If you aren’t worried about the fact that we’re seeing measles outbreaks and deaths, it’s probably because you haven’t thought much about how bad a disease measles really is.
Measles is literally the most contagious infectious disease known to man.
And even though for most people it’s a mild and self limited illness, measles has real risks for people who get infected.
Measles doesn’t just cause hospitalization and death—it has long-term, life-altering consequences.1
The other major reason that measles should make you worried is because of the longer term risks of more widespread infections:
Measles causes immune amnesia, which can get rid of the protection that you’ve developed against other diseases.2
A measles infection that initially seems harmless can have fatal consequences years (or decades) later if it causes subacute sclerosing panencephalitis, a progressive and uniformly fatal brain disease.3
And so while this isn’t the first measles outbreak that we’ve had - and I’m not suggesting that the current outbreaks are RFK’s fault - the perspective that our nation’s top public health official seems to be taking here is totally unserious
That’s a thoughtfully considered conclusion, not reflexive fear mongering - and I think that my two previous pieces on RFK (here and here) demonstrate that I’ve been pretty open minded about what kind of a public health leader he’s going to be.
I’ve come to think that RFK’s approach to measles is deeply unserious after watching his recent interviews on Fox News and reading most of his book on Anthony Fauci.
Let me explain why.
RFK is wrong about basic facts when it comes to measles
RFK is incorrect about way too many things to take what he says seriously.
He’s wrong about the way vaccine immunity wanes. He quotes 4.5% per year, but the actual number is closer to 0.4%.
He’s completely incorrect about the risks of vaccination. He says vaccination can cause all of the problems that measles causes, but that’s wrong for two reasons:
The measles vaccine has a robust safety track record and is way less risky than actually contracting measles. Risk of a serious consequence like encephalitis is orders of magnitude lower with vaccination than with infection.4
Getting vaccinated for measles doesn’t cause the immune amnesia that the measles virus causes. Because of the way that measles infection impacts immune memory, getting measles increases a child’s risk of developing many other infectious diseases.
He’s wrong about how to treat measles. He touts vitamin A as a miraculous treatment for measles, but a Cochrane review5 on the topic found that vitamin A is not useful in measles.
In the interview with Sean Hannity, RFK describes himself as a “freedom of choice person” who think that “we should have transparency” to allow people to make their own decisions.
So how are we to take the word seriously of someone who says , “we need to give them the best information” in order to make those choices but then gives us information that’s wildly incorrect?
RFK isn’t just misinformed—he refuses to learn. That makes him an unreliable voice in public health.
RFK’s theory of how to treat infectious diseases is too holistic and not reductionist enough
When I was reading RFK’s Fauci book, I was pretty struck by the way that RFK’s approach to Covid mirrored his comments about measles.
He talks a lot about the importance of good nutrition and of avoiding chronic disease, and that narrow point is true: people who are chronically unwell or malnourished are more likely to get really sick from an illness than people who aren’t.6
And he is totally correct that our public health officials should be working on policy and encouraging people to eat a nutritious diet, get regular exercise, sleep way, reduce stress, and maintain a healthy weight.
A holistic perspective is important for long term conditions that are multifactorial.
That means multifactorial conditions like diabetes, metabolic syndrome, and atherosclerosis are often better served with a holistic and integrative approach.
But I think that that’s the wrong perspective for treatment of acute illnesses - it’s actually too holistic and not reductionist enough.7
The modern medical system is really good at treating infections, trauma, heart attacks, strokes, and essentially all other acute illnesses, where a reductionist approach works well.
And so a discussion about chronic disease should be totally different than a discussion about measles.
Make it simple - vaccination is the best approach here, so we should emphasize that as being the best approach and not confuse people by discussing the risks of vaccination and the benefits of vitamin A.8
A corollary to the holistic vs. reductionist question - RFK is focused on modulating the immune system rather than specific antiviral treatments
In the Fauci book, RFK talks a lot about treating Covid.
He discusses hydroxychloroquine, vitamin D, ivermectin, remdesivir, mRNA vaccines, and zinc.
The thing that is in common with the treatments he supports (vitamin D, hydroxychloroquine, ivermectin, zinc) is that they module the function of the immune system.
He brings various mechanistic explanations about the way that these treatments help the immune system to fight Covid.
Similarly, he rails against the mRNA vaccines and remdesivir, which are both more directed approaches to prevention and treatment.
I think he demonstrates a consistent perspective with this - supporting the immune system is effective and safe while more medicalized/precise antiviral efforts are risky and bad.9
It’s a corollary to his holistic approach, and fits with the premise that he doesn’t really fully believe in germ theory.
And I think he’s wildly off base on this.
He’s not coming to this perspective armed with the best information, he’s coming to it with preconceived - and incorrect -notions about how the biology works.
