By Jeffrey A. Tucker at Brownstone dot org.

I've never been as excited and nervous about a new book of mine. The reason is that I know for certain it will be read. It is 132 pages with gorgeous illustrations at each chapter that capture the theme. The prose is about communication first. Each chapter covers an animating spirit of the historical American ethos: respect, hard work, pioneering, gratitude, patience, faith, independence, forbearance, and so on.

It's not preachy. It's illustrative with a distinct purpose of celebrating the 250th anniversary of the Founding. The ethos is about coming to terms with the physical world around us, its opportunities, limits, and implied obligations.

This small book follows two previous books written in full rage against the lockdowns that wrecked life and liberty in 2020 and following. The battles are not over but it seems time to reflect more deeply on larger themes.

An angry life is not a good life. We need to rally around that which we love. These years have tempted us all to forget this.

This project began when a friend pressed a monograph in my hands by Eric Sloane, an American legend in historiography and illustration, the voice that nearly invented what is called "Americana." The title is The Spirits of '76, published in 1973. It is not in print and likely won't be again.

As it turns out, this is Sloane's least-celebrated book. I suspect I know why: it is dark and truth-telling in ways that upset today's professional-class sensibilities.

In particular, his emphasis on hard work as the basis of the good life and society cuts against all digital-age aspirations, in which the goal is to do as little as possible. Sloane's view is different. This attitude and aspiration will wreck individual lives and whole societies. Regretting work is like regretting life: it is hard to contain once it begins and invades all things. It results in spiritual despair.

For me, the book came at exactly the right moment. Disabused of my past techno-utopianism, demoralized by the spectacular failure of ideological systems to resist lockdowns, and shattered by the triangulating schemes of party politics, I realized that I too had lost touch with normal life in all its authenticity, simplicity, and beauty. More than that, the values that undergird such a life, a life of genuine freedom, needed refurbishment and restoration.

Here is my personal attempt to recapture some of what we lost in these years. It is a commentary following Sloane's themes with the addition of some of my own. Some versions of these thoughts previously appeared in the Epoch Times, which provides me with the implausible generosity of printing my articles six times per week, and Brownstone Institute, our beloved project to rekindle an honest intellectual culture in times of corruption and censorship.

My appreciation for all my colleagues, friends, and loved ones is incalculable; a list of them all would be impossibly long. My thoughts are a product of my engagements in these years in which our legacy communities were smashed by force. I think of all today who have the strength to write, read, and hope as survivors.

The question this book seeks to answer is, why have we the living been blessed with another day and what are we to do with our lives? As we approach the 250th anniversary of America's birth, these are questions that bear careful reflection. The book is dedicated to my mother.

Here are some images from the book.

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By Roger McFillin at Brownstone dot org.

"I don't know who this person is anymore," James told me, his voice cracking as he described his wife of fifteen years. "She started Zoloft eight months ago for some mild anxiety about work. Now she's rewritten our entire history together. According to her new narrative, I've been emotionally abusive for years. She's filed for divorce, moved in with some guy she met at a yoga retreat, and told our kids that daddy was never really there for them."

He paused, searching for words. "The strangest part? She seems completely unbothered by destroying our family. It's like she's watching it happen from outside her own body."

Welcome to the SSRI marriage apocalypse: a phenomenon so widespread that entire online communities have formed to support its casualties. Spouses gathering in digital refugee camps, comparing notes about partners who transformed into unrecognizable strangers after starting antidepressants.

The stories are eerily similar: personality changes, moral compass spinning wildly, empathy evaporating, sexual connection obliterated, and a strange, detached willingness to torch everything they once held sacred.

But here's what makes my blood boil: The mental health establishment celebrates these relationship demolitions as therapeutic breakthroughs. "The medication lifted their mood enough to finally leave that toxic relationship!" they'll proclaim, completely ignoring that the "toxicity" might be a drug-induced fabrication. This is my fundamental criticism of the therapy industry: therapists attach to their client's inner world as if it's absolute fact, unquestionable truth.

