In my youth I was a punk and I especially loved the Dead Kennedys. The Dead Kennedys’ arguably most famous song is California Über Alles, a sendup of Jerry Brown’s (first) hippie-rightwing tenure as California governor from 1975-83 (“your kids will meditate in school,” Jello Biafra, in character as Brown, threatens in his warbly singing voice as the song reaches the chorus, “YOUR KIDS WILL MEDITATE IN SCHOOL!”). After Reagan’s election, the band recorded an updated version of California Über Alles for their 1981 In God We Trust, Inc., inserting some jazzy, louche, lounge-singing interludes between the blasts of power chords (waiting for Bon Appétit to release a recipe for the “Tricky Dicky Screwdriver,” which Biafra entreats the listener to enjoy: one part Jack Daniels, two parts purple Kool-Aid, and “a jigger of formaldehyde from the jar with Hitler’s brain in it”) and revising the lyrics to skewer the Great Communicator himself. The song also gets a new title: We’ve Got A Bigger Problem Now.
Well, folks, here I stand at The Limits of Rhetoric thinking to myself… we’ve got a bigger problem now. For years, I’ve been writing and speaking about what I see and believe in as “leftist” public health, a complicated, difficult story about public health and what it’s doing in the world, historically and in the present. I’ve been complicating the narrative to death, interrogating flashlight-in-face style the faulty assumptions of public health and biomedicine, arguing in an increasingly shrill and angry voice for a collectivist idea of public health that is regulatory, precautionary, organized around something other than the “valorization of value” (aka the profit motive) at the heart of the capitalist logic of everything. And I’ll be brutally honest, I didn’t really see MAHA coming, I didn’t take it seriously enough, I just ascribed it to more of the same in our fucked up economy of health.
Which, it kind of is, but with a sinister new twist. I have another post coming and mostly drafted about what it would mean to actually take this shit seriously rather than dismissing it out of hand as for a) crackpots, b) losers, c) stupid people, d) health economics-brained liberals. There’s a lot in there about science and science communication, but I’ll save that for later. Right now I think I’m going to try to back the fucking truck up and see clearly where we’re actually at now that RFK Jr. is in charge of HHS, Dr. Oz is in charge of CMS, and so on.
I’ve been investigating the Means siblings, Calley and Casey means, brother-sister team of health entrepreneurs that are some of the most visible proponents of the MAHA movement. (That’s Make America Healthy Again, for anybody that doesn’t know.) Apparently Calley is launching a newsletter on 12/19 which I will absolutely be signing up for. In looking at Calley’s webiste, I was really struck by something, though. Even though I know this dude is just an alternative health grifter, here’s how he summarizes what he has learned on his “journey”:
“We are getting sicker and more depressed at an increasing rate – and I think this is largely because our system doesn’t prioritize food and lifestyle factors that are the center of health.”
What is striking about this is how much this is basically identical to mainstream public health rhetoric. Public health is still stuck in this paradigm of “lifestyle” factors, including diet as the ultimate “lifestyle choice,” as the most important determinants of health. There are political-economic and process reasons for this. Public health interventions have to be proposed, implemented, and evaluated on a grant cycle of about five years. Interventions that really “move the needle” on health are, of course, big regulatory changes — fluoridating water, regulating food safety, abolishing slavery, ending pretrial detention (or doing away with prisons altogether). Those things are not within the ability of a single principal investigator (PI) to implement, let alone to evaluate, on the administrative timeline for public health research. So we get “secondary” and “tertiary” prevention instead — one-off exercise programs or screen time interventions, educational interventions (my favorite in their nihilist futility), nudges for managing, in maybe slightly more optimal ways, chronic illnesses that have already taken hold. These things don’t really work, but we can quantify how much they don’t work, publish our papers about how they don’t work (we will torturously rationalize the findings and overstate them, of course), use them to cycle back into the system to get more grants to produce more research.
Because public health research runs on this cycle, the “theorization” of the discipline is completely wagged by the exigencies of the grant cycle. Everything is thought of in terms of access to health care encounters (never mind how exploitative, useless, racist, expensive, burdensome, or otherwise outright harmful those health care encounters are) and the choices people make about how healthful their “lifestyle” will be (never mind the things that structure what people eat, whether and how much people can exercise, what kinds of risks they’re exposed to at work, and so on).
I think about public health in terms of political economy, of primary prevention through policy and concrete political struggle to achieve policy. It’s disheartening that I’m still, even after the events of Covid-19, in an extreme minority in public health — if you can even say that I’m “in public health” anymore.
The rhetoric of MAHA pretty much the same rhetoric of mainstream public health, and it’s gonna slot in very nicely into our health infrastructure. I’m fond of saying that good analysis begets good politics. Does it? I’m right, I’ve always been right, and here’s where it’s gonna get us: all the grifters clinging on to MAHA are gonna finally get their big payout. If you sincerely think there’s anything in MAHA that is genuinely deregulatory, you’re a gullible rube. They’re never gonna actually piss off big pharma, or big ag, or whatever else. What they’re gonna do is message public health in this exact same language of faux concern about prevention and a healthy environment to make sure that Medicaid has to reimburse Kinoki Foot Pads and ayahuasca-facilitated soul retrieval and colloidal silver — it’s gonna MLM-ify the entire American health infrastructure even more than it already is and make all of us into the pool of marks, into the market that is gonna be endowed with the wonderful freedom to put more of our income (disposable or not) into the pockets of supplement hawkers and energy healers.
It feels like we are really losing the horizon of collective action over any issue of public import in a fiberoptic bellow of social media content and niche posturing over fake controversy. The mechanical and joyless discourse of the importance of joy in activist circles is disheartening. My next post is going to reckon with this a little bit more… the question for me now is how to sit with awareness of what is. It’s all too easy to bypass this and get lost in the what should be, and I (like everyone else) have no shortage of ideas there. But it can be a false comfort, sitting in the rightness of one’s own analysis and confining one’s approach to measuring the distance between that correctness and reality. I have some specific thoughts about how this relates to science and scientific communication for next time but right now I’ve got to go to a Zoom meeting. Wish me peace.