As I sat down to write my weekly post, I had originally been thinking that, as much as I say that I’m tired of writing about our Secretary of Health and Human Services (HHS), Robert F. Kennedy, Jr., I probably still had to write about the utter clown car of a fiasco that was his testimony last Thursday in front of the Senate Finance Committee. Then I thought: What is left to say four days later? All you need to know is that the chair of the committee, Sen. Mike Crapo (R-Idaho), rejected a request by ranking member Sen. Ron Wyden (D-Oregon) to require RFK Jr. to testify under oath. This left RFK Jr. free to lie, prevaricate, deflect, deny that he’d ever said things that he is clearly on record as having said, and generally be RFK Jr. for three hours, which he immediately proceeded to do with his usual combination of resentment at anyone daring to question him and brazen shamelessness. As I thought about the depressing task of going through three hours of this, I came across an article in—of all places!—The Wall Street Journal by Sara Ashley O’Brien entitled RFK Jr. Is Dismantling Public Health. A Fringe Theory May Explain Why. Intrigued, I read the tagline: The Health and Human Services secretary has long embraced anti-scientific ideas that run counter to germ theory, the basis of treating infectious diseases.
Wow. I was shocked. Someone at the WSJ actually gets it, and an editor let her actually publish commentary about it! She even correctly identified the ideas:
Why do people get sick? Ask Robert F. Kennedy Jr., America’s highest-ranking public-health official, and he may chalk it up to their terrain.
For centuries, doctors and scientists have agreed that germs are the underlying cause of infectious diseases. Someone coughs on you, you get a cold. Drink raw milk, and you might end up with E. coli or listeria. This widely accepted truth is the basis of pasteurization, vaccines and antibiotics.
But Kennedy has long embraced ideas rooted in theories that run counter to germ theory and help explain his deep mistrust of vaccines and his efforts to remake the U.S. public-health system. Those efforts came to a head last week as the Trump administration fired the head of the Centers for Disease Control and Prevention and other top officials quit their jobs in the midst of disagreements with Kennedy vaccine policy. On Thursday, Kennedy testified before a heated Senate panel about the administration’s health agenda and the recent staffing shake-ups.
And, here’s the kicker:
As chemist Louis Pasteur’s germ theory of disease was gaining traction in the 1800s, his rival Antoine Béchamp raised an alternative explanation: Disease, he said, was caused by the state of the body, which he referred to as the “terrain.” In his view, a strong inner environment, bolstered by nutritional food and a healthy lifestyle, could fend off illness.
Reading this, it occurred to me that now is as good a time as any to discuss two key components of the “make America healthy again” (MAHA) movement. The first is, as mentioned above, germ theory denial, as alluded to above. The second is denial of genetics, as I will discuss. (Yes, I know there are other sciences denied by MAHA, but I believe that these are the two main ones.) From my perspective as well, MAHA is a loosely associated movement consisting of “natural health” aficionados, “health freedom” activists, antivaxxers, and fitness influencers that is rooted in a combination of alternative medicine and techno-utopianism. Obviously, nothing springs up from nothing. What is now called “MAHA” predated RFK Jr.’s ascension to HHS Secretary but underwent a rebranding when RFK Jr. coined his MAHA slogan soon after he had folded his independent Presidential campaign in order to bend the knee to Donald Trump in return for the promise of a powerful role in health policy,. When Trump won the 2024 election, the position promised to RFK Jr. in return for kissing Trump’s ring was revealed to be HHS Secretary.
Since then, although there have been predictable tensions between the extreme antivax wing of MAHA and the more pragmatic antivax approach of incrementally making vaccines harder to get until they are gone as well as the “right to try” movement and the weaponization of evidence-based medicine paradigms to make vaccines more difficult to approve and market, MAHA is firmly in charge of HHS, which includes all non-military public health, medical, and biomedical research programs in the federal government; e.g., the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health. That’s why I think it’s worth looking at what I now call two pillars of MAHA.
