By Jessica Rose at Brownstone dot org.

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Chairman Rand Paul has been collecting and releasing documents as part of the ongoing (what is it now, 6 bloody years?) investigation into SARS-2 origins. You can find that here. It is "largely accepted" that SARS-2 is of natural origin and that it "most likely" arose through natural zoonotic evolution (either in an animal host or during early human transmission) and thus not a laboratory construct, thanks to this paper published on March 17, 2020 in Nature Medicine.

The featured files that I have dug into include 1. the New Slack Messages: Proximal Origin Authors Privately Doubted Their Own "No Lab Leak" Conclusion which includes a condensed version and a full version of the messages, and 2. Fauci's Two-Decade Relationship with the Intelligence Community.

This article will focus on the former Fauci 'n' Intel friends document. I will write up a Part Deux on the Proximal Origin Authors' (Kristian Anderson, Eddie Holmes, Andrew Rambaut, and Robert Garry) Slack exchanges.

The released Fauci 'n' Intel friends document contains a lot of emails, but what caught my eye was the 5-page memo on "page 70" written by DARPA fellow and Marine Major Joseph Murphy 1 on August 13, 2021 to the Inspector General. This 5-page memo can also be found here.

His memo is an analysis of undisclosed (and ultimately DARPA-rejected) EcoHealth Alliance Defusing the Threat of Bat-Borne Coronaviruses (DEFUSE) proposal documents (found unmarked on a DARPA system) as evidence that SARS-CoV-2 originated as a leaked American-engineered recombinant bat coronavirus – he suggests a vaccine precursor – developed at the Wuhan Institute of Virology (WIV). He describes having the opportunity to "sit in the back-row," which positioned him to hear government revelations firsthand, while also being privy to observing and reading the field. Indeed, because of his position and role – as a Marine, no less – he had a rare "bird's eye view" on the true goings-ons.

This memo suggests a massive coverup from within.

This memo that gave me pause – not because the information itself was new or surprising to me, but because it existed inside intelligence communities yet was deliberately hidden since 2021. What bothers me even more is that after filing his concern through a formal DoD Hotline Case, the Director of Maintaining Technology Advantage Jessica Appler, rejected it outright, claiming that his findings were "not substantiated."

Let's be rational. Simply based on "the coincidental" – almost simultaneous – existence of the DEFUSE proposal and the WIV and the unique furin cleavage site in SARS-CoV-2, was it not worth taking his findings into consideration and perhaps launching an investigation considering the context?

His memo raised legitimate questions that have yet to be properly addressed or adequately answered.

N.B. I spoke about this memo with Viva Frei on July 22, 2026.

The memo

Page 1

The Major writes:

SARS-CoV-2 is an American-created recombinant bat vaccine, or its precursor virus. It was created by an EcoHealth Alliance program at the Wuhan Institute of Virology (WIV), as suggested by the reporting surrounding the lab leak hypothesis. The details of this program have been concealed since the pandemic began. These details can be found in the EcoHealth Alliance proposal response to the DARPA PREEMPT program Broad Agency Announcement (BAA) HR00118S0017, dated March 2018 – a document not yet publicly disclosed.

I wonder if this Broad Agency Announcement (BAA) HR00118S0017 document was disclosed if the Major's findings would be rendered "substantiated?"

To be clear, because all of these acronyms can be quite confusing, DEFUSE was a specific ~$14+ million proposal submitted by EcoHealth Alliance (led by Peter Daszak, with partners including Shi Zhengli at the WIV, Ralph Baric at UNC, and others) under DARPA's PREEMPT program. It was pitched by EcoHealth Alliance at the PREEMPT Proposers Day event (early 2018)...

By Yaakov Ophir at Brownstone dot org.

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Health Secretary Robert F. Kennedy, Jr.'s recent decision to terminate the Covid-19 Emergency Use Authorization (EUA) declarations invites reconsideration of the evidence that launched this extraordinary regulatory chapter. The FDA's first EUA for a Covid-19 vaccine rested on its determination that the known and potential benefits of the Pfizer–BioNTech vaccine outweighed its known and potential risks. Yet the pivotal trial report did not bring those benefits and risks together within a common quantitative framework.

Better late than never: more than five years later, I did—and what I found was startling.

