I try to read and watch anything with or done by Vinay Prasad, the San Francisco-based oncologist and researcher who was recruited to regulate "biologics" at the FDA.
I started following him and Jay Bhattacharya during the COVID insanity of 2020 and beyond because they were rare voices of sanity from people involved in medicine and epidemiology at a time when scaremongering, panic, and propaganda swamped all reasoned discussion, and I got hooked on both because of their relentless focus on science and reason as the best tools to understand and respond to public health crises.
He served as director of the FDA's Center for Biologics Evaluation and Research (CBER) for about a year, taking a leave of absence from his teaching position and clinical work, and is now back to doing research and saving lives.
And doing public education on medical issues, just as he was doing when he rose to prominence. He writes at Sensible Medicine, does occasional pieces at The Free Press, and has his own YouTube podcast/show. I don't follow him as an authority, but as a person who thinks clearly and is informed.
And since his time at the FDA, he does the occasional interview.
What did Vinay Prasad learn inside the FDA? @VPrasadMDMPH talks with @TheAbridgedZach about his controversial tenure at the agency, Fauci’s diaries, and why working for the government made him “a bit more libertarian.” https://t.co/hctl5sC1QL
— reason (@reason) August 26, 2026
I watched this, despite it being especially long at over an hour, because Prasad dove deep into his time at the FDA and what he learned there as the guy in charge of one of the most important divisions. After all, hundreds of millions of people get vaccinated, healthy or not, and vaccinations begin the day that an infant is born. There is no precise number of doses given out each year, but it runs into the hundreds of millions in the United States.
Add in all the drug approvals and other stuff the FDA regulates, and it is one of the most consequential agencies in the world.
And, according to Prasad, it is just as broken as the entire public health industry. And while he has ideas on how to fix some of it, he's quite open about the fact that 'fixing" the agency or public health entirely is just not possible.
There's a lot to unpack in this discussion, but the one that stood out to me came toward the end.
The exchange here is amazing.
Zach Weissmueller: Is it time for people to start trusting public health again?
Prasad: [Laughs] No way. No way. No way.
That's the problem in a nutshell: Vinay Prasad, who is an advocate of sound science, thinks that most people should get most vaccines, and is anything but a crank or podcast bro, thinks that the people in charge of regulating medicine and giving us advice are not trustworthy.
Not because most of them are bad people, or self-interested, although plenty are. Prasad actually praises most of the people at the FDA. But the system itself is broken, getting to the top of the pyramid is a political path, money plays a major role in what gets done and always will, and there is a level of contempt for and carelessness about the needs and desires of ordinary people.
Masking for Monkeypox? The disease doesn't spread that way.
Don't eat fruits and vegetables to avoid Cyclospora? Are you insane?
A San Diego infectious disease doctor says it’s probably best to stay away from fresh produce for the next week or so, even if you wash it. A fecal parasite illness, known as cyclosporiasis, has now reached California. NBC 7’s Shandel Menezes has details. https://t.co/beYdXip2Ds
— NBC 7 San Diego (@nbcsandiego) July 14, 2026
The problem is clear: these people are indifferent to the real world effects of what they propose, and are often incapable of thinking about the secondary effects.
Watch that bit. He hits the nail on the head. And it's problem you find running through every bureaucracy because they are myopic, can't weigh costs and benefits, don't think about the secondary effects, and believe that trade-offs don't exist.
That's how you get to the point of fighting a 2-year-old to wear a cloth mask that doesn't work, and the entire public health establishment telling people falsehoods "for their own good."
After a year at the FDA Prasad thinks that he moved the needle — but only a little. The bureaucracy is almost immovable, and it's not clear how to fix it.
It's the same problem we face at universities: these are institutions that form the backbone of our society, and they are fundamentally broken and incapable of reform.
There seems to be a race between the vast expansion of our knowledge and capabilities to do amazing things due to technological progress and the expansion of knowledge and the institutions that often seem to exist to provide barriers to that progress, take complicated issues and distort our view of them, and the politicization of what ought to be questions we explore with reason and a sensitivity to the competing values people have and the complexity of society.
Everything becomes a one-dimensional fight, and the media makes it worse.
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