Thoughts on the MAHA Movement

Robert F Kennedy, Jr will face confirmation hearings today. Health will be in the news.

I want to write a few things about the MAHA movement. There is much to be happy about, but there are areas to clarify.

I have long advocated for healthy living measures—especially for our children. There should be more physical activity in school. I also favor policy changes that would bring back walkable neighborhoods. Long lines of cars dropping children off at schools is an American blemish. I hope MAHA helps improves this.

Our food supply could also be improved. When I counsel patients about weight loss, the most common recommendation is to reduce processed food and sugary drinks. There will never be agreement on the “healthiest” diet, but clearly it is best to eat real food.

MAHA blames big Ag for the obesity crisis. They use the term toxicity and poisoning. The more nuanced, less sexy, approach to toxicity and poison is dose. Water is toxic at high doses.

Processed food is not toxic nor is it poison at small doses—say at a Super Bowl party. The problem with processed food is dosage. I advocate removing it from schools—along with soft drinks. But it’s soft thinking to place blame on processed food. It’s fine to eat processed food once in awhile. In small doses.

There will also be talk about the “medical-industrial complex” and how it conspires to make us sick…for profits. Again, there is partial truth here.

I have long argued that the medical profession over-diagnoses and over-treats people. We lower disease thresholds so that normal people now have pre-diabetes or pre-heart failure. This is dumb. I am against it.

I am also against low-value interventions, of which there are too many. Expensive drugs when there are generics; procedures that are poorly vetted by evidence are much too common.

It is one thing to use GLP1a drugs to reduce diabetes and obesity in a 65-year-old patient; it is yet another to give these drugs to overweight children. The former use has solid evidence; the latter has zero evidence.

Low-value care has many causes. MAHA persuades us that it is all due to nefarious profit-driven actors in industry and the medical profession. This, too, is soft thinking.

Low-value care exists in cost-constrained systems as well. Non-nefarious causes of low-value care include patient demand and lack of critical appraisal skills amongst doctors.

For instance, tech titans think they can outsmart disease with expensive tests, scans and supplements. That idea—of cheating disease—is pervasive. It’s why so many people accept screening programs, which have a dubious evidentiary basis.

In other words, in the Thomas Sowell framing, many people are unconstrained thinkers when it comes to disease prevention. More is better. All is modifiable. Constrained thinking about healthcare has no cheering section. Unconstrained thinking provides a tailwind for low-value care.

Finally, my strongest opposition to the MAHA movement is their framing of industry and doctors as sinister. This is also soft thinking. Thinking of industry as sinister is like being mad when it rains.

Industry has one job: make products that make profits. Industry and innovation has helped transform medicine into a much better place. In my field, patients with heart rhythm disorders have benefited greatly from industry-led innovations. Of course these companies have made a profit.

Cancer care has also hugely advanced. Industry innovation has transformed once deadly diseases to chronic conditions. Patients having an MI (heart attack) now often go home the next day with no heart damage and a band-aid on their wrist. This too is due to industry-MD collaboration in which money was made.

While there is occasional fraud, the much larger problem with industry stems from weaknesses in critical appraisal. We are a rapturous audience. Doctors are too easily bamboozled. That lack of critical appraisal is on us—not industry.

While I don’t advocate deceptive marketing, imagine a world where doctors were far more skeptical and less easily bamboozled.

The goal of this Substack, as well as Sensible Medicine and CardiologyTrials is to bring robust non-cynical critical appraisal in the public sphere.

Profits from innovation should not be discouraged. The answer is not to demonize those who innovate, but rather to have the strength of mind to critically appraise evidence.

I hope the MAHA movement promotes the value of strong thinking. Because this would improve much of what ails US healthcare.