Prasad’s lifelong commitment to scientific rigor will help rebuild lost trust in regulatory bodies.
Dr. Adam Cifu is a founder Sensible Medicine, a monetized misinformation Substack that published gems such as Why Doctors Should Learn to Stop Worrying and Love MAHA and The Nomination of Robert F. Kennedy Jr. as Secretary of the Department of Health and Human Services: A New Beginning? Sensible Medicine also celebrated the appointment of Dr. Jay Bhattacharya by saying:
The recent news that Dr. Jayanta Bhattacharya is being considered for the post of Director of the National Institutes of Health (NIH) was received with enthusiasm by many of us who opposed the US pandemic response. Jay, a Professor of Medicine, Economics, Heath Research and Policy at Stanford, was a primary author of the Great Barrington Declaration (GBD) and a consistent and articulate opponent of unscientific, harmful, and ineffective covid policies. He is a courageous, thoughtful, and deeply humane person who would make a great leader of any of our US public health agencies.
That wasn’t true, and predictably things aren’t going well at the NIH today.
However, Dr. Cifu similarly lavished MAHA doctors with praise, especially his friend Dr. Vinay Prasad. Sure, Dr. Prasad botched basic facts all the time- no COVID did not kill just 1 in a million children– but who cares whether or not doctors communicate accurate information about a deadly virus? Not Dr. Cifu, apparently.
Dr. Prasad openly campaigned for Trump and Kennedy, and Dr. Cifu barely batted an eye. He felt it was totally acceptable for doctors to elevate deluded anti-vaxxers to the highest offices in the land under the pretense this was the best way to save vaccines.
Dr. Prasad was cruel, juvenile, and profane. He sought to enrage online mobs, implying that beleaguered vaccine-hero Dr. Peter Hotez was indifferent to child sexual abuse, for example, and Dr. Cifu didn’t care at all. In fact, he thought it was funny that Dr. Prasad called doctors “motherfuckers” and “fucking morons” for not treating rare, temporary vaccine side effects as a fate worse than death from COVID.
While other doctors cited Dr. Prasad’s vulgar, vengeful, vitriol in articles on the fatal attack at the CDC, Dr. Cifu claimed this was effective, important science communication. In an essay defending this “style”, Dr. Cifu wrote:
This style, however, brought more attention to the issues he feels strongly about than the scores of sober papers he published. It probably also played a significant role in getting him appointed to a leadership position at the FDA, a role that seemed tailor-made for him.
Indeed, Dr. Cifu felt Dr. Prasad’s “style” and overt MAHA/MAGA activism meant there was “no better candidate” to help lead the FDA. Along with another misinformation superspreader, Dr. John Mandrola, Dr. Cifu endorsed him writing:
Prasad’s lifelong commitment to scientific rigor will help rebuild lost trust in regulatory bodies.
That wasn’t true, and predictably things aren’t going well at the FDA today.
He’s wreaking havoc with the staff. People are terrified.
And we should be clear about the stakes here. Not long ago, Drs. Cifu and Mandrola recorded an entire podcast with Dr. Prasad bemoaning a single canceled speech. With Dr. Prasad at the helm, many people’s entire careers have been cancelled. His brief tenure has been marked by high school drama, anti-vaccine fear mongering, purges, censorship, and outright lies about critics– namely myself. He avoids journalists, skips key meetings, and barely comes into the office. According to one article titled Under Vinay Prasad, Employees at A Key FDA Center Fear Speaking Out, Look for the Exits:
Dozens of scientists are considering leaving the Center for Biologics Evaluation and Research, where Prasad serves as director, to escape a work environment that eight agency officials described to STAT as rife with mistrust and paranoia. These officials said staffers are terrified of pushing back on Prasad, lest they face retaliation.
The fear has been fueled by Prasad pushing at least seven senior leaders out of their positions, employees told STAT, and offering no public explanations to staff or the leaders’ supervisors. Some of his workers are fed up, and are attempting to transfer to the FDA’s drug center. Prasad has tried to block these transfers in apparent recognition that CBER can’t afford to lose many more employees. The center has lost hundreds of employees since the start of this year to retirements, layoffs, and resignations, and hiring conditions are difficult.
CBER employees are concerned that the exodus of employees and the worsening morale problems will affect the functioning of the center, which ensures the safety and efficacy of vaccines and helps speed potentially lifesaving therapies to rare disease patients…
“He’s wreaking havoc with the staff,” one agency official said. “People are terrified.”
