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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article, “When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise.” Muhamad offers a counterintuitive perspective on the recent wave of layoffs and leadership changes sweeping through federal health agencies like the NIH, CDC, and FDA. He argues that this “rock bottom” moment, rather than signaling collapse, presents a critical opportunity for a fundamental overhaul of a system that has lost public trust. He points to events like the perceived disengagement of many HHS employees during the COVID-19 pandemic’s peak in 2021 and the 2021-2022 baby formula crisis as catalysts for this erosion of faith. Muhamad contends that the U.S.’s status as the “sickest wealthy nation,” plagued by high maternal mortality, rampant chronic diseases, an addiction crisis, and falling life expectancy, demonstrates the failure of the old guard and conventional approaches. He suggests that the criticism of newly appointed “unconventional” leaders overlooks the desperate need for new thinking. The article calls for these institutions to become truly human-serving, prioritizing patient-centered care, transparency, and direct community engagement over bureaucratic inertia and data-driven detachment, ultimately aiming to rebuild a health system that genuinely protects and serves the American public.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Muhamad Aly Rifai. He is a psychiatrist and internal medicine physician. Today’s KevinMD article is “When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise.” Muhamad, welcome back to the show.

Muhamad Aly Rifai: Thank you for having me to talk about this timely topic about the U.S. Department of Health and Human Services.

Kevin Pho: OK. So, tell us what your article is about.

Muhamad Aly Rifai: So, my article talks a little bit about the current situation that is happening at the U.S. Department of Health and Human Services. And I want to tell your audience, as a full disclosure, I worked for the U.S. Department of Health and Human Services. I was a federal employee at the National Institute of Mental Health for about three years early on in my career. So, I consider myself an insider and I can give people just an idea about the changes. There’s a lot of political winds with the changes in the Department of Health and Human Services, changes at the National Institutes of Health, changes at the Centers for Disease Control and Prevention, and changes at the Food and Drug Administration. With significant layoffs and significant reshaping of these federal agencies, there’s a lot of angst, a lot of discomfort from the physician community, number one, from the federal employees who are being laid off, and from the American public and the patient population.

So, everybody is uncomfortable. Everybody’s anxious about this situation, but I see it as a situation where there may be a warranted correction in our course and that this may be a blessing in disguise. We may have some positive outcome from this situation, even though there’s chaos and turmoil at the Department of Health and Human Services. But basically, we need some change, and we can definitely benefit from a significant course correction in what’s been going on in the health situation in our country.

Kevin Pho: All right. So before talking about that course correction, just to lay out some context, what are you hearing about some of that angst from the public and from physicians regarding the appointees of this new administration to Health and Human Services? What are you hearing in terms of some of that pushback?

Muhamad Aly Rifai: So, there’s a lot of trepidation and there’s a lot of reservations about the appointees, about their credentials, about their life experiences, about their preconceived notions, about their preformed opinions on a lot of health topics, and that some of their opinions that are already preformed may shape the health policy in our country. The Secretary for Health and Human Services is already confirmed. The director for the National Institutes of Health, the Commissioner for the Food and Drug Administration, and the CDC director are confirmed. We have currently a pending appointment for Surgeon General.

So, there’s a lot of concern that these are unconventional appointees, unconventional nominees that are being proposed for these positions, and that they have already formed a lot of very controversial opinions that are public about a lot of topics ranging from our food policy, ranging from our medication policy to vaccinations, to positions about COVID, and what has happened with the COVID situation. So, sometimes some physicians think that these are not appropriate appointees because they don’t have the credentials and the expertise. Some people think that they’re appropriate. Patients are caught in the middle because, basically, they get a lot of information and a lot of opinions.

A lot of people feel that the people who are being laid off or dismissed from these agencies were attached to the status quo and that maybe their dismissal would allow some changes in course. So we have a lot of conflicting opinions, and it’s related to the political winds or personal aspiration. But my point is that we should let things play out, and maybe some change will come out of that. And we’re going to talk a little bit about some of the situations that have made people reach that conclusion.

