The MAHA Strategy: A Pharmacist Reads the Fine Print

Yesterday afternoon, RFK finally released his official Make Our Children Healthy Again (MAHA) Strategy. It’s a glossy, twenty-page PDF stamped with agency seals and an eagle crest, and if you skim it fast enough you might be duped into thinking it’s a serious plan. But read it as a pharmacist, and the thing lands like a bad parody of public health: part wellness influencer, part regulatory wish list, part conspiracy-theory greatest hits. Honestly, it’s terrifying.

RFK’s White House is not a sideshow anymore. These “strategies” are not Substack posts — they’re executive branch marching orders. And when the President of the United States spends his political capital gutting the FDA, hinting at junk science on vaccines, and promising deregulation of drugs and devices in the name of “freedom,” the damage to American faith in medicine isn’t just cosmetic. It’s generational.

I’ve written before about how fragile our drug system already is — from compounded Ozempic getting hijacked on Instagram to Novo Nordisk’s cat-hair tainted factory in Indiana — and how little margin for error exists when it comes to trust. Reading this plan, I kept thinking: if RFK gets his way, we won’t even have that margin left.

I’m trying something new with today’s newsletter and giving you my initial gut reaction after spending some time combing through this plan. I haven’t read any other analysis yet. Everything that follows is my own personal opinion. For the purpose of Drugstore Cowboy, I am only commenting on the parts of the plan that pertain to pharmacy and drugs.

Let’s take a pharmacist’s scalpel to this so-called strategy.

The MAHA document is peppered with digs at the FDA. It promises to:

On paper, some of this looks like overdue reform. (The GRAS loophole is a mess, and FDA sunscreen rules really are behind Europe’s.) But the way it’s framed here tells you everything: this isn’t about strengthening oversight, it’s about weakening it under the banner of “innovation.”

If you read my recent piece on The Risk of RFK’s FDA, you know the agency is already hanging by a thread. Years of budget starvation, political scapegoating, and impossible mandates have left it inspecting a microscopic fraction of foreign plants while trusting companies to self-police. The MAHA Strategy doubles down on that trajectory, while pretending it’s consumer protection.

This is like telling the fire department you’ll “modernize” its work by throwing out the hoses and trusting AI to put out the flames.

Buried in the incentives section is a full “Vaccine Framework” promising to:

This is RFK’s brand distilled. It sounds benign — who doesn’t want the best schedule?! — but for decades he’s trafficked in misinformation about vaccines and autism. Now, as President, he’s laundering that skepticism into federal policy.

It’s worth recalling what happens when public health gets politicized: measles outbreaks, COVID disinformation, and entire communities losing trust in doctors. Once that trust is gone, it doesn’t come back. I said it when we talked about Supplements vs. Drugs: FDA oversight may be imperfect, but “mostly safe” isn’t good enough when you’re injecting something into a child.

This is the same sleight of hand RFK has always used — elevate the specter of harm, demand “choice,” then walk away as trust erodes.

It’s not all bad. Oddly, the plan calls for increased oversight of DTC drug advertising, including a direct mention of influencer marketing and telehealth startups hawking pills on Instagram.

If you read my July piece on Drug Ads, you know I’ve long argued that the U.S. stands almost alone in letting pharma advertise directly to patients. It drives demand, muddies expectations, and turns every living room into a mini Madison Avenue.

So yes, tightening rules on influencer-driven Ketamine TikToks is a good thing. But here’s the catch: RFK isn’t doing this because he cares about truth in advertising. He’s doing it because it fits the populist script: evil Big Pharma brainwashing your kids through commercials. And in practice, this administration’s credibility on regulating pharma marketing is near zero.

It’s hard to cheer the arsonist when he offers to turn down the flames.

For all its bluster about making kids healthy, the MAHA plan is conspicuously quiet on the one part of the drug supply chain bleeding Americans dry: pharmacy benefit managers (PBMs).

No mention of rebate walls, spread pricing, or the mafia-like control Caremark, Express Scripts, and Optum have over formularies. Instead, the phrase “conflicts of interest” pops up in vague references to advisory committees.

If you’ve been reading Drugstore Cowboy since June, you know PBMs are my white whale. We’ve covered how my own pharmacy lost $26,000 dispensing Ozempic thanks to PBM games, and how these middlemen rake in margins bigger than Nike or Coca-Cola. For the White House to release a sweeping drug strategy and sidestep PBMs entirely tells you either they don’t understand the system — or they do, and don’t care.

Either way, that omission is damning. You may be asking, “what do PBMs have to do with making kids healthy?” Well, driving up health care costs astronomically and controlling access to medication is arguably the most important factor in the health of the entire country. This is a critical miss.

The plan directs NIH and FDA to:

If you’ve read my recent deep dive on The Asterisk Economy, you know exactly where this goes wrong. Supplements live in a regulatory Wild West thanks to the 1994 DSHEA law, which lets companies imply benefits without proving them. “Clinically studied” means very little when the study is a six-person pilot trial in Albania.

And “repurposed drugs” sounds innovative — and sometimes it is. But more often, it’s a buzzword for cutting corners: skipping costly trials by claiming old generics can solve new conditions. Done right, that requires rigorous science. Done RFK’s way, it risks flooding the market with snake oil that looks an awful lot like medicine.

There’s also a section on prescribing psych meds to kids — SSRIs, stimulants, antipsychotics. As a pharmacist, I don’t dismiss that concern; ADHD meds, in particular, are in crisis-level shortage (and in my own humble opinion, egregiously overprescribed). But instead of proposing meaningful fixes (like stabilizing supply chains or fixing FDA inspection capacity), the plan nods vaguely at “school-based diet interventions” and “updating drug labels.”

This is the same magical thinking we saw with compounded semaglutide: assume you can improvise your way around shortages, side effects, and dosage forms. You don’t get a pat on the back from me for calling out a problem and proposing no solution.

The throughline of MAHA is clear: if in doubt, deregulate. Remove barriers. Fast-track. Shrink oversight. Whether it’s infant formula testing, regenerative medicine, or investigational drugs, the solution is always to “get Washington out of the way.”

But deregulation doesn’t make medicine safer, it makes it shakier. And in a drug supply chain already stretched across oceans and dependent on self-policing factories, the last thing patients need is looser guardrails.

If you read my piece Made in China. Injected in the USA., you know we can’t even trace where most of our APIs come from. Loosening the screws further is asking for another NECC-level disaster — but this time with presidential blessing.

RFK Jr. loves to posture as the truth-teller who sees through corrupt elites. But when it comes to medicine, his plan is the opposite of truth-telling. It’s a mash-up of half-baked reforms, deregulation-by-another-name, and populist vaccine rhetoric dressed up as “freedom.”

Thankfully, this enormous document is just a bunch of half-baked ideas with nothing actually showing how they will be put into action. I have serious doubts that most of it will turn into actual policy. But it can still be dangerous by eroding confidence in the system.

The tragedy is that Americans’ trust in medicine is already fragile. Every compounded Ozempic on Instagram, every contaminated factory we sanction, and every PBM rebate scheme chips away at it. What RFK is doing — officially, from the White House podium — is taking a hammer to what little trust remains.

Once that faith is gone, you can’t rebuild it with a better label or a new framework. It takes generations.

Which means the real legacy of the MAHA Strategy won’t be healthier kids. It’ll be a country that no longer believes its medicines are safe. And that’s not just a bad policy outcome. That’s a catastrophe.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy