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Diagnostic radiologist Rakesh A. Shah discusses his article “A critique of medicine’s response to RFK Jr.” Rakesh argues that major physician organizations have failed in their duty to protect public health by remaining silent and timid in the face of Robert F. Kennedy Jr.’s anti-vaccine misinformation. He contends that this “cowardice” prioritizes institutional self-interest over patient welfare and endangers not just immunization programs but the future of medical research, including promising mRNA-based cancer treatments. This episode explores the crisis of leadership in organized medicine, the difference between being apolitical and surrendering to a public health threat, and why Rakesh believes this silence is a profound abdication of professional duty. Learn why he argues that when politicians show more courage than doctors, the very credibility of medicine is at stake.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Rakesh A. Shah; he’s a radiologist. Today’s KevinMD article is “A critique of medicine’s response to RFK Jr.” Rakesh, welcome to the show.

Rakesh A. Shah: Thank you so much. Great to be here.

Kevin Pho: All right, let’s start by briefly sharing your story and journey.

Rakesh A. Shah: I have been a radiologist for 30 years, and my main focus, of course, has been the practice of radiology. But I am also very interested in politics, economics, how what happens in D.C. affects health care, and conversely, how we in health care can influence policy.

Kevin Pho: All right, so of course, let’s talk about RFK Jr. You wrote a critique of organized medicine’s response to him. Tell us what led you to write this article and then talk about the article itself for those who didn’t get a chance to read it.

Rakesh A. Shah: Basically, I was very surprised, shocked, and surprised as many people were, when at the time of confirmation, not every doctor, but the vast majority of doctors and most major organizations were kind of silent. There were a number of reasons or excuses I heard for this, but I was very surprised given his past views and what he said that there was not more organized resistance to his confirmation.

We can go into some of the reasons why I think that happened, but I was really quite outraged. To me, it epitomizes how doctors have basically lost leverage or sway in the political world, even when we have someone clearly unsuitable for the job as RFK Jr., in my opinion.

Kevin Pho: So at the time of his confirmation, why do you think that organized medicine stayed silent?

Rakesh A. Shah: I think there were three reasons. One is I think some people assumed he wouldn’t get in, which I think is a self-fulfilling prophecy. They thought, “Oh, he is not going to get in. Let’s just not rock the boat.”

The second reason was that I think there was a feeling, “If he gets in, let’s not create an enemy.” So I think there was a feeling that they approve every nominee, so let’s just let him in and not pick a fight with someone who is going to have power over us.

The third reason, and I think the biggest mistake, was the idea there would be adults in charge. Basically, we thought, “Yeah, he is a little bit wacky, but there are enough adults in the room that they will keep him in check.” A lot of people say things on the campaign trail before they are in office. They come in, and they moderate. I would argue it has gone the opposite direction. Things in my opinion have gotten worse than what I expected, but I think there was a hope in some people’s minds that maybe there are enough adults in the room. It turns out he fired the adults. It turns out things got worse than what I expected because he fired the adults, and the guardrails were demolished. So I think those were the three reasons I gave for why we were silent, but I think they were all flawed reasons.

Kevin Pho: Now I hear that some organized medical societies are calling for his removal. Is it a little bit too late? What’s your opinion on some of their actions now calling for his removal?

Rakesh A. Shah: I give a lot of credit to the ACP organizations. There has been actually a pretty strong pushback, just as I wrote my article. In fact, six Surgeons General and thousands of doctors have pushed back. A pushback at this point is actually quite strong, but it is too little, too late. Trump never backs down. I don’t want to get too political, but he is not about to back down from his previous nominee. In fact, he has doubled down on things like Tylenol, which I think most doctors take as at best questionable, if not completely wrong.

I think the most vulnerable point was at the confirmation. There were several senators like Bill Cassidy of Louisiana and Susan Collins who might have been swayable. That was the point of weakness. Once someone was in the job, especially with the current administration, it is extraordinarily difficult to get them to relinquish power. I think that was a huge tactical mistake and strategic error on behalf of medicine to wait to see what happens and then try to get them out.

Kevin Pho: There are a lot of physicians who supported and continue to support RFK Jr. What kind of message do you have for our physician colleagues who continue to support RFK and his agenda?

Rakesh A. Shah: First of all, a broken clock is right twice a day. There are some things about him which I think most doctors will agree with, such as processed foods and chronic health. There are a couple of things. One of the reasons why he has gained traction is he has touched a nerve with a lot of people and a lot of physicians about things that I think are valid. I think chronic illness is a concern. I think processed foods are an issue. We shouldn’t have fake dyes in our food. So I think some of that may do that.

