Pitzer, an infectious-disease epidemiologist at Yale, told me. (The administration’s nod to international consensus is tenuous at best; rotavirus also remains the leading cause of diarrheal death among young children worldwide.)

In an email, Andrew Nixon, HHS’s deputy assistant secretary for media relations, defended today’s decision as “based on a rigorous review of evidence and gold standard science, not claims from individuals with a financial stake in maintaining universal recommendations.” (Offit, who is a co-patent holder on RotaTeq, did profit from his invention but sold his interest in the vaccine more than 15 years ago and does not currently receive royalties from its sale.)

I called Offit to discuss the federal backtracking on the vaccine he once helped bring to market, and what the loss of protection will mean for future generations. Our conversation has been edited for length and clarity.

Katherine J. Wu: Rotavirus was once a disease that hospitalized up to 70,000 children each year. Since the arrival of the vaccine you co-invented, as well as another two years later, those rates have plummeted. What was it like to see a vaccine you helped develop have that sort of impact?

Paul Offit: I remember a meeting at Merck [the company that manufactured the vaccine] when they revealed the results of our big Phase 3 trial. [The presenter] showed the data, that it clearly was safe, in 70,000 children. And it was like 95 percent effective at preventing severe illness. She showed a map of the world, with Asia, Africa, Latin America studded with black dots, and each black dot represented 1,000 deaths. She said, “Now we have in hand the technology to prevent this.” Then she showed a picture of a map of the world where all those black dots were gone. And she put her head down, shoulders going up and down, and wept.

The vaccine was taken up relatively quickly, I think in large part because it was an oral vaccine and that is perceived as less difficult than a child getting a shot. To go from 1980 to 2006, and to start to see the incidence of the disease decline, it was just an amazing feeling.

Wu: What will it mean for this vaccine to no longer be recommended by the federal government?

Offit: My wife’s in private practice in pediatrics, and there certainly were many parents who she saw who were hesitant about getting vaccines. And I think it’s more convincing when you can say, “Look, this is a recommended vaccine. This is something that the CDC, the major public-health agency in this country, believes is important for your child to receive.” You can’t really say that now. And if you get rotavirus in early childhood, you have a chance of being one of those 70,000 children [who were hospitalized] before there was a vaccine.

Some diseases, you need to build up a susceptible population, like measles, which we eliminated from this country. That’s not true for viruses like rotavirus, flu, RSV. The virus is always circulating. So if you choose not to get a vaccine, you are at risk, because you may come in contact with that virus. So if there’s a fairly rapid erosion in vaccine rates, I think you would immediately see children suffering a preventable illness.

Wu: In a decision memo addressed to the acting director of the CDC, top officials at the Department of Health and Human Services downplayed the virus’s threat to American children and suggested that the decrease in rotavirus deaths that followed the approval of RotaTeq and another vaccine called Rotarix may instead have been attributable to factors “unrelated to the vaccine, including improved medical care, changes in diagnostic practices, or random fluctuations.” I’m curious what you make of that justification. Were there other reasons rotavirus might have been among the six vaccines targeted?

Offit: A phrase like almost no mortality—really? So the 20 to 60 children who died every year of rotavirus in this country, that’s okay? One child dying is too many, especially if you can safely prevent it. So I don’t agree with that.

Sure, right now the morbidity is low because of the vaccine, and certainly the mortality is largely gone because of the vaccine. We are once again exposing children unnecessarily to harm. There’s no advantage to this. There were 70,000 hospitalizations a year, which was not trivial, and virtually eliminating them was one of the major successes for vaccines in this country. And I don’t understand why you would ever back off that success.

I also just never imagined we would ever get to a time when the CDC, the nation’s No. 1 public-health agency, and the ACIP, which was a group of outside expert advisers who went through the science and made best recommendations, would get to the point where it was basically not a scientific organization anymore. It’s an organization run by an anti-vaccine activist who was a science denialist and conspiracy theorist. I mean, that’s where we are now. We don’t have the CDC anymore. We don’t have an ACIP anymore. I certainly never imagined that. [Editor’s note: Kennedy has an established history of anti-vaccine activism and of embracing conspiracy theories. Nixon, the HHS spokesperson, did not offer further comment on this criticism.]

Wu: This actually isn’t the first time that a rotavirus vaccine has lost a government endorsement. The U.S.’s first rotavirus vaccine, RotaShield, was taken off the market in 1999 after officials detected a rare intestinal-blockage complication. How does the current situation compare? Was there a safety reason to make current rotavirus vaccines less accessible to the public?

Offit: I was actually on the ACIP when that happened. [Editor’s note: Offit was no longer on the ACIP when his own vaccine was voted on.] The [rare side effect was] quickly picked up, and the vaccine was off the market within a little over a year. We care about vaccine safety. It depends on which paper you read, but anywhere from one in 10,000 to one in 30,000 children developed [the blockage]. You were still at greater risk of being hospitalized and dying from rotavirus, but the decision was made to take it off the market.

Wu: What do you think will be the future of the rotavirus vaccine you helped develop and bring to market, and watched help reshape the portrait of diarrheal disease in this country?

Offit: The American Academy of Pediatrics will certainly still recommend it. But younger pediatricians may be less compelled to offer this vaccine, because they didn’t experience this disease when they were in training. But I think what they hopefully realize is that this virus continues to circulate. It’s still out there. And the lower immunization rates, even a little, will cause children to suffer unnecessarily.

Nearly a year ago, Health Secretary Robert F. Kennedy Jr. pledged during his confirmation hearing to support the CDC’s childhood-vaccine schedule. Yesterday, he broke that promise. The Department of Health and Human Services has announced that the CDC will drop several vaccines from its recommendation list. With that move, Kennedy has shown that he can change the vaccine schedule by fiat.

Kennedy appears to have a clear road if he wants to do more. The acting CDC director, Jim O’Neill, who signed off on the plan, took over the position when the previous director was fired after defying Kennedy. The new recommendations were written by two Kennedy allies at HHS; the agency’s vaccine advisory board, which Kennedy remade in his own image last year, appears to have been cut out of the process entirely. Following this map, Kennedy could dispense with any recommendation he dislikes, issue whatever advice strikes him and those he’s hired as wise, and thereby remake public-health policy in the United States in accordance with the anti-vaccine arguments he’s been advancing for 20 years.

