1. “Letting fucking morons run public health is the greatest anti-vaccine movement imaginable.”
Dr. Vinay Prasad rose to power as a COVID content creator, famous for his opinions not his actions. He spent the pandemic “calling for” his predecessors to do incredible, wonderful things and treating this a significant accomplishment. However, as MAHA doctors are learning at our expense, calling for things on social media and podcasts is a lot easier than actually doing them.
While it would take a dense tome to fully document the chaos and destruction at the FDA the past year, Dr. Prasad’s brief tenure was marked by endless personal drama, the normalization of quackery, and a justified collapse of public trust. The bottom line is this: when given the opportunity to prove his real-world prowess, Dr. Prasad failed.
Dr. Prasad was sent packing twice in under a year, and though his Sensible Medicine business partners claimed at the start of his tenure that “Prasad’s lifelong commitment to scientific rigor will help rebuild lost trust in regulatory bodies”, the opposite happened. Thanks largely to his efforts, the headlines now read Americans Trust Fauci Over RFK Jr. and Career Scientists Over Trump Officials. Morale at the FDA, especially in Dr. Prasad’s division, has tanked and respected FDA regulators quit rather than work with him.
Despite his reputation as a staunch defender of EBM, Dr. Prasad’s FDA claimed that Tylenol causes autism, removed warnings about some quack autism treatments, and promoted others. The vaccine schedule was decimated under Dr. Prasad’s stewardship as chief vaccine regulator, and multiple states and major medical organizations are wisely ignoring this guidance. Instead of promoting the MMR as measles injured kids under his watch, Dr. Prasad fretted mightily about ultra-rare MRI abnormalities after the COVID vaccine. He was not wrong when he said:
Although Dr. Prasad’s defenders portray him as a fearless doctor, willing to tell harsh truths to powerful people, his tenure at the FDA reveals the reverse is true. It was easy for him to take on big bad Moderna with Kennedy as his boss. But, when it mattered most, when Kennedy was going wild on our health, Dr. Prasad was a passive and weak enabler, his silence lending the legitimacy of the medical profession to Kennedy’s every act of scientific vandalism and disinformation.
2. “How Vinay Prasad Came to Washington — And Why It Was Always Going to End This Way”
There was no loud outcry of anger in the medical community when Dr. Makary announced the end of Dr. Prasad’s sabbatical at the FDA. Very few doctors trust Dr. Prasad today. While cranks like the pro-tobacco, child labor advocate Jeffrey Tucker mourned Dr. Prasad’s departure, there were a handful of doctors, all long-time defenders of Dr. Prasad, who are willing to stick up for him today. In their telling, Dr. Prasad didn’t fail the American public, rather we failed Dr. Prasad.
If only we had quietly genuflected to government doctors and unquestionably accepted Dr. Prasad’s inherent integrity and wisdom, then his tenure at the FDA would have been a smashing success. Dr. Prasad’s defenders claim that he was a helpless, blameless victim of nefarious forces, namely zealous patient advocacy groups, pharma, and the media. Dr. Prasad’s defenders never engage with the reasonable objections doctors have to him.
Dr. Anish Koka, for example, wrote an obsequious essay titled How Vinay Prasad Came to Washington — And Why It Was Always Going to End This Way that said:
Prasad couldn’t survive the combination. The rare disease advocacy community is not small, and it is not politically passive. The pharmaceutical companies funding the stories are not without influence. And the media infrastructure covering the beat has little institutional incentive to examine the science carefully when the goal is to take scalps of the enemy.
Notably, outside of his boss Dr. Marty Makary, no one even tried to make the affirmative case that Dr. Prasad succeeded at the FDA or that CBER is stronger and more trusted now than this time last year, effectively conceding point, that when given the opportunity to prove his real-world prowess, Dr. Prasad failed.
3. “Farewell Boy Wonder.”
Although Prasad’s defenders refuse to admit it, the obvious truth is that only Trump, Kennedy, and Dr. Makary had authority over Dr. Prasad, and Dr. Prasad relentlessly fluffed all of them to catapult himself into power. Whatever role “pharma $$” played, these men sent Dr. Prasad back to UCSF. They are responsible. No one else.
