Oxman is an intensive care physician and associate professor of medicine.
It was one of the more memorable images of the COVID pandemic. Anthony Fauci, MD, a prominent member of the White House COVID task force and director of the National Institute of Allergy and Infectious Diseases, stands at the back of the White House briefing room dais during a press conference. Unexpectedly, President Donald Trump diverts the conversation from COVID towards grievances about the so-called "deep state." Fauci fidgets and then -- just for a second -- lets the mask of the apolitical civil servant drop while he covers his face with the palm of his hand.
The so-called "Fauci facepalm" (immortalized in bobbleheads, T-shirts, and bumper stickers) immediately went viral. The pose summed up the frustration that so many of us in the medical field felt as we struggled to care for surges of COVID patients while being undermined by messaging from our political leaders. For Fauci, it was probably a momentary release -- a scream out of the window before collecting himself and going back to work.
Now, president-elect Trump appears to be signaling -- most notably by nominating Robert F. Kennedy Jr. (RFK Jr.) to head HHS -- that he plans to go further than occasionally grabbing the mic from his medical advisors. Rather, it seems that he sees undermining faith in mainstream science as part of his mandate. Yet sadly, leaders of American medicine -- like the major physician professional societies -- have not yet figured out what to do.
In RFK Jr., Trump nominated a man who has promoted theories that vaccines are linked to autism, that HIV is not the cause of AIDS, that antidepressants can lead to school shootings, and that fluoride may lower the IQ of American children. He also has ties to a film that suggested that COVID wasn't so spontaneous and might really have been a "plandemic," cooked up as a pretext to take away personal liberties. Commenting on RFK Jr.'s nomination, Peter Lurie, MD, MPH, president of the public advocacy group Center for Science in the Public Interest, pulled no punches: "Nominating an anti-vaxxer like Kennedy to HHS is like putting a flat Earther at the head of NASA."
Despite this stark reality, major medical societies -- like the American Medical Association (AMA), the American Academy of Pediatrics (AAP), and the American College of Physicians (ACP) -- are staying mum, or at most, issuing anodyne statements supporting the safety of vaccines while not mentioning RFK Jr. by name or failing to express specific concerns surrounding him.
Perhaps it's understandable that they are holding their fire. After all, like Amazon founder and Washington Post owner Jeff Bezos -- who conveniently changed the paper's policy on presidential endorsements days before the election -- medical organizations will have a lot of business coming in from the next Trump administration. And who knows how petty the retribution for speaking out could be: Cancellation of your NIH-sponsored research grant? A sudden change in Medicare reimbursement rates for physician services?
Medical societies are facing the dilemma other leaders of civil society wrestled with during the first Trump administration. Object too much and get cast out -- stripped of your influence and watching from the sidelines, unable to mitigate harm. But be too quiet, and risk facilitating the problem.
Perhaps our medical and science leaders have it right, and it won't be so bad. Maybe, if confirmed, RFK Jr. won't do half the crazy things his comments suggest he might. Or perhaps he will try, but will just be too ineffective to have much impact.
But the problem with holding your fire for too long is you risk being overrun. Stopping the damage that an anti-science conspiracist would cause by becoming the most powerful administrator in American medicine requires immediate and forceful action to head him off at the pass.
Standing at the back of the platform -- doing our work in the background despite the chaos at the forefront -- and occasionally self-soothing with a facepalm -- is not a strategy. Fauci only had to endure 10 more months before the 2020 election restored sanity. We are in for a much longer ride, and something tells me doctors need to strike a different pose.