Some of this may be a feeling that there are some people, not including doctors, who are just fine breaking the whole house down. They are fine with a bull in a china shop. So they feel if the house is broken, it is OK. Let this guy tear it up, but it is not working for me. The biggest critique I have is if you genuinely believe RFK Jr. is best for patients, that is fine. My issue is when doctors feel, “I know he is kind of crazy, but I like the administration and I think they are on my side.” That is what I find very objectionable because if you think they are helping patients versus helping you, that is where I have a real objection.

Kevin Pho: In your piece, you wrote that it’s not just about childhood vaccines, but the future of mRNA research and the implications for things outside of autism, like cancer. How do you feel like anti-vaccine rhetoric is directly threatening oncology?

Rakesh A. Shah: It is huge. I am not a cancer expert, and we don’t know at this point what the promise of these vaccines is, but my understanding from people I talk to is it is quite promising. I think there was quite a substantial amount of exciting research going on in this area. A lot of oncologists were very excited about it. mRNA of course was how we turned the impact to COVID. There is tremendous possibility here.

It is funny because it is one thing not to fight the war on cancer. This administration is actually trying to lose the war on cancer. We have one of the most promising technologies that I know in recent memory, and we are not even funding it. In fact, we are going the opposite direction. I think that is very chilling to research in the field and to all cancer research. I think the implications are hard to reverse. You can’t just come in in three years and say, “Hey, new guys in town, we are going to change. We are going to refund it.” Once you lose ground and lose road, it is very hard to get back to it. The amount of money that has been taken away is significant. Again, as a theoretical loss, we don’t know what it would have been. I think it is catastrophic. Most people who I have talked to in the sphere are really quite disturbed. They are very quite disturbed by the mRNA research and that these promising technologies and science are just being tossed aside.

Kevin Pho: What do you think about the trust that we have in our public health authorities now that public health and the CDC have essentially become politicized? Going forward, even after the tenure of RFK Jr., what kind of damage do you think that’s being done to our public health institutions?

Rakesh A. Shah: I think there is tremendous damage, and I think it is going to take a long time, if ever, to recover. I am not saying things were perfect before. I think that a COVID vaccine may have been oversold, but I think a lot of our institutions were a little threatened. A lot of people felt maybe we swung too far with COVID. So I think there was some stress. To be fair, even before RFK Jr., there were those who felt in this country that the government was spreading false information about vaccines and COVID. I think there were some minor cracks in the ship before RFK Jr.

But at this point, if you are a patient looking for accurate information, you are kind of in a wilderness here. We have the CDC saying one thing. One interesting development just in the last few weeks is that we have kind of an altered path of doctors’ groups doing their own vaccine recommendations and their own guidelines because RFK Jr. does not seem to be going away. So you have at ID Week, I think last week, people coming up with their own guidelines. You kind of have these workarounds, which is interesting. I find it very intriguing that rather than trying to take the guy out, now you have a workaround. You say, “Forget that guy. Here is our thing.” That may work for the short term. Over the long term, it creates a two-track system where you have blue states and red states doing one thing, and basically who you trust will depend on your political persuasion and who you follow.

I think it creates a really bad situation where we are questioning actual facts. We are not even debating what the best treatment is. It is OK to have different opinions, but we can’t have different facts. I think we are entering a world now where people are going to have a whole different set of facts based on who they listen to, and that is very dangerous. I think it is an erosion of trust. When we have the next public health crisis, if people can’t trust the authorities, it is going to be a massive catastrophe.

Kevin Pho: A lot of medical groups would argue that they have to stay apolitical to protect their scientific credibility. So what’s your response to that specific defense?

Rakesh A. Shah: Then I would ask them what is your exact role? I can understand the idea to maybe have a big tent to let people have all opinions. Let’s be honest, many doctors at least voted for the current administration. It is not as if we are monolithic in our political views. I can certainly understand if you are in a room with a hundred physicians how you may not want to rock the boat. But we have to stand for something. We have something that even most doctors know is clearly against public health will. To not rock the boat, to say, “Well, we can’t be political,” then why are you here? If you are not going to engage in a clear threat that involves engaging politics, in my opinion, you are irrelevant.

To be honest with you, at the current point, I think one in six doctors are part of the AMA. I don’t think we have done a good job in making doctors feel that there is anyone advocating for public health or for them. So I think we have to engage in the political sphere, otherwise we are largely irrelevant.

Kevin Pho: So when you talk about this critique to your fellow physician colleagues in general, what has their reaction been? Are they in agreement? Do some of them defend the medical organizations? Just give us a spectrum.

Rakesh A. Shah: Personally, I have a friend who is very active in the AAP, and he is a good friend of mine. He goes, “What were you guys thinking? How could you say nothing?” And his response goes, “Well, we first of all didn’t even think he would get in. So there was a feeling he is not going to get in. Then there was a feeling, well, if he gets in, why rock the boat? And then the third is, well, now what can we do?” I think that is one critique I have.

