Doctors and medical experts in the United States are irate about the mixed messaging and controversial advice being dispensed by Health & Human Services Secretary Robert Kennedy Jr, saying it is distracting efforts to increase vaccination amid the current measles outbreak, and that some misinformation is already going viral online.
They are concerned about the prioritising of ideology over evidence-based medicine, to their detriment – and even at their children’s expense – and are also fed-up with their jobs being politicised, they say.
“Let us do our jobs without interference,“ one said.
Recently, Kennedy said that cod liver oil, the steroid budesonide and the antibiotic clarithromycin, give good results. He also told Fox News that the federal government was shipping doses of vitamin A to the outbreak’s epicentre, reports The Independent.
With a history of anti-vaccine activism, he has said little, however, about vaccination, calling the decision to vaccinate “a personal one” – but in the same breath acknowledging it can contribute to “community immunity“.
The controversy around his appointment has intensified after the measles outbreak – and subsequent death of an unvaccinated Texan child – with some doctors saying his public acknowledgement of vaccine efficacy and herd immunity is nothing but a PR exercise.
Ideology and evidence-based medicine should not be given equal weight, said Chloe Nazra Lee, MD, MPH, in Medpage Today, referencing a quote by Kennedy in 2023 where he said: “I see somebody on a hiking trail carrying a little baby and I say to him, better not get them vaccinated”.
Yet, added Lee, a resident physician in the Department of Psychiatry at the University of Rochester Medical Centre in New York, in his Fox News op-ed, he promoted the role of immunisation with the measles, mumps, and rubella (MMR) vaccine, citing the Texas outbreak as a “call to action …for us to reaffirm our commitment to public health”.
While he “appears to actually acknowledge vaccine efficacy and herd immunity”, this feels “more like an attempt to preclude bad PR after a preventable death, especially when we consider his history of anti-medicine misinformation”, and considering that days ago, he dismissed the outbreak as “not unusual”.
Though he argues he is not anti-vaccine, the bulk of his statements and actions seem to indicate otherwise, she wrote.
Ideology at patients' expense
“Many of us in the medical community worry that his audacious rhetoric on the national stage will further undermine public confidence in vaccines. In fact, this trend was seen in Florida under Surgeon-General Joseph Ladapo, MD, PhD, who publicly questioned the necessity and safety of vaccines.”
Childhood immunisation rates in Florida have dropped precipitously since Ladapo was appointed in 2021.
“We cannot underestimate the power of people’s attachment to their ideologies – to the point that they may even undermine science to create outcomes that fit their ideology.”
Vaccines should never have been politicised, she added, yet politicians on both sides of the aisle are pushing ideology as fact… and putting doctors in the middle.
“We’re consistently on the defensive, fruitlessly countering wild, unsubstantiated claims with research, statistics, and data in a battle seemingly won by whomever shouts loudest.”
Furthermore, these political voices stymie medical progress by slapping bold labels on doctors who are trying to have nuanced discussions about very real issues in healthcare policy and best practices:
If I’m pro-choice, I must want to murder babies and have no regard for human life.
If I support #MeToo and validate when women in the OB clinic are uncomfortable with male providers examining them, I must hate men.
If I express concerns about the extremes of Health at Every Size, I must be fat-phobic.
If I steadfastly encourage vaccination, I must not care about individual rights and personal choice.
Lee said these labels undermine doctors’ credibility by eliciting extreme emotional responses.
“With these labels, we are deemed unworthy of being heard, and patients hesitate to engage.
“We can’t do our jobs like this. Medicine cannot be governed by emotion without reason. One preventable death of a child is one death too many. Frankly, I’m tired of dancing around the issue for the sake of politeness.
“Now is the time for strong wording and direct language. We have to stop giving deeply-held beliefs and evidence-based medicine equal weight. It’s already proven deadly.
“To the politicians scoring points on innocent children’s lives with inflammatory rhetoric that divides us: sit down, learn some humility, and let us do our jobs without interference.”
Virus eliminated
Many US doctors have never seen a case of measles, given that the virus was declared eliminated in the country in 2000. There are no antiviral medications specifically to treat infection.
And while the WHO says vitamin A is important for vision and immunity, and recommends two doses for all children and adults diagnosed with measles, and the US Centres for Disease Control and Prevention also says it should be given to children with severe measles, it is not a substitute for vaccination, Dr Megan Ranney, dean of the Yale School of Public Health, told CNN.
The National Foundation for Infectious Diseases notes, meanwhile, that experts found use of the therapy was low across the US in a 2019 study.
In his opinion piece, Kennedy referenced studies that show that vitamin A can “dramatically reduce measles mortality”, but experts say vitamin A is most useful for measles support in patients with a specific deficiency, and that the studies mainly draw on evidence from low-income countries where that deficiency is common.
Although it was actually valid information, said Dr Amesh Adalja, a senior scholar at the Johns Hopkins Centre for Health Security, it is “out of context”.
Dr Peter Hotez, co-director of the Texas Children’s Hospital Centre for Vaccine Development, and Dean of the National School of Tropical Medicine at Baylor College of Medicine, agreed.
“In the American context, the data for vitamin A use in measles are weak,” he said. “Vitamin A really doesn’t have much of a role in the current discussion on the Texas measles epidemic because it becomes a distraction about what we really need to focus on, which is vaccinating our children.”
One of the medications Kennedy mentioned – the antibiotic clarithromycin – could be an attempt to prevent secondary bacterial infections like pneumonia, but evidence for that is limited. Budesonide is a steroid with a variety of uses, but it’s not clear how it might help someone with measles.
The American Academy of Paediatrics released comments seeking to combat the misinformation, advising that high doses of vitamin A can also lead to dangerously high pressures inside the skull that push on the brain; liver damage, confusion, coma and other problems.
Dr Sean O’Leary, chair of the American Academy of Paediatrics Committee on Infectious Diseases, stressed that vitamin A can prevent complications in those who are already infected, particularly for children who are hospitalised, but also warned that “it should not be used to try to prevent measles”, and that high doses were potentially very harmful.
“The only effective way to prevent measles is the MMR vaccine,” he said, while Dr James Campbell, vice-chair of the committee, said: “No one should take, and no parent should give to their child, vitamin A in hopes of preventing measles. It will not do that.”
“Vitamin A is only recommended in hospitalised patients, and only recommended at specific doses,” said Dr Leslie Motheral, a paediatrician in Lubbock, Texas, where the measles outbreak is centred.
“I want to be very clear with that, because I do think there are patients who are not vaccinating and are just giving their children high doses of vitamin A.”
Medpage Today article – RFK Jr.’s 180 on Measles: Too Little, Too Late (Open access)
See more from MedicalBrief archives:
Measles jab a personal choice, says Kennedy after child’s death
Worldwide measles cases almost double in a year
Anti-vaxxers target doctors on social media and rating websites