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The Madness of King Bobby
The Madness of King George is a British costume drama about King George III, who ruled Britain during the American Revolution. Besieged by periodic hallucinations, he lost his grip on reality, but nevertheless, kept governing. Ministers whispered. Parliament panicked. The king, meanwhile, felt clearer headed than ever and shared his views with anyone in earshot. He once apologized to a tree, having mistaken it for the King of Prussia. By most accounts he felt real distress at his own unraveling.
I mention this because it is the closest historical parallel, I can find for Robert F. Kennedy Jr., who now runs the Department of Health and Human Services, a $1.7 trillion empire with better branding than most small countries. Kennedy, while equally aberrant, shows no self-doubt. George III had the excuse of porphyria, or perhaps bipolar disorder. With Kennedy, we have MAHA.
RFK’s first major action at HHS was firing the entire Advisory Committee on Immunization Practices (ACIP) and replacing them with anti-vaccine auteurs. It’s the governing style of a man who uses a sword in a town where the pen is mightier. A federal judge ruled the action illegal and discharged the replacements. The ACIP sits mired in litigation. While its prior determinations remain law, we endure with no guidance available should a new virus threat arise.
The entire agency is without guidance. Key positions such as Surgeon General, Director of the CDC, Director of NIH have acting, shared, or absent directors.
The Peptide Affair
Consider the peptide affair, a case study in HHS governance. In February, Kennedy told Rogan’s audience he was “a big fan” of peptides, short chains of amino acids popular with bodybuilders and biohackers. He had used some himself, he said, “with really good effect.” Weeks later, Kennedy declared a set of these substances, previously restricted by the FDA, fit for compounding pharmacies to make on request.
A quick primer for anyone who has never needed one: compounding pharmacies mix custom doses or combinations of drugs that the big manufacturers do not sell off the shelf. Think of them as the tailor shops of medicine. Kennedy suggested the tailors could start stitching peptides too, no clinical pattern required.
The July 23 and 24 meeting of the FDA’s Pharmacy Compounding Advisory Committee reviewed seven of these substances, and approved 6 of them. Of the six, BPC-157 is unlike the others. It has real animal safety studies dating back to the 1990s, plus a fan base: some 50 million views across YouTube and TikTok, and a Reddit following of 100,000, as of a 2024 count.
It is a natural gastric protective compound, so it can’t be patented by a big pharma company. It stayed in obscurity, a failed stomach ulcer treatment, until it found a second career healing joints and calming inflammation. It has human biologic efficacy such that it is banned by the World Anti-Doping Agency’s prohibited list.
The Advisory Committee vote was hard to call because scientific committee members have been replaced by members with financial ties to the industry, and because the only BPC-157 has public fervor, evidence be damned. When push came to shove, the votes were 8-6 in favor of six of the seven peptides, including a Russian anti-anxiety peptide whose studies appear to be fabricated and can’t be replicated.
This is the pattern with Mad King Bobby. An announcement, made with enthusiasm and no advance warning. Then an institution scrambling to retrofit a rationale, while career scientists write reports nobody in charge much wants to read. And then committee politics. The new committee members all merchandise peptides one way or another.
History remembers George III’s madness as tragic because it was involuntary. Kennedy’s version looks more like a lifestyle choice, with the regulatory machinery of HHS trailing a few steps behind. Even his defenders concede the point: he leaves wreckage behind him. This year, the wreckage has a consequence; the delayed approval of a flu vaccine that tens of millions of Americans were counting on.
Moderna submitted its application to the FDA for mFlusiva February 18, 2026, on the strength of the largest vaccine trial since the depths of the COVID-19 pandemic. It reduced flu-like illnesses by 27% in a study group of 40,000. What should have been a routine regulatory approval became a cascade of regulatory disputes, political interference and legal threats. The scheduled hearing for is August 5, 2026. Thirty other countries have scheduled their acceptance dates for August 5.
In previous years, flu vaccines finished potency testing and were on trucks by early August. This year, because of Health and Human Services turmoil, Moderna has informed health departments in the United States and Europe to fall back on older, traditional vaccines for the remainder of 2026. Moderna needs FDA approval to initiate full production.
This is not caution. This is not rigor. It is RFK jr’s long-standing hostility to vaccines, dressed up as due process and imposed on a public that will pay for it in hospitalizations and lives lost. This is not how to Make America Healthy Again. It is the cost of indulging a man forever lost in his own biases.
James Katz, MD, MPH, FACOEM
