By Eyal Shahar at Brownstone dot org.

Dear Editor:

In an ideal world of uncensored Covid science, I would have submitted this letter through the online submission website. However, my experience in 2021 and 2022 and more recently has taught me that there was zero chance that you would have published this text.It has been over four years since the following letter to the editor was published in your journal, but I discovered it only last month. I think there is no expiration date for the search for the truth, and I hope you agree.

Relying on data from 280 nursing homes across 21 states, the authors concluded: "These findings show the real-world effectiveness of the mRNA vaccines in reducing the incidence of asymptomatic and symptomatic SARS-CoV-2 infections in a vulnerable nursing home population."

That is far from the truth.

First, they did not report a single estimate of effect, such as a risk (probability) ratio. That the authors conclude "real-world effectiveness" without showing any estimate is astonishing. It is also astonishing that peer-reviewers or the editorial board have allowed that to happen.

Second, in every nursing home an unvaccinated resident was followed at least three weeks longer than a fully vaccinated resident, so their risk (probability) of infection was higher. Time at risk was neither reported nor considered.

Third, a key risk ratio I will shortly compute from the data is confounded by time trends in the background risk of an infection.

Fourth, comparing the risk ratio of infection (mucosal immunity) with the risk ratio of symptoms if infected (systemic immunity), we observe implausible results.

Lastly, a rudimentary correction suggests near-zero effectiveness of two doses of an mRNA vaccine in this population.

To set the record straight, I offer a peer review of the study and show several risk ratios.

The first dose of an mRNA vaccine was administered on December 18, 2020. Follow-up of nursing home residents who received two doses began at least 21 days later, on January 8, and lasted till March 31. The timeline is shown in the figure along with the epidemic curve.

Unvaccinated residents "were present at their facility on the day of the first vaccination clinic" (i.e., at the time of the first dose, if administered by February 15) and were not vaccinated by March 31. Therefore, in every facility, the follow-up time of unvaccinated residents was three weeks longer if the second dose was the Pfizer vaccine and four weeks longer if it was Moderna.

Moreover, follow-up of unvaccinated residents in some nursing homes started between December 18 and January 8. Not only was it earlier, but that was a period of high risk of infection just before the peak of the winter wave (see figure). All two-dose recipients were spared that early, high-risk exposure time. This bias-confounding by time trends in the background risk-has operated in other "real-world" studies from that time.

The bias is worse if the follow-up is delayed until 14 days after the second dose (to allow full immunity). In this case, follow-up of recipients of two doses began on January 22, ten days after the peak.

Using data from Table 1 in the letter, I computed three risk ratios (RR). In every facility, day 0 for the unvaccinated was 3-4 weeks earlier than day 0 for two-dose recipients.

The key number is the risk ratio of symptomatic infection. It is 0.1 (90% vaccine effectiveness). Surprisingly, the mRNA vaccines seem to have offered fragile residents of nursing homes with a weakened immune response almost the same level of protection that was reported for younger, healthy populations. Remarkable if true, or difficult to believe.

The risk ratio of symptomatic infection, which I questioned, is the product of two risk ratios: the risk ratio of infection (0.19) times the risk ratio of symptoms if infected (0.52).

The first estimate is unquestionably implausible. Upper respiratory infection is primarily prevented by secretory IgA antibodies on ...

By Joaquim Couto at Brownstone dot org.

There was a time when debates about determinism and free will belonged to philosophy departments and late-night dorm room conversations. They were enjoyable precisely because they seemed harmless. Whatever the answer, life went on. Courts judged, doctors decided, teachers taught, and politicians were still-at least nominally-held responsible for their actions. That era is over.

Artificial intelligence has transformed what once appeared to be an abstract philosophical question into a concrete issue of governance, power, and accountability. Determinism is no longer merely a theory about how the universe works. It is becoming an operating principle for modern institutions. And that changes everything.

AI systems are deterministic by construction. They operate through statistical inference, optimization, and probability. Even when their outputs surprise us, they remain bound by mathematical constraints. Nothing in these systems resembles judgment, interpretation, or understanding in the human sense.

AI does not deliberate.

It does not reflect.

It does not bear responsibility for outcomes.

Yet increasingly, its outputs are treated not as tools, but as decisions. This is the quiet revolution of our time.

The appeal is obvious. Institutions have always struggled with human variability. People are inconsistent, emotional, slow, and sometimes disobedient. Bureaucracies prefer predictability, and algorithms promise exactly that: standardized decisions at scale, immune to fatigue and dissent.

In healthcare, algorithms promise more efficient triage. In finance, better risk assessment. In education, objective evaluation. In public policy, "evidence-based" governance. In content moderation, neutrality. Who could object to systems that claim to remove bias and optimize outcomes? But beneath this promise lies a fundamental confusion.

Prediction is not judgment.

Optimization is not wisdom.

Consistency is not legitimacy.

Human decision-making has never been purely computational. It is interpretive by nature. People weigh context, meaning, consequence, and moral intuition. They draw on memory, experience, and a sense-however imperfect-of responsibility for what follows. This is precisely what institutions find inconvenient.

Human judgment introduces friction. It requires explanation. It exposes decision-makers to blame. Deterministic systems, by contrast, offer something far more attractive: decisions without decision-makers.

When an algorithm denies a loan, flags a citizen, deprioritizes a patient, or suppresses speech, no one appears responsible. The system did it. The data spoke. The model decided.

Determinism becomes a bureaucratic alibi.

Technology has always shaped institutions, but until recently it mostly extended human agency. Calculators assisted reasoning. Spreadsheets clarified trade-offs. Even early software left humans visibly in control. AI changes that relationship.

Systems designed to predict are now positioned to decide. Probabilities harden into policies. Risk scores become verdicts. Recommendations quietly turn into mandates. Once embedded, these systems are difficult to challenge. After all, who argues with "The science?"

This is why the old philosophical debate has become urgent.

Classical determinism was a claim about causality: given enough information, the future could be predicted. Today, determinism is turning into a governance philosophy. If outcomes can be predicted well enough, institutions ask, why allow discretion at all?

Non-determinism is often caricatured as chaos. But properly understood, it is neither randomness nor irrationality. It is the space where interpretation occurs, where values are weighed, and where responsibility attaches to a person rather than a process.

Remove that space, and decision-making does not become more rational. It becomes unaccountable.

The real danger of AI is not runaway intelligence or sentient machines. It is the slow erosion of human re...

By Roger Bate at Brownstone dot org.

Argentina's government has become increasingly skeptical of the World Health Organization, reflecting a wider reconsideration of international health institutions in the aftermath of Covid-19. Although Argentina has not formally withdrawn, it has expressed dissatisfaction with the WHO's performance, its growing reliance on donor-funded agendas, and its push for expanded treaty authority.

This reassessment coincides with the even more consequential reality that the United States has initiated its withdrawal from the WHO. It is the first time since the Soviet Union rejoined the WHO in the 1950s that a major funder, in this case its most influential member, has stepped away.

The US departure changes the strategic environment in which Argentina must act. Washington's decision was driven by concerns that the WHO mishandled the pandemic, promoted extreme and damaging restrictions, tolerated poor scientific practice, and allowed private philanthropies and advocacy networks to shape policy. The United States may seek reentry if future negotiations produce meaningful reform, and it may rejoin under a future administration, but for the foreseeable future the WHO will operate without its principal sponsor. This shift presents Argentina with new risks and new opportunities.

Argentina could leave immediately, but doing so now would limit its influence. Remaining as a conditional participant offers a more effective path. Conditional engagement means Argentina stays within the WHO while making clear that its membership depends on substantial changes in governance, transparency, and scientific integrity. This approach preserves access to certain technical networks, avoids needless diplomatic friction, and allows Argentina to align its stance with that of the United States during a period of global institutional realignment. Just as importantly, it leaves withdrawal as an option if the WHO remains unresponsive.

The case for this strategy rests on well-documented failures. During Covid-19, the WHO endorsed restrictive measures that imposed severe economic and health and social costs, particularly in low- and middle-income countries (LMICs). It resisted acknowledging successful alternative strategies, notably in Sweden and Tanzania, and later revised its historical guidance in ways that shielded institutional authority rather than enabling honest evaluation. In tobacco control and other areas, the WHO has become increasingly shaped by donor priorities that do not reflect the interests of sovereign nations.

The well-intentioned initiatives to limit the harms from smoking have led to unintended and perverse consequences that the organization has been reticent in acknowledging. The proposed expansion of the International Health Regulations and the Pandemic Agreement-negotiated with limited transparency-would grant the organization unprecedented influence over national emergency responses. These dynamics undermine trust and justify Argentina's insistence on reform.

Conditional engagement allows Argentina to use its membership to demand these reforms. It can press for transparency in donor funding, scientific pluralism in decision-making, strict limits on the WHO's authority during emergencies, and priority attention and resources to the most lethal infectious diseases in the LMICs. It can refuse to implement WHO recommendations unless they pass independent national review. With the United States now outside the WHO, Argentina becomes one of the few reform-minded voices still at the table, giving it a degree of influence it would not have from the outside. Should meaningful reforms fail to materialize, Argentina can still withdraw later-and that withdrawal would carry more weight because it followed a period of principled engagement.

At the same time, Argentina should deepen bilateral and regional cooperation, especially with the United States, which is building alternative health partnerships to replace WHO me...

By Jeffrey A. Tucker at Brownstone dot org.

Among the many incredible revelations over the past five years is the extent of the power of the pharmaceutical companies. Through advertising, they have been able to shape media content. That in turn has affected digital content companies, which responded from 2020 onward by taking down posts that questioned the safety and efficacy of Covid vaccines.

They have captured universities and medical journals with donations and other forms of financial control. Finally, they are far more decisive in driving the agenda of governments than we ever knew. Just for example, we found out in 2023 that the NIH shared thousands of patents with pharma, with a market value approaching $1-2 billion. This was all made possible by the Bayh-Dole Act of 1980, which was pushed as a form of privatization but only ended up entrenching the worst corporatist corruptions.

The hold over governments was cemented with the National Childhood Vaccine Injury Act of 1986, which granted a liability shield to the makers of products that appear on the childhood schedule. The injured are simply not permitted to fight it out in civilian courts. No other industry enjoys such sweeping indemnification under the law.

Pharma today arguably competes with the military munitions industry in its hold over power. No other industry in human history has managed to close the economies of 194 countries to force most of the world's population to wait for its inoculation. Such power makes the East India Company, against which the American founders revolted, look like a corner grocery by comparison.

There is ample talk about how much pharma has suffered since its vaunted product flopped. But let's not be naive. Their power is still ubiquitously on display in every sector of society. The fight at the state level for over-the-counter therapeutics - and for medical freedom for the citizenry - reveals the scope of the challenges ahead. The reformers that now head agencies in Washington are fighting daily through a thicket of influence that goes back many decades.

Just how far in the past does this power extend? The first federal effort to push vaccination - however primitive and dangerous - was from President James Madison. "The Act to Encourage Vaccination" of 1813 required that smallpox vaccines be given away for free and properly delivered to anyone who requests them. As injury and death piled up, and amidst cries of profiteering and corruption, Congress acted decisively in 1822 to repeal the act.

The turning point in public opinion was what came to be known as the Tarboro Tragedy. The most reputed vaccinologist in the country and the official guardian of the vaccine, Dr. James Smith, had accidentally sent material containing live smallpox virus instead of cowpox vaccine to a physician in Tarboro, North Carolina. This caused a local smallpox outbreak, infecting around 60 people and resulting in approximately 10 deaths. This error damaged public and Congressional trust in the federal program's ability to safely handle and distribute vaccine matter.

The great promise of vaccination, which seemed to raise the possibility of the scientific eradication of deadly disease under the guidance of elite healers, had fallen into disrepute.

