Brownstone Journal

By James Lyons-Weiler at Brownstone dot org.

Anthony Fauci does not appear in The Dog Stars. He is nevertheless in the theater.

Ridley Scott's new science-fiction film opens after a catastrophic flu has erased most of humanity. A pilot, his dog, and an armed former Marine inhabit what remains. The machinery is familiar: contagion, social collapse, desperate survivors, violent scavengers, and one more search for a pocket of human decency after civilization has failed. Scott did not invent this machinery, but the director of Alien and Blade Runner is one of the people who taught modern audiences how to surrender to it.

This time, audiences largely stayed home. The Dog Stars opened in fifth place with about $8 million in North America and another $11.3 million overseas, against a reported production budget of $70 million to $100 million. The Associated Press called it a flop. The result was especially poor because Boxoffice Pro had forecast an $18 million to $23 million domestic opening. The film landed at less than half the low end of that range.

There are ordinary explanations. Critics found the movie slow and derivative. As of September 1, Rotten Tomatoes showed a 39 percent critic score and a 71 percent verified-audience score. Marketing was weak. Adult dramas have a difficult theatrical market, streaming has trained people to wait, and post-apocalyptic fiction has been feeding on itself for years. A bad opening weekend cannot tell us what millions of people privately thought.

Yet the scale of the miss invites a harder question. Has the public's experience of Covid changed the mental contract on which the killer-virus movie depends? More bluntly, did Fauci and the institutions for which he became the human logo spend so much public trust that even Ridley Scott can no longer borrow it for two hours?

The classic outbreak story asks for a larger gift than belief in an unusually lethal pathogen. It asks the audience to accept a hierarchy of knowledge. The virus is invisible. The scientist can see it. Government may be slow, corrupt, frightened, or politically compromised, but somewhere inside the system there is a technically competent truth-teller trying to get reality through the door. The audience is expected to recognize that person immediately, usually by the white coat, the lab bench, or the lonely briefing at which the room finally falls silent.

The formula survived many variations because it rested on a presumption: the expert might be wrong, but the expert was trying to find out. Institutional failure came from delay, cowardice, budget cutting, or a villain who ignored the scientists. Once the pathogen was loose, emergency orders carried a certain moral clarity. People who resisted quarantine were reckless. People who demanded ordinary liberties while bodies accumulated were selfish. The drama could compress epidemiology and ethics into the same clean line.

Covid broke that line.

The public watched recommendations change, which is normal in a developing emergency. It also watched provisional judgments presented as settled science, policy preferences presented as epidemiological necessities, and dissent treated as evidence of defective character. Those are different things. Science can revise itself without shame. Authority cannot demand obedience on the ground that uncertainty has ended and then claim the privileges of uncertainty when the rule fails.

That distinction became painfully concrete. In his 2024 Congressional interview, Fauci said the six-foot distancing rule "sort of just appeared" and that he was not aware of studies supporting that exact threshold. He did not say distancing itself was useless; the admission was narrower and more revealing. A number with enormous social consequences had acquired the tone of scientific law without the evidentiary pedigree the public had been led to assume.

The same House transcript records Fauci saying that he technically signed off on NIAID grants without reviewing the in...

By Charles Krblich at Brownstone dot org.

My time of late has been consumed by youth baseball, so I found myself the other day sitting along the first base line watching one of my son's practices when I looked up to see a radiant image. Framed between two, aged oak trees shrouded with Spanish Moss, the fall thunderstorm clouds in the distance, and the sweeping stratus clouds supervising a silhouetted scoreboard, the setting sun announced the finality of the day.

The pleasant scene allowed for quiet reflection on the memories of my own playing days and drifted into thoughts about how superstitions exist to help us, not only to just get through our days, but also to process complex emotions like fear and anxiety. The idea is that by taking some sort of acute, immediate action, we will be blessed with good luck, good health, or something else. Baseball has no shortage of acute, immediate rituals one may perform for good luck, and along with other thoughts, I recalled an old blog post that will be forever seared into my memory about a woman consumed with the thrall of pandemic superstition.

Baseball is my favorite game because of the lessons it teaches. First, it's a team game that individuals play: your at-bats and fielding are yours and yours alone, but they are put to work in the service of your team. Second, and most importantly, it is a game of individual and team failure: you are out more often than you are on base, a team winning percentage of .550 – .600 — just more than half of your games played — is a championship-caliber team, and each attempt is isolated. It is recorded. There is nowhere to hide the miss. The game forces you to live with failure as a normal outcome.

