Dear Dr. Marine,
Though there have been countless reports describing the dismal state of STEM under Kennedy and his crew, Drs. Jay Bhattacharya, Tracy Beth Hoeg, Vinay Prasad, Marty Makary, and Martin Kulldorff, I’d like to draw your attention to three recent articles about the total incompetence and dysfunction of MAHA from this month alone.
Kennedy Shows Minimal Engagement with Vast Health Portfolio:
Mr. Kennedy has shown little interest in managing the details of work in his department, according to multiple colleagues… The secretary’s detachment from much of the work of the agency, along with the administration’s deep staff cuts and his attacks on career staff, have driven down morale, they say. It’s a dynamic that could threaten the department’s ability to protect Americans in a crisis, according to public health experts and former secretaries.
Are MAGA and MAHA Heading for Divorce:
Over Kennedy’s 16-month tenure, while the MAGA White House has paid lip service to Kennedy’s agenda, its big-money alliances with tobacco, pesticide, and talc companies have repeatedly undercut MAHA priorities, and have even taken Kennedy and his deputies by surprise. Meanwhile, Kennedy’s weak leadership skills, drifting attention, and the operational naivete of his handpicked staff have led to chaos so detrimental that agency lawyers have repeatedly warned officials that their policy rollouts fail to comply with regulations, or will not survive legal challenges…
As the MAHA-MAGA compact has faltered over many months, Kennedy has reverted to stunts and marginalia: plunging into an ice bath wearing jeans, doing chin-ups in an airport, and even delving into the question of extraterrestrial life with a visiting billionaire at an HHS meeting.
Has the MAHA Movement Given Up?:
At present, there is no confirmed head of the Centers for Disease Control and Prevention or of the Food and Drug Administration. There is no surgeon general and no head of the National Institute for Allergy and Infectious Disease, effectively the government’s lead scientific position for Anthony Fauci’s nearly four decades in the role. There is also no confirmed boss at the F.D.A.’s Center for Biologics Evaluation and Research, which regulates vaccines, and none at its Center for Drugs Evaluation and Research, which oversees drug therapies. Last year, staffing at the Department of Health and Human Services was reduced by 25 percent, leaving huge deficits of personnel and expertise. The agency looks less like an army of acolytes than a barren bureaucracy. This is not an overhaul; it is an evacuation, a disemboweling…
It already seems clear that the resentful health libertarianism that bound the movement together in podcast studios, social media groups and conferences stages has no novel answer for new disease threats, even lesser ones.
You should read these articles in their entirety, and they should be of great interest to you, because as MAHA loomed in the fall of 2024, you wrote an essay on the monetized Substack Sensible Medicine titled Why Doctors Should Learn to Stop Worrying and Love MAHA. While we here at SBM desperately tried to sound the alarm bells about MAHA, you wrote:
I argue that we should embrace the Make America Healthy Again (MAHA) agenda and try to convince our medical leaders to work for major changes in our dysfunctional health agencies and deteriorating health care system.
RFK Jr has tapped into a strong sense among the public that government health agencies, and the health system at large, have been corrupted by corporate interests that have become increasingly misaligned with the public interest, a fact that was exposed by the disastrous authoritarian covid response.
You concluded by saying:
This is the choice that physicians are going to have to make in the coming months: stand with the corporate interests that the public and many doctors increasingly see as harmful to their health and their lives or stand with patients and public for major reform.
The right choice should be clear to everyone.
You followed this up with another Sensible Medicine gem titled The MAHA Report: A Seismic Shift in US Health Policy. Although much of the MAHA Report was AI slop, full of fake citations, you were nonetheless impressed by it, writing:
The MAHA Report represents a seismic shift in US government healthcare policy. It will form the foundation for US health policy for the next four years. Now that the MAHA Commission has published its guiding principles, there are more concrete ideas for physicians to engage with.
The sensible response for physicians will be to embrace its best ideas and reflect on its criticism of our current medical and biomedical research models and practices. We should embrace the opportunity for change.
A lot has happened since then, and you owe it to Sensible Medicine readers to provide a thorough update on how MAHA is doing. You should be brutally honest about the state of STEM today, and you should name the people who are responsible for it. This includes large numbers of people at your own institution who have lost their jobs.
After that, you should argue that you were right about MAHA in 2024. Taking into account current events, you should make the affirmative case that MAHA has been a smashing success, that it succeeded in restoring trust and promoting free speech, and that doctors should “love” it today. That was your previous instruction.
You could be the first person to write such an article. Again, I confess to having asked ChatGPT about this, and here’s what it said:
I searched specifically for articles written by doctors or scientists who are not themselves part of the MAHA movement and who argue that RFK Jr. and MAHA are succeeding and doing a good job promoting science and medicine.
I could not find a meaningful list of such articles. The available evidence points in the opposite direction: most physician/scientist commentary I found was critical of MAHA’s scientific rigor or public-health impact.
Kennedy has boasted of his “wins” at least, warning us about food dyes in ice cream and getting Steak and Shake to change the way they make French fries. Maybe you can convince me that this will dramatically improve Americans’ health. My mind is open, and I have so much to learn from your wisdom and nuance.
