By Roger Bate at Brownstone dot org.

When delegates gather in Geneva on November 17 for the 11th Conference of the Parties (COP11) to the World Health Organization's Framework Convention on Tobacco Control (FCTC), few will ask the obvious question: who pays for the room where it happens?

The FCTC is the world's only binding treaty on tobacco control. It now shapes national law far beyond its original remit, guiding taxation, packaging, advertising, and - indirectly - the regulation of new nicotine products. Yet the decisions that ripple out from Geneva are made within an ecosystem financed not by member-state dues but by a tight web of foundations, governments, and advocacy groups whose interests align with one another - and with parts of the pharmaceutical industry.

The Philanthropic Powerhouses

Since 2007, Bloomberg Philanthropies has poured more than $1.6 billion into global tobacco control. Through its Bloomberg Initiative to Reduce Tobacco Use, it funds Vital Strategies, the Campaign for Tobacco-Free Kids (CTFK), The Union, and the University of Bath's Tobacco Control Research Group. These organizations run the STOP consortium, a mainstay of FCTC side events and briefings.

The Bill & Melinda Gates Foundation plays a complementary role, notably bankrolling the Knowledge Hub on Tobacco Taxation at the University of Cape Town, co-funded by Cancer Research UK. And donor governments - particularly the UK, Norway, Australia, and the European Commission - finance the FCTC 2030 program, which underwrites participation by poorer countries.

Between them, these actors pay for the travel grants, research networks, and technical papers that shape what becomes official orthodoxy. Their combined effect is to make global tobacco policy a donor-driven enterprise rather than a genuinely multilateral one.

The Quiet Pharmaceutical Presence

Article 5.3 of the FCTC excludes tobacco-industry involvement, but it says nothing about pharmaceutical companies. That leaves the door ajar for firms whose products - nicotine-replacement therapies, prescription cessation drugs - benefit directly from restrictive tobacco and vaping policy.

The connection is not theoretical. Pfizer and GlaxoSmithKline, makers of Chantix and Nicorette, sponsored major WHO-endorsed conferences such as the 2006 and 2009 World Conferences on Tobacco or Health. Professional societies tied to the WHO, including the European Respiratory Society, routinely accept pharmaceutical sponsorship for congresses and fellowships while collaborating on cessation guidelines. The International Pharmaceutical Federation, an observer accredited to the FCTC, promotes pharmacist-led cessation within COP sessions.

Meanwhile, commercial NRT brands sustain visibility through sports and "quit-smoking" campaigns that echo WHO messaging. Each new guideline or subsidy for cessation pharmacotherapy expands its potential market. It is a tidy symmetry: what the FCTC defines as a public-health obligation also functions as product promotion for the companies supplying the sanctioned cure.

The Absent (and Excluded) Industry

By contrast, tobacco and vaping manufacturers are nowhere near the COP's official agenda. The Secretariat's donor lists include no industry money; Article 5.3 is interpreted to mean zero contact. When firms seek a hearing, they do so outside the tent - through events like the Global Tobacco and Nicotine Forum or the "counter-conferences" that coincided with COP10 in Panama. Delegates are advised to stay away.

Whatever one's view of the industry, this asymmetry matters. It ensures that only one side of the nicotine-policy spectrum has institutional access, and that side is heavily financed by donors and industries whose interests are presented as moral rather than commercial.

The Bootleggers, the Baptists - and Their Modern Merger

The economist Bruce Yandle first coined the phrase "Bootleggers and Baptists" in 1983 to describe how moral campaigners and profit-seekers can support the same...

By Bert Olivier at Brownstone dot org.

It is becoming ever more obvious that many people fear rapidly developing Artificial Intelligence (AI), for various reasons, such as its supposed superiority, compared to humans, as far as processing and manipulating information is concerned, as well as its adaptability and efficiency in the workplace, which many fear would lead to the replacement of most human beings in the employment market. Amazon recently announced that it was replacing 14,000 individuals with AI robots, for example. Alex Valdes writes:

The layoffs are reportedly the largest in Amazon history, and come just months after CEO Andy Jassy outlined his vision for how the company would rapidly ramp up its development of generative AI and AI agents. The cuts are the latest in a wave of layoffs this year as tech giants including Microsoft, Accenture, Salesforce and India's TCS have reduced their workforces by thousands in what has become a frenzied push to invest in AI.