The move didn’t come as a surprise. Kennedy spent much of 2025 undermining confidence in vaccines and sidelining public-health officials who disagreed with him. The overhaul of the pediatric schedule followed a request last month by President Donald Trump to bring the United States in line with a set of other developed countries and had been hinted at for weeks, as well. The vaccines no longer universally recommended for children include those for hepatitis A, rotavirus, and the flu. Although these diseases can be serious—the CDC estimates that, before the vaccine, rotavirus killed dozens of children each year and sent hundreds of thousands to the hospital—they don’t represent the same level of threat as polio or measles, each of which killed thousands of children in the 1950s and each of which, at least for now, remain on the vaccine schedule. An HHS spokesperson, Andrew Nixon, told me that the new list “maintains strong protection against diseases that cause serious harm or provide clear community benefit, while aligning U.S. guidance with international norms.” Whatever the pros and cons of any particular vaccine, this move is still the strongest evidence yet that the health secretary intends to unilaterally impose his will on an agency he has repeatedly assailed as corrupt.

[Read: Rotavirus could come roaring back—very soon]

Public-health experts are generally aghast at the new policy. Although Mehmet Oz, the chief of Medicare and Medicaid, said yesterday that insurers will still cover the vaccines that are no longer recommended, the onus will now be on doctors and professional associations such as the American Academy of Pediatrics to make the case for the demoted immunizations to parents. Daniel Jernigan, the former director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, told me that revoking the recommendations for some immunizations “sends a message that those vaccines are of uncertain value.” That could prove dangerous: Vaccination rates have already fallen in many states in recent years, and Jernigan fears that the schedule change might lead parents to forgo certain shots, or perhaps not immunize their children at all.

Nixon said that the new schedule “returns decision-making to families,” and Kennedy has said that it is intended to rebuild trust in public health. (In a survey last fall, just over half of Americans said they considered the vaccine schedule safe.) But it seems guaranteed to contribute to greater confusion. In the short term, if the schedule change leads to fewer vaccinations, children in America will suffer through more diarrhea from rotavirus, nausea from hepatitis A, and fevers from the flu. In the long term, it could lead to an increased burden on American hospitals.

The schedule overhaul was hailed as a “victory for American children” by the Informed Consent Action Network, which has paid millions of dollars to attorneys challenging vaccine mandates. Del Bigtree, who was the communications director for Kennedy’s presidential campaign and is the CEO of ICAN, told me that the change is “setting our children on the same path to health that Denmark enjoys,” because the new recommendations mostly mirror that country’s. (The comparison is fraught: Denmark is far smaller and less diverse than the United States, and it has universal health care.)

Yet Bigtree and other Kennedy allies see the announcement as merely a first step toward eliminating all of the government’s vaccine recommendations. Aaron Siri, a lawyer who has sued states over vaccine mandates and has been a close adviser to Kennedy, told me that he is especially keen on removing the polio vaccine from the recommended list, along with DTaP, which protects against diphtheria, tetanus, and whooping cough. Bigtree wants an end to vaccine mandates, which he sees as a violation of the Nuremberg Code, he said. (The CDC’s recommendations are not mandates but are frequently used to justify states’ school-admission requirements.) Mark Gorton—who is best known as the creator of the file-sharing service LimeWire and has since become an anti-vaccine activist and a co-president of the MAHA Institute, a pro-Kennedy think tank—told me he would like to go much further. He favors pulling all vaccines from the market until they’ve undergone additional testing. (Decades of evidence have shown that the vaccines on the U.S. pediatric schedule are safe.) “Politically, we’re not there yet,” he told me. But if Gorton has anything to do with it, that’s where the U.S. is heading. (Nixon declined to comment on whether Kennedy and HHS are actively considering any of these moves.)

If more American parents opt out of the inoculations that the federal government no longer recommends, harm will inevitably come to pass. The high fevers, hospitalizations, and dehydration that these illnesses cause can be painful and disruptive—and, with vaccines, avoidable. This year’s brutal flu season is a reminder of just how devastating even routine infections can be. But the illnesses that the U.S. is now officially less concerned about preventing are not usually deadly or permanently debilitating. The World Health Organization does not recommend universal vaccination against any of them, with the exception of Hepatitis B. (As of last month, the U.S. recommends that vaccine only to children who are born to a mother who is positive for the virus or whose status is unknown.)

[Read: The vaccine guardrails are gone]

The same cannot be said of the immunizations the CDC still does recommend. If they were to be taken off the market or if more parents were to opt out of them, Americans could see diseases that most of us have never encountered—such as polio and diphtheria—return with a vengeance. The nation is getting a taste of that already with the resurgence of measles, which killed three people last year, and whooping cough, which claimed the lives of more than a dozen. Without the protection that widespread vaccination provides, the United States could become a nation that’s not only far sicker but also much less safe for children.

Since he was confirmed as Health and Human Services secretary early last year, Robert F. Kennedy Jr. has previewed big changes to the Dietary Guidelines for Americans—the government’s go-to guide on what to eat, and how much of it. Rewritten only every five years, the dietary guidelines are ubiquitous in American life: The food pyramid, launched in the 1990s, is a result of the document. The guidelines determine what millions of kids eat in school cafeterias every day.

Chief among those supposedly forthcoming changes that Kennedy has promised is a dramatic rethinking of how the United States deals with saturated fat. For decades, the dietary guidelines have recommended that people get no more than 10 percent of their daily calories from these fats because they increase bad cholesterol. But Kennedy is a saturated-fat evangelist. The HHS secretary, who has said that he follows a “carnivore diet,” once famously prepared a Thanksgiving turkey by submerging the raw bird in a vat of beef tallow.

Surprisingly, the new guidelines, which were released earlier today, retain the exact same recommendation about saturated fat that Kennedy seems to loathe. During a press briefing, he declared that the guidelines “end the war on saturated fat.” The guidelines do plug beef tallow as a “healthy fat” and say that Americans should get some of their protein from red meat. (The previous version says that a healthy diet includes “relatively lower consumption of red and processed meats.”) But all of that is hardly a dramatic change in how Americans should approach saturated food.

What happened? Despite all of Kennedy’s bluster, the revisions appear to be built much more around incremental change than around any all-out war on established health wisdom. Kennedy and his staff appear to understand that an embrace of saturated fat is controversial. “It was our goal for this report to not be ‘activist’—and only make statements that are widely accepted by the latest nutritional research,” Andrew Nixon, a spokesperson for the Department of Health and Human Services, told me in a statement. “No universal nutrition recommendation will be agreed on by everyone in the nutrition research field—nor should it,” he added. Indeed, there is little evidence to back up the adoption of an explicitly pro-fat diet. The American Heart Association, for example, recommends that fewer than 6 percent of daily calories come from saturated fat.

Overall, the new dietary guidelines focus on a much less controversial take-home message than “Make Frying Oil Tallow Again.” The takeaway, as Kennedy put it in a post on X, is “EAT REAL FOOD.” One of the biggest points of emphasis is on the importance of eating more protein—which already is a popular message among Americans. The release of the new guidelines was paired with a new inverted version of the food pyramid that’s meant to stress that a healthy diet consists of a majority of fruits, vegetables, healthy fats, and proteins. Few people follow the dietary guidelines to a T, but those who actually want to keep their saturated-fat intake to a minimum while upping their protein consumption will have to look to leaner options, such as beans and tofu. The carnivore health secretary may have inadvertently encouraged more Americans to embrace the “soy boy” lifestyle.

