MAHA and evidence-based medicine don’t have to be in opposition

The fights over the next surgeon general and the next Centers for Disease Control and Prevention director have been shaped by a movement that calls itself holistic while practicing its opposite. Last month, senators grilled Erica Schwartz, Trump’s CDC nominee, on whether she would defend vaccine science under a wellness-aligned U.S. Department of Health and Human Services. She would not fully commit.

Three months earlier, the White House withdrew Casey Means as its surgeon general nominee — a wellness author whose Oregon medical license had been inactive since 2019, who had dropped out of her surgical residency, and who was repeatedly pressed by senators on the standard infant hepatitis B vaccine.

The replacement, Nicole Saphier, is a radiologist who also sells herbal supplements, hosts a podcast called Wellness Unmasked, and wrote the 2020 book whose title, Make America Healthy Again, became the slogan of a national movement.

The specifics differ. The underlying category error is the same.

On its critique of American medicine, the MAHA movement is not wrong. After performing thousands of spine surgeries, I have come to believe — along with much of the literature in my own field — that a meaningful share of the elective spine operations in the U.S. are performed on patients who would do better without them.

We medicate teenagers for inattention without asking how they sleep. We treat the disc and forget the life it sits inside. When the wellness movement says American medicine has been reduced to organ systems and 15-minute appointments, the criticism lands because the charge is true.

The trouble is what the movement offers instead. The word holistic — from the Greek holos, whole — was supposed to mean a way of seeing that integrates what reductive medicine has pulled apart. In the movement claiming the word, it has come to mean the opposite: a parallel architecture that excludes vaccines, excludes the cardiologist, excludes the entire framework that produced antibiotics, anesthesia, and the survival of children who, a century ago, would simply have died.

That is not integration. It is the same fragmentation in different clothes.

A real defense of the whole person would acknowledge what each gets right and refuse what each gets wrong.

I think about two patients I saw last year in clinic, a week apart. The first was a woman in her 20s with six months of worsening back pain. She had seen a chiropractor weekly, taken supplements from a wellness coach, and tried three essential oil protocols. She had not seen a primary care physician in four years. When she finally reached me, her foot had begun to drop. Her MRI showed a large disc herniation crushing the L5 nerve root. She needed surgery within days.

The second was a man in his 60s, wealthy and well-connected, who had already undergone two lumbar fusions and was being recommended for a third. His pain was real. His anatomy did not explain it. No surgeon had asked him about his sleep, his weight, the 70 hours a week he sat at a desk, or whether he had tried any of the dozen nonsurgical paths that might have helped.

Both were failed by a system that has lost the capacity to put the pieces back together. One by a wellness world that calls itself holistic but excludes the tools of modern medicine. The other by a medical system that calls itself evidence-based but excludes anything that does not fit into a billing code. They are the same problem in mirror image.

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Real holism is harder. It says that a child benefits from both unstructured play and the pediatrician who notices the heart murmur. That a patient with back pain benefits from both yoga and the surgeon who knows when to — and when not to — operate. Holism integrates. The movement that owns the word does not.

Patients do not have to wait for Washington.

Integrated programs — where physical therapists, behavioral health clinicians, nutritionists, pain specialists, and surgeons share a single chart and a single conversation about the same patient — exist around the country. They are not yet the default, but they can be found.

If you are navigating a chronic problem, three questions are worth asking your clinician: Do you have colleagues outside your own discipline who will be part of my care, and do you talk with them? Is the goal of the first visit to decide on a procedure, or to decide whether a procedure is the right answer? Last, what would have to be true for you to recommend a treatment other than the specific thing you do for a living? A clinician who can answer those questions without flinching is closer to holism than any movement claiming the word.

This is what the country’s next surgeon general — and its next CDC director — should be arguing for. Not another round of the wellness-vs.-medicine fight, with two sides accusing each other of missing the whole.

A real defense of the whole person would acknowledge what each gets right and refuse what each gets wrong, and insist that the institution — not the patient — do the integration.

Whoever takes those offices next will be asked, eventually, what holistic means. It would be worth the country’s time if their answer were a real one.

Vijay Yanamadala is vice chair of neurosurgery at Hartford HealthCare’s Ayer Neuroscience Institute, associate professor of surgery at Quinnipiac University’s Frank H. Netter School of Medicine, and a 2026 public voices fellow with the OpEd Project.