By Chloe Nazra Lee, MD, MPH

"Olivia, my eldest daughter, caught measles when she was 7 years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn't do anything.

'Are you feeling all right?' I asked her.

'I feel all sleepy,' she said.

In an hour, she was unconscious. In 12 hours she was dead." -- Roald Dahl on the death of his daughter to measles in the 1960s.

"I see somebody on a hiking trail carrying a little baby and I say to him, better not get them vaccinated," -- Robert F. Kennedy Jr. (2021)

Reckless Ideology Has Consequences

In a stunning shift in his usual messaging, HHS secretary Kennedy penned an op-ed, also posted on the HHS website, promoting the role of immunization with the measles, mumps, and rubella (MMR) vaccine. He cited the measles outbreak in Texas that resulted in the death of an unvaccinated school-age child as a "call to action for all of us to reaffirm our commitment to public health." Since the op-ed was published, an unvaccinated adult in New Mexico tested positive for the measles virus after their death, but the cause has not yet been determined.

While Kennedy still emphasizes parental choice -- caging his position as mere concern about transparency and vaccine safety -- he actually acknowledges vaccine efficacy and herd immunity.

This feels like an attempt to preclude bad PR after a preventable death, especially when we consider Kennedy's history of anti-medicine misinformation -- and considering the fact that mere days ago, he dismissed the outbreak as "not unusual." Up until recently, Kennedy had no problem spouting misinformation from a national platform, undermining the medical community and disrupting our work, as the current administration appears to be acting on the culture of anti-intellectualism that is insidiously pervading our society.

Since President Trump's second term commenced, we have withdrawn from the World Health Organization, inexplicably canceled the FDA's annual meeting to update next season's flu vaccine, indefinitely postponed the February meeting of the Advisory Committee on Immunization Practices, and spent inordinate amounts of time perseverating over what terms are considered unacceptable in CDC publications.

Though he argues he is not anti-vaccine, the bulk of Kennedy's statements and actions seem to indicate otherwise. Extensive reporting has recounted Kennedy's dismissal of vaccines and claims that they cause autism, speculation that HIV does not cause AIDS, and false claims linking SSRIs and mass shootings. Yet, Kennedy was still confirmed as head of HHS.

Ideology at Patients' Expense

Many of us in the medical community worry that Kennedy's 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 immunization 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. For instance, Ladapo, a vocal supporter of hydroxychloroquine to treat COVID-19 and apparent skeptic of COVID vaccine safety, allegedly altered data from a state-driven study on the vaccine to inflate the risk of cardiac complications for young men. A medical professional in a leadership position allegedly engaged in scientific fraud to produce an outcome that suited his beliefs. This is dangerous.

There are many instances of people prioritizing ideology over evidence-based medicine to their detriment -- and even at their children's expense.

"Wellness warrior" Jessica Ainscough offers one tragic case. After trying chemotherapy initially for epithelioid sarcoma, Ainscough rejected further recommended medical treatment in favor of Gerson Therapy, an non-evidence-based alternative treatment predicated on the belief that cancer can be cured with healthy food, nutritional supplements, and enemas. She died 7 years after diagnosis. A character in the new Netflix mini-series Apple Cider Vinegar is loosely based on Ainscough.

In another instance, college professor Rita Swan, PhD, lost her toddler son to bacterial meningitis after she and her husband, then devout Christian Scientists, declined to pursue immediate medical intervention due to the influence of their church. Deeply regretful and furious with the church, Swan became a prominent advocate against religious restrictions on medical care. Swan later co-authored a seminal 1988 paper examining pediatric fatalities where parents deliberately withheld medical care for religious reasons. The authors concluded that all but three would have benefited from clinical intervention, and 140 of the 172 deaths resulted from illnesses with a >90% chance of survival with medical treatment.

Is it reasonable or right to expect children to bear the consequences of their parents' and politicians' devotion to ideology over medical evidence?

Stop Politicizing Our Jobs

Vaccines should never have been politicized.

To be perfectly clear: I am neither blue nor red; I stand for whatever I believe is ethical, safe, and well-informed.

This climate is anything but. Pompous, uninformed bluster and proud ignorance based on ideology, not evidence, are running our country at the expense of innocent lives. With all the thoughtfulness of Billy McFarland's Fyre Festival, politicians on both sides of the aisle push ideology as fact, becoming more extreme, and put 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.

These labels undermine doctors' credibility by eliciting extreme emotional responses. With these labels, I and other physicians 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.

Chloe Nazra Lee, MD, MPH, is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York.