Of course, the MAHA coalition was always unstable, composed of anti-vaxx supplement salesmen, “right to try” libertarians, biotech investor bros, and self-proclaimed EBM gurus like Dr. Prasad. The entire movement coalesced based only on a mutual affinity for COVID disinformation and lacked a unifying philosophy beyond this. Sitting at the top it all was their mercurial leader Trump.
Dr. Prasad willingly threw himself into this morass, and only someone with deft political and interpersonal skills had a prayer of balancing these disparate interests. That’s not Dr. Prasad. He never even tried, though it’s not clear that he was cognizant of the internal tensions within MAHA.
High on his own supply, he seemingly believed he could bend these forces to his will with the raw power of his sheer genius. In so doing, he managed to alienate basically everyone, including the WSJ, vaccine-scientists, right-wing politicians, left-wing politicians, pharma executives, and patient advocates. His own FDA staff celebrated his first departure, and none have publicly bemoaned his second departure. So much for rebuilding lost trust in regulatory bodies.
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4. “Vinay Prasad loves President Trump.”
At the start of the pandemic Dr. Prasad performatively lamented the mixture of politics and medicine, writing:
Society faces a risk even more toxic and deadly than Covid-19: that the conduct of science becomes indistinguishable from politics. The tensions between the two policy poles of rapidly and systematically reopening society versus maximizing sheltering in place and social isolation must not be reduced to Republican and Democratic talking points, even as many media outlets promote such simplistic narratives.
Fast forward a few years later, and Dr. Prasad had become an overtly political actor. He routinely dunked on Biden and “Dems” and openly campaigned for both Trump and Kennedy. “God gave people two arms… One to vote for Donald Trump, and the other one to give thumbs up to RFK Jr.”, he said back when he was auditioning for his role at the FDA. He wrote patently absurd articles such as Sabotaging RFK Jr’s Confirmation Will Increase Vaccine Hesitancy to numb people to the risks of MAHA, and just last month, in a desperate bid to save his position, Dr. Makary insisted that:
Vinay Prasad loves President Trump… If you listen to his podcast for the last four years, you’ll see he has been an ardent supporter of everything Trump has done and is trying to do.
That’s an incredible accusation to make. Vinay Prasad loves President Trump! It’s infinitely more damning than anything Dr. Prasad’s critics have ever said.
It’s also true. Dr. Prasad used to his voice to elevate MAGA/MAHA to power, and his responsibility for that doesn’t end when he leaves the FDA. He is on the hook not just for everything that’s happened so far, but for everything that’s going to happen moving forward. As the Lancet recently said:
The destruction that Kennedy has wrought in 1 year might take generations to repair, and there is little hope for US health and science while he remains at the helm.
Dr. Prasad helped unleash this on us all and thus should be linked to it all for the rest of his career. As Dr. Angela Rasmussen wrote in her article A Not-So-Fond Farewell to Vinay Prasad after his first departure:
Prasad may have been too incompetent at enabling fascism for the fascists, but we should not forget that he volunteered to be part of that. He chose to support people who are actively annihilating the American government and attempted to prevent people from accessing lifesaving vaccines and medications. He is not a colleague. His actions at FDA demonstrate that he is a traitor to our country and we should never forget that. We should never let him forget it, either.
Things have gotten much worse since then.
It doesn’t matter if Dr. Prasad or anyone else objects to this. Public officials don’t get to decide how private citizens regard and remember them.
5. “Prasad overruled FDA staff to reject Moderna’s flu vaccine application”
When Dr. Prasad arrived at the FDA, he promised to make “expedite the approval” of vaccines to high risk groups based on immunogenicity alone, the production of antibodies. This turned out to be a false promise. He later ignored apolitical FDA scientists and initially refuted to review Moderna’s mRNA flu vaccine, even though it supported by a large RCT. Trump personally overruled him, apparently, landing the FDA’s leaders in hot water with the Dear Leader- Makary, Prasad Under Fire as FDA Turmoil Reaches President Trump. Dr. Prasad made many obviously bad decisions like this at the FDA. So bad that even Trump saw the problem and had to right the ship.
6. “Rare Disease Advocates Fume Over FDA’s Mixed Signals.”
However, even if we pretend that all of Dr. Prasad’s decisions at the FDA were scientifically unimpeachable, he refused to follow established procedure or clearly communicate his rationale to relevant stakeholders. He was unpredictable and guilty of regulatory whiplash, changing the rules at the last minute based on his whims and personal views. He never answered questions from journalists. His FDA dunked on independent, outside advisory committees, and ignored desperate patients and their families. An article titled Rare Disease Advocates Fume Over FDA’s Mixed Signals quoted Jeff Carroll, a Huntington’s researcher and gene carrier, as saying:
I just wish one of them, somebody from the FDA, would be like, ‘Hi, my name is Dr. Smith, and this is why I made this decision, and here’s the policy that explains why and how you will have to jump in the future to get these kinds of therapies done.’
On the rare occasions when he did speak, people wisely knew not to trust him. The article also quoted Wilson Bryan, who previously directed the gene therapy division at the FDA.
Bryan said he just ignores what Makary and Prasad say on stage. “Their public statements are, to me, just like pharmaceutical company press releases,” he said. “So, I don’t put any stock in what they say publicly. I just don’t think it matters.”
Instead of quietly engaging with biotech companies as professionals at the FDA did previously, he threw tantrums about them in the press. As STAT News journalist Adam Feuerstein reported:
Earlier today, the FDA held a media call with the same “senior FDA official” who spoke to me (and other reporters) individually earlier in the week.
The call was set up obstensibly so that this senior FDA official could rail against UniQure without going on the record. He did exactly this for 30 minutes, repeating the same criticisms, claiming Uniqure’s Huntington’s therapy is a failure, the sham surgery would be blinded even if just small “nicks” in the skin were made in a 30-minute procedure, dismissing the idea of formally reviewing the therapy, disregarding outside scientific experts, and then accusing the media of not adequately covering what the FDA (and this official) have been doing.
Reporters from Bloomberg, STAT, NY Times, WSJ, Politico and other media organizations were on the call.
The FDA was appropriately boring previously. Under Dr. Prasad, it was a high school soap opera, too much for even his bosses.
7. “I want to write a children’s book about a bear who didn’t want to leave home till it was perfectly safe. He never left and life passed him by.”
From mocking anyone who tried to avoid COVID, even during the deadliest wave in January 2021, to treating rare, temporary vaccine side effects as a fate worse than death, Dr. Prasad was a fountain of pro-infection propaganda during the pandemic. I’ve literally written volumes on the topic, though even this just scratched the surface.
While his defenders will continue to frame this as “thinking differently”, honest brokers recognize that nothing Dr. Prasad does will erase the consequences of his fake statistics and failed predictions regarding COVID. It should stain him for the rest of his career, and writers who discuss Dr. Prasad’s tenure at the FDA while glossing over his deluge of pandemic disinformation are failing their readers.
8. “I don’t believe in forgiveness because in my opinion these pieces of shit are still lying.”
As a private citizen, Dr. Prasad was juvenile, vulgar, and even vaguely threatening-I don’t believe in forgiveness because in my opinion these pieces of shit are still lying. The Pandemic Accountability Index collected over 120 individuals and organizations he insulted, and Dr. Prasad was even happy to send internet mobs to harass beleaguered vaccine-heroes who disagreed with his MAHA agenda.
This unprofessional behavior continued at the FDA, where he was accused of berating and retaliating against staff, necessitating an external investigation. He tried to shut down my puny YouTube channel and spread vile lies about me in the press when his pathetic attempt at censorship was revealed.
Today, Dr. Prasad’s defenders demand that he be treated with the maturity and professionalism he denied to others. Fair enough. I’m pleased I’ve not seen any doctor debase themselves like Dr. Prasad, who called other doctors “fucking morons.”
9. “At at least 10 children have died after and because of receiving COVID-19 vaccination.”
