Public Health owns its Problem

Atlantic July 2025.

John Tierney wrote an article regarding discredited Public Health institutions.

I will present his argument in a shortened and edited format and then add some of my thoughts generated from an article that actually is touching on several cultural shifts within our country. He makes a valid point…..Public health owns some of its lost reputation.

In 1976 I was told clearly, in a lecture hall at UCLA’s school of medicine that I would live to see a devastating plague, like the 1918 Flu pandemic. I should be prepared as it was for many doctors of the time, unprecedented.

Fast forward to post 9/11—the local public health department put on an-all day teaching exercise with a “what if….scenario.”  What if an Evergreen College student worked at an archeological dig in Egypt came back to classes in the Fall and then developed a fever, and then a rash (just for the fun of the exercise, the rash came two days after the fever and visit to the ER) consistent with Smallpox? The scenario was one of  bioterrorism. My learning was that Public Health Officers in such a crisis have dictatorial powers over the region they are responsible for: as in enforcing stay at home (or on campus) policies, blocking freeway access in and out of the city, bringing in the National Guard. I was told my workplace (Group Health, serving 40,000 patients) would be the perfect place to hospitalize small pox patients as the hospital could not be a site of contamination given its other missions……..

Public Health formally ie through Government and regulation has always had an unusual amount of power based on the experience of the flu epidemic of 1918-1919, the organized focus around fighting problems generated by WWII, and no real reform of those mind sets in a century.

I was prepared for the power displayed by the unprecedented guideline to stay at home during covid. This is the scenario that John Tierney starts with in this article, and he points out that the Black Lives Matter protests following the murder of George Floyd found 1200 academics signing a petition to allow protests as a matter of public health ie protesting racism had health implications long term that over-rode the short term concern of a national plague. This petition went out when 50 states all had some version of prohibiting close gatherings. Put another way, you could protest in mobs with the blessing of some but could not take your kids to the park or go to a funeral……or church……or in some cases, work.

The academics had no standing with official public health institutions like the CDC; they simply were signing a petition of their private opinions. And yet, “they” is “them” associated with the thinking that advanced Public Health.

Conservatives took issue with this precedent which was in fact, based on ideology, and with it, such topics as fluoridation and vaccination were again on the table and now even more suspect by those who never believed in this version of public health.  Their argument: the libs corrupted the Public Health concept with politics and now they,  the “Right” have used the precedent to serve their ends and point of view. Public Health is not held with the respect it deserves and I agree with the thesis that largely speaking, public health’s scope has expanded to the point that science and ideology are in conflict. The author claims they have been in conflict for awhile. His argument:

Infectious diseases affecting public health were eliminated through civic engineering (sewage systems, safe water) and medical advances (vaccinations and elimination of environments that bred disease (yellow fever, born by mosquitoes was a plague during revolutionary times in Philadelphia—it is now a tropical disease). This success lead to leaders in public health to look for new targets with the population and causes of death and morbidity (non deadly health problems) in mind. Cigarette smoking was identified—an easy target, right?  As acceptance that tobacco smoking caused lung cancers became more and more accepted, the non-infectious nature lead to conflict on how much power to confer on public health entities. The president of the American Cancer Society giving testimony to congress did not believe smoking should be illegal—that people should choose for themselves.

Model of targets over time came to view firearms, domestic abuse, as well as tobacco as targets to be managed and overcome. Momentum built and the “deep state” of public health thinking (in official roles as well as academic roles) began thinking more broadly: making green energy, child care, transgender rights, as well as racism as being relevant to public health.  In a sense, the term, “Public Health” got hijacked by people with strong ideological principles in the same way the American flag and the word, “patriotism” got hijacked by MAGA with the ideological biases that make the  relationship of these things to our past pretty tenuous.

The credibility of health care institutions advocating for social justice when historically their mission was to overcome nature was lost. People, “wack jobs” with complicated folk wisdom views of our healthy suddenly gained credibility by having criticized the old along with the new version of Public Health. Fluoridation? Covid Vaccines? Childhood vaccines? Cancer treatments?

The author points out other failures: The food pyramid: the government advanced advice on a proper diet in the 1980’s. I went to an anti aging class where this was discussed and the speaker pointed out, “This is the diet you would feed pigs to fatten them up for market.”

People following this advice (that’s an hypothesis untested—-when did any of us slavishly follow the government’s advice consistently?) or at least living in the following decades saw an upsurge in obesity and type II diabetes. Robert F Kennedy loves this point re the system letting us all down.

Low salt diets were advocated to the general population when there is no evidence it changes much.

Second hand smoke was cited as a scourge and a source of lung cancer. There is no science to reliably confirm this point of view—it is a hypothesis. People smoking in public gave a subliminal message that it was, “OK” and should be forbidden. Controlling subliminal messages is not normal Public Health

Vaping: The author suggests that it is at least 95% safer as a nicotine delivery system than actually smoking and yet you would not know it by the publicity and propaganda that surrounds it.There is little concrete study to answer that question.  If RFK Jr. makes crazy claims about vaccines hurting people, with no credible science to back it up, how is that different than this danger of vaping argument.

And then there was Coronavirus……the coronavirus issue went through stages but he focusses on a point early: The CDC and other medical establishment authorities had a plan for the next “flu” crisis. Their initial response followed the plan and yet, the reports of healthy people dying, ICU’s full of ventilated patients all over the world, and the Chinese assertion that they had controlled spread by a lockdown led to a reversal: our authorities followed the Chinese lead.  The author asks, “Why would you do that without data and evidence to back it up?”  He goes on to point out that different countries tried different approaches and that Sweden, criticized for a “loose’ approach has commendable statistic 5 years out. All the noise: school closures, business closures and limitations, enforcement headaches, and of course, Black Lives Matter rendered science irrelevant even to those who understood it in the first place.  The CDC demonstrated the administrative version of Joe Biden’s Debate Performance: well intended, lots of experience, some good points but in the end unintelligible with terrible optics.

Some thoughts:

I can forgive indecision during the initial year of Covid, when there was so much on the line and so little information. What became evident to me with time was how cumbersome the representatives giving guidance looked ie the CDC: stilted odd communications without depth or connection. Of course, there was President Trump who was contradicting them openly pandering to those who want to believe whatever he said—but there was no effective counter with a face. Drs. Birx and Fauci tried but often sounded (to me) like they were speaking to peers and not the public. Over time and with perspective on different approaches, especially as the vaccine rolled out, a much less conservative approach could have easily been projected as “reasonable” and for the doubting, “with unclear but not extraordinary risk” as school closures, public gatherings, and so on were considered.  A scared public owns some of this as well: People walking by themselves outdoors masked vs the bikers in the Dakotas starting their own mini epidemic by refusing to mask when in tight groups.

Compared to the days when Covid was new, it is now a whole new war. Consider fighting fire with fire: RFK has no scientific much less medical background. He does not believe in Germ theory! Healthy Children don’t get sick or die….of anything!  He mischaracterized or lies in an obvious manner when making his points especially when citing authorities or studies.  I tried this when writing to my nephew, ex army, who celebrated ascension (and the the intent) of RFK Jr.  My approach: “The military is in your wheel house.  Medicine is in my wheelhouse.  RFK is a wack-job who is not saying anything that makes sense, well intended as he may be. He is as wacky to me as if I were to say to you: You know how veterans suffer from PTSD and suicide? And how experts think this is a complex psychological problem stemming from emotional trauma in their service requiring drugs and therapist? Bullshit! They have it wrong, the problem is brass. Bullets have brass cartridges and all recruits handle them, those in combat even more! It is exposure to brass that brings on PTSD! We have to eliminate brass from the arms industry……”

With the larger criticism of this article in mind, and having worked for a large organization constantly trying to reinvent itself, I found the Public Health system’s need to branch out for new work/issues/conceptual frameworks very familiar. It is a dilemma: If you don’t constantly try to improve, how can significant advancements be made? If you are conservative in the sense of being satisfied with the wins (we got infections controlled and only need to monitor that)—joined with, “Let’s go slow on behaviors as this crosses into political and behavior territory way too complex to manage from our “wheelhouse”. The author from the Atlantic offers a  suggestion: experience humility and reject hubris. Let the science take you where it will and if it is uncomfortable, get over it—but present it. In our world with easy access to any opinion you could want to scratch your health need itch, I am not sure his answer is enough—though I agree it is foundational. The public and legislature need to have an open mind if information gathering is being done (Congress prohibited the CDC from pursuing gun deaths as a public health issue decades ago). I am reminded of a pediatrician years ago expressing frustration about the work that went into educating parents about a proper diet and realizing that Madison Ave was eating him for breakfast. With no help from a Congress who, as with guns, might, in crazy times,  prohibit contrary research to Count Chocula and his friends.

Lastly, for all of us: I got a C grade in medical school statistics. While I can’t run the equations and have forgotten the terms, I have a sense for statistics that are needed if you want to understand not just medicine, but the modern world.  We live in a very complex social and physical environment and if you don’t use statistical based thinking, you will come to bad conclusions and make bad decisions—like buying an arsenal because murder is rampant in the news and on social media but in fact, the reported statistics show it is down and continuing to trend down.  Like driving in cars, the risk of dying from gunshots is lower than it was, statistically thinking, for our parents. Translating statistical thinking into plain talk with obvious conclusions and next steps is no small thing.  Someone out there knows how to do it. I did it when I explained pros and cons of getting vaccines, taking hormones, considering elective surgery,

or training for first a marathon at age 60. I would sure like to see it in action on social media and network news coverage!