Modern “Public Health” is Based on Utilitarianism and Socialism
“Public Health” relies on top-down, centrally planned interventions and mandates.
Rachel Levine swearing in as Assistant Secretary for Health and Human Services
Modern “Public Health” is Based on Utilitarianism and Socialism
(Author Robert Malone, MD, MS, from a soon-to-be-published book chapter. Sections of this chapter were previously published by Malone.News )
Modern “Public Health” primarily focuses on disease prevention and treatment, rather than on health promotion. “Public Health” relies on top-down, centrally planned interventions imposed on populations rather than individually optimized health promotion and treatment decisions. The “Make America Healthy Again” (MAHA) movement strives to focus on health promotion rather than disease treatment. Success in this enormous transformational endeavor will require a re-examination of the organizational, cultural, and structural drivers that have led to the currently dominant focus on disease.
One simplistic argument is that this modern focus on disease is the consequence of “capitalism” and the profit motive (as embodied by “Big Pharma”) distorting what should be a public utility (“healthcare"). While the predatory nature of many large pharmaceutical firms and their marketing arms is self-evident, they have become adept at exploiting a niche, a business opportunity, that emerged consequent to fundamental political and sociological trends towards centralized planning based on utilitarianism and socialist theories.
Public Health, Utilitarianism, and Socialism
“Public Health” as defined by current Western two-year “Masters in Public Health” (MPH) training programs (that require no prior medical or biological training), theorizes that imposing healthcare management decisions on the population at large will achieve statistically optimal minimized average disease for all people.
In other words, Western “Public Health” is based on the political and sociological logic of both utilitarianism: the greatest good for the greatest number, and socialism: equality of outcome rather than equality of opportunity, coupled with a form of medical authoritarianism in which “healthcare” interventions are imposed on the population in general, rather than developed and negotiated on an individual basis in a private physician-patient relationship.
Current western “Public Health” is characterized by a commitment to achieving equality of statistically optimized “minimal disease” outcomes across the overall population, rather than equality of opportunity to achieve health, and rather than optimizing health on a case-by-case basis for each individual citizen. As history has repeatedly demonstrated, when centralized planning and decision-making imposed on populations errs in assumptions or interventions, the consequences are typically catastrophic due mainly to the scale of the imposed mistake. This is one of the key truths illustrated by the COVID “pandemic” debacle.
The modern practice of “Public Health” relies on big data, and primarily involves statistically isolating and defining measurable medical signs and symptoms associated with existing “bad” public health, and then identifying interventions that are demonstrated to move population-based statistical parameters towards “good” public health. In many cases, “good” and “bad” are subjective, and often myopically lack broader context.
In modern practice, these subjective determinations are made by an “expert” elite (that typically benefits from the priorities it establishes), separate and isolated from the general population- typically in the “ivory towers” of the academy- rather than subjected to any public deliberative democratic process. There are no referendums on injecting fluoride into public water systems, discouraging a meat-based diet or substituting seed oils for animal fats. It is no wonder that one consequence of modern “Public Health” has been the rise of various “health” priesthoods, such as now exist in pediatrics, cardiology, infectious disease, and epidemiology. This is the direct consequence of the logic of centralized planning and socialist philosophy (ends justify the means!) infiltrating the entire US national and global (WHO) healthcare enterprise. Central planning requires an anointed expert elite to guide and justify centralized decision-making.
These interventions are then promoted by various top-down mechanisms (governmental and corporate policies coupled with coercive judicial enforcement and propaganda). Often, these policies are enforced through mandates (notably vaccine mandates), insurance rate incentives, taxation (alcohol, cigarettes), financial compliance incentives to physicians, as well as other methods of theft, violence and coercion, typically coupled to governmental, corporate, and social pressures.
Why is Public Health Focused on Disease Treatment rather than Health Promotion?
What drove the transformation of Medicine and Public Health from health promotion to disease treatment? The Flexner Report.
Quoting from “The Flexner Report - 100 years later”
Citation- Duffy TP. The Flexner Report--100 years later. Yale J Biol Med. 2011 Sep;84(3):269-76. PMID: 21966046; PMCID: PMC3178858.
