Our health care system has failed patients when it comes to preventing and managing chronic diseases such as diabetes, heart disease and obesity. I see the consequences every day. We tell our patients to diet and exercise when they do not have the time or financial resources to do so. Once a patient has a heart attack or a stroke, our system will deliver excellent care, but then we leave the recovery to beleaguered family members.
What would it take to end the chronic disease epidemic in children and adults as our new health secretary, Robert F. Kennedy Jr., has promised? I scan my patient list at the long-term-care hospital. In a given day, I’ve cared for a woman whose years of smoking led to a lung transplant, a relatively young man whose severe obesity required a tracheotomy tube to help him breathe and a low-income man in his 60s with heart disease. That man is now on a ventilator and dialysis after a risky surgery to open his blocked arteries. He just wants to go home, but he’s frustrated with medical interventions that make him feel worse instead of better.
One recent morning, curiosity led me to a video promoting Mr. Kennedy’s Make America Healthy Again movement. With the hospital’s cacophony of ventilator and heart rate monitor sounds in the background, I watched Mr. Kennedy stand in a grassy field and promise to find and target the root causes of chronic illness — with few actual specifics.
I thought about my patient on the ventilator. He worked long hours as a bus driver. Presumably his primary care doctor had told him to exercise or to change his diet, but when was he supposed to do that? He knew he was overweight and had developed diabetes, but he did not have the time or money to make healthy home-cooked meals. How was he to combat the effects of stress and poor sleep? And then, when he started to feel short of breath, how was he supposed to know that was a symptom of his failing heart and not simply the consequence of being overweight?
There is no single factor that could have reversed his fate. The poorest among us endure the highest burden of disease. Mr. Kennedy will find the root cause of chronic disease not in patterns of vaccination but in the realities of poverty, pollution, racial disparities and access to primary care. We know that obesity is a risk factor for so much disease, but we make effective obesity drugs financially unreachable to so many. Mr. Kennedy’s video shows a picture-perfect family enjoying a large salad at an outdoor picnic table. But realistically, overwhelming social change is needed if we can ever hope to make that a daily reality for everyone — especially those who must work more than one shift, seven days a week.
By the time I see my patients as a critical care doctor, it is often so late in the course of their disease that the best I can do is treat their symptoms versus offer a cure. To truly reverse the development of chronic disease, we have to start in childhood, with access to healthful food and exercise and clean air and high-quality health care. There is no reason school lunches should contain lots of ultraprocessed foods. I don’t know any physician who disagrees with Mr. Kennedy’s assertion that the American diet is horribly broken. But it is troubling that the MAHA movement’s proclamations come at a time when the Trump administration has made massive cuts to health care workers in public health agencies and has threatened the structure of the National Institutes of Health’s research funding. Republicans are entertaining huge cuts to Medicaid, which provides health care to over 70 million low-income Americans.
Looking at the positive public response to the MAHA movement, it is increasingly clear to me that modern medicine has done itself a disservice by focusing less on health and more on treating disease once it has reached a crisis point. Patients don’t want to just survive their stroke; they want to feel like themselves again. Longevity researchers increasingly talk about health span in contrast to life span — what’s important are not just the number of years lived but the number of years in good health. These are the outcomes that matter to people.
Mr. Kennedy seems to have gained the support of many Americans who have felt disregarded by the medical establishment. If he uses that trust to motivate people to make healthier choices and uses his position to drive the social changes needed to support those choices, then he has done us a service. I worry, however, that all of his pseudoscience, the criticism of antidepressants and weight-loss medications and the anti-vaccine statements will overshadow everything else.
Medicine is nothing without public trust. We can order treatments, but they are useless if our patients choose not to take them. We can make thoughtful recommendations, but they are helpful only if our patients listen to them and have access to the tools to follow through. Those of us in health care worry that the MAHA movement will only increase the numbers of patients who inadvertently harm themselves by forsaking tested, traditional medicine because they do not believe the data or their doctor.
But perhaps we can learn from what appeals to our patients about it. We need to find out what matters most to our patients and fight for it. That will require more from our government institutions than vague promises. For MAHA to become more than a slogan, we need real social change. Only then can we hope for a country that is healthier rather than sicker.