Lest this is too disturbing to tolerate, contrast this with the reassuring statement, from an AI developer, to boot, that AI agents could not replace human beings. Brian Shilhavy points out that:

Andrej Karpathy, one of the founding members of OpenAI, on Friday threw cold water on the idea that artificial general intelligence is around the corner. He also cast doubt on various assumptions about AI made by the industry's biggest boosters, such as Anthropic's Dario Amodei and OpenAI's Sam Altman.

The highly regarded Karpathy called reinforcement learning - arguably the most important area of research right now - 'terrible,' said AI-powered coding agents aren't as exciting as many people think, and said AI cannot reason about anything it hasn't already been trained on.

His comments, from a podcast interview with Dwarkesh Patel, struck a chord with some of the AI researchers we talk to, including those who have also worked at OpenAI and Anthropic. They also echoed comments we heard from researchers at the International Conference on Machine Learning earlier this year.

A lot of Karpathy's criticisms of his own field seem to boil down to a single point: As much as we like to anthropomorphize large language models, they're not comparable to humans or even animals in the way they learn.

For instance, zebras are up and walking around just a few minutes after they're born, suggesting that they're born with some level of innate intelligence, while LLMs have to go through immense trial and error to learn any new skill, Karpathy points out.

This is already comforting, but lest the fear of AI persist, it can be dispelled further by elaborating on the differences between AI and human beings, which, if understood adequately, would drive home the realisation that such anxieties are mostly redundant (although others are not, as I shall argue below). The most obvious difference in question is the fact that AI (for example, ChatGPT) is dependent on being equipped with a vast database on which it draws to come up with answers to questions, which it formulates predictively through pattern recognition. Then, as pointed out above, even the most sophisticated AI has to be 'trained' to yield the information one seeks.

Moreover, unlike humans, it lacks 'direct' access to experiential reality in perceptual, spatiotemporal terms - something which I have experienced frequently when confronted by people who draw on ChatGPT to question certain arguments. For example, when I gave a talk recently on how Freud and Hannah Arendt's work - on civilisation and totalitarianism, respectively - enables one to grasp the character of the globalist onslaught against extant society, with a view to establishing a central, AI-controlled world government, someone in the audience produced a printout of ChatGPT's response to the question, whether these two thinkers could indeed deliver the goods, as it were.

Predictably, it summarised the relevant work of these two thinkers quite adequately, but was stumped...

By Peter C. Gøtzsche at Brownstone dot org.

When people under psychiatric care commit suicide or homicide, or are killed or seriously harmed, because of medical malpractice, it is extremely rare that it has any consequences for the doctors. Psychiatry seems to be the only area in society where the law is being systematically violated all over the world. Even Ombudsman and Supreme Court decisions are being ignored.

In 2003, using scientific arguments, lawyer Jim Gottstein convinced the Supreme Court in Alaska to decide that the government cannot drug patients against their will without first proving by clear and convincing evidence that it is in their best interests and that there is no less intrusive alternative available.2 Unfortunately, this victory for human rights has not created a precedent in Alaska, where the authorities continue to force people into being treated with antipsychotics. Just like everywhere else, including in Norway.

I have collaborated with Norwegian former Supreme Court Attorney Ketil Lund on these issues, and we explained in a law journal why forced medication cannot be justified. The efficacy of antipsychotics is poor, and the risk of serious harms is so great that forced medication seems to do far more harm than good. Two years later, the Ombudsman concluded in a concrete case, with reference to the Psychiatry Act, that it violated the law to use forced treatment with an antipsychotic.

I studied consecutive cases where patients had appealed forced treatment orders, which had never been done before. It was difficult to get access to the records, but it was worthwhile as it turned out that the legal protection of patients was a sham.

We found that the law had been violated in every single case. The 30 patients were forced to take antipsychotics, even though less dangerous alternatives could have been used, e.g., benzodiazepines.6 The psychiatrists had no respect for the patients' experiences and views. In all 21 cases where there was information about the effect of previous pills, the psychiatrists claimed a good effect, whereas none of the patients shared this view.

The harms of prior medication played no role in the psychiatrist's decision-making, not even when they were serious. We suspected or found akathisia or tardive dyskinesia in seven patients, and five expressed fears of dying because of the forced treatment.

The power imbalance was extreme. We doubted the psychiatrists' diagnoses of delusions in nine cases, and there is an element of Catch-22 when a psychiatrist and a patient disagree. According to the psychiatrist, it shows the patient has a lack of insight into the disease, which is a symptom of mental illness.

The abuse involved psychiatrists using diagnoses or derogatory terms for things they didn't like or didn't understand; the patients felt misunderstood and overlooked; and the harm done was immense.

The patients or their diseases were blamed for virtually everything untoward that happened. The psychiatrists were not interested in traumas, neither previous ones nor those caused by themselves or their staff. Withdrawal reactions after stopping drugs were not taken seriously - we didn't even see this term being used although many patients suffered from them.

When Jim Gottstein and I wanted to do a similar study of 30 consecutive petitions from Anchorage, we were met with so many obstacles that it took over four years of litigation before Jim was granted access to redacted records. US psychiatrist Gail Tasch and I found that the legal procedures were a sham where the patients were defenceless.

In violation of previous Supreme Court rulings, the patients' experiences, fears, and wishes were ignored in 26 cases, even when the patients were afraid that the pills might kill them or when they had experienced serious harms such as tardive dyskinesia. Several psychiatrists obtained court orders for administering drugs and dosages that were dangerous. The ethical and legal imperatives of offe...

By Charlotte Kuperwasser at Brownstone dot org.

I'm going to touch on a highly controversial subject, one that has become the third rail among cancer biologists and the broader medical community: the possible link between Covid-19 vaccination and cancer. Because my laboratory's mission is centered on cancer prevention, I cannot in good conscience ignore the elephant in the room.

As my colleague, internationally renowned cancer biologist Dr. Wafik El-Deiry, and I articulated in the September ACIP meeting on Covid vaccines, nearly 50 publications have reported a temporal association between Covid-19 mRNA vaccination and the onset of cancer. Epidemiological studies (one from Italy and one from South Korea) have also described increased cancer incidence among Covid-vaccinated individuals compared to unvaccinated groups (albeit with caveats). These reports are mounting and it's time we acknowledge that something meaningful may be occurring rather than dismissing them outright; this latter response seems to be the dominant reaction in academia, the media, and by our regulatory agencies.

My goal here is to unpack the science and outline plausible biological mechanisms between the association of Covid mRNA vaccination and cancer that warrant further and urgent investigation. The purpose is not to make claims either way but to frame the issue that must be addressed in hopes that open scientific discussion and more importantly, research funding can be directed towards this urgent and growing area of concern. The current climate has made it impossible for scientists to study this without fear of personal or professional repercussions.

What We Know and Don't Know

At present, there are no published studies demonstrating a direct causal mechanism by which the mRNA vaccines induce cancer. However, that does not mean such a causal connection doesn't exist. In fact, there are at least three biologically plausible mechanisms that, in my view, merit rigorous study and evaluation given their known links to causing cancer. I've written about these mechanisms before in other contexts, but here I'll explain how they may apply to the Covid-19 mRNA vaccines.

Mechanism 1: Cellular Transformation Due to Spike Protein Biology

The transformation of a normal cell into a cancer cell involves the disruption of multiple safeguards controlling cell growth, survival, and DNA repair. The Covid mRNA vaccines work by instructing the body's cells to produce the SARS-CoV-2 spike protein for prolonged periods of time (anywhere from days to weeks, to months, and even years). This foreign spike protein then elicits an immune response.

Laboratory studies have reported that the spike protein, whether it is produced by infection or by vaccination, has biological activities. It interacts with cellular pathways that regulate the cell cycle, tumor suppressor functions, and DNA damage repair pathways and machinery. Therefore, in theory, such interactions of spike protein with these pathways could contribute to cellular transformation - although the same could be said for infection with Covid-19 itself. The difference, however, lies in the duration of spike protein produced after vaccination compared to natural infection. This also raises an important question about whether multiple Covid infections are biologically equivalent to the artificial spike protein produced by the vaccine.

Since the spike protein that is produced by the mRNA can persist for as little as a few days, to weeks, months, and even years after vaccination, it is important to acknowledge whether cancer incidence correlates with spike protein expression (or persistence) in the body, but also whether it is present in tumors. A recent case study showed evidence that spike protein can be found expressed in metastatic breast cancer. Thus, in thinking about the relationship between Covid vaccination and cancer, chronic exposure to an agent with biological activity that disrupts cell cycle and DNA damage respons...

By Eyal Shahar at Brownstone dot org.

Everyone is familiar with the results of the Pfizer Covid vaccine trial, published back in December 2020. The endpoint was "confirmed Covid," defined as at least one symptom coupled with a positive PCR test.

Not very many know, however, that the famous trial had another key endpoint - asymptomatic infection. It appears in a long document titled "Final Full Clinical Study Report."

Between one-third and one-half of SARS-CoV-2 infections were asymptomatic, and asymptomatic transmission was believed to have played a key role in the pandemic (it didn't). That was the official explanation for imposing lockdowns (though not necessarily the true one). And that's why asymptomatic infection was deemed an important endpoint in the trial.

The results are found in several places in the Pfizer document. One representative table is shown below. We find similar results in other tables.

The number of people was almost identical in the two arms, but the time at risk was only about half for placebo recipients because most of them eventually received the vaccine (crossover after unblinding). Since the number of asymptomatic infections was similar (644 versus 625), the rate ratio is about 0.5, which means 50% effectiveness. Exact computation below:

Not as good as 90% to 95% effectiveness against symptomatic infection - if you believe in miracles - but still, the risk was cut by half.

Was it?

We'll find out shortly.

A footnote explains who was included in the analysis:

Negative N-binding antibody result at visit 1

Negative PCR at visits 1 and 2

Negative PCR at any other time, when measured for suspected symptoms

A case was identified by detecting N-binding antibodies sometime after the second injection.

The N-binding antibody blood test is not as widely known as the PCR test. This test identifies antibodies that target the nucleocapsid (N) protein. They are markers of past infection.

For reasons that are not completely understood, vaccination is associated with a lower anti-N-antibody response to a subsequent infection, and the test misses many more infections in the vaccinated than in the unvaccinated. In technical terms, the sensitivity of the test is lower in the former. This observation was reported by three groups.

Allen et al. found that anti-N antibodies were detected in only 26% of cases of post-vaccination infection (6/23), which was confirmed by PCR and anti-S (spike) antibodies. The frequency was 82% in all documented previous infections (663/812). Evidently, the test underperformed in the vaccinated, and the correction factor is 3.1 (82/26). It was the Pfizer vaccine.

Follman et al. examined the same issue in recipients of the Moderna vaccine. Among participants with PCR-confirmed Covid during the blinded phase of the trial, seroconversion to anti-N antibodies was found in 40% of vaccine recipients (21/52) versus 93% of placebo recipients (605/648). Again, the test underperformed in the vaccinated, and the correction factor is 2.3 (93/40).

Dhakal et al. corroborated the findings in a series of graphs, showing persistently lower anti-N antibody response over time in post-vaccination infection. They did not provide similar percentages.

A valid comparison of the two arms of the Pfizer trial requires correcting the number of asymptomatic infections in the vaccine arm to account for underdetection by the test. It was a lot more than 644 cases. Based on the studies I cited, we should multiply that count by 2 to 3.

If we double the number (a correction factor of 2), the true effectiveness was about zero. If we multiply by 2.5, we are entering the range of negative effectiveness.

The Pfizer vaccine was useless or worse against asymptomatic infection.

My search of PubMed did not find any articles on the mRNA vaccine and asymptomatic infection in the Pfizer trial. I wonder why. Were they reluctant to publicize 50% effectiveness, or were they worried that a post like mine might show up as a letter to th...

By Roger Bate at Brownstone dot org.

When politicians talk tough on trade, they usually promise to protect American jobs. But sometimes those gestures do the opposite. The Trump administration's proposed 100 percent tariff on large cigars imported from Nicaragua is a case in point. According to my latest research, the tariff would shrink US GDP by $1.26 billion, reduce total output by $2.06 billion, eliminate nearly 18,000 jobs, and cost state and local governments $95 million in tax revenue.

There is no domestic industry to protect. The United States produces almost no large cigars, which are rolled by hand from long tobacco leaves and sold through tobacconists, cigar lounges, and small brick-and-mortar shops. Roughly 60 percent of all 430 million cigars imported each year come from Nicaragua. Doubling landed import costs would devastate the 3,500 retailers and 50,000 workers whose livelihoods depend on that trade.

Worse, this tariff reverses one of the administration's genuine policy successes - its early effort to limit the Food and Drug Administration's overreach into small-batch cigars and other low-risk nicotine products. It also repeats the same arbitrary logic behind the FDA's recent warning letter to NOAT - a Swedish company selling mild, recyclable nicotine pouches already cleared for sale in Europe. In both cases, symbolic toughness trumps scientific and economic sense.

From NOAT to Nicaragua: A Pattern of Policy Whiplash

Over the past year, US regulators have exhibited a kind of policy whiplash - swinging between deregulation and sudden restriction with no coherent principle in sight.

In September 2025, the Office of the United States Trade Representative proposed raising tariffs on all Nicaraguan goods to 100 percent under Section 301 of the Trade Act of 1974. The administration's stated goal was to "respond to unfair practices." Yet there is no evidence of unfairness in the cigar industry. The measure instead weaponizes trade law for political theater - inflicting collateral damage on American small businesses.

Both the NOAT decision and this tariff decision share three traits:

They target imported goods with no domestic substitute, guaranteeing higher costs for US consumers.

They stretch statutory intent, turning laws written for health or trade enforcement into blunt political instruments.

They contradict stated priorities - of deregulation, small-business support, and partnership with democratic nations in the Western Hemisphere.

The result is a credibility gap. When the same government that defends small retailers against FDA overreach then hits them with a massive import tax, rhetoric and reality collide.

The Economics of a Dead-Weight Tax

The losses are staggering:

The largest hit falls on retail and wholesale trade, accounting for $905 million in lost output and more than 11,000 jobs. Downstream sectors - transport, logistics, finance, and hospitality - also lose business.

Because there is no US manufacturer to benefit, this tariff functions purely as a dead-weight consumption tax. Prices rise, demand falls, and total welfare declines. Economist Eric Zitzewitz has shown that tariffs on small consumer markets almost always destroy more value than they create. That logic applies perfectly here.

The administration's own record underscores the contradiction. In 2020, a White House inter-agency workshop led by the FDA's Center for Tobacco Products recognized that large cigars are a low-risk, artisanal product warranting lighter regulation. The proposed tariff discards that evidence in favor of empty symbolism.

Geopolitical Blowback

Economic folly is bad enough, but the strategic damage may be worse. Nicaragua's cigar sector has been one of the country's few pro-US industries, employing tens of thousands in cities like Estelí and linking the country's fortunes to transparent trade under the CAFTA-DR agreement.

Punitive tariffs would almost certainly push Managua toward closer alignment with China and Russia,...

By Brownstone Institute at Brownstone dot org.

This year, Brownstone Institute awarded its prize for outstanding achievement to three exceptional individuals who have been brilliant servants of society and truth in times of great upheaval.

Thomas S. Harrington

Thomas S. Harrington, a distinguished scholar of Hispanic culture and history, has dedicated his career to unraveling the intricate threads of identity, nationalism, and political upheaval in the Iberian Peninsula. Born and raised in the United States, Harrington's fascination with Spain's diverse cultural landscape drew him across the Atlantic early in his academic journey. He immersed himself in the vibrant worlds of Madrid, Lisbon, and Santiago de Compostela, honing his expertise through lived experience as much as formal study. This hands-on approach culminated in three prestigious Fulbright Senior Research Scholar awards - one in Barcelona, Spain, another in Montevideo, Uruguay, and one in Sardinia, Italy - where he delved deeply into Catalonian language, history, and the simmering currents of nationalism that have long defined the region's soul.

For over two decades, Harrington served as Professor of Hispanic Studies in the Department of Language and Culture Studies at Trinity College in Hartford, Connecticut. There, he captivated students with courses on 20th- and 21st-century Spanish cultural history, literature, and film, encouraging them to question dominant narratives and explore the alchemy of collective identity. His scholarly output reflects this passion: his acclaimed book Public Intellectuals and Nation Building in the Iberian Peninsula, 1900-1925: The Alchemy of Identity (Bucknell University Press) examines how thinkers and writers forged modern national consciousness amid the ruins of empire.

Harrington's intellectual reach extends further. A prolific public intellectual, he lends his incisive voice to outlets like Common Dreams, dissecting US foreign policy, media distortions, and the cultural fault lines of global affairs with a clarity born of his transatlantic perspective.

Harrington's engagement with contemporary crises reached a crescendo during the Covid-19 pandemic, a period that exposed what he saw as a profound betrayal by the "credentialed class" - those experts entrusted with safeguarding society. In his 2023 book The Treason of the Experts: Covid and the Credentialed Class (Brownstone Institute), Harrington chronicles this era with a blend of scholarly rigor and personal indignation.

Drawing on Eisenhower's prescient warnings about the military-industrial complex, he argues that a new elite - scientists, policymakers, and media gatekeepers - abdicated their duty, prioritizing power and conformity over evidence and humanity. The work, at turns reflective and fiery, is not just a critique but a call to reclaim rational discourse in an age of manufactured fear. Through it all, Harrington remains a bridge-builder: a Catalan expert who critiques American hubris, a historian who warns of tomorrow's shadows, and a teacher who believes that true expertise lies in questioning authority, not blindly serving it. Today, as debates over trust in institutions rage on, Harrington continues to write, teach, and provoke as Senior Fellow of Brownstone Institute.

Bret Weinstein

Bret Weinstein, the evolutionary biologist turned unyielding truth-seeker and Brownstone Fellow, embodies the rare fusion of scholarly rigor and defiant curiosity that propels him to challenge the sacred cows of modern science and society. Born on February 21, 1969, in Los Angeles to a family of intellectual wanderers - his father a mathematician, his mother an artist - Weinstein grew up in Southern California, earned a bachelor's in biology before venturing to the University of Michigan for a PhD in evolutionary biology. There, under the tutelage of luminaries like Richard Alexander, he honed a framework that views evolution not as a blind march but as a delicate dance of design t...

By Robert Malone at Brownstone dot org.

Continuing on our breakneck world tour, following speaking engagements in Canada, Brussels, and Amsterdam, Jill and I have just completed the Salt Lake City Brownstone Institute retreat.

Next stop, Mar-a-Lago for the CPAC MAHA kickoff, and then immediately to Rome to testify in the Italian Senate and potentially to present a report to a senior member of the Catholic Church in the Vatican.

At the Brownstone annual conference in Salt Lake City, I had been scheduled for a 30-minute on-stage interview, but at the last minute, it was decided that I should just speak directly to the audience. Below is the text I prepared on short notice.

In other related news, it appears that the Kaiser Family Foundation "news" reporters are preparing another hit piece. I have posted their written inquiry below the text for the speech, for your amusement if nothing else. And to think that they called me a conspiracy theorist!

Meanwhile, the real work involved in turning around the HHS enterprise and focusing on Making America Healthy Again continues.

Just another "day in the life" window into what it is like to be constantly targeted by Pharma, medical-industrial-complex surrogates like KFF, and the usual trolls and chaos agents that serve Mordor.

Brownstone, Nov 01, 2025

The MAHA Movement: A View from Within (My Written Notes for the Talk, Not a Direct Transcript)

I am a Maryland-licensed physician, and serve as the co-chair of the CDC Advisory Committee on Immunization Practices, and as Medical Advisor to MAHA alliance, a 501(c)4 non-profit.

Technically, in my current work supporting the Federal Administration, I serve as a "Special Government Employee" without pay.

The opinions expressed here are my own, and do not necessarily represent those of the US Government, the US Centers for Disease Control and Prevention, or the CDC Advisory Committee on Immunization Practices.

Medical Ethics

I hope and trust that you share my strong support for both individual informed consent (as defined in the Nuremberg accords and Helsinki Agreement) as well as the Principle of Subsidiarity enshrined in both the doctrines of the Catholic Church as well as Article 5(3) of the Treaty on European Union (TEU).

This brilliant foundational component of the Treaty on European Unity states that;

"Under the principle of subsidiarity, in areas which do not fall within its exclusive competence, the Union shall act only if and in so far as the objectives of the proposed action cannot be sufficiently achieved by the Member States, either at central level or at regional and local level, but can rather, by reason of the scale or effects of the proposed action, be better achieved at Union level.

The institutions of the Union shall apply the principle of subsidiarity as laid down in the Protocol on the application of the principles of subsidiarity and proportionality. National Parliaments ensure effective implementation of the principle of subsidiarity through the procedure set out in that Protocol."

In my opinion, in medical treatment matters, the patient is the lowest effective level of governance, for, if we are not allowed to govern our own bodies and what medical treatments we accept, then there is no personal freedom and there can be no proportionality.

The cornerstone of this ethical structure is the principles of Patient Informed Consent, which were widely violated during Covid. In a free society, citizens must have the freedom to decide what medical procedures they wish to accept for themselves and their children. They must be provided with complete, transparent access to the full spectrum of information concerning risks and benefits of a procedure, including vaccination. And they must be allowed to choose whether to accept a medical procedure - whether or not it is experimental - without being subjected to coercion, compulsion, or enticement. The interests of the collective society should not outweigh the rights of the individual ...

By Aaron Kheriaty at Brownstone dot org.

Physician Ronald Dworkin, a very fine writer, has published at Civitas a review of Making the Cut that is a terrific essay in its own right on the subject of doctoring. I am republishing it here with permission.

While pondering their early years in medicine, some doctors, reading Dr. Aaron Kheriaty's thoughtful and entertaining memoir of being a physician, Making the Cut, will probably think meanly of themselves. I did. Right from the start, while still a student, Dr. Kheriaty demonstrated the proper disposition for a physician. He loved medicine; he was awed by its significance; he was humble; he liked talking with patients; he had a natural bedside manner.

In my case, it's not that I had poor bedside manner so much as I had no bedside manner. I didn't do bedside manner. Nor, as a young anesthesiologist in training, did I expect to. Once, during my residency, a middle-aged patient informed me of my deficit. I snapped back, "You shouldn't expect good bedside manner from your anesthesiologist. Just be grateful that you woke up." To paraphrase Willy Loman, I was not liked, let alone well-liked, by patients.

I changed over the years, but Dr. Kheriaty wisely explains how medicine can accommodate all sorts of odd personalities; even if I had not changed, I would have found my place. Not surprisingly, given his strengths, he pursued a career in psychiatry, where his career flourished at a California university until the pandemic, when he challenged the university's vaccine mandate policy in federal court and was subsequently fired. Government efforts to censor the medical field through social media control led him to become a plaintiff in the Missouri vs. Biden case, in which the judge decided that the Biden administration had, in fact, violated physicians' First Amendment rights. Besides having a good bedside manner, Dr. Kheriaty has courage and backbone.

His book opens with the enthusiasm of a young person learning how to practice medicine - enthusiasm gradually tempered by reality. The hours in medicine are long. The smells are bad - he opens the first chapter with a story of having to manually disimpact a morbidly obese patient suffering from constipation. The hierarchy among physicians, stretching from the lowest medical student to the highest attending physician, can sometimes border on the ridiculous.

In nineteenth-century Russia, the status of the serf was such that a noble could beat him without suffering legal consequences. Dr. Kheriaty describes a similar experience during his early years in a teaching hospital, where medical students, already emasculated by the shortness of their white coats, can be berated, ordered about, and humiliated by attending physicians, with no right to defend themselves.

Dr. Kheriaty is at his most interesting when he uses those everyday training experiences as a springboard to wax philosophical. In one example, he humorously describes how doctors approach the sensitive subject of sex by engaging in what he calls "the sterilization of the erotic." By making sex seem no different from bowel habits or joint mobility, doctors try to put patients at ease so they will be more likely to discuss their concerns.

Yet the language doctors use to talk about sex also risks changing the way they think about sex. Phrases such as "safe sex" or "sex life" make sex seem like any other physiological process. Gone is the sense of awe and mystery. At the same time, Dr. Kheriaty admits, medicine's efforts to erect a completely sterile field around sex are useless. "Love and sex remain forever beyond our impoverished clinical words," he writes.

This last point resonated with me. While a medical student, I learned how to perform a pelvic exam on a live model provided by the medical school. Along with several other male medical students, I waited anxiously outside the building for my turn. I felt like a sailor on shore leave in a foreign port. When my turn came, the naked wo...

By Joseph Varon at Brownstone dot org.

There was a time when the white coat symbolized courage. It meant that a physician stood between humanity and harm, guided not by decree but by conscience. We earned our knowledge through humility, not hierarchy; our oaths through suffering, not signatures. Somewhere along the way, that covenant was broken. Medicine ceased to be a vocation of service and became a system of obedience.

The quiet transformation began long before the pandemic. It crept in under the banners of efficiency, safety, and scientific consensus. Hospitals turned into bureaucracies, universities into funding machines, and physicians into employees of invisible masters. The doctor's sacred question - "What is best for this patient?" - was replaced by the bureaucrat's: "Is this permitted?"

The public never saw the chains being forged. To the outside world, the physician still appeared sovereign, standing tall in the light of reason. But inside the institutions, we felt the tightening leash. Grants dictated thought, algorithms replaced judgment, and the art of healing was coded into a billing system. By the time the world noticed, the transformation was nearly complete.

The Capture of Science

The 20th century brought miracles - antibiotics, imaging, organ transplants - yet every triumph deepened dependence on the machinery that funded it. Regulatory agencies that were meant to protect the public became revolving doors for the industries they governed. Academic journals ceased to be marketplaces of ideas and became gatekeepers of ideology. The phrase "follow the science" came to mean "follow the approved version."

The great irony is that censorship in our time did not require bonfires; it required algorithms. Search engines and social platforms quietly learned to decide what truths were permissible. A paper could be erased not by rebuttal but by invisibility. A career could end not in scandal but in silence. The most dangerous heresy was not being wrong - it was being early.

Within this apparatus, obedience became the new professionalism. Medical students were trained not to think but to comply. Residency programs rewarded deference. Institutional review boards stifled curiosity under the guise of safety. The result was a generation of clinicians fluent in protocol but illiterate in courage.

The Pandemic as Revelation

When 2020 arrived, the system finally revealed its true form. A global emergency provided the perfect justification for control. Bureaucrats issued treatment decrees from offices far from the bedside. Editors, administrators, and social-media executives decided what constituted "acceptable science."

Doctors who tried to treat patients with inexpensive, well-known medications were condemned as dangerous. Data were suppressed, autopsies discouraged, and dissenters decredentialed. Those who refused to stay silent discovered that the punishment for compassion was exile.

The moral injury inflicted during those years will echo for decades. We watched patients die alone because policy demanded it. We were told to prioritize compliance over conscience, metrics over mercy. And yet, in that darkness, something ancient stirred - the physician's instinct to heal, even when forbidden.

That defiance was the beginning of the Great Medical Awakening.

The Moral Cost of Compliance

Every act of compliance has a moral cost. In ordinary times, it is measured in bureaucracy; in crisis, in blood. Many physicians, trapped by fear, told themselves they were protecting patients by following orders. But medicine divorced from conscience becomes cruelty by protocol.

To obey an unjust rule is easy; to live with the memory of obedience is not. The sleepless nights that followed were not due to exhaustion but to shame. We realized that the burnout so often diagnosed in clinicians was, in truth, the body's revolt against moral betrayal.

Healing began with confession. Physicians spoke to one another not about treatment regimens but about...