Terrain theory and MAHA
We at SBM have long been writing about how germ theory denial is at the root of so much of alternative medicine and the antivax movement, large swaths of which have found common cause under the banner of MAHA. Indeed, looking back through our archives, I found that the first SBM post mentioning germ theory denial was by me in 2008. It was a post about antivaxxers and the human papillomavirus (HPV) vaccine. A few months later Dr. Harriet Hall was the first to write a post specifically germ theory denial and alternative medicine in 2008, sarcastically riffing on the Mythbusters’ famously sarcastic tagline, “I reject your reality and substitute my own,” as she related the story of a chiropractor and a woman whom she called a “raw food lady” (sound familiar?), both of whom confidently told her that germs don’t cause disease. She then discussed various flavors of germ theory denial before concluding, “I wish we could reject the reality that germ theory deniers exist.” (So do I.) A couple of years later, I wrote one of my typically long posts about germ theory denial and alternative medicine, in which I discussed the Antoine Béchamp in the context of the history of germ theory denial. Since then, we’ve updated our discussions of germ theory denial to account for the new variants (if you’ll excuse the term) that have popped up since the COVID-19 pandemic, most recently earlier this year.
What I find interesting about germ theory denial inspired by terrain theory are two things, starting with how little it has changed since the 1800s. However, equally interesting is how conveniently the modern version of terrain theory leaves out certain aspects of Béchamp’s original ideas. Let’s start with the modern incarnation of how Béchamp’s terrain theory is commonly invoked by antivaxxers, quacks, and MAHA acolytes. I find it convenient to quote from the WSJ article above, as it’s a succinct representation of how many MAHA acolytes now present terrain theory:
Kennedy’s Make America Healthy Again movement has advanced fringe proposals such as removing fluoride from public water and defying vaccine schedules. Meanwhile, wellness influencers are promoting myriad “detoxifying” supplements and treatments to their millions of followers. All of this has brought long-debunked ideas about health back into the zeitgeist.
Actor Woody Harrelson, a vocal Kennedy supporter, asserted his belief in terrain theory while appearing on Rogan’s podcast in February. “People’s immune system gets messed up from what they’re consuming,” he said. “And in a nutshell, that’s why I believe in Béchamp’s theory as opposed to the germ theory. And, at least, it’s got to be both.” Harrelson, who declined an interview request, also discussed the theory on Bill Maher’s podcast in 2022, where Maher showed support for the theory too.
In their remarks, Harrelson and Maher acknowledge that germs do exist—but that healthy people tend not to be affected by them. “No serious person would contend that terrain isn’t a factor in our health,” Maher said in a statement. “A pathogen invading healthy terrain will have a harder time surviving. Terrain is a key factor among many.”
You’ll excuse me if, seeing Bill Maher mentioned in the context of terrain theory and the antivax movement, I can’t resist yet another callback to one of my favorite lines of all time. Back in 2008, Bob Costas was a guest on Maher’s HBO show, Real Time with Bill Maher. Somehow, the topic of flu vaccines came up and how easy it is to catch it in crowded places like on an airplane, which led Maher to brag about how his “terrain” was so resistant to infection that he didn’t need the flu vaccine and would “never get flu on an airplane.” Bob Costas’ response was one for the ages: “Oh, come on, Superman!“
In any event, the modern-day invocation of Béchamp’s terrain theory tends to emphasize claims that pathogens, be they viruses, bacteria, or other pathogenic organisms can’t make you sick if your “terrain” is made resistant, usually by the now familiar combination of diet, exercise, and other health virtues, as Maher said in that episode, “The model you have is wrong. You’re thinking that the problem is the mosquitos, not the swamp. If there’s no swamp, the mosquitos can’t take root.” This is, of course, a commonly used metaphor. So is this:
Of course, the idea that healthy people are more resistant to infectious disease and, if they do become infected, are less likely to become severely ill or die from the disease is basically accepted science. After all, if you are chronically ill, malnourished, elderly, and/ or debilitated, your immune system will not be able to launch as robust a response to a pathogen as someone who is “young and healthy.” Moreover, there is no incompatibility between germ theory and acknowledging that your general health, which is impacted by lifestyle, can modulate your susceptibility to disease. That, however, is not what terrain theory advocates are saying. Those who invoke terrain theory tend to emphasize “the terrain” über alles as the be-all and end-all of preventing infectious disease. What they are arguing is that pathogenic microorganisms and viruses can’t make you sick if your terrain is “clean” and “pure.” There are, of course, gradations of terrain theory, ranging from the more radical that denies that germs can cause disease to more of a fusion that grudgingly admits that germs can make you sick but places far too much power in the ability of interventions touted by alternative medicine to “clean the tank” and make the terrain supposedly resistant to disease.