Even without SSRIs, people alter reality and create stories to cope with pain. But add psychiatric drugs to the mix, and you've got modern therapists providing unfettered validation to chemically distorted narratives, rarely approaching cases with empirical scrutiny. They jump right on the victim mindset, and in many cases, actively create it.

"Yes, you were trapped in an abusive marriage!" they'll affirm to someone whose brain chemistry has been so altered they couldn't recognize genuine love if it slapped them in the face.

The Spell-Binding Effect

Dr. Peter Breggin, Harvard-trained psychiatrist and former consultant to the National Institute of Mental Health, who's spent decades exposing the dark underbelly of his own profession, called it "medication spellbinding:" the insidious way psychiatric drugs prevent users from recognizing their own drug-induced dysfunction. (I'm actually traveling to Dr.

Breggin's home next week to interview him, and you can bet your ass I'll be drilling deep into this spellbinding phenomenon.) It's not just that SSRIs change you; they rob you of the ability to perceive that you've been changed. You become a stranger to yourself while believing you're finally seeing clearly.

"Lisa" sat across from me six months after stopping Lexapro, tears streaming down her face. "I feel like I'm waking up from a nightmare I created. I had an affair. I told my husband of twenty years that I'd never really loved him. I was prepared to walk away from my children without a second thought. Now I look back and think, 'Who was that person?' But at the time, it all made perfect sense. I felt nothing. No guilt, no remorse, no connection to my old life.

It was like living in emotional Novocain."

This is your brain on SSRIs: chemically castrated, not just sexually but emotionally, morally, spiritually. The same serotonergic manipulation that's supposed to lift your mood also severs the invisible threads connecting you to everything that matters. But you won't realize it's happening because the drug disables your ability to recognize its own effects.

The psychiatric establishment has convinced millions that flooding the brain with serotonin is as benign as taking vitamin C. They've never bothered to mention that serotonin doesn't just regulate mood; it shapes moral reasoning, empathy, pair bonding, sexual r...

By Toby Rogers at Brownstone dot org.

Introduction

In a previous article, I presented ten practical and material criticisms of Evidence-Based Medicine (EBM). But there are even larger metaphysical, ontological, and epistemological problems with EBM. Numerous authors make the case that EBM and evidence hierarchies elide important debates in the philosophy of medicine. In this article I will review seven philosophical debates in connection with EBM and evidence hierarchies including:

1. Hierarchies are not how causation in science is usually constructed;

2. Evidence and interpretation are two different things;

3. The inferential gap may be unbridgeable;

4. Bayesian statistics has long since proven superior to the frequentist statistics relied on by RCTs;

5. Science can never prove hypotheses, only refute them;

6. Actual medical practice is necessarily pragmatic and different from the objectivism of EBM; and

7. Medicine is a practice not a science per se.

Hierarchies Are Not How Causation in Science is Constructed

Several authors have noted that EBM tends to overlook and ignore the contributions of basic science (also called "bench" or "fundamental" science and I will use these three terms synonymously in this section). Bench research is defined as "any research done in a controlled laboratory setting using nonhuman subjects. The focus is on understanding cellular and molecular mechanisms that underlie a disease or disease process" ("Bench research", n.d.).

Merriam Webster's Dictionary defines basic science as, "any one of the sciences (such as anatomy, physiology, bacteriology, pathology, or biochemistry) fundamental to the study of medicine" ("basic science", n.d.).

The CEBM evidence hierarchy lists basic science as the fifth level of evidence, below the threshold suggested by Strauss et al. (2005) and others as even worth reading.

To be clear, the CEBM and other evidence hierarchies are not excluding bench science entirely from the study of medicine - they are proscribing the consideration of bench science by doctors when they make clinical decisions (presumably others, namely pharmaceutical companies and academic researchers would be free to continue with a more comprehensive approach).

Excluding basic science in this way is an odd choice because basic science has always been an essential component of establishing causation.

