By Joseph Varon at Brownstone dot org. 
When was the last time your doctor actually examined you? I do not mean when someone checked your blood pressure, copied your medication list, looked at your laboratory results, or listened briefly through a shirt before returning to the computer. I mean examined you. Looked at you. Watched you breathe. Felt your pulse. Looked at your eyes. Examined your neck. Listened carefully to your heart and lungs. Palpated your abdomen. Watched you walk. Noticed the color of your skin, the movement of your hands, the expression on your face, and the thousand other small pieces of information that a human body offers to someone who has learned how to observe it. 
For most of the history of medicine, this was not an optional ritual performed before ordering the "real tests." This was medicine. Today, increasingly, it is treated as something quaint, inefficient, or unnecessary. 
I have spent most of my professional life taking care of very sick people. Critical care is one of the most technologically intensive areas of medicine ever created. I love technology. I have watched mechanical ventilators breathe for patients who could no longer breathe for themselves. I have used ultrasound, CT imaging, sophisticated hemodynamic monitoring, extracorporeal technologies, molecular diagnostics, and laboratory measurements that physicians a generation before me could only have dreamed about. 
I would never want to return to a world without these tools. But after decades at the bedside, I have also learned something that becomes more obvious, not less, with experience: technology is most powerful when it extends the physician's senses. It becomes dangerous when it persuades the physician that those senses are no longer necessary. 
Experienced clinicians understand something that is remarkably difficult to teach in a lecture hall or classroom. Sometimes you walk into a room and know immediately that something is wrong. You may not yet know what it is, but you know it before the laboratory does. The patient is breathing differently. His skin looks different. She answers a question a fraction of a second more slowly than she did several hours earlier. Posture, speech, facial expression, respiratory effort, or level of attention changes. None of these observations is magical. They are data, collected by a biological instrument trained through thousands and thousands of encounters: the physician. 
When I round in an intensive care unit (ICU), I can learn an enormous amount before touching the computer. I can see whether a patient is fighting the ventilator. I can hear secretions from the doorway. I can see accessory muscles contracting. I can recognize when someone who looked reasonably comfortable earlier suddenly looks exhausted. I can see peripheral perfusion, diaphoresis, agitation, abdominal distension, or a subtle change in mental status. None of this means I should ignore the arterial blood gas, the chest radiograph, the CT scan, or the monitor. Of course I need them. The mistake is believing that because those measurements are more technologically sophisticated, they are necessarily more real than what is happening directly in front of me. 
Medicine once began with the patient and proceeded toward testing. Increasingly, it begins with testing and eventually works its way back toward the patient. Abraham Verghese and colleagues have described this inversion of the diagnostic process, in which clinicians may encounter an image or electronic representation of a patient before encountering the patient himself. That change sounds subtle. It is not. Once the CT scan, laboratory panel, consultant note, medication list, and previous diagnoses have entered our minds, we no longer approach the patient without preconceptions. The data have already told us what we are supposed to see. 
This is one reason the physical examination should never be reduced to nostalgia. Its value is not that physicians once carried black bags and ...

By Joseph Varon at Brownstone dot org. When was the last time your doctor actually examined you? I do not mean when someone checked your blood pressure, copied your medication list, looked at your laboratory results, or listened briefly through a shirt before returning to the computer. I mean examined you. Looked at you. Watched you breathe. Felt your pulse. Looked at your eyes. Examined your neck. Listened carefully to your heart and lungs. Palpated your abdomen. Watched you walk. Noticed the color of your skin, the movement of your hands, the expression on your face, and the thousand other small pieces of information that a human body offers to someone who has learned how to observe it. For most of the history of medicine, this was not an optional ritual performed before ordering the "real tests." This was medicine. Today, increasingly, it is treated as something quaint, inefficient, or unnecessary. I have spent most of my professional life taking care of very sick people. Critical care is one of the most technologically intensive areas of medicine ever created. I love technology. I have watched mechanical ventilators breathe for patients who could no longer breathe for themselves. I have used ultrasound, CT imaging, sophisticated hemodynamic monitoring, extracorporeal technologies, molecular diagnostics, and laboratory measurements that physicians a generation before me could only have dreamed about. I would never want to return to a world without these tools. But after decades at the bedside, I have also learned something that becomes more obvious, not less, with experience: technology is most powerful when it extends the physician's senses. It becomes dangerous when it persuades the physician that those senses are no longer necessary. Experienced clinicians understand something that is remarkably difficult to teach in a lecture hall or classroom. Sometimes you walk into a room and know immediately that something is wrong. You may not yet know what it is, but you know it before the laboratory does. The patient is breathing differently. His skin looks different. She answers a question a fraction of a second more slowly than she did several hours earlier. Posture, speech, facial expression, respiratory effort, or level of attention changes. None of these observations is magical. They are data, collected by a biological instrument trained through thousands and thousands of encounters: the physician. When I round in an intensive care unit (ICU), I can learn an enormous amount before touching the computer. I can see whether a patient is fighting the ventilator. I can hear secretions from the doorway. I can see accessory muscles contracting. I can recognize when someone who looked reasonably comfortable earlier suddenly looks exhausted. I can see peripheral perfusion, diaphoresis, agitation, abdominal distension, or a subtle change in mental status. None of this means I should ignore the arterial blood gas, the chest radiograph, the CT scan, or the monitor. Of course I need them. The mistake is believing that because those measurements are more technologically sophisticated, they are necessarily more real than what is happening directly in front of me. Medicine once began with the patient and proceeded toward testing. Increasingly, it begins with testing and eventually works its way back toward the patient. Abraham Verghese and colleagues have described this inversion of the diagnostic process, in which clinicians may encounter an image or electronic representation of a patient before encountering the patient himself. That change sounds subtle. It is not. Once the CT scan, laboratory panel, consultant note, medication list, and previous diagnoses have entered our minds, we no longer approach the patient without preconceptions. The data have already told us what we are supposed to see. This is one reason the physical examination should never be reduced to nostalgia. Its value is not that physicians once carried black bags and ...

Medicine Has Forgotten How to Touch the Patient
The Patient Before the Data
The Screen between Us
The Physical Examination Is Not Primitive Technology
We Are Losing the Teachers Too
Touch Is Also Communication
Covid Accelerated the Distance
And Now Comes 

By Paul Thacker at Brownstone dot org. 
During a bombshell Senate hearing last week, CIA officer, Jim Erdman III testified under oath that the CIA's scientific analysts determined that the Covid pandemic started from a lab leak, but their scientific conclusions were hidden from Congress and the American public, in what Erdman called "a coverup." 
"Public policy would have been very different had the American public been made aware that a virus from a lab in China was going to serve as the foundation for an Emergency Use Authorization of mRNA products being mandated by the former administration," Erdman said, questioning the validity of the Covid vaccine approval process. 
Erdman also indicted Tony Fauci, the then-director of the National Institute of Allergy and Infectious Diseases (NIAID), for inserting himself into the Intelligence Community's (IC) assessment of the Covid origins, on two documented occasions. In both instances, Fauci steered IC discussion toward a natural origin and away from declaring that the pandemic started from the Wuhan Institute of Virology, which Fauci had funded via US government grants. 
"Dr. Anthony Fauci influenced the IC's analytic process and COVID origin's findings by leveraging his position to ensure the IC consulted with a conflicted list of curated Subject Matter Experts (SME), public health officials, and scientists. This included the authors of the paper 'The Proximal Origin of SARS-CoV-2' and other public health experts and scientists who have been in his orbit for 20+ years, many of whom have and did receive funding from NIAID, as well as scientists working under IC contract. This contradicts Dr. Fauci's 2024 testimony to Congress, when he answered 'not to my knowledge' when asked if he had briefed any intel agency concerning viral research." 
— Testimony of James E. Erdman III before the US Senate Homeland Security & Governmental Affairs Committee 
Such explosive charges—a CIA coverup, Fauci's complicity, and the misguided approval of Covid vaccines—should have ignited a media inferno; instead we got a cold frost. No front-page headline from the New York Times, no angry Washington Post editorial, no story of horror from NPR. And frozen silence from Science Magazine, Nature, Scientific American, and The Atlantic. Not even an icy tweet. 
Now why is that? The answer is rather obvious. 
From the pandemic's beginning these media outlets have promoted the fairy tale that lab accident talk is paranoid conspiracy theory and anyone questioning the efficacy and safety of Covid vaccines is a lunatic who hates science, the laws of physics, and arithmetic taught in kindergarten. Evidence to the contrary, such as a CIA official testifying under oath to the Senate, leaves these writers only two options to preserve both the narrative and their own threadbare journalistic credibility: 
1. Knock it down – find someone willing to call newly uncovered facts a "conspiracy theory" and dash out your narrative enforcing news piece. 
2. Hard ignore – pretend newly uncovered facts don't exist, keep your powder dry, and pray like hell the public gets distracted by oil prices and foreign conflict. 
Erdman was too credible for legacy media to skewer, and his testimony forced them to pick the second option. 
A week after he testified, not a single reporter has managed to float a flimsy critique that aims to dent Erdman's story with rumors from unnamed sources that he once brushed up against an intern in the CIA's halls or stole a stapler from the agency's office supply closet. Nothing even from the downtrodden Rolling Stone which only exists because people now on Medicare have faint memories that this corpse of a magazine once published news with a faint regard for accuracy. 
Nonetheless, I get up every morning, and after dropping my daughter off at school, sit in a café and scroll though the New York Times and Washington Post, reading as many stories as I can in the hour it takes me to down two cups of coffee. I do this bec...

By Paul Thacker at Brownstone dot org. During a bombshell Senate hearing last week, CIA officer, Jim Erdman III testified under oath that the CIA's scientific analysts determined that the Covid pandemic started from a lab leak, but their scientific conclusions were hidden from Congress and the American public, in what Erdman called "a coverup." "Public policy would have been very different had the American public been made aware that a virus from a lab in China was going to serve as the foundation for an Emergency Use Authorization of mRNA products being mandated by the former administration," Erdman said, questioning the validity of the Covid vaccine approval process. Erdman also indicted Tony Fauci, the then-director of the National Institute of Allergy and Infectious Diseases (NIAID), for inserting himself into the Intelligence Community's (IC) assessment of the Covid origins, on two documented occasions. In both instances, Fauci steered IC discussion toward a natural origin and away from declaring that the pandemic started from the Wuhan Institute of Virology, which Fauci had funded via US government grants. "Dr. Anthony Fauci influenced the IC's analytic process and COVID origin's findings by leveraging his position to ensure the IC consulted with a conflicted list of curated Subject Matter Experts (SME), public health officials, and scientists. This included the authors of the paper 'The Proximal Origin of SARS-CoV-2' and other public health experts and scientists who have been in his orbit for 20+ years, many of whom have and did receive funding from NIAID, as well as scientists working under IC contract. This contradicts Dr. Fauci's 2024 testimony to Congress, when he answered 'not to my knowledge' when asked if he had briefed any intel agency concerning viral research." — Testimony of James E. Erdman III before the US Senate Homeland Security & Governmental Affairs Committee Such explosive charges—a CIA coverup, Fauci's complicity, and the misguided approval of Covid vaccines—should have ignited a media inferno; instead we got a cold frost. No front-page headline from the New York Times, no angry Washington Post editorial, no story of horror from NPR. And frozen silence from Science Magazine, Nature, Scientific American, and The Atlantic. Not even an icy tweet. Now why is that? The answer is rather obvious. From the pandemic's beginning these media outlets have promoted the fairy tale that lab accident talk is paranoid conspiracy theory and anyone questioning the efficacy and safety of Covid vaccines is a lunatic who hates science, the laws of physics, and arithmetic taught in kindergarten. Evidence to the contrary, such as a CIA official testifying under oath to the Senate, leaves these writers only two options to preserve both the narrative and their own threadbare journalistic credibility: 1. Knock it down – find someone willing to call newly uncovered facts a "conspiracy theory" and dash out your narrative enforcing news piece. 2. Hard ignore – pretend newly uncovered facts don't exist, keep your powder dry, and pray like hell the public gets distracted by oil prices and foreign conflict. Erdman was too credible for legacy media to skewer, and his testimony forced them to pick the second option. A week after he testified, not a single reporter has managed to float a flimsy critique that aims to dent Erdman's story with rumors from unnamed sources that he once brushed up against an intern in the CIA's halls or stole a stapler from the agency's office supply closet. Nothing even from the downtrodden Rolling Stone which only exists because people now on Medicare have faint memories that this corpse of a magazine once published news with a faint regard for accuracy. Nonetheless, I get up every morning, and after dropping my daughter off at school, sit in a café and scroll though the New York Times and Washington Post, reading as many stories as I can in the hour it takes me to down two cups of coffee. I do this bec...