“The Flexner Report of 1910 transformed the nature and process of medical education in America with a resulting elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training. This transformation occurred in the aftermath of the report, which embraced scientific knowledge and its advancement as the defining ethos of a modern physician. Such an orientation had its origins in the enchantment with German medical education that was spurred by the exposure of American educators and physicians at the turn of the century to the university medical schools of Europe. American medicine profited immeasurably from the scientific advances that this system allowed, but the hyper-rational system of German science created an imbalance in the art and science of medicine. A catching-up is under way to realign the professional commitment of the physician with a revision of medical education to achieve that purpose.”
Subsidiarity and Patient Focused Medical Care
Before the Rockefeller-funded, “Flexner Report”-driven transformation of medicine, medical treatment was grounded in the logic of individualized health optimization and the principle of subsidiarity. Although not explicitly mentioned in the US Declaration of Independence, Constitution, or Bill of Rights, the principle of subsidiarity is a key subtext that runs through these founding documents.
The fundamental principle of subsidiarity is centuries old, was once a core tenant of both the Catholic church and many other Christian theological disciplines, and is written into the original charter of the European Union.
Subsidiarity is the principle of social organization that holds that social and political issues should be dealt with at the most immediate or local level consistent with their resolution.
According to the European Union:
Citation: Fact Sheets on the European Union
European Parliament https://www.europarl.europa.eu/factsheets/en/sheet/7/the-principle-of-subsidiarity
“the general aim of the principle of subsidiarity is to guarantee a degree of independence for a lower authority in relation to a higher body or for a local authority in relation to central government. It therefore involves the sharing of powers between several levels of authority, a principle which forms the institutional basis for federal states.”
When those raised in the classical liberal Western tradition speak of “freedom,” in many ways, they are referencing the principle of subsidiarity. The ideas of freedom and subsidiarity underpin the assumption that, in a “free” society, individual adults are presumed to be competent to make their own personal daily decisions so long as they do not interfere with the rights of other citizens.
The principle of subsidiarity forms the bedrock upon which modern “libertarianism” and “anarcho-capitalism” (as defined by Murray Rothbard) have been constructed. The principle of subsidiarity recognizes that optimal decision-making during periods of change occurs in a decentralized, locally-based manner. The principle of subsidiarity rejects the logic of large-scale, top-down centralized planning, instead endorsing decentralized bottom-up problem solving.
The principle of subsidiarity is grounded in millennia of experience with human social organization. Socialism, utilitarianism and centralized planning are modern political and social experiments that have repeatedly failed since their 19th century origins through to the present.
The logic of subsidiarity is fundamental to traditional Western allopathic and osteopathic medical practice. In that context, the local authority is the autonomous licensed physician and, even more so, the physician-patient relationship.
Quoting from “Subsidiarity: Restoring a Sacred Harmony”
Kieffer JW. Subsidiarity: Restoring a Sacred Harmony. The Linacre Quarterly. 2017;84(1):1-9. doi:10.1080/00243639.2016.1264249
“The principle of subsidiarity is a bastion of Catholic social teaching. It is also a principle in the philosophy of the American Founding Fathers. In the USA, subsidiarity is ignored without a sense of the proper harmony between authority and responsibility. Human dignity and wise stewardship are compromised. Conscience protection becomes a concerning issue as highlighted by the conflicts arising after passing of the Patient Protection and Affordable Care Act. A reconnection of the patient to be steward of his health care is critical in addressing these issues. Third parties, including the government, business, and insurance companies, are firmly entrenched in health care, oftentimes with the result being increased cost and detachment of the patient from the stewardship of his or her care. Vitally needed is a return to the principle of subsidiarity in health care.
The genius of the American Founding Fathers is their unprecedented success in implementing subsidiarity. The idea of independently sovereign states coming together to form a united nation is subsidiarity put into practice. Since the time of the initial European immigrants to North America, from the Quakers and Puritans of the middle and northern colonies to the Celtic and Cavalier cultures of the southern and western regions, the common conception of power was from the base upwards (McClanahan 2012).