Kevin Pho: So you said some of these appointees were unconventional. Of course, we’re talking about Robert Kennedy, we’re talking about Jay Bhattacharya, and we’re talking about Marty Makary. So these are the people that were appointed and confirmed to these posts. You said that some of them were unconventional. What makes them unconventional?

Muhamad Aly Rifai: I think it’s their preconceived ideas and their experiences. Some of them defended topics, specifically for COVID, that a lot of people disagreed with: vaccination, the origin of the virus. For example, Secretary Kennedy does not believe in vaccinations for certain things and has certain preconceived ideas about the diagnosis of autism, which is specific for me as a psychiatrist, and the fact that there’s been an explosion in the phenomenon of autism in this country.

The fact that they have these ideas already coming into the position makes them unconventional. We also talked about some nominees. We talked about the current nominee for Surgeon General, who is somebody who is not practicing medicine, who left residency, and who has an attachment to ideas about healthy living and not a lot of practice of conventional medicine. So that makes people who are in practice uncomfortable about that situation.

Kevin Pho: So you said that you’ve had experience working in Health and Human Services in your past. So, tell us what you saw there that warranted some reforms.

Muhamad Aly Rifai: So, working at the National Institute of Mental Health at NIH in Bethesda, I saw a lot of great people. I saw a lot of devoted federal employees who were public servants who had devoted their lives. They were brilliant, they were hardworking, and they were caring for the public. But I also saw a lot of inertia. I saw a lot of people just being attached to the status quo, not wanting to change any positions in terms of what the outcomes are or how we can serve the public better. So I think that there was a lot of room for change from what I saw working as a federal employee.

And I think that’s what the public aspires to, or at least that’s what the leadership with the government and the president aspires to: to make some changes to what we are. Right now, in terms of our health status, we are the sickest, wealthiest nation on the face of the earth. And I think that that is very, very significant.

Kevin Pho: So, tell us what’s been done in terms of some of the reforms that have already happened that you think have moved in the right direction. What’s already been done?

Muhamad Aly Rifai: I think there are a lot of good things that are being done. I think just a reappraisal of what’s going on and trying to re-understand a lot of phenomena. For example, with the Secretary of Health and Human Services, his approach to trying to understand the phenomenon of obesity in this country. We have close to 60 to 70 percent of individuals who live in this country who are considered obese. And so trying to address that and understand that phenomenon, I think is very, very helpful.

So he’s moving in the right direction, even though people think that that’s unconventional, that some of these thoughts may be just out there and wild. But I think he’s moving in the right direction. He’s doing something different that has not been done before, and I think that that merits allowing it to play out and figure out if we are doing things right. Because what we have done so far has led to this explosion of this epidemic of obesity and metabolic syndrome. Maternal mortality is very high, and our children’s health education and physical education is close to nil. And so I think it’s OK to have a Secretary of Health and Human Services who pumps iron and shows that he has muscles and promotes physical exercise for this country. So I think what I’m seeing so far is appropriate and is moving in the right direction.

Kevin Pho: So you mentioned when you were working at the National Institutes of Health, a lot of dedicated civil servants, a lot of brilliant people, as you said yourself. A lot of these people, as you know, are getting laid off, right? And their funding and grants have been cut. So how do you address that human impact of these layoffs on what you describe as really dedicated, brilliant civil servants, with what’s going on with a lot of them being laid off?

Muhamad Aly Rifai: It’s very hard. My heart bleeds for these colleagues who lost their jobs, layoffs. Their livelihood is gone. But, you know, as a civil servant, as a federal employee, they were stewards of the taxpayer’s money. And I put in the article some examples where the public’s patience had expired. Early on in the COVID pandemic, the chief of staff for the Secretary of Health and Human Services did a survey like Elon Musk asked people to send him an email once a week to tell him what they’ve done, just five things that they’ve done that week. They looked to see who signed into their email, who signed into their account at work, and they found that close to 50 percent of the employees in the year 2020 did not sign in to their computer. That’s half of the department. So I think that the American public noticed that.

And then on top of that, we had the baby formula issue where basically baby formula was not available because the CDC was asleep at the wheel and they didn’t get notices on contamination in some factories that were making baby formula. And so the shelves were empty. People had to scramble to get baby formula. And then the controversy about COVID vaccines and masking and public guidance and the distribution of vaccines, I think wore down the patience of the American people with the health care establishment and the Department of Health and Human Services.

