American doctors have lost their Mount Olympus of medicine

The other day I was talking to one of my patients about her vaccinations, and I noticed that she hadn’t had a COVID-19 vaccine since the early days of the pandemic. “The virus has changed so much since then,” I told her, “so we recommend that you get the current vaccine…”

And then I stopped dead in my tracks, the words “we recommend” lingering in the air. This is how I’d always phrased these types of recommendations, but I was suddenly unsure of who the “we” was. Up until recently, it meant a medical community that included not just my health care colleagues, but also the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, respected medical journals and the research community. It’s not remotely feasible for practicing clinicians to review every medical study out there, so we rely on trusted colleagues and institutions with the relevant expertise to help guide us.

The “we” suddenly rang hollow. The institutions I trusted to be deliberative and evidence-based sources of knowledge that extend my medical abilities are no longer that. In the first Trump administration, despite relentless attacks from the president, the nation’s public health institutions remained largely intact, if wearied. But the plunder of the second Trump administration has disemboweled them and installed fox-guarding-the-henhouse leadership. Medical professionals can no longer fully trust federal health guidance, and our patients are the ones who will suffer the most.

For most of my colleagues and me, the CDC and the NIH were the medical Mount Olympus, the towering pillars of medical authority. Contrary to right-wing portrayals, these were not dictatorial authorities. These were earned authorities, comprising our best, brightest and most dedicated peers. The formidable talents of these doctors and scientists would have commanded enviable salaries had they taken jobs in industry, but they chose the public sector instead — something that we clinicians were forever grateful for.

Were there egos, missteps and shortcomings? Sure. But by and large, the people I met who worked for the CDC or NIH were brilliant and rigorous, and cared passionately about the science they were pursuing. While there are some doctors who viewed our public health institutions with disdain —some of them now are running these very organizations — most practicing physicians relied heavily on them to deliver the best care possible to their patients, despite occasional quibbles.

What a relief, I always felt, that there were people organizing the things I can’t do — testing new treatments, conducting population studies, keeping tabs on worldwide diseases, issuing guidelines and more.

But now that support is a shell of what it once was. I can no longer automatically rely on these institutions because their scientific North Star, even if imperfect at times, has been replaced by one that seems nakedly political. Remaining staffs are no doubt working valiantly to do their jobs, but they are hobbled by loss of colleagues, resources and reliable leadership. So when I hear that the CDC has changed a vaccine recommendation, I now question whether that’s a recommendation I can trust. When the F.D.A. commissioner says he wants to change how the agency approves or rejects new treatments, I no longer feel sure that science is driving those decisions. It’s hard to convey how profoundly grieved my colleagues and I feel.

The rapid-fire evisceration of our public health institutions initially baffled me. I couldn’t figure out why anyone would support moves that weakened America’s medical enterprise and dissuaded the top minds here and abroad from joining these institutions. Don’t they want the most advanced treatments when their mother gets cancer? But Robert F Kennedy Jr.’s view seems to be that we doctors are shills for corporate interests and government bureaucrats, and that torching our vaunted institutions is the prescription to fix us.

Kennedy’s ire seems oddly directed. I, too, am disgusted by the role of money in health care, but I see it more as a result of the system we’ve set up, rather than the people who labor within it. And the public seems to be able to make that distinction as well. Americans may be upset with how the system works and how much care costs, but most people say they are satisfied with their medical care. Most trust their doctors, even if that has declined slightly over the years. Nursing continues to top the list for most trusted profession.

Notably missing from Kennedy’s Make America Healthy Again agenda is any suggestion that we provide universal health care, as most other developed countries do. There is no push to expand Medicare and Medicaid, which help some of our sickest patients. There is no focus on expanding access to early childhood education and supplemental nutrition programs, which offer steep health benefits. In line with the thrust of most of the Trump administration’s actions and the outlines of Project 2025 is a barely concealed antipathy toward the people who are the engine of these institutions — doctors, scientists, policy wonks.

These attacks feel deeply personal for so many of us in health care. And of course, we are most pained about what this means for those we take care of. Cuts to infectious-disease surveillance means that outbreaks will almost certainly creep up more stealthily on our patients. Cuts to the National Center for Chronic Disease Prevention and Health Promotion means fewer resources for prevention of cancer, heart disease and diabetes — some of the leading causes of death. Cuts to the NIH and the FDA could drastically reduce the development and approval of new medical treatments. Add in cuts to injury-prevention research and patient safety programs, and it’s a prescription to make America sick again.

Every time you go to your doctor or get treated by a nurse, there’s a chorus of researchers, public health workers, policy experts, epidemiologists and advisory panels arrayed behind them, aided by laboratories, databases, websites, early-detection systems and clinical guidelines. Our current government seems determined to wrench this away, handicapping your health care team’s ability to care for you.

Professional medical groups might pick up some of the slack, but there’s no organization with sufficient heft or reach to replicate what the CDC, NIH, FDA and other institutions do. So many of our resources are now gone, and those that remain no longer feel trustworthy. Americans’ health will decline at the hands of our federal government. And there’s no vaccine for that.

(Danielle Ofri, a primary care doctor at Bellevue Hospital, is the author of “When We Do Harm: A Doctor Confronts Medical Error.”)

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