Citation: McClanahan Brion 2012. Colonial background lecture. US history to 1877. Liberty classroom. https://www.libertyclassroom.com/courses/us-history-to-1877/colonial-background/.
That is, people saw authority first within themselves and their family and looked next to their local town then to the county and after to the state and finally, last of all and least importantly, to the federal authority. In our very own Bill of Rights, the 10th Amendment to the Constitution makes this belief clear. Namely, any power not expressly delegated in the Constitution to the federal government resides with the states or the people.
However, the deterioration of subsidiarity is evident in the United States today. The office of the presidency dominates modern political discussion while local politics is almost completely disregarded. The Supreme Court renders decisions (see Roe v. Wade, Obergefell v. Hodges) about all facets of life ranging from marriage to abortion.
The default response to societal problems today is centralization. Physicians must combat this response in order to maintain the sacred relationship between them and their patients. The principle of subsidiarity is instrumental in this effort. Specifically, reconnecting the patient with his or her health care is the fundamental solution subsidiarity offers for some of the greatest ills within the healthcare system today.”
The Rise of Yellow Beret Socialism in the US Public Health Enterprise
The Yellow Berets, also known as Public Health Service trainees, were a group of physicians who participated in the National Institutes of Health (NIH) Associate Training Program during the Vietnam War era. They were often derogatorily referred to as "Yellow Berets" by supporters of the war who viewed them as avoiding military service. However, this term eventually became a badge of honor among the participants, many of whom formed a network of influential scientists and medical leaders that continue to dominate the public health enterprise, particularly at NIH. While most of these are now retiring out of the USPHS, they have fostered a culture and mentored others that continue to enforce that culture and support the informal networks, alliances and power relationships that dominate the USPHS and the overall US medical research enterprise.
Physicians who served in the U.S. Public Health Service (USPHS) during the Vietnam War primarily worked at the NIH or other federal health institutions, including the CDC and FDA. For example, during the Vietnam War, physicians could serve their draft requirement by joining the USPHS, which allowed them to work at places like the CDC. Their common experience, background, and cultural biases fostered natural affiliations that eventually developed into a loose network of influence that came to dominate both the NIH and the USPHS. Dr. Anthony Fauci is one example of a successful “Yellow Beret”.
For more than 200 years, men and women have served US public health in what is today called the Commissioned Corps of the U.S. Public Health Service. These commissioned officers wear uniforms and have ranks similar to those of US Navy officers. For example, Dr. Rachel Levine holds a commission as a USPHS Admiral. These military titles, uniforms, and trappings of authority confer unwarranted legitimacy to these career PHS bureaucrats.
Given this background, conservatives and libertarians should not be surprised that “Public Health,” as currently practiced in the United States and its Western allies, is based on utilitarian and socialist political and economic philosophy. “Public Health” seeks to obtain the greatest good for the greatest number, and focuses on optimizing and standardizing health outcomes rather than opportunities and information that will enable individuals to optimize their own personal health and that of their children.
This represents yet another example of blowback. The male young adult children of the wealthy and upper middle class, having been provided with the benefits of the best educational opportunities, facing the horrors of Viet Nam and “The Draft” were then provided a pathway to avoid the selective service sacrifices required of most of their age cohort. They did not need to debase themselves on an “Alice’s Restaurant” group W bench strategy or even contrived claims of bone spurs to avoid the draft. They just had to apply to serve in the pseudo-military public health service, and would be given a cushy job for the duration in DC or Atlanta. And so they did, with the consequence being that these “public health enterprise” agencies became captured by pseudo-hippies that viewed public service not as a responsibility and calling, but rather as yet another entitlement. And no surprise that they jumped right into bed with corporate America and Big Pharma, for this was the caste from whence they whelped.
Today’s NIH, CDC, and FDA Cultures are Fundamentally Socialist and Pro-Corporatist
Given this background, it should surprise absolutely no one that the underlying cultures of NIH, CDC, and FDA are Socialist/Corporatist. Whether by intent or circumstance, these organizations are led by the children of privilege, typically graduates of elite East Coast “Ivy League” prep and finishing schools, and have been for decades. Federal policies have consequences, and those consequences often persist for a very long time.
