I didn’t love Craig Spencer’s ‘embrace MAHA’ column in The Atlantic. Instead of canceling my friend, I called him.

Even the sharpest disagreements can be civil. Here's my line-by-line response to Dr. Craig Spencer's argument for embracing MAHA.

Dr. Craig Spencer is widely respected in public health. He’s an outspoken, articulate voice for science and global equity in health. I know Dr. Craig Spencer. I love Dr. Craig Spencer. Some of my best friends are Dr. Craig Spencer. (We actually are quite close.)

However, his latest essay in The Atlantic, quite frankly, sucks.

Look, sometimes bad headlines accompany otherwise good articles. That’s not the case here.

The headline? “Public Health Needs MAHA.” Not good.

The subheadline? “The field must swallow its pride and admit where the insurgent movement is right.” Not good.

The essay itself? Also not good.

As someone who loves Craig like a brother-from-another-mother, the piece incensed me all the more. I didn’t know where to start after reading it. I knew it wouldn't be productive to vent in group chats, nor would I cancel my friend online.

Instead, I called him. You know. On the phone.

He cheerfully picked up. First, we happily caught up on life. Eventually, he mentioned his “upcoming” Atlantic piece that he thought might ruffle some feathers.

“Oh, my dude, that’s actually why called you in the first place,” I said, realizing he hadn’t realized the piece was already live.

What did I think of it, he wanted to know. I told him the truth—a truth only possible to convey and hear when there is deep respect and friendship. I told him I thought it was my least favorite thing he’s ever written, by a substantial margin. (Again, I truly adore most of his writing, and we frequently share drafts with each other for feedback, though not in this case.)

I told him I needed to respond in Inside Medicine. My plan was a line-by-line takedown. His response? “Yes! Do it! That’s what I want!” (I also invited him to do a live Q&A with me, but, so far, the scheduling hasn’t worked out.)

In-group dissent is important. But to be productive, it hinges on the notion of good faith. I know Craig has good intentions. He’s just misread this situation, as portrayed in his essay. In fact, that’s why this piece aggravated me so much.

So, I went to work, using Fiskkit.com, a website that lets you annotate articles, line by line. My devastating flawless eminently fair response to Craig’s essay is below.

Please let me know what you think in the Comments. But first…

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A line-by-line rebuttal to…

Public Health Needs MAHA.

The field must swallow its pride and admit where the insurgent movement is right.

By Craig Spencer. The Atlantic, July 25, 2026.

Craig’s original text is in quotes. My replies are in bold.

“Since Robert F. Kennedy Jr. took office, more than a year ago, I’ve been trying to understand the MAHA movement from the inside. I’ve sat in on MAHA Institute roundtables, roamed the conference halls of anti-vaccine gatherings, and talked with grassroots supporters across the country. They tell me their concerns about toxic chemicals and ultra-processed foods and the worrying rise in childhood chronic conditions. But when I share what I’m hearing with my colleagues in medicine and public health, many chide that engaging with MAHA is completely pointless. For them, the whole movement is nothing more than a subversive anti-vaccine, anti-science syndicate.”

It’s giving ‘Other than that, how was the play, Mrs. Lincoln?’

“That assumption is wrong. MAHA is an opportunity, and one the public-health sector—academics, doctors, and leaders of advocacy groups—cannot afford to squander. Yes, MAHA’s anti-vax wing is very loud and litigious.

But for many in the MAHA movement, their top issues lie elsewhere: environmental pollutants, the cost of health care, and a bone-deep conviction that health institutions have been captured by the industries they’re supposed to regulate.”

Name a single important MAHA issue that wasn’t already obvious. Every reasonable idea predated the movement, had been prominently identified, researched, championed, and lobbied for by credible factions in science, medicine, and public health. It’s not like we have MAHA to thank for raising the issue of lead in the water supply. It’s not like Michelle Obama didn’t use her platform to encourage healthy eating—nor was that even her breakthrough.

So, I reject the idea that MAHA or RFK Jr. are owed credit because they have not made novel contributions (That said, we should give credit to those who stand up to the powerful when doing so may be personally or professionally risky. That’s different.)

“These are not fringe, unscientific concerns. They are concerns that millions of Americans have been angry about for decades, long before the MAHA label even existed.”