Variants of terrain theory were popular around the same time in the 19th century, championed in different versions by Claude Bernard and Antoine Béchamp, among others. Here’s where it gets interesting. The modern version of Béchamp often conveniently leaves out a very critical part of Béchamp’s original terrain theory that is obviously wrong. Béchamp, for example, strongly argued that microorganisms were not the cause of disease but rather the consequence of disease. Specifically, he argued that injured or diseased tissues produced the microorganisms, and that it was the health of the organism that mattered, not the microorganisms. In other words, the “terrain” was all. Bernard, for his part, described what he called the milieu intérieur, the interstitial fluids regarded as an internal environment in which the cells of the body are nourished and maintained in a state of equilibrium, which he and others also called terrain. Both men’s ideas, but in particular their shared concept of the “terrain,” have been very attractive to germ theory deniers.
In, particular, let’s focus on Béchamp’s idea, given that MAHA stans tend to invoke him rather than Bernard. Known as the pleomorphic theory of disease, Béchamp’s hypothesis stated that bacteria change form (i.e., demonstrate pleomorphism) in response to disease. In other words, they arise from tissues during disease states, rather than invade tissue to cause disease. Béchamp further postulated that bacteria arose from structures that he called microzymas, which to him referred to a class of enzymes, that microzymas are normally present in tissues, and that their effects depended upon the cellular terrain. As our readers know, Pasteur’s theory won out over the ideas of Bernard and Béchamp, based on evidence, but Béchamp was definitely very influential in the 19th century, and, given the science and technology of the time, his hypothesis was not entirely unreasonable. It was, however, superseded by Pasteur’s germ theory of disease and Koch’s later work that resulted in Koch’s postulates.
That’s not to say that more extreme forms of germ theory denial that claim that, for instance, viruses don’t exist don’t have influence, but the idea most commonly cited by antivaxxers and MAHA tends to be a version of terrain theory, often disguised as a fusion of terrain theory that grudgingly acknowledges that germs can in fact cause disease, but only in those who are not healthy to begin with. We saw this a lot during the COVID-19 pandemic, and it’s an old idea that antivaxxers have long applied to measles, claiming that measles is a harmless childhood disease that doesn’t kill healthy children, only children who are unhealthy to begin with.
In addition, besides not fitting with the scientific evidence, Béchamp’s idea had nowhere near the explanatory and predictive power that Pasteur’s theory did. On the other hand, as I mentioned above, there is a grain of truth in Béchamp’s ideas. Specifically, it is true that the condition of the “terrain” (the body) does matter when it comes to infectious disease. Debilitated people cannot resist the invasion of microorganisms as well as strong, healthy people. There is a twist, though, that modern day advocates of terrain theory almost never mention; that is, if by “terrain” you mean mainly the immune system. We now know that the “terrain” can facilitate the harmful effect of microorganisms in unexpected ways. One well-known example is how certain strains of influenza (as in 1918 and H1N1) are more virulent in the young because the young can mount a more vigorous immune response against them, which damaged tissues and made the lungs more susceptible to bacterial infection.