It will be extremely difficult to shift current USPHS culture, and extremely difficult to shift the underlying cultures of NIH, CDC and FDA. But without cultural change, any structural changes implemented by MAHA leadership will rapidly revert back to current norms as soon as the focus shifts to other areas, or a left-wing administration assumes power. It is important to understand that these agencies see Congress rather than either the President or the voters as their customers. We have a midterm election coming at us like a freight train, and Congress has long abused the USPHS, and in particular the NIH as a pork barrel opportunity. Upon confirmation, the new overall director of NIH will find that he or she is hamstrung, and the various NIH institute directors are focused on servicing their Congressional benefactors (and in turn their client corporations) rather than responding to any direction coming from the overall NIH Director.
This was NOT the Original Culture of the USG Research and Development Enterprise
The current version of the USG research and development enterprise traces its origins back the (highly entrepreneurial) Manhattan Project, and in particular to the contributions of Vannevar Bush.
Quoting from Wikipedia:
“Vannevar Bush (March 11, 1890 – June 28, 1974) was an American engineer, inventor and science administrator, who during World War II headed the U.S. Office of Scientific Research and Development (OSRD), through which almost all wartime military R&D was carried out, including important developments in radar and the initiation and early administration of the Manhattan Project. He emphasized the importance of scientific research to national security and economic well-being, and was chiefly responsible for the movement that led to the creation of the National Science Foundation.
On June 28, 1941, Roosevelt established the Office of Scientific Research and Development (OSRD) with the signing of Executive Order 8807. Bush became director of the OSRD. The OSRD had the resources and the authority to develop weapons and technologies with or without the military. Furthermore, the OSRD had a broad mandate, moving into additional areas such as medical research and the mass production of penicillin and sulfa drugs. The organization grew to 850 full-time employees, and produced between 30,000 and 35,000 reports. The OSRD was involved in some 2,500 contracts,] worth in excess of $536 million.
Bush's method of management at the OSRD was to direct overall policy, while delegating supervision of divisions to qualified colleagues and letting them do their jobs without interference. He attempted to interpret the mandate of the OSRD as narrowly as possible to avoid overtaxing his office and to prevent duplicating the efforts of other agencies. Bush would often ask: "Will it help to win a war; this war?" Other challenges involved obtaining adequate funds from the president and Congress and determining apportionment of research among government, academic, and industrial facilities. His most difficult problems, and also greatest successes, were keeping the confidence of the military, which distrusted the ability of civilians to observe security regulations and devise practical solutions, and opposing conscription of young scientists into the armed forces. This became especially difficult as the army's manpower crisis really began to bite in 1944. In all, the OSRD requested deferments for some 9,725 employees of OSRD contractors, of which all but 63 were granted. In his obituary, The New York Times described Bush as "a master craftsman at steering around obstacles, whether they were technical or political or bull-headed generals and admirals."”
Populist Pushback: MAGA and MAHA
The history of American populism and populist movements worldwide is a history of unrecognized grievances being forced out into the open by “the governed,” followed by failure to convert those bottom-up, decentralized politics into sustainable long-term policy changes. Both MAHA (Make America Healthy Again) and MAGA (Make America Great Again) populism have now accomplished political milestones that are almost unprecedented in American history.
One has to reach back to Presidents Theodore Roosevelt (POTUS 26) and Andrew Jackson (POTUS 7) to find solid parallels to the Presidency of Donald J. Trump (POTUS 45, 47). Jackson for this battle with the Second US Bank and eliminating the US Federal Debt. And, of course, “Teddy” Roosevelt was known for promoting a muscular expansionist US foreign policy and his commitment to health and exercise, in many ways foreshadowing a similar emphasis during the administration of John F. Kennedy (POTUS 35) and now JFK’s nephew RFK Jr.
Not to be negative, but the history of US populist political movements is littered with stories of unmet high expectations and subversion of those movements by established political power centers.