So a lot of the public sees that… I know there are probably a lot of dedicated employees at the Department of Health and Human Services, but I think when you find out that 50 percent didn’t sign into their computer, then you know that there’s a significant amount for improvement and that some of the layoffs may be appropriate to affect changes in the policy of that department.

Kevin Pho: Is there anything that you’ve seen from this new administration, and I know it’s only been less than a year, that’s given you a little bit of pause, a little bit of trepidation, making you think, ‘Hey, maybe this isn’t something I agree with?’

Muhamad Aly Rifai: A lot of my colleagues have a lot of trepidation about the nominee for Surgeon General, that she is not a practicing physician. She’s going to become the head of the Public Health Service. I was part of the civilian corps of the U.S. Public Health Service. She has to be a practicing physician. She has to have a medical license. So maybe that may be an area where there may be pause for that, but only time will tell. Maybe she’ll reactivate her license and lead the Public Health Service successfully. I think time is too early for us to tell.

With any health care policy, there are no immediate results. And certainly, it took us many, many years to get into this situation: overdoses from opiates, public health issues with autism, no physical exercise with kids in school, the issue with obesity, maternal mortality. So there are a lot of issues that need a lot of attention, and some of the changes will take time.

But for example, I think what’s encouraging right now is the banning of artificial dyes in our food chain. I think that’s very important. And some members of Congress said that they were working on it for many, many years, 20 years, and it’s done in the first hundred days. So there may be some hope that we are seeing. Certainly, with the political climate, there’s always room for people to be uncomfortable with what’s going on. But I think that we need to give it time and to recalibrate and certainly to change direction with the Department of Health and Human Services because we were certainly going in the wrong direction. So for people to say that we took the wrong turn already, we’re definitely in the wrong direction, so any turn that we are going to take is going to get us to the right direction.

Kevin Pho: So under your best-case scenario, what would you like to see happen, or what do you envision Health and Human Services and its various umbrellas to look like at the end of this administration?

Muhamad Aly Rifai: I think a revamping, for example, and I’ll start with the National Institutes of Health, where I worked, a revamping of the priorities. I think a lot of the priorities were actually toward more basic science research and away from clinically meaningful research. I can tell you about my specific field, about my psychiatry. We basically do a lot of neuroscience, basic science research, and not a lot of clinical trials that will address how do you treat depression in the community? How do you treat anxiety in the community? How do you treat schizophrenia in the community? How do you treat bipolar disorder in the community?

It’s all theoretical research that’s basic science and neurotransmitters and not a lot of a meat-and-potatoes practice of medicine. Hopefully, some of those research priorities and funding priorities are going to change to address real-life questions that face the practitioner every day in the field of medicine. So I feel that with that repositioning, we’re going to see a lot of clinical trials that address the real questions that we have in clinical practice.

The Food and Drug Administration, I think is very, very important. They’re going to need to focus more on patients and less on industry. We, the taxpayers, are their stewards. It’s not the pharmaceutical industry. So, they need to focus on that and they need to address the grievances that the American public has with that. And then the CDC, I think they have a lot of work to earn the public trust because the public has some doubt always now with messaging from the CDC. So I think they need to work very, very hard on regaining the trust of the public.

Kevin Pho: We’re talking to Muhamad Aly Rifai. He’s a psychiatrist and internal medicine physician. Today’s KevinMD article is “When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise.” Muhamad, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Muhamad Aly Rifai: I’m very hopeful. This is our country. I think change in the Department of Health and Human Services is overdue. Patients are waiting for it. They are counting on us. We as practicing physicians out in the community need to be receptive and we need to be helpful to our Department of Health and Human Services to affect these changes that are going to serve our population. That are going to bring us back on the pathway to health, the pathway to weight loss, the pathway to serving our patient population, a healthy patient population, healthy kids. So I’m very hopeful. I think we’re going to have a course correction, and within a few years, we’re going to be happy with these changes that have happened.

Kevin Pho: Muhamad, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Muhamad Aly Rifai: My pleasure. Thank you.