Even so, when the Civil War broke out in 1861, there was a push to get all soldiers vaccinated to stop deadly smallpox outbreaks. With that came a slew of injuries and deaths. Historian Terry Reimer writes:

"Unfavorable results from vaccination, or spurious vaccinations, were all too common. Even pure vaccine, obtained from official Army dispensaries, sometimes caused complications. Sometimes, faulty preservation of the crusts could have compromised their effectiveness. As is the case even with modern vaccines today, occasionally, the vaccine did not take, failing to produce the major reaction at the vaccination site that was expected. In other cases, the site of the vaccination became overly sore and swollen, and...

By Eric Hussey at Brownstone dot org.

In the theatrical musical version of Peter Pan, Peter leads the Neverland children in a song about (not) growing up. Toward the end of the song, Peter and the kids sing "We won't grow up! We will never grow a day! And if someone tries to make us…we will simply run away."

That strikes me as not wildly different from the attitudes of many Americans about "health care." Although, it's not about "health care" as such, it's about billing: who will pay for doctor visits, hospital visits, and medications. I suffered through a local professional association meeting not long ago and had to listen to a state senator talk about how his foremost goal legislatively is to assure "access" to "health care" for all in the State of Washington. He also let slip that Washington State is the "most highly leveraged" state in the Union for "health care." Then he went on to bemoan that the State of Washington doesn't have its own printing press to make money like the federal government does.

If you will allow me to do what some might call a "pirate translation" of the above, let me suggest that Washington State - I usually call it The People's Republic of Washington State - borrows more money per capita than any other state in the Union, from a federal government $37+ trillion in debt, to pay for doctor visits, hospital visits, and medications for whoever asks. The state bureaucracy to oversee this is paid for by ever-increasing taxes on the state population.

"Access" is not the correct word. Payment is the correct word. Well, actually, freedom from payment is the correct term.

Sometimes I hear a soon-to-become-former patient of mine - occasionally an already-former patient of mine - tell me how they hate it, but they can't come to see me any more since I don't take their insurance. No, that's incorrect. I assure you, you can come see me. But, because your insurance is a big pain in the neck for a single-doctor office like mine, I will not do the paperwork and take the discounts that they require to get any pay for my work. In fact, I will be happy to see you in my office. But, you will need to tell us how you will be paying for the visit.

To add some perspective to that, my independent one-doctor office has one-and-one-half full time people primarily billing insurance companies. Although three or four companies are involved, the majority of people in the State of Washington have some form of insurance through the State via one of those companies. That is, people who would never admit to this openly or even to themselves, are essentially on welfare with the State of Washington borrowing, keeping their insurance payments lower than they should be.

Which brings me back to Peter Pan.

I don't have any particularly embarrassing instances to share, but I have some vague recollections of my mother saying "Grow up!" after an errant behavior of mine. A great deal of growing up means you are taking responsibility for yourself and your actions. Does that include paying your way? If you are paying your way, you need to know how much something costs. When you are on welfare, that becomes irrelevant.

Ben Carson famously suggested his remedy for the "health care crisis" in 2013 at the National Prayer Breakfast. It took 43 seconds to deliver:

"We've already started down the path to solving one of the other big problems, health care. We need to have good health care for everybody. It's the most important thing that a person can have. Money means nothing. Titles mean nothing when you don't have your health. But we've got to figure out efficient ways to do it. We spend a lot of money on health care, twice as much per capita as anybody else in the world, and yet not very efficient. What can we do?

Here's my solution: When a person is born, give him a birth certificate, an electronic medical record, and a health savings account [HSA] to which money can be contributed, pre-tax, from the time you are born to the time you die. When y...

By Joseph Varon at Brownstone dot org.

Introduction

In the past, medical judgment was underpinned by three fundamental pillars: honest observation, open debate, and the humility to acknowledge our limitations in knowledge. While these principles still thrive in the day-to-day interactions within clinics and ICU corridors, they have been increasingly overshadowed online by a chaotic environment that often prioritizes sensationalism over substance.