Maybe as a result, a wide range of superstitions and rituals developed and many have been passed down through the generations. You never talk about a no-hitter or perfect game in progress. You will never step on a foul line. Players develop their own custom rituals for how they tap the bat when they step up to the plate. They have lucky shirts or seats when they are winning. There is the enduring Rally Cap. Lastly, there are the curses: the Billy Goat, and the Bambino.

All of those are pretty silly, and they often make for great comedy in movies like Major League and Bull Durham. I will absolutely be the first to admit I have worn the inside-out rally cap with paper cups on my ears because along with all of my teammates doing the same — that is what would win us the game!

Whenever I think about my playing days in baseball, I find it is really hard to recall any of the bad things that happened. I can't remember a single error I made, even if it made us lose the game. I can't remember any of the team politics. I can't remember any of the stupid rituals I made up. I can't remember specific times that I was a bad teammate and maybe said or did things to hurt other teammates. In fact, I can only remember lots of good things.

One of the funny things about a memory is its specificity and similarly, its flexibility. Seared into my mind is an image of a poor woman circa early 2021. What I thought would be easy to find, though, was difficult: The search function on the website didn't work at all to help me find it. It was something else that burned it into my memory.

The blog post is titled We Have a Winner, and it shows the image of a woman riding the escalator in the San Francisco Macy's in February of 2021, just less than a year after lockdowns began in March of 2020.

The post itself is completely forgettable: It simply documents that this poor woman was wearing two face masks, plastic gloves, and a face shield. The magic that placed it into my mind forever was a comment.

For many people, daily life becomes a threat. Of course they don't realize it's happening at the time, but they start to view life as something they have to get through.

Those types of people are most likely to have gone off the deep end on covid. This person exemplifies that. It's not really ...

By Aaron Kheriaty at Brownstone dot org.

The following was originally published as a chapter in the book, Man and Woman in the Order of Creation, and is reprinted here with the publisher's permission.

Naturam expellas furca, tamen usque recurret.

–Horace, Epistles, 1:10

The above epigraph, a Latin proverb from the poet Horace, translates, "You can try to drive out nature with a pitchfork, yet nature will always return." Or as my colleague Bill Hurlbut at Stanford University, a physician and ethicist, likes to say, "Human nature always bats in the bottom of the ninth inning."

My purpose here is to look at what science, medicine, and psychiatry can tell us about biological differences between men and women and some of the implications for those differences beyond simply our role in reproduction.

Sex differences between men and women are not confined to the reproductive organs. They run through all levels of human biology—from subtle features of organs and tissues to differences on the cellular and molecular level. It turns out that aside from our reproductive organs, the most sexually differentiated human organ is the brain. The differences are not just physical but also psychological, influencing our cognitive, behavioral, and emotional functioning.

There are important and measurable sex differences in our experience of emotion, memory, vision, and hearing. Men and women differ in our perceptual processing of faces, in pain perception, navigation, neurotransmitter levels in our brain, and the effects of stress hormones our bodies. We are prone to different diseases, and we respond differently to the same medical treatments.

Many of these differences are innate rather than acquired—they are present from before birth and persist throughout life. Keep in mind also that these differences are subtle, and we should not exaggerate them, as sometimes happens in popular treatments of this issue—"Men are from Mars and women are from Venus," and so forth.

There is also considerable intrasex variation—sex traits exist on a bell curve, with considerable overlap between the sexes. One mistake that gender ideology makes is the notion that a man with some characteristically feminine traits or interests is "really a woman," and vice versa. This is not true: he is simply a man at the tail end of this normally distributed bell curve—a boy who likes ballet, or a girl who likes football. That's all.

Gender ideology fails to acknowledge the full extent of intrasex variation (and overlap between the sexes) in gender-specific traits. In this way, transgenderism ironically "defines" male and female too narrowly.

We should note in this context that biologists distinguish between the sexes on the basis of their role in reproduction, not gender-typical behaviors or traits. Also, rare "intersex" conditions, which are caused by genetic or hormonal abnormalities, do not undermine the basic biological fact of sexual dimorphism—the biological norm of male and female. For example, biological males have an XY complement of sex chromosomes, and females have XX chromosomes. Intersex conditions may cause someone to be born with XXY chromosomes.

