A note before the reckoning

I have been asked many times what to read to understand how American biomedical science was captured. People expect me to recommend a virology textbook, or perhaps a regulatory primer. I do not. I tell them to read Murray Rothbard.

Rothbard, the late Austrian-school economist and libertarian theorist, never wrote about Anthony Fauci. He died in 1995, when Dr. Fauci had been director of the National Institute of Allergy and Infectious Diseases for only eleven years and was still mostly known to those of us inside the AIDS-research community. But Rothbard had spent his career describing, with unusual analytical clarity, the precise machinery that would, over the following three decades, produce the figure of Fauci, and the catastrophe of 2020. He gave us the diagnostic vocabulary before we knew we needed it.

I write this essay as a participant-observer. I was there at the Salk Institute in the late 1980s. I conceived of the underlying mRNA platform technology that was eventually deployed, against my warnings, in the Operation Warp Speed countermeasures. I sat in NIH working groups during the early COVID response. I watched colleagues I had known for decades reinvent themselves as compliance officers for a narrative. And I watched, as Robert F. Kennedy Jr. has documented exhaustively in The Real Anthony Fauci and The Wuhan Cover-Up, the deliberate construction of a pharmaceutical-biosecurity apparatus that has now metastasized through every organ of the federal research enterprise.

Rothbard would not have been surprised. He would have been grim, but not surprised. What follows is my attempt to read these two manuscripts (the public record they assemble, and the half-century of institutional decay they describe) through the lens he handed us.

I. Scientism is not science

Rothbard drew a distinction that almost no one in our public conversation can hold in their head for more than a sentence at a time. Science, in the older sense of scientia, correct knowledge, is the human activity of inquiring honestly into the structure of reality. Scientism is the use of the prestige of science to compel obedience. The first is a method. The second is a posture. The first proceeds by conjecture, falsification, and replication. The second proceeds by accreditation, gatekeeping, and excommunication.

For most of his career, Dr. Fauci was the most powerful working practitioner of scientism in the world. I want to be precise about this charge. I am not saying he was uneducated, or that he never did legitimate science as a young clinician. I am saying that the role he occupied for thirty-eight years at NIAID, and the manner in which he occupied it, was structurally incompatible with science as a free inquiry. The role was a priestly one. The famous formulation, “attacks on me are really attacks on science,” was not a slip of the tongue. It was a precise statement of his self-understanding, and an unintentionally perfect illustration of Rothbard’s distinction. A scientist welcomes attacks; that is what a scientist is. Only a priest of scientism can find a personal critique to be a sacrilege.

The Kennedy manuscripts document this priestly posture in extraordinary granularity: the suppression of repurposed therapeutics during the COVID period; the campaign against any clinician (Kory, McCullough, Risch, Bhattacharya, Kulldorff, and yes, myself among many others) who proposed alternative hypotheses; the orchestration of the Lancet and Nature Medicine statements on the origins of SARS-CoV-2 to short-circuit a debate that had not yet happened. This is not how science behaves. This is how a magisterium behaves.

Rothbard’s contribution was to insist that scientism is the natural product of a particular institutional arrangement. Wherever you place a single bureaucracy in charge of allocating research funding for an entire scientific field, you will, eventually, get scientism. You will not get it because the bureaucrat is wicked. You will get it because the incentive gradients of the position itself reward conformity, public-relations management, and the suppression of paradigm-threatening lines of inquiry. The institution selects for the disposition. Fauci is what the chair he sat in produces.

II. The political economy of NIAID

Here is the part of Rothbard that mainstream commentators have never been able to absorb, and that Kennedy’s books finally make legible to a broader public: the National Institutes of Health is not a neutral funder of the scientific community. It is a monopsony. It is the dominant (in many subfields, the only) buyer of biomedical research labor in the United States. And like all monopsonies, it sets the terms.

