The worst-case scenario for health in the U.S. is much closer to reality this week after President-elect Donald Trump said he had chosen Robert F. Kennedy Jr. to lead the Department of Health and Human Services.

The environmental lawyer, who has courted conspiracies and traded in anti-science, would oversee key health agencies, including the Food and Drug Administration, Centers for Disease Control and Prevention and the National Institutes of Health.

The Senate will have to give Kennedy its approval (unless Trump follows through on a threat to use recess appointments to circumvent that process). But the fact that Kennedy has gotten this far is enough to wreak havoc on public health.