These genetic variations are found in less than 1% of the population. Medicine understands these conditions to be anomalies or disorders of sexual development: they involve functional and reproductive deficiencies, like infertility, when measured against the natural norm of male and female.

These scientific findings on sex differences are ignored today by a theory of gender that rejects our embodied sexuality and attempts to divorce gender entirely from biological sex. On the contrary, contemporary scientific findings suggest that sex and gender can be distinguished but not completely separated.

The tragic case of David Reimer is instructive here. David was born a boy in 1965, but a botched circumcision left his genitals badly burned. His parents were referred to a psychologist at Johns Hopkins Hospital, John Money, who ...

By Jeffrey A. Tucker at Brownstone dot org.

This essay is the introduction to The Complete Novels of Garet Garrett (Brownstone Institute, 2026), which brings together The Driver, The Cinder Buggy, Satan's Bushel, and Harangue in one volume, available in paperback and ebook.

One of the best nonfiction books to appear following the onset of the Great Depression was by the financial journalist Garet Garrett (1878–1954). It is called A Bubble That Broke the World (1931), and it was a bestseller. His analysis was exactly right. This was not a crisis of capitalism, he wrote, but of postwar credit expansions and imbalances. The economic downturn represented the coming due of the bill, and a cry for rebalancing production, consumption, savings, and interest rates in the US and all over the industrialized world.

If Garrett is known at all today, it is by those who are captivated by the handful of intellectuals who wrote in opposition to the New Deal planning state and the regimentation of national life that it brought about. They were a rare breed, and largely forgotten. Aside from that, there is much more to Garrett than people know.

Years ago, I read everything by him I could find, and then was amazed he is not better known. Garrett is a case study of a forgotten genius, which often happens in times of depression and war when even the most popular writers are forgotten by history. He began to write fiction after Warren G. Harding had called for a "return to normalcy" after World War I. But for Garrett, "normalcy" was civilization itself.

As a financial journalist, Garrett began as a featured contributor to America's most successful periodical, The Saturday Evening Post, but his contributions were not limited to this publication. He also wrote for Collier's, Everybody's Magazine, and The New Republic. His topics usually centered on financial matters. Garrett was at the top of his game and became one of the most widely read writers on economics in the country.

He embarked on a new venture of novel writing, writing his three best one year after another.

The Driver (1922), an exciting book that heralds entrepreneurial achievement, was the first. It tells the story of a Wall Street financier, Henry Galt, a shadowy figure who stays out of the limelight as much as possible until he unleashes a plan that had been years in the making: he uses his extraordinary entrepreneurial talent to acquire control of a failing railroad. In many ways, this book is the template for Ayn Rand's Atlas Shrugged, but we do not know if this was intended or coincidental.

Through outstanding management sense, good pricing, excellent service, and overall business savvy, Galt outcompetes all the big names in the business, while making a fortune in the process. Garrett has a way of illustrating just what it takes to be a businessman of this sort, and how his mind alone becomes the source of a fantastic revenue stream.

But his success breeds trouble. The government conspires with envious competitors to regulate him using the Sherman Antitrust Act, calling him a monopolist and accusing him of exploiting the public. There is a courtroom scene that allows Galt to explain to the assembled legislators how investors and capitalists are helping society in ways that politicians can't possibly imagine. What the politicians see as shady is really a form of public service that enriches the whole country.

A recurring literary motif throughout the book has people asking, "Who is Henry Galt?" The shades of Ayn Rand here are obvious, and some writers have speculated that she borrowed Garrett's literary motif, which may or may not be true.

In any case, the novel is thrilling, one that provides an excellent lesson in how entrepreneurship works.

His next novel was his epic story of steel. It is The Cinder Buggy (1923), the longest of the three books in this trilogy and his unforgettable masterpiece. With a great story, and tremendous literary passion, it chronicles the transformation...

By Eyal Shahar at Brownstone dot org.

The validity of a study, or a series of studies, may be questioned by several methods, one of which is identifying unexpected results. Consider the following example, which I used to teach in an introductory epidemiology course.

Having yellow-stained fingers is associated with lung cancer, but we know that the association does not reflect causality. Yellow-stained fingers do not cause lung cancer. Rather, the association is explained by smoking — a confounder — a cause of both yellow fingers and lung cancer.

Suppose a group of researchers reported that the association in question was not removed after adjustment for smoking status. Obviously, something is wrong, either in the data or in the way it was analyzed. Regardless of the reason, we will not trust any inference from that study, including the estimated effect of smoking. It is equivalent to rejecting a witness's entire testimony after detecting a single relevant lie. That's an analogy, of course, not a claim about intentional lying by the researchers.

