Public health just got a lot more difficult.

We must continue to fight.

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Hi Inside Medicine readers,

Well, the next four years are going to be challenging ones for public health.

Let’s talk it through for a moment.

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In 2016, I wrote in Slate that I was very concerned about the Republican party’s embrace of pseudoscience during its wacky summer convention. But when it came down to filling positions at the highest levels of the federal government’s public health infrastructure, Donald Trump’s choices as President often turned out to be more or less mainstream. Even if you didn’t agree with many of the particular views, these were frequently people who had long and serious prior involvement in healthcare and public health. Maybe they were a little on the crony side and had a few more scandals in their rearview mirror than one would have liked, but they nevertheless generally recognized important truths—little things like, oh, I don’t know, vaccines work.

Last time could have been worse.

At the time of the Covid-19 pandemic, the CDC was run by Dr. Robert Redfield, a physician with substantial government experience. HHS was run by Alex Azar, a lawyer with relevant experience in the healthcare sector. And when Covid-19 hit, it was Dr. Deborah Birx—a physician and long-time public servant—who ran the White House response, and whom we can thank for getting President Trump to sign on to a social distancing plan that literally saved hundreds of thousands of lives in the early months of the crisis. Remember, Trump never fired Anthony Fauci.

This time might be much worse.

Well, now we are facing Round Two, and while I would like to think that things won’t be much worse this time, I worry they might be. In recent days, Trump signaled that some legitimately dangerous ideas held by Robert F. Kennedy Jr., would be considered. There’s talk of taking some vaccines off the market. There’s talk of removing fluoride from the water supply. These are genuinely bad ideas that could cause a lot of suffering and death.

Turning away from science should be seen as anti-American, since so much of the progress that humanity has made in medicine and health came from work done right here the States. Apparently, that’s not the way a lot of people see it. I would like to understand why that is, because I do not.

Turning away from science should be seen as anti-American, since so much of the progress that humanity has made in medicine and health came from work done right here the States. Apparently, that’s not the way a lot of people see it…

Brain drain.

To me, one of the sadder parts of this is the number of highly talented public health experts who won’t be working in government on your behalf over the next four years. Do I think that the FDA and the CDC are performing at their best on some key issues? Not particularly, no. Both of those agencies have gotten some imp

ortant things wrong over the years, and yes, including under President Biden’s watch. However, my sense is that the kinds of people Harris might have brought on board had a real chance to improve things. (I say this because I know and admire many of them.) Meanwhile, Trump seems to be suggesting that he wants to burn it all down.

International implications.

Then there’s the international implications. Will the United States withdraw support for the WHO? That was slated to happen under Trump right until Biden won the 2020 election, at which point we reversed course. If that happens now, what will that mean for public health around the world? If we pull out of the WHO, it’s likely that people will literally die for lack of medical care. That’s on our hands, I’m sorry to report.

Fighting misinformation.

Lastly, there’s misinformation to consider. I suppose people like me will have a lot of work to do in the coming years, depending on who is installed into what governmental positions. It won’t be easy. My colleagues and I are really going to need your support. If we can’t work on these issues from the inside (or with a sympathetic audience there), we’ll keep doing our best from out here, laying the groundwork to take back lost ground later.

We can make a difference.

This is my commitment to you: No matter what, I’ll keep speaking up for medicine, science, health, and data. And…

You can help.

How? Join me in speaking up for facts—for the truth. Shout it from the rooftops. Don’t delete your social media profiles. Stick around and make those places better. Spread facts and promote reasonable discourse. Try to move minds. We can do that. I know we can. But we’ll need to work together. We’ll need to amplify each other now more than ever. That is our task. We aren’t alone—this community is just one of many. Let’s lead by example.

What other option do we have? Our health and our lives depend on it.