So what is populism, this pan-US and EU movement currently threatening to overwhelm and supplant the globalist “New World Order”?
The Populist Zeitgeist. Mudde, Cas. Cambridge University Press: 28 March 2014
“I define populism as an ideology that considers society to be ultimately separated into two homogeneous and antagonistic groups, ‘the pure people’ versus ‘the corrupt elite’, and which argues that politics should be an expression of the volonté générale (general will) of the people. Populism, so defined, has two opposites: elitism and pluralism. Elitism is populism's mirror-image: it shares its Manichean worldview, but wants politics to be an expression of the views of the moral elite, instead of the amoral people. Pluralism, on the other hand, rejects the homogeneity of both populism and elitism, seeing society as a heterogeneous collection of groups and individuals with often fundamentally different views and wishes.”
There are fundamental fault lines between MAHA and MAGA, and in many ways they resolve into pro-regulatory big government initiatives versus promotion of deregulation/small government.
It is worth noting that the MAHA movement exists outside of Kennedy and the government, and encompasses many societal issues outside of the focus of the Trump administration. For instance, homesteading, medical and personal sovereignty, and personal responsibility for healthcare choices may all be outside of the MAHA whole of-government approach. For this article, I am writing of MAHA directives within the government. But MAHA is much bigger than that.
MAHA has emerged mainly from the left and, out of frustration due to the Democrat party corruption and rejection, has embraced the center-right. In turn, MAHA has been enthusiastically endorsed by MAGA and center-right populists, including many formerly associated with the Tea Party movement.
The arc of the Presidential campaign of RFK Jr. closely adheres to this narrative. Bobby started out seeking the Democratic party nomination as representing “Kennedy Democrats,” and announced a platform proposing a return to his legendary father and uncle's pre-Carter, pre-Ronald Reagan “New Deal” positions. But the Democrat party of today bears little resemblance to that of his father and uncle’s time, and the changes in National political thought on both left and right wrought by Reagan, Carter, and then the succession of the military-industrial corporatist Bushes and Clinton(s)-Obama-Biden on the left. To no one's surprise, apparently other than Bobby and his team, today’s Democrat party made it abundantly clear that there was no room for this Kennedy in the tent. So he decided to make a run as an independent, and Nicole Shanahan stepped up to bankroll and prop up the drive to get Bobby on the ballot in all 50 states - which was amazingly successful to the credit of all concerned. However, it was clear that, once again, an independent run would primarily function as a spoiler, in this case for the campaign of Donald J. Trump. After much advice, consideration, deep self-examination, and the disappointment of many of his supporters, RFK Jr. famously decided to pivot to endorsing and joining the candidacy of the once and future President Trump. The pivotal moment was RFK jr.’s empathetic phone call to DJT after the assassination attempt, which still reeks of a deep state operation much like what happened to Bobby’s uncle and father. And RFK Jr. did so in a spectacular manner, with a ringing endorsement speech that will live in history.
So, MAHA largely originates from the left, but the appeal crosses all party lines. Who does not want to be more healthy?
The initial MAHA mandate is to demonstrate measurable improvements in the health of US citizens within 12-18 months, with a particular focus on chronic disease and children’s health. One aspect of this effort will involve re-focusing the HHS on health promotion and de-emphasizing disease-specific treatment.
At its core, MAHA is predominantly pro-regulation. The logic is that we must use regulatory authority to improve transparency and eliminate that which leads to unhealthy outcomes. Examples include drugs with side effects that, when considered in whole, do not have a strongly favorable risk/benefit ratio. And glyphosate (Roundup) contamination of our grain and soybeans.
However, there is also a deregulatory aspect to the MAHA movement. For example, is unpasteurized milk really a health risk, and what health promotion properties are associated with unpasteurized milk? Similarly, the move towards backyard poultry and eating locally slaughtered grass fed beef. Or reexamination of the widespread US policy of fluoridating municipal water supplies. And there is also an investigational research aspect, for example, what are the drivers behind the explosion of autism, obesity, and other childhood chronic diseases.
