Robert F. Kennedy Jr. will likely be the next Secretary of Health and Human Services. He has said things that are not true about vaccines, autism, raw milk, and more that we do not have to list here. Furthermore, I do not want to waste time with facts about his opinions. The health professionals who are reading this essay already know that RFK Jr.’s opinions are not supported by facts.

If there is one thing that we learned during the pandemic, citing facts did not help us when we were talking to folks who did not believe in facts. Our problem today is to decide how we are going to deal with the damage that RFK Jr. is likely to cause. During the pandemic, I thought that if each of us talked to our patients with our practiced ability to communicate, we would be able to counter the misinformation that they were hearing. It turned out to be harder than I thought because the misinformation was being spread by top officials and by the president of the United States. The authority that their status afforded them suggested that their lies were believable. We learned that lies spread faster than the truth. We were overwhelmed by the lies then, and they continue to this day. If RFK Jr. becomes a cabinet member, his misinformation and his lies will have the seal of the U.S. government affixed to it.

While this is not a political essay, there are other political events occurring that we health professionals should be watching. The appointment of RFK Jr. is not the only appointment that is astoundingly worrisome: a Fox News host to be the secretary of defense; a congressman who is being investigated for ethics to be attorney general; a congresswoman with no experience to be the head of the CIA. These appointments fit a pattern that suggests that Donald Trump has poor judgment—or worse. Political experts suggest that there are other explanations for these appointments, but I suggest that those of us who are used to evaluating patients with cognitive deficits see something more worrisome.

At this point, I have to step back and address the Goldwater Rule from 1973: “[I]t is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.” The Goldwater Rule says that if you are not the doctor treating the public figure, you are not allowed to suggest a diagnosis. The Goldwater Rule has stifled doctors from describing what they see. It made sense in 1973 when we had a general consensus about facts. We believed that the news media was truthfully reporting facts. We thought that the reforms after the Nixon Watergate years guaranteed that government officials would not lie to us again. A lot has happened in the last fifty years that has splintered the framework that supports those beliefs. That is why it is now more important than ever for health professionals to speak out about what they are observing in plain sight.

I have never formally evaluated Donald Trump. I know that he reported achieving a perfect score on the Montreal Cognitive Assessment (MOCA) six years ago. It is a screening test for dementia. It does not evaluate a person for delusions or judgment or executive function or any other quality whose derangement could put this country at risk. It is a score at one point in time and does not indicate anything that happened to him in the last six years. It certainly does not indicate cognitive excellence. The fact that he repeatedly cites his MOCA score from 2018 is an indication of his limited understanding.

I have listened to his public comments. When hearing him free associate for extended periods of time at his rallies, I have heard him lose his train of thought, divert into non sequiturs, use malapropisms, confuse dates and names, and most alarmingly, tell stories about events that never happened. His confusions have charitably been called lies, but I think that it would be more accurate to call them delusions and evidence of cognitive decline. He has repeated them as if he really believes them. Since the election, he has started to appoint people to high positions in the government who I feel should never be given access to that level of power. The appointment of RFK Jr. to a position in which he is likely to cause harm to the health of our country is a call to us to be ready to speak out forcefully about RFK Jr.’s unfounded and dangerous opinions. We also have an obligation to speak out about the poor judgment of the president who is making these appointments that may be harmful to our country.

You cannot shout “Fire!” in a crowded theater. But colleagues, the president-elect has shown us that he is willing to set the country on fire with his choices for his cabinet. We cannot let the Goldwater Rule of 1973 keep us from sounding the alarm now. RFK Jr. is a threat to everything we have learned about science, health care, and the practice of medicine. A rule from fifty years ago should not stop us from calling out the insanity of letting someone like RFK Jr. have anything to do with the health of our country.

David Galinsky is an internal medicine physician and emeritus staff, Lankenau Medical Center.