For the first time, the guidelines explicitly recommend against eating ultra-processed foods, which they refer to as “highly processed foods.” An accompanying scientific report that was released today notes that processed foods have been “consistently associated with increased risk” for a number of conditions, including type 2 diabetes and obesity. And the guidelines also take a particularly strong stance against added sugar. Both the 2020 and 2025 guidelines stress the need to limit added sugar, but the new guidelines add that “no amount of added sugars or non-nutritive sweeteners is recommended or considered part of a healthy or nutritious diet.”

These new suggestions come with some controversy. Ultra-processed foods constitute a broad and amorphous category, as I’ve previously written, and whether recommending that people stay away from all ultra-processed foods is feasible or desirable remains to be seen. But the guidelines are largely being well received by major health and nutrition groups. The American Medical Association said in a statement that the guidelines “offer clear direction patients and physicians can use to improve health.”

[Read: Coke, Twinkies, Skittles, and … whole-grain bread?]

The average American won’t necessarily change what they eat because of these new recommendations, but the guidelines do play a central role in determining what food can be served by a number of programs that provide food to millions of Americans. The lunch menus offered in schools, for example, legally must be “consistent with the goals” of the dietary guidelines. Kennedy has pledged to remove processed food from schools, and these new guidelines could pave the way for this to happen by giving the Trump administration justification for such a ban. That said, doing so would be hard, given the ubiquity of these foods and the limited resources that schools have to make all of their meals from scratch. Any such change would require formal regulation and could take years to finalize, and it’s not actually Kennedy’s call: The rules for school lunches are set by Agriculture Secretary Brooke Rollins.

Regardless of the challenges ahead, the release of the guidelines is a milestone in Kennedy’s tenure as HHS secretary, and it’s indicative of the way that he’s approached food regulation generally. Kennedy came into office pledging radical reform, yet he has seemed content with small steps. Before taking office, for example, he implied that he thought a number of chemical additives in foods should be banned. But so far, he’s settled for companies’ promises that they will voluntarily phase out certain synthetic dyes over the course of several years.

The strategy marks a sharp departure from Kennedy’s willingness to impose his own beliefs on another major priority area: vaccines. On that front, Kennedy initially pledged to be a moderate, although he has been anything but. Just this week, the CDC removed six shots from its list of recommended childhood vaccines—after Kennedy told Congress during his confirmation hearing that he would “support the CDC schedule.” In other words, America’s health policy seems like it’s being led by two health secretaries with very different approaches.

Chief among the burdens weighing upon the weary sports parent—worse than the endless commutes, the exorbitant fees, the obnoxious parents on the other team—is the sense that your every decision has the power to make or break your child’s future. Should your 11-year-old show up to her elementary-school holiday concert, even if it means missing a practice with the elite soccer team to which you’ve pledged 100 percent attendance? What if this turns out to be the fork in the road that consigns her to the athletic scrap heap?

These are heavy decisions—at least they are for me, a soccer dad who happens to have spent years writing about the science of athletic success. Making it to the pros, the conventional wisdom says, is a consequence of talent and hard work. Best-selling books have bickered over the precise ratio—whether, say, 10,000 hours of practice trumps having the so-called sports gene. But the bottom line is that you need a sufficient combination of both. If you’re talented enough and do the work, you’ll make it. If not—well, decisions (and holiday concerts) have consequences.

Rationally, stressing out over missing a single practice is ridiculous. Believing that it matters, though, can be strangely reassuring, because of the suggestion that the future is under your control. Forecasting athletic careers is an imperfect science: Not every top draft pick pans out; not every star was a top draft pick. Unexpected injuries aside, the imprecision of our predictions is usually seen as a measurement problem. If we could only figure out which factors mattered most—how to quantify talent, which types of practice best develop it—we would be able to plot athletic trajectories with confidence.

Unless, of course, this tidy relationship between cause and effect is an illusion. What if the real prerequisite for athletic stardom is that you have to get lucky?

Joseph Baker, a scientist at the University of Toronto’s Sport Insight Lab, thinks that the way talent development is usually framed leaves out this crucial ingredient. Baker is a prominent figure in the academic world of “optimal human development,” who moonlights as a consultant for organizations such as the Texas Rangers. He’s also a longtime skeptic of the usual stories we tell ourselves about athletic talent. The most prominent is that early performance is the best predictor of later performance. In reality,  many cases of early success just mean an athlete was born in the first months of the year, went through puberty at a young age, or had rich and highly enthusiastic parents.

This critique of talent is not entirely new. It’s been almost two decades since Malcolm Gladwell’s Outliers spurred a cohort of hyper-ambitious soon-to-be parents to begin plotting January birth dates (or at least to tell people they were considering it). Over time, the debate about what factors actually matter has devolved into a game of whack-a-mole. If physical development isn’t the best predictor of long-term success, then it must be reaction time, or visual acuity, or hours of deliberate practice. The default assumption is that there must be something that reveals the presence of future athletic greatness.

Baker’s perspective changed, he told me, when he read Success and Luck, a 2016 book by the former Cornell University economics professor Robert H. Frank. Frank describes a hypothetical sports tournament whose outcome depends 49 percent on talent, 49 percent on effort, and 2 percent on luck. In mathematical simulations where as many as 100,000 competitors are randomly assigned values for each of these traits, it turns out that the winner is rarely the person with the highest combination of talent and effort. Instead, it will be someone who ranks relatively highly on those measures and also gets lucky.

This turns out to be something like a law of nature: It has been replicated and extended by others since Frank’s book came out. Among the most influential models is “Talent Versus Luck,” created by the Italian theoretical physicist Andrea Rapisarda and his colleagues, which simulates career trajectories over dozens of years and reaches the same conclusion. This model earned a 2022 Ig Nobel Prize “for explaining, mathematically, why success most often goes not to the most talented people, but instead to the luckiest.”

To Baker, these models suggest that it’s not just hard to reliably predict athletic futures; it’s impossible. He cites examples including a youth-soccer player for Northampton Town who missed a text message from the team’s manager telling him that he’d been dropped from the roster for an upcoming game. He showed up for the bus, went along for the ride, subbed in when another player got injured, impressed the manager, earned a spot for the rest of the season, and went on to play in the Premier League. Luck takes many forms, such as genetics, family resources, and what sports happen to be popular at a given place at a given time. But sometimes, it’s simply random chance: a gust of wind or an errant bounce or a missed text.

