{"id":11585,"date":"2025-08-02T15:34:57","date_gmt":"2025-08-02T19:34:57","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=11585"},"modified":"2025-08-02T15:55:32","modified_gmt":"2025-08-02T19:55:32","slug":"the-short-political-half-life-of-a-medical-contrarian","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/the-short-political-half-life-of-a-medical-contrarian\/2025\/08\/02\/","title":{"rendered":"The Short Political Half-life of a Medical Contrarian"},"content":{"rendered":"

\"\"In early May, I\u00a0wrote about the surprising FDA appointment of Dr. Vinay Prasad to lead the FDA’s Center for Biologics Evaluation and Research.\u00a0<\/a> Prasad is a UCSF hematologist-oncologist known for his views on COVID-19, oncology clinical trials, and his sometimes sharp-elbowed communication style, in particular directed at people with whom he disagrees. My goal was to write something balanced, and even hopeful, acknowledging both Prasad’s impressive skills in interpreting medical evidence and<\/em> his well-documented provocations, at least as viewed from the perspective of an ID doctor.<\/p>\n

Let\u2019s just say: not everyone loved that piece.<\/p>\n

I wrapped up that post with this:<\/p>\n

\n

Ultimately, my deepest hope \u2014 and I suspect everyone\u2019s \u2014 is that this appointment of Dr. Vinay Prasad leads to a continued focus on improving the safety, efficacy, and public trust in biologics, especially vaccines. We need rigorous science, honest communication, and thoughtful leadership more than ever.<\/p>\n<\/blockquote>\n

That doesn\u2019t sound too bad, does it? The comments I received here on this site were quite thoughtful, led by Dr. Jonathan Blum’s clever “I am cautiously pessimistic” — ha! I also got a nice note from Dr. Adam Cifu, who is a friend of Prasad’s and co-founded the interesting Sensible Medicine newsletter<\/a> with him.<\/p>\n

But, judging by some of the responses I received by email or on social media, you\u2019d have thought I\u2019d volunteered to ghostwrite for RFK Jr. For those who think Bluesky is the kinder, gentler social media platform, allowing only polite and balanced responses \u2014 I have some strong evidence to the contrary<\/a>. Yeesh. Turns out anonymous burner accounts are nasty no matter where they post.<\/p>\n

Now, not even 3 months later, Prasad is out<\/a>. Officially, he resigned \u2014 the classic \u201ctime with family\u201d explanation. Unofficially? He’s gone because he did what we say we want<\/em> FDA leaders to do: he questioned the approval of an expensive, potentially toxic therapy with scant evidence of benefit.<\/p>\n

And no, this wasn\u2019t about COVID-19. Or vaccines. Or even infectious diseases.<\/p>\n

It was about a treatment for Duchenne muscular dystrophy \u2014 a tragic and incurable disease that understandably generates passionate advocacy and whose therapies have a long track record of FDA controversy.<\/p>\n

But after a Wall Street Journal<\/em> op-ed<\/a> from a non-physician critic and some well-placed accusations of political disloyalty (apparently, he\u2019s too much of a Bernie guy now?), he\u2019s gone. Just like that.<\/p>\n

This raises a disheartening possibility: that both his appointment and his dismissal had less to do with his ability to interpret clinical studies and more to do with politics, all while mixing in an unhealthy tincture of conflict of interest.<\/p>\n

That\u2019s deeply unfortunate — because whether you loved or loathed Prasad\u2019s presence at the FDA, one thing is clear: science-based public health leadership shouldn\u2019t be a partisan tug-of-war. Not when trust in our institutions is already on shaky ground.<\/p>\n

I’d like to give the last word to one of my long-term mentors, a now-retired ID doctor who held some important government positions during his distinguished career. He’s been watching this turn of events with detached amusement from his summer home, and wrote me this sage comment in a terse email:<\/p>\n

It\u2019s<\/span> a lot eas<\/span>ier throwing bombs<\/span> at others<\/span> from the outs<\/span>ide than taking criticis<\/span>m coming in.<\/p><\/blockquote>\n

Isn’t that the truth?<\/p>\n

And speaking of sharp thinkers who challenged conventional wisdom, and because last week I finished with a tribute to some recent celebrities who died, this past week we lost satirist-mathematician Tom Lehrer at age 97<\/a>. His songs were a master class in wit, skepticism, and brainy mischief — all qualities that (whether you like him or not) Prasad might admire.<\/p>\n

Lehrer\u2019s work also brings back fond memories of the smartest kid in my school, my friend Jimmy P, who introduced me to these nerdy musical gems. (I was an 8.5\/10 on the nerd scale; Jimmy easily 10\/10.) If you\u2019ve never seen it — or just want to be reminded how funny chemistry can be in the right context — here\u2019s one of the all-time classics:<\/p>\n