A word on the term, because it is unfamiliar to most readers and indispensable to what follows. Monopoly is the condition in which a single seller controls a market and can therefore set the price at which goods are sold. Monopsony is its mirror image: a single buyer controls the market and can therefore set the price at which goods, services, or labor are purchased. The word comes from the Greek monos (single) and opsōnia (purchasing of provisions). The classical examples are a coal-mining town with one mining company that hires every available miner, or a defense ministry that is the only legal buyer of fighter jets. In each case the buyer is not constrained by competition, because there is no competition; the seller, whether a worker or a manufacturer, must accept the buyer’s terms or exit the field entirely. NIH, and within NIH the NIAID Fauci built, occupies precisely this structural position with respect to American biomedical researchers. There is, for most subfields and most career stages, no realistic alternative funder. A young virologist who wishes to do virology in the United States either receives an NIH grant or finds another line of work. The buyer dictates not only price but the substantive direction of inquiry: what may be studied, what may be published, and what conclusions may be safely reached.

Rothbard’s analysis of state R&D was elementary: when the price system is replaced by political allocation, you do not get a better outcome than the market would have produced. You get a different outcome: one that reflects the preferences of the political allocator rather than the preferences of the patients, clinicians, and curious investigators who would have constituted the market. State science does not fail because bureaucrats are stupid. It fails because their feedback signal is wrong. They are graded by Congress, by the press, by the pharmaceutical lobby, and by their own professional networks. They are not graded by whether the research they fund actually heals anyone.

Run this analysis through the Fauci-era NIAID and the picture is devastating. Kennedy documents (and the inventories of NIH grants confirm) that under Fauci’s tenure the agency’s portfolio shifted decisively toward two priorities: vaccines (especially novel-platform vaccines with patent protections) and “biodefense” (especially gain-of-function work on potential pandemic pathogens). It shifted away from chronic-disease etiology, toxicology, environmental medicine, nutrition, and the hard work of asking why the post-1986 American child is so much sicker than the pre-1986 American child. Kennedy’s marshalling of the data on this point is unanswerable: the explosion of allergic, autoimmune, neurodevelopmental, and metabolic disease in the cohort that grew up under Fauci’s NIAID is a public-health catastrophe whose causes the responsible agency has shown no interest in investigating. Rothbard would have predicted this exactly. The chronic-disease question has no patentable answer; therefore the institution has no incentive to ask it.

The shift toward biodefense is the more sinister half of the story, and Kennedy’s Wuhan Cover-Up is the indispensable text. After the 2001 anthrax letters (a domestic event whose attribution remains contested, and whose immediate political effect was to install the biosecurity faction at the commanding heights of public-health policy) Project BioShield (2004) and the subsequent Biodefense and Pandemic Vaccine and Drug Development Act (2006) re-routed roughly a third of NIAID’s annual budget into work that was, for all functional purposes, a continuation of the offensive bioweapons program that Richard Nixon had ordered shuttered in 1969. The fig leaf was that this work was now “defensive”: that one builds enhanced pandemic pathogens in order to study how to defeat them. Rothbard would have laughed bitterly at this. He understood, as anyone who has studied the history of arms races understands, that there is no operational distinction between an offensive and a defensive bioweapons program. The molecular biology is identical. The distinction lives entirely in the press release.

What we got, in exchange for the abandonment of the chronic-disease research mission, was the construction of a sprawling network of BSL-3 and BSL-4 facilities; a research pipeline that (as the Kennedy manuscript shows in painful detail) funneled American taxpayer money through EcoHealth Alliance to coronavirus gain-of-function work at the Wuhan Institute of Virology; and a single man, sitting at the top of a chain of command no one had ever explicitly authorized, with personal decision-making authority over the trajectory of a globally consequential research program.

This is what Rothbard meant by the partnership of state and corporate power. Not a conspiracy, not a smoke-filled room, but the slow accretion of overlapping interests until the regulator and the regulated and the funder and the contractor and the journal editor and the press officer have become, functionally, a single organism with a single appetite.

III. Agency capture, inverted

Rothbard’s most-cited contribution to the political economy of regulation is the observation that regulatory agencies, over time, almost always come to serve the industries they were created to constrain. The classic case is the Interstate Commerce Commission, captured by the railroads it was built to regulate. The mechanism is straightforward: the regulated industry has concentrated, intense, persistent interest in the agency’s decisions; the public has diffuse, episodic, weak interest. The industry hires the staff, supplies the expertise, funds the conferences, and offers the post-government employment. Capture is not a moral failure. It is a thermodynamic inevitability of the institutional design.

