‘Everybody’s Got a Different Circle of Competence. The Important Thing Is Not How Big the Circle is. The Important Thing Is Staying Inside the Circle.’ — Warren Buffett (1930- )
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
There was a time following my anesthesiology fellowship when I experienced the sublime joy of being competent in my chosen profession. I had completed my residency training at Walter Reed Army Medical Center, passed the oral boards and was on the cutting edge (at the time) of an acute-pain medicine fellowship at Duke University.
I had achieved all the benchmarks needed to proclaim myself an anesthesiologist, but that success did not give me the feeling of competence in my profession. Instead, it was the subtle recognition that my senior peer group of staff-attending physicians tended to involve themselves in my clinical practice less and less. I assume, in their eyes, I had achieved a level of competence that no longer required their oversight, and they could move on to other trainees who needed their attention. This change happened quietly and without fanfare, but it was one of the best feelings I have ever experienced.
While the graduations, passed board examinations and diplomas hung on the wall were lovely baubles heralding my professional prowess, the recognition of my competence as a staff anesthesiologist from my peer group had significant meaning for me. In time, I would attain extraordinary competence as a consultant in regional anesthesia (almost peerless for the briefest of time) on the modern battlefield. Those skills, forged over decades of hard work, allowed me to lead others in improving military medicine. My career would not have been possible, and the improvements established would have been lost if not for competence ingrained within myself and my peers.
Recently, the president-elect announced Robert F. Kennedy Jr. as his U.S. secretary of Health and Human Services nominee. Individuals in this Level 1 position serve as the principal adviser to the president on all national health matters. The health secretary oversees 11 agencies, including the Food and Drug Administration (FDA), Centers for Disease Control (CDC) and National Institutes of Health (NIH), among others. I can think of no other more critical and consequential position within our government regarding the nation’s health and general welfare. In my opinion, Kennedy, albeit sporting a famous name, is not competent for this position.
Admittedly, he has demonstrated some competence within his circle as an environmental lawyer, successfully crusading against and suing corporate polluters of water resources. I applaud his efforts in this arena. He also has denounced the corporate food industry in this country for the unhealthy products produced to serve corporate greed rather than public nutrition; I agree, but find his position on vaccines disqualifying
Kennedy has no formal training in medicine, epidemiology or science but is a self-proclaimed anti-vaccine advocate and churns in the macabre world of government and drug industry conspiracy theories regarding vaccine development or soundly debunked theories linking vaccine administration to autism. He has likened the CDC to a “cesspool of corruption,” filled with profiteers, harming children. I would argue, with overwhelming and solid science supporting my statement, that vaccinations have saved more patients from unnecessary morbidity and mortality than any medical intervention in history. As a society, we have had the privilege of forgetting about the scourges of polio, smallpox, and cholera (the list goes on and is very long) thanks to vaccine development. Ask your grandparents what life was like when these diseases were unchecked. The nation cannot afford a Health Secretary who is not competent in his understanding of vaccines. This issue is particularly poignant as we finally emerge from the COVID-19 pandemic and face the possibility of similar plagues in the near future. Check out the developing H5N1 avian flu that has mutated into our dairy herds (Kennedy promotes unpasteurized milk) and is poised to leap into humans.2
The only “qualification” I can recognize regarding the president-elect’s selection of Kennedy is that he dropped out of the presidential race as a third-party candidate and endorsed Trump. From my perspective, this is not only an incredibly feeble reason for installing Kennedy n such a key position but also patently un-American. Americans pride themselves in their ability to speak truth to power, as codified in the First Amendment to the U.S. Constitution. Our strength as a country, in no small way, rests with our diversity in opinion. How many examples of stagnating dictatorships (power forsaking competency) must history serve up for this lesson to take?
I recognize that not everyone shares my opinion of Kennedy’s competence. Many might argue that Trump won the election and can therefore pick anyone he desires for his Cabinet. I do not disagree that the president-elect has that right, but that does not preclude my right to respectfully disagree and speak truth to power.
As we begin another year of U.S. Medicine serving as the “The Voice of Federal Medicine,” I would remind our readers that my opinions are my own and not necessarily representative of this periodical. I take great pains to reinforce my opinions with facts, but they remain my views exclusively. I feel no obligation for the reader to agree, only to consider and, most importantly, think. Remember, “All tyranny needs to gain a foothold is for people of good conscience to remain silent (spurious quote).”
I have clarified my dissenting opinion regarding Kennedy’s lack of competence for this appointment in this column and to my federal representatives. Agree or disagree, I would encourage readers to do the same. This expression is genuinely democracy at work and consistent with the Constitution we serve to protect. I am proud that we have once again met the promise of our republic through the peaceful transition of power to a new administration of leaders. I will remain loyal to the document that makes this unique transition possible, and I will continue to serve those leaders, regardless of political affiliation, with my competent opinion.
- Brandy Zadrozny, “RFK Jr. attacked the CDC’s ‘fascism’ and likened vaccinating children to abuse by the Catholic Church.” 27 November 2024. https://www.nbcnews.com/health/health-news/rfk-jr-vaccines-cdc-fascism-abuse-catholic-church-autism-conferences-rcna181605. Accessed 1 December 2024.
- Zeynep Tufekci, “A bird flu pandemic would be one of the most foreseeable catastrophes in history.” 29 November 2024. https://www.nytimes.com/2024/11/29/opinion/bird-flu-pandemic.html. Accessed 1 December 2024.
