America no longer has a public health system

Kirk Milhoan's recent interview is terrifying

Epidemiologist Elizabeth Jacobs is not being hyperbolic when writing:

The STAT article is truly frightening. Yet true to the long game Robert F Kennedy Jr and his anti-vax coalition are playing: to sow so much distrust in modern medicine and vaccines that millions of Americans stop getting them. And it’s working.

Kirk Milhoan is a (recently fired) pediatric cardiologist who was appointed to serve as chair of ACIP, the vaccine advisory board, last month. Also: a senior fellow at the Independent Medical Alliance (formerly the Front Line COVID-19 Critical Care Alliance), an anti-vax nonprofit founded in April 2020 by critical care physicians Paul E. Marik and Pierre Kory. In August 2024, both men had their medical board certifications revoked by the American Board of Internal Medicine for spreading false or inaccurate medical information.

As Walker Bragman writes:

IMA is best known for its promotion of the anti-parasitic ivermectin as a treatment for COVID—and for continuing to endorse its use long after research has proved it ineffective for that purpose. Ivermectin was the second false COVID cure seized on by the MAGA movement, following the anti-malarial hydroxychloroquine, which President Donald Trump touted as a pandemic quick fix as he sought to downplay the pandemic threat ahead of his 2020 reelection bid.

Milhoan has promoted both drugs, providing them to Maui patients during free house calls to treat and prevent COVID. In 2021, the Hawaii state medical board filed complaints against him but later dropped them.

During an episode of Why Should I Trust You?, Milhoan was more upfront and honest about ACIP’s intentions than the normally slippery Kennedy, though couched in the notion that he’s actually performing sound science. While the podcast positions itself as balanced, they’ve hosted leading MAHA and anti-vax guests like Del Bigtree, Zen Honeycutt, Piere Kory, and Bret Weinstein—the latter two alongside Kennedy-founded anti-vax organization, Children’s Health Defense. (Actual experts like Paul Offit have also been guests, though their list skews MAHA.)

First off, Milhoan states that the goal of ACIP is not, in fact, the thing vaccines are designed for:

What we are doing is returning individual autonomy to the first order, not public health, but individual autonomy to the first order… [Patients] should be making the decisions on what the risks are of disease, what the risks are of vaccines, which is different for each person, what the family history is, and then make a decision from there, as opposed to what was sort of more of a heavy-handed, authoritarian thought of the vaccine schedule that led to mandates that if you didn’t have this set of vaccines exactly how they were prescribed, then you didn’t get in school.

A worldview antithetical to public health. Such an anti-intellectual strain has existed in America for centuries, yet nowhere is it more present than in health. Many beliefs espoused Milhoan can be traced back to 19th-century proponents of heroic medicine. The real danger is they’re now in charge of public health policymaking.

Polio and measles arose during the conversation. Fitting, given a recent measles surge in South Carolina further threatens America’s elimination status. Milhoan expressed skepticism that either vaccine is still necessary before suggesting a bit of soft eugenics:

What we’re going to have is a real-world experience of when unvaccinated people get measles. What is the new incidence of hospitalization? What’s the incidence of death?

This “let it rip” mentality has long been cherished by “medical freedom” advocates. Ironic, given that they also position themselves as crusaders against chronic disease—people with chronic diseases are more likely to suffer the worst outcomes from vaccine-preventible illnesses.

Public health—the system Milhoan is tasked with informing—is not about the individual, but what’s best for the largest number of people. This doesn’t mean, as anti-vaxxers like to claim, that science is compromised when making public health decisions. The opposite is true: epidemiologists and researchers use the best science available to make the soundest recommendations possible.

Not ever recommendation is going to work. But it’s a hell of a lot better than whatever the current incarnation of ACIP is cooking up. In order to distract from that fact, Milhoan, Kennedy, and others concoct culture war issues to distract the public from pulling back the veil on their propaganda. That’s how you overshare this absolutely mind-numbing (yet quite revealing) tidbit:

I don’t like established science. Science is what I observe.

No, that’s not what science is. Observation is part of the process, not the end of it. That comes with peer review, verification, and continued testing.

It’s not surprising that people aren’t interested in the laborious task of actual science. But it should shock all of us that they’re in charge of a system they don’t understand or even seem to care about.

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Below is a brief video expressing my thoughts on Milhoan’s interview. Also: I was featured in a local Portland publication, Williamette Week, yesterday.