By Paul Thacker at Brownstone dot org. 
During a bombshell Senate hearing last week, CIA officer, Jim Erdman III testified under oath that the CIA's scientific analysts determined that the Covid pandemic started from a lab leak, but their scientific conclusions were hidden from Congress and the American public, in what Erdman called "a coverup." 
"Public policy would have been very different had the American public been made aware that a virus from a lab in China was going to serve as the foundation for an Emergency Use Authorization of mRNA products being mandated by the former administration," Erdman said, questioning the validity of the Covid vaccine approval process. 
Erdman also indicted Tony Fauci, the then-director of the National Institute of Allergy and Infectious Diseases (NIAID), for inserting himself into the Intelligence Community's (IC) assessment of the Covid origins, on two documented occasions. In both instances, Fauci steered IC discussion toward a natural origin and away from declaring that the pandemic started from the Wuhan Institute of Virology, which Fauci had funded via US government grants. 
"Dr. Anthony Fauci influenced the IC's analytic process and COVID origin's findings by leveraging his position to ensure the IC consulted with a conflicted list of curated Subject Matter Experts (SME), public health officials, and scientists. This included the authors of the paper 'The Proximal Origin of SARS-CoV-2' and other public health experts and scientists who have been in his orbit for 20+ years, many of whom have and did receive funding from NIAID, as well as scientists working under IC contract. This contradicts Dr. Fauci's 2024 testimony to Congress, when he answered 'not to my knowledge' when asked if he had briefed any intel agency concerning viral research." 
— Testimony of James E. Erdman III before the US Senate Homeland Security &amp; Governmental Affairs Committee 
Such explosive charges—a CIA coverup, Fauci's complicity, and the misguided approval of Covid vaccines—should have ignited a media inferno; instead we got a cold frost. No front-page headline from the New York Times, no angry Washington Post editorial, no story of horror from NPR. And frozen silence from Science Magazine, Nature, Scientific American, and The Atlantic. Not even an icy tweet. 
Now why is that? The answer is rather obvious. 
From the pandemic's beginning these media outlets have promoted the fairy tale that lab accident talk is paranoid conspiracy theory and anyone questioning the efficacy and safety of Covid vaccines is a lunatic who hates science, the laws of physics, and arithmetic taught in kindergarten. Evidence to the contrary, such as a CIA official testifying under oath to the Senate, leaves these writers only two options to preserve both the narrative and their own threadbare journalistic credibility: 
1. Knock it down – find someone willing to call newly uncovered facts a "conspiracy theory" and dash out your narrative enforcing news piece. 
2. Hard ignore – pretend newly uncovered facts don't exist, keep your powder dry, and pray like hell the public gets distracted by oil prices and foreign conflict. 
Erdman was too credible for legacy media to skewer, and his testimony forced them to pick the second option. 
A week after he testified, not a single reporter has managed to float a flimsy critique that aims to dent Erdman's story with rumors from unnamed sources that he once brushed up against an intern in the CIA's halls or stole a stapler from the agency's office supply closet. Nothing even from the downtrodden Rolling Stone which only exists because people now on Medicare have faint memories that this corpse of a magazine once published news with a faint regard for accuracy. 
Nonetheless, I get up every morning, and after dropping my daughter off at school, sit in a café and scroll though the New York Times and Washington Post, reading as many stories as I can in the hour it takes me to down two cups of coffee. I do this bec...