However, assuming you can’t honestly acknowledge what’s happening in STEM today and then defend MAHA, you should at least have the humility and integrity to admit you vastly overestimated the abilities of MAHA doctors to deliver in the real world. Their pitiful job performance has implications regarding your belief about the “authoritarian covid response,” which was your main justification for MAHA.
We can agree that beaches and hiking trails should have stayed open, but you predictably portrayed all COVID mitigations as deliberate choices made by malevolent people rather than the inevitable consequences of a deadly new virus repeatedly washing over us for years. I’ve described this previously as the fantasy of the optional pandemic, where everything we hated about COVID, the deaths and mitigations alike, could have been avoided if only sage MAHA doctors had been in charge.
They certainly weren’t humble about their imagined abilities. They claimed they could have delivered this COVID utopia, but pandemic bad guys- YouTube and the NIH- got in their way. I can see why this was attractive, and something you’d want to believe was possible. Their fantasy of the optional pandemic certainly sounds a lot better than the awful actual pandemic. I admit it.
However, the purveyors of the optional pandemic are (or were) MAHA royalty. It’s the exact same doctors. Today, Dr. Bhattacharya can’t fix a few broken windows at the CDC and Dr. Kulldorff can’t run a single meeting of the ACIP. They shouldn’t get any accolades for their entirely imagined COVID glories in years past. Dr. Vinay Prasad is correct that he Tweeted a lot about RCTs, but this is nothing to boast about, and no one should applaud him for it. He failed to deliver RCTs when he had power, and his tenure at the FDA was a soap opera. That’s what matters.
The counterfactual alternative histories, and there are many of them, where MAHA doctors spared us the pandemic, depend entirely on these doctors being individuals of great competence. They were the ones who supposedly “would have” opened schools and protected the vulnerable when COVID raged. In reality, they delivered changes to the Shake Shack menu when given the opportunity to lead.
As such, if you can’t defend these doctors’ real-world performance today, then you can’t plausibly claim they “would have” tackled COVID in 2020. Your fan fiction about them can automatically be thrown in the bin along with all their Great Declarations, editorials, podcasts, and Fox News appearances. It was all just empty words.
The obvious truth is that COVID would have been a worse debacle had Kennedy and his crew been in charge in 2020. Anyone who still pretends otherwise in 2026 is just playing make-believe at this point.
Of course, MAHA doctors already had a real-world track record before assuming office, and just because you ignored the warning signs doesn’t mean they weren’t there. Indeed, Dr. Martin Kulldorff said about himself and Dr. Bhattacharya, “One place where we had some success was Florida“. Here’s what Dr. Kulldorff considered “success”:
- They failed to protect “vulnerable” people: “Florida Leads Nation in Number of COVID-19 Deaths of Nursing Home Residents and Staff,” August 2021.
- They failed to protect “not vulnerable” people: “Child Covid Deaths More Than Doubled in Florida as Kids Returned to the Classroom,” September 2021.
- They failed to keep schools open: “School Closures Reported In Five Florida Counties; Districts ‘Drowning’ In COVID,” August 2021.
- They failed to protect educators: “15 Miami-Dade Public School Staff Members Die of COVID In Just 10 Days,” September 2021.
- They failed to achieve herd immunity: “Florida’s COVID Deaths Reach Nearly 6,000 in 2024,” January 2025.
While we discussed these realities often at SBM, you didn’t care about them at all, and the most recent addition to their list of “success” is Florida Reading Scores Fall to Last in the Nation, Report Says. This is what MAHA doctors accomplished when they had the opportunity to prove their pandemic mettle, and I’m glad I never predicted they would thrive at the CDC, NIH, and FDA.
You could also admit you fundamentally misunderstood what the MAHA movement was all about. Let’s not forget you said, “MAHA is more than RFK and has little to do with vaccines.” I wrote an entire article about that absurd statement in which I made several predictions of my own.
I predicted Kennedy would attack vaccines, and he has, though that was hardly some brilliant insight on my part. After all, Kennedy was showing the propaganda move Vaxxed III: Authorized to Kill at the time, though you didn’t care about that either.
My article concluded with a promise about myself and a prediction about you. I wrote:
If I am wrong, and RFK Jr. leaves vaccines alone for the next 4 year, I will happily admit it. If RFK Jr. relentlessly attacks vaccines, will Dr. Marine admit error? I think we all know the answer.
Indeed, we all knew the answer. You haven’t admitted error yet, and based on my experience with Sensible Medicine doctors and their poor predictions, you never will. Being a Sensible Medicine doctor means never having to take responsibility for your words. You won’t write a coherent, robust defense of MAHA, and you’ll refuse to even acknowledge how things are going in STEM today. As always, with Sensible Medicine, unwanted news is unmentionable news, and I’m the true villain for having the gall to remind you that you told doctors to “love” MAHA.
In contrast, we at SBM, the guys who accurately warned about Kennedy and his ilk, are not afraid to honestly discuss what is happening to STEM with MAHA in power. I do it every week, and you should feel free to ask me to defend any of my prior essays, books, or podcasts. It’s totally fair and appropriate to hold me accountable for things I’ve said.
I’m ready.