Bluhm (2005) writes,

[B]ench [laboratory] research and clinical (epidemiological) research are intimately related. The history of epidemiology shows that advances in one of these aspects of biomedical research often depends on advances in the other; this point is particularly clear in the case of infectious diseases but is equally important for understanding chronic disease (p. 538).

Bluhm (2005) argues that EBM should move from hierarchies of evidence to "networks of evidence" in which both epidemiology and lab-based biochemistry work hand in hand (p. 535). It is a fine point as far as it goes, but it strikes me that one could push this idea of networks of evidence even further - to include the subjective wisdom of both doctors and patients as well. I will elaborate on this point later in the article.

Rawlins (2008) writes:

Hierarchies attempt to replace judgment with an over-simplistic, pseudo-quantitative, assessment of the quality of the available evidence…. Hierarchies of evidence should be replaced by accepting - indeed embracing - a diversity of approaches (p. 586).

Goldenberg (2009) argues that the degradation of pathophysiology in evidence hierarchies is unwarranted "as pathophysiology often provides more fundamental understanding of causation and is in no way scientifically inferior" (p. 180).

La Caze (2011) voices alarm that evidence hierarchies overlook the contributions of basic science. As pointed out above, basic science is usually assigned to the lower tiers of evidence hierarchies. While the assignments to the different tiers are rationalized based on reference to "quality" in fact, "p...

By Steve Templeton at Brownstone dot org.

The following is an excerpt from Steve Templeton's book, Fear of a Microbial Planet: How a Germophobic Safety Culture Makes Us Less Safe.

Germophobia, also known by the more clinical term, mysophobia, isn't generally considered a condition all by itself. Instead, it's usually associated with obsessive-compulsive disorder, or OCD. Germs just happen to be one thing that people on the OCD spectrum tend to obsess about and use to justify compulsive behaviors. Not all people with OCD are germophobes, but it's much safer to say that most, if not all, germophobes are further along the OCD spectrum than most.

How do people with OCD tendencies become germophobes? In the case of my sister, she became a nurse and worked in a cardiac surgical team. As anyone knows, the threat of nosocomial, or hospital-acquired infection, is a serious one in patients that undergo open-heart surgery.

Basically, it was a part of her job to obsess about the possibility of contamination and infection in her patients, and obsessively clean and disinfect everything near and in contact with them to prevent potentially-life threatening infections in a vulnerable population.

The problem is that the more she worked in this demanding job, the harder it got not to see every room like an operating room. Unfamiliar places like hotel rooms became especially suspect - God knows who had been there and what they were doing - and how bad a job cleaning the housekeeping staff was doing. A germophobe doesn't need to see the deadly germs; they simply know they are there, ready to infect unwitting people, and everyone is vulnerable.

A common thread among germophobes seems to be an inciting event of terror-inducing infection or exposure - something that drove them from mere OCD to full-on mysophobia. In the 2005 book Germ Freak's Guide to Outwitting Colds and Flu, self-described germophobe Allison Janse recounts the effect of birthing two twins seven weeks premature on her sense of their vulnerability.

She observed the compulsively clean environment of the NICU and, upon the discharge of her twins, was told to stay away from "obviously sick people."

But that turned out to be impossible, as she found herself in line at a pharmacy with a coughing and sneezing "obviously sick person." Two days later, she became one herself, and was thus terrified of infecting her own children, possibly not realizing that her own immune system would also provide protective antibodies through her breast milk.

But a doctor made an already bad situation worse by prescribing Ciprofloxacin (useless for a likely viral infection) and telling her to stop breastfeeding because the antibiotic would be secreted in her breast milk. It didn't help, and only scared the hell out of her, causing her to wear gloves and a mask when she handled her kids for a week. As she put it, "a germ freak was born."

The rest of Janse's book contains a lot of obvious germophobe tips that wouldn't have impressed my sister, like how to avoid handshakes and touching anything in public places to use of products like a UV-light toothbrush sanitizer. Pretty much every situation outside of hiding under your covers had a fail-safe method to prevent being exposed.