What Kennedy documents (and what I can confirm from the inside of the system) is that NIAID under Fauci represented a particularly advanced form of capture. The agency captured the industry as much as the industry captured the agency. The traffic of personnel, intellectual property, and money among NIH, the major pharmaceutical houses, the Gates philanthropies, the academic medical centers, and the rotating Defense-Department-adjacent biosecurity consultancies was so dense and so reciprocal that the language of “capture” almost understates the case. There was no longer an agency and an industry; there was a single ecosystem with multiple feeding stations.

The royalty arrangements alone would have ended Rothbard’s patience with the entire arrangement. The 1980 Bayh-Dole Act, and the subsequent Federal Technology Transfer Act of 1986, created the legal infrastructure by which federal scientists, including those at NIH, could collect royalty payments on patents derived from research conducted on the public dime. By the COVID era, dozens of NIH scientists were named on patents associated with vaccine technologies their own agency was simultaneously evaluating and promoting. Fauci himself, according to the documentation Kennedy assembles, was a co-inventor on multiple HIV-related patents and stood as the most highly compensated employee of the entire United States federal government: better paid than the President, the Chief Justice, and any general officer of the armed forces. None of this is hidden. None of it is illegal. All of it is exactly what Rothbard described: the formal apparatus of the state being repurposed, lawfully and transparently, into a private rent-extraction mechanism for a credentialed elite.

IV. The court intellectual

Rothbard inherited from Bertrand de Jouvenel and Albert Jay Nock a piece of vocabulary that is indispensable for understanding the Fauci phenomenon: the court intellectual. Every regime, throughout history, requires a class of credentialed apologists whose social function is to translate the regime’s interests into the language of disinterested truth. In feudal Europe these were the scholastics; under absolutism they were the royal historians; under Soviet Marxism they were Lysenko and his peers; in the contemporary American imperium they are, predominantly, certain figures within the public-health bureaucracy, the major-university health-policy faculties, and the prestige science press.

Anthony Fauci is the apex specimen of this archetype. He was not, let us be honest, a serious bench scientist for most of the period of his greatest cultural authority. His function was to incarnate the prestige of science in service of the state’s preferred narrative, and to deploy that prestige against any dissenter who threatened to disrupt the narrative. Consider the fifty-eight honorary degrees, the named buildings, the Saturday Night Live impersonations, the bobblehead dolls. None of these are the trappings of a research scientist. They are the regalia of a court intellectual. Even his post-government appointment to a distinguished professorship at Georgetown, with a joint posting in a school of public policy, makes the role transparent: he is being installed where court intellectuals are properly housed, in an institution that produces the next generation of regime explainers.

This matters because court intellectuals are not, in the relevant sense, replaceable. Once installed, they become load-bearing. Their displacement requires more than the election of a new administration; it requires what Thomas Kuhn called a paradigm shift, and what Rothbard, drawing on his own historical study, called a de-legitimation. Whether one is underway right now (in the small but growing number of state attorneys general willing to sue, the federal indictments of former Fauci advisers for concealment of communications, the rescission of his personal security detail, the slow erosion of public trust in the institutions he came to symbolize) is for the historians to judge in twenty years. I am not optimistic. The court intellectual class is deep and self-reproducing. Replacing one Fauci produces another.

V. Crisis is the health of the state

Randolph Bourne’s line (“war is the health of the state”) was absorbed by Rothbard and updated for the modern security era. Rothbard understood that the state’s natural condition is to seek out, and where necessary manufacture, crises that justify emergency expansions of its authority. The Cold War filled this role for half a century. The War on Terror filled it from 2001 to roughly 2015. The biosecurity paradigm, formalized at the international level by the Obama administration and the WHO in 2009-2010 and retrospectively ratified by the COVID emergency, is the third great post-war crisis architecture.

Kennedy’s Wuhan Cover-Up is most clarifying when it is read as the chronicle of how the biosecurity faction, beginning with the post-anthrax-letters environment of 2001-2002, built, over twenty years, a system of legal pre-authorizations (the Emergency Use Authorization, the PREP Act liability shields, the centralized declaration of “public health emergencies”) that allowed almost every constitutional and pharmaceutical-safety norm to be suspended on the say-so of a small number of officials, the most powerful of whom was Anthony Fauci.

I want to be careful to distinguish two claims here. The first claim, which I do not make, is that the COVID pandemic was itself deliberately engineered as a pretext for an authoritarian power grab. The evidence I have seen is consistent with a research accident at the Wuhan Institute of Virology, of a kind whose probability was raised (perhaps to near-certainty) by the funding and structure of the gain-of-function research program that Fauci and Peter Daszak collaboratively built. That is a serious enough indictment without inflating it.

The second claim, which I do make, and which Rothbard’s framework makes available to us: once the crisis arrived (by accident or design) the system that had been pre-built to exploit it executed exactly as designed. The countermeasures were ready before the pathogen. The communications strategy was ready before the science. The censorship infrastructure, jointly operated by federal agencies and the major social-media platforms, was ready before the dissent. The mass vaccination campaign was ready before the safety data. None of this had to be conspired by anybody in 2020. It had been conspired, in the proper Rothbardian sense, over the preceding two decades, by the slow co-evolution of every institution involved.

This is what makes the Fauci role so consequential and so generalizable. He was not the architect of the crisis; he was the most visible administrator of a crisis-management apparatus that had been waiting, fully provisioned, for a sufficient occasion. When such a system exists, an occasion will eventually arise. That is the Rothbardian point.

VI. What was destroyed

I want to close on the cost, because this is the part where my participation in events compels me to write rather than analyze.

The American scientific enterprise, as I encountered it in the 1980s, when I was working at Salk, and in the early 1990s, when I held my first faculty positions, was an imperfect but serious thing. Its failure modes were known and discussed. Peer review was clubby and conservative. Funding favored the well-connected. Fashions in research methodology came and went with cycles of grant-program priorities. None of this was admirable, but it was tolerable, because the underlying culture still held: a culture in which a young investigator could, in principle, falsify a senior figure’s hypothesis, publish the result, and be respected for it. The orthodox term for this culture was organized skepticism, and it was the only thing standing between the scientific community and its conversion into a clerisy.

What Fauci did, which the institutional pressures of his role forced him to do, and which his particular temperament made him exceptionally effective at doing, was to dismantle organized skepticism within the biomedical sciences. The dismantling proceeded by means that Rothbard would have recognized perfectly: control of grant money, control of publication venues, informal coordination with credentialing bodies, deployment of the press, mobilization of social-media platforms in the COVID period, and, most importantly, the creation of a culture in which young investigators learned, very early, that certain questions were career-ending and certain answers were career-protecting.

We will be a generation rebuilding what was destroyed. The next mRNA controversy, the next gain-of-function debate, the next pandemic-response decision will be made by clinicians and researchers who came of age under the Fauci regime, who absorbed its norms, and who learned from its enforcers what happens to those who dissent. The damage is in the bones of the profession.

Rothbard, writing in the 1960s about an analogous capture of the social sciences, observed that the way out is neither reform nor reorganization but the slow, patient cultivation of independent institutions outside the captured apparatus. I believe he was correct. I believe the only way back to genuine biomedical science is through independent journals, independent funding, independent clinical-research networks, and independent training programs for the next generation. None of this is romantic. All of it is necessary.

The Fauci era ended, as a matter of personnel, in December 2022. The Fauci system did not end then and has not ended now. It is still funded. It is still credentialed. It is still in the chairs. The most useful thing one can do for a person who wants to understand why this is so is hand them Murray Rothbard and Robert F. Kennedy Jr. and ask them to read the two together.

They illuminate each other. They illuminate, between them, what happened to us.

Bibliography

A note on this bibliography. The essay is structured around two bodies of source material: (1) the two Kennedy manuscripts that supply most of its empirical claims, and (2) the Rothbardian intellectual tradition that supplies its analytical framework. The bibliography is organized accordingly. A third section lists primary documents and contemporary news coverage relevant to specific claims; a fourth lists representative counter-sources.

