OPINION:
I am a supporter of Health and Human Services Secretary Robert F. Kennedy Jr.’s Make America Healthy Again (MAHA) movement. However, the recent MAHA Commission report is a disappointment — but not for the reasons most critics are now harping on.
A few weeks ago, the MAHA Commission released its much-ballyhooed report. The 72-page document focuses on four major threats to children’s health: ultra-processed foods, cumulative exposure to toxic chemicals, effects of digital age behaviors (especially the decline in physical activity) and overmedication, in particular, vaccinations.
The final section looks at two steps to help address these issues. First, it calls for closing existing research gaps through large, randomized, placebo-controlled clinical trials. Second, it advocates for a national strategy for children’s health.
As a father of two young girls and the CEO of a health-related company, there is a lot to like in the report. I share the concern about the pesticides used to grow the foods we eat. I worry that ultra-processed foods are engineered to be addictive — there is a reason you can’t eat just one Dorito. I’m concerned about the vast amounts of screen time our kids are exposed to. I’m disturbed by how many drugs have very little data to support their safety and efficacy.
Nevertheless, critics have jumped on the report. Some argue that there is no evidence that vaccines cause increasing rates of obesity, diabetes or autism. Agricultural interests have criticized the report’s focus on pesticides. Others say the report’s food section fails to address the excessive use of salt and the inadequate consumption of healthy foods, like fruits and vegetables.
My concerns with the report are different.
First, its failure to address hygiene is a major missed opportunity. “An ounce of prevention is worth a pound of cure,” after all. Hygiene — behaviors done to improve health and reduce the risks of disease — puts that wisdom into practice. We are foolish to overlook the value of basic hygiene: washing our hands, brushing our teeth, cleaning our noses and the like.
Indeed, hygiene is the most important tool for addressing the sorts of health risks Mr. Kennedy is focused on. For example, a 2018 study determined that people who brush their teeth less fewer than two times a day for less than two minutes had a three-fold increased risk of heart attack, heart failure or stroke. Studies also show that daily flossing can add up to 6.4 years to a person’s lifespan.
According to the Centers for Disease Control and Prevention, “Handwashing can prevent about 30% of diarrhea-related sicknesses and about 20% of respiratory infections (e.g., colds).” Hand hygiene is particularly important in keeping kids healthier — daycare and school classes are proverbial Petrie dishes.
Nasal hygiene, which is often overlooked, is also an important prevention tool. For example, a 2024 controlled clinical study published by Lancet found that the use of a saline nasal spray significantly reduced the rate of all respiratory infections, from the flu to COVID-19, reduced the number of days of illness.
Most importantly, by preventing all sorts of diseases, hygiene has been shown to significantly decrease the use of antibiotics. Antimicrobial resistance (AMR), which is the growing number of pathogens impervious to existing antibiotics, is one of the most significant health risks we face. AMR results in over 35,000 deaths in the U.S. each year — and that number is growing. Until we can find new ways to fight these pathogens, it is vital that we reduce our over-reliance on antibiotics. Improved hygiene is perhaps the best tool we currently have to address this threat.
The MAHA report’s failure to emphasize the need for better hygiene is a critical missed opportunity.
Second, while I recognize the importance of scientific research, I am concerned that the report over-emphasizes the role of large, randomized, controlled clinical trials (RCTs).
While most in the medical and scientific communities consider RCTs the “gold standard,” there is a growing movement to look beyond just RCTs. RCTs are expensive and time consuming. As a result, they are impractical in the face of rapidly emerging serious threats, as we saw with COVID-19. Their use with deadly pathogens also raises serious ethical issues. Moreover, because RCTs don’t test under real world conditions and with real world populations, they often produce results that cannot be replicated in true clinical settings.
Lastly, because only Big Pharma can easily afford RCTs, over-emphasizing them actually increases our dependence on Big Pharma drugs and significantly impedes health innovation. In other words, over-emphasizing RCTs can actually undermine Mr. Kennedy’s effort to reduce our over-reliance on Big Pharma drugs.
Among scientists, there is an adage: There is no clinical evidence that parachutes work. Which is to say, while RCT studies should play a large role in determining in guiding health care policy and medicine, other sources of data, such as real-world evidence, should also play a key role. Here, too, the report’s focus on RCTs as the gold standard is a missed opportunity to bring a greater focus on prevention, efficiency and innovation to American health care.
All that said, the MAHA report is not the final word on either children’s health or American public health in general. It is my sincere hope that as Mr. Kennedy continues to move the focus of our health care policies away from expensive drugs and toward prevention and health, further opportunities for greater progress will not be missed.
• Nathan Jones, a leading figure in the natural health industry, has spent more than two decades dedicated to discovering effective ingredients in oral and nasal hygiene, American health care reform and the benefits of xylitol. He is the founder and president of Xlear Inc., (xlearproactive.com), the leading manufacturer of xylitol-based products in North America.
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