Yet the most interesting parts of the book were where Janse managed to acknowledge the truth about our bacterial environment, while still failing to understand the limitations of her "the only good germ is a dead germ" mentality. She admitted that antibacterial soap isn't more effective than regular soap and might have other drawbacks like "unnatural selection" of disease-causing variants.

She also dismissed the utility of masks for healthy people: "You're not that much of a germ freak - plus unless your mask fits perfectly it's useless." Finally, she conceded that the boatload of germs found in places like gyms and daycares probably weren't all that harmful to healthy adults and children, and in some circumstances, might even be benef...

By Julie Ponesse at Brownstone dot org.

[The following is an excerpt from Julie Ponesse's book, Our Last Innocent Moment.]

One of the things we have learned over the last three years is just how much regulatory capture factored into the Covid response, how economics turned vaccine technology into an industrial profit machine. One crucial piece of evidence for this came from the Pfizer report, released last year by the FDA as part of a US court order, containing what Naomi Wolf calls "evidence of the greatest crime against humanity in the history of our species."

The report shows massive incongruity between how the vaccines were marketed to the public and what Pfizer knew about them prior to their release to market. It shows:

Pfizer knew their gene-based injections had negative efficacy as early as November 2020 (with the third most common side effect of the vaccine being Covid, itself)

shortly after the vaccines came to market, Pfizer hired 2,400 full-time employees to process the adverse event reports (a stunning fact given the culture of silence that prevented so many adverse events even from being reported to, or processed by, physicians)

that the vaccines cause myocarditis within a week after injection

the shot's lipid nanoparticles do not remain at the injection site but are quickly biodistributed throughout the body to the brain, liver, spleen, and ovaries where they may remain permanently

an asymmetry between the adverse events that were disclosed to the public (chills, fatigue, swelling at injection site) and those contained in the documents (haemorrhages, blood clots, neurological disorders, Bell's palsy, Guillain-Barré syndrome)

there were 61 deaths from stroke, half of which took place within 48 hours of injection

These are the things Pfizer knew. These are the things Pfizer did not reveal to the public. These are the things that made us the turkeys and Pfizer, the butcher.

It has been said that there is no historical parallel to the Covid vaccines: a vigorously marketed experimental product on a global scale, which garnered almost perfect support from policymakers. The scale of money involved is almost beyond comprehension. Pfizer's 2023 "Annual Review" states: "2022 was a year in which we set all-time highs in several financial categories." That year, Pfizer's revenue was a record-setting $100.3 billion, 38% coming from the Pfizer-BioNTech vaccine.

While it's no secret that pharmaceutical companies spend large portions of their budgets on marketing, it's hard to think of pharmaceutical products being marketed like cars or lipstick. But they are. Perhaps even more so. In 2022, Pfizer spent $2.8 billion on marketing, a mere 2% of the revenue they earned from the Pfizer-BioNTech vaccine. But just how pharmaceutical products are marketed is a complex business.

One thing we find in the Pfizer report is a long list of donations to organizations that encouraged vaccine use, and/or directly addressed vaccine hesitancy. Pfizer couldn't produce ads endorsing mandates - that would have been too obvious - but they could fund various lobbying groups, healthcare colleges, media, and even medical journals that promote vaccine use, address vaccine hesitancy, and support mandates.

Among Pfizer's charitable donations, the report lists: $200,000 to the American Academy of Paediatrics, $100,000 to the American College of Emergency Physicians for Vaccine confidence PSAs, and $337,550 to the American Lung Association's Pneumonia Awareness Campaign. (If you want to promote the uptake of a vaccine for a respiratory virus, it makes strategic sense to advertise pneumonia as a severe side effect of Covid.)

It is also noteworthy that Pfizer is a regular contributor to universities, most of which mandated their product. When the newspapers started to report my story in the fall of 2021, the Toronto Star contacted Arthur Caplan, Director of Medical Ethics at NYU Medical Centre, for a comment.

His response was "I've been working on vaccines ...

By Joseph Varon at Brownstone dot org.

In a time when trust in public health is already hanging by a thread, recent revelations from the US Department of Health and Human Services (HHS) have delivered another blow - one that strikes at the very heart of medical ethics.

"Our findings show that hospitals allowed the organ procurement process to begin when patients showed signs of life, and this is horrifying," Secretary Kennedy said. "The organ procurement organizations that coordinate access to transplants will be held accountable. The entire system must be fixed to ensure that every potential donor's life is treated with the sanctity it deserves."

Hidden beneath the surface and quietly ignored by corporate media is a story that should horrify every physician, patient, and policymaker: the commodification of human life in the American transplant system.

The Independent Medical Alliance (IMA), a coalition of physicians dedicated to restoring transparency and patient-centered care, has publicly denounced the findings of a recent HHS report. As President of IMA, I can tell you this: what we've uncovered is not a case of benign negligence. It is a deliberate erosion of the most sacred values in medicine - consent, dignity, and the inviolability of the human body.

A System That No Longer Sees the Patient

Organ transplantation is, in theory, one of the great achievements of modern medicine. When practiced ethically and transparently, it has saved countless lives. But like so many institutions corrupted by profit and policy, it has drifted far from its original mission.

In 2024 alone, over 45,000 organ transplants were performed in the United States. That number should inspire hope - but instead, it invites scrutiny. A substantial portion of those organs were harvested under ethically ambiguous conditions, including donation after circulatory death (DCD) and questionable determinations of brain death. The line between patient and donor is blurring - and not in a way that honors either.

Organ Procurement Organizations (OPOs) are incentivized not by patient outcomes, but by volume. The more organs they harvest, the more funding they receive. Hospitals, too, receive significant reimbursement for transplant procedures, creating a perverse system where terminal patients are seen less as individuals with complex medical stories and more as reservoirs of reusable parts. The New York Times has published a piece that urges standards of death to be liberalized even further.

"We need to figure out how to obtain more healthy organs from donors… We need to broaden the definition of death."

Where Are These Organs Coming From?

The public assumes, understandably, that most organ donors are willing participants - cadaveric donors who've signed cards or checked boxes. But the data doesn't support that rosy picture. A growing percentage of organ procurement comes from patients who are not dead in the traditional sense but are declared brain dead or transitioned to DCD protocols under murky guidelines.

Let's talk plainly: Who decides when a person is truly dead? And how confident are we, as physicians, that our criteria are airtight?

The Trouble with Brain Death

Brain death is defined as the irreversible cessation of all brain activity, including the brainstem. On paper, that sounds final. In practice, it's anything but. There is no universal standard for determining brain death in the United States. Each state, and often each hospital, may have its own protocol.

Here's how it's supposed to be done:

1. Prerequisites:

Establish cause of coma (e.g., trauma, hemorrhage, anoxic injury)

Rule out confounding factors: intoxication, metabolic disturbances, hypothermia

Ensure normothermia, normal electrolytes, and absence of sedatives or paralytics

2. Neurological Exam:

No responsiveness to verbal or noxious stimuli

Absent brainstem reflexes:

Pupillary response to light

Corneal reflex

Oculocephalic reflex ("doll's eyes")

Oculovestibular reflex (cold calorics)

...

By Leslie Manookian at Brownstone dot org.

On July 31, 2025, the Ninth Circuit issued its ruling in Health Freedom Defense Fund et al. v. Megan K. Reilly et al., vacating the earlier ruling of a three-judge panel of the Ninth Circuit in favor of plaintiffs Health Freedom Defense Fund (HFDF), California Educators for Medical Freedom (CAEMF), and several individual plaintiffs.

The reasoning of the court in its latest ruling, as represented by Judge Bennett's majority opinion, is an affront to all who value truth, justice, the United States Constitution, and logic. Incredibly, the court concluded that as long as a government official believes a vaccine will protect public health, it is irrelevant whether the vaccine actually works.

Armed with this rationale, a state government, simply by uttering the words "This is for public health," can force any individual to submit to a medical treatment, even if that medical treatment does not benefit that individual - and perhaps harms him. The implication of this line of thinking is clear: Government is our absolute ruler, our master, and we are its chattel.

Here is the context of the ruling: In November 2021, the plaintiffs sued the Los Angeles Unified School District (LAUSD) for mandating Covid injections for all employees. We argued that the Covid injections do not stop transmission or infection and therefore lack any public health justification. We contended that Jacobson v.

Massachusetts, a Supreme Court of the United States (SCOTUS) case from 1905, did not apply to our case because Jacobson was predicated both on the extreme emergency posed by smallpox - its death rate was 30%, whereas Covid has a 1% rate of death - and on a safe and effective smallpox vaccine that was believed to actually stop the spread of the dreaded disease based on decades of use, therefore providing a public health justification.

Nearly a year later, in September 2022, the district court ruled against the plaintiffs. But in January 2023 plaintiffs appealed that decision. In June 2024 a three-judge panel ruled in favor of plaintiffs, overturning the district court and remanding the case to the district court. The next month - July 2024 - the defendants filed a petition for an en banc review by the Ninth Circuit.

That petition was granted in February of 2025 and oral argument was held in front of the 11-judge panel, on March 18, 2025. On July 31, 2025, the Ninth Circuit issued its ruling in favor of the defendants and dismissed the case.

It bears mentioning that the SCOTUS has overturned decisions rendered by the Ninth Circuit more often than it has any other circuit court in the US. This case amply serves to illustrate precisely why the Ninth has earned such an ignominious reputation.

Indeed, the recent ruling is so egregious that it warrants a thorough breakdown of the main issues:

1. The Ninth Circuit asserted that the right to direct one's own medical treatment is not a fundamental right. It cited several precedents, including Mullins v. Oregon, 57 F.3d 789, 793 (9th Cir. 1995), in which the court held, "Only those aspects of liberty that we as a society traditionally have protected as fundamental are included within the substantive protection of the Due Process Clause." To be clear, nowhere does our Constitution empower the state to dictate any medical intervention.

On the contrary, the Constitution serves as a restraint on government, not on the people. Moreover, there is not a single case in the 105 years since Jacobson when a locality mandated a vaccination or otherwise directed the medical treatment of the people in general. Thus, the Ninth Circuit's insinuation that our society routinely accepts vaccine mandates for adults in general is patently false. By this metric and Jacobson's holding in 1905, women would still not be allowed to vote.

In actuality, Jacobson did not allow the state to condition employment or engagement in normal life on receipt of an injection. Instead, it merely allowed the stat...

By Sinead Murphy at Brownstone dot org.

Imagine that we do not know what blindness is.

Imagine that we describe people as blind very often, but that we do not know what blindness is.

Imagine that blindness is increasing so that, in some districts, three in ten children are diagnosed as blind. But that we do not know what blindness is.

Imagine that we can name many symptoms of blindness. Disinclination to shake hands. Tendency to fall over. Timidity of posture. Slowness of gait. But that we do not know what blindness is.

Imagine that there is posited a spectrum of blindness, including those who sometimes trip on the rug and those who must cling to another person before taking a single step. But that it is not known what blindness is.

Imagine that it is said that blindness may hide itself and affects many people who walk about with the appearance of confidence and respond to facial expression with seeming assurance. But that it is not known what blindness is.

Imagine that the numbers of those who retrospectively interpret their own lives and the lives of others as having been shaped by undiagnosed blindness increase and increase, so rampantly that we are all inclined to understand ourselves and others as at least a little blind. But that we do not know what blindness is.

Imagine that the attribution of blindness so gathers pace that blindness acquires the atmosphere of a natural human condition, a mere difference. But that we do not know what blindness is.

Imagine that strides are made in determining possible causes of blindness - environmental toxins, genetic predisposition, style of upbringing, experience of trauma. But that it is not known what blindness is.