I. The Kennedy manuscripts (primary source material for the essay)

Kennedy, Robert F., Jr. The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health. New York: Skyhorse Publishing, 2021. ISBN 978-1-5107-6680-8.

Kennedy, Robert F., Jr. The Wuhan Cover-Up: And the Terrifying Bioweapons Arms Race. New York: Skyhorse Publishing, 2023. ISBN 978-1-5107-7398-1.

II. The Rothbardian framework

Rothbard, Murray N. “The Mantle of Science.” In Scientism and Values, edited by Helmut Schoeck and James W. Wiggins, 159–180. Princeton, N.J.: D. Van Nostrand, 1960. The locus classicus of the Rothbardian distinction between science and scientism. Cited in Section I of the essay.

Rothbard, Murray N. Science, Technology, and Government. Auburn, Ala.: Mises Institute, 2015 (manuscript composed circa 1959, published posthumously). Rothbard’s sustained critique of state R&D allocation. Cited in Sections II and VI.

Rothbard, Murray N. Anatomy of the State. Auburn, Ala.: Ludwig von Mises Institute, 2009 (essay first published 1965). Source for Rothbard’s adaptation of the Bourne thesis on crisis and state power. Cited in Section V.

Rothbard, Murray N. For a New Liberty: The Libertarian Manifesto. New York: Macmillan, 1973; revised edition, Auburn, Ala.: Mises Institute, 2006. Contains Rothbard’s general theory of regulatory capture.

Bourne, Randolph S. “The State.” Unfinished essay, 1918. Reprinted in War and the Intellectuals: Collected Essays, 1915–1919, edited by Carl Resek. New York: Harper Torchbooks, 1964. Source of the “war is the health of the state” formulation. Cited in Section V.

Nock, Albert Jay. Our Enemy, the State. New York: William Morrow, 1935. The intermediate source through which Rothbard inherited the court-intellectual concept. Cited in Section IV.

de Jouvenel, Bertrand. On Power: The Natural History of Its Growth. Translated by J. F. Huntington. New York: Viking, 1949 (French original 1945). The deepest historical treatment of the court-intellectual function in Western political thought.

Hayek, F. A. The Counter-Revolution of Science: Studies on the Abuse of Reason. Glencoe, Ill.: The Free Press, 1952. The complementary Austrian-school analysis of scientism that Rothbard drew on directly.

Kuhn, Thomas S. The Structure of Scientific Revolutions. Chicago: University of Chicago Press, 1962. Source for the paradigm-shift concept invoked in Section IV.

Merton, Robert K. “The Normative Structure of Science.” In The Sociology of Science: Theoretical and Empirical Investigations, edited by Norman W. Storer, 267–278. Chicago: University of Chicago Press, 1973 (essay first published 1942). The classical statement of the “organized skepticism” norm invoked in Section VI.

Stigler, George J. “The Theory of Economic Regulation.” Bell Journal of Economics and Management Science 2, no. 1 (1971): 3–21. The Chicago-school formalization of regulatory capture, parallel to Rothbard’s. Cited in Section III.

III. Primary documents, statutes, and contemporary reporting

Statutes and federal directives

Bayh-Dole Act, Pub. L. No. 96-517, 94 Stat. 3015 (1980), codified at 35 U.S.C. §§ 200–212. Established the framework permitting federal grantees to retain title to inventions developed with federal funds. Cited in Section III.

Federal Technology Transfer Act of 1986, Pub. L. No. 99-502, 100 Stat. 1785, codified at 15 U.S.C. § 3710. Authorized royalty payments to federal scientist-inventors. Cited in Section III.

Project BioShield Act of 2004, Pub. L. No. 108-276, 118 Stat. 835. Created the Emergency Use Authorization framework and authorized $5 billion over ten years for stockpiled medical countermeasures. Cited in Section II.

Pandemic and All-Hazards Preparedness Act, Pub. L. No. 109-417, 120 Stat. 2831 (2006). Successor legislation that further consolidated federal pandemic-response authorities.

Public Readiness and Emergency Preparedness (PREP) Act, Pub. L. No. 109-148, div. C, 119 Stat. 2818 (2005), codified at 42 U.S.C. § 247d-6d. Source of the liability-shield mechanism invoked in Section V.

Homeland Security Presidential Directive 10 / National Security Presidential Directive 33: Biodefense for the 21st Century. The White House, April 28, 2004. Available via the George W. Bush Presidential Library archive. Cited in Section II.

Origin-of-COVID statements referenced in Section I

Calisher, Charles, Dennis Carroll, Rita Colwell, et al. “Statement in Support of the Scientists, Public Health Professionals, and Medical Professionals of China Combatting COVID-19.” The Lancet 395, no. 10226 (March 7, 2020): e42–e43. doi:10.1016/S0140-6736(20)30418-9. The 27-signatory letter, organized by Peter Daszak, that characterized lab-leak hypotheses as “conspiracy theories.”

Andersen, Kristian G., Andrew Rambaut, W. Ian Lipkin, Edward C. Holmes, and Robert F. Garry. “The Proximal Origin of SARS-CoV-2.” Nature Medicine 26 (March 17, 2020): 450–452. doi:10.1038/s41591-020-0820-9.

“Addendum: Competing Interests and the Origins of SARS-CoV-2.” The Lancet 397, no. 10293 (June 21, 2021): 2449–2450. The journal’s subsequent disclosure of Daszak’s undisclosed EcoHealth/Wuhan Institute of Virology relationships.

Bloom, Jesse D., Yujia A. Chan, Ralph S. Baric, et al. “Investigate the Origins of COVID-19.” Science 372, no. 6543 (May 14, 2021): 694. doi:10.1126/science.abj0016. The 18-signatory letter that called for re-opening the origins inquiry.

Gain-of-function debate

Fauci, Anthony S. “Research on Highly Pathogenic H5N1 Influenza Virus: The Way Forward.” mBio 3, no. 5 (2012): e00359-12. doi:10.1128/mBio.00359-12. Fauci’s defense of gain-of-function research, including the “hypothetical scenario” passage cited in Kennedy, Wuhan Cover-Up, ch. 17.

Inglesby, Thomas V. Statement before the National Science Advisory Board for Biosecurity (NSABB), Bethesda, Md., January 7–8, 2016. Available via the NIH Office of Science Policy archive.

Lipsitch, Marc, and Alison P. Galvani. “Ethical Alternatives to Experiments with Novel Potential Pandemic Pathogens.” PLOS Medicine 11, no. 5 (2014): e1001646. The leading peer-reviewed challenge to the GOF research agenda.

Investigations and indictments cited in Section IV

United States Department of Justice. “Former Senior NIAID Official Indicted for Concealing Federal Records During COVID-19 Pandemic.” Office of Public Affairs press release, April 28, 2026. Indictment of Dr. David M. Morens. Cited in Section IV.

U.S. House of Representatives, Select Subcommittee on the Coronavirus Pandemic. After Action Review of the COVID-19 Pandemic: The Lessons Learned and a Path Forward. Final report. Washington, D.C., December 2024. Source for the Morens email correspondence and the EcoHealth/NIAID grant trail.

Compensation, patents, and post-government appointments

Andrzejewski, Adam. “Dr. Anthony Fauci: The Highest Paid Employee in the Entire U.S. Federal Government.” Forbes, January 25, 2021. Source for the salary claim in Section III.

Georgetown University. “Dr. Anthony Fauci to Join Georgetown Faculty as Distinguished University Professor.” Press release, June 2023. Source for the post-government appointment cited in Section IV.

IV. Counter-sources and contrary perspectives

Fauci, Anthony S. On Call: A Doctor’s Journey in Public Service. New York: Viking, 2024. Fauci’s own memoir; the most comprehensive first-person rejoinder to the Kennedy / Malone account.

Specter, Michael. “How Anthony Fauci Became America’s Doctor.” The New Yorker, April 10, 2020. The most-cited mainstream profile, sympathetic to Fauci.

Hotez, Peter J. “Mounting Antiscience Aggression in the United States.” PLOS Biology 19, no. 7 (2021): e3001369. A systematic argument that critics in the Kennedy / Malone tradition are a public-health threat. Direct opposition to the essay’s thesis.

Goodman, Jack, and Flora Carmichael. “Coronavirus: The Misleading Claims about Anthony Fauci.” BBC Reality Check, December 2021. Representative of the mainstream fact-checking response to the Kennedy book.

Office of the Director of National Intelligence. Updated Assessment on COVID-19 Origins. Washington, D.C., October 2021; updated June 2023. The Intelligence Community’s formal position: insufficient evidence to confirm either zoonotic or laboratory origin. The single most important counter-data point for any strong claim about the Wuhan Institute’s role.

Carpenter, Daniel, and David A. Moss, eds. Preventing Regulatory Capture: Special Interest Influence and How to Limit It. New York: Cambridge University Press, 2014. The leading recent academic volume on regulatory capture; argues against the strong Rothbard/Stigler thesis on empirical grounds.

Sean Spicer’s new book Trump 2.0: The Revolution That Will Permanently Transform America (Regnery / Skyhorse Publishing, March 2026, 288 pages, foreword by President Donald J. Trump) arrives at a particular moment, and it is worth being clear about that moment before saying anything about the book itself.

We are roughly fourteen months into the second Trump administration. The midterms are in front of us. The MAHA Commission has issued its Make Our Children Healthy Again strategy. Robert F. Kennedy Jr. has fired six hundred employees at the CDC, dismissed the entire ACIP, removed the CDC director, and removed COVID-19 vaccines from the recommended schedule for healthy children and pregnant women. The FDA, under Marty Makary, is dismantling thirty years of accumulated direct-to-consumer pharmaceutical advertising that no other developed country except New Zealand permits. The petroleum-based food dyes are on their way out. Jay Bhattacharya, a man whose calls for open scientific debate got him censored by his own university and the federal government during COVID, now runs the National Institutes of Health.

If you had told me, in the spring of 2022 — when I was permanently banned from Twitter for “repeated violations of [the] COVID-19 misinformation policy” — that this would be the policy landscape four years later, I would have wanted to believe you. I would not, at the time, have been able to.

So that is the moment into which Spicer publishes. And the book ought to be evaluated as what it actually is: a participant’s ledger, written in real time by a man who has been in the MAGA inner circle since 2016, of the first year of an administration that is delivering — at a speed and across a breadth that even those of us inside the MAHA movement keep finding ourselves slightly stunned by.

It is not a work of policy analysis. It is not an academic history. It is not — and Spicer is honest about this — meant to be the final word. It is a chronicle. A ledger. A first-draft accounting, kept by a friendly hand, of what is being done. On those terms — and especially on the terms of what it does for the MAHA reader — it is a book worth having.

Let me say what it does well, where it lands particularly hard for those of us in this movement, and where the honest reader will want to keep their own counsel.

What the book is

Trump 2.0 is organized around ten chapters covering, in turn: the border, trade and tariffs, NATO, defense and intelligence, law and order, education, MAHA, DOGE, the media, and the Kirk assassination. There is a foreword from President Trump, an introduction, a conclusion, and an afterword on Vice President Vance.

The throughline — repeated, deliberately, on nearly every page — is that the four-year break between Trump’s first and second terms was not a defeat but a gift. It allowed the America First Policy Institute, the Heritage Foundation’s Project 2025 coalition, Newt Gingrich’s America’s New Majority Project, and what Spicer calls the “America First Avengers” to do something they had no time to do the first time around: think, plan, recruit, vet, and prepare. The thesis is straightforward. Trump 1.0 was the rough draft. Trump 2.0 is the published edition. The president, as Spicer puts it, “was not sitting around and reminiscing about all his monumental wins from his first administration. He was planning how he would win even more during his second.”

The book’s argument for this thesis is essentially evidentiary: chapter by chapter, sector by sector, here is what we said we would do, here is what we have done, here is the documented receipt. Spicer cites White House fact sheets, executive orders, court filings, legislative scoring, lobbying disclosures, polling data, OpenSecrets, KFF, and a wide array of news reporting. He quