In the media鈥檚 rush to cover the nomination of Casey Means to the position of Surgeon General, one important name was neglected.
Means, of course, deserves scrutiny as the co-shepherd of the Make America Healthy Again movement. She (allegedly) dropped out of her surgical residency and embraced functional medicine, where tests and dietary supplements are overprescribed. Her bestselling book Good Energy misrepresents the state of our knowledge on mitochondrial dysfunction, and her idea of testing the safety of raw milk is to stare a farmer in the eyes and . Clearly, the senators tasked with confirming or rejecting her nomination should raise a few eyebrows.
But the day before the announcement, Dr. Vinay Prasad was revealed to be the new director of the FDA鈥檚 Center for Biologics Evaluation and Research (CBER). Prasad is a man who built a career out of being an inflammatory, outspoken contrarian. He compared the U.S.鈥� public health measures against COVID-19 to ; now, he joins an authoritarian regime that continues to draw comparisons to the darkest days of the 20th century, while his boss, Robert F. Kennedy Jr., remains a leader of the modern anti-vaccine movement.
He doesn鈥檛 seem to have a problem with that. Last November, Prasad addressed the White House COVID advisor on X, , 鈥淕od gave people two arms鈥� One to vote for Donald Trump, and the other to give thumbs up to RFK Jr.鈥�
Basketball鈥檚 kids league
笔谤补蝉补诲鈥檚 , remarkable though they may be, are only the beginning of the story. He double-majored in philosophy and physiology, before being tempted to take the medical school entrance exam by a roommate. He earned a medical degree from the University of Chicago, pursued a residency in internal medicine, completed a Master鈥檚 degree in public health, and finished his education with a fellowship in oncology and hematology. Practicing medicine, however, did not seem high on his list of priorities. In , he was said to see patients 鈥渞oughly one day a week.鈥� Instead, he cared about evidence.
Medicine has always had an evidence problem, from its early foundation of mistaken beliefs to its later emphasis on eminence and scientific plausibility. We are now in the era of evidence-based medicine, where treatments should be rigorously tested to know if they work or not, but the system leaks. Prasad wanted to hold doctors鈥� claims of safety and efficacy accountable to the evidence鈥攁 very noble goal鈥攂ut the way in which he went about it stripped his arguments of nuance and invited problematic collaborations.
One of his professors, Dr. Adam Cifu (with whom he would co-author ), once characterized Student Prasad as having but money has to come from somewhere. During the pandemic, Prasad penned published by the Brownstone Institute, a nonprofit founded by libertarian Jeffrey Tucker who has and while his think tank was funded by tobacco giant . I will remind the reader that Prasad has a graduate degree in public health.
Before COVID-19, though, Prasad started a podcast, Plenary Session, and took to Twitter to position himself as a fly in the medicinal ointment. His smugness earned him the nickname 鈥淭he Prasad鈥� on social media, while his thin skin resulted in him blocking anyone who dared criticize him, an act so common and all-encompassing it inspired the Twitter account He set his sights on the hyped-up promises of personalized medicine鈥攖he idea that measuring a patient鈥檚 DNA top to bottom would result in the best customized care for them, an idea particularly appealing in oncology. But on social media, speed and sensationalism are what put you at the top, not accuracy, as was remarked in an article published about him in at the time.
While Prasad was poking holes in the new frontier of cancer medicine and y, he came to the attention of skeptics by accusing us of wasting our time. In a now-infamous tweet, Prasad wrote, 鈥淒unking on alternative medicine is setting the hoop to 7鈥� and pretending to be Michael Jordan.鈥� He later tweeted about people fighting science misinformation, belittling the bulk of us as 鈥渦nemployed鈥� and not publishing papers, while writing that 鈥渉alf of what they say is incorrect.鈥�
In a twist of striking irony, he repeated his disparaging remark on the debunking of alternative medicine, illustrating it with a video of a basketball player moving past a regulation hoop and dunking the ball in a basket short enough for a kid.
The date was March 2, 2020.
鈥淢asking without evidence is an untreated mental illness鈥�
The COVID-19 pandemic was a radicalizing event for many. It highlighted the socioeconomic disparities between the people who were allowed to work from home and those who were sent to the frontlines to keep the economy churning. It also revealed that aerosol transmission was an inconvenient truth for most, who were quick to drop the annoying mask and have faith in the vaccine as complete salvation. But others were radicalized in the opposite direction.
