The last few weeks have not been great for the “make America healthy again” (MAHA) movement. MAHA, which is now so ubiquitous that I wondered whether I even needed to define its acronym at the outset, is a movement designed to bring antivax fanaticism under the same banner as the quackery-loving “health freedom movement.” It’s an acronym and slogan coined by Robert F. Kennedy Jr. (RFK Jr.), the antivax activist who is now our Secretary of Health and Human Services (HHS), as an obvious homage to President Donald Trump‘s longstanding slogan, “make America great again” (MAGA) after he had abandoned his independent campaign for President, to bend the knee to Donald Trump in return for a promised high-ranking health post in the new administration, should Trump win. Unfortunately, Trump won, and RFK Jr. is now our HHS Secretary, which means that the health and medical bureaucracy of the federal government is now marked by a combination of RFK Jr.’s antivax efforts to eliminate vaccines, the administration’s Lysenkoism 2.0 applied to the National Institutes of Health, and the increasing promotion of dubious treatments favored by wellness grifters, including the nomination of a “functional medicine” quack named Casey Means as Surgeon General, a nomination that is, fortunately, stalled and faltering.
One indication of this last week was an opinion article that I saw on the medical website KevinMD entitled Make America Healthy Again fails true functional medicine, by functional medicine doctor Dr. Shiv K. Goel. It’s an indication that the “integrative medicine” docs who had once been big fans of RFK Jr. and MAHA are getting restless. Had this article appeared on a MAHA-affiliated website, I probably would have taken no notice of it, but it was published a week ago on KevinMD, which started out as a medical blog founded by internist Dr. Kevin Pho in 2004 and became so increasingly popular and well-trafficked that it soon partnered with MedPage Today, frequently publishing co-branded articles on both sites. These days, KevinMD is branded as MedPage Today’s KevinMD and “social media’s leading physician voice” and billed as the “web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.” Given who platformed Dr. Goel and what the message was—that MAHA isn’t quacky enough for a functional medicine doctor—I couldn’t resist, in light of STAT News’ rather clueless recent effort to ask why science-based public health and MAHA can’t get along.
Before I move on to the article itself, I do want to point out that there have also been a lot of other setbacks for MAHA in the last month or so. For instance, The Lancet published a cover article on just what a disaster for public health the last year-plus of RFK Jr. as HHS Secretary has been, and ProPublica reported on how MAHA policies are contributing to a resurgence in potentially deadly vaccine-preventable diseases—and not just measles.
More recently, there have been several news stories about how the MAHA base is becoming disenchanted with RFK Jr. and the Trump administration because the White House, realizing as the midterm elections fast approach that the antivax policies that RFK Jr. had been promoting as HHS Secretary are wildly unpopular, has instructed RFK Jr. to cool it with the antivax and focus on the more popular things about MAHA, such as promoting healthy food and lifestyle interventions to combat chronic diseases. Meanwhile, a federal judge ruled against RFK Jr.’s remaking of the Advisory Committee on Immunization Practices that turned ACIP into an antivax messaging platform. These developments have led to pressure from the antivax and quack wings of MAHA—which, let’s face it, make up the vast majority of MAHA—on RFK Jr. and President Trump to cater to their desires and legal shenanigans by MAHA allies designed to provide cover for RFK Jr. to implement his antivax policies, to the point where Trump recently met with MAHA leaders to try to mollify them. Add to that RFK Jr.’s recent grilling in front of Congress last week in which, in particular, his being raked over the coals over his attacks on vaccines, the cutting of medical social safety net programs, the administration’s attacks on “DEI” with respect to studying disparities in health outcomes, and, most dramatically, a podcast appearance before he was nominated in which he made the racist statement that black children on psychiatric medications should be “reparented,” and it’s been a rough patch. (RFK Jr. lied and claimed that he never said such a thing, demanding to hear the recording. Let’s just say that it didn’t take long for a number of social media influencers to post the audio.)
That’s not even counting the publication of a biography, RFK Jr.: The Fall and Rise by investigative journalist Isabel Vincent, that revealed, among other things, RFK Jr.’s numerous extramarital affairs documented in his diary with ratings and an incident in which during a family trip he stopped the car so that he could cut the genitals off of a raccoon that he had noticed dead on the side of the road to “study them later.”
This brings me back to Dr. Goel’s article criticizing MAHA for failing to “true functional medicine,” and it’s a doozy. What drew me to this article was not just the content of the criticism, either, but also the fact that it was published in a publication as ostensibly as Dr. Pho’s MedPage Today-branded KevinMD, the point being how mainstream medicine has allowed the language of MAHA to be normalized to the point where KevinMD and MedPage Today would publish an article criticizing MAHA for not having failed the quackery known as functional medicine.
The critique begins
Unsurprisingly, Dr. Goel begins with the central trope at the heart of MAHA, that the US is the “sickest” nation on earth, which is, of course, of a piece with RFK Jr.’s false claim in 2019 that the current generation of children is the “sickest generation” in history, a claim that arguably was one of the earliest seeds that sprouted to become the MAHA movement. (Hint: RFK Jr. claimed that the causes of chronic illness were vaccines, “environmental exposures,” pesticides, and diet. Sound familiar?) Dr. Goel echoes this claim in the introduction to his post:
I grew up in a family of nine in New Delhi, where scarcity was our daily companion. We had no processed food, no artificial dyes, no glyphosate-laced cereal aisles stretching into infinity. We ate whole foods, not by philosophy, but by necessity. We moved our bodies, not by gym membership, but because life demanded it. We slept when the sun went down and woke when it rose. Circadian rhythm was not a wellness trend. It was simply life.
Then I came to America. I became a physician. And I watched, in examination room after examination room, as a country drowning in abundance became paradoxically the sickest developed nation on earth.
See what I mean? Dr. Goel, like RFK Jr. and other MAHA stans, invokes fallacies of a “lost golden age” and a more “natural time” in which everyone ate “healthy food” and exercised, and chronic disease was nowhere to be found (or at least so uncommon as to be mostly negligible). Never mind that many of these chronic diseases, such as heart disease and type II diabetes, tend to be diseases of aging, and, as life expectancy increased and people lived longer, more people are living to be old enough to be at a much higher risk of these diseases.
I’ll ignore that trope for the moment, because it’s interesting to point out how Dr. Goel then likens MAHA to functional medicine:
So when Robert F. Kennedy Jr. stood up and said America’s chronic disease epidemic was a crisis, when he pointed at ultra-processed food, at broken food systems, at a health care model that treats symptoms instead of causes, I felt something I had not expected: recognition. He was describing, in political language, what functional medicine physicians have been saying in clinical language for decades.
But recognition is not endorsement. And the story of Make America Healthy Again (MAHA) is, ultimately, a story of a real diagnosis attached to the wrong prescription.
See what I mean? Dr. Goel loved MAHA because it spewed the same tropes beloved of quacks for decades and decades, namely that science-based medicine only treats “symptoms” instead of the “root cause” of illness and disease and that that most chronic disease is caused by “contamination” (as I like to put it). It’s not for nothing that I like to refer to alternative medicine and MAHA as a cult of purity, in which disease is due to “purity” being somehow “contaminated” by the fruits of science, technology, and, yes, modernity. Worse, as we learned during the pandemic, this “contamination” seems to be contagious, in which the “contaminated” (in this case by COVID-19 vaccines) can spread their evil humors to others and thereby make them sick too. Let’s just say that there’s a reason why so much alternative medicine (including functional medicine) involves “detoxification” and “purification” of those evil humors.
None of this is to say that environmental exposures do not impact health negatively. No one would deny that pollutants and other exposures can’t contribute to ill health. It’s just that MAHA takes it further, in essence denying the genetic predisposition to disease while it also denies germ theory. The latter, of course, is perhaps the sole exception to MAHA’s emphasis on environmental exposures as a cause of disease. After all, an infectious disease is nothing if not the result of an environmental exposure to a pathogenic microorganism. No one ever said that consistency was a major emphasis of MAHA.
