How pediatricians became afraid to stand up to RFK Jr.

Following the Senate confirmation hearings of Robert F. Kennedy Jr. for the head of Health and Human Services, medical community members rebuked the American Academy of Pediatrics for not opposing the nomination, which was approved in a purely partisan vote.   

If there is one covenant that binds pediatricians, it is the belief that vaccination is one of our most powerful tools for protecting the health of our children. Pediatrics is also rooted in other public health preventative strategies, including the belief that all children deserve healthcare. It supports essential preventative measures, including fluoridation, to prevent children's teeth from rotting.

Several of these tenets have been opposed by RFK Jr. Yet, why did the American Academy of Pediatrics shy away from taking a stance when other organizations, including the American Public Health Association, spoke forcefully?

The answer is that many pediatricians, like other physicians, are now afraid.

The American Academy of Pediatrics is an organization with more than 67,000 members. The decision not to oppose the RFK Jr. nomination was not made by a vote of members but by its executive and administrative leadership.

The reaction to this position was swift and vicious, with the academy being called “cowardly” and members threatening to cancel or not renew their membership. This issue, though, transcends cowardice. Instead, it reflects a fear of speaking out and retribution that now grips American medicine.

In my early years of medical school, we were shown the rankings of the most trusted professions in America. Physicians ranked first by far, a fact impressed upon us so we would realize the importance of our calling.

The field of medicine has blossomed through biomedical research, sharing discoveries, collective wisdom in developing treatment standards and identifying needed new directions. Medicine has shaped the training and conduct of physicians through standards for medical education, accreditation boards and credentialing panels.  

Until recently, medicine, regulated itself without regard to politicians. But during the pandemic, we saw dramatic shifts in medicine.

As politics elbowed its way into the pandemic response, respect for the physician fell and the scientific expert was discredited. We also saw the rise of non-mainstream and potentially harmful treatments, such as hydroxychloroquine and ivermectin.

In the past, if a physician deviated from mainstream medical practice or publicly advocated for ineffective and potentially dangerous treatments, they would be brought to the attention of state or hospital medical boards, which could take disciplinary action.

But now, to protect the voices of fringe physicians that satisfy a political agenda, laws have been passed in some states allowing physicians to make false statements and advocate for false practices without consequence. Furthermore, if a medical or credentialing board attempts to take corrective action, that entity could be subject to repercussions.   

Showing the rise of viewpoints that are the antithesis of modern medicine, the anti-vaccine movement has gained favor by hitching itself to the Republican Party. Over medical and public health opposition, we see the anti-vaccine movement sponsor legislation to dismantle one of the greatest public health successes, the vaccination of school-age children. Pediatricians also need to spend more time with vaccine counseling than before.   

As we observe the spillover effect of anti-vaccine viewpoints leading to reduced immunization rates, we see outbreaks of vaccine-preventable illnesses, including measles and whooping cough (pertussis), to which the Centers for Disease Control and Prevention will help local authorities respond.

In Texas now, there is an expanding measles outbreak. Typically, CDC sends field staff to the site to work with local public health personnel to control measles outbreaks. Yet, the federal response to this outbreak has been limited to shipping additional vaccines, and more than 700 CDC personnel were fired over the past week.

Of concern, whereas this outbreak has had widespread media coverage, there have not been recent public comments by either RFK Jr. or the CDC about this outbreak.

Continuing the political attack on medicine, we see the axing of the biomedical research infrastructure through drastic cuts to NIH funding and communication bans for the CDC. We see the removal of the financing for programs that combat serious illnesses, like HIV, and the isolation of the U.S. from global public health.

Despite hurting children, we saw the hasty freezing of federal funds earmarked for Head Start programs and programs that allow hungry children to receive meals in schools.

ICE raids also have an impact on pediatric care. Previously regarded as protected space, hospitals now draft policies for how to respond to ICE raids. Individuals are avoiding healthcare out of fear of government raids. Physicians now question what they can write in the social history, which is part of standard medical encounter documentation, fearing that noting a patient is an undocumented immigrant could lead to their deportation.

Contextually, the changes affecting medicine are just one part of the colossal changes our country is seeing. It is now recognized that our sense of community, our moral compass and our intrinsic kindness and decency are being supplanted by meanness.

How does this avalanche of change affect the pediatrician who spends their day protecting and treating children? We now see fear in the practice of medicine, fear that our opinion is not respected and long-standing and validated medical practices are being trashed.

We fear the medical community can no longer regulate itself to the detriment of high-standard healthcare. We fear the overt threat that the purse strings of medicine and health care are being squeezed with more than $880 billion in cuts to Medicare and Medicaid being considered in Congress. 

There was a time when the American Academy of Pediatrics publicly stood against policies it thought were harmful to children and families. The academy publicly decried family separation at the border. It advocated Medicaid expansion for groups in need. It has forcefully advocated for vaccination and fluoridation.  

But we recently saw a strong part of pediatrics' moral voice muted. Why was an organization that has advocated for children since 1930 afraid to take a stand against RFK Jr., who is now confirmed? What will happen when we do not stand up for those without a voice?  

We are already seeing some answers now. 

Scott A. Rivkees, M.D., is a pediatrician and professor of practice at the Brown School of Public Health. He is the Florida's former state surgeon general and secretary of health.