SALUS POPULI SUPREMA LEX ESTO
MAHA is Paleo-Futurism's Health & Fitness Battalion
At its earliest articulation, Galileo’s theory was wrong, empirically. Pop history often presents the confrontation between Galileo and the Catholic Church in the following way: “We’re the Catholic Church and we say this, so therefore this is the way it is. In a conflict of us vs The Science, we are supreme”. Suffice to say, that’s not what happened.
In “Against Method”, Philosopher Paul Feyerabend reminds us that the best empirical evidence and a majority of the scholars, at the time, ascribed to the geo-centric model of the universe. Galileo was undoubtedly not following “The Science”. The Church was. He wasn’t going against the arbitrary authority of the Church, he was going against a long standing Aristotelian model of the cosmos with all of the evidence stacked up by brilliant minds over Millenia. The Church backed this theory because this was what the best minds thought the evidence pointed to. Galileo had an elaborate mathematical model, a “crackpot” theory, but didn’t have the tools (yet) and techniques available to definitively prove his theory. Eventually he did.
Defending the old position wasn’t the chief sin of the Church. The “evidence”, the intelligentsia, at the time, and Aristotle was on their side! All things being equal, you should default to defending the position with the most evidence and intellectual authority. The failing was in the silencing and jailing Galileo after he mocked the Pope and the Church.
This dramatic hinge point in the development of knowledge shows the difficulty of manufacturing and maintaining a Truth regime. Decades, centuries and even millennia of accepted Truth can come tumbling down in almost an instant. This and other moments in the history of knowledge should inculcate everyone with a deep sense of epistemic humility.
This is true for those in “hard” sciences like physics and chemistry and even more so for everything outside of it. Biology and medicine isn’t the humanities but it has a much softer and squishier surface area than the “harder” stuff. In many ways, it is much more complex! This requires even greater degrees of humility and openness to revision.
Producing knowledge of living systems is much more difficult within the highest standards of scientific methodology. The ideal is to be able to replicate experiments with the exact same components in the exact same conditions and context. This is hard enough in the physical sciences and close to impossible with living systems. And because of highly justified ethical constraints absolutely impossible when trying to learn about human beings.
This doesn’t mean it’s impossible to learn and generate useful knowledge. The take away is it’s time consuming to do so and laden with hard, as well as moral, constraints that cap our ability to develop absolute certainty outside of the most simple statements and observations which render medical degrees or schooling of any type superfluous. Our knowledge may be “effective” or “reasonable” in aggregate but it is always, to some extent, provisional, incomplete, and subject to improvement.
Epistemic Reformation
Like the Catholic Church, the medical establishment wasn’t wrong to defend their institutional point of views during COVID. They had ample empirical “evidence” they could cite. But their sins against knowledge formation were even greater with much higher negative impacts than this small blight in Church history.
The epistemic crimes were legion. The continual assertion of certainty and absolutism that they couldn’t possibly have, overstating their evidence, while also repressing counter-evidence and attacking those, within and without their ranks, that deviated from their certainties. The wise position to take would be to gently lean into the institutional knowledge you have while opening oneself up to criticism for further refinements or complete rollbacks as new evidence and new perspectives come to light. But this did not happen. They went aggressively and overconfidently in a certain direction and tried to shut down and punish all dissent. It wasn’t random, deranged layman shouting incomprehensible noises they were punishing but rather highly accomplished physicians and researchers who, in large part, turned out to be right about quite a lot.
Upon this first, and in one sense this sole, rule of reason, that in order to learn you must desire to learn, and in so desiring not be satisfied with what you already incline to think, there follows one corollary... Do not block the way of inquiry.“
Charles Sanders Pierce, "The First Rule of Logic"
This complete and utter unforced error is directly responsible for the strength and popularity of the MAHA movement. In a way, the tragedy of COVID-19 was a blessing because it opened up the space for more people to look under the hood and question biomedical orthodoxies more broadly.
If you look under the hood from a progressive point of view, one that cares about continual improvement in the human condition, “progress” in human health seems to have flat lined in the 70s and 80s after over a couple centuries of improvement. Then it became increasingly clear in the 21st century many metrics were actually getting worse. If “they” were so wrong and corrupt about COVID-19 and health outcomes are at best not improving, and in many ways, getting worse, it makes sense to put everything on the table for examination.
Institutions like the NIH, CDC, and the WHO have pretty rigorous gatekeeping standards. Everything they do and say usually has at least a handful of “peer-reviewed” citations backing it up. This is what we’d want and expect from “scientific” institutions. They never say, “we made it up”. So if the evidence they were citing was on their side, and they were so wrong, it makes sense to start to question the quality of this evidence and the process by which this evidence is produced.