Exactly. The good concerns, anyway. But that leaves the important issues—of which vaccine policy towers. Despite Craig’s contention, undermining vaccines has been the main project of consequence in Kennedy’s HHS.

“And they are concerns that many in public health share—if only they could see beyond that label, and make common cause.”

Strawman. MAHA interest in chemicals in the environment do not negate those abiding concerns that have long existed in public health. In fact, who do you think carries out this research? The universities whose research grants the Trump administration has relentlessly attacked.

“MAHA’s greatest achievement to date is not policy but politics. It has shown that people are hungry for a movement that fights for their health visibly, loudly, and in plain language.”

I’m all in favor of borrowing good tactics. If we can learn a few strategies (i.e. harness good marketing), well, that’s just wonderful. But we don’t have to join a problematic faction to do so.

“That’s why a movement just two years old draws support from four in 10 Americans, according to polling from KFF.”

There are media reports of MAHA voters breaking up with MAGA. Where will they go? Perhaps back to Democrat candidates who have supported the evidence-based science all along. What if that does not happen, though? Will it be because the Left continues to support science-backed vaccine policy?

“MAHA supporters cite the cost of health care as their top priority, followed by restricting chemical additives in food and limiting corporate influence in food policy.”

The idea that healthcare costs are priorities of the MAHA movement is hard to take seriously. President Trump did not seriously run on this, nor did Robert F. Kennedy Jr. ever advance a credible thought on this. The Trump administration’s signature achievement in this space, H.R.1 (“One Big Beautiful Bill”), will deprive millions of people of their health insurance.

While I generally don’t delve into food science, it’s hard to ignore that these priorities are not actually important ones. Kids don’t eat an entire bag of Skittles because of the food dyes. They eat them because of the sugar. There’s no definition of what “ultra-processed” means, and there’s no evidence that these chemicals are the major problem. (Read Dr. Jessica Knurick on this topic.) Adding too much sugar or salt to food (natural chemicals), is far worse for our bodies than many (if not all) preservatives that lengthen shelf life—which makes food more affordable, by the way. I’ve yet to see this issue discussed or studied in a serious way by the MAHA contingent. The analysis seems to start and end with some variation of “long words on lengthy ingredient lists = bad,” or “I don’t like ingredients I can’t pronounce.” There’s a name for this intellectually destitute concept: Chemophobia. It’s the irrational fear of chemicals. Everything we consume is a chemical, including dihydrogen monoxide, better known as water. Let’s not concede these points, when responsible experts like Dr. Knurick are out there fact-checking MAHA.

“At the same time, nearly eight in 10 MAHA supporters consider long-established vaccines such as those for measles, mumps, rubella, and polio safe, and only 4 percent cite vaccines as their reason for supporting the movement.”

This rings false. Why? Because vaccines are life-saving tools that rendered childhood routinely survivable. Childhood became survivable in the 20^th century not because lead paint was removed from toys, and not because we decided against using DDT. No, the millions of saved pediatric lives are in large part due to vaccines. (It’s admittedly difficult to know what fraction of the credit vaccines should receive, but it’s not small, we can agree.) That’s why we (“public health”) have watched in horror as Mr. MAHA himself, Secretary Kennedy has done everything in his power to destroy US vaccine policy. So I ask, if MAHA is pro-vaccine, why have its members not joined us shoulder-to-shoulder in outrage against Secretary Kennedy’s campaign to send us back 100 years on pediatric mortality?

Make America Healthy Again. The word “again” is too often ignored. When, precisely, shall we go back to? Pick a year. Whatever year you pick, child mortality in the United States will be higher than it is today—and those discrepancies would be even worse if we hadn’t let gun violence become so prevalent this century. Yes, shootings are the leading killer of children (starting somewhere in middle school, last I checked) and teens. But nary a mention does it receive in Secretary Kennedy’s MAHA manuals.

“That disconnect alone shows that MAHA is not synonymous with a solely anti-vaccine constituency. It represents and reflects something far larger.”

I disagree. I think it’s an open question as to what would happen to the MAHA coalition if its platform abandoned anti-vaxxer sentiments and sympathies. Can you imagine MAHA without its anti-vaccine core? I cannot.