Social media has radically transformed not only the means of communication but also the very fabric of our daily lives. It has reshaped how we think, how we evaluate information, and whom we choose to trust. Instead of fostering informed dialogue, it has turned medical science into a contentious battleground where opinions clash and algorithms amplify the most extreme and polarizing voices, often sidelining more measured perspectives. Yet, amid the cacophony, there are invaluable elements that have emerged. Like medicine itself, social media encompasses a spectrum of experiences: the good, the bad, and the ugly.

The Good: Knowledge Finally Reached Everyone

James Madison eloquently asserted that a free society must arm itself with the power that knowledge provides. Social media has, in many ways, fulfilled this imperative, democratizing information in unprecedented ways.

Patients with rare diseases, who once felt isolated in their suffering, can now connect with one another through forums and support groups. They share personal experiences, collaborate on finding solutions, and gain insights faster than many traditional healthcare institutions can publish. On a global scale, physicians are able to consult with one another, sharing clinical patterns and treatment responses in real time, facilitating discussions that transcend geographical boundaries-something no medical journal could match in terms of speed.

During public health crises, the speed of information sharing on social media became even more critical. Frontline doctors were able to alert their colleagues around the world, share early observations about disease patterns, and identify trends long before official guidelines could catch up. This rapid exchange of information became a lifeline for both patients and clinicians, providing critical support and empowering individuals in ways that were previously inconceivable. This aspect of social media, fostering connection and knowledge sharing, is something we must strive to uphold and protect.

The Bad: Expertise Collapsed Under the Weight of Noise

George Washington recognized that truth prevails only when individuals are willing to work diligently to uncover it. Unfortunately, this principle has been undermined in the social media landscape, which now rewards speed, outrage, and unfounded certainty. These attributes are fundamentally incompatible with the rigorous, evidence-based approaches that underpin the practice of medicine.

In an era where every voice can be amplified, the lines separating informed medical professionals from those devoid of scientific understanding have blurred significantly. Individuals lacking formal training can present themselves as experts, and the public often struggles to make informed distinctions. Confidence can resemble knowledge, and performance can be mistaken for credibility.

This phenomenon has created a chilling effect, even on qualified clinicians who may hesitate to express their viewpoints openly. They do so not because they lack evidence or expertise, but because they fear retribution from a vocal online mob. A single misinterpreted statement can lead to harassment, damage to professional reputations, or even formal complaints. In a climate where dissenting voices are often silenced, many choose to remain silent-believing it safer than risking honesty. Such dynamics are detrimental to the field of medicine, where healthy scientific discourse and a willingness to engage in constructive disagreement are essential for progress.

The Ugly: C...

By Russ Gonnering at Brownstone dot org.

What is the relationship between education, knowledge, and wisdom? This is not a trivial question, and the ramifications are far from obvious. Our lives may literally depend on it.

Let me illustrate the problem. On 12/5/2025, a Joint Statement from numerous medical organizations was released, highly critical of the recent recommendation of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) on modification of universal administration of the Hepatitis B vaccine to every newborn. The wording of the statement is telling:

"We are deeply alarmed by the actions taken this week by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP). The apparent goal of this meeting was to sow doubt in vaccines rather than advance sound vaccine policy, and we will all pay a price for that.

"This is a significant departure from the historic role ACIP has played in shaping vaccine policy in the United States. Previously, we could expect science to drive decisions, experts to debate evidence, and consensus to lead to shared, clear recommendations. That is not the case with the current committee, and this change puts Americans' health at risk. (emphasis added)

This is like the statement from the National Foundation for Infectious Diseases from June 27, 2025, regarding the current makeup of the ACIP:

Deviation from the long-standing evidence-based process that has historically guided ACIP deliberations undermines transparency and trust, risks legitimizing misinformation, and is harmful to public health. A process that includes input from Centers for Disease Control and Prevention (CDC) experts, working groups, and trusted scientific and medical organizations, has been critical to ensuring rigorous, transparent, evidence-based recommendations that the public and healthcare professionals can trust. Voting on critical policy recommendations without due process that includes a thorough, balanced, and vetted review of available data by qualified experts invalidates the results and leads to confusion and distrust of recommendations.

On 12/14/2025 Politico published a piece entitled This vaccine adviser to RFK Jr. has some choice words for his critics. It reviewed the firestorm of criticism being leveled at the current members of the ACIP of the CDC as well as the response from Retsef Levi, including:

I think we've adopted an extremely medicalized view of health. Our system is very centralized and coercive. Too many public-health policies assume that a small group at the top should make decisions for everyone and enforce them instead of putting the individual at the center and empowering people, with the support of doctors and others, to take ownership of their health.

Some ACIP members and presenters are criticized as not appropriate for the ACIP because they are not physicians or "experts." My view is quite different, and I agree with Professor Levi. They are terrific choices, not despite not being physician "experts," but because of it! And I will back this up with clear evidence.

The problem has to do with entrained thinking in both leaders and experts. When both are combined in decision-makers, so is the danger as explained by David Snowden and Mary Boone in A Leaders Framework for Decision Making:

…leaders are susceptible to entrained thinking,a conditioned response that occurs when people are blinded to new ways of thinking by the perspectives they acquired through past experience, training, and success…

Entrained thinking is a danger in complicated contexts, too, but it is the experts (rather than the leaders) who are prone to it, and they tend to dominate the domain. When this problem occurs, innovative suggestions by nonexperts may be overlooked or dismissed, resulting in lost opportunities. The experts have, after all, invested in building their knowledge, and they are unlikely to tolerate controversi...

By Daniel Nuccio at Brownstone dot org.

Earlier this month, after roughly a 20-year wait, audiences finally had the opportunity to see Quentin Tarantino's Kill Bill: The Whole Bloody Affair.

Initially released in 2003 and 2004, Kill Bill: Volumes 1 and 2 comprised Tarantino's then long-awaited fourth film, originally envisioned by the auteur as a single work but later split by producer Harvey Weinstein to avoid either releasing a movie with an over four-hour run-time that might deter the casual moviegoer or a greatly pared version that would severely compromise Tarantino's vision.

Hence, Volume 1 introduced viewers to "The Bride," a young, female, assassin, beaten, gunned down, and left for dead on the day of her wedding (or, more accurately, wedding rehearsal) by the Deadly Viper Assassination Squad, the team of trained killers led by the titular Bill, The Bride's former lover and father to her unborn child.

In Volume 1 we see The Bride awaken from a coma after several years and win a knife fight against one of her former co-workers. Yet, the bulk of the volume focuses on The Bride's acquisition of a legendary Hattori Hanzō sword and the series of stylized battles she must overcome before facing O-Ren Ishii, a former teammate who has ascended to the head of the Tokyo yakuza.

Slower and more methodical, Volume 2 better develops the remaining characters, further exploring their backstories and relationships with one another while gradually building towards The Bride's final confrontation with Bill, which manages to both subvert and exceed expectations.

Although both volumes can be viewed as individual masterpieces, for Millennial cinephiles a single film called Kill Bill came to be viewed as something like the original theatrical release of George Lucas' Star Wars. Unlike the four-hour cut of David Lynch's Blue Velvet or the lost pie fight scene from Stanley Kubrick's Dr. Strangelove, it was known to still exist. Tarantino had screened it in 2006 at Cannes and again for a special showing in 2011. He just wasn't releasing it for general audiences.

Then finally on December 5, 2025, Kill Bill: The Whole Bloody Affair, quietly hit theaters, taking the number six spot for its opening weekend - something pretty impressive for a largely unadvertised four hour and thirty-five minute remix of a pair of films from more than 20 years ago.

When I learned of its release by chance while checking the movie listings for my local AMC, I promptly cleared an evening to ensure I could experience Kill Bill as intended. And, I am glad I did.

