‘There Is Nothing So Useless as Doing Efficiently That Which Should Not Be Done at All.’ — Peter Drucker (1909-2005)

Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA

The ongoing assault on America’s health infrastructure has been brutal to watch. The selection of Robert F. Kennedy Jr. as the 26th secretary of the U.S. Department of Health and Human Services (HHS) marks a low point in the department’s leadership history. That decision is already potentially contributing to increased morbidity and mortality within U.S. borders with the recent resurgence in measles cases. Kennedy’s comments regarding the measles outbreak included the benefits of vitamin A and cod liver oil in treating measles. The one proven therapy effective in preventing measles outbreaks is vaccination, and unfortunately, Kennedy’s message has been “the decision to vaccinate is a personal one.”¹

In a previous editorial, I have clarified my position regarding my assertion that Kennedy is unqualified for his office. I mention the current measles outbreak response because it is a developing health issue, and it is instructive on other actions he has taken (or failed to take) that I would prefer to dwell on this month. If the recent trend in measles infections continues, there will be ample time and material to comment on this developing public health disaster in the future.

This month, I want to point out Elon Musk’s ongoing assault on HHS personnel through his Department of Government Efficiency (DOGE). Musk, who heads DOGE (or does not, depending on the court case or the political speech), has unleashed his army of 20-something technology “bros” on the personnel lists of key HHS infrastructure agencies. He did this in a classic wrecking ball style. Musk’s cuts to health personnel (incoming and existing) were made based on, well, I can only assume what looked good on a computer spreadsheet or political soundbite. I seriously doubt these DOGE minions had any fundamental understanding of the jobs they were recommending to slash, and I suspect in many cases probably could not pronounce or spell the positions they were eliminating (do not get me started on “transgender mice,” so much insanity, so little editorial space).

As a career federal healthcare worker, it has been heart-wrenching to watch the gutting of America’s health institution infrastructure through such a brutal and nonsensical approach via DOGE. Musk has suggested that his DOGE warriors are slashing “fraud, waste and abuse in the federal government.” While this statement makes excellent political hay, I know it is often not factual. In a previous editorial, I detailed the advantages of the Epidemic Intelligence Service (EIS), which serves as America’s disease detectives. I also noted how proud I was that my daughter, Susan, had been selected for this prestigious organization within the federal health community. Because DOGE’s formula for employee elimination focuses on federal workers on a provisional or to-be-hired status, the incoming 2025 EIS class has been held and possibly eliminated due to a hiring freeze. This situation is occurring throughout the HHS and government departments generally; I am only using EIS as an example, of which I have first-hand knowledge.

The EIS has a critical function within our health infrastructure to identify and respond to infectious diseases and other health challenges that impact Americans (measles outbreaks, for example). The professionals selected for these positions are highly trained and likely could find more lucrative positions in the private sector. Instead, these individuals opt for lower-paying government positions from a sense of service and a desire to apply their skills where they will have the most significant impact. The provisional status of these federal hires has nothing to do with their competence or performance; it just means they are new. These new hires are the fresh ideas and attitudes our governmental institutions depend on to function. I can understand how a no-federal-experience tech bro might make this mistake, but that is why the president appoints federal government department leaders to these essential institutions of our democracy. We need adults in the room to make these critical personnel decisions.

Kennedy is supposed to be that adult. Last I checked, DOGE is not a government department with cabinet-level status. The Senate did not confirm Musk to any position. The fact that I am not supportive of Kennedy’s performance thus far is not lost on readers of this column. Then again, supporting the HHS leader who thinks it appropriate to publish selfies of his New Mexico hike as the measles outbreak grows is hard. Kennedy does have an opportunity to get his HHS house back in order by defying the DOGE nonsense and reestablishing the HHS activities that will protect American health. I will be the first to congratulate and applaud Kennedy if he can stomach this role. If efficiency is the president’s mandate, do the hard work of finding these inefficiencies and appropriately hire and fire as the nation’s health needs dictate. Indeed, nothing is so useless as doing something efficiently that never should have been done.

1. Godoy, M. (2025, March 7). ”Amid a growing measles outbreak, doctors worry RFK Jr. is sending the wrong message. NPR. (https://www.npr.org/2025/03/07/nx-s1-5320352/measles-rfk-west-texas-outbreak)