Who Knows Best? Experts Or You?
By
Leonard Zwelling
https://www.nytimes.com/2025/09/01/opinion/cdc-leaders-kennedy.html?searchResultPosition=1
It is no secret that Health and Human Services Secretary Robert F. Kennedy, Jr. has upended the system of public health, federal regulation, and biomedical research since his appointment by President Trump. A noted opponent of vaccines, Secretary Kennedy has cut funding and staffing at the NIH and lost, by resignation or firing, the entire leadership staff of the CDC. On top of this, the public health leadership in the state of Florida has eliminated mandatory vaccination, a state power established by the Supreme Court in 1905. In essence, Republican leadership under Trump is answering the question in the title of this blog. Where in the past the American people depended upon experts (see attached article), both in the government and out for their health information, now everyone is basically on his own. In a burst of libertarianism Trumpism has supplanted the wisdom of experts with a DIY approach to health care. Only you know what is best for your medical care and disease prevention despite the fact that the vast majority of Americans have not gone to medical school.
This is dangerous.
In our society, the professions are characterized by having a fiduciary relationship with the public. Doctors, lawyers, accountants, and members of the clergy, for example, are to be guided by doing what is best for those they serve regardless of political ideology. This is becoming obsolete thinking. Instead, you, and only you, decide what’s best for you. I guess each of us has to do his or her own research to determine whether or not to get vaccinated or to vaccinate our children. If the panel of expertise at the CDC that guided the CDC Director in matters of vaccine efficacy, safety and wisdom of deployment is now replaced by anti-vaccine ideologues and directors unqualified for the job, how can any American depend on such “experts”? They cannot. Perhaps the Surgeon General of Florida is right. Each person can decide whether or not he or she will get vaccinated for highly communicable diseases like measles despite the fact that this disease was functionally eradicated in the United States. Now it is making a comeback. What’s next? Polio?
The medical establishment–doctors, hospitals, and nurses–was always assumed to be looking out for the individual patient. Public health officials did the same for large populations. If the medical establishment has become infected with the drive for profit and the public health system has been seized by anti-vaxxers and political zealots, diseases will go untreated and infectious diseases thought to be in our rearview mirror will be gaining on us.
Congratulations Mr. Trump. You have managed to make America sicker, less apt to make crucial discoveries, and more susceptible to ideological nonsense spouted by the top health official in the federal government, including yourself.
And you managed to do all that in just eight months. Amazing!
Now if the leadership of the health delivery system in the state of Texas is also led by legislative egotists who also believe that they know what is best for the many universities in the state and who install in leadership roles inexperienced and unqualified people, there too the public will lose faith in the medical establishment and academic medicine will suffer without the research and education missions of the university systems.
We in medicine must insist on the advice and counsel of true experts, not because we are arrogant and think they know everything, but because it’s through the collective thinking of these experts that the best health care can be delivered to the citizens of Texas and the United States. It’s the fiduciary role of medicine to serve the patient and the public. This is what we do. It is what we have always done. We must resist the forces of ideological negativity and doubt and do our jobs. All of us.