Meanwhile, a small cohort with a blindness diagnosis cleave to the walls of their home, their room, unresponsive to the myriad strategies employed for inclusion of the blind - a small cohort whose tragedy is concealed in the general clamour for blindness; a pitiable few, wrecked and solitary in a darkness wholly overlooked. Because we do not know what blindness is.

The scenario would be implausible were it not real.

We describe people as autistic very often. Autism is increasing; in parts of London, three in ten children are diagnosed with the condition. Almost everyone can name some symptoms of autism: lack of eye contact, tendency to sniff at things, liking for routine, propensity for distress. Autism is understood as a spectrum condition, affecting celebrity achievers and those who cannot speak, dress themselves, or use the toilet.

Autism is said to mask, hiding itself beneath the simulation of functionality. Autism is advertised as a natural divergence, so ubiquitous as to explain aspects of the lives of us all. Autism is attributed to a range of causes, from childhood vaccination to the impersonal routines of metropolitan societies.

Yet we do not know what autism is.

Meanwhile, a not-so-small cohort of young people spin and flap beyond the bounds of sympathy and significance, unable to access the consolations of human life, unable to get in. A not-so-small cohort whose tragedy is obscured by the general enthusiasm for auties; a strange race whose unique forsakenness has no words to speak its name. Because we do not know what autism is.

This cohort of young people is growing and not slowly, relatively unnoticed in the melee of autism-mania except by those charged with the heavy task of supporting it, a task made infinitely more demoralising by widespread innocence about what autism is.

It is beyond time that we try to dispel this innocence.

Why is my 11-year-old son indifferent to the world and those in it, though his mind is alive and his eyes are wide? Why is he able to double large numbers but unable to grasp that subtracting from a number makes it smaller? Why can he learn Wordsworth's 'The Daffodils' by heart while being unable to understand the word 'it?' Why can he not call my attention? Why does he shout 'Mom!' very loudly, though I am right beside him and ...

By Russ Gonnering at Brownstone dot org.

We, especially those engaged in the health professions, need to stop the relentless attempts to normalize all data to fit the nice bell-shaped distribution that we assume is how the world works. Sometimes it does, but sometimes it doesn't. We need to understand the words "It depends."

Two decades ago, I was a Six Sigma Blackbelt deeply immersed in the applications of statistical quality control to healthcare. Our efforts were primarily focused on the process, and as such, the way to improve the outcomes depended entirely on optimizing the processes of care. Our work was organized around the "DMAIC" wheel:

We would Define the problem and the process to improve it, Measure the process, Analyze it, take actions to Improve the process, and then make sure we could Control it. The Control would take the form of specialized charts that showed variation in our measures, such as this one on patient waiting time versus time of appointment:

There would be variation in any process, split into the normal random common cause variation (such as the background up and down motion of the data points around the center line) and special cause variation (like the points in the box). Voila! Masterful! It took a chart to show that patient wait time increased over the lunch hour!

I don't mean to be too sarcastic. There were many instances in which statistical process control led to significant improvements in patient care. For instance, we were able to reduce the time it took for a patient with chest pain from a blocked coronary artery to reach the Cath lab from 2 hours to 32 minutes. The problem came when we thought that everything could be improved this way.

Fresh from this success with the coronary blockage, we attempted to use the same techniques to reduce the time from abnormal mammogram to biopsy. When we started, that time was measured in weeks! Imagine the stress caused to the patient! We were able to get it down to 4 days…but the effort destroyed everything else in the pathology department, as we didn't have the structure to support the process.

More than a half-century ago, Avedis Donabedian understood that Outcome depends on a delicate dance between process and structure:

The structure that supports a process is more than bricks, mortar, and machines. It includes the intellectual capital of the professionals caring for the patient, the expectations and emotional state of the patient, the family structure, even the climate! This is the fallacy of believing that importing "best" practices will be the answer. The "best practices" of the Mayo Clinic work because of the interactions of all these elements.