It’s easy to see how luck shapes individual moments in sport—how it changes the course of a game, a series, even an entire season. But what’s harder to accept is that luck might also play a role in longer arcs—not just what happens in games but who appears on the court in the first place. The more you reckon with this, the more disorienting it can be, as things start to feel ever more arbitrary and unfair. As Michael Mauboussin, an investor who writes about luck in his 2012 book, The Success Equation, put it to me: “Talking about luck really quickly spills into the philosophical stuff.”

You might think that the growing professionalization of youth sports offers an escape from this randomness—that by driving to this many practices and paying for that many coaches, you’re ensuring the cream will rise to the top. But the opposite is actually true, according to Mauboussin. In The Success Equation, he describes what he calls the “paradox of skill.” Now that every soccer hopeful is exhaustively trained from a young age, an army of relatively homogeneous talent is vying for the same prizes. “Everyone’s so good that luck becomes more important in determining outcomes,” Mauboussin said.

Baker and one of his colleagues at the University of Toronto, Kathryn Johnston, recently published a paper on the role of luck in athletic development in the journal Sports Medicine–Open. I felt a curious sense of relief when I read it. My daughters, who are 9 and 11, both play competitive soccer on teams requiring a level of commitment that I had naively thought went out of style with the fall of the Soviet Union. Seeing the evidence that future athletic success is not entirely predictable felt like a license for parents to loosen up a bit—to choose the holiday concert over the soccer practice without worrying about the long-term ramifications.

Linda Flanagan, the author of the 2022 book Take Back the Game and a frequent critic of today’s youth-sports culture, doesn’t share my optimism. She has no trouble believing that luck is involved with athletic success, but she doesn’t think that acknowledging this fact will change parental behavior. “Hell, they might double down on the investment in time and money, thinking that they need to give their child more chances to get lucky and impress the right coach,” she told me.

But that sort of luck—getting a job on your hundredth interview because the interviewer went to the same high school as you did, say—arguably is more about hustle than it is about serendipity. So is showing up to every soccer practice. Mauboussin’s definition of luck is narrower: It’s the factors you can’t control. No matter how much luck you try to “create” for yourself or your kids, some irreducible randomness might still make or break you.

To Baker, the takeaways from recognizing the role of luck are less about individual parents and more about how sports are organized. His advice to teams and governing bodies: “If there’s any way possible for you to avoid a selection, don’t select.” Keep as many athletes as you can in the system for as long as you can, and don’t allocate all of your resources to a chosen (and presumably lucky) few. When real-world constraints eventually and inevitably do require you to select—when you’re anointing these lucky few as your future stars, and casting out those who perhaps sang in one too many holiday concerts—try to leave the door open for future decisions and revisions. After all, Baker says, no matter how carefully you’ve weighed your predictions, “you’re probably wrong.”

Every few weeks I turn up in a hospital gown at a medical exam room in Massachusetts and describe a set of symptoms that I don’t really have. Students listen to my complaints of stomach pain, a bad cough, severe fatigue, rectal bleeding, shortness of breath, a bum knee, HIV infection, even stab wounds; on one occasion I simply shouted incoherently for several minutes, as if I’d had a stroke. Then the students do their best to help.

I have been given nearly 100 ultrasounds in just the past year, and referred to behavioral counseling dozens of times. I have been consoled for my woes, thanked for my forthrightness, congratulated for my efforts to improve my diet. I have received apologies when they need to lower my gown, press on my abdomen, or touch me with a cold stethoscope. Our encounters, which sometimes run as long as 40 minutes, end with the students giving me their diagnoses; detailing every test, treatment, and drug they want me to have; and then answering all of my questions without ever looking at their watch. Before leaving, they commend me for coming in and promise to check back in on me. It’s a shame I have to feign an illness to get that kind of care.

I learned about fake medical care four years ago when my son, an M.D.-Ph.D. student, mentioned that he was being graded on his skill at treating “standardized patients”: people who are paid to role-play illness. I’m fascinated by the practice of medicine, so I found this notion irresistible. I applied for a job in the standardized-patient program at the University of Massachusetts, and after two full days of training, plus a lot of reading and videos, I was ready to get started.

The practice of faking medical encounters for the sake of education dates back to 1963 at the University of Southern California, but UMass developed one of the first formalized programs in 1982 and has been a model since. Such programs are now, well, standard: According to a count published in a 2023 review of the practice, 187 of the 195 accredited medical schools in the U.S. describe the use of standardized patients on their websites.

Each specific case that an SP might inhabit—and there are hundreds—comes with a minimum of two hours of additional training in person or via Zoom, along with more reading. We’re buried in a blizzard of unique details to memorize about the patients we portray. By the time I’m ready for my fake exam, I can rattle off what vaccinations I’ve had, how long I’ve worked at my job, whether I’ve had my tonsils out, when my mother died, how much weight I’ve gained or lost in recent months, which vitamins I take, how much coffee I drink, how chatty I tend to be, and whether I’ve traveled recently (and might have parasites!).

There’s no script for my encounters, because you never know what the students might ask, say, and do. So I improvise most of my responses, in keeping with the facts I’ve been given. What do I usually eat for breakfast? What do they make at the factory where I work? What sexual acts do my partner and I engage in? My ad-libs are acceptable, according to the grades I get from staff members who occasionally observe the encounters via camera. But many of my colleagues are professional actors, and their performances are superb. We sometimes work in pairs, and more than once I’ve found myself deeply moved—even to the verge of tears—by my partner’s fake suffering.

Of course, we SPs are not the only ones faking it in these sessions; the students are playing along, too. We score them on as many as 50 different elements, including their tone of voice (was it friendly but professional?), their body language (did they lean in to show engagement?), and their facility at palpating our spleens (did they dig in firmly in the right spot?). Most important, we are meant to check that they are learning empathy. Numerous studies have shown that more empathetic care is correlated with better clinical outcomes, perhaps because it makes patients more inclined to share their full medical history, and more likely to stick with whatever treatment has been recommended. In one survey, orthopedic-surgery patients reported that a doctor’s empathy was more central to their satisfaction than the time it took to get an appointment, how long they were stuck in the waiting room, or even what sort of treatment they ended up receiving.

It may not even matter if the doctor’s kindness is sincere, as long as it sounds that way to patients. Dave Hatem, an internist and professor emeritus at UMass who has helped oversee the school’s SP curriculum, told me that even just the act of trying to say empathetic things is valuable for students. “If you get the right words to come out of your mouth, and you do it often enough, then you get to the point where you really mean it,” he said.

Most of the medical students who examine me do seem genuine in their concern. I suspect that if it were up to them, they’d practice medicine this way for the whole of their careers. But however much they might want to provide the superb treatment that I experience as a standardized patient, the health-care system won’t let them.