To date, the MAHA movement has primarily focused on things that big government can do to promote improved health of US Citizens. Removing known toxins from food. Investigating autism causes. Questioning the pediatric vaccine schedule and revising the CDC VAERS vaccine adverse event reporting system so that truly informed decisions can be made concerning the safety and efficacy of vaccine products.
But behind that is the potential for the MAHA initiative, if institutionalized and bureaucratized, to morph into another overbearing set of nanny state mandates. To make the point, I often use the example of the person who loves McDonald’s Hamburgers consumed with Sugary Coca-Cola. You know who I am talking about. Should the State mandate that such a person not eat these things, despite the clear-cut health risks? Should the State outlaw cigars? And what about regulating foods? Where should MAHA draw the line? What principles should be applied to guide these decisions? What is the proper role of small government as it relates to food and drug regulation?
This really involves the boundaries between individual sovereignty, libertarianism, Murray Rothbard’s anarcho-capitalism, and the utilitarian/socialist logic of modern “Public Health”. The modern “public health” enterprise seeks the greatest good for the greatest number and is driven by narrow analysis of large data sets to identify, regulate, promote or mandate specific “health care” interventions such as vaccines- while often disregarding other related issues including long term, unanticipated or difficult to predict consequences. The current “public health” enterprise seeks to achieve optimization of collective health outcomes rather than optimizing health opportunities coupled to respect for individual autonomy (choice). This “public health” enterprise that has repeatedly used top-down management via government, insurer, and health management organizations to require and deploy pre-approved treatment protocols rather than individually optimized health management and promotion, reflecting each patient's complexities. One size fits all, and do what you are told.
Consider seat belt mandates. Like many big government initiatives that stand at the top of slippery slopes, there is a general consensus that it is right and proper for government to mandate seat belts be installed in cars. But is it right to legally require their use when driving? Next comes motorcycle helmets. Same issues, but slightly less clear. Cigarette smoking? In all three cases, the argument is made that irresponsible health behaviors by individuals cost all of society due to increased health care and insurance costs (including publicly subsidized costs), and loss of person-years. The same logic then can be applied all the way down to whether the State should mandate your dietary choices, which is why I use the McDonald’s hamburger example. Should we “allow” citizens to experiment with nutraceuticals and health supplements that are not officially endorsed by the FDA?
And there we go, right straight to nanny state medical fascism. But seatbelts save lives. Air traffic controllers save lives (most of the time, with some recent exceptions). You get my point.
If MAHA is to transition from merely a populist uprising and set of immediate grievances to a new, transformed and sustainable set of public health enterprise policies, we need to take some time to think about and define acceptable limits on the role of the State in promoting, advancing and in some cases mandating limits on infringement of individual sovereignty and autonomy.
Immediate short term interventions are absolutely necessary, and I applaud the use of both the bully pulpit as well as executive orders. But if MAHA is to become more than just a populist uprising, and to result in sustainable long term policy changes, it is also important to take the time required to examine, define, and develop public support for the boundaries between the proper role of a Constitutional Republic - based federal government, the constitutional role of individual States (which are responsible for regulating the practice of medicine), and both the sovereign rights of the individual and the global right to truly informed consent to medical interventions.
How can the USPHS, NIH, CDC and FDA Culture be Changed?
MAHA must begin by recognizing that they are not just dealing with organizational charts and a massive siloed bureaucracy that is structurally biased towards a disease treatment model rather than a health promotion model. They are faced with transforming a deeply entrenched socialist/corporatist bureaucratic culture. This is a culture for which the idea of entrepreneurship is not only foreign, but is seen as a threat. For which libertarian and conservative beliefs in the primacy of the individual and right to choose are alien. This is a culture that firmly believes in utilitarian outcomes-based socialism while fiercely defending their own privileges. For which risk-taking is a threat to be strictly avoided, suppressed, and never rewarded. Team players are what is selected for.
The only way this can be changed will be to actively recruit, incentivize and promote a new generation of leaders, and help them to work up the ladder to replace the Yellow Berets and their bureaucratic offspring.