Caplan is head of the Division of Medical Ethics at the NYU Grossman School of Medicine.
While many critics of Robert F. Kennedy Jr. and Mehmet Oz are focused on their criticisms of vaccines, that focus is somewhat misplaced. The data supporting the safety and efficacy of recommended vaccines is far beyond dispute. But the reality is that the damage to getting Americans to vaccinate has already been done. The soon-to-be nominees for Health and Human Services secretary and leader of the Centers for Medicare and Medicaid Services will be focused on another battle: over wellness and prevention.
There isn't a lot left for vaccine opponents to do. There are almost no serious state mandates for childhood vaccines. Parents who want to opt out are easily doing so, as can be seen by the resurgence in measles and whooping cough. Nearly 40% of teenagers are not up to date on the HPV vaccine even as Australia and Scotland are on the verge of eliminating cervical cancer thanks to serious immunization campaigns. And huge numbers of adults are not getting vaccinated for Covid, flu, RSV, or shingles. The Biden administration totally confused the public about why in particular they needed "boosters" for Covid. Democrats avoided vaccination as an issue this election year because they knew that, post Covid, vaccination has become something of a political third rail. Could Kennedy and Oz make things worse -- absolutely. But are matters already bad -- sadly, yes.
Where both Kennedy and Oz have traction is in their focus on wellness and prevention. The emphasis on expensive cure and treatment in American health care is problematic, and the American people know it. That is why they disdain pharmaceutical companies for perpetuating treatments for enormous profits.
What is far from clear is whether RFK Jr., Oz, and their MAHA colleagues have any chance of taking on the current health system and swinging it toward prevention and wellness. What stands in their way? A lot.
First, the man doing the appointing loves his cheeseburgers. A president who serves McDonalds at White House functions is not a man who may prove all that interested in a low-fat, low-sugar diet. Donald Trump Jr. recently posted a photo of Kennedy appearing ready to dig into some McDonald's with the president-elect. Sure, Trump said he wanted to let Kennedy "run wild on health," but that may not last long when the runner arrives at his dinner table.
Second, prevention comes with a bitter, divisive moral choice: help those in need right now or benefit those not yet here. The fruits of prevention and wellness may not be seen for decades. The plight of those currently sick is right before our eyes. Those many tens of millions with cancer, ALS, muscular dystrophy, asthma, diabetes, Alzheimer's, cystic fibrosis, osteoarthritis, severe mental illnesses, heart disease, and so on will not be happy if Kennedy and Oz end up redirecting research funding and health insurance coverage toward wellness. When push comes to shove, the American people want money spent on rescuing those in need now rather than to create a healthier dotage.
Third, wellness and prevention are rife with kooky nostrums, goop, and potions. Americans are already spending $1.8 trillion a year on wellness, according to McKinsey. How's that working out for us? Dr. Oz's love of blueberries may be sincere, but a lot of expensive wellness ideas don't work and cost a lot.
Fundamentally, wellness and prevention are not as much fun as the freedom to live as you like. MAGA folks love their freedom. It is not for want of trying that doctors haven't made a dent in our lifestyles. More than 40% of us are obese, and the situation is worse in red states than in blue states. What is easier: giving up the fried chicken or taking a weekly, costly drug injection of Wegovy or Ozempic? Kennedy and Oz, I predict, won't like the answer they get from those who don't want to be told what to do to live healthier or who try to change the content of what is on MAGA American menus. (Remember what happened when Michelle Obama tried to push healthier eating as first lady?)
You need to have trust to get people to follow your hard-to-take message to pursue self-denial for long-term rewards. Kennedy doesn't. Not as he babbles about the "dangers" of seed oils, which have done much to reduce heart disease. And Oz has a long, televised career of hawking wellness junk that he made money from. I doubt these are the guys to get America to make the changes that evidence-based wellness and prevention require and then stick with them.
The biggest challenge: pushing prevention in a Congress full of red state legislators whose economies depend on growing corn for fructose and animals for breakfast and dinner. Kennedy and Oz don't stand a chance against this deeply entrenched crowd.
Yes, we need to do more to prevent disease. We need providers to push us toward evidence-based, wellness behaviors. And we need guides to get us on these paths. Kennedy, Oz and their peers are the wrong choices in the wrong political environment to get us there.