Each year the CDC reports estimates of the effectiveness of the flu vaccine in the previous season. These estimates are derived from a version of the case-control study that is called the test-negative design. Both cases and controls are selected from people who sought care for respiratory symptoms (outpatient setting) or were hospitalized (inpatient setting). Cases tested positive for the flu; controls tested negative.

Since the Covid pandemic, the largest source of data has been a CDC-associated network called VISION. It is described on the CDC website:

Reports from the VISION network are observational studies; they are not randomized trials. People do not flip a coin to decide whether to get the annual flu shot. Those who get the shot differ from those who do not on many attributes, some of which are measured and others are not. Some of these attributes also affect the clinical outcome (i.e., confounders).

It is well known that vaccinated people are healthier on average than their unvaccinated counterparts. That's the healthy vaccinee effect, which leads to confounding bias. At least part of the association between vaccination and a clinical outcome is not causality. Since the estimated effectiveness is exaggerated, it is called positive confounding.

Some of the confounding, though not all, may be removed by matching or by statistical adjustment. For example, if the unadjusted association shows an odds ratio of 0.5 (vaccine effectiveness of 50%), the adjusted odds ratio might be only 0.75 (25% effectiveness).

That's not the case in randomized trials. In large enough trials, randomization results in a similar distribution of every baseline variable in the two (or more) arms of the trial. Therefore, the two groups — say, vaccine recipients and placebo recipients — are called "exchangeable." They are similar in every respect except the randomized treatment. There is no need for any adjustment, and adjustment should not change the estimated effect.

The take-home message is this. In observational research of vaccine effectiveness, we expect smaller effectiveness after adjustment. If the association is largely unchanged, something must have been wrong, or a miracle happened (pseudo-randomization to vaccination status). Miracles don't happen often, however.

A study of vaccine effectiveness typically contains hundreds of numbers, and the VISION reports are no exception. Although more information is preferred, it also makes it more difficult to identify questionable results. The difficulty is compounded if we try to examine a series of studies, say, over the years and search for patterns in the data. Referring to the witness analogy, it is equivalent to identifying a lie in a long testimony that contains many details.

Unlike a testimony, however, there is a solution, which I used to teach: reduction. Focus on a narrow set of results about which you have clear expectations; that is, you ha...

By Jeffrey A. Tucker at Brownstone dot org.

Those who are confident about the safety of vaccines have before them an easy route to shore up public confidence and completely shut down the anti-vaxx movement. They could open the data to what's called the Vaccine Safety Datalink or VSD.

Right now and for the past quarter century, access is severely restricted to only a handful of people at the CDC and the employees of the National Center for Health Statistics Research Data Center, which has the impossible acronym NCHSRDC, in Hyattsville, Maryland.

No one can buy the database or access, not the public, not researchers at NIH, not statisticians at universities nor medical doctors at hospitals.

Cries for Help Injury and Death Buried in V-Safe Data Parts I & II · React19 Buy on Amazon

VSD is one of several systems designed to monitor safety. The Vaccine Adverse Events Reporting System (VAERS) is the portal through which doctors and citizens report injuries. The records of injury here from the Covid shot have broken all records for previous records by a thousand times over.

Another system is the v-Safe system that allowed shot recipients to report before it was shut down. The result was more than 7 million records. Brownstone has published a 1,048-page book of the free-text fields that the CDC would only cough up under court order. The result is the book set Cries for Help.

But those who continue to say that the shots are safe dismiss both systems as mere anecdotal lacking in a rigorous system of establishing scientific causality. They say that the only real way to know traces to VSD, a program established in 2002 in cooperation with many health-core providers. Here and only here will you find the data you need.

Sounds great, so let's have a look!

Not so fast. There is an obstacle course, Nothing says "Trust the science" like a mountain of bureaucratic paperwork to get to existing evidence. There will be no fishing exhibitions, the CDC declares. You have to send a proper proposal with the title, your name plus two because only three people get the workstation.

Then you write a summary of what you want: background, why this matters for public health, your actual hypothesis, and a methodology that is not just the abstract of someone else's paper. Define the population, years, study type, variables, confounders, and exactly how you plan to analyze it.