Now that we have the groundwork laid, Dr. Goel decides to lay out what, in his opinion, MAHA gets right. Unsurprisingly, this includes, of course, the belief that ultraprocessed food is the root of almost all health evil. One thing that I like to note is that Dr. Goel references CDC reports and at least one study but, shockingly, does not include the links to either. For instance, he states:
A landmark Lancet series confirmed what functional medicine practitioners have long observed: Ultra-processed foods are associated with higher risks of heart disease, diabetes, depression, kidney disease, and early death, and their addictive properties rival those of tobacco.
I found the series, of course, because that’s what I do whenever I see a series or study referenced. Of the three papers in the series, it is mainly the first paper in the series that lays out the evidence. (The other two are policy papers.) Far be it from me to claim that ultraprocessed foods are good for our health (or even neutral) or that, overall, they can cause harm. Our fearless leader Dr. Steve Novella has written about this way more than I have, which is why I will refer you to his posts on ultraprocessed foods, which point out that there isn’t even a clear definition of the term and that foods known to contribute to obesity and poor health, namely calorie dense foods “higher in fat, sugar, and salt, and lower in fiber and micronutrients” can contribute to chronic diseases. Indeed, Dr. Novella also discussed the weaknesses in the Lancet series on ultraprocessed foods soon after the three articles were published. While noting that there is some truth to the claim that many processed foods are also calorie dense, as well as high in sugars, fat, and sodium, Dr. Novella argues that the case is more complex than that, stating, ” I don’t think this story is as clear as the Lancet authors claim. There is likely some real signal here in the data, but the details are fuzzy.” I tend to agree. Again, no one is claiming that “ultraprocessed foods” are really good for you. What we contest is the representation of these foods as the be-all and end-all of obesity and chronic disease, as if magically eliminating them would magically eliminate obesity and its associated chronic diseases.
Naturally, Dr. Goel can’t resist, before shifting to his criticisms of MAHA, making some magical claims for his beloved functional medicine:
As a physician who trained in functional medicine precisely because conventional care was failing my patients, I believe in root-cause thinking. I believe in food as medicine. I believe in the circadian rhythms, the gut microbiome, the inflammatory pathways that ultra-processed foods disrupt at the cellular level. On those foundational truths, MAHA and functional medicine share common ground.
Note the outrageously stupid attack on conventional medicine, namely the oft-repeated insinuation that science-based physicians don’t study and address the “root cause” of disease, while “functional medicine” does. After all, what is an antibiotic but an attempt to address the “root cause” of an infectious disease. What is a vaccine other than an intervention designed to interfere with the “root cause” of infectious diseases? Without being too hard on Dr. Goel, I will concede that, unlike MAHA, he appears not to be antivax. Indeed, one of his complaints about MAHA is its antivax stance, and he devotes a entire paragraph to lamenting the resurgence of measles in the US as being due to decreased vaccine uptake, concluding by complaining—quite correctly, I might add—that “MAHA-aligned groups are simultaneously fighting against legislation that would tighten measles, mumps, and rubella (MMR) requirements for school entry” and noting later in the article that “a movement cannot simultaneously claim to protect children’s health while fighting vaccine mandates during a measles outbreak.” I couldn’t have said that part better myself. Bravo! He even notes what he thinks that “real transformation” of the healthcare system looks like
It looks like vaccine coverage that stays above 95 percent, because herd immunity is itself a form of functional medicine, a community-level intervention that protects the most vulnerable members of the biological ecosystem we all share.
Given how antivax I’ve found functional medicine to be over the years, in particular its tendency to embrace 19th century terrain theory over the germ theory of infectious disease, I did rather roll my eyes at this statement, but then I thought better of it and now applaud Dr. Goel for the sentiment. If only most other functional medicine doctors thought the same way about vaccines, even as I note that conventional science-based medicine and public health has long had the view that herd immunity is an intervention that protects the must vulnerable members of society. There’s nothing unique to functional medicine in that.
Dr. Goel also perceives:
As a physician who has seen both the scarcity of New Delhi and the abundance of American illness, I recognize this pattern. It is the pattern of a movement that has captured the language of healing without fully committing to its practice.
Or, as I would put it, MAHA cynically captured the language of healing, the better to allow its supplement grift to proceed.
On the other hand, what did Dr. Goel expect? Was he unaware that RFK Jr. has been a fanatical antivax activist for over two decades? Did he really expect that, when RFK Jr. first introduced the acronym MAHA to the nation in 2024, he would give up his longstanding antivax activism? (Hint: RFK Jr. did not.) Was he honestly fooled by RFK Jr.’s assiduously avoiding any mention of vaccines in the MAHA manifesto that he first published in the editorial pages of the Wall Street Journal? RFK Jr.’s antivax followers were not fooled. They were complaining about the lack of mention of vaccines in RFK Jr.’s MAHA call to action as early as a few weeks after it had been published. They continue to do so. It’s the selective blindness of so many physicians (and not just functional medicine docs) who like what MAHA says about chronic disease, ultraprocessed foods, exercise and lifestyle interventions, and environmental “toxins” and are so desperate to be onboard that they willingly overlook all the antivax quackery that is at the very foundational heart of MAHA.
And now Dr. Goel is upset that RFK Jr. has, as I always predicted he would, sold out the anti-pesticide activists, noting with extreme disapproval how RFK Jr. is totally onboard with President Trump’s February executive order to increase the production of glyphosate-containing herbicides, to promote national defense. He is upset that MAHA has, as he put it, ignored the social determinants of health:
And perhaps most critically: MAHA has nothing to say about the social determinants of health. No mention of food deserts. No mention of the Medicaid cuts that are stripping coverage from 11.8 million Americans, threatening to close more than 400 hospitals. No mention of economic inequality, racial health disparities, or the communities, like the one I grew up in, where structural poverty is the root cause that no seed oil ban can fix.
Correct, but, again, what the heck did Dr. Goel expect? He didn’t really think that RFK Jr.’s MAHA was about actually addressing societal and population determinants of health, did he? After all, as I’ve long pointed out, MAHA is more about soft eugenics (particularly with respect to measles) and placing the entire burden of health on the individual, rather than society. Indeed, MAHA emphasizes the primacy of the individual as the sole arbiter of ensuring individual health, screw public health. Indeed, it goes beyond that into a philosophy that can only be described as health as a result of personal virtue, with its frequent messaging that you—yes, you!—are completely in control of your own health. What flows from that messaging is the idea that if you are healthy, you must be living the “correct”—or virtuous—lifestyle. After all, MAHA was born of an unholy union between the antivax movement, the anti-public health movement that mobilized to oppose nonpharmaceutical interventions against COVID-19 during the pandemic, and the “health freedom” movement that emphasizes the individual right to choose whatever treatment a person wants, regardless of whether it is scientifically demonstrated to be safe and effective or not, at whatever price supplement hawkers can charge.
That’s why, even as I recognized this observation by Dr. Goel as right on the money, I couldn’t help but eye roll again:
The movement that claimed to champion functional health has, in many expressions, devolved into supplement grifting, fear-based marketing, and conspiracy frameworks that erode the very institutional trust needed to reform public health systems. As Newsweek noted, functional health is increasingly at risk of becoming a luxury, costing up to $25,000 annually, accessible only to affluent biohackers while the Americans who need it most are left out.
One suspects, one does, that Dr. Goel is more upset at the prospect of functional medicine becoming unaffordable to all but the wealthy. Again, what did he expect?
A brief interlude: What is functional medicine?
At this point, I think it’s worth revisiting exactly what functional medicine is. I realize that I (and other SBM bloggers) have discussed functional medicine in depth on several occasions, most recently last October, but whenever the topic comes up I always deem it useful at least to discuss briefly what its core tenets are. Even now, I like to reference Wally Sampson’s posts explaining why FM is quackery, especially his characterization of functional medicine principles as an “indecipherable babble and descriptive word salad.“. To describe functional medicine, I like to let the reader see what functional medicine advocates themselves say about it, for instance on this page What Is Functional Medicine? First, here are its main principles:
Functional medicine is personalized medicine that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease. It is a science-based field of health care that is grounded in the following principles:
- Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals.
- Patient-centered medicine emphasizes “patient care” rather than “disease care,” following Sir William Osler’s admonition that “It is more important to know what patient has the disease than to know what disease the patient has.”
- Dynamic balance of internal and external factors.
