Those of us in the Public Health world have read the recent Making America Healthy Again (MAHA) report with interest. You can read it here if you wish: https://www.nytimes.com/interactive/2025/05/22/us/maha-master-docdocx.html
Sometimes the war on injustice makes for strange bedfellows. At one time I had said I would not work with a conspiracist like RFK Jr. But now, I am not so sure. I think of Drs. Tracey Woodruff and Maricel Maffini and realize that some of the people whose views on policy I respect the most are willing to work with nearly anyone if it advances the causes of children’s environmental health. It must be said that RFK is an unreliable narrator, for his anti-vaccine campaigns alone. But much of what came out in the MAHA report could just as easily have come from the groups I work with in Public Health.
I am surprised that they say so many of the right things, and as my friend Leyla McCurdy, Founder and Chair of APHA Children’s Environmental Health Committee, said in a Zoom meeting, many of the principles are the same as ours – that we should tackle the child chronic health crisis by addressing causes, not just symptoms, that we must hold industry accountable. I see similarities with UCSF’s Center to End Corporate Harm, and my forthcoming book, Poisoning Children. I particularly like their formulation of our current healthcare system as “sick-care.” This has been my experience to a great degree, as we in the United States pay so much for such paltry returns (See Figure 1). They also aptly criticize ultra-processed foods, as Dr. Laura Schmidt has done, and note the corrupting role of industry in food research.
Figure 1: Life Expectancy and Health per Capita by Country.
The report is correct in saying that although we spend about twice as much per capita on medical expenses as other rich countries, our outcomes and life expectancies fall far short. Rates of increase in diabetes, cancer, allergies, autoimmune disease, and mental health problems in children all seem correct, and they paint an appropriately grim picture. They do underestimate the number of synthetic chemicals our children are exposed to, though these exposures are given some attention.
Figure 2: Routine Exposure to Chemicals
I got halfway through before I found a sentence that soft-pedals the risks of toxic chemicals:
It is critical to recognize that chemicals are important tools that are inextricably linked to economic growth and innovations – helping to feed, shelter, and power every American and maintain food safety standards. Yet regulatory and medical systems around the world largely evaluate chemicals or chemical classes individually and may be neglecting potential synergistic effects and cumulative burdens, thereby missing opportunities to translate cumulative risk assessment into the clinical environment in meaningful ways. The cumulative effect of multiple chemical exposures and impact on children over time is not fully understood.
There it is. Though largely true, this is phrased in a way that has industry fingerprints all over it. If you read carefully, you can see both the urge to delay action until further research is done and also to protect any one chemical from action since we are apparently only concerned with “synergistic effects and cumulative burdens.” The report goes on to mention complex mixtures. Those aspects are all essential to focus on, but not to the exclusion of banning individual bad actors and classes of chemicals. The report offloads responsibility to AI to determine culprits, when we already know many chemicals are dangerous and should be banned given existing research.
By the time I reach “Crop Protection Tools,” I think really? – this is blatant industry-speak. I see the influence of industry even more in grossly understating the robust research linking pesticide exposure to health harms. Ironically, the section on corporate influence immediately follows. They do point out that the chemical industry grossly distorts research findings, with industry-sponsored research finding much less harm than non-biased studies.[1] For instance, they point out that “An analysis of 115 studies before 2005 revealed that 100% of chemical industry-funded studies declared BPA safe, while over 90% of non-industry research identified harm at low doses,” citing researchers I implicitly trust and respect.[2] But the emphasis on corporate capture focuses on medicine more than on petrochemicals, a serious misdirection in my considered opinion. So while scientific research has indeed been shown to be distorted, the effect is typically seen with the petrochemical industry – less, and less perniciously, by medical institutions. I leave to others to reflect on whether or not pharmaceutical companies are equally culpable, as charged. But the report does cite recent articles in journals as careful and prestigious as JAMA and comments from editors of The Lancet, NEJM, and BMJ.
The report also says they will embrace science at a time when Trump et al. are systematically dismantling scientific research and attacking academic freedoms, an irony that rankles. Adam Serwer of The Atlantic has written thoroughly about how the administration is aggressively seeking to destroy systems of knowledge and even record-keeping in the U.S. in order to remain unaccountable for the damage they are doing. This includes RFK destroying more than a dozen "data-gathering programs that track deaths and disease.”
There is a hint of anti-vax sentiment in discussions of how social media platforms were asked to suppress “pediatric vaccine-risk profiles” and then fairly full-blown anti-vax statements later, much of which have been thoroughly debunked. The argument to use “true placebos,” or “inert placebo-controlled trials,” means that some children whose parents want them vaccinated will go unprotected, at the same time reducing herd immunity. There seems little memory of the high rates of child death from infectious disease before the advent of vaccinations.
Overall, they get many things right about diet, contaminants, physical activity, and light pollution. The to-do list includes GRAS (ingredients Generally Regarded as Safe) oversight reform at the FDA, which Dr. Maffini, who worked with the FDA for many years, and has criticized it, says is essential. The list does not include systematic chemical regulation reform, however, perhaps because that falls more under the EPA. And I am pessimistic that much good will happen under such an autocratic, anti-science regime, very plainly in the pockets of the petrochemical industry.
Over years of struggling with difficult realities, I have become more pragmatic than pure, and indeed I feel an ethical obligation to maintain openness in the face of changing evidence, so long as that evidence is high quality. Because of corporate capture, the nation’s government agencies have been failing America’s children for many decades. I will be curious to see if any good can come of this new approach.
[1] Bero L, Anglemyer A, Vesterinen H, Karauth D. 2016. The relationship between study sponsorship, risks of bias, and research outcomes in atrazine exposure studies conducted in non-human animals: Systemic review and meta-analysis. Environ Internat 92-93: 597-604. DOI: 10.1016/j.envint.2015.10.011.
[2] Vom Saal FS, Vandenberg LN. 2021. Update on the health effects of Bisphenol A: Overwhelming evidence of harm. Endocrinology 162(3): bqaa171. DOI: 10.1210/endocr/bqaa171.