At first glance, the famous 95% efficacy against protocol-defined, laboratory-confirmed symptomatic Covid-19—based on eight versus 162 cases in a trial that randomized 43,548 participants—seems highly promising. But when this finding is considered alongside the broader set of participant-relevant outcomes (dispersed across the trial publication, its Supplementary Appendix, and the contemporaneous FDA review materials), the overall clinical picture looks markedly different.

Depending on the counting period used, the vaccine group had 2–8 fewer cases of severe Covid-19, whereas the safety data showed numerical excesses of 4–101 participants across clinically consequential adverse-event categories. These categories are not directly comparable, and some may overlap. Even so, the evidence did not establish that the vaccine's clinically consequential benefits outweighed its potential harms. Nor did the trial establish that vaccination reduced the overall burden of Covid-like symptoms, let alone that it reduced person-to-person transmission. Crucially, this conclusion does not rest on hindsight: the relevant evidence was already before the FDA when it issued the EUA.

The full basis for this conclusion is presented in my comprehensive reassessment of the evidence, currently available as a preprint. That reassessment is necessarily detailed because the relevant data are complex, scattered across multiple documents, and subject to important methodological and interpretive qualifications. The present column is not intended to replace that analysis, but to distill several of its central findings and implications for a broader readership.

1. What Did the 95% Efficacy Figure Actually Measure?

The gap between the headline figure and the overall clinical picture begins with the narrow endpoint and brief followup behind the 95% efficacy estimate. That figure applied only to protocol-defined, laboratory-confirmed symptomatic Covid-19 over an average of approximately 44 days. The trial did not assess asymptomatic infection or person-to-person transmission, and the publicly available record allows SARS-CoV-2 testing to be reconstructed for no more than 8.6% of participants. It therefore could not establish whether vaccination reduced the overall risk of acquiring or transmitting the virus, or how long its protection against symptomatic disease would last.

This gap later attracted considerable public attention. During a hearing in the European Parliament, a Pfizer executive acknowledged that the vaccine had not been tested for its effect on transmission before entering the market, explaining that the company had needed to "move at the speed of science." Yet the facts discussed in that exchange had already been documented before the rollout. The trial's narrow endpoint and brief followup were clear from the published record, and the FDA explicitly acknowledged the absence of direct evidence on asymptomatic infection and transmission when it issued the EUA.

These facts had far-reaching implications. At the time, vaccine mandates and passport systems were presented as tools to reduce transmission in public spaces and protect others—especially older and vulnerable people. Yet those claims could not be grounded in the trial's central finding, which concerned only short-term protection aga...

By Brownstone Institute at Brownstone dot org.

On the afternoon of July 25, 2026, Senator Rand Paul released the full diaries of Anthony Fauci, the former head of National Institute of Allergy and Infectious Diseases and the leading voice of the Covid response during the most critical time in US history in the 21st century. The diaries are a hugely important documentation concerning a period otherwise shrouded in mystery. So far as we know, they are unredacted and from Fauci's own pen, a day-by-day chronicle to compare against the public record.

Below we post Senator Paul's rendering and a version from AI engine Claude.

This publication is intended as a readable version of the original posting by Senator Paul's office.

By Wendy McElroy at Brownstone dot org.

When and why did the word "gender" displace the word "sex?" "Gender" refers to a person's socially constructed identity of being male, female, or some other category, while "sex" refers to physical characteristics of male or female, such as chromosomes. Gender is a matter of a person's self-perception; sex is a circumstance of birth.

When did sex get pushed to the curb by gender? In his book The Man Who Invented Gender, Terry Goldie claims that the sexologist John Money of Johns Hopkins Medical Center (Baltimore) first used the word "gender" in its modern meaning in 1955. Money pioneered the word to describe his famous John/Joan experiment that was conducted on a young boy named Bruce who'd lost his penis in an accident. To 'prove' Money's theory that sexual identity was learned and not biological, Bruce's parents raised him as a girl, complete with a surgically constructed vagina. The experiment failed. Bruce ultimately insisted on living as male, but he did not recover from the ordeal Money imposed on him, which he called torture. Bruce committed suicide in his 30s.