- Web-like interconnections of physiological factors – an abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without effect on each other. For example, we now know that immunological dysfunctions can promote cardiovascular disease, that dietary imbalances can cause hormonal disturbances, and that environmental exposures can precipitate neurologic syndromes such as Parkinson’s disease.
- Health as a positive vitality – not merely the absence of disease.
- Promotion of organ reserve as the means to enhance health span.
In pretty much every post about functional medicine that I’ve ever written, I feel compelled to remind our readers that the very first principle is, in essence, functional medicine’s “get out of jail free” card for basically anything its practitioners want to do. FM docs can always find reasons, whether science-based or not, to justify any form of treatment, be it science-based or quackery, simply by invoking the “biochemical individuality” of the human being they are treating. I feel compelledto remind my readers yet again of my favorite retort to this claim: Yes, human beings are individuals, and each human being is unique. However, we’re not so unique that our bodies don’t all work pretty similarly. In other words, in terms of biology, physiology, and yes, systems biology, we human beings are far more alike than we are different. If that weren’t the case, modern medicine, developed before we had the tools to probe our genetic, metabolic, and biochemical individuality, wouldn’t work as well as it does.
FM fetishizes “biochemical individuality,” not so much because humans are so incredibly different that each one absolutely has to employ a totally different treatment for a given disease or condition in any given individual. We’re not. Nor am I arguing that the insights scientists have derived from genomics, metabolomics, and proteomics, which have revealed different system-level biochemical and metabolic pathways in physiology, don’t matter. They do. We’re just not as radically “individuals” on a biochemical basis as FM docs try to argue. In essence, FM fetishizes biochemical “individuality” because emphasizing such “individuality” distinguishes functional medicine as a brand distinct from conventional science- and evidence-based medicine and, I suspect, because it makes its practitioners feel good, like “total” doctors who are never at a loss for an explanation for a patient’s symptoms or clinical condition and can always think of more tests to figure out a problem. It also patients feel special and that their every bit of “individuality” is being catered to. As for the last bit about FM being a “science-using” profession, FM “uses” science more as a means of justifying whatever its practitioners do rather than guiding them to scientifically-proven treatments.
I went into a lot more detail about this in previous posts, but FM is also all about finding “imbalances” and then “correcting” them. I’ll illustrate this with a diagram I frequently use, having found it on functional medicine websites:
I can’t help but point out that prescientific medical systems such as humoral medicine and traditional Chinese medicine are also all about “correcting imbalances.” When it comes to functional medicine, many of these “imbalances” might as well be imbalances in humors, as in humoral medicine, or between hot/cold, wet/dry, etc., as in traditional Chinese medicine. In practice, however, functional medicine is the worst of both worlds. With its panels of hundreds of lab tests that it recommends to screen asymptomatic people for abnormalities and, of course to correct them with supplements, functional combines the tendency of conventional medicine towards overtesting and overtreatment with the quackery of alternative medicine, such as the embrace of naturopathy. There’s a reason that I wrote a post with the title, Functional medicine: Reams of useless tests in one hand, a huge invoice in the other. Peruse Dr. Goel’s website, and you will find similar reams of tests ranging from standard to occasionally useful to nearly always useless except in very specific circumstances.
And Dr. Goel is a functional medicine quack, and he lets his freak flag fly high in the KevinMD article:
I practice functional medicine not because it is fashionable, but because it asks the question that medicine too often skips: Why is this patient sick?
Let me just interject here that this quack trope really pisses me off, as it implies that we science-based physicians are not interested in why patients are sick. That must be why physicians spend years and hundreds of thousands of dollars studying biology, biochemistry, genetics, anatomy, physiology, embryology, and pathology and why the NIH spends billions every year funding scientists examining the causes of disease and how to treat disease. Again, “Why are patients sick?” is just a rehashing of a longstanding trope that we physicians just “treat the symptoms” and ignore the “root cause.” No! It’s more that the actual root causes of diseases tend to be the same as what functional medicine doctors preach mainly by coincidence. Basically, functional medicine doctors love to engage in what I like to call biobabble (like Star Trek technobabble, but about human biology instead of physics). Don’t believe me? Check out this next passage:
The answer is almost never one thing. It is a constellation, gut dysbiosis fed by years of ultra-processed food, circadian misalignment from shift work and blue light, cortisol dysregulation from chronic financial stress, hormonal disruption from endocrine-disrupting chemicals, inflammatory cascades triggered by diets that never give the immune system a rest.
Root-cause medicine means looking at all of these threads simultaneously. It means understanding that a child whose gut microbiome has been shaped by 62 percent ultra-processed calorie intake cannot be “fixed” by removing Red Dye No. 40 from Skittles, however symbolically satisfying that might be. It means understanding that vaccine-preventable diseases like measles are not wellness inconveniences, they are killers, disproportionately dangerous to immunocompromised patients, infants too young to be vaccinated, and communities with compromised access to care.
I’ll give Dr. Goel a pass on vaccines, but notice the biobabble. Dr. Goel is writing all this as though it actually meant something, when I reality it’s more like a medical Mad Libs game about the “root cause” of disease, like this:
The circadian medicine principles I work with every day offer a compelling example. America’s chronic disease epidemic is not only about what people eat, it is about when they eat, when they sleep, when they move, and how profoundly the structure of modern life has severed human biology from the natural rhythms it was designed to follow. Temporal biomarkers, cortisol curves, insulin timing, sleep architecture, tell stories that no food label policy can fully address. Healing requires structure, not just substitution.
Yes, medical Mad Libs coupled with a fallacious appeal to nature!
Personally, I couldn’t resist wondering what Dr. Goel does in practice, which led me to his website, Prime Vitality Healthcare. Naturally, it didn’t take me long to find this common narrative about combining the best of East and West, with a twist:
Unsurprisingly, Dr. Goel offers unproven peptide therapy, as well as IV vitamin drips (including NAD+, glutathione, iron, hydration, immunity, and custom cocktails), and “detoxification.” (Of course the website insists that its IV therapy isn’t a “spa drip bar,” but “physician-directed nutrient therapy designed to correct deficiencies, accelerate recovery, boost immune function, and support longevity — all verified by lab work and calibrated to your biology.” Sure thing.) Naturally, again, he offers an artificial intelligence service, Time Vitality AI, that claims to calculate your true biological age and treating time as a “vital sign.” Intrigued, I hit a link called The Science and was lead to this:
Presumably, this is what Dr. Goel views practicing true functional medicine as looking like, given that this is apparently how he practices functional medicine. At least he’s not antivax. That’s about all I can say.
Wait, not quite all. What I can also say is that his concierge integrative/functional medicine practice is pricey:
Why did KevinMD decide to publish this critique of MAHA?
Despite the fact that Dr. Goel is a functional medicine doctor, there was a lot right in this critique, especially its explicitly pro-vaccine retort to MAHA antivax activism. Moreover, Dr. Goel correctly perceived that MAHA is, at its heart, a vessel to enable grift involving supplements and unproven treatments, such as peptides and that MAHA isn’t really about public health, ignoring as it does nearly completely the social determinants of health. Unfortunately, buried in Dr. Goel’s critique of MAHA were some gems that destroyed yet another of my irony meters, in particular his being unhappy about the supplement grift. After all, Dr. Goel sells supplements too—lots of supplements—as well as unproven peptides and IV boosters. It therefore amused me that he would criticize MAHA for promoting these modalities, even as it undercut my ability to take his critique seriously.
What amused me less is that KevinMD would platform such a doctor practicing unproven functional medicine as a credible critic of MAHA. Certainly, Dr. Goel’s critique can never be truly science-based given his embrace of functional medicine nonsense. Indeed, his critique comes across very much as, “I don’t want to be associated with these quacks because I’m not a quack like them,” even though Casey Means, the nominee to be Surgeon-General, does indeed practice the same functional medicine that Dr. Goel does.
Why would KevinMD platform someone like Dr. Goel, who practices “integrative medicine,” which is, as I like to say, the “integration” of woo with science-based medicine, the woo in his case being functional medicine? We at SBM have been long complaining of the “integration” of quackery into medicine and how it’s becoming increasingly normalized in medical academia and medicine in general, and that, unfortunately, also includes MedPage Today and KevinMD.