“When I sat down with Nancy Fuller, a lifelong Democrat and, more recently, a MAHA supporter, at a Christian coffeehouse in rural Ohio, she told me that what she likes about the movement is its willingness to try. Ever since her son was diagnosed with autism, decades ago, she has wondered whether environmental exposures or maybe vaccines were to blame, and she has spent years watching health institutions dismiss parents like her as ignorant or uninformed. In her view, public health steps up to the plate only when it already knows the outcome.”

We need to stop capitulating on this talking point. I’ve long noticed a fundamental asymmetry, an unfairness that needs attention. (I’m not alone in noticing this, by any means.) When the mainstream medical community doesn’t know something, we speak cautiously. When we’ve reached the end of our expertise, we admit that we can’t do anything more for someone. This is humility. This is a strength. Meanwhile, if we get anything wrong—if we so much as change our advice on when to wear a mask to respond to changing ground conditions (and, as it happens, taking public sentiment into consideration) during a rapidly developing pandemic—we are skewered for years, having “broken trust” with the public.

Are wellness grifters or other “clinicians” favored by MAHA subjected to anything like these standards? No. They invent nonsense out of thin air—ideas that are either demonstrably false, equally maddening, impossible to verify—and there are no consequences.

In my view, when someone like Nancy Fuller is told the truth by an establishment doctor, that disappointing truth is better than grifters selling her unproven folate analogs, or something far pricier.

Wellness influencers favored by MAHA sell the Nancy Fullers of the world hope, for a profit. What is the cost of hope? Whatever the market will bear.

“Whether the issue is autism, AI, or something else, MAHA swings at anything and everything. That means more misses—and occasional hits—on issues everyone else had decided were too complicated, too compromised, or too politically inconvenient to touch.”

Again, the accountability asymmetry. Why do influencers get to be wrong, but suffer no penalty? And when they get something right, it’s never novel. We must not give credit where credit is not due.

I’m having trouble identifying instances where establishment scientists, physicians, and other experts shied away from science on MAHA’s agenda that was somehow politically inconvenient. The search for autism causes is often mentioned. Autism is likely due to some combination of genetics and environmental factors. The reason it’s not pinned down is its complexity, not that it’s some third rail. The idea that the knowledge gap is due to fear on “our” part has zero support in reality. It is a grifty talking point advanced by Dr Jay Bhattacharya and others cosplaying sudden interest in the topic.

Remember, the best way to tackle challenges like this is through basic science research. The current administration, with Mr. MAHA himself at the helm of HHS, has now twice attempted to cut research funding at the NIH by tens of billions of dollars in its annual budget proposals. Fortunately, Congress rejected this last year and likely will this year. But if it didn’t, it would mean the end of much basic research as we know it, the very endeavors that can answer these questions. Where’s the outrage?

“MAHA has never been shy about naming problems loudly and promising to take them on, even—and sometimes especially—when that means going after powerful corporations and other major institutions that others had learned to work around.”

As usual, people who are trying to resuscitate MAHA (in this case, a well-intentioned but misguided attempt), point fingers at one side but not the other. How much of MAHA’s success is thinly veiled profiteering? Sure, the big names in MAHA don’t take money from pharmaceutical companies, but that’s precisely so that they can directly market supplements to you for as much money as you’re willing and able to fork out.

“This is not a model public health should replicate wholesale. Many of MAHA’s swings have been genuinely reckless—pushing unproven and often dangerous wellness hacks, fabricating falsehoods about vaccine ingredients, and making claims that run counter to all credible evidence.”

Of course we shouldn’t replicate this. Even if we did, we wouldn’t survive the week. We can’t afford to even occasionally make mistakes like those the grifter society makes on a daily basis. That’s why we have this problem in the first place.

“But public health has been too cautious, setting the bar for evidence too high. On ultra-processed foods, environmental toxins, and drug prices, public health’s problem was rarely insufficient data. It was insufficient nerve.”

Is there not an entire infrastructure of activists and environmentalists within mainstream public health who have been fighting for better regulation for several generations? What seems to have happened is that activists abandoned the Left when Secretary Kennedy did. They followed him to MAGA—rebranded as MAHA—without a second thought about how unlikely this was to achieve their aims, given the Right’s long record opposing things like environmental protections and stronger regulations on food safety (let alone funding for school lunches). Unsurprisingly, Kennedy has not turned his HHS into a regulatory agency bent on making our communities safer where the Left and the “public health establishment” failed. Will some eventually be disillusioned? Probably. That’s the next opportunity.