By then, however, Money had declared for decades that John/Joan was a complete success; discussions of "gender identity" abounded in '60s medical journals and academia. By the '70s and '80s, feminists brought the term to the streets, with "gender" describing a person's self-defined sociocultural identity and "sex" meaning biology. Then, the word wedged its way into government. In 1993, for instance, the Food and Drug Administration (FDA) replaced "sex" with "gender" in its literature. In 2011, "sex" returned to the FDA to mean biology while "gender" meant "a person's self-representation." The term went global. Also in 1993, the United Nations Declaration on the Elimination of Violence Against Women (DEVAW) vaguely defined this aggression as "any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women."

Genderspeak became the language of elites, social justice activists, and the government, while average people still spoke of "sex". But more than elitism lies behind the difference in words. By swapping in their own terms, elitists—especially professional feminists—grabbed the narrative on sexuality and politicized it to dismiss anyone who disagrees. Since the average male generally still uses biology to define his sexuality, he is an opponent; the average male is a living, breathing disagreement.

The ideology of gender faces an obstacle, however. If people can argue effectively against gender, then the narrative is difficult to manage. Those who dissent must be intimidated into silence or otherwise marginalized. The main strategy is to condemn dissenters as hate-filled. If some people cannot be silenced, then their words or opinions can become hate crimes punishable by law. George Orwell's novel Nineteen-Eighty-Four is about a dystopian society of social control, which is maintained largely through restricting language. Since words are the foundation of thought, this means people cannot form thoughts, let alone articulate them. The villain of Nineteen-Eighty-Four proclaims, "The whole aim of Newspeak is to narrow the range of thought." He concludes, "The Revolution will be complete when the language is perfect."

Men's health researcher James L. Nuzzo highlights an attempt to perfect the language. "In recent years, use of the phrase "gender-based violence" (or "gendered violence") in the titles and abstracts of papers indexed in PubMed has increased noticeably. Between 2019 and 2025, the phrase "gender-based violence" (or "gendered violence") appeared in the titles or abstracts of 2,784 articles indexed in PubMed." [Chart available here.]

A typical definition of gender-related violence or gendered violence is "any form of physical or non-physical violence or abuse against a person or group of people because of biased or harmful beliefs about gend...

By Brownstone Institute at Brownstone dot org.

Finally, a mainstream news source is highlighting one of a million data points showing how lockdowns were a hinge of history, a mighty shock to economics, demographics, health, social well-being, and freedom.

"Shocking 105 million Americans are not working – more than during Covid or the Great Recession," blared the New York Post.

Finally that's something.

The graph alone tells the story. You thought that having the government forcibly send millions of people into lethargy and sloth, bankrupting millions of smaller businesses, slicing and dicing workers into essential and nonessential, would be devastating for labor force participation. It's actually worse now than in the depths of the lockdowns, and 10.8 million more than were out of the labor force in 2019, for a total of 105 million.

The growing crisis of labor drop outs since 2020 hits men more substantially than women: Woman not working up 10.9%; Men not working up 13.6%; Overall number not working up by 11.19%.

The labor force participation rate reveals the trends, not as grim as the lockdown days but still trending downwards – the opposite of what should be happening.

The topic is still taboo – but the longer time goes on, the more scholars and people will mark the Covid lockdowns as a grave turning point in the history of our times. We are now at enough distance to see this clearly in ways we could not. More than that, it was frequently denied.

Today it is undeniable. We have enough real-world data to point to the lockdowns and forced injections as a decisive desideratum of decivilization.

It's not just the aggregate data that is sounding alarms. We have a generational shift in the works, as noted by journalistic conventions that conveniently leave out causality. "Gen Z Fell Out of Love With Work," writes Emi Nietfeld.

"Gen Z-ers are often accused of shrugging off work — in fact, they say so themselves — and who can blame them? They've watched millennial workers burn out, wages stagnate, degrees turn worthless and institutions crumble. Now, they're entering what's widely called the worst job market in years. Almost half of recent college graduates are unemployed or underemployed. The cost of living has soared; buying a house feels impossible. Who knows where we'll live anyway once the Earth is uninhabitable. One viral meme captured the prevailing sentiment that 'basically nobody under 40 right now expects good things to happen ever again.'"

There are many factors at work here including tight labor markets, forced retirements, and self-reported injury. There has been a sharp rise in disabilities post-2020, reaching 38 million. So-called "long Covid" continues to get the blame despite mass forced distribution of a dangerous experimental shot.

