This week saw the release of Robert F. Kennedy Jr.’s Make America Healthy Again Commission 73-page report primarily focused on the chronic diseases of children. Like many reports, it has many sound components based on past recommendations by public health and social scientists, but also oversimplifies and overstates other issues.
Co-mingling these subjects can be misleading. It appropriately links many of the causes on America’s focus to ultra-processed foods and additives, but less on the social determinants of health such as poverty and pollution which likely play as great a role, but difficult to attribute blame unless one looks in the mirror. This is especially irksome as this administration is actively undermining efforts to mitigate those causes.
I agree with the criticism of the sedentary lifestyles and short-attention spans children have due to their technology-driven and screen-time habits that contribute to their being physically unfit, inattentive to activities that require prolonged concentration, and non-critical in their thinking. And they are becoming adults now.
I also agree that modern society is overmedicated and not appropriately medicated. But this report goes further, and says that doctors are the wrong ones to figure out our healthcare system’s shortcomings. It intimates that doctors should deviate from evidence-based and expert consensus therapeutic approaches, although we are “well intended.”
Thanks, but why should we spend more than a decade of one’s finite lifespan locked into a white tunnel learning the intricacies of the Dark Arts when one could go into a much shorter financial track to learn how to screw people out of their money with much less effort? That is because of an obvious fact. Most doctors start their arduous education trek actually wanting to help people. They get waylaid along the path by debt, financial commitments, or are piqued by some arcane area or medicine that just interests them or has personal meaning, or just get plain greedy. In other words, just like almost everyone else who wasn’t gifted their future.
In other observations, RFK Jr.’s report implies that doctors are not original thinkers, and labels doctors as subject to groupthink. This suggests that they do not fully understand how the vast majority of doctors actually work. Doctors know the relatively little space in which they work, surrounded by colleagues who settled into similar tracts. Fewer have the big picture since most are focused on what’s best for the patient in front of them, although not necessarily the general population. By the way, that is exactly what you, as a patient, actually want. You want your doctor to take all of that knowledge and experience, and apply it to your circumstance to give you the best probability of an optimal outcome.
If anything, we doctors are marked by our independence. Give 10 doctors the same patient, you likely will get 10 different assessment and management plans. It’s a function of training, clinical experience, cultural orientation, and intelligence in their ability to synthesize disparate data. You hopefully will get general agreement, but the devil is in the details known or noticed.
That’s why there have not been doctors’ unions since few can imagine doctors doing things in unison after voting on it. That’s also why today’s American Medical Association, a professional organization, not a union, has only a minority of member doctors. That is until now, when corporatization of healthcare has driven doctors to consider forming and joining unions, because now they have common enemies, other than insurance companies. Corporatization of healthcare generally has been a disaster for all parties, except the executive ones skimming off the profits in name of enhanced efficiency. Rather like DOGE.
When certain strategies yield better results, that collated and vetted information is shared to our colleagues so that they and their patients may benefit from that new knowledge. Adherence to those evidence based guidelines is not groupthink, it’s standard of care. If some cowboy clinician wants to give a human patient a non-approved veterinary medicine for some condition, that clinician certainly can, but likely shouldn’t. That clinician’s colleagues may look a bit askance at that behavior, which Kennedy characterizes as being ostracized. And RFK Jr. doesn’t want licensing boards to take action against those providers who regularly stray from recommended therapies. He apparently wants to welcome us back to the era of snake oil sales people, instead of the time when our US FDA, warts and all, was the standard for the world for medicine safety.
Trump’s director of the NIH, Jay Bhattacharya, has called much of the medical literature “unreliable.” So he must feel that the gold standards of randomized and blinded clinical trials and peer-review publications are not up to his standards. Maybe, like his boss, if he sees it on TV, it must be true. That must be why Fox News has been the feeder to the golden White House and many current federal agencies.
I have been a physician for over 50 years and have worked with the pharmaceutical industry for 40 years to help develop and validate new medicines for common and less common maladies. And yes, they try like hell to influence us doctors and our prescribing habits; it’s called sales and marketing, a bedrock activity of our capitalist economic model. That’s why there’s a Madison Avenue. And the use of vaccines to prevent or reduce the severity of preventable diseases in the young and vulnerable adults has passed the rigors of scientific scrutiny with known risks and greater benefits. One can decline them, but it is dangerous to withhold them.
It’s simply stupid and inaccurate to say, as this report does, that medicine does not look for root causes of chronic disease. The whole premise of new medicines is to discover new and underlying mechanisms of diseases so that new investigational products with targeted mechanisms of action can be developed and safely deployed in the afflicted population. That’s what basic research is all about. And I wholeheartedly concur that we should focus on non-medicine determinants of health such as diet, exercise and lifestyle choices. That’s what those of us in preventive medicine have been doing for generations.
Yet that’s what Kennedy and Musk have been undermining by cutting funding to NIH, NSF, universities, and other medical research centers. Just because they don’t understand how it’s done doesn’t mean that’s prima facie evidence of fraud and abuse. If these guys just want to get rid of things they don’t understand in government, they’d be getting rid of a lot of departments and people that make our government actually work. Oh, wait …
I expect the inevitable unsigned hate mail from MAGATs who protest my opinions. Indeed, my friends and patients in the District Attorney’s and Sheriff’s Department have quite the collection already from the regulars. It’s just evidence that my comments hit a nerve. RFK Jr. may have a supplement for that.
Irving Kent Loh, M.D., is a preventive cardiologist and the director of the Ventura Heart Institute in Thousand Oaks. Email him at drloh@venturaheart.com.
This article originally appeared on Ventura County Star: Dr. Loh: RFK Jr.’s commission has healthy amount of issues
Reporting by Dr. Irving Kent Loh / Ventura County Star
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