I asked my friend Dr. Evan Hepler-Smith for help on this. “There are great examples of how you can do the good parts of community-engaged public health work, based on concerns of members of affected communities, being duly critical of institutions when they’re wrong, without adopting an all-out MAHA anti-institutional stance,” he told me.

He pointed to Flint, Michigan, as a case study.

“The Virginia Tech team that did the groundwork on Flint, responding to concerns shared by a community activist,” he said. He further mentioned another example where studies by Duke University researchers in partnership with the city of Durham “showed high heavy metal levels in parks developed over former incinerator sites, but there was no mechanism to share this info promptly with people who lived in these communities and used these parks.”

If there is a micro theme here—university scientists holding public health agencies to account—then perhaps Secretary Kennedy’s HHS should support universities, not decry them as woke while prolifically canceling grants at the behest of Russel Vought and Elon Musk.

Also, I really need an answer to this one: What is the definition of an ultra-processed food, and just how big of a problem is it? If you can find me good data, and I mean good data, showing these chemicals are driving major health problems, then by all means, let’s regulate. But even if they are causing some problems (and, yes, there may be something here), I suspect this isn’t why American kids are less healthy than they were in the past, if they even are less healthy. Again, pick a year you’d send your child back to.

Meanwhile, in exchange for conceding this point, we are watching the MAHA movement, by way of its patriarch in Secretary Kennedy, attempt to systematically demolish the system that made childhood survivable and extended adult life expectancy by more in one century than during the previous 300,000 years.

And sure, certainly, drug prices are a problem. But the bigger problem? Selling people placebos for exactly as much money as they can pay. These grifters, of which MAHA is simply the latest and most powerful embodiment, are morally destitute on this. They’re not interested in bringing drug prices down. They’re interested in increasing prices for the nonsense, while pointing the finger at the medical establishment. (Sure life-saving GLP-1s are too expensive. Where’s their platform to address that?)

MAHA is in no position to argue for more affordable healthcare. There’s no record of them succeeding in this. There’s no record of them believing that this is actually something that they care about. However, that’s not to say that someone should not do this. I think this is exactly the kind of thing that we in the mainstream medical and scientific community should take on. On this point, I will concede that legislators in Washington on both sides of the aisle are too ensconced in the current system to do anything meaningful about this. People like Senator Bernie Sanders and Senator Elizabeth Warren have been all over this for decades now. Nor were they the first. Just because they haven’t identified the right strategy or built the right coalition to achieve some of their laudable aims (I do think they sometimes ignore some of the realities of our system) does not mean that a bunch of people who would prefer vitamins over chemotherapy, ivermectin over vaccines, and raw over pasteurized milk, somehow hold the secret to confronting the medical debt crisis in the United States. It’s such a non-sequitur that it is actually preposterous.

“Public health was not always so timid. The field was born as a potent political force, arguing for safer workplaces, cleaner water, better housing. Somewhere along the way, it shrank into the background, with many of its leaders preferring to see themselves as a technical and technocratic enterprise that operates outside the fray.”

This is stated without any evidence. It’s a condition that seems to be necessary to justify bending to MAHA, though. That’s why it’s included here.

“The problem with invisible shields is that nobody knows they’re there. When the field was forced out front, as it was during the coronavirus pandemic, many Americans experienced public health not as a shield, but as a scold—speaking in acronyms and waving data-filled reports.”

This is an anti-intellectual argument. It says that when we show people data, we are somehow insulting them. It says that when we tell them that bad things might happen, we are fearmongering, even if we’re right. Also, what’s wrong with acronyms? MAHA is built on one!