Elaine Thompson is a recent graduate of Emory University’s medical school, where she learned to provide the same sort of long, thoughtful, whole-person interactions that I get from students. For the past three years, she has been an ear, nose, and throat resident at Johns Hopkins Medicine, one of the best medical centers in the world. Her real-life patient encounters now last for an average of 10 minutes.

“You quickly learn as a resident that the job is to move things along,” Thompson told me. “I’m still curious about my patients as people and want to learn about their families, but if it’s not relevant to their current problem, then asking about it opens a door that will add time to the visit.” So much for chatting to put them at ease, soliciting a full narrative of their symptoms, hearing all their concerns, asking about their job, uncovering anxieties, addressing financial and social challenges, and encouraging their questions. (In an emailed statement, a spokesperson for Johns Hopkins Medicine said that it is committed to delivering “patient-centered training” and “whole person care.”)

[Read: Learning empathy from the dead]

The same is true for Emily Chin, who received her medical degree from UMass in 2023 and is now an ob-gyn resident at UC San Francisco. She told me that she got the message about keeping visits short early on from senior residents, who made a point of tracking the length of her encounters. “I’d just have time to check the cervix, do a quick ultrasound, and then make a decision about admitting or discharging the patient,” she said. Another source of pressure is the knowledge that spending any extra time with a patient means that dozens of other patients will be waiting longer to be seen: “You see the patients piling up in the waiting room, and you see the schedule screen going red.” (UCSF’s vice dean for education, Karen Hauer, did not object to this characterization, but noted that the school advises its residents on how to establish patient rapport when time is short.)

Residents also learn that time is money. Hospitals and practices view a doctor’s interactions with a patient in terms of “revenue value units.” Reimbursement for seeing a patient whose high cholesterol leads to a prescription for a statin might bring $60 into the hospital or clinic. Reimbursement for extra time spent discussing the patient’s fears of side effects and concerns about affording the drug’s co-pay or making dietary changes brings in $0. “That doesn’t exactly encourage providing the most empathetic, patient-centered care,” a UMass Memorial Health resident named Hans Erickson told me.

The residents I spoke with worried that these time pressures were only going to get worse when they finished residency and became full-fledged doctors. In light of those constraints, does it still make sense to emphasize highly empathetic care for students? I asked that question of Melissa Fischer, the physician who directs the SP program and other simulation training at UMass. Fischer argues that the lessons we impart to students can survive the crush of residency, even if they have to be applied in abbreviated ways. “That interest in building connections to patients stays,” she said. “They just have to find faster ways to build them.”

[Read: How to teach doctors empathy]

Lisa Howley, an educational psychologist who serves as the senior director for transforming medical education at the Association of American Medical Colleges, told me that training up a generation of more empathetic medical students will make the health-care system better. “We think of young medical learners as agents of potential change,” she told me. “They’ll see the gaps and weaknesses, and they’ll look for ways to make improvements.” Besides, what would be the benefit of forcing medical students to learn about patient encounters in the hectic, abbreviated format they’ll confront as residents? “It doesn’t make sense to apply those pressures early in their education,” she said. After all, we don’t teach student pilots how to fly a plane while trying to make up for time lost to flight delays or dealing with unruly passengers.

All of the residents I spoke with said they look for ways to connect with patients despite the harsh realities of the system. “The desire to get to know the patient as a whole person doesn’t go away; it’s just a matter of finding ways to bring it to the surface as a stressed resident,” Erickson said. Chin put it this way: “It’s not that it’s challenging to keep up empathy, it’s that it’s hard to be empathetic all the time.”

At the end of my fake encounters, I try to be encouraging. I tell the students how I, as a patient, felt treated by them, and then I challenge them to give ideas for how they might improve. Sometimes, when one of them has done a bang-up job of making me feel heard, I tell them that I hope they’ll be able to sustain that level of engagement when they’re a practicing doctor—and I always get the sense that the students hope so too.

Along with champagne and fireworks, nothing is more quintessential to New Year’s than abandoning one’s best efforts at self-improvement. Surveys have found that fewer than 10 percent of Americans who make resolutions stick to them for a year. By the end of February 2024, according to a survey conducted by the Harris Poll, about half of respondents who set resolutions had already given up on them. (I’m impressed they lasted that long. My latest resolution was to stop wasting time scrolling, and minutes later I was online, researching what people typically do to spend less time online.)

Clearly, the way Americans have been approaching this whole resolution business—that is, tackling our challenges head-on—simply does not work. If you want 2026 to be different, you have to try something new and bold. So let me offer a counterintuitive piece of advice: To make your New Year’s promise stick this year, consider breaking it before you even get started.

Absurd as it may sound, purposefully working against what you would like to achieve is a well-established intervention in psychology. Paradoxical intent, as it’s known, is commonly used to treat conditions such as insomnia. Imagine that you’re having trouble drifting off at night and lie in bed for hours, desperate for sleep to take hold, which only makes you more anxious and awake. A paradoxical strategy—for example, trying to stay awake—has been shown to be effective at improving sleep, and is a widely used tool in cognitive behavioral therapy for insomnia.

Some studies suggest that paradoxical intent works in clinical settings in part because it decreases performance pressure, especially among patients who are prone to anxiety. Most people are distressed by the condition or habit they’re seeking treatment for, so they fear that addressing it less than perfectly will result in failure and make them miserable. But when you intentionally seek the failure you fear, you learn pretty fast that nothing catastrophic happens (usually). In some therapeutic situations, paradoxical intent might involve elements of exposure therapy or breaking down daunting projects into smaller, easier tasks, both of which might contribute to its power. A therapist might, for example, encourage an anxious patient who’s been putting off studying for a major exam to review for an insufficient amount of time—say, five minutes each day. But perhaps most valuable of all, paradoxical intent has an absurd, even humorous quality that can jolt you out of an anxiety-induced impasse and help you get what you want.

[Read: Anxiety is like exercise]

No randomized clinical trials have studied the effect of paradoxical intent on New Year’s resolutions. But there’s reason to suspect that it might work. Many New Year’s resolutions fail not because people lack motivation, but because fixating on a goal can initiate a self-defeating cycle of avoidance. Let’s say that you’re sick of procrastinating: You’re in trouble with your boss for not getting projects done on time, and your friends are fed up because you always arrive late. If you resolve to never procrastinate again, the chance of failure is high, which could make you anxious and lead you to stop trying—better to simply give up than to risk failure. So instead of making a punishing schedule of activities, or setting endless alarms to keep yourself on track, at some point this month, try to take as long as you can, working in the least efficient way possible, to complete a low-stakes task such as organizing your closet. Want to save money? Buy one small item you know you’ll immediately regret! Want to spend more time with your friends or get outdoors? Schedule a day to rot alone on your couch with TikTok! The specific prescription matters less than your commitment to temporarily, but wholeheartedly, working against your best interest.

