Serious followers of healthcare policy in the U.S. didn't expect much good to emerge from its takeover by President Donald Trump and his secretary of Health and Human Services, the anti-vaccine activist Robert F. Kennedy Jr.

But the agency and its leadership managed to live down to the worst expectations May 27, when HHS released a 73-page "assessment" of the health of America's children titled "The MAHA Report" (for "Make America Healthy Again").

A sloppier, more disingenuous government report would be hard to imagine. Whatever credibility the report might have had as a product of a federal agency was shattered by its obvious errors, misrepresentations and outright fabrications of source materials, some of it plainly the product of the authors' reliance on AI bots.

At least seven sources cited in the report do not exist, as Emily Kennard and Margaret Manto of the journalism organization NOTUS uncovered. HHS hastily reissued the report with some of those citations removed, but without disclosing the changes — an extremely unkosher action in the research community.

"I, and my co-authors, did not write that paper," epidemiologist Katherine M. Keyes of Columbia told me by email, referring to a citation to a purported paper about anxiety among American adolescents resulting from the COVID pandemic. "It does make me concerned given that citation practices are an important part of conducting and reporting rigorous science."

Keyes said she has done research on the topic at hand: "I would be happy to send this information to the MAHA committee to correct the report, although I have not yet received information on where to reach them," she said.

We'll go deeper into the fabrication fiasco in a moment. What's important is its context: concerted attacks by Kennedy and his associates on the fundamentals of public health in America.

Those attacks have profound implications not only for Americans' health, but on pocketbook issues and the U.S. economy generally. HHS bowed toward the latter issue by asserting in the report that the health profile of American children poses "a threat to our nation's health, economy, and military readiness."

As it happens, the recent actions at HHS and its subagencies, the Food and Drug Administration and the Centers for Disease Control and Prevention, increase those threats.

Take the agencies' May 20 decision to remove COVID boosters from the CDC's list of recommended vaccinations for healthy children and pregnant women. The decision opens the door for insurance companies to start charging full price for the shots, rather than covering them without copays as the law requires for preventive services.

That could mean out-of-pocket charges of $100 or more each booster, which could itself discourage families from getting vaccinated. This is a reminder of how family economics affect health.

The MAHA report attributes the rise in childhood obesity and diabetes in part to ultraprocessed foods, or UPFs. But it's silent on what experts call the "social determinants of disease," which are heavily related to economics. The report doesn't mention "food deserts," mostly low-income neighborhoods in which "children do not have access to anything other than UPFs, ... or the cost of fresh food vs. the hyperpalatable and cheap UPFs," observed the Delaware Academy of Medicine in its gloss on the report.

And although the report mentions that safety net programs such as the Supplemental Nutrition Assistance Program — SNAP, or food stamps, school lunch and breakfast programs, and the Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC, could play a role in promoting healthy eating, it doesn't mention that those programs face severe budget cuts from the Trump White House.

Last month, HHS canceled nearly $800 million in grants to the pharmaceutical company Moderna for the development of a human vaccine against bird flu, part of a Biden administration effort to prepare for possible future pandemics, the potential social and economic impact of which should be self-evident, given our experience with COVID. Bird flu already has devastated the dairy and poultry industries in many regions and sickened dozens of farmworkers.

There was some hope in the research community that sound science might still live at HHS because some HHS appointees had scientific or medical credentials that Kennedy lacked. Those hopes get dashed on a regular basis.

On Sunday, for instance, FDA Commissioner Marty Makary — a former professor of medicine at Johns Hopkins — was reduced to incoherence when CBS' "Face the Nation" moderator Margaret Brennan reminded him that on May 20 he co-authored a report in the New England Journal of Medicine that identified pregnancy as factor increasing the risk of "severe COVID-19" — warranting that pregnant women get the vaccine.

"Yet seven days later," Brennan said, Makary joined with Kennedy in a video announcement recommending against giving pregnant women the booster. "So what changed in the seven days?" Makary argued that only 12% of pregnant women got the shot last year, "so people have serious concerns."

