President Donald Trump’s nominee to be surgeon general, Dr. Casey Means, has made a lot of good points about the flaws in America’s health care system and our general approach to health and medicine. The Make America Healthy Again (MAHA) movement started by Health and Human Services secretary Robert F. Kennedy Jr. has observed a lot of problems that need to be fixed. Unfortunately, neither Means nor the rest of the MAHA movement has much in the way of solutions.
In Means’s book Good Energy, she writes that many of our health problems today are the result of “too much sugar, too much stress, too much sitting, too much pollution, too many pills, too many pesticides, too many screens, too little sleep, and too little micronutrients.” Some of those things are more dangerous than others, but everyone agrees that too much sugar and not enough exercise are bad. A policy agenda focused on these hazards to our health would be welcome.
Unfortunately, RFK Jr. and the institutional MAHA movement have little to show after a year at the helm.
They’ve goaded individual manufacturers into taking artificial dyes out of certain products—at best a symbolic victory and at worst, in the words of farmer Garth Brown, “playing into the hands” of food companies that got us into this mess. They’ve completely folded on pesticides, yielding to agribusiness advocates within the Trump administration.
They’ve sowed doubt about vaccines. They came out with a new food pyramid that seems to reflect advances in scientific knowledge, but without any other policy directives it’s unlikely to change anyone else’s behavior. If significant improvements in health arrive during the next few years, it’s more likely that the wide rollout of GLP-1 drugs like Ozempic will be responsible than social media posts from the HHS secretary.
Changing health behaviors is critical to getting control over chronic diseases. Means complains in her book that doctors are too quick to prescribe pills when “an ultra-aggressive stance on diet and behavior would do far more for the patient in front of them.” Means, who didn’t finish her ear, nose, and throat residency and doesn’t hold an active license to practice medicine, makes a good point. But has she ever sat with recalcitrant patients and tried an “ultra-aggressive stance on diet and behavior” with them?
Anyone who has practiced primary care medicine, as I have for over a decade, will tell you it’s not as simple as that. In fact, most patients will avoid coming back to your office if you try to be “ultra-aggressive” about any behavior in their lives. Means and RFK Jr. overestimate the power that individual lectures from doctors have on their patients’ choices and habits, which is not surprising considering that neither of them has ever treated chronic diseases like hypertension and diabetes over the long run.
Hyping the dangers of ultraprocessed foods may get lots of views and likes on social media, but it doesn’t tip the scale for a tired mom who just wants an easy dinner for her kids on a Wednesday night in between school and soccer practice. Accusing doctors of prescribing too many pills sounds good, but doctors who are dealing with real people in their offices prescribe pills because they want their patients to get better. What will make a difference, then?
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Perhaps the most important thing that can be done at an institutional level is finding ways to make good food cheaper and more easily available. The MAHA movement has long called for a reduction in subsidies for crops like corn and soy that get turned into ultraprocessed food, but so far the Trump administration has not touched those payments, and the price of fresh fruits and vegetables has not changed much in the past year. The Department of Health and Human Services should also work with Congress to improve school lunches, which will require more funding because good food is not always the cheapest.
If we want more intensive lifestyle changes and help for the people most affected by chronic diseases, then dedicated community health nurses are more effective and less expensive than doctors. A lot of MAHA content is directed toward people who have the money to buy pricey organic food. But these nurses and other community health promoters are far better at caring for people who have suffered the most from decades of too much sugar and too much sitting.
Means quit a surgical residency, but her interests seem far more suited to primary care. In fact, I can imagine quite a different path for Means had she simply done her training in a specialty, like family medicine or pediatrics, where it’s still possible (if increasingly unusual) for patients to have continuous, lifelong relationships with their doctors. She very briefly had a boutique “functional medicine” practice where she could not prescribe medications, but in recent years she has focused far more on selling specialty products with unproven health benefits. Would she have pursued a career as a health influencer—including taking psychedelics and using mediums to open herself up to demonic powers—if her medical career had been built around meaningful interactions with patients?
I train medical students, interns, and residents nearly every day as part of my work as a family doctor. These trainees, because they have more classroom experience than clinical time treating patients, often come up with diagnoses and prescriptions that sound good on paper but won’t work because they don’t have the wisdom that comes after seeing and treating many patients. They don’t know what they don’t know, and when they’re not carefully supervised, they can do more harm than good.
Means reminds me of them, demonstrating the overconfidence that comes with a little bit of knowledge and the foibles of a movement better at social media than governing or healing. Americans should demand a better candidate for our nation’s top doctor—and demand more from the MAHA movement as a whole.
Matthew Loftus lives with his family in Kenya, where he teaches and practices family medicine at a mission hospital. His book Resisting Therapy Culture: The Dangers of Pop Psychology and How the Church Can Respond is forthcoming from InterVarsity Press.
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