Jim O’Neill, President Donald Trump’s nominee for the second-highest position at the Department of Health and Human Services, could usher in policies to encourage anti-aging technologies, shorten approval times for new drugs, and compensate organ donation.

O’Neill, a close business associate of venture capitalist and Trump mega donor Peter Thiel, was initially floated to be Trump’s first-term Food and Drug Administration commissioner in 2017, ultimately being passed over for Scott Gottlieb.

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But O’Neill’s blend of public and private sector experience in health, coupled with a Silicon Valley flair, could complement Health and Human Services Secretary Robert F. Kennedy Jr. and other leaders Trump has selected for the “Make America Healthy Again” agenda of his second term.

O’Neill’s nomination is set to be considered in the Senate Health, Education, Labor, and Pensions Committee on Thursday. Here’s what to know about his background.

Who is Jim O’Neill?

O’Neill graduated from Yale University with a bachelor of arts in humanities in 1990 and a master of arts from the University of Chicago in 1997.

Before working in healthcare, O’Neill briefly worked for former Republican Sen. Kay Bailey Hutchison of Texas before becoming a senior speech writer for the Education Department.

A year later, in 2002, O’Neill began writing speeches for Tommy Thompson, the first HHS secretary under former President George W. Bush.

O’Neill quickly rose in the ranks for six years in the Bush HHS, overseeing policy in a range of areas from pandemic preparedness to FDA reform. By 2007, he was named principal associate deputy secretary of HHS.

But by October 2008, O’Neill made the switch into the private sector, starting out at Thiel’s Mithril Capital Management, funding anti-aging research projects. O’Neill later served as CEO of SENS Research Foundation, focused on medical research to prevent and reverse the aging process.

Longevity research and new treatments

Based on his recent work, O’Neill could be in a position to orient the federal health agencies toward fast-tracking new technologies and products to treat or prevent chronic disease, a central feature of MAHA policy.

In association with Thiel, O’Neill invested or advised investments in more than 60 science and technology companies before joining the board of directors at Advantage Therapeutics in 2023.

Advantage Therapeutics specializes in neurodegenerative conditions, particularly Alzheimer’s disease. The company’s crowning achievement, the compound AD04, is a novel immunotherapy treatment for early Alzheimer’s that is undergoing clinical trials in Europe but has not been cleared for use in the United States. 

In November 2024, Advantage Therapeutics launched a spin-off company, Klothea Bio, to conduct research and development on the protein Klotho, which is tied to anti-aging properties.

The fledgling company’s initial focus has been metabolic disease syndrome, but it could expand to other diseases of interest to the MAHA agenda, including obesity and cancer.

A free-market FDA

O’Neill has also long been a critic of regulation at the FDA and excessive barriers to entry for new products onto the market.

Shortly before he was nominated for deputy secretary, O’Neill posted on X the common libertarian point that the U.S. does not have a free market in healthcare, saying that “hundreds of bureaucratic rules, perverse incentives, and opaque pricing make health care more expensive and less efficient than it should be.”

A new drug in the U.S. takes between 10 and 12 years to come to market. The FDA requires several years of safety and efficacy testing through clinical trials with sometimes thousands of study participants.

When Trump announced his pick for O’Neill in November 2024, comments resurfaced from a speech O’Neill had made at a biotechnology conference in 2014, calling for the FDA to only require limited safety testing for new products and not require as rigorous efficacy testing before putting new products on the market.

O’Neill’s “progressive approval” method would effectively allow consumers to determine whether new drugs work, just as with other products in a free market. Patients would be able to use new products “at their own risk, but not much risk of safety,” O’Neill said in 2014.

Despite sharing the goals of slashing waste in government agencies, O’Neill’s zeal for deregulation of products at the FDA may clash with more conservative voices at HHS who are calling for more intensive clinical trials for products such as COVID-19 booster vaccinations or more oversight of ingredients in food products.

Organs on the market

O’Neill has also faced significant scrutiny for his advocacy of financial compensation for those who donate their organs to patients in need of transplant, another quintessentially libertarian point of view.

At a conference in 2009, O’Neill remarked that there are “plenty of healthy spare kidneys walking around unused,” according to a report from Stat News from 2017 during his consideration for FDA commissioner.

Nearly 116,000 people in the U.S. are currently waiting for organ transplants, according to the Organ Procurement and Transplantation Network from HHS. That includes more than 98,000 waiting for a kidney, 9,000 waiting for a liver, and almost 4,000 for a heart transplant

Sen. Catherine Cortez Masto (D-NV) questioned O’Neill about his philosophy on organ donation Tuesday during his first confirmation hearing before the Senate Finance Committee.

O’Neill replied that he did extensive work on organ donation policy during the Bush administration, highlighting the need for incentives to reduce the massive transplant waitlist, including allowing monetary compensation for the donor.

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“I think it is reasonable to look at improving these policies so that someone who makes the very generous decision to donate a kidney or another organ to have their follow-up medical care, lost work, and so forth compensated by the recipient if the recipient is able,” O’Neill said.

The Senate Health, Education, Labor, and Pensions Committee will also hold a confirmation hearing for O’Neill on Thursday morning.