“Motivating biases need not be considered nefarious, only considered.”
In their foundational essay The Case for Being a Medical Conservative, Drs. Vinay Prasad, Adam Cifu, and John Mandrola wrote eloquently about the need to consider conflicts of interest in medicine. They said:
The medical conservative, therefore, is pragmatic about human nature and the prevailing business model of medical science. To wit, content experts, professional societies, or journal editors who too harshly criticize an industry product jeopardize future funding. Motivating biases need not be considered nefarious, only considered.
I agree and devoted an entire chapter to this topic in my book on cognitive biases in medicine.
These doctors would go on to found Sensible Medicine, a Substack that was not shy about discussing the issues of the day when COVID raged. When politicians and public health leaders tried to stop people from dying of COVID, Sensible Medicine talked about current events constantly, for years on end. They were not neutral reporters, however. They had an agenda. Their goal to spread doubt and rage about the people tasked with containing the virus.
To pick one example amongst many, I previously discussed the bountiful absurdities of an article that excoriated public health officials for not doing an RCT of hospital visiting policies in 2020. I later discussed the deluge of hateful comments this article generated towards those public health officials, which was its true purpose.
When MAHA loomed and in its early days, Sensible Medicine mostly cheered it on, publishing propaganda articles titled Why Doctors Should Learn to Stop Worrying and Love MAHA, The Nomination of Robert F. Kennedy Jr. As Secretary of The Department of Health and Human Services: A New Beginning? and The MAHA Report: A Seismic Shift in US Health Policy. According to that last article, by Dr. Joseph Marine:
In conclusion, 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. We should talk more to patients about prevention and lifestyle modification and examine how we can change our own practices to align with its principles.
The sensible response for medical societies will be to engage with HHS and the health agencies to understand and advance aspects of the agenda where they intersect with their fields and missions.
In reality, the MAHA report was AI slop.
However, perhaps their most noxious article was Dr. Prasad’s abomination Is RFK Jr to Blame for the Samoa Measles Outbreak?. “We have to be honest when it comes to health policy commentary,” said Dr. Prasad as he dishonestly absolved Kennedy of his role in sparking a measles outbreak that killed dozens of children. Kennedy has “some good ideas,” Dr. Prasad concluded.
Sensible Medicine also helped launch the brief, disgraceful tenures of Drs. Marty Makary, Tracy Hoeg, and of course, Dr. Prasad himself at the FDA. In an essay there titled Sensible Medicine Endorses Vinay Prasad for Director of the Center for Biologics Evaluation and Research (CBER) at the US FDA, Drs. Cifu and Mandrola ignored his anti-vaccine disinformation, overt MAHA/MAGA political activism, and vulgar behavior to conclude:
We can’t think of anyone more qualified to lead the biologics division. Prasad’s lifelong commitment to scientific rigor will help rebuild lost trust in regulatory bodies.
“What Anthony Fauci Should Say to the American People”
Things didn’t work out that way. The FDA is approving untested peptides and lettuce is dangerous, though you wouldn’t learn that from reading Sensible Medicine. Instead of humbly reflecting on their own medical reversals, Sensible Medicine has moved on, as if MAHA/MAGA was all a distant dream. Drs. Prasad’s anti-vaccine disinformation and censorship of vaccine research in office never gets discussed, and any mention of his purges or unprofessional behavior at the FDA is strictly prohibited.
Similarly, when Dr. Jay Bhattacharya was nominated for the NIH, Sensible Medicine said he was a:
Courageous, thoughtful, and deeply humane person who would make a great leader of any of our US public health agencies.
Today, Dr. Bhattacharya nods along next to Stephen Miller, Kennedy, and Trump as they spew Wakefieldian lies about vaccines in the middle of a measles outbreak. If this monstrous betrayal of medical ethics bothers the doctors at Sensible Medicine, they’ve kept it entirely to themselves, as they have with everything MAHA/MAGA has done.
While they previously weighed in on current events, they are totally silent about them today. They have zero criticisms of our current medical establishment, and they are all done demanding RCTs from them. Those lofty expectations were exclusively for previous public leaders who who had to audacity to limit COVID.
As MAHA/MAGA ushers in American Lysenkoism, Sensible Medicine is busy publishing articles such as Atrial Fibrillation and Symptoms – A Great Mystery, How I Learned About Incontinence, and What Anthony Fauci Should Say to the American People. Meanwhile their X feed is a toxic cesspool, desperately trying to recapture the glory days of 2020 by sharing revenge fantasies against Fauci from anti-vaccine luminaries and juvenile cranks. Even though Fauci is getting death threats and threats of prosecution, they are perfectly willing to join the pile on and enlarge the target on his back. This is the professionalism and ethical standards they bring to their work.
Sensible Medicine is fundamentally a dispatch from an alternative universe, a time capsule from a gentler era where STEM was imperfect, but working to improve and under no grave external threats. They refuse to even acknowledge anything that is happening under MAHA/MAGA, and they are hardly unique in their see no evil, hear no evil, speak no evil approach. They are just a small subset of previously prolific pandemic pundits who freely expressed their criticisms regarding COVID but have nothing to say about the current events they enabled.
While Dr. John Ioannidis was eager to undermine public health officials on TV in 2020, the only problem he has with MAHA/MAGA is that some of us have the impudence to criticize it. He reserves his sanctimonious scolding exclusively for us at SBM, powerless critics of our current medical establishment. Princeton professors Stephen Macedo and Frances Lee have also slinked away into obscurity after praising MAHA/MAGA doctors. Dr. Stefan Baral, who had many mighty meltdowns because I warned about MAHA/MAGA, has nothing to say about its actions, which include mass layoffs at his own department. There are many more examples of previously vocal commentators who are now suddenly silent, and we don’t need their permission to notice their silence at this moment.