Last year, I tried this theory out on a patient of mine, who had long been out of shape and finally resolved to get fit. He quickly hired a trainer and hauled himself off to the gym, but at the first session, he was overwhelmed by the trainer’s ambitious plan. Discouraged, he quit and did not exercise again for several weeks. So I suggested that he go to the gym and just loll about—if he really wanted, he could try doing just five minutes of low-exertion activity, but nothing strenuous was allowed. My patient laughed at me and pointed out that doing something strenuous is the whole point of exercise. But it did the trick: He returned to the gym and eventually contacted his trainer again.

Paradoxical intent may be a poor fit for other resolutions. If, say, you have a drinking problem and want to stop or cut back on your alcohol consumption, drinking all you want in January would be harmful and ineffective. That’s because problematic drinking is a complex behavior that is driven by powerful neurobiological factors, not primarily by the kind of performance pressure and anxiety that stops people from lifting weights or arriving at dinner on time. Similarly, if you have an eating disorder, deliberately bingeing or restricting would not be for you. But if, like many people, you don’t have such a problem and simply want to cut back on junk food, giving yourself permission to indulge—at least once!—might ease your path to self-control in the long run.

[Read: Quit your bucket list]

In this age of endless self-improvement, perhaps Americans have lost sight of the true purpose of New Year’s: to prepare for a dark, cold season by celebrating with loved ones. Paradoxical intent allows you to embody that hedonistic spirit—in the service of getting a little bit better. Besides, if your New Year’s resolution is statistically doomed to fail, you might as well bungle it on purpose.

Of all the diseases that the U.S. government announced today that it will no longer recommend vaccines against, rotavirus is by no means the deadliest. Not all children develop substantial symptoms; most of those who do experience a few days of fever, vomiting, and diarrhea, and then get better. In the early 1970s, when no rotavirus vaccines were available and most children could expect to be sickened with the virus at least once by the end of toddlerhood, Paul Offit considered it to be no big deal, relatively speaking. In this country especially, rotavirus “was an illness from which children recovered,” he told me.

That perception shifted abruptly during Offit’s pediatric residency training, when he saw hundreds of severe rotavirus cases admitted to the Children’s Hospital of Pittsburgh each year. Although plenty of children weathered the infection largely without bad symptoms, others vomited so profusely that they struggled to keep down the fluids they desperately needed. Offit can still recall the nine-month-old he treated in the late 1970s who was hospitalized after her mother had struggled to feed her sufficient fluids at home. The infant was so severely dehydrated that Offit and his colleagues couldn’t find a vein in which to insert an IV; as a last resort, they attempted to drill a needle into her bone marrow to hydrate her. “We failed,” Offit told me. “And then I was the one who had to go out to the waiting room to tell this mom of a little girl who had been previously healthy two days earlier that her child had died.”

Within a few years, Offit had partnered with several other scientists and begun to develop a rotavirus vaccine. Their oral immunization, called RotaTeq and delivered as a series of sugar-sweet drops to infants, would ultimately be licensed in 2006. Today, it remains one of the two main rotavirus vaccines available to American children. Offit is now a pediatrician at Children’s Hospital of Philadelphia, where, he told me, “most residents have never seen an inpatient with rotavirus-induced dehydration”—thanks in large part to the country’s deployment of rotavirus vaccines, which reaches about 70 percent of U.S. children each year.

Now, though, the United States’ rotavirus shield stands to fracture. Today, the Trump administration overhauled the nation’s childhood vaccination schedule, shrinking from 17 to 11 the number of diseases it broadly recommends that all American kids should be immunized against. “After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent,” Health Secretary Robert F. Kennedy said in a statement today. Among the vaccines clipped—including immunizations against hepatitis A, meningitis, and influenza—is the rotavirus vaccine, which the administration frames as more of a personal choice, allowable under consultation with a health-care provider but not essential, because the virus poses “almost no risk of either mortality or chronic morbidity.” Experts suspect that vaccination rates will plummet in response. If they do, rates of diarrheal disease are likely to quickly roar back, Virginia Pitzer, an infectious-disease epidemiologist at Yale, told me. (The administration’s nod to international consensus is tenuous at best; rotavirus also remains the leading cause of diarrheal death among young children worldwide.)

In an email, Andrew Nixon, HHS’s deputy assistant secretary for media relations, defended today’s decision as “based on a rigorous review of evidence and gold standard science, not claims from individuals with a financial stake in maintaining universal recommendations.” (Offit, who is a co-patent holder on RotaTeq, did profit from his invention but sold his interest in the vaccine more than 15 years ago and does not currently receive royalties from its sale.)

I called Offit to discuss the federal backtracking on the vaccine he once helped bring to market, and what the loss of protection will mean for future generations. Our conversation has been edited for length and clarity.

Katherine J. Wu: Rotavirus was once a disease that hospitalized up to 70,000 children each year. Since the arrival of the vaccine you co-invented, as well as another two years later, those rates have plummeted. What was it like to see a vaccine you helped develop have that sort of impact?

Paul Offit: I remember a meeting at Merck [the company that manufactured the vaccine] when they revealed the results of our big Phase 3 trial. [The presenter] showed the data, that it clearly was safe, in 70,000 children. And it was like 95 percent effective at preventing severe illness. She showed a map of the world, with Asia, Africa, Latin America studded with black dots, and each black dot represented 1,000 deaths. She said, “Now we have in hand the technology to prevent this.” Then she showed a picture of a map of the world where all those black dots were gone. And she put her head down, shoulders going up and down, and wept.

The vaccine was taken up relatively quickly, I think in large part because it was an oral vaccine and that is perceived as less difficult than a child getting a shot. To go from 1980 to 2006, and to start to see the incidence of the disease decline, it was just an amazing feeling.

Wu: What will it mean for this vaccine to no longer be recommended by the federal government?

Offit: My wife’s in private practice in pediatrics, and there certainly were many parents who she saw who were hesitant about getting vaccines. And I think it’s more convincing when you can say, “Look, this is a recommended vaccine. This is something that the CDC, the major public-health agency in this country, believes is important for your child to receive.” You can’t really say that now. And if you get rotavirus in early childhood, you have a chance of being one of those 70,000 children [who were hospitalized] before there was a vaccine.

Some diseases, you need to build up a susceptible population, like measles, which we eliminated from this country. That’s not true for viruses like rotavirus, flu, RSV. The virus is always circulating. So if you choose not to get a vaccine, you are at risk, because you may come in contact with that virus. So if there’s a fairly rapid erosion in vaccine rates, I think you would immediately see children suffering a preventable illness.

