It’s fair to say Jeremy Faust is a thought leader in medicine and public health. His Inside Medicine newsletter has more than 87,000 subscribers; he gets regular billing at the Aspen Ideas Health festival; he’s editor-in-chief of the medical news site MedPage Today. The way he engages on high-stakes issues has consequences: It serves as a model for others, and gives them permission to do the same.

As proof, a recent post of his got kudos in at least one of my public health group chats. In it, he turned his talents on one of his friends: Craig Spencer, a Brown University public health professor and emergency medicine doc. In late July, Spencer wrote an Atlantic essay in which he argued public health should stop reflexively dismissing what the MAHA movement gets right. Faust posted a line-by-line rebuttal in his newsletter. 

His response is instructive because it contains several near-perfect specimens of patterns a lot of us in and around public health fall into without noticing. Many of these patterns make it harder for ordinary Americans to trust people who work in health and medicine. To replace them with something better, we need to first identify what they look like.

Faust's response circles a question that isn't really about MAHA at all: Who gets credit. He protests that MAHA's concerns are not novel. He objects that "every reasonable idea predated the movement." He accuses Spencer of handing MAHA credit it hasn't earned.

This is an understandable, deeply human reflex, especially in academia (and journalism): The currency of expertise is getting to an idea first. But it's beside the point for the people the piece claims to be about. Regular Americans who support MAHA don’t give a hot buttered damn if their concerns are original; they want lower medical bills and air, food, and water that doesn't scare them. “Who said it first?” is a question only highly credentialed people care about.

Faust's subtitle promises that "even the sharpest disagreements can be civil," and he opens by describing warmly how he phoned Spencer instead of venting about him online — a real and admirable choice. (And one I didn’t make; I don’t know Faust personally, nor Spencer.) But established goodwill can be its own trap. Having proven himself gracious once, he feels freer in the rest of the piece to call MAHA supporters "the mob" and discount their concerns about food additives and corporate influence on food policy as “not actually important.”

Psychologists call this moral licensing: The credentials we build for good behavior can make us less able to see our own bad behavior clearly. It can happen even when people intend to hold themselves to a high standard.

A harder problem is the way the piece deals with evidence that bumps up against pre-existing narratives. Faust built credibility on a claim he made memorably during a 2023 public dispute with Leana Wen, that he is “on the data.” But confronted with polling from health policy powerhouse KFF, he doesn’t sound like it.

KFF’s recent surveys suggest health care costs are the top priority for MAHA voters, and only 4 percent cite vaccines as their reason for supporting the movement. To Faust, this evidence is “hard to take seriously” and “rings false.” I’m not sure if he’s disputing KFF’s methodology or discounting how people describe themselves. If it’s the first one, go off I guess? If it’s the second one, consider this: When we assume someone can’t credibly describe their own opinions because they identify with a movement, it telegraphs contempt and breeds alienation.

Faust writes that he’s “having trouble identifying instances where establishment scientists, physicians, and other experts shied away from science on MAHA’s agenda that was somehow politically inconvenient.” It's worth asking how hard he tried. Autism researchers have themselves suggested that few scientists study the condition’s environmental causes because the field is controversial. Newly surfaced messages show Covid scientists privately hedging on the virus's origins while publicly ruling them out. Sandro Galea wrote a whole-ass very good book about public health’s errors during the pandemic.

For anyone interested in creating a public health future that’s better than its past, it makes a lot more sense to look for the teachable moments than deny any of them ever existed. 

One of the most disappointing moves in the piece is when Faust treats MAHA as synonymous with its grifters and loudest cranks. KFF’s recent surveys suggest four in ten American adults — around 113 million people — support MAHA. Even if that included all of the 12 million Americans who work as full-time influencers (!), that would still leave more than 100 million ordinary people to make up the balance. 

This is not a fringe group. But by collapsing them into a monolith, then refusing them empathy and curiosity, Faust ensures that if they ever run across his work, they’ll feel invisible in the eyes of the public health and medicine establishment. 

There are reasons people outside that establishment distrust people within it. To have any hope of a way forward, those of us on the inside need to look for better ways to talk — and listen.

I went deep on Faust’s response here because he’s got such a big voice in the medicine and public health discourse. However, his response is representative of what I see and hear among other public health and medicine professionals.

In my next piece, I’ll talk a little about why I think some people in these fields have adopted a tone like this one. Got theories of your own? Email me at [email protected], fill out this form, or find me on Signal at kerenlandman.07.

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