RFK Jr. is totally down with these ideas, too, as described in the WSJ article:
As his political profile grew, Kennedy made his war on germ theory part of his public platform. As a presidential candidate in 2023, he promised to tell the National Institutes of Health to “give infectious disease a break for about eight years,” NBC reported. On a 2023 episode of Joe Rogan’s popular podcast, Kennedy said “it’s hard for an infectious disease to kill a healthy person with a rugged immune system”—an assertion that runs counter to modern medical consensus. When Rogan said that wasn’t true of the 1918 Spanish flu, which killed more than 50 million people globally, Kennedy replied: “Well, the Spanish flu was not a virus.”
Naturally, RFK Jr. blamed the 1918 influenza pandemic on a flu vaccine. I’ve discussed this conspiracy theory before in the context of a virus denier who invoked it to deny that SARS-CoV-2, the virus that causes COVID-19, exists and so will refer you here if you want more information.
Obviously, there are a number of attractive features of terrain theory if you doubt modern medicine and are enamored of the ideas underlying “natural” health movements. First of all, if pathogenic microbes can’t cause disease when the “terrain” is resistant—or never cause disease at all!—then vaccines are obviously unnecessary. Even if you believe in a less absolutist version of terrain theory that acknowledges that microbes can cause disease and even that vaccines can work, you can easily be led to view even rare injuries due to vaccines as resulting in a risk-benefit ratio that is unfavorable, allowing a justification for instead opting for whatever health-virtuous lifestyle, supplements, and “detoxification” (to eliminate the “toxins” supposedly “poisoning” your terrain) instead. Second, if someone does become sick due to an infectious disease, then one can comfort oneself by believing that that person must either be already ill or must not have been living a sufficiently virtuous lifestyle or is somehow “impure.” These latter consequences thus allow one to indulge latent eugenicist beliefs combined with religious beliefs. (I’ve long referred to antivax beliefs as a purity cult.)
Finally, if you believe that infectious diseases are a result of a “polluted terrain” rather than pathogenic microbes, you can then justify treating such diseases with all manner of supplements and magic. We saw this when during the West Texas measles outbreak earlier this year RFK Jr. emphasized treating measles with vitamin A (which was only ever shown to be beneficial in underdeveloped nations where the children tended to be significantly malnourished) and touted doctors using quackery, even steroids, to treat children with measles.
If germ theory denial, in particular terrain theory, is a major piece of MAHA, so is the denial of genetics.
Denial of genetics as a cause of disease: A second pillar of MAHA
If, as MAHA seems to preach, you can prevent nearly all disease if only you live a sufficiently “virtuous” lifestyle with respect to health, one huge reality check is the existence of genetic predispositions to disease. The prototypical example is the marathon runner who drops dead of a heart attack at age 45 due to a strong genetic predisposition to heart disease. Sure, without a supremely healthy lifestyle, that marathon runner might have dropped dead at age 35 instead, but the curse of genetics meant that the odds of the runner ever living to be 80 under any circumstances were always so close to zero as to be practically indistinguishable from it. I use this example not to disparage exercise and diet, but rather to point out that there are very definite limits on what health as a consequence of a virtuous lifestyle can accomplish in the face of genetic predispositions and that those limits are far more stringent than anything a wellness influencer would want to admit.
Perhaps the best example of how MAHA denies genetic predisposition to health conditions is autism. I’m just going to repeat it again right here. Autism is primarily, but not exclusively, genetic in nature. The evidence for this conclusion has been building for decades, and we’ve written about it a number of times here on SBM dating back to 2010. Indeed, we now know that the genetic contribution to autism and autism-spectrum disorders is approximately 65%-90%, perhaps as high as 80%-90%. We know this from twin studies, population studies, and a number of other studies. None of this means that environmental factors are not important, as they can influence risk. Indeed, the most well-characterized environmental risk factor for autism is prenatal rubella infection, although more recent reappraisals have questioned how strong the link is.