They saw public health measures as tyranny and the new vaccines as dangerous. The pandemic birthed a new class of anti-vaxxers, who still (at least temporarily) trusted classic vaccines but vilified the COVID ones, particularly those using messenger RNA technology. Their story, repeated ad nauseam on Substack, Twitter, medical journal op-eds, and right-wing television programs, was that the illness had been hyperbolized and we had been lied to about the vaccines.
Prasad went into overdrive downplaying the pandemic and forming an alliance with other COVID contrarians under the name 鈥渢he Urgency of Normal.鈥� He opposed protecting infants, children, teenagers, and young adults from the ravages of the novel coronavirus, arguing that the virus was . In 2024, he co-authored that called the COVID vaccines 鈥渁 miraculous, life-saving advance offering staggering efficacy in adults,鈥� but throughout the pandemic he insisted they would cause harm to anyone else. He that COVID never leads to serious damage to the heart, going so far as to announce that 鈥渢he verdict is in;鈥� while some early studies had problems, it is now clear that in many ways, and that this harm can persist at least a year after the infection.
Meanwhile, he hyped up the tiny risk of myocarditis and pericarditis in young men tied to the COVID vaccines, earlier this year that 鈥淧fizer and Moderna SHOULD be sued for myocarditis,鈥� as 鈥渢heir products hurt and killed some young men.鈥� It is true that the vaccines did increase a bit the risk of myocarditis鈥攁n inflammation of the muscle of the heart鈥攅specially in young men, but and the risk was dwarfed by the similar harm caused by the virus itself.
Whatever harm Prasad once believed COVID could cause, though, he claims the disease He says people who carry CO2 monitors around to check for air exchange have an that period, and that the people who wore N95 masks to protect their lungs from the 2023 Quebec forest fires had because the evidence was 鈥減iss-poor鈥� and public health was led by 鈥渢he dumbest people;鈥� and that long COVID had been and that the small sums of money invested in researching the condition plaguing millions of people worldwide was According to Prasad, who studied public health, you just need to make peace with the fact that you鈥檒l be infected with COVID over and over and to just show up to work regardless, unless you鈥檙e feeling really sick.
He lashed out at any institution that said otherwise, calling for their destruction. He wanted the American Academy of Pediatrics to be He said teachers鈥� unions and that public schools needed ; and that the Centers for Disease Control should be because Prasad disagreed with the statistics it was publishing on how many kids had died of COVID. Manufacturers of respirator masks aimed at children, he said,
But when actual experts criticized his friend John Ioannidis鈥� terrible, conflicted study that downplayed the fatality rate of the new coronavirus, Prasad was quick to say that this criticism was Contrarians love to pummel their adversaries but when the latter point to flaws in their thinking or to academic sloppiness, it鈥檚 always framed as an attack. Prasad says 鈥渁nyone who uses the word 鈥榤isinformation鈥� is ,鈥� but that 鈥渢he majority of science is .鈥� This is not scholarship; this is lucrative schoolyard bullying.
Can a leopard change its spots?
On March 28 of this year, Dr. Peter Marks, the head of CBER鈥攃ommonly referred to as FDA鈥檚 vaccine chief鈥攕ent in . He explained that he was initially willing to work with Robert F. Kennedy Jr. but that 鈥渢ruth and transparency鈥� were clearly not desired by Kennedy. 鈥淩ather,鈥� Marks wrote, 鈥渉e wishes subservient confirmation of his misinformation and lies.鈥� Marks is being replaced by Vinay Prasad. In , Prasad accused Marks of rubber-stamping COVID-19 vaccine boosters and said he 鈥渕ight be the worst FDA regulator in modern history.鈥�
Like Russian dolls, the Food and Drug Administration is under the larger Department of Health and Human Services in the United States, while CBER is nestled within the FDA. The Center for Biologics Evaluation and Research is tasked with regulating most biological material used in medicine: vaccines; blood; materials that produce allergies and that can be used to diagnose or reduce allergic reactions; functional collections of cells known as tissues; and therapies that involve cells and genes. (Some biologics, such as protein-based ones and biosimilars, are under the purview of within the FDA, although .)
