This time last year, we were eager to see how blockbuster obesity drugs would actually perform, and if they had staying power. We’ve gotten some answers. However, our crystal ball failed to predict the arrival of Robert F. Kennedy Jr. and his “Make America Healthy Again” entourage, which materialized seemingly overnight in the summer.
We knew the drugs were changing society, but we didn’t know that Kennedy would hand a megaphone to critics of the drugs and the pharma industry, or that he’d become a conduit for a vast array of health concerns. Average people are talking about disease prevention, looking to modify their diets and lifestyle habits to ward off the leading causes of death and disability. (Primary care physicians rejoice!) That, along with the widespread health care dissatisfaction that became glaringly evident, has made chronic disease a top issue as we enter 2025.
What comes next? Here are three things we’re keeping an eye out for next year:
Is primary care at an inflection point?
Yes, primary care has returned to the spotlight, but not in a good way, unless “good” means things can only get better from here. Right now in the United States, if patients are lucky enough to have a primary care provider, they may have long waits for visits and fall behind on screenings and immunizations. Covid certainly interrupted care, but a hoped-for rebound in preventive visits and screening has not occurred. That lack of recommended care can have an impact on chronic illnesses, including the longtime leading cause of deaths in Americans: cardiovascular disease.
Robert Califf, a cardiologist and outgoing commissioner of the Food and Drug Administration, blamed the crisis in primary care for dragging back progress in the nation’s cardiovascular health. “I think the biggest single remediable issue for us is that we don’t have a primary care system in the U.S. that’s functional,” he said.
Valentín Fuster, a cardiologist and president of Mount Sinai Fuster Heart Hospital, warned: “We have a problem,” he said. “Pay attention to health and prevention — that is the challenge of the next century.”
One sign that things might change: Physicians in general are organizing themselves into unions at a more rapid pace than 20 years ago, a JAMA study published Monday found, citing declining morale and increasing corporate employment. A more pointed example may be efforts by primary care physicians at Mass General Brigham to unionize in their “fight against burnout” and “the corporatization of medicine.”
One solution could be better integrating advanced practice providers — a term that includes nurse practitioners and physician assistants — into primary care. That could shorten the primary care physician’s workday from a current estimate of 26.7 hours.
We can look to Portugal, as STAT’s Usha Lee McFarling and Crystal Milner did in their special report on how the less wealthy country outdoes the U.S. in longevity and other measures of health, thanks to its abiding commitment to primary care for its people.
“Primary care is the foundation of our health care system,” Barbra Rabson, president and CEO of Massachusetts Health Quality Partners, told STAT. “It’s the front door. It’s the place where you go for prevention and managing chronic diseases.”
Will RFK Jr. put his stamp on the national dietary guidelines?
Critics of the Dietary Guidelines for Americans have been around for decades, but rarely if ever has a chief critic of American nutrition patterns had the final say on the matter. That’ll change next year if Kennedy is confirmed as secretary of Health and Human Services, the agency overseeing the guidelines process this time around. Experts have been meeting for two years to assess the evidence on how food affects health, and they issued a scientific report with plant-forward guidance earlier this month. They notably failed to reach a hard line on ultra-processed foods — public enemy No. 1 in many health circles.
Two other panels (both scrutinized) are investigating the links between alcohol and health. One report, released Tuesday, concluded moderate drinking was linked to a lower risk of all-cause mortality and cardiovascular disease death than not drinking at all — going against other recent studies and public health policy. The other panel is to be released by mid-January.
Next year, all of the reports will be woven into guidelines that will stand until 2030. We’ll be interested to see how heavy-handed an editor Kennedy is, and whether the drinking guidelines change in response to mounting evidence of alcohol’s harms.
What will be Enemy No. 1 for the Trump commission on chronic disease?
Before “Make America Healthy Again” burst onto the national stage, President-elect Donald Trump made a vow in campaign materials: He’d start a presidential commission to investigate the root causes of childhood chronic illness. That promise has taken on more dimension now, as Kennedy — a longtime critic of childhood vaccinations — has become Trump’s top public health adviser. Kennedy has in the past blamed a variety of factors, including environmental toxins, food, and vaccines, for the high rates of chronic disease in children.
Many experts agree that children’s health has worsened, and food and environment probably have something to do with it. However, the undermining of vaccines troubles many clinicians and researchers who see inoculation as a highly effective tool for preventing infectious disease deaths. If Trump follows through on his promise, we’ll be watching whom he decides to appoint to this commission and what scientific questions they decide to pursue. That’ll elucidate where “Make America Healthy Again” is truly headed — and how much Kennedy’s views on vaccines will dominate public health policy in coming years.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.