Also, Covid-19 revisionism seems to have settled on this idea that we botched it. In some ways we did, and in other ways I think we did better than anticipated. As best I can tell, though, the single most important thing we could have done to reduce morbidity and mortality from Covid-19 was to reduce the number of people who got infected before the vaccines and therapeutics became available. This argues for a stronger response, not a weaker one—which would have been even less popular, and a bigger spend of public health clout. Now, I’m not sure that the American people were on board for that (certainly some places more than others), and it’s difficult to know whether the juice would have been worth the squeeze. But the idea that we somehow got it wrong by being too cautious during the pre-vaccine era is simply not backed by evidence. If you think that the establishment gets unfairly blamed for being too aggressive (too scoldy) in trying to slow the spread of Covid-19, just imagine if we’d actually done something as draconian as the China lockdowns? (I’m not saying we should have, by the way.)

“In COVID-19’s shadow, trust in essential health agencies including the National Institutes of Health and the Food and Drug Administration has dropped to all-time lows. Fewer than half of Americans now have confidence in the CDC to carry out its core responsibilities, a nearly 40 percent drop from the start of the pandemic.”

The very people who are in power today are there because they fomented maximal distrust in these agencies. Certainly, I criticized the CDC and FDA for various things during the pandemic, but I think my approach shows that you can do that without torching them. Meanwhile, the very people who succeeded in undermining public trust by highlighting—magnifying—everything that went wrong (including things that would have been very difficult to get right in a rapidly progressing emergency), are now complaining that there’s no trust. They literally succeeded in their attempt to undermine it all and have the audacity to raise this as a justification for their own consolidated power? It’s outrageous.

“Now essentially out of power, the public-health community has been justifiably alarmed by what’s happened over the past year. The administration has prioritized politics over sound public-health policy in determining what’s approved by the FDA or what research is funded by the NIH. Severe staffing cuts at the CDC have weakened the response to health threats such as screwworm and Ebola. Many key leadership posts at the agency remain empty—the CDC has had a confirmed director for only 29 days of this administration. On immunizations, RFK Jr.’s Department of Health and Human Services altered the childhood-vaccine schedule in ways that reflect ideology, not epidemiology. It also overhauled the Advisory Committee on Immunization Practices, the expert body that has guided U.S. vaccine policy for decades. In response, the American Academy of Pediatrics distanced itself from the CDC and positioned itself as an independent, evidence-based guide for childhood vaccinations. More than two dozen states have already broken rank with the CDC’s recommendations.”

Exactly. Exactly. And MAHA has, at worst, cheered the whole way. At best, they’ve twiddled their thumbs, and in the name of what? Getting red dye out of Jell-O? Sure, let’s join this movement!

“The result is a fracturing of vaccine guidance, a reflection of the fact that Americans no longer trust a single institutional voice on vaccines.”

This is proof only that the grifters who set out to undermine public trust in public health succeeded in persuading the mob. It’s not proof that that was a splendid idea.

“Public health has had some success at stopping the damage. In March, a federal judge sided with the AAP in its case against HHS, blocking the new vaccine schedule and ruling the ACIP overhaul a violation of proper scientific procedure. (HHS has appealed the ruling.) In effect, this overturned most federal actions on vaccines of the past year.”

A few paragraphs ago, we were told that public health was too timid. But last I checked, “we” are the only ones doing a single thing about all of this, albeit in this political environment, the courtroom is indeed our last hope.

“Many in public health have treated that win as vindication. But court cases cannot substitute for winning in the court of public opinion.”

A few paragraphs ago, we were told that most of MAHA was actually in favor of vaccines. If so, I guess we have already won in the court of public opinion, have we not? Perhaps MAHA is a slightly more anti-vaxxer than Craig wants to acknowledge in this piece.

“One step to winning back the public’s trust would be a serious reassessment of the field’s financial relationships. The AAP’s own donor page lists at least 10 pharmaceutical companies as supporters, including six that manufacture vaccines the AAP recommends. And the six health organizations that sued HHS collectively received millions of dollars in donations from the pharmaceutical industry. Each organization maintains that these gifts are used to fund education or advocacy programming, not to influence policy recommendations or approvals.”

Asymmetry, asymmetry, asymmetry. No one ever follows the money on MAHA, do they? No one stops to notice that behind this movement is an industry selling billions of dollars of nonsense to people who will, again, literally pay for hope.