This strategic silence is disturbing but also revealing. It shows how the COVID Amnesia Project, the deliberate attempt to rewrite the history of the pandemic, is seamlessly morphing into the MAHA Amnesia Project, the deliberate attempt to cover up how MAHA/MAGA vandalized and politicized STEM and public health. It’s the same people, doing the same thing.
“Subscription Science: How Crowdfunding Has Become a Conflict of Interest”
There are several potential reasons for this selective mutism. The simplest is that Sensible Medicine doctors haven’t voiced any objections to MAHA/MAGA because they don’t object to it. They see what MAHA/MAGA is doing like everyone else, the political censorship of science and the cancelled clinical trials, and they approve of it. In November 2024, Dr. Prasad had this to say in response to masking young children:
I also said this in my latest YouTube video. I would fire at least ~10000 people (1/4) in the CDC and everyone who touched this decision or didn’t stop it. Anyone working from home should go, as well.
Fast forward to today, and the headlines read The CDC Has Zombie Programs. Congress Funds Them, But Few People Are Left To Do The Work. That article said:
The Centers for Disease Control and Prevention still has an Alzheimer’s disease program. Congress appropriated $41 million to it this year. There’s just no one staffing it.
Then there’s the agency’s Office on Smoking and Health. Congress allocated $246 million for that. Its staffers were cut, too.
Same for the epilepsy program. Its sickle cell disease data collection operation. Its rape prevention unit.
Think of them as the CDC’s zombie programs — they appear to be alive, at least according to legislation and congressional appropriations. But functionally they are dead or nearly dead, because the CDC experts who did the work were laid off by President Donald Trump’s administration or remain on leave — paid but not allowed to do their jobs.
This is exactly what Dr. Prasad wanted, and he has every right to take a victory lap. Why would he or anyone else at Sensible Medicine complain about it?
Sensible Medicine doctors have long been primarily political actors masquerading as neutral scientists who merely want more robust evidence. Don’t take my word for it. Listen to Dr. Makary explain it better than I ever could. “Vinay Prasad loves president Trump,” he said.
If you listen to his podcast for the last four years, you’ll see he’s been ardent supporter of everything President Trump has done and is trying to do.
That’s true, and there’s no reason to think that’s changed. A main goal of Sensible Medicine has been to weaponize EBM to portray liberals as hysterics who overreacted to threats– both COVID and MAHA/MAGA- which turned out to be very real and very dangerous. The real threats in their telling were masks, vaccines, and anyone who pointed out their disinformation. Our work was “unproductive“. We had to watch our “tone“.
Conversely, there may be some reluctance on their part to comment on current events. Were they to honestly acknowledge the state of STEM under MAHA/MAGA, the Hot Dog Guy memes would fly, and they would invariably be accused of complaining about everything they enabled. These obviously wouldn’t be baseless accusations, but rather an acknowledgment of basic reality. Sensible Medicine doctors may feel damned if they do and damned if they don’t, which is an appropriate fate for those who enabled MAHA/MAGA. No one forced them to do that.
Perhaps most importantly, however, Sensible Medicine doctors have “motivating biases” of their own. They have paying customers to please, and this is no small incentive. As Drs. Ben Mazer and Michael Rose wrote in their must-read article Subscription Science: How Crowdfunding Has Become a Conflict of Interest:
Crowdfunding has become another potent but overlooked source of revenue for physicians who want to share their views on medical topics. Crowdfunding refers to payments that are voluntarily contributed by individuals who would like to support an author’s work. Digital platforms such as Patreon, Substack, YouTube, and Twitter allow fans to offer recurring payments to healthcare professionals who produce opinion articles, explanatory videos, and podcasts. Although crowdfunding is often seen as a principled alternative to industry influence, these payments may also create meaningful conflicts of interest.
Physicians do not always agree about which third party payments are unacceptable. Yet two variables typically come into play: the size of the payment and how strongly the payer is associated with a specific scientific viewpoint. Crowdfunding poses a risk in both domains. For example, Substack, an online newsletter platform, is increasingly used by physicians to write medical commentary, with some newsletters reaching 10s of thousands of subscribers. Substack estimates that 5-10% of readers will upgrade to a paid tier, and paid subscriptions on the service cost a minimum of $5 per month. Although $5 sounds negligible, consider a newsletter with 10 000 total subscribers, 1000 of whom pay a $5 monthly fee. After subtracting Substack’s 10% cut, a doctor could expect $54 000 in annual payments. If physicians accrue 5000 backers, they can expect $270 000 in revenue. This is greater than the $265 000 average salary of primary care physicians in the US.
Sensible Medicine subscribers don’t pay their hard-earned money to learn about problems with MAHA/MAGA. They pay to escape into a fantasyland where MAHA/MAGA isn’t worth mentioning, and the problems we face in 2026 are all because of what Fauci did in 2020. Sensible Medicine’s business model necessitates their current silence, and their refusal to even acknowledge current events sends a clear message to their readers- Everything’s fine now. Nothing that is happening under MAHA/MAGA is worth getting upset about.
Drs. Mazer and Rose concluded:
Doctors who wish to remain trusted arbiters of medical science, in all its complexity and ambiguity, should seek to avoid any financial scheme that explicitly or implicitly circumscribes the conclusions they reach.
Thankfully, Science Based Medicine is free. We don’t have to cater to paying customers, which means we can write about whatever we want. Unlike Sensible Medicine, we resist amnesia and are not afraid to acknowledge the basic reality of what is happening to STEM today. We’ve written about it multiple times this month alone. We have no plans to stop, and if anyone is displeased with this they can message me for a full refund.