Next comes a gauntlet of reviews. NCHSRDC checks if your proposal is complete, if the data even exist, if they have the staff, or if letting you near it risks spilling state secrets.Then you need a permission slip from an Institutional Review Board, send them the letter and final protocol, and remember that approval doesn't let you start digging in. You are already hundreds of hours and thousands of dollars deep.

Everyone then has to sign the "I Won't Leak the Data and I'll Behave" forms and the confidentiality affidavit. Only then does NCHS actually build or format your dataset. After that you get access under all the rules, procedures, and fees. You must be there in person. No electronics are allowed in: no cameras, no cell phones, nothing.

Hence, as you can see, the science is settled even before the evidence is examined. In reality, no outside researcher has made it through this process for more than twenty years. Many have tried, hundreds of attempts, but they have never amounted to anything. A father-and-son pair of researchers once got through early on (Mark and David Geier) but their work was smeared even before it appeared.

In effect, the VSD is among the most secretive services in the entire government, comparable to Fort Knox, the Federal Reserve, and the National Security Agency and Central Intelligence Agency. It's the real Puzzle Palace.

And remember that we are not talking about national security here. We are talking about products injected into the bodies of 99% of the public. In some states, you cannot exercise full citizenship rights as an unvaccinated human.

I spent a...

By Brownstone Institute at Brownstone dot org.

For more than two decades, Anthony Fauci kept a private diary. It was discovered by the new administration more than two years after Fauci had resigned. The contents were treated as private. In fact, the diaries were a public record because he wrote them on government computers with the assistance of staff of the National Institutes of Health.

To be sure, Fauci never intended them to be seen in this form. They were notes toward an autobiography. He left a copy behind because of public-records preservation requirements. Once they had been discovered, they went through various channels and finally landed in the offices of Senator Rand Paul, who in 2026 released them in four separate installments.

These documents are brought together here for the first time in a single chronological edition, in three volumes.

Volume I covers 2001 through 2014, the years in which Fauci, as Director of the National Institute of Allergy and Infectious Diseases, became the federal government's leading voice on infectious disease. It opens with his own history of the AIDS epidemic and moves through the anthrax attacks of 2001, the creation of PEPFAR under President George W. Bush, the H5N1 bird flu scare and the 2009 H1N1 pandemic, and the 2014 Ebola outbreak, including the cases treated in the United States. Throughout are his dealings with presidents, cabinet secretaries, members of Congress, and the press.

Volume II covers 2015 through 2020. It begins with the aftermath of Ebola and the Zika outbreak and follows the transition from the Obama administration to the Trump administration. In 2020 the diary becomes a near-daily record of the Covid-19 pandemic: the White House Coronavirus Task Force, his work alongside Deborah Birx, Robert Redfield, and Francis Collins, the fights over shutdowns and treatments, the early questions about Wuhan, his constant media appearances, and the threats that brought him a security detail.

Volume III covers January 2021 through December 17, 2022, shortly before Fauci left government. As Chief Medical Advisor to President Biden, he records the vaccine rollout, the Delta and Omicron waves, boosters and mandates, the arrival of Paxlovid, and his clashes with Senator Paul over gain-of-function research and the origins of the virus, along with his view of his critics and his preparations to step down.

Fauci's entries are reproduced as written and uncorrected; material written by others has been omitted. What remains is his own account of his work, his schemes and worries, his excuses and fears, his contacts and psychological state, and the identities of many people around him, recorded as events unfolded.

They are now available for purchase in softcover or digital editions. You can also download them in PDF here and share them widely.

By Leland Lehrman at Brownstone dot org.

Files that were removed from the internet are in the evidence pack.

The scale of the violation is hard to imagine, I know. After the dazed feeling wears off, let's get busy. I also want to thank Dr. Clayton Baker, who was the first to bring my attention to the role of Tom Shimabukuro in covering up vaccine safety signals for over ten years. Incredibly, he is still at the CDC, serving as the deputy director of the Influenza Division in their National Center for Immunization and Respiratory Diseases (NCIRD).

The following research brief benefited from various digital research assistants, and I have not edited the language yet. But the information cannot wait.

Read and share with friends and family. It's not over yet.

The United States began vaccinating against Covid-19 on 14 December 2020. Two CDC programs were designed and paid to catch any harm that clinical trials had missed. VAERS takes reports from doctors, patients and manufacturers. V-safe sends vaccinated people text messages asking how they feel. Here we follow the paper trail of those two systems from the Christmas 2020 rollout into 2022. The bottom line:

The government's "worst case" for amount of Covid vaccine injury reports assumed 1,000 reports a day. For fourteen months it was double that. For some of those months, it was triple.

The document that matters most is a monthly report from the contractor that runs VAERS for the CDC, General Dynamics Information Technology (GDIT). It covers December 2020 and went to the CDC's contracting officer's representative on 16 January 2021, with CDC program staff and an FDA reviewer copied. Its first page carries a chart.

A red line marks 1,000 reports a day, which the government's own planning called the "worst case." The reports crossed that line on 21 December, the winter solstice, in the first week of the rollout. They dipped under it for three days around Christmas. From 26 December they stayed over it. The contractor told the CDC. that it was "unable to meet processing and other timeframes (data processing, telephone inquiries, clinical inquiries, etc.)" (GDIT report, PDF p. 8). All this while they were telling everyone everything was ok.

And the report numbers did not come back down.

From 4 January 2021 to 31 January 2022, only nine ordinary weekdays dropped under 1,000, and the lowest was 790. In February 2022 the typical weekday finally fell under it. The contract had called 1,000 a day a peak "not expected to reflect sustained activity." It lasted 14 months. The busiest single day was Sunday 22 August 2021, with 14,593 reports, almost all of them carrying a manufacturer's report number (public VAERS data, counted for this brief).

All that time the public heard something else. Eighteen days after that Sunday, on 9 September 2021, President Joe Biden went on television.

"What more is there to wait for? What more do you need to see? We've made vaccinations free, safe, and convenient. The vaccine has FDA approval. Over 200 million Americans have gotten at least one shot. We've been patient, but our patience is wearing thin. And your refusal has cost all of us. So, please, do the right thing." (Biden, 9 September 2021)

He called the speech "a new plan to require more Americans to be vaccinated, to combat those blocking public health." The plan required vaccination of 17 million health care workers in facilities that take Medicare and Medicaid, all executive-branch federal employees and federal contractors, and, through a Labor Department rule, vaccination or weekly testing for every employer with 100 or more employees, over 80 million workers. The word he used for the vaccines was "safe."

In VAERS, the month of the speech brought 47,172 reports, 953 of them reporting a death and 4,897 a hospitalization. It was not the worst month. April 2021 had brought 103,637 Covid-19 reports, 1,486 reporting a death and 6,800 a hospitalization, the worst month of the year on every count, more...

By Alan Cassels at Brownstone dot org.

In my day, being young was dominated by three basics: sex, drugs, and rock 'n' roll.

Boy, that world has changed.

Seems like our kids aren't having much sex these days.

Drugs? Yes, mostly of the prescribed type.

And rock 'n' roll? Well, not much anymore, as the listening tastes of today's youth center on hip-hop and AI-enhanced electronic pop that hardly passes for music nowadays.

But it is the lack of sex that seems to be most concerning.

Apparently, the fact that young people aren't having much sex today is being captured in surveys from around the world. This is proving to be worrisome not simply as a cultural artifact, but because the lack of sex is resulting in plunging birth rates, causing fertility in nearly every OECD country to drop to historic lows. The lack of sex is not only shrinking populations, but also causing huge demographic changes as countries turn older. What exactly is going on?

Those who study the sexual habits of young people generally point to three key reasons: There's the unaffordability of housing, which makes younger people live at home longer (not exactly conducive to lots of sex). There's the lack of booze—the social lubricant that used to be a precursor to most intimacy—and apparently kids aren't as drinking much today as we used to. Then there's the third one: youth mental health issues, which are exacerbated by too much screen time, isolation, and loneliness.

Seems like kids aren't dating much these days, at least not in person. Probably spending so much time with your face buried in your phone will leave you less interested and less competent in successfully hooking up with a real person you would otherwise want to shag.

I would add a fourth reason, and one that is slowly gaining attention in medical circles. Several commonly prescribed drugs, particularly antidepressants, are causing sexual dysfunction in youth. The most surprising aspect of this is that sometimes the sexual dysfunction is permanent and continues after the person stops taking the drug, a phenomenon well enough documented to have its own name, PSSD (Post-SSRI Sexual Dysfunction).

SSRI antidepressants, such as Prozac, Zoloft, and Paxil, among others, as well as drugs for acne (isotretinoin) and baldness (finasteride) are at the top of the list of treatments capable of causing serious and sometimes long-term sexual dysfunction, described as numb genitalia, inability to orgasm, emotional blunting, and so on.

The proportion of our youth taking antidepressants—despite warnings against using these drugs in young people—grew enormously during and after Covid. The medical journal Pediatrics reported that in the US monthly antidepressant dispensing rates to ages 12–25 increased 66.3% from January 2016 to December 2022 (from ~2,576 to ~4,285 per 100,000 people). The number of individuals in this age group with more than one dispensed antidepressant rose 46.1%. More recent data from the CDC shows that about 19.3% of adults in the US currently "take medication for their mental health," which would mostly be SSRI antidepressants.

All of this poses the question: Is the rate of SSRI prescribing affecting sexual activity across a broad spectrum of people in America today?

It was 23 years ago (2003) that the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK issued its first warning that SSRIs increased suicide and self-harm risks in young people, even though they knew of this problem for a long time. The US FDA followed with its own black box warning in 2004, later extended through age 24. The UK's 2003 warning was likewise limited to young people, until this month.

Fast forward to now, the MHRA issued warnings this month about suicidal thoughts and behaviours associated with SSRIs in patients of all ages—not just those under 25—as covered by the US black box warning—as well as warnings about post-SSRI sexual dysfunction.

Shockingly, the US FDA has yet to require a specific warning ...

By Joseph Varon at Brownstone dot org.

A couple of days ago I was on national TV being asked the usual round of questions about an NFL player who'd apparently developed blood clots. How can a young, fit athlete get a pulmonary embolism (PE)? What are the symptoms? Can you fly with a clot? Could it have been picked up earlier?

All perfectly sensible questions, especially for a young athlete, who faces far more scrutiny than an ordinary patient would. Within the hour, the story was all over TV station websites. . Obviously, he's got the country's attention.

I've spent much of my career answering requests like this type. After doing emergency, pulmonary, and critical care for so long, you'd think you'd know everything about thromboembolic disease by now, and I really don't find anything too surprising in that field anymore. I've seen PE kill patients who were absolutely stable just minutes before. I've also seen patients who were absolutely convinced they had a nasty clot, despite their presentation being very different. Both experiences have shaped how I think about the disease and reinforced that medicine needs the human element, something no machine, test, or algorithm can ever provide: Judgment.

The more I thought about that interview, the more I realized it wasn't really about a footballer or pulmonary embolism. It was an interview about where modern medicine has gone. We have such wonderful diagnostic tools now, and at the same time we have created a situation where doctors are increasingly unwilling to use their own clinical judgment without some form of technological validation.

We can now pick up abnormalities that would have been completely invisible a generation ago, yet we can find ourselves in a position where we're not sure whether that abnormality is of any significance. We're absolutely superb at detecting disease, and we're surprised by how uncertain we can be about when to stop looking.

At one time, a doctor's most important tool was his own mind. That's still true today, though I'm not sure we believe it anymore.

About 180 years ago, Virchow examined the mechanisms of thrombosis and pulmonary arterial obstruction. His 1846 work and the papers collected in 1856 formed the pathological basis of what we now call thromboembolic disease [1,2]. Every medical student has heard of him at some stage, invariably in the context of the classic triad of venous stasis, endothelial injury, and hypercoagulability. The triad as we know it wasn't actually Virchow's. Historians have examined how later interpretations and reassemblies of his original observations produced the concept that now bears his name [3].

The historical detail is of course interesting, but the real issue is the physiology. Clots form because the biological milieu is pro-thrombotic. Flow may be slow. The vascular endothelium may be damaged or activated. The coagulation system may shift to a pro-thrombotic state. All of these can happen in isolation or in combination, and their relative importance varies from patient to patient.

A post op patient who is bedbound is not in the same physiological situation as a young athlete who has had an injury. A patient with active cancer is not in the same situation as a patient who has simply spent several hours sitting on an aircraft. They may all go on to have a venous thromboembolism (VTE), but the circumstances in which it occurs and the risks involved will be very different.

That's why you can't just see a symptom and order a test. You have to understand the patient, the patient's situation, and the biology behind it. A swollen leg could be venous thrombosis, chronic venous insufficiency, a drug effect, trauma, inflammation, or a hundred other things. Shortness of breath could be a pulmonary embolism; it could be cardiac disease, it could be a pulmonary infection, it could be obstructive airways, it could be anemia, or it could be anxiety. The presence of a symptom is the first thing you consider in the diagnostic...