Why I Don't Trust Legacy Media
Written Testimony of James E. Erdman III Before the U.S. Senate Homeland Security & Governmental Affairs Committee
Full Committee Hearing: Whistleblower Testimony on the COVID Coverup May 13, 2026

By Alan Cassels at Brownstone dot org. 
A recent article in the New York Times on the increasing rates of heart disease in young women (Why Are More Young Women Developing Heart Disease?) was amusingly frivolous and about as fact-free as an article about health advice can be. 
The key thrust of the article is that any woman who wants to preserve and improve her health should become informed of her "numbers." Which is to say, she should know her blood pressure, cholesterol, BMI, and hemoglobin A1C (a measure of average blood glucose levels) which are claimed to be "important for assessing risk." 
The Times quotes Dr Priya Freaney, director of the Women's Heart Care program at Northwestern Medicine: "Knowing your numbers is your most powerful tool," [she said] "And it's never too early to start." 
What numbers are we talking about? Well, apparently doctors recommend "all adults strive for these levels:" 
BP (Blood Pressure) under 120 mm Hg / 80 mm Hg 
LDL (Low-density lipoprotein) under 100 mg/dL 
HbA1C (Hemoglobin A1C ) of 5.6 or lower 
BMI (Body-mass index) under 25 
Now the four Horsemen of the Apocalypse, blood pressure, blood sugar, cholesterol, and BMI, threatening to strike you down in your healthy middle age unless you submit to the testing, treating (ie: medications and lifestyle changes), and a retesting paradigm which can lead many to become obsessed by the numbers. 
By the way, these four measures have one thing in common: They are typically treated with a prescribing pen that has been carefully guided in your doctor's expert hands by the helpful people in the pharmaceutical industry. Just saying… 
Let's approach these four with a bit of basic epidemiology, examining the wisdom of telling people of "average risk" to aim for these targets. Obviously, people with pre-existing conditions or those with inherently much higher or multiple risks (such as levels that are in the red flashing light category) involve a different calculus. 
But for the sake of evaluating the drive to push people toward these health targets, what do the highest quality studies ultimately say about the value in chasing these numeric targets in healthy people? 
I will always remember that old quip from an aging physician: "High blood pressure is better than no blood pressure at all." But the question one should ask is this: If you lower your blood pressure does it lead to a reduction in your chance of a cardiovascular event or dying? 
First off, despite what many guidelines and health care providers say about knowing your numbers, what they should have said was know your cardiovascular risk numbers (your percentage chance of having a heart attack or stroke over the next 10-30 years) not your numbers of cholesterol, blood pressure, or glucose numbers. Those are what we call 'surrogate markers' and the only reason to lower these numbers is to possibly reduce your risk of heart attacks and stroke. It's not that these surrogate numbers are useless — rather they are the wrong numbers to worry about. Their only use is to help us give a more accurate ballpark assessment of your cardiovascular risk. 
For starters, the target of 120 is not an evidence-based but an "expert-recommended" target, and in case you wondered, having a blood pressure of 130/80 or 140/90 is not the death sentence that your doctor might warn you about. Your blood pressure often jumps all over the map and how and when you measure it can significantly impact that number. It climbs as we get older, naturally. Like grey hair and wrinkles. Chasing this number is one of the biggest uses of a doctor's time and causes considerable (and frequently unnecessary) worry in patients. 
Me? I wish our doctors would have spent time learning more about evidence appraisal and how to properly do shared decision-making with their patients because the decision around the treatment of surrogate numbers is very dependent on a person's values and preferences. Cholesterol or blood pressure "management" makes a ton of money...

By Alan Cassels at Brownstone dot org. A recent article in the New York Times on the increasing rates of heart disease in young women (Why Are More Young Women Developing Heart Disease?) was amusingly frivolous and about as fact-free as an article about health advice can be. The key thrust of the article is that any woman who wants to preserve and improve her health should become informed of her "numbers." Which is to say, she should know her blood pressure, cholesterol, BMI, and hemoglobin A1C (a measure of average blood glucose levels) which are claimed to be "important for assessing risk." The Times quotes Dr Priya Freaney, director of the Women's Heart Care program at Northwestern Medicine: "Knowing your numbers is your most powerful tool," [she said] "And it's never too early to start." What numbers are we talking about? Well, apparently doctors recommend "all adults strive for these levels:" BP (Blood Pressure) under 120 mm Hg / 80 mm Hg LDL (Low-density lipoprotein) under 100 mg/dL HbA1C (Hemoglobin A1C ) of 5.6 or lower BMI (Body-mass index) under 25 Now the four Horsemen of the Apocalypse, blood pressure, blood sugar, cholesterol, and BMI, threatening to strike you down in your healthy middle age unless you submit to the testing, treating (ie: medications and lifestyle changes), and a retesting paradigm which can lead many to become obsessed by the numbers. By the way, these four measures have one thing in common: They are typically treated with a prescribing pen that has been carefully guided in your doctor's expert hands by the helpful people in the pharmaceutical industry. Just saying… Let's approach these four with a bit of basic epidemiology, examining the wisdom of telling people of "average risk" to aim for these targets. Obviously, people with pre-existing conditions or those with inherently much higher or multiple risks (such as levels that are in the red flashing light category) involve a different calculus. But for the sake of evaluating the drive to push people toward these health targets, what do the highest quality studies ultimately say about the value in chasing these numeric targets in healthy people? I will always remember that old quip from an aging physician: "High blood pressure is better than no blood pressure at all." But the question one should ask is this: If you lower your blood pressure does it lead to a reduction in your chance of a cardiovascular event or dying? First off, despite what many guidelines and health care providers say about knowing your numbers, what they should have said was know your cardiovascular risk numbers (your percentage chance of having a heart attack or stroke over the next 10-30 years) not your numbers of cholesterol, blood pressure, or glucose numbers. Those are what we call 'surrogate markers' and the only reason to lower these numbers is to possibly reduce your risk of heart attacks and stroke. It's not that these surrogate numbers are useless — rather they are the wrong numbers to worry about. Their only use is to help us give a more accurate ballpark assessment of your cardiovascular risk. For starters, the target of 120 is not an evidence-based but an "expert-recommended" target, and in case you wondered, having a blood pressure of 130/80 or 140/90 is not the death sentence that your doctor might warn you about. Your blood pressure often jumps all over the map and how and when you measure it can significantly impact that number. It climbs as we get older, naturally. Like grey hair and wrinkles. Chasing this number is one of the biggest uses of a doctor's time and causes considerable (and frequently unnecessary) worry in patients. Me? I wish our doctors would have spent time learning more about evidence appraisal and how to properly do shared decision-making with their patients because the decision around the treatment of surrogate numbers is very dependent on a person's values and preferences. Cholesterol or blood pressure "management" makes a ton of money...

Four Forms of Numericide
Numericide Number One: Blood Pressure at 120/80
Numericide's Number Two: Low-Density Lipoprotein, or LDL, under 100 mg/dL
Numericide's Number Three: HbA1C (Hemoglobin A1C ) of 5.6 or Lower
Numericide's Number Four: BMI under 25

The Neo-Liberal Consensus Is Coming Apart

They Have the Money, We Have the Numbers

Biohacking to Better Health

Pandemic in Africa: Lessons and Strategies

Save Furniture, Save the Past

Considerations on Civil Disobedience

Prostate Cancer: Over-Testing and Over-Treatment

Tedros: Kill Free Speech to Regain Trust

Covid Exposed the Fall of Education Like Nothing Else

Monkeypox: Evidence of the “Pandemic Preparedness” Lie

Daily readings from Brownstone Institute authors, contributors, and researchers on public health, philosophy, science, and economics.

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