Wu: In a decision memo addressed to the acting director of the CDC, top officials at the Department of Health and Human Services downplayed the virus’s threat to American children and suggested that the decrease in rotavirus deaths that followed the approval of RotaTeq and another vaccine called Rotarix may instead have been attributable to factors “unrelated to the vaccine, including improved medical care, changes in diagnostic practices, or random fluctuations.” I’m curious what you make of that justification. Were there other reasons rotavirus might have been among the six vaccines targeted?

Offit: A phrase like almost no mortality—really? So the 20 to 60 children who died every year of rotavirus in this country, that’s okay? One child dying is too many, especially if you can safely prevent it. So I don’t agree with that.

Sure, right now the morbidity is low because of the vaccine, and certainly the mortality is largely gone because of the vaccine. We are once again exposing children unnecessarily to harm. There’s no advantage to this. There were 70,000 hospitalizations a year, which was not trivial, and virtually eliminating them was one of the major successes for vaccines in this country. And I don’t understand why you would ever back off that success.

I also just never imagined we would ever get to a time when the CDC, the nation’s No. 1 public-health agency, and the ACIP, which was a group of outside expert advisers who went through the science and made best recommendations, would get to the point where it was basically not a scientific organization anymore. It’s an organization run by an anti-vaccine activist who was a science denialist and conspiracy theorist. I mean, that’s where we are now. We don’t have the CDC anymore. We don’t have an ACIP anymore. I certainly never imagined that. [Editor’s note: Kennedy has an established history of anti-vaccine activism and of embracing conspiracy theories. Nixon, the HHS spokesperson, did not offer further comment on this criticism.]

Wu: This actually isn’t the first time that a rotavirus vaccine has lost a government endorsement. The U.S.’s first rotavirus vaccine, RotaShield, was taken off the market in 1999 after officials detected a rare intestinal-blockage complication. How does the current situation compare? Was there a safety reason to make current rotavirus vaccines less accessible to the public?

Offit: I was actually on the ACIP when that happened. [Editor’s note: Offit was no longer on the ACIP when his own vaccine was voted on.] The [rare side effect was] quickly picked up, and the vaccine was off the market within a little over a year. We care about vaccine safety. It depends on which paper you read, but anywhere from one in 10,000 to one in 30,000 children developed [the blockage]. You were still at greater risk of being hospitalized and dying from rotavirus, but the decision was made to take it off the market.

Wu: What do you think will be the future of the rotavirus vaccine you helped develop and bring to market, and watched help reshape the portrait of diarrheal disease in this country?

Offit: The American Academy of Pediatrics will certainly still recommend it. But younger pediatricians may be less compelled to offer this vaccine, because they didn’t experience this disease when they were in training. But I think what they hopefully realize is that this virus continues to circulate. It’s still out there. And the lower immunization rates, even a little, will cause children to suffer unnecessarily.

Nearly a year ago, Health Secretary Robert F. Kennedy Jr. pledged during his confirmation hearing to support the CDC’s childhood-vaccine schedule. Yesterday, he broke that promise. The Department of Health and Human Services has announced that the CDC will drop several vaccines from its recommendation list. With that move, Kennedy has shown that he can change the vaccine schedule by fiat.

Kennedy appears to have a clear road if he wants to do more. The acting CDC director, Jim O’Neill, who signed off on the plan, took over the position when the previous director was fired after defying Kennedy. The new recommendations were written by two Kennedy allies at HHS; the agency’s vaccine advisory board, which Kennedy remade in his own image last year, appears to have been cut out of the process entirely. Following this map, Kennedy could dispense with any recommendation he dislikes, issue whatever advice strikes him and those he’s hired as wise, and thereby remake public-health policy in the United States in accordance with the anti-vaccine arguments he’s been advancing for 20 years.

The move didn’t come as a surprise. Kennedy spent much of 2025 undermining confidence in vaccines and sidelining public-health officials who disagreed with him. The overhaul of the pediatric schedule followed a request last month by President Donald Trump to bring the United States in line with a set of other developed countries and had been hinted at for weeks, as well. The vaccines no longer universally recommended for children include those for hepatitis A, rotavirus, and the flu. Although these diseases can be serious—the CDC estimates that, before the vaccine, rotavirus killed dozens of children each year and sent hundreds of thousands to the hospital—they don’t represent the same level of threat as polio or measles, each of which killed thousands of children in the 1950s and each of which, at least for now, remain on the vaccine schedule. An HHS spokesperson, Andrew Nixon, told me that the new list “maintains strong protection against diseases that cause serious harm or provide clear community benefit, while aligning U.S. guidance with international norms.” Whatever the pros and cons of any particular vaccine, this move is still the strongest evidence yet that the health secretary intends to unilaterally impose his will on an agency he has repeatedly assailed as corrupt.

[Read: Rotavirus could come roaring back—very soon]

Public-health experts are generally aghast at the new policy. Although Mehmet Oz, the chief of Medicare and Medicaid, said yesterday that insurers will still cover the vaccines that are no longer recommended, the onus will now be on doctors and professional associations such as the American Academy of Pediatrics to make the case for the demoted immunizations to parents. Daniel Jernigan, the former director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, told me that revoking the recommendations for some immunizations “sends a message that those vaccines are of uncertain value.” That could prove dangerous: Vaccination rates have already fallen in many states in recent years, and Jernigan fears that the schedule change might lead parents to forgo certain shots, or perhaps not immunize their children at all.

Nixon said that the new schedule “returns decision-making to families,” and Kennedy has said that it is intended to rebuild trust in public health. (In a survey last fall, just over half of Americans said they considered the vaccine schedule safe.) But it seems guaranteed to contribute to greater confusion. In the short term, if the schedule change leads to fewer vaccinations, children in America will suffer through more diarrhea from rotavirus, nausea from hepatitis A, and fevers from the flu. In the long term, it could lead to an increased burden on American hospitals.

The schedule overhaul was hailed as a “victory for American children” by the Informed Consent Action Network, which has paid millions of dollars to attorneys challenging vaccine mandates. Del Bigtree, who was the communications director for Kennedy’s presidential campaign and is the CEO of ICAN, told me that the change is “setting our children on the same path to health that Denmark enjoys,” because the new recommendations mostly mirror that country’s. (The comparison is fraught: Denmark is far smaller and less diverse than the United States, and it has universal health care.)

Yet Bigtree and other Kennedy allies see the announcement as merely a first step toward eliminating all of the government’s vaccine recommendations. Aaron Siri, a lawyer who has sued states over vaccine mandates and has been a close adviser to Kennedy, told me that he is especially keen on removing the polio vaccine from the recommended list, along with DTaP, which protects against diphtheria, tetanus, and whooping cough. Bigtree wants an end to vaccine mandates, which he sees as a violation of the Nuremberg Code, he said. (The CDC’s recommendations are not mandates but are frequently used to justify states’ school-admission requirements.) Mark Gorton—who is best known as the creator of the file-sharing service LimeWire and has since become an anti-vaccine activist and a co-president of the MAHA Institute, a pro-Kennedy think tank—told me he would like to go much further. He favors pulling all vaccines from the market until they’ve undergone additional testing. (Decades of evidence have shown that the vaccines on the U.S. pediatric schedule are safe.) “Politically, we’re not there yet,” he told me. But if Gorton has anything to do with it, that’s where the U.S. is heading. (Nixon declined to comment on whether Kennedy and HHS are actively considering any of these moves.)