We've witnessed historic declines in student reading proficiency, as 12th-grade reading scores hit their lowest level since tracking began (1992), with only 35% proficient (down from 37% in 2019). Elementary-grade reading has also dropped sharply, the largest declines in decades, worsened by prolonged school closures and remote learning.

Broader proficiency gaps appear in incoming college students, with reports of 14% of US college students testing at or below a 10-year-old's reading level. This aligns with K-12 pandemic losses compounding into higher education, hence pervasive ignorance despite high graduation rates.

Overdose fatalities surged dramatically post-2020, with annual deaths often exceeding 100,000 in recent years — a major contributor to excess mortality. Isolation, economic stress, and disrupted treatment access during lockdowns amplified the crisis.

Researchers report nothing but confusion as to why "excess deaths in the United States kept rising even after the peak of the COVID-19 pandemic, with more than 1.5 million in 2022 and 2023 that would have been prevented had US death rates matched those of peer countries."

Younger adults, minorities, essential workers, ...

By Aaron Kheriaty at Brownstone dot org.

Freedom of speech is an integral aspect of authentic freedom, grounded in the distinctively human capacity to adhere to truth through persuasion rather than imposition. While truth is objective and independent of the knowing subject, it can only be received by the subject freely.

We can contrast this with a thinly grounded notion of freedom as merely a pragmatic expedient to "get along" in a pluralistic society in which we assume that truth is more or less unattainable. In this thin form of liberalism, when it no longer appears the optimal empirical solution to maintain social comity or stability, freedom of speech will be easily abandoned. We have seen this dynamic play out in Western societies in the past decade, where elites now frequently insist that censorship is necessary to "protect democracy" from the populist rabble.

Principled freedom that encourages the shared discovery of truth must always exclude violence against ideas. Such force reduces individuals to mere means and undermines the possibility of honest persuasion. Instead, public authorities should only intervene to prevent persecution or the propaganda of "truncheon arguments"—that is, various forms of coercion or incitement to violence—while permitting the open expression of opposing views, however controversial.

The late Italian Catholic philosopher Augusto Del Noce illustrates this by insisting that even ideological adversaries, such as Fascists, should be permitted to voice their bad ideas (which they were not permitted to do in Italy immediately following World War II): "Let the Fascists also support their idea of violence if they so wish; we will fight them with arguments, and the task will not really be too difficult," Del Noce confidently asserted. He warned that forcefully suppressing false speech only breeds underground myths and perpetuates defeated ideologies, as seen in the posthumous "Mussolini legend" that arose in the climate of postwar Italian censorship.

Among the central problems with censorship is this: the prohibition on pronouncing certain things often makes them seem true even when they are not. Better to allow falsehoods to be voiced and refute them with arguments than to forcefully silence them before they can be spoken.

Recovery of enduring principles on which to ground freedom of speech is essential as we face new challenges from the advent of enormously powerful digital technologies and global platforms of communication. Discovery in our Missouri v. Biden case revealed extensive coercion of digital platforms by the White House, the Surgeon General, the CDC, and other federal agencies to flag, suppress, deboost, or remove online content and accounts—via direct pressure, algorithmic changes affecting thousands of posts, or the actions of suborned third parties. This "censorship-industrial complex" targeted critics of the government's preferred Covid policies, election integrity, abortion, gender ideology, foreign policy, and other issues of public importance.

As the appellate court noted in our case, given the vast reach of new digital technologies, the scope and scale of this censorship had no precedent in prior free speech cases in the US. In the words of the district court judge, what our case uncovered was arguably the "worst violation of free speech in United States history." Previous cases of censorship by overzealous government officials typically dealt with one-time offenses: a single article suppressed, a few paragraphs struck from a book, a journalistic story killed before it saw the light of day. But what we saw in our age of social media was entirely new, facilitated by the powerful reach of advanced digital technologies: government action censoring tens of thousands of ordinary Americans hundreds of thousands of times.

For many Americans like me who were on the receiving end of this, such actions felt very personal: every citizen with a Twitter or Facebook account became a potent...

By Alan Cassels at Brownstone dot org.

