This will be my last post of the year and as usual I like to look back at how SBM is doing. We have now completed 17 years as a blog, which I think is something in itself. As always I have to thank David Gorski and all of the regular contributors here for their tireless work without any compensation except fulfilling the desire to make the world a slightly better and more rational place.
2025 has been a rough year, I think unequivocally the worst year we have had since starting SBM. At the heart of what we do is a philosophical conflict – Science-Based Medicine is a particular philosophy of medicine. We promote the idea that science, in all its aspects, is the best tool for determining which treatments are safe and effective, that safety and efficacy matter (yes, this has to be stated explicitly), and that an SBM approach to clinical decision making leads to the best outcomes. But it’s not enough to simply defend this approach, because it is horrifically complicated, so we also spend time delving into wonky discussions of how to optimize the SBM approach, knowing that this is an endless project.
On the other side (I will honestly try to be as charitable as I can here, but all the caveats apply about listening to hostile sources, which I definitely am), there are those who I think sincerely believe that science is not the ultimate determination of the utility of medical and health interventions. Or they may think their approach is scientific, but they are clearly doing it wrong, and for a variety of reasons. Often they are just stuck in a narrative that does not align with reality.
To take a recent example which I think illustrates this well, Mark Crislip just wrote about the current administration’s approach to pandemic preparedness, which focuses on making people healthy to be better able to resist infection. This is a typical wellness narrative, but Mark, who is an infectious disease expert, details that reality is quite different. Organisms evolved to be good at infecting us, and our immune systems are variable, better able to tackle some infections than others. Just relying on good nutrition is folly, it is subjugating science, evidence, and logic to an ideology.
But even mainstream professionals may sometimes go astray because they fail to consider the full spectrum of evidence. They fall for the “evidence-based medicine” fallacy – the notion that you can focus entirely on clinical trials without consider overall scientific plausibility. Or they are simply insufficiently educated about things like P-hacking, publication bias, the decline effect, or Bayesian statistics.
At the other end of the spectrum, however, there are con-artists, charlatans, and snake-oil peddlers. Of course they are going to infiltrate a movement that is premised on loosening the regulations and science-based standards of a multi-billion dollar industry. The wellness / alternative medicine industry is practically manufactured for deception and exploitation. It is a haven for every kind of fraudster. It is so intrinsic that it is often impossible to tell to what degree someone is a sincerely believer or a sinister con artist. I suspect most people in the wellness industry are a combination, somewhere along a continuous spectrum. The likely believe their own hype, but also have some sense that they are cutting corners and are just being “good salespeople”.
Then we throw into the mix the conspiracy theorists and fantasists, people whose relationship with reality is tenuous at best, or they simply have a critical failure in their reality-testing circuitry. There is a spectrum here as well. Neurotypical or average people have a tendency to fall for conspiracy theories, especially if they align with their narratives or world view. The wellness industry embraces the full spectrum, because it is an extremely useful tool for selling their wares. “Our magical claims are better than mainstream medicine, because you can’t trust mainstream medicine, because it’s all a giant conspiracy.” If you want to see how pervasive this narrative is, just browse TikTok for a bit (until your brain melts).
So why has 2025 been so bad? Even casual readers here know, as evidenced by our near obsession with a few people in the current administration. I have honestly had to make a concerted effort to avoid writing about RFK Jr., Dr. Makary, Vinay Prasad, and Jay Bhattacharya (my colleagues here have it covered pretty well), in order to have some balance here and continue to tackle some of the more classic topics at SBM. But every week there is some outrage that deserves discussion on SBM. It’s hard to avoid.
We are facing nothing short of the barbarians being inside the gates – the charlatans are in charge of health care at the federal level. RFK Jr. represents much of the very philosophy we are pushing back against – he is not an expert but thinks he knows better, he is a conspiracy theorist, and he buys into all the dubious narratives of the wellness industry. He is blatantly anti-vaccine, despite his coy protestations.
Under his tenure healthcare regulation in the Trump administration has been eviscerated. He is waging war against vaccines, and has gone farther than even we feared. Pandemic preparedness is a joke, and we all have to hope that we are not hit with the next pandemic anytime soon. The CDC, FDA, NIH are all compromised. We can no longer trust their recommendations or rely upon their expertise.
The “Make America Healthy Again” (MAHA) movement is a dream of the wellness and alternative medicine industries. It is a fantasy that flies in the face of a century of medical science and evidence, it is a triumph of narrative over reality. Sure, like much of CAM, there is some basic lifestyle advice thrown in – we didn’t need MAHA to tell us to eat right and exercise regularly. Otherwise they are focusing on the wrong things – we will not make America healthier by banning food dye and reducing access to vaccines.
RFK also makes it hard not to be cynical. He is obsessed with environmental contributions to poor health. Of course, they are real, but he grossly overestimates their role in health and downplays may other legitimate factors. And yet, on the one environmental issue that perhaps has the biggest actual effect on health – pollution from fossil fuels – RFK instantly caved to Trump’s global warming denial and fawning support for the fossil fuel industry. On his second day as HHS secretary he cut NIH programs studying the effects of pollution and climate change on public health. He has pivoted away from his environmentalist roots and refuses to push back against Trump’s climate change denial.
It is scary to think that we potentially have three more years of people like RFK dismantling the institutions of medicine. They weren’t perfect to begin with – medicine is hard, and regulations are complex, but at least there was a steady push for incremental improvements. Now a crank conspiracy theorist is doing his best to tear it all down.
We will get through this, and hopefully the public will gain some insight into what happens when you abandon objective standards for feel-good snake oil. But it remains to be seen how much long term and even permanent damage will be done in the meantime. There will be a death toll attached to RFK’s nonsense (as there already has been), we just don’t know how many zeroes there will be.
Either way, SBM will be here in 2026 and hopefully beyond to tell you all about it.
So Long 2025