What he didn't say was that those concerns have been ginned up by FDA critics — including Makary — and vaccine opponents, even though clinical trials involving tens of thousands of subjects have validated the recommendation that pregnant women get the vaccine.

That brings us back to the MAHA report.

Let's start with its core assertion — that "today's children are the sickest generation in American history." As soon as the report was issued, this trope was picked up uncritically by the news media, before the report's citation errors were discovered. But it's undoubtedly wrong, the product of cherry-picking official statistics and ignoring what they really say.

An attack on childhood vaccination gets a subject heading all its own in this report, which asserts that the number of recommended vaccines for children by 1 year of age has increased from three in 1986 to 29 now, including vaccines for pregnant mothers.

Pediatrician Vincent Iannelli has ably punctured this claim, which he identifies as anti-vax "propaganda."

The report reaches its count of 29 by including some vaccines given to children older than 1 year and double-counting shots such as the RSV vaccine, given to either the mother or the infant, not both. An honest count would be as few as 17, not all of which are injections. The report also counts combination vaccines such as MMR and TDaP as three shots rather than one.

In pushing the "sickest generation" trope, the report glides over the health threats faced by children — and adults — before vaccines were available for specific diseases. In the U.S., measles cases averaged more than 530,000 per year throughout the 20th century; as of 2023, the average was 47, according to the CDC.

Mumps fell from more than 162,000 cases annually to 429 and rubella from nearly 48,000 to three. Whooping cough, or pertussis, fell from nearly 201,000 cases to 5,611. And polio, the fearsome nemesis of American families in the 1950s, from 16,300 to zero.

One can trace the "sickness" of children in bygone generations through child mortality statistics. In 1900, the average life expectancy of a 1-year-old in the U.S. was about 56 years; that bespeaks a morbid population of infants. In 1950 it was still only about 70. Now it's 79.

For all that the MAHA report purports to identify the leading health threats to America's kids — processed foods, environmental chemicals, vaccines — it totally ignores what we know to be the single biggest cause of childhood mortality in the U.S.: firearms.

The CDC has reported that in 2021, firearm injuries killed 2,571 children. That rate of 3.7 deaths per 100,000 children aged 17 and younger was an increase of 68% since 2000. The firearm death rate of 6.01 per 100,000 children aged 1-19 was 10 times the rate in Canada and 20 times the rates in France and Switzerland. Why the silence in the MAHA report? What does that say about how far you should trust the MAHA team at HHS?

As for the multiple false citations in the report, they point to the sheer irresponsibility of a federal agency's outsourcing of research to AI.

I asked HHS for an explanation of how these errors got into the MAHA report, but I received no reply. White House spokeswoman Karoline Leavitt, however, responded to a reporter's question about the fiasco by claiming there were "formatting issues" with the report.

Her excuse made me laugh, because it was the same excuse offered by the big law firm Latham and Watkins when it was caught submitting AI fabrications to a judge as part of a legal filing, as I reported recently. In neither case did the excuses explain how "formatting issues," whatever that means, resulted in the fabrication of source citations.

HHS attributes the report to a 14-member "Make America Healthy Again" commission, composed mostly of cabinet members and other officials with no responsibility for or expertise in public health, such as the secretaries of Housing and Urban Development, Education, Agriculture and Veterans Affairs and directors of White House budget and economic offices. Makary and Bhattacharya are on the panel. They lent their names and reputations to this product, much to their discredit.

But it's unclear about who actually put pen to paper. Some of its language can be traced back to Kennedy's own words. The report's assertion that "today's children are the sickest generation in American history" was picked up and amplified by media coverage of the report's release, even though it's not supported by the facts. It is a verbatim echo of a claim Kennedy has made repeatedly, however, mostly as a plank in his anti-vaccination platform. It was part of the title of a book his anti-vaccine organization, Children's Health Defense, issued in 2018 ("The Sickest Generation").

The most frightening aspect of the MAHA report is that it's likely to be the blueprint for a comprehensive attack on public health; scarier in that news media and political leaders are citing it as though it has scientific value. It's so infected with falsehoods, misrepresentations and ideological blinkers that it will only subject the health of American children to the greatest risk they've faced in, yes, American history.

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