At the end of November, Dr. Prasad sent a “leaked” memo that the COVID vaccine killed at least 10 children. Though his defenders had “faith” the proof would soon arrive, Dr. Prasad has yet to provide a shred of evidence. I will be skeptical if he releases any “evidence” before he departs, though cranks and quacks claim Dr. Prasad’s words are proof enough. The damage has already been done, as Dr. Prasad likely intended.
10. “Vaccine Makers Curtail Research and Cut Jobs.”
Prior to assuming office, Dr. Prasad routinely said “RCT or STFU“, though he changed his mind the moment he gained power and responsibility. While his predecessor at the FDA delivered Operation Warp Speed, Dr. Prasad delivered zero RCTs. Although he promised that vaccine companies would do new RCTs under his tenure, thus far the headlines read Vaccine Makers Curtail Research and Cut Jobs. No matter what he says about the need for better clinical trials moving forward, Dr. Prasad’s real-world contribution to the cause of EBM is curtailed research and cut jobs, and that’s all that matters.
11. “I would fire at least ~10000 people.”
When he was out of power, Dr. Prasad dreamt of mass purges at the HHS- I would fire at least ~10000 people– and he was able to partially enact his fantasy at the FDA, having trusted regulator Dr. Nicole Verdun her deputy Rachael Anatol escorted out of her office last summer, for example. Anyone who bemoans Dr. Prasad’s dismissal should acknowledge that he gleefully inflicted this fate on others.
12. “The FDA commissioner & his CBER director are breaking the law.”
Dr. Makary’s job security is likely tenuous and unless Dr. Rick Pazdur is willing to return, I can’t imagine anyone reasonable would want to clean up after Dr. Prasad at CBER. His replacement might be worse, someone ready to green light all of Kennedy’s quackery and woo. Meanwhile, Rep. Jake Auchincloss has said “The FDA commissioner & his CBER director are breaking the law” by “disclosing trade secret information without legal authorization.” Senator Ron Johnson, a true crank and former ally of Dr. Makary, is enraged by and investigating Dr. Prasad’s decisions as well. Though Dr. Prasad will soon be leaving, the real drama may just be getting started.
13. Why didn’t you do that when you were at the FDA?
Overall, Dr. Prasad’s trajectory is a sad one, and it didn’t have to be this way. He is very smart and is a very skilled communicator. He previously made many reasonable points, debunking Dr. Makary’s absurd claim that medical error was the 3rd leading cause of death, for example.
However, he squandered it all, turning himself into a 7-foot hoop for power, fame, and paid subscribers. He hurt a lot of people on the way, and his main usefulness today is as a cautionary tale. Medical students should treat his career arc as a warning and strive to be his opposite in every way. He surrounded himself in an echo chamber and never doubted himself or paused to consider if his critics had any valid points.
It turns out we had many valid points, and Dr. Prasad might be in a better place today if he had the humility to listen to them. We knew who Kennedy was and would have warned him not to hitch his star to that wagon. In contrast, his so-called “friends” literally endorsed it all and pushed him along his ill-fated path.
While they are welcoming Dr. Prasad’s return to the commentariat class, I would advise him to quietly find meaning in clinical practice and retreat from the public eye. He’s not obligated to share his opinions on everything with everyone once again. He should relish being out of the limelight, curing cancer.
But more importantly no one is obligated to take his opinions seriously if he can’t contain them. No one is required to treat him as some sage EBM avatar anymore. We should remember his COVID disinformation and judge him on his real world performance at the FDA. That’s it. While it would be entertaining to hear him whinge about his treatment there, thus throwing Trump, Kennedy, and Dr. Makary under the bus, no one needs to care about his oh-so-controversial hot takes ever again. Someone who was MAHA royalty and still loves President Trump can be dismissed out of hand today, especially by those of us who desperately tried to warn about these forces. After all, I got my start here 5 years ago, discussing Dr. Prasad’s budding anti-vaccine career.
And though I’d be happy to never write about him again, I doubt that Dr. Prasad will heed my advice. However, every time he “calls for” something moving forward, the only response should be, “Why didn’t you do that when you were at the FDA?”