It works well at the Mayo Clinic, but may, and often doesn't, work at other places. Indeed, even the Mayo Clinic recognizes that nuances of varying community needs must alter their care processes. What needs to be done is to use Critical Thinking skills to discover the "best practice" for the unique makeup of patients, professionals, and the system for each location.

We have empiric reasons to prove this is a viable approach. In 1990, Marian Zeitlin, Hossein Ghassemi, and Mohamed Mansour published Positive Deviance in Child Nutrition. A year later, Zeitlin followed this with a journal publication on the same topic. Both the book and the journal article noted that in impoverished countries, some children seemed to flourish (Positive Deviants) while others in the same situation did not.

The authors discovered that simple, sometimes overlooked factors such as supplementation with locally available nontraditional but high-quality foods, social interaction, and praise played monumental roles in achieving success.

By identifying these Positive Deviants and understanding what made them stand out, the differences could be applied to the larger population, with significant improvement. Importantly, these differences would only be applicable to individuals in the same micro-environment. It was the interacti...

By David Bell at Brownstone dot org.

Clever people are using computer programs to produce fake humans, say how great they are, and push them for money. They are designed to be sexually suggestive or work on other human desires for self-gratification, including that of child abuse, because that is how money can be made.

There can be beauty in a picture, partly through the implied care a person took to capture or produce it. Beauty is not skin deep, and seduction is not beauty - more so when it implies an acceptable path to corruption. It uses a shallow image of reality to fool us. We are being asked, by the tech industry, to become very shallow. We don't have to comply.

As a child, I grew up in a rural coastal region, where the town's streetlights were switched off at 11 pm each night. Some nearby areas had no electrical power at all, and the nearest city was 100 miles away. At night, the Milky Way was just that, stretching across the sky, with the Magellanic Clouds clearly visible half the year and Scorpio, Orion, and the Southern Cross part of normal life.

As street lighting improved, this faded a little, but remained bright and clear, and was unchanged from the hills and farms around. The creek had platypus and blackfish. There were 10 miles of empty sand beach on the coast to the southwest, broken only by a clear water entrance, and the mountains of the promontory to the south backing the wide inlet and islands where mutton birds returned from a yearlong circumference of the Pacific.

This is the stunning reality that humans have lived in, in various forms in various parts of Earth, for a hundred thousand years. Watching the vastness of the universe domed above and a land and seascape fading toward a distant vague horizon must inevitably change the way we view the world and each other. The beauty of the spheres.

During my childhood, in the midst of this, I remember listening to a radio interview with a Dutch astronomer. The program was discussing light pollution in Europe, and the inability of most people in Europe to see stars in the night sky. The astronomer stated that this did not matter, as astronomers like him could travel to Surinam in South America where it was clear enough to use telescopes. What mattered was that people who matter could still see and document for everyone else.

The shallowness of his mind struck me then - there was no understood value in others seeing, as the astronomer had actually lost the ability to see for himself. He had become so blind that he could see no meaning in the universe beyond documenting it.

The astronomer seemed a sad husk of a human. A sense of awe may once have driven him to study astronomy. Perhaps he had loved the patterns of mathematics, or was fascinated by the way light is refracted, or carries memories of a distant past. As a child he must have dreamed of doing something great. By the time the radio reporter reached him, he had lost the most important thing he could hold as a human - a sense of wonder and of beauty, and a desire for others to experience the same.

Now, decades later, far more humans live shielded from the skies our ancestors wondered at. We watch screens where daft presenters express surprise that some ancient monument aligns with certain stars or the sunrise at the equinox, as if our ancestors were as ignorant and gormless as we have become. We have shrunk the universe.

Given the opportunity to live within the music of the spheres from a Spring pasture to the vastness of the jeweled galaxy and beyond, we have shrunken our worlds to screens and forfeited our minds to the narration of others.

Now we substitute human narrators for pathetic AI-generated figures that are supposed to resemble a human mind. As we accelerate the ability to fool and imprison ourselves, those who profit from the emptying of our minds strive to convince us that the shallower we can become, the more we progress. The more divorced we become from understanding our own place and limit...