It turns out there is not only a general reproducibility crisis throughout prestigious research institutions but also a troubling amount of blatant fraud that often goes unpunished: Alzheimer’s research, psychology, etc.
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my (Dr. Marcia Angell) two decades as editor of The New England Journal of Medicine” (1).
More recently, Richard Horton, editor of The Lancet, wrote that “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness” (2).
These types of quotes make the critiques of MAHA reforms all the more ridiculous. If you listen to critics you’d think RFK Jr and current NIH director, Dr Jay Bhattacharya are trying to destroy biomedical research. This is ridiculous hyperbole. There are still ample public funds available for research and even if there were “devastating” cuts (they aren’t), private funding has become a larger and larger component of major biomedical research since 2000 coming close to matching it in 2025.
There is a larger epistemic reformation going on that makes the modest cuts trivially unimportant. Dr Bhattacharya is prioritizing reproducibility and allocating funding towards more ambitious research that doesn’t just incrementally move the needle within a certain point of view or focus on politically motivated DEI initiatives and other left leaning pet projects. They are not destroying research. They’re allocating resources in such a way to produce research that is verifiably high quality and has high potential for greater impact. Will they succeed? Maybe, maybe not, but the status quo is suboptimal and in some cases completely diseased.
Research can yield quite interesting and even revolutionary insights but this is rare. And even when there is breakthrough there is usually some substantial time lag between breakthrough and impact. More immediate actions have been taken by the admin that have nothing to do with medical science and might be more even more important.
Lifestyle, Lifestyle, Lifestyle
A cliche but nonetheless true is our medical system is “sick-care”, not health care. This is common knowledge. Our system is quite good at sick-care—post problem interventions— but very little federal effort has been put into going upstream and doing things that prevent problems that lead to the need for sick-care.
There also needs to be a disclaimer about the unhealthiness of Americans. Many Americans are healthy and some are extremely healthy. They eat well, exercise a lot, some take proper supplements to optimize, etc. Generally speaking, these are wealthier, educated people with higher incomes than the prototypical un-healthy American. At the lower end of the socio-economic (SE) hierarchy the compounding effect of choices and activities result in much higher levels of metabolic syndromes and chronic disease. They are more likely to make poor choices and depend on public services like Medicaid and if they make it to Medicare, can be quite costly users. These are the prototypical unhealthy Americans. Obviously there are unhealthy people throughout the SE distribution but the gradient is real and true.
The bad news is the unhealthy group are more likely to be net receivers of government benefits putting strains on our federal and state balance sheets. The good news is this means the State can take direct action to improve the situation and has incentive to do so. The recent inversion of the famous “food pyramid” is a long overdue change. HHS is now working with states who administer welfare programs like SNAP to bar its use for junk or “ultra-processed” foods, leaving the whole foods that HHS and USDA are recommending, available for SNAP beneficiaries.
HHS is also partnering with the US Department of Agriculture (USDA) on a joint program that swims way upstream of modern health issues that affect everyone. It’s a small program but it sets the stage for a large shift in our food production system. The program compensates farmers for experimenting with “regenerative farming”, a collection of practices designed to move us away from chemically dependent, yield maximizing monoculture towards an agricultural paradigm in which livestock and organic cycles drive the production of high-quality, nutrient-dense whole foods.
The gist of the theory is that the overproduction of single cash crops combined with the liberal use of chemical protections and optimizations have eroded soil quality. Unhealthy soil erodes the nutrient density of the yields while also contributing to negative side effects in the livestock that eat the crops and people, who eat both the crops and the livestock. Being less chemically dependent, diversification of crops, and incorporating livestock into the production process can yield healthier soil, healthier crops, healthier livestock, and healthier people.
This program will slightly increase the number of farms engaging in these practices and collect data on the efficacy and trade offs of this approach. This will not have a large, immediate impact but it sets the foundation for separating fact from fiction and rolling out larger changes in our food production system overtime.
MAHA is also attacking another pillar of lifestyle, physical fitness. After the sunsetting of the President’s Physical Fitness program during the Obama Admin, MAHA is working to reinstate the program introduced during JFK’s presidency. The aim is to get schools to reinvigorate their physical education programs, rewarding athletic excellence, and cultivating a lifestyle of physical exertion and development that may not be a priority of the household a particular child is in. Again, swimming way upstream of the potential health problems a young, inactive child would experience. In the same vein, they’re also working with the Department of Transportation (DOT) to set up workout areas and mini-gyms in airports to give people the opportunity to get some physical activity in before going on long bouts of inactivity. I haven’t seen plans for this but it would be awesome to see them expand this to rest stops on the interstate highway system. These are small gestures in the grand scheme of things but nonetheless a major cultural shift happens when a few large and many small things accumulate into a new zeitgeist.