Now, “two wrongs don’t make a right” is not an argument I wish to advance. But I will say that there is such a thing as having faith in some legacy institutions. For example, The Atlantic can publish essays decrying the mistakes of Big Pharma on one page, and publish an ad from Merck on the next, because the journalists and ad teams work separately. At some point, yes these things can become distasteful. But we all recognize that this is the world we live in. Similarly, the news desk at The New York Times has a firewall with the opinion section, which we respect (or should). That said, would it be better if the AAP could be funded in other ways? Probably. So fine, let’s advocate for that. But do not let the other side off the hook for their sins.

“In a low-trust environment, however, the appearance of a conflict is still bad, and RFK Jr. has made this entanglement the centerpiece of his critique. Public health’s refusal to acknowledge it has handed him an argument he doesn’t deserve to keep winning.”

Where is the criticism that Secretary Kennedy won’t acknowledge conflicts as bad, if not actually far worse, from wellness grifters to ambulance chasers? The peptides shenanigans at the FDA are but the latest example—and that was just in the past few days.

“If these societies can accept money from anyone, it’s worth asking why the donor pages are dominated by the very companies whose products they evaluate and recommend. If public health wants to save vaccine infrastructure in this country, it has to end these entanglements.”

I’m skeptical that this caused the problem, nor represents the solution, but I’m open to ideas for how these societies can be funded. I don’t see a proposal here.

“The distrust that fuels MAHA is far older than the movement, and it will not evaporate in three years.”

That’s because it is a fundamentally anti-intellectualist movement. It just happens to finally have an ally running the United States Department of Health and Human Services.

“The conditions that allowed MAHA to flourish—the trust deficit, the corporate entanglements, the gap between research and community, the invisibility of public health in people’s daily lives—have been festering for decades.”

Those conditions were present well before this problem emerged. So, it’s almost as if that’s not the cause of the problem! Perhaps the real cause is something far deeper: a turn away from science at the hands of people who identified its limits, and were more than happy to accept your dollars so as to plunder the wilderness looking for answers.

“Public health must recognize there is opportunity in entropy.”

I have no idea what this means. I suppose it’s true that crisis brings about opportunity—albeit the supposed Chinese etymological connection of the words “crisis” and “opportunity” is, apparently, false.

“The path forward for the field is simple, but requires public health to do something it has been reluctant to do: Show up. Visibly. Politically, but not in a partisan way.”

Where? At a MAHA convention? Is that really it? Is that why I’m failing? By not showing up to those events? If that’s so, you’re going to have to tell me why my doing so will lead to affordable health care, lower drug prices, and better science. How will it defeat anti-intellectualist movements that fester in school boards, political action committee conferences, and yes, religious institutions, across this country?

“There are fights that are strongly supported by both sides, including air quality in neighborhoods sharing zip codes with industrial facilities, lead and toxins in the water kids are drinking, and the poor quality of the food Americans eat and its clear negative impact on our health.”

Name me one instance where MAHA’s current home, the political Right, has led the way (especially one that was opposed by the usual activists). Then we can name dozens where they explicitly stood in the way.

“These are issues where public health can stand next to communities, name what is harming them, and fight like it means something.”

We’ve been here doing this for decades. MAHA should join us. (If they’ll only accept vaccines, and other scientific achievements. Will they?)

“What MAHA understands—imperfectly and sometimes dishonestly—is that people do trust institutions, but not because those institutions have good data. They trust them because they feel like those institutions are on their side.”

This is why we have a regulatory infrastructure that seeks input from stakeholders. This is the very thing that Mr. MAHA himself, Secretary Kennedy, tried to dismantle in one of his earliest actions at the helm of HHS.

What a comically bleak place to end: Precisely where RFK’s tenure began.

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Closing thoughts…

We should not join a movement built on misinformation in order to communicate more effectively. We should not blame ourselves for windows that we did not break.

Yes, we should listen. Yes, we should be humble. Yes, we should be inclusive. But we should not betray science for popularity. If all of this shows anything, it’s that popularity is fickle. Science—its process, not its answers—is forever.

Further reading and thanks: Professor Dorit Reiss has written about this (as have others), and Craig appeared with our mutual good friend Dr. Céline Gounder to discuss it. You should read Dr. Jessica Knurick on the topic of food safety. Also, my thanks to Dr. Megan Ranney and others for helpful discussions on this.

Comments? Questions? Ideas? Venting? Please share your views in the Comments section.

Thank you for reading! If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.