To Sue or to Woo? The Medical Establishment Is Divided on MAHA

The Trump administration’s celebration of its new meat- and milk-centric dietary guidelines was held in an auditorium decorated with colorful posters of “Real Food” and a crowd of MAHA luminaries.

Mike Tyson was in the house. Agriculture Secretary Brooke Rollins. Health Secretary Robert F. Kennedy Jr. and his adviser Calley Means, who catapulted into the federal government from the wellness industry while pushing raw milk and decrying vaccine mandates. The Senate’s resident vegan, Cory Booker, was invited, but wasn’t there.

Bobby Mukkamala was. As president of the American Medical Association, few would expect Mukkamala to show up for a photo op with Kennedy and his Make American Healthy Again acolytes.

That morning, among the posters of carrots, steak and a Photoshopped picture of Kennedy with a Mike Tyson-style face tattoo, Mukkamala joined Kennedy on stage and spoke glowingly about their joint efforts to improve the American diet.

Kennedy’s campaign to get Americans to eat less processed foods is an area of agreement between much of the medical and public health establishment and the MAHA world. There are many more areas of deep and serious disagreement.

The wide range of issues that fall under the MAHA umbrella has forced medical societies to ask themselves whether it’s possible — or worthwhile — to collaborate with a movement that pushes cleaner food as fervently as it does vaccine misinformation.

Some medical advocacy groups have decided the risk MAHA poses to public health is too great. Those groups have sued the Trump administration over its efforts to dismantle the childhood vaccine schedule and started pointed campaigns to counter misinformation coming out of the federal government.

The AMA has taken a different approach.

“It’s just like anything, there’s going to be things we disagree on,” Mukkamala told NOTUS earlier this year. “With Secretary Kennedy, I mentioned to him, actually, the first time we met, ‘You know what? On the vaccine issue, I know we see things differently. I’m totally fine with putting that on the shelf and working on this together.’”

The two are on a texting basis and have “very productive conversations” about health care and the health system, Mukkamala said.

Some within the medical community have questioned the AMA’s decision to maintain a close relationship with the Trump administration.

“While I would very much welcome the AMA stepping up and helping to prevent Trump, RFK Jr., and their cabinet of willing physicians from further dismantling public health, I’m afraid I’m not optimistic,” Gavin Yamey, the director of the Center for Policy Impact in Global Health at Duke University, wrote on BlueSky in January. “They seem to believe that being ‘restrained’ and that ‘aligning’ with Trump is the way forward.”

It’s not just the AMA that’s picking and choosing when to align itself with the administration. The American Heart Association put out a statement in support of Kennedy’s “eat real foods” edict. The president of the Association of American Medical Colleges attended an HHS event on increasing nutrition education in medical schools.

The reality is that medical organizations are divided on how to interface with the new HHS leadership.

Last July, the American Academy of Pediatrics, the American College of Physicians and five other medical groups sued Kennedy and other HHS leaders. Their lawsuit challenged Kennedy’s decision to replace members of the CDC’s Advisory Committee on Immunization Practices with vaccine skeptics of his own choosing. The coalition of medical groups called Kennedy’s decision unlawful because it did not follow the standard procedure for updating federal vaccination recommendations.

Later, the lawsuit was amended to also challenge the CDC’s January announcement that the childhood vaccine schedule would be reduced from 17 to 11 diseases.

The AMA joined an amicus curiae brief filed by 20 other medical associations. It is not a plaintiff in the lawsuit. Mukkamala told NOTUS he didn’t know the details of why his organization decided to file a brief instead of joining the lawsuit as a plaintiff, but he said that filing a brief was a “legitimate way to look out for what’s best for our country, from our perspective, with somebody that disagrees, but yet maintain a relationship.”

“I’m totally fine with disagreeing politely in a way that would lead to conversation as opposed to criticism,” Mukkamala said.

Historically, the American College of Physicians has expressed polite disagreement through “evidence-based policy papers,” the group’s president, Jason Goldman, said. Joining the AAP in suing the administration was a step beyond.

“It was not a decision that we took lightly,” Goldman said. The ACP board met several times to discuss whether joining the lawsuit was worth risking government retaliation.

“We had no choice but to engage in a lawsuit to protect our patients, protect the practice of medicine and ensure public health,” Goldman said. “Previous administrations, we’ve been able to have constructive dialogue and communication with HHS, CMS, Congress. That has not been the posture of this current administration in regards to conversations.”

At least one plaintiff, the AAP, has faced what appear to be repercussions for joining the lawsuit. In December, HHS cut seven federal grants to the AAP, totalling nearly $12 million dollars. A federal judge later ordered the government to restore the grants while the lawsuit proceeds.

The AAP didn’t respond to requests for comment from NOTUS. In a statement released after the judge’s ruling, Mark Del Monte, the AAP vice president, wrote, “The federal government remains an essential partner to improving the health of children. The AAP will continue to do all we can to support children’s health and well-being, just as we’ve always done, and we will continue to speak out and take action against threats to children’s health, just as we’ve always done.”

HHS did not respond to a request for comment.

Historically, major medical associations like the AMA, AAP and ACP have enjoyed a close, if sometimes strained relationship with the federal government — one marked by intense lobbying and sometimes collaboration on health care legislation and policy.

The AMA, for example, has benefited from its ties to the federal government. The organization holds the copyright to Current Procedural Terminology, or CPT, codes used by Medicare and Medicaid to process claims. Hospital systems and insurers pay fees to the AMA to use CPT codes, generating approximately $300 million a year in income for the group and allowing it to become less reliant on dues from its physician members.

As to whether the CPT coding revenue structure factored into AMA’s decision to cooperate with the current HHS leadership, Mukkamala told NOTUS via text, “CPT is an important documentation of patient care and driver of health tech innovation. It is the data ‘language.’ Our work with HHS centers on improving the quality of care for our patients. In just the last few months, that includes nutrition, conversations on innovation with [the Center for Medicare and Medicaid Innovation], and efforts to shape the future of medical education.”

Still, some of the most powerful voices within the MAHA movement are skeptical of medical advocacy groups’ ties to the pharmaceutical industry. Kennedy himself has repeatedly criticized the AAP on his X account, calling it in 2022 a “corporate and government mouthpiece that touts the wares of drug, vaccine and formula manufacturers.”

On a podcast last year, Means said the Centers for Medicare and Medicaid are “controlled” by the AMA.

Despite these claims, Mukkamala said he would like to collaborate with Kennedy to promote physical fitness and mental health. He has invited the secretary to visit his hometown of Flint, Michigan, “just to see a blue-collar town.” (Kennedy expressed interest, Mukkamala said.)

“Just like my friends at home, we’ll disagree on half this stuff,” Mukkamala said. “They’re on the other side of the political line, but we get along like siblings.”

The groups that have taken a more adversarial approach are anticipating a different path. In March, a federal judge ruled in favor of the medical societies’ challenge and temporarily blocked the administration’s changes to the childhood vaccine schedule and invalidated all the decisions made by the Kennedy-appointed ACIP, calling its new members “distinctly unqualified.”

The ruling forced the CDC to postpone a scheduled meeting of the committee; a few days after the postponement was announced, the committee’s vice chair resigned.

“The hope is that we will get to a place where we can once again trust our federal agencies, and they will not be hijacked for individual agendas,” Goldman said. “But in the absence of that time, the ACP and other medical societies will continue to do what we have always done, which is step up.”