A few thoughts on RFK: I don't think the medical community at large understands how upset and disappointed people are with the current medical system: paternalism for the past 60 years, poor outcomes relative to expense, increasing chronic disease burden, and bureaucracy. I believe the medical community (physicians) deserve a portion of the blame for this. 

I am not surprised by the response to our medical system. It is not a new sentiment. During the 1960s and 1970s medicine’s public image took a beating. The infamous Ivan Illych penned a critique entitled “Medical Nemesis,” in which he stated, “Doctors contribute little to the health of populations, they probably did more harm than good.'' Berkeley political scientist, Aaron Wildavsky, made the claim in 1977 that “The marginal value of one–or one billion–dollars spent on medical care will be close to zero in improving health.” I share his sentiment, considering despite our efforts currently only 12% of Americans are without evidence for metabolic syndrome, which is characterized by high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The conclusions of these critics of the health care system are not surprising since it was the height of medical paternalism at a time when society was questioning our institutions while in the midst of Watergate and the Vietnam War.

Iraq, Afghanistan, GFC, Covid and we now find ourselves in a similar position, where Americans are not convinced of "first do no harm," and are seeking autonomy of choice above all else. However, in the prioritization of individual freedoms, the United States has socialized the responsibility for complications of those poor choices. If we are honest with ourselves, we have all succumbed to selectively ignoring the externalities of our poor choices. The only way to gain true freedom; to not be subject to or affected by (a particular undesirable thing), is to not have to rely on a third party in the first place. If freedom means a lack of outside influence on your autonomy, then by default there is an increase in personal responsibility for your choices. It is your freedom to eat whatever you want, to choose not to be active, but if these choices result in increased doctor visits, hospitalizations, more debt and symptoms that restrict your enjoyment in life, how truly free are you? Individual rights should not be inversely related to individual responsibility. 

In 1977, Dr John H Knowles, wrote “...This [sic: poor lifestyle choices] is justified as individual freedom–but one man's freedom in health is another man's shackles in taxes and insurance premiums. I believe the idea of a "right" to health should be replaced by the idea of an individual moral obligation to preserve one's own health–a public duty if you will.” Additionally, “the choice is individual responsibility or social failure [sic: plus individual failure]. Responsibility and duty must gain some degree of parity with right and freedom.”

RFKs biggest hurdle is not Big Pharma, it is behavior change and individual autonomy, and that hurdle is only overcome with empathy and understanding and NOT solely Dr. Science. Afterall, information alone does not change behavior. From the individual's perspective, a career contrarian is not a logical solution to the preservation of one's health – and as Dr Knowles so clearly elucidated, therein lies the rub – you as an individual have to live with your choices whose outcomes may not be known for years. But it is these choices that should be discussed with an empathetic ear and ultimately respected. 

 As a physician, do you largely agree that doctors have been taught by a captured regulatory system/university that promote medicine that treats the symptom and intentionally ignores the root problem?
Thats been my observation.
Perverse incentives/perverse outcomes.
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