The Trump administration’s clean up of the “Make America Healthy Again” Commission’s hallmark and error-riddled report is opening new questions about how the report’s authors drew some of its sweeping conclusions about the state of Americans’ health.
At least 18 of the original report’s citations have been edited or completely swapped out for new references since NOTUS first revealed the errors Thursday morning. While some of the original report’s inconsistencies have been changed, a few of the new updated citations continue to misinterpret scientific studies.
One study NOTUS identified as misinterpreted in the original report was intended to support the claim that psychotherapy is more effective for children than medication for treating mental health concerns. That study was swapped out with a new “systematic overview” authored by psychologist Pim Cuijpers, who told NOTUS via email that MAHA’s new citation is also wrong.
Cuijpers said his referenced study doesn’t cover psychiatric medications in children at all — the research was focused on adults. The citation is located in a section of the MAHA report titled, “American children are highly medicated – and it’s not working.”
“Treatments of depression in adolescents have a different efficacy than treatments in adults, so they cannot be compared, and this reference is therefore not usable in adolescents,” said Cuijpers, one of Amsterdam’s most-cited psychologists. “It also fails to state that the combination of therapy and antidepressants is superior to therapy or antidepressants alone.”
He added that there is no evidence that psychotherapy is more effective than antidepressants in adolescents.
He also took issue with the report’s claim that “antidepressant prescription rates in teens increased by 14-fold between 1987 and 2014.”
“It is strange to say that,” he said. “Modern antidepressants were developed in the late 1980s. So it can also be said that these drugs were simply used for the adolescents who could benefit from them.”
More on the MAHA Report
• The MAHA Report Cites a Paper Criticized as ‘Junk Science’ on Pesticides
• The MAHA Report Has Been Updated to Replace Citations That Didn’t Exist
• Democrats Say MAHA Report Inconsistencies Show Kennedy Isn’t Fit to Lead HHS
• The White House Blames ‘Formatting Issues’ for the MAHA Report’s Citation Problems
HHS did not immediately respond to a request for comment on the report’s changes.
The seven studies cited in the original report identified by NOTUS as nonexistent were all replaced with other studies or news articles. But some sources that NOTUS didn’t flag as nonexistent or otherwise problematic in its initial review were swapped out, including a citation on a line about screen use disrupting melatonin production in children.
The original cited study (“Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans”) was exchanged for another (“Digital media and sleep in childhood and adolescence”). NOTUS hasn’t yet identified a clear reason for the switch, but it’s possibly because the original study cited only looks at how ambient lighting affects melatonin in adults.
Trump administration officials have so far downplayed the seriousness of the issues in the MAHA report. White House press secretary Karoline Leavitt called them “formatting issues” and said the White House still has full confidence in Secretary Robert F. Kennedy Jr. And an HHS press secretary told NOTUS in an email late Thursday that “minor citation and formatting errors have been corrected.”
A batch of errors was corrected sometime between 10:15 a.m. and 3:28 p.m. Thursday, according to versions of the document archived by the Wayback Machine. But even the process by which the MAHA report was updated doesn’t meet the normal standards of making corrections to scientific papers, according to epidemiologist David Michaels.
“It is a basic practice of scientific journals to note when corrections are made,” Michaels said.
Thursday’s changes were also not the report’s first update. Earlier this week, WhiteHouse.gov hosted a version called “Microsoft Word - WH - The MAHA Report - 1PM_Updated_5.24_10AM_DPC_5.26_6PM_5.27_6PM_CLEAN,” which noted within five citations that specific changes, like fixing hyperlinks and incorrect author listings, were made on Tuesday.
But as reporters found more inaccuracies within the report on Thursday, the White House stopped denoting changes and removed references to past corrections. Officials continued to update the report throughout the night to remove AI chatbot fingerprints and other errors, according to The Washington Post.
Another “correction” to address a nonexistent study cited in the original is still misstating the credited researcher’s conclusion, he told NOTUS.
The report initially cited a pulmonologist (though not a real paper he contributed to) to support the claim that “an estimated 25-40% of mild cases” of asthma are overprescribed drugs.
Pulmonologist Harold J. Farber acknowledged he did find overprescription in a very limited study on one Medicaid-managed care program in Texas, which used data from 2011 to 2015. But at the time, he rejected the idea that those results were at all generalizable before the report was updated.
Farber outlined those concerns for NOTUS’ first story on the citations, saying using that specific study of his to generalize about national asthma-care patterns would require a “tremendous leap of faith.”
But now, after an update, the MAHA report cites that Medicaid-managed care program study in Texas to say that there is “evidence of overprescription of oral corticosteroids for mild cases of asthma” — attempting to paint a national picture about asthma care that Farber doesn’t believe is nuanced or accurate.
“Our challenge in asthma is that there is both over-prescribing and under-prescribing. In the 1990s, under-treatment and under-recognition of asthma were common,” Farber told NOTUS via email. “The challenge is to right-size, not too much and not too little. You don’t want to throw out the baby with the bath water.“
Another correction was to fix a citation for a study that was attributed to incorrect authors — citation 337, which was, until Thursday night, attributed to “Barros, R. M., Silver, E. J., & Stein, R. E. K. (2011). Recess, physical education, and elementary school student outcomes. Economics of Education Review, 30(6), 1358–1364.”
Now, it’s attributed to “Barros, R. M., Silver, E. J., & Stein, R. E. (2009). School recess and group classroom behavior. Pediatrics, 123(2), 431–436. https://doi.org/10.1542/peds.2007-2825.” The bibliographic information is correct — but the study still fails to support the report’s claim that “since the 1970s, recess and physical education (PE) have steadily declined.”
The study says it simply “compares the group classroom behavior of children receiving daily recess with that of children not receiving daily recess,” focusing on just 8-to 9-year-old children.
—
Margaret Manto and Emily Kennard are NOTUS reporters and Allbritton Journalism Institute fellows.
Have tips? You can reach Margaret on Signal at margaretmanto.61 and Emily at emilykennard.24.