Well, well, look here. In its June 2026 update the venerated OED or Oxford English Dictionary, finally added the 'new' word, fearmongering. It explains fearmongering as "the action or an act of spreading fear or alarm among the public, esp. by exaggerating the dangers associated with a political, social, or economic issue; alarmism."

Thank goodness, the dictionary has caught up to our society's most pernicious habit; that is, using fear to sell anything. Especially when it comes to our health.

Here we find the most destructive aspect of fearmongering, ie: trying to convince normal, healthy people we are "abnormal" or "sick," and fundamentally changing the way we think about ourselves. The marketing of fear often drives people to their doctors, and to the inevitable prescription pad, with predictable results: people getting unnecessary, sometimes harmful drugs for natural, normal phases of life.

The grift goes wide and deep. Many influencers and physician-educators have financial ties through sponsored content or brand partnerships, sometimes pushing lines of supplements, telehealth services, books, or their appearances on the speaking circuit. Sadly, information about who funds them to say what they say is not always straightforward and the top social media posts about certain drugs or therapies often obscure their potential conflicts of interest (e.g., selling related products/services).

We know that many of these campaigns are backed by medical specialists or social media influencers, wedded to their theories and pushing whatever to cash in on all the fear. Those campaigns are about 'moving product' by subtly convincing millions of healthy people that their bodies are broken, dysfunctional, deficient, and decaying. I've written these words before but they are worth repeating: fearmongering is an assault on our collective soul and the theft of wellness for which we all pay a high price.

We can see fearmongering everywhere, but the most brazen current example is the full-frontal assault on menopause. If you've read a newspaper or scrolled through social media lately you might be asking yourself: Why the heck is everyone getting worked up about menopause? Are hot flashes taking over the planet? Are women really as angry as the media portrays them to be? And the drugs: who do you believe about whether the drugs will help or harm you?

These are good questions, focusing on a condition that every woman—our mothers, grandmothers, great-grandmothers and so on – went through, back to the dawn of time. The fearmongering today bypasses the fact that most women who arrive at the end of their periods get through this phase without serious discomfort or suffering. For some, it's a big "meh." Others might be helped by what's on offer but they have to swim through a sea of corporate-sponsored fearmongering messages to get there.

The key theme in most of the media stories is that women's needs are unmet, many of them are deeply suffering and they all need to be considering MHT (Menopausal Hormone Therapy) in order to live their best lives. By the way, MHT is the new way hormones are branded, which used to be called HRT (hormone replacement therapy). Same stuff, different wrapping, carrying less baggage of the HRT horrors of the past.

In the mainstream media you'll find oodles of journalists in love with a story like this, featuring female suffering, emancipation, and empowerment in one tight little bundle with enough frilly gift wrapping to hide pharma's fingerprints. The dangers of hormones haven't changed, only the marketing of those dangers has.

This might have been kicked off by a story, "Women Have Been Misled About Menopause" in the New York Times Magazine, (Feb 1, 2023) a long-form essay which barely camouflages a shameless bit of salesmanship, setting the tone for so many other media outlets to follow. It aims to correct those who are still being 'misled' by outdated ideas about the dangers of...

By David Stockman at Brownstone dot org.

Here's a graph the Keynesians, statists, and Wall Street gamblers—yes, we repeat ourselves—would prefer not to explain. At the same time, it also explains why socialism at this late date in history—and after all its abysmal failures the world over—is having some kind of dubious second coming in America.

During the last three decades the national savings rate (red line) has essentially collapsed, having fallen from 6.3% of GDP in 1997 to 0.5% of GDP in 2025. Between the same two dates, however, the net worth of US households (blue line) has soared from 4.6X personal income to 6.5X personal income.

In economist jargon, the question would recur as follows: How in the world over a three-decade period did the stock of wealth soar when the flows of savings virtually evaporated?

Or in plain English, how did so many Americans get so damn rich while living high on the hog? And we do mean wealthy: According to the Fed's Flow of Funds data, household net worth erupted from $32 trillion in 1997 to $169 trillion at present. These figures amount to an average of $320,000 per household in 1997, which grew to an average of $1.250 million per household 28 years later.

Needless to say, some substantial part of that gain is reflective of inflation. But even in constant 2025 dollars, average net worth per household has virtually doubled from about $630,000 to the aforementioned $1.250 million.

In short, the average savings per household diminished to nearly zero over that three-decade period—even as $85 trillion in added wealth accumulated in household balance sheets.

As it happened, of course, the massive $136.4 trillion increase in net worth over this period went to the holders of financial and housing assets, less associated debts. Accordingly, with a lot of debt at the bottom income rungs relative to modest asset levels, the resulting wealth distribution skewed sharply to the tippy-top of the economic ladder.

To wit, $44.1 trillion of the gain was accounted for by the top 1% of households and fully $94.2 trillion by the top 10%. And while Keynesians, statists, and stockbrokers would have you believe this was nothing more than Mr. Market at work, we beg to differ.

Under a regime of sound money and honest markets there would have been no soaring gains in net worth relative to the very modest gains in national income and savings. To the contrary, the former is the work of the money-printers at the central bank and the Cantillon Effect of monetary inflation.

That is to say, when the Fed prints money it effectively first deposits the receipts among the primary bond dealers, which sell government bonds to its open market desk and then send the proceeds ricocheting through the canyons of Wall Street. At length, the inflation gets to Main Street in the form of higher energy, food, and other everyday prices, but not before much of the inflation is absorbed by the leveraged gamblers on Wall Street.

So there is no mystery as to why the wealth distribution in America has been skewed sharply to the top of the ladder during recent years. The culprit was not the Reagan tax cuts back in the 1980s or the inherent inequality of capitalism.

To the contrary, the normal skew of wealth to the most productive, capable, persistent, and enterprising households has been badly thrown out of kilter by the capture of the Federal Reserve by Wall Street speculators.

In the interim, however, the chart below speaks for itself. By embracing Greenspan-style monetary central planning in lieu of gold standard sound money, the modern day GOP has paved the way for the emerging Mamdani socialist coup in the Democrat Party.

That is to say, the wealth disparities shown below did not exist with nearly this much skew as recently as 1987, when Alan Greenspan's pro-inflation, pro-wealth effects regime became official policy at the Fed. Then again, the Fed's balance sheet stood at $250 billion in Q2 1987 after 73 years of a moderately tame pri...

By Joseph Varon at Brownstone dot org.

Recently, I encountered a social media post from a respected colleague expressing frustration about the frequent prescription of prednisone for cases that were essentially "common colds." She stated bluntly: this is malpractice!

This comment highlights a broader issue extending beyond corticosteroid prescribing. Prednisone exemplifies a pattern that has become prevalent in contemporary medical practice, influencing nearly every specialty, clinic, and hospital. The medication itself is neutral; like most treatments, it offers significant benefit when used appropriately but can cause harm if administered without careful consideration. The central concern is not the drug, but the increasing tendency to act reflexively rather than thoughtfully evaluating the necessity of treatment.

Medicine has traditionally emphasized intervention. Those of us in medicine diagnose, treat, alleviate pain, and occasionally cure disease. However, as scientific knowledge has advanced, the field has gradually shifted from deliberate decision-making to habitual action. Increasingly, the primary question during clinical encounters is not whether treatment is necessary, but which treatment to select. The possibility that observation or delayed intervention may represent the optimal approach is frequently overlooked and, in many instances, feared by the healthcare practitioner.

This shift does not reflect diminished concern among physicians. Rather, modern practice is shaped by scientific advances, patient expectations, medicolegal pressures, administrative demands, and technology, collectively making intervention appear safer than restraint.

However, increased intervention does not necessarily equate to improved outcomes in medicine. Every prescription entails risks. Each diagnostic test may generate false positives, unexpected findings, patient anxiety, and additional procedures. Every treatment alters the body in both anticipated and unanticipated ways. The primary challenge is not merely understanding what is possible, but determining what is appropriate.

Sir William Osler identified this dilemma well before the development of antibiotics, intensive care units, or electronic medical records. His insight remains highly relevant: "One of the first duties of the physician is to educate the masses not to take medicine."(1) Although this statement may initially seem paradoxical, especially from a founder of modern clinical medicine, Osler recognized that restraint is a defining feature of effective practice. His guidance was not a rejection of therapeutics, but rather an acknowledgment that physicians best serve patients by discerning when intervention is necessary and when natural recovery is preferable.