How might Prasad affect the direction of CBER? His had none of the usual arrogance and black-and-white thinking that are the heart of his communication strategy; rather, he highlighted the need to better disseminate science and said, 鈥淚鈥檝e learned a lot from reading your papers over the last 20 years.鈥� His fans will argue he鈥檚 mellowed out, but this could also be read as a passive-aggressive attack: I鈥檝e learned from reading your papers that you鈥檙e in need of radical change because you鈥檝e failed at your jobs.
And these kinds of addresses can be misleading. To parents of autistic children, RFK Jr frequently referred to thimerosal-containing vaccines as a Holocaust, but in front of legacy media cameras, he said he had never been anti-vaccine. People lie, and the gravity of public office can encourage them to present a softer veneer.
笔谤补蝉补诲鈥檚 ruthless insistence on randomized controlled trials or RCTs鈥攖o the point of being referred to as 鈥渕ethodolatry,鈥� meaning a worship of RCTs to the exclusion of any other form of scientific study鈥攚ill provide a test case for him. He insisted during the pandemic that mitigation measures had to be tested by randomly assigning people to abiding by the measure or not: no other form of evidence would be enough for him.
I turned to Dr. Jonathan Howard, who has documented 笔谤补蝉补诲鈥檚 contrarianism for and for his book, . 鈥淗e excoriated the previous medical establishment,鈥� Howard told me via email, 鈥渇or not doing more trials and has supported removing COVID vaccines until they show their value against hospitalization and death in new RCTs.鈥� In his recent FDA address, though, 笔谤补蝉补诲鈥檚 dictate softened: 鈥淕ood evidence is context dependent,鈥� he finally admitted. He said that for rare diseases, RCTs are 鈥渘ot always necessary,鈥� as recruiting enough participants, many of us would argue, can be very challenging if not impossible. His stance on RCTs in was likewise nuanced: they can only be done 鈥渆thically,鈥� he wrote, 鈥渋f there is real uncertainty as to which is better, the treatment or the placebo.鈥� So, which is it? It seems it鈥檚 鈥淩CT for thee but not for me:鈥� COVID protection measures needed bulletproof evidence before being rolled out, but any disease Prasad deigns to be worse can benefit from his charitableness. As Howard pointed out to me, 鈥渋f Dr. Prasad does not have a large portfolio of RCTs four years from now, his tenure will be a total failure by his own standards.鈥�
Prasad, who has acted as judge, jury, and would-be executioner being the podcast mic throughout the pandemic, now ultimately works for the anti-vaxxer-in-chief, RFK Jr. Everyone in charge of an important pillar of the Health and Human Services department鈥擳V snake oil salesman Mehmet Oz, COVID contrarians Marty Makary and Jay Bhattacharya, pseudoscience devotee Casey Means (awaiting confirmation), cholesterol-denier Aseem Malhotra as Chief Medical Advisor of the MAHA movement, and now Vinay Prasad鈥攚ill get caught in the vaccine quarrel. The pro-vaccine-to-anti-vaccine spectrum is long and they all find themselves occupying different spots on it. Who will be further radicalized? Who will cave? Prasad tweeted out when Moderna鈥檚 stock price dropped recently and argued that a messenger RNA vaccine against bird flu should have by the largest biomedical funding agency, the NIH, directed by his friend, Bhattacharya. Will he start doubting every vaccine?
The irony is that 笔谤补蝉补诲鈥檚 smug dismissal of fighting against complementary and alternative medicine was out of step with reality. The pandemic turbocharged conspiracy theorists and wellness entrepreneurs, who sold fake, all-natural remedies and ivermectin to desperate people and convinced them to distrust public health authorities. Addressing misinformation during the pandemic was not as easy as dunking through a seven-foot hoop; it was a real challenge. Prasad thought the lessons of the skeptic movement were beneath him. They were not.
Yet another layer of irony is that Health and Human Services has been bastardized by the nomination of quacks and contrarians to direct its agencies. American parents wanting evidence-based health advice will now have to do something Kennedy and his pals have been promoting for years: their own research.