RFK is making the same mistakes with anecdotes about acute measles treatment that many doctors made during Covid
At the beginning of the pandemic, we had no idea what worked in Covid and what didn’t, so we often relied on anecdotes and low quality data to make treatment decisions.
That’s why we started giving everyone hydroxychloroquine at the beginning of the pandemic.
It’s why Mount Sinai Hospital instituted a protocol to give full dose blood thinners to all patients hospitalized with Covid.
We didn’t realize until high quality randomized trials were conducted that these approaches didn’t help (and might even have hurt).
Making broad medical decisions based on anecdote or plausible biological mechanism is way more likely to be wrong than it is to be right.
So when I see quotes from RFK on the benefit of things like clarithromycin, budesonide, and cod liver oil to treat measles because of these anecdotal reports, I think that he’s making the same mistake that too many doctors made at the beginning of Covid - throwing stuff against the wall to see what sticks is probably going to be wrong.
It’s possible to be right about some things and wrong about others
RFK is totally right that chronic disease is an enormous problem in this country.10
But he’s wrong about the measles vaccine, the way to treat the disease, and much of what he says about infectious diseases in general.
And while returning our ways of eating and moving to what we did generations ago is probably a good thing, there’s something farcical about considering that as an important part of how you fight against an incredibly contagious viral infection.
The way that RFK tends to give very tentative support to measles vaccination in interviews is truly alarming to me - and I’m worried it’s going to mean a lot of dead children if his tune doesn’t change.
I’m supportive of the fight to reduce the burden of chronic disease but deeply alarmed about the way measles is being handled.
This is an unserious response to a serious problem - and even if things turn out ok it’s still quite alarming
Even though I don’t think that measles is about to spread in a way that immediately runs through the population, small changes in the number of people who get vaccinated will have a big impact over just a few years.
That’s why the tone of support for vaccination matters.
But more importantly, the way he’s treating measles is particularly unserious and pathetic from the perspective of someone who’s supposed to be a steward of public health.
RFK is acting like an activist pushing a single issue agenda to persuade the people in power to take action.
He’s not acting like the person in charge of safeguarding the public health, and it’s deeply unsettling.
If you want to do something simple, you don’t need that many tools in your toolbelt.
But when you want to do things that are really complex - like change the food system, inspire Americans to be healthy, and curtail the spread of a deadly infectious disease - you’re going to need a complex set of tools and you should be willing to use everything at your disposal.
The approach to measles so far seems to be deliberately avoiding using our strongest tool, which is encouraging the use of a safe, highly effective, and incredibly well studied vaccine.
And so when I say that RFK’s approach to measles is deeply unserious, I mean that very literally.
A public health official who truly felt a responsibility to the public health would treat the spread of this disease very differently.
Image having a platform like RFK does, seeing what’s happening with measles, having access to the best experts in the world, and then just spouting bullshit when you’re talking to an audience of millions.
It’s a deeply unserious response to a very serious situation.
And we’ve already started having reports about kids dying and people being hospitalized. The news right now is already quite alarming.
That is just an additional reason why “natural immunity” to measles, which RFK has touted as being being better than vaccination, is actually worse than immunity developed from vaccination.
I previously discussed a case of SSPE that I saw during residency in a previous RFK post. It was absolutely tragic, a normal and healthy young woman who had measles as a child developed this problem shortly into her first pregnancy. She had progressive neurologic decline, and essentially ended up braindead within months.
We don’t know enough about the true incidence of SSPE, which has been estimated to occur somewhere in somewhere between 2/10,000 and 1/600 cases, but it’s such a tragic outcome, that the devastation from this may be profound even if it’s quite rare.
The MMR vaccine has been studied deeply for decades. Its safety track record (both short and long term) is something that we can feel really confident about. You can contrast that with the Covid mRNA vaccines, which had way less safety and efficacy data when they came out.
Considered the gold standard for evaluation of the scientific literature.
That’s part of the reason why vitamin A seems to be effective in treating measles in countries with significant malnutrition but doesn’t seem to work well in the developed world.
You can contrast this approach with the approach much of our public health establishment took during Covid, which could be summarized as “do anything, no matter how disruptive to society, to reduce transmission of SARS-CoV-2.” And while I understand the impulse of folks who are critical of the Covid public health response to want to see the opposite as better, I think that in the case of measles, it is a deeply misguided perspective.
Being healthy - getting exercise, eating a balanced diet, sleeping enough, etc - is important. But encouraging vaccination doesn’t mean discouraging healthy behaviors. And especially when a vaccine has the safety track record that the MMR vaccine has, it makes the both/and approach an easy call.
Consistent doesn’t mean correct.
I think he’s also probably right that food stamps shouldn’t be allowed to be used to buy soda. And it’s possible he’s right about seed oils, or food coloring/additives. Although I doubt that cooking our fries in beef tallow and removing red 40 from the food supply is going to move the needle on chronic disease in any significant way.