Department of Health & Human Services (HHS) Secretary Robert F. Kennedy Jr.’s promise to usher in an era of radical transparency has been upended by the Department of Government Efficiency’s (DOGE)  drive to slash jobs across the government – in particular, the personnel who respond to public records requests. Even with Secretary Kennedy’s recent promise to restore such functions, the discussion around making government more transparent in reaction to requests for information is important, but it misses a larger area for Kennedy to reform HHS: making the department more transparent through proactive disclosure.

DOGE has loomed large over the first few months of the Trump Administration, reducing staff and ending contracts across the government. At HHS specifically, the DOGE cuts have slashed around 20,000 employees. With the White House and DOGE driving these actions, Secretary Kennedy has admitted to being unfamiliar with specific cuts even while endorsing the DOGE project. Consequently, National Institutes of Health Director Dr. Jay Bhattacharya and Food & Drug Administration Commissioner Dr. Marty Makary, in individual messages to their agencies, broadly acknowledged the difficult times staff were facing, but they pledged to do the best they could to fulfill their missions.

The DOGE cuts ultimately contradict Kennedy’s radical transparency plank of his Make America Healthy Again (MAHA) agenda. Among the casualties were Freedom of Information Act (FOIA) staff and offices. While Secretary Kennedy has promised to usher in an era of unprecedented transparency and easy information sharing, the cuts accomplished the opposite by destroying the department’s capacity to respond to public information requests.

In his recent press conference about removing petroleum dyes from food, Secretary Kennedy pledged to restore FOIA offices, but he did not elaborate on the specifics. He stated, “the papers that we produce in this agency do not belong to us … they belong to the American people, and we need to be honest with them.” While this somewhat vague and idealistically-phrased answer may depress fears of transparency destruction, it misses a key contributor to opacity in government: lack of proactive disclosure.

Lack of Proactive Disclosure Boosts Big Pharma

Lack of proactive disclosure has significantly benefited corporate actors like the pharmaceutical industry; take the case of clinical trials. Drug companies fund and sponsor the trials proving that their products are safe and effective. The FDA internally evaluates trial results to determine if they are safe and effective enough to approve so that they are available on the market. Yet, drug companies own the data from their trials so that predominantly no actor outside of themselves and the FDA can examine trial results. When companies get their trial results published in peer-reviewed medical journals, the peer reviewers do not get to see the full results, only limited summary information that the drug companies and trial authors select. Thus, even reviewers cannot not truly vet and review trial results.

This lack of transparency grants significant power to the pharmaceutical industry, as they control the information that health professionals like doctors rely upon to make clinical decisions for their patients. The FDA only reviews if a drug is safe and effective enough to get on the market at all, it does not determine if a drug is better than existing treatment. Thus, pharmaceutical companies can distort the benefits and safety profiles of their drugs to make them seem premier when they are not better than competitors. In fact, drug companies do not spend the most advertising on their products with the most added clinical benefit to patients.

Additionally, lack of transparency can cause significant risks to the physical and financial health of people and governments. For example, failure to disclose trial results showing Merck’s drug Vioxx caused severe cardiovascular events led to the estimated deaths of 40,000-60,000 Americans in the early 2000s. Misleading published trial results for Tamiflu – a medication to prevent and treat flu-like illnesses – led to $18 billion of wasted spending by governments globally to stockpile the drug.

Drug companies profit from their products due to government-granted patent monopolies that prevent any competition, allowing for incredibly high prices. The introduction of generic competition often lowers the prices of drugs by 80-85 percent. Thus, poor transparency also allows for patients and employers to pay significantly high prices for products – directly or indirectly through health insurance costs – that may not be the best treatment available.

Secretary Kennedy and FDA Commissioner Makary currently have the power to bring transparency without any action by Congress. Since the FDA maintains records of trial results for the products it approves, the agency legally has the authority to release full trial results – deidentified to protect the privacy of trial participants – upon each approval.

Such proactive disclosure is ideal due to the numerous limits of the FOIA process. Public records requests are inherently reactive, can be costly when many pages are requested (which applies to trial results), and can take a long time for the government to fulfill. Additionally, the FDA has historically and voluntarily sided with industry to block FOIA requests for trial results when it has not had to do so.

Proactive disclosure not only applies to clinical trial results but also to the large swaths of data that the federal government collects. Government databases are essential for researchers and health care professionals to track important public health developments and respond accordingly. Yet, the significant staffing cuts at HHS have called into question the department’s ability to collect data for its numerous databases across agencies like the CDC. For example, staffing cuts to employees that ensure the integrity of the National Electronic Disease Surveillance System Base System – which helps states and localities track diseases – have reportedly threatened the ability for the system to remain operational.

In defense of HHS downsizing, the agency and Secretary Kennedy have insisted that the cuts have focused on removing unnecessary numbers of administrative personnel. However, administrative workers are necessary to maintain public databases; therefore, severe reductions in administration will hamper transparency rather than radically promote it.

Only time will tell to what extent the cuts at HHS will harm data disclosure. However, if Secretary Kennedy wants radical transparency, he must make sure that department downsizing does not compromise such functions. The ultimate form of transparency is not just providing information when someone has undergone the effort to request specific pieces of data, it should include proactively releasing information to the public without the need for any request at all. If “the papers that we produce … belong to the American people,” as Secretary Kennedy states, then it is imperative that a radically transparent HHS do everything in its power to allow their owners immediate access.