Jonathan V. Last: MAHA Is a Fraud

Jonathan V. Last writes for and edits one of the liveliest and most informative sites on the Internet: The Bulwark. That is home base for a significant number of Republican Never Trumpers. In this post, he explains that Robert F. Kennedy Jr. is not only unqualified in medical issues but his ignorance puts all of us in danger.

America has never been healthier. Going backwards is going to mean more people getting sick and dying.

(Composite / Photos: GettyImages / Shutterstock)

1. The Past Sucked

I had a great conversation with Your Local Epidemiologist, Katelyn Jetelina, yesterday. It’s here if you missed it.

As she was explaining the state of play with measles outbreaks and falling vaccination rates, I asked her if there was any analog to this moment in the history of public health. She couldn’t think of one.

What America’s new public health establishment—by which I don’t mean actual public health experts but their dilettante conspiracist bosses—is doing is choosing to move the country backwards. Less medical research, a pull-back on life-saving vaccines, turning away from science and embracing folk medicine.

Our new health establishment is explicit about wanting to go backwards. It’s right there on the hat: Make America Healthy Again.

Again.

Meaning: America used to be “healthy” and now is not.

I’m sorry, I know we’re supposed to meet people where they are and give them a loving truth sandwich, but this is the stupidest fucking thing I’ve ever heard.

Does anyone remember what “health” looked like in America a generation or two ago? Half the country smoked. People dropped dead at 50 on the reg. Child birth was dangerous. Seatbelts were suss. Drug use was off the charts.

Dangerous communicable diseases were still around. Cancer was a death sentence. AIDS looked like an unstoppable tsunami.

Food? Do remember what grocery stores looked like in 1980? Aisles of canned vegetables, processed foods, and frozen TV dinners. Fresh produce? Good luck. That section of the Acme was a shoebox.

But that’s all anecdotal. Let’s look at the data. Because it shows—absolutely, unequivocally—that this is the healthiest period in American history.

Let’s start with the dumbest possible metric: life expectancy.

We’ve had a slight downtick in the last year or two largely driven by COVID. You know why a lot of people died from COVID? Because they refused to follow public health advice during the pandemic and then refused to get vaccinated once we had vaccines in hand. So it was precisely the MAHA idiocy that moved our life expectancy backward.

Let’s zoom out and look at America compared to the rest of the developed world:

You want to “Make America Healthy Again”? Get the fucking COVID vaccine like everyone else in the civilized world did.

How about infant mortality? That’s another excellent marker of health in a society. Oh, look—it’s incredibly low: 5.61 deaths per 1,000 live births. This is up slightly from 2020 because, again, COVID. But it’s still a historic low.

When do you think the golden, “healthy” past was? In 1980, the infant mortality rate was more than double what it is today (12.0). In 1960 it was more double that number (25.9).

Real problems do exist. For instance: Access to healthcare for African-American women. The black infant mortality rate is double that of white Americans and the maternal mortality rate for African-American women has been rising sharply for a generation.

These statistics are absolutely shameful. Yet you don’t hear a lot about them from the beef-tallow crowd, do you?

How about infectious diseases? In 1900 half of all deaths in America were from communicable diseases. Through medical advances—especially vaccines—we got that number down to about 5 percent—until COVID. All by itself COVID accounted for 12 percent of all deaths in the United States in 2021.

So again: If you want America to be healthy you’d do exactly the opposite of what the Trump administration is doing and urge everyone to get vaccinated.

And while we’re talking about healthy habits: Americans don’t smoke like they used to.

Also, forty years ago less than a fifth of people in cars used seatbelts. Today that number is well over 90 percent.

2. The Big C

Let’s talk about cancer. You ever feel like, “Man, people are getting cancer like crazy these days?”

Here’s what happened. There was a huge spike in the incidence of cancer diagnoses from 1975 to 1995. Why? Two things.

First, people were living longer and you have to die of something. Since people weren’t dying from polio, measles, and communicable diseases, they were living long enough to get cancer.

Second, medical science developed more tools to detect cancer. Inventing effective tests and screenings means finding more incidences. Donald Trump knows this.

So when you look at this graph the solid lines are cancer incidences. You see that they go up, and then down. But I want you to look at the dotted lines:

The dotted lines are the cancer mortality rates. And what you see is that in the early 1990s, people started surviving cancer at higher rates even as the incidences of cancer increased. And from 1995 to 2000, as the cancer incidence rate peaked, the mortality rate fell off a cliff.

Why?

Because better tests = more cancer diagnoses = earlier interventions + therapeutic advances = much higher survival rates.

The pattern we see with cancer incidence describes a lot of our health challenges today. Why do so many people get dementia or Alzheimer’s now? Because they’re surviving cancer and—again—something is going to get us eventually.

Why so many autism diagnoses? Because 40 years ago doctors didn’t understand what they were seeing in kids who had ASD. Now they do. Once medical science understands what it’s looking at, you’re going to get more diagnoses. This isn’t hard to understand.

Look: There are some things that have legitimately gotten worse over time. The incidence of Type 2 diabetes has increased dramatically since 1950. Some of this is linked to increasing obesity.

What’s the answer? Diet and exercise, which you may recall Michelle Obama talking a lot about (and getting ridiculed by Republicans for her trouble). Semaglutide drugs show tremendous potential for helping curb obesity and reduce the incidence of diabetes.

You may be surprised to hear that MAHA does not like this class of pharmaceuticals.

So what’s going on here? Why does the “Make America Healthy Again” movement romanticize the health outcomes of the past (which were worse) and misunderstand the health outcomes of the present (which are significantly better along the most important vectors and continue to improve over time)?

Why do people like RFK Jr. oppose medical practices that create better outcomes (vaccines; the Ozempic-class drugs)?

I don’t know. Maybe you have a theory and can discuss it in the comments.

But at the end of the day, the “why” doesn’t matter. What matters is the results. And the results are going to be bad.

3. Worse Than Fraud

Buildings used to catch on fire all the time in America. It was a serious problem. That’s why cities had as many fire stations as churches.

Over time, we cut way down on the number of fires. We switched construction materials. We came up with safer mechanisms for delivering gas and electricity. We developed best-practices and enshrined them in building codes. The big thing was the invention of the sprinkler system.

The result was that even as the total number of buildings in America kept growing, the annual number of structure fires kept going down. Dramatically.

Imagine a movement that looked at this data and decided America didn’t need sprinkler systems anymore.

Modern building costs are too high. There’s too much red tape. We spend billions on sprinkler systems every year that are never used. Let’s go back to the old ways. Make Buildings Great Again.

After all, we don’t have to worry about fires anymore.

The MAHA movement is like that. Except that while trying to get rid of sprinkler systems and building codes, they are also walking around carelessly tossing lit matches.

These people aren’t just frauds. They’re arsonists. And right now they run the U.S. government, the CDC, the NIH, and the fire department, too.