If more American parents opt out of the inoculations that the federal government no longer recommends, harm will inevitably come to pass. The high fevers, hospitalizations, and dehydration that these illnesses cause can be painful and disruptive—and, with vaccines, avoidable. This year’s brutal flu season is a reminder of just how devastating even routine infections can be. But the illnesses that the U.S. is now officially less concerned about preventing are not usually deadly or permanently debilitating. The World Health Organization does not recommend universal vaccination against any of them, with the exception of Hepatitis B. (As of last month, the U.S. recommends that vaccine only to children who are born to a mother who is positive for the virus or whose status is unknown.)

[Read: The vaccine guardrails are gone]

The same cannot be said of the immunizations the CDC still does recommend. If they were to be taken off the market or if more parents were to opt out of them, Americans could see diseases that most of us have never encountered—such as polio and diphtheria—return with a vengeance. The nation is getting a taste of that already with the resurgence of measles, which killed three people last year, and whooping cough, which claimed the lives of more than a dozen. Without the protection that widespread vaccination provides, the United States could become a nation that’s not only far sicker but also much less safe for children.

Since he was confirmed as Health and Human Services secretary early last year, Robert F. Kennedy Jr. has previewed big changes to the Dietary Guidelines for Americans—the government’s go-to guide on what to eat, and how much of it. Rewritten only every five years, the dietary guidelines are ubiquitous in American life: The food pyramid, launched in the 1990s, is a result of the document. The guidelines determine what millions of kids eat in school cafeterias every day.

Chief among those supposedly forthcoming changes that Kennedy has promised is a dramatic rethinking of how the United States deals with saturated fat. For decades, the dietary guidelines have recommended that people get no more than 10 percent of their daily calories from these fats because they increase bad cholesterol. But Kennedy is a saturated-fat evangelist. The HHS secretary, who has said that he follows a “carnivore diet,” once famously prepared a Thanksgiving turkey by submerging the raw bird in a vat of beef tallow.

Surprisingly, the new guidelines, which were released earlier today, retain the exact same recommendation about saturated fat that Kennedy seems to loathe. During a press briefing, he declared that the guidelines “end the war on saturated fat.” The guidelines do plug beef tallow as a “healthy fat” and say that Americans should get some of their protein from red meat. (The previous version says that a healthy diet includes “relatively lower consumption of red and processed meats.”) But all of that is hardly a dramatic change in how Americans should approach saturated food.

What happened? Despite all of Kennedy’s bluster, the revisions appear to be built much more around incremental change than around any all-out war on established health wisdom. Kennedy and his staff appear to understand that an embrace of saturated fat is controversial. “It was our goal for this report to not be ‘activist’—and only make statements that are widely accepted by the latest nutritional research,” Andrew Nixon, a spokesperson for the Department of Health and Human Services, told me in a statement. “No universal nutrition recommendation will be agreed on by everyone in the nutrition research field—nor should it,” he added. Indeed, there is little evidence to back up the adoption of an explicitly pro-fat diet. The American Heart Association, for example, recommends that fewer than 6 percent of daily calories come from saturated fat.

Overall, the new dietary guidelines focus on a much less controversial take-home message than “Make Frying Oil Tallow Again.” The takeaway, as Kennedy put it in a post on X, is “EAT REAL FOOD.” One of the biggest points of emphasis is on the importance of eating more protein—which already is a popular message among Americans. The release of the new guidelines was paired with a new inverted version of the food pyramid that’s meant to stress that a healthy diet consists of a majority of fruits, vegetables, healthy fats, and proteins. Few people follow the dietary guidelines to a T, but those who actually want to keep their saturated-fat intake to a minimum while upping their protein consumption will have to look to leaner options, such as beans and tofu. The carnivore health secretary may have inadvertently encouraged more Americans to embrace the “soy boy” lifestyle.

For the first time, the guidelines explicitly recommend against eating ultra-processed foods, which they refer to as “highly processed foods.” An accompanying scientific report that was released today notes that processed foods have been “consistently associated with increased risk” for a number of conditions, including type 2 diabetes and obesity. And the guidelines also take a particularly strong stance against added sugar. Both the 2020 and 2025 guidelines stress the need to limit added sugar, but the new guidelines add that “no amount of added sugars or non-nutritive sweeteners is recommended or considered part of a healthy or nutritious diet.”

These new suggestions come with some controversy. Ultra-processed foods constitute a broad and amorphous category, as I’ve previously written, and whether recommending that people stay away from all ultra-processed foods is feasible or desirable remains to be seen. But the guidelines are largely being well received by major health and nutrition groups. The American Medical Association said in a statement that the guidelines “offer clear direction patients and physicians can use to improve health.”

[Read: Coke, Twinkies, Skittles, and … whole-grain bread?]

The average American won’t necessarily change what they eat because of these new recommendations, but the guidelines do play a central role in determining what food can be served by a number of programs that provide food to millions of Americans. The lunch menus offered in schools, for example, legally must be “consistent with the goals” of the dietary guidelines. Kennedy has pledged to remove processed food from schools, and these new guidelines could pave the way for this to happen by giving the Trump administration justification for such a ban. That said, doing so would be hard, given the ubiquity of these foods and the limited resources that schools have to make all of their meals from scratch. Any such change would require formal regulation and could take years to finalize, and it’s not actually Kennedy’s call: The rules for school lunches are set by Agriculture Secretary Brooke Rollins.

Regardless of the challenges ahead, the release of the guidelines is a milestone in Kennedy’s tenure as HHS secretary, and it’s indicative of the way that he’s approached food regulation generally. Kennedy came into office pledging radical reform, yet he has seemed content with small steps. Before taking office, for example, he implied that he thought a number of chemical additives in foods should be banned. But so far, he’s settled for companies’ promises that they will voluntarily phase out certain synthetic dyes over the course of several years.

The strategy marks a sharp departure from Kennedy’s willingness to impose his own beliefs on another major priority area: vaccines. On that front, Kennedy initially pledged to be a moderate, although he has been anything but. Just this week, the CDC removed six shots from its list of recommended childhood vaccines—after Kennedy told Congress during his confirmation hearing that he would “support the CDC schedule.” In other words, America’s health policy seems like it’s being led by two health secretaries with very different approaches.