I’m glad I played no role in respected scientists being marched out of their office without explanation.
Another article, How Two Top FDA Officials are Quietly Upending Vaccine Regulations, reported that Dr. Prasad is censoring research showing results he doesn’t want to be true, namely that the COVID vaccine is beneficial.
In October, Prasad decided to withdraw the paper, which examined health outcomes among patients with private health insurance who received Covid vaccines from 2023 to 2024. The paper concluded that there were no new safety concerns following Covid-19 vaccination for people aged 6 months to 64, and that “the benefits of vaccination outweigh the risks,” according to a copy viewed by STAT.
“The retraction of the study marks a choice by leadership away from transparent and comprehensive reporting of the results of these government funded studies towards opaque and selective reporting of particular results,” a former employee of an FDA contractor told STAT.
The article also noted that, “the deputy director in the office of vaccines, quit the agency on Friday” and “The FDA, Prasad, and Høeg did not respond to STAT’s requests for comment, or provide answers to a detailed list of questions sent by email.”
Here are some other articles we are all reading about the FDA:
Instead of rebuilding “lost trust,” confidence in our federal health agencies has tanked, and large swaths of the country are wisely ignoring their “guidance.” Talk about a medical reversal.
It’s nice to think there’s someone to blame, isn’t it?
While Dr. Cifu was happy to earn income from pro-Kennedy balderdash and fluff MAHA doctors himself, he purposefully undermined those of us who warned of their dangers. He repeatedly dunked on my writing, though he never even attempted a coherent refutation of even a single word. Instead of thoughtfully engaging with the arguments I made or the data I presented, he used haughty snark and sarcasm to breezily dismiss it all. It was bad faith enagement all the way down.
“It’s nice to think there’s someone to blame, isn’t it?” he said to me- and only to me- when I merely considered criticizing the authors of the Great Barrington Declaration, two of whom now hold prominent positions in the Trump administration. Apparently, influential advocates of herd immunity via mass infection, backed by a pro-tobacco, child-labor advocate and current MAHA powerbroker, deserved a safe space where they were shielded from even the slightest criticism.
Elsewhere, Dr. Cifu morphed into a music critic, fretting mightily about unspecified flaws in my “tone”. In a pandemic where over a million Americans died, many due to the misinformation I warned about, my decorum is what mattered most to him. “It is hard to engage when you feel like you’re being yelled at,” he said- again, only to me- without providing any examples. Imagine if I had created a collage of prominent doctors to shame and mock them on social media.
Other times, Dr. Cifu put his words in my mouth to make me sound like a blathering idiot and discredit my warnings about the threat of medical disinformation. He said to me:
I think it’s wonderfully optimistic to think had it not been for Drs. X, Y, Z everything would have gone swimmingly. You know our country as well as I do.
As people who’ve read my work know, I never said anything that stupid, though Dr. Cifu is not such a person. In fact, he made a great show of publicly refusing to even read an article of mine that corrected Dr. John Ioannidis’s baseless, nasty accusation that frontline doctors killed our patients through premature intubations. “It’s problematic when a paragon of evidence-based medicine claims vaccines spread disease and amplifies internet rumors,” I wrote. I stand by that. However, rather than even entertain the possibility that a peon like me could critique a hero of his, Dr. Cifu said that he had to run to clinic.
Trying to have a serious, mature conversation with him about evidence and science was impossible. I tried. I failed. I tried again. I failed again. It was like trying to teach a fish to ride a bicycle. It just wasn’t going to happen.
And while the disingenuous tone policing and deceptive straw man arguments were annoying, the core problem is that Dr. Prasad and I delivered very different messages. I warned that Kennedy might turn the CDC into an anti-vaxx propaganda outfit. In contrast, Dr. Prasad called the FDA a “corrupt entity that needs to be entirely renovated” and wrote articles such as Sabotaging RFK Jr’s Confirmation Will Increase Vaccine Hesitancy.
However, according to Dr. Cifu, the vulgar doctor who glorified Kennedy had a “lifelong commitment to scientific rigor” and deserved to lead CBER, while the doctor who sternly warned about Kennedy could be scolded and dismissed out of hand.