Financial-care Not Health-care
The bulk of the discourse around “healthcare” is centered around a mis-framing. The healthcare we have in the United States is pretty good quality, relatively speaking. And no hospital or medical facility can legally turn someone down in a moment of need. The debate is about insurance, a financial product, and costs. Who gets covered, who pays, how much does it all cost, etc.
Again we have an asymmetry at the heart of this. A small minority of people are the core drivers of health care consumption. Much of this a combination of age, choice, and bad luck. Many could never pay the tab for their consumption.Others, healthier and wealthier, pick up the tab by paying premiums and taxes. Most people want to take care of these people or at least not let them hang out to dry. But this empathy is constrained by how much they feel like they’re getting squeezed.
The core achievement of the Obama administration was the Affordable Care Act. Again, this is a mis-framing. It expanded insurance coverage. It didn’t make health care or health insurance more affordable. For the overwhelming majority, it has become more expensive. The Expanded Coverage Act would be a charitable, more accurate renaming. The Unaffordable Insurance Act would be the uncharitable but also more accurate renaming.
Federal action designed to improve the affordability of insurance and healthcare services more generally, has to focus on pushing out programs and policies that decrease demand and increase supply. Simple but hard. The two most effective levers, at scale, are incentives and technologies.
We want to decrease the demand for medical resources. We need people to live healthier lifestyles, pay providers for outcomes not activity, punish fraud, and push hard into technologies that can improve health outcomes and delivery. HHS, through various departments and initiatives is doing all of this.
We also want to increase the supply and accessibility of medical resources at the same time. Regulatory reform can move the needle here. The FDA is at the center of this reform.
acc/FDA
The FDA is the key gatekeeper of medical technologies. Devices, therapeutics, and biologics, all need to pass through their gates for approval and adoption. Like the NIH, the FDA is undergoing an epistemic reformation that can unlock and dramatically speed up the proliferation of advanced technologies and treatments.
Since the ‘60s the FDA has been under the Randomized Control Trial (RCT) standard. The FDA is not throwing it out but acknowledging sometimes certain methodologies are not universally applicable nor warranted for everything. Plus, we now have advanced tooling that the agency can take advantage of.
The genomics revolution severely reduces the need for large, expensive, time consuming RCTs. We can now isolate only those patients with the specific genetic mutations a drug targets. This drastically lowers the number of participants (noise) required for statistical proof while increasing a study’s signal. It also enables the use of digital twin studies and “plausible mechanism” pathways for approval. Some diseases are rare, making large RCTs prohibitively expensive and in some cases, impossible.
This reformation opens the spigots, increasing medical resources, competition, and innovation to flow into the medical system.
In addition, the FDA is getting prepared to offer new frameworks for handling the continued rise of robotics and the introduction of Agentic AI in healthcare. We expect the same pattern of applying different methodologies to assess different use cases while moving at high velocity.
Stacking Up Small but Significant Wins, is Big
I’ve covered some of the larger structural shifts but there are a lot of “smaller” wins that have accumulated over the last year. Getting major food companies to commit to removing food dyes, artificial flavors, and high fructose corn syrup. Ending “generally recognized as safe” status for dozens of additives, forcing manufacturers to prove safety. Renewed scrutiny on infant formula. Reducing the number of vaccines and dosage recommended for children, moving us closer to the developed world’s medical consensus. Increasing the regulatory scrutiny on phthalates, chemicals highly associated with endocrine disruption and negative reproductive impacts. Putting this all together means much less synthetic material is imposing health risks on the population. This is a big win.
Kennedy
A through-line of RFK Jr’s general orientation towards health and wellness is holism. When you actually listen, he’s not a one trick pony who myopically cares about vaccines. That’s a gross caricature created by a maniacally hostile media. That person doesn’t actually exist. He’s interested in the entirety of what contributes to or desecrates health. His rhetoric is wide ranging, commenting on agricultural practices, nutrition, exercise, regulatory capture, new technologies, and even spiritual well-being.
Kennedy’s philosophy, and the MAHA movement more generally, seeks to re-embed ancient wisdom into the highest levels of our bio-medical infrastructure. In ancient Greece and Rome, the Cult of Asclepius served as the dominant “health-care” institution. Their healing facilities—Asclepieia— were the ancient equivalent of a structure in which a hospital, church, and gymnasium were integrated into one coherent entity. The division between lifestyle, medical intervention, and spiritual practice was virtually non-existent. MAHA is bringing this holism back in a modern context.
Paleo-futurism is ascendant.