The other critique I have is I don’t think anyone defends him. I think a lot of my colleagues quite frankly thought this wouldn’t be the way it went. They go, “We knew he was a little crazy, but we thought there would be enough guardrails. We didn’t think he would go after Tylenol.” There is stuff coming out now that goes well beyond anything he has ever said. The war on Tylenol is particularly absurd. So I think I can’t find anyone at this point, at least in my personal sphere, who defends him. But some of them say, “People will know where to go for the right answers.” But again, maybe you and I will, but a lot of the public will not.

Kevin Pho: Physicians in general traditionally have been taught to stay relatively apolitical, right? They don’t want to alienate half of the patients that they see ideologically. So now, how do you get doctors to become more politically active? Because they have been trained to kind of stay out of the fray of politics for so long.

Rakesh A. Shah: No, I agree. I think that there is almost, especially in the current arena, almost a fear. We have a very polarized country. Half our patients are one persuasion, and depending where we live, maybe more than half. The other half are doctors. Let’s be honest. If I go to the doctors’ lounge, there is a wide range of political opinions. It is a war with MSNBC vs. Fox News. We are not monolithic even in our own specialty. But again, I really think that we have to take the chance of putting your neck out, even if it is unpopular, even if there is a personal loss and even physical risk to ourselves because there are major public health issues at risk.

I can understand being apolitical when it comes to foreign policy or Palestine or things like that. When people’s lives are on the line and we are in the business of public health of saving lives, that is when we have to kind of cross that barrier and say, “Listen, I am normally apolitical, but this is too important not to speak up.”

Kevin Pho: So what kind of advice do you have for physicians, maybe outside your own personal political sphere, in order for them to perhaps speak up about some of the things they’re seeing? What kind of advice do you have for them right now?

Rakesh A. Shah: First of all, I think people need to speak up in general. We have reached an era where I think people are afraid. I will be honest with you. I wrote my piece, and I mentioned my wife and you as well said make sure no one doxes you or make sure no one comes after you. This is the world we live in now because we are just too afraid to speak up. Politically we are very polarized. My advice is number one, don’t be afraid to speak up. There is strength in numbers.

And number two, we have to organize as a whole society, a whole medical profession. I am a radiologist, and I am active in my society. There is really at this point, and I don’t want to take a swipe at the AMA, but there is no society that puts all doctors together and says this is what we stand for. One in six doctors are part of the AMA, and my point is they are either unwilling or unable to advocate as a group for all physicians. So we need to both step up and find a way to come together across specialties and say this is what we believe in, because that is not happening now. We are like a balkanized specialty where everyone is looking out for themselves and really all major public health issues are left by the wayside.

So my advice is speak up, unite. Tell your patients you don’t have to be political, tell your patients the truth. Vaccines are not dangerous. Tylenol, from what I understand, doesn’t cause autism. So yeah, I think we should not be afraid to speak the truth to our patients, even if that is not what we are hearing.

Kevin Pho: Now, how realistic is that? Because you said yourself that the physicians’ ideologies, they’re not monolithic. How realistic is it to have a single organization unite all doctors and speak with a single voice?

Rakesh A. Shah: I don’t know if it is every doctor, but at this point you don’t even have 20 percent of doctors. So I think there is strength in numbers. And at this point, again, I give ACP credit. That is a big block of doctors. But you have a lot of doctors out there who are not using the clout they have. Even if you are Republican, maybe you can say, “Listen, you can tell your senator if this guy doesn’t get out, I am not voting for you next time. I am not giving you money.” We are not going to that level. I think this is the kind of threat where we have to go to the mat. If you are a Republican, and I have many colleagues who are, say, “Listen, I am not going to vote for you next time unless you get this guy out.” No one has gone to the mat for that. So I really think there is kind of this feeling that we don’t like him, but no one is actually willing to go to the mat for it. I think you have to stick your neck out in certain circumstances.

Kevin Pho: We’re talking to Rakesh A. Shah. He’s a radiologist. Today’s KevinMD article is “A critique of medicine’s response to RFK Jr.” Rakesh, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Rakesh A. Shah: Number one, like I said, we have to be vocal. I think in this polarized country, we have to be vocal in defense of our patients. I understand that sometimes that is difficult. We have to be vocal. The other take-home point is we have to be proactive and not reactive. I think with RFK Jr., we were kind of not proactive. We said we will see what happens. I think the current political climate and life in general requires us to play a very proactive role in patient’s health and not a reactive one. As I mentioned, once he was confirmed it was too late. So I think our role, and my message to all doctors, is speak up and let’s be proactive. Let’s not let this happen again. Let’s work together as a group whenever public health arises to really make sure we are not only looking at it for ourselves, but our patients as well.

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

Rakesh A. Shah: Thank you so much.