On whatever level, the experience is different watching the film as a single whole in a single sitting as opposed to watching it as two separate films months apart. Moreover, it was also a reminder of what movies used to be - and still could be.

Every scene is expertly crafted. Every shot is perfectly framed. Every color is carefully chosen. Every line of dialogue, no matter how seemingly insignificant, reveals something about the characters and their relationships with one another. The construction of the narrative is a masterclass in storytelling.

Moreover, after more than twenty years, watching The Bride embark on her globe-trotting, blood-soaked quest for revenge was just as captivating as it ever was. Watching her battle through O-Ren Ishii's henchmen at the House of Blue Leaves was no less exciting. Watching her training under the mystical Pai Mei pay off as she punches her way out of her grave was no less triumphant. Watching her final confrontation with Bill was no less suspenseful.

Yet, throughout the film, I could not help but be troubled by a couple of nagging thoughts no matter how much I tried to cast them aside.

They Just Don't Make Them Like They Used to

The first nagging thought, to which I already alluded, was that movies really have changed since 2004, undoubtedly for the worst. It seems strange thinking about Kill Bill in 2025 the way people did about Lawrence of Arabia or The Godfather in ...

By Peter C. Gøtzsche at Brownstone dot org.

fiction or faith. It is a major failure to give equal prominence to people presenting scientific facts and people talking about their feelings or beliefs with no evidence in their support, or to allow them to contradict unchallenged the most reliable evidence we have.

However, virtually every time I know something about a healthcare issue considered controversial, this is what I see in the news, and the hepatitis B vaccine controversy illustrates this abundantly.

On 5 December 2025, with a vote of 8 versus 3, the Advisory Committee on Immunization Practices (ACIP) at the Centers for Disease Control and Prevention (CDC) ended the recommendation that all newborns in the United States receive a hepatitis B shot at birth. The birth dose was recommended only if the mother had tested positive for the virus or if her infection status was unknown.

The change was very rational, and as in Western Europe, only Portugal recommends a universal birth dose, it would seem difficult to argue against it. But the media did and failed us badly. Two days after the vote, I downloaded news stories from 14 major media outlets, and they were all very negative. The media used three main tactics to support their beliefs:

They denigrated the Secretary of Health, Robert F. Kennedy, Jr., the members of ACIP he had selected, and some of the presenters at the meeting.

They gave undue prominence and praise to the three dissenting ACIP voices and outsiders, who were depicted as experts or scientists, as if to say that they must be right, and they were widely quoted for their remarks, which were rarely rational or evidence-based.

They didn't check if what the critics of the policy change claimed was correct.

The Denigration of Kennedy

Of the 14 news outlets, only Nature did not denigrate Kennedy.

Reuters started its press release by saying it was "a major policy win" for Kennedy that vaccine advisers named by him reversed a decades-long recommendation "that disease experts say will reverse decades of public health gains." So, Kennedy's advisers were not experts, and as the critics were experts, they must be correct, right?

Reuters noted that the CDC is "now run by a Kennedy-appointed acting head, Jim O'Neill, who is not a scientist;" that Kennedy founded the anti-vaccine group Children's Health Defense; fired ACIP's previous 17 "independent" experts and replaced them with a group that largely supports his views; dropped broad recommendations for the Covid vaccine and cut funding for mRNA vaccines.

The facts are that several of the previous experts at the ACIP were not independent but had conflicts of interest in relation to vaccine manufacturers and other drug companies; that recommending Covid vaccines only to high-risk groups brought the US on par with Europe; and that cutting funding for mRNA vaccine research was well motivated. Kennedy said that his team had reviewed the science and found that these vaccines fail to protect effectively against upper respiratory infections like Covid and flu. His department was therefore shifting the funding toward "safer, broader vaccine platforms that remain effective even as viruses mutate."

Reuters misrepresented the ACIP meeting entirely, claiming that "many of Kennedy's committee members criticized the vaccine as unsafe." What they said was that safety had not been adequately studied, which was correct.

The other media called Kennedy a vaccine sceptic (The Hill, Health Policy Watch, CBC), a vaccine activist (CNN, the Guardian), or an anti-vaccine advocate (PBS), who fired all 17 previous members of the ACIP, replacing them with people who largely shared his scepticism (New York Times, Washington Post, National Public Radio, CNN, PBS, CBS News, Time, Health Policy Watch, CBC, BBC, the Guardian) with a "goal of upending vaccine policy" (New York Times), and the vote fulfilled a long-held goal of the anti-vaccine movement (The Hill).

The CBC, the largest news broadcaster in C...

By Roger Bate at Brownstone dot org.

Every morning, hundreds of millions of people perform a socially approved ritual. They line up for coffee. They joke about not being functional without caffeine. They openly acknowledge dependence and even celebrate it. No one calls this addiction degenerate. It is framed as productivity, taste, wellness-sometimes even virtue.

Now imagine the same professional discreetly using a nicotine pouch before a meeting. The reaction is very different. This is treated as a vice, something vaguely shameful, associated with weakness, poor judgment, or public health risk.

From a scientific perspective, this distinction makes little sense.

Caffeine and nicotine are both mild psychoactive stimulants. Both are plant-derived alkaloids. Both increase alertness and concentration. Both produce dependence. Neither is a carcinogen. Neither causes the diseases historically associated with smoking. Yet one has become the world's most acceptable addiction, while the other remains morally polluted even in its safest, non-combustible forms.

This divergence has almost nothing to do with biology. It has everything to do with history, class, marketing, and a failure of modern public health to distinguish molecules from mechanisms.

Two Stimulants, One Misunderstanding

Nicotine acts on nicotinic acetylcholine receptors, mimicking a neurotransmitter the brain already uses to regulate attention and learning. At low doses, it improves focus and mood. At higher doses, it causes nausea and dizziness-self-limiting effects that discourage excess. Nicotine is not carcinogenic and does not cause lung disease.

Caffeine works differently, blocking adenosine receptors that signal fatigue. The result is wakefulness and alertness. Like nicotine, caffeine indirectly affects dopamine, which is why people rely on it daily. Like nicotine, it produces tolerance and withdrawal. Headaches, fatigue, and irritability are routine among regular users who skip their morning dose.

Pharmacologically, these substances are peers.

The major difference in health outcomes does not come from the molecules themselves but from how they have been delivered.

Combustion Was the Killer

Smoking kills because burning organic material produces thousands of toxic compounds-tar, carbon monoxide, polycyclic aromatic hydrocarbons, and other carcinogens. Nicotine is present in cigarette smoke, but it is not what causes cancer or emphysema. Combustion is.

When nicotine is delivered without combustion-through patches, gum, snus, pouches, or vaping-the toxic burden drops dramatically. This is one of the most robust findings in modern tobacco research.

And yet nicotine continues to be treated as if it were the source of smoking's harm.

This confusion has shaped decades of policy.

How Nicotine Lost Its Reputation

For centuries, nicotine was not stigmatized. Indigenous cultures across the Americas used tobacco in religious, medicinal, and diplomatic rituals. In early modern Europe, physicians prescribed it. Pipes, cigars, and snuff were associated with contemplation and leisure.

The collapse came with industrialization.

The cigarette-rolling machine of the late 19th century transformed nicotine into a mass-market product optimized for rapid pulmonary delivery. Addiction intensified, exposure multiplied, and combustion damage accumulated invisibly for decades. When epidemiology finally linked smoking to lung cancer and heart disease in the mid-20th century, the backlash was inevitable.

But the blame was assigned crudely. Nicotine-the named psychoactive component-became the symbol of the harm, even though the damage came from smoke.

Once that association formed, it hardened into dogma.

How Caffeine Escaped

Caffeine followed a very different cultural path. Coffee and tea entered global life through institutions of respectability. Coffeehouses in the Ottoman Empire and Europe became centers of commerce and debate. Tea was woven into domestic ritual, empire, and gentility.

Cru...