Evidence-Based Medicine Requires Urgent Reform, Physician Says
Given this background, Dr. Cifu recently gave a lecture that caught my eye. It was summarized in an article titled Evidence-Based Medicine Requires Urgent Reform, Physician Says. He’s right. Would Dr. Cifu be bold enough to discuss what Kennedy and MAHA doctors are doing right now? Not according to the article. It said:
Evidence-based medicine faces fundamental challenges that threaten its core mission of integrating clinical expertise with rigorous research, according to Adam Cifu, MD, who delivered a lecture at a Toronto physicians’ meeting. His analysis identified two competing explanations for what he calls evidence-based medicine’s failures: inherent design limitations predicted by early skeptics and systematic corruption by special interests.
Dr. Cifu identified several flaws in EBM: foundational flaws in trial design, post-randomization confounding, low positive predictive value, medical reversal phenomenon, and industry-influenced trial design.
The article concluded with Dr. Cifu’s proposed solutions:
Dr. Cifu outlined requirements for EBM restoration: “This demands unbiased research. It demands trials that are actually designed by actual physicians, practicing physicians, to answer important clinical questions that they identify.”
From NASA to the National Institutes of Health, federal agencies conduct research that universities cannot. Agency scientists speak out about the irreplaceable facilities, institutional knowledge and training opportunities that the country is losing.
Dr. Cifu’s talk, at least reported by the article, was mostly banal pablum, like saying kittens are cute and papercuts stink. Who doesn’t want “unbiased research?” and “trials that are actually designed by actual physicians”?
We all do, of course. The problem is that some of us can also read the news. We know what’s happening in science and medicine today and wonder who is going to carry out this “unbiased research” moving forward. Unless one feels Americans need to be protected from the grave threats posed by vaccines, food dyes in ice cream, wind farms, Tylenol, and chemtrails, we do not seem to be entering a golden age of biomedical research.
Dr. Cifu didn’t acknowledge any of this, however. There was no mention of any current events or the people responsible for them. His talk was a time capsule from a more innocent age, when Kennedy was a powerless crank, Dr. Ioannidis (whom Dr. Cifu positively referenced) was an unquestionable saint, and vital medical questions could be definitively answered if only we summoned the collective will to run the proper studies.
Dr. Cifu’s talk, it turns out, was just a dispatch from the pundit fantasy world. I previously used this term to describe sheltered pundits who acted as if all it took to open schools and protect the vulnerable was to utter the words “open schools” and “protect the vulnerable”. Maintaining this illusion required them to actively deny what happened in the real world when COVID was allowed to spread unchecked. Unwanted news was unmentionable news.
It’s super wonderful that Dr. Cifu wants “unbiased research,” but how does he feel things are going, not just at the FDA, but also the NIH and CDC? Can he make the affirmative case that these agencies are thriving under the doctors he defended and promoted?
If not, his complaints about the current state EBM should be viewed as a searing indictment of their failed leadership. After all, they are the medical establishment now, and they are to blame if they don’t deliver the “unbiased research” Dr. Cifu claims to value.
Perhaps I’ve missed it, but other than to deliberately distort Dr. Prasad’s pandemic record- yes Dr. Prasad repeatedly said “RCT or STFU” to undermine his predecessors- I’ve never seen Dr. Cifu seriously grapple with any of the headlines about the state of science in the U.S. today. Unwanted news is still unmentionable news.
Motivating biases need not be considered nefarious, only considered.
I have several proposals of my own to remedy this willful denial. Moving forward, anyone who opines on problems with EBM should, at a bare minimum, acknowledge what is happening to scientific research today and name the individuals responsible for it. It’s not that hard to simply be honest.
Furthermore, speakers should disclose if they opposed or enabled the people behind the headlines today, especially if they profited from articles like this. Our audiences deserve to know such things. That is as relevant as any pharma ties, and Dr. Cifu once wrote eloquently about the importance of considering such “motivating biases.” I agree.
My disclosures would read that I volunteered for a vaccine-RCT. Though that was a small contribution, it was a real one, and I am proud of it. Additionally, along with many others, I desperately tried to sound the alarm bells about Kennedy and MAHA doctors. We failed, but at least there’s a clear record of us doing everything we could to stop them.
I don’t think Dr. Cifu can’t say that.
As such, no one should care about his ideas to fix EBM in theory, when in reality, he volunteered as a defense attorney for the MAHA doctors taking a wrecking ball to it today. Though that was a small contribution, it was a real one. Nothing else about him should matter, and his empty pleas for “unbiased research” won’t change that.
And just to be clear, I totally agree with Dr. Cifu- tone is important. That’s why I’ve never said anything like this. I don’t think it is unfair for me to ask Adam to pause and reflect on that.