You wouldn’t know that autism is primarily genetic in nature, however, from what RFK Jr. says about it. Remember, he first “came out” as an antivaxxer in 2005 when he published an article in Salon.com and Rolling Stone entitled Deadly Immunity. In it, he presented a conspiracy theory in which the mercury-containing preservative thimerosal was the primary cause for the “autism epidemic” but the CDC had met in 2000 at the Simpsonwood Conference Center to strategize how to cover up this supposed link. Later, as evidence that thimerosal-containing vaccines were not a risk factor for autism accumulated, particularly after autism prevalence kept rising after thimerosal was removed from nearly all childhood vaccines in 2001, he easily pivoted to the more general antivax idea that it was vaccines, either specific vaccines like MMR or the idea of “too many too soon”, that cause autism. While it is true that some antivax narratives suggest a “genetic susceptibility” to autism that is triggered by vaccines, I still consider this to be genetics denial, as in these narratives the primary cause is never genetic. Rather, it’s the vaccines in genetically susceptible individuals, which seems to be most children. Moreover, try as antivaxxers might, they have never actually identified specific genes that somehow predispose to vaccine-induced autism.
As the Autism Science Foundation put it:
Autism doesn’t have a single cause. It is the result of a complex mix of genetics and environment. We know that genetic factors play the biggest role: hundreds of genes have been linked to autism, and inherited or spontaneous changes in these genes can alter brain development. Environmental factors also matter, especially during pregnancy, such as advanced parental age at conception, prematurity or very low birth weight, and exposures that affect brain development, like fever or illness during pregnancy.
Again, though, the predominant causes of autism appear to be overwhelmingly genetic. Again, that doesn’t mean that environmental causes don’t impact the risk, but if you listen to RFK Jr. and MAHA you can’t help but think that only environmental exposures—cough, cough, vaccines—cause autism.
Finally, one can’t help but note what RFK Jr. did almost immediately upon assuming the office of HHS Secretary, which was on April 16 to announce a study to find the causes autism. Nowhere in descriptions of that study does one see mention of genetics. Rather, RFK Jr. explicitly said that by September “we will know what has caused the Autism epidemic and we’ll be able to eliminate those exposures,” and, even more amazingly, promised to release preliminary results this month, only five months after his announcement. Any real researcher knows that a five month timeline for a project of this sort is impossible and likely indicates that the results were preordained. Adding to this impression was the observation that RFK Jr. had hired David Geier, the son half of the father-son team of antivax autism quacks who two decades ago “pioneered” the Lupron protocol, in which they treated autistic children with puberty blockers because they believed that testosterone bound to mercury and made it harder for chelation therapy to bind to mercury and remove it, to head it.
Meanwhile, NIH Director Dr. Jay Bhattacharya announced a “real world platform” look for causes of autism:
The National Institutes of Health (NIH) and the Centers for Medicare & Medicaid Services (CMS) today announced a landmark partnership to enable NIH to build a real-world data platform enabling advanced research across claims data, electronic medical records, and consumer wearables.
This partnership will focus first on enabling research around the root causes of autism spectrum disorder (ASD). In the long term, the partnership will link real-world data, in a manner consistent with applicable privacy laws to protect Americans’ sensitive health information, for research on chronic conditions—a core priority of President Trump and the Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr.
“We’re using this partnership to uncover the root causes of autism and other chronic diseases,” said HHS Secretary Robert F. Kennedy, Jr. “We’re pulling back the curtain—with full transparency and accountability—to deliver the honest answers families have waited far too long to hear.”
CMS and NIH will start this partnership by establishing a data use agreement under CMS’ Research Data Disclosure Program focused on Medicare and Medicaid enrollees with a diagnosis of ASD. Using ASD as the pilot research program, teams at CMS and NIH will establish a secure tech-enabled mechanism to enhance this data sharing with timely, privacy and security compliant data exchange. This pilot research program will inform continued development of a landmark NIH platform to ultimately be used by researchers in understanding healthcare utilization, chronic disease etiology and treatment, and the economic burden of chronic conditions.
Nothing to be worried about there, is there? I’m sure we’re all reassured by the supposed appeals to “privacy.” Basically, this looks like one big fishing expedition that will likely pull up a number of false positives.
Meanwhile, just last Friday, the WSJ reported that the HHS autism report promised this month will link acetaminophen use during pregnancy and folate deficiency to autism. I’m not going to go into detail about this, given that the report hasn’t been released yet, other than to say that existing evidence does not support a link between acetaminophen use during pregnancy and autism. There are small studies that suggest a link, but they are confounded and small. Indeed, just last year, a large Swedish cohort study encompassing nearly 2.5 million children born between 1995 and 2019 found no evidence of an association between prenatal acetaminophen use and elevated risk of autism spectrum disorder, concluding:
Acetaminophen use during pregnancy was not associated with children’s risk of autism, ADHD, or intellectual disability in sibling control analysis. This suggests that associations observed in other models may have been attributable to familial confounding.
The authors are referring to a handful of earlier studies that suggested a link. In brief, again, the overall scientific consensus is currently that there does not appear to be a link between acetaminophen use in early pregnancy and autism spectrum disorders. Nor is there good evidence that folate use (or leucovorin use) during pregnancy can prevent autism, although there is very good evidence that folate deficiency can lead to neural tube defects, which is why folate supplementation has long been recommended during pregnancy.
We’ll see what the report says later this month, of course. Speculation about whether it will include vaccines as an “environmental cause” of autism is rampant. It is, of course, is possible that RFK Jr. is saving vaccines for a subsequent report and focusing first on a disproven link between acetaminophen use during early pregnancy and autism and suggesting that leucovorin, because it supposedly passes the blood-brain barrier easier than folate, can prevent autism, the better to deflect against charges that he is antivaccine and that the report had a predetermined conclusion. My guess is that RFK Jr. won’t be able to help himself and knows that failure to mention vaccines in this first report would cause a major row among his followers.
MAHA: Health as virtue
As I’ve discussed before, like the philosophies on which MAHA is based, MAHA tends to deny external causes of disease that modern pharmaceuticals address, such as pathogenic bacteria that can be treated with antibiotics and pathogenic bacteria and viruses that can be prevented with vaccines, in favor of the idea that one’s health is nearly totally within one’s own control through one’s own virtue. Similarly, it tends to deny internal causes of disease, such as genetic predispositions, because genetic predisposition to disease means that one cannot be in near-total control of one’s own health through virtuous behavior, such as consuming a healthy diet and avoiding unhealthy foods, exercising, and taking the right supplements. To do this, large swaths of modern science must be denied or minimized, which is why I have been referring to MAHA as Lysenkoism 2.0, after Trofim Lysenko, whose lack of belief in genetics as science had come to understand it in favor of a more ideological conception of agricultural science worsened famines across the USSR during his three decades as the preeminent Soviet agricultural science. To this end, all agencies in HHS, including NIH, are being what I like to refer to as Lysenko-ized in service of MAHA’s ideological science.
Unfortunately, I fear that the results will be similar to those resulting from Trofim Lysenko’s control of Soviet agriculture from the 1930s to the early 1960s, only worse. After all, Lysenko only controlled Soviet agricultural science at the national level. RFK Jr. controls all non-military medical science. The damage he has already caused will likely take a generation or more to repair; that is, if it is repairable at all. Certainly, I highly doubt that I will live to see it repaired and will likely live long enough to see it get much worse. This is what happens when someone hostile to science that he doesn’t like is elected President and then promises to let an antivaxxer and germ theory denier “go wild on health.” Unfortunately, “going wild on health” is exactly what RFK Jr. is doing, and we will all suffer for it.