Contemporary medicine occasionally overlooks the body's intrinsic capacity for self-healing. Many common conditions, such as viral infections, minor injuries, or mild gastrointestinal disturbances, often resolve spontaneously through natural physiological processes. In these situations, the physician's role shifts from active intervention to careful observation, monitoring for atypical recovery, and providing reassurance grounded in clinical experience rather than unfounded assurances.

Unfortunately, observation and watchful waiting are frequently perceived as inaction. Patients may interpret the absence of a prescription as a lack of concern for their symptoms. Physicians, under time constraints and mindful of patient satisfaction metrics, may prescribe medication primarily to demonstrate responsiveness. While this dynamic is understandable, it carries risks. The prescription may become a symbolic gesture of care, even when it does not influence the course of the illness.

Nearly a century ago, Francis Weld Peabody offered a lasting reminder: "The secret of the care of the patient is in caring for the patient."(2) Although frequently cited, this principle is often insufficiently considered. Genuine care is not mea...

By Alan Cassels at Brownstone dot org.

Remember that thing that we said was good for you, then we changed our minds telling you it's now bad for you. And now? We're changing our minds again…umm, maybe it is good for you again.

Medicine that claims to be 'evidence-based' is never static. It changes. Sometimes quickly and sometimes slowly and so too do our doctor's suggestions about what they think is right to keep us healthy.

In that light, sometimes medical recommendations around screening, surgery, or treatments like drugs or vaccines follow a certain pattern: widespread Enthusiasm based on promising early evidence, a Reversal when rigorous trials reveal limited benefits or unexpected harms, and then a Revival driven by new interpretations, technological tweaks, manufacturer greed, or good old advocacy. Here are six examples of ERRing, which no doubt confuses patients and clinicians alike:

Enthusiasm: For about 40 years, from the 1930s to the 1970s millions of tonsillectomies were done annually, often bundled with adenoidectomy and was viewed as a near-standard childhood rite. I am old enough to remember feeling envious when many of my friends in elementary school were getting their tonsils removed. This was the early 70s where tonsillectomy was one of the most common surgeries worldwide, routinely performed for recurrent sore throats, enlarged tonsils, or even preventive reasons. After all, better safe than sorry, right? Sure my brother and sisters and I went through bouts of sore throats but my mother, a nurse, didn't buy into the tonsillectomy hype, so we all still have them. Here's how that worked out…

Reversal: It wasn't until the PARADISE study, (PAtient-centered outcomes Research and ADvanced Intervention for the Surgical treatment of Ears, Nose, and Throat diseases), a randomized trial published in the New England Journal of Medicine in 1984 found the surgery might have some benefit for kids suffering recurrent and severe infections, but overall most kids improve spontaneously. Surgery-related complications which are rare were manageable. Soon tonsillectomies were history, falling by more than 50% in many countries and guidelines became highly restrictive.

Revival: In the 2000s it was recognized that obstructive sleep apnea could be treated with tonsillectomy so there was a major revival. Today about 500,000 tonsillectomies are performed annually on US children alone, and widely promoted for quality-of-life and neurocognitive benefits. Let's just say, even today, doing tonsillectomies can be lucrative for those doing them, whether they are warranted or not.

Enthusiasm: In the 1980s through early 2000s, systemic estrogen (often with progestin) was widely prescribed for menopausal hot flashes. Pharma-funded campaigns pushed HRT as an anti-aging elixir that could also help prevent heart disease, osteoporosis, and dementia. Observational studies and heavy pharmaceutical marketing positioned HRT as essential for women's health. That was until real science stepped in.

Reversal: One of the largest and best randomized trials ever conducted of HRT, the Women's Health Initiative (WHI), was published in 2002 and found increased risks of breast cancer, heart attack, stroke, and blood clots, with no net preventive benefit in older postmenopausal women with the exception of slightly reduced osteoporotic fractures. Prescriptions plummeted more than 50%, and guidelines shifted against routine use. There was a lot of major ass-covering and finger-pointing in drug company circles, but at least we had some high-quality science to point to.

Revival: In the last five years, no doubt aided by Big Pharma trying to revamp markets, the WHI was 'reanalyzed' and women are now told that the benefits of HRT may outweigh risks if started near menopause for moderate-to-severe symptoms. Newer guidelines and women's health advocates are now pushing individualized low-dose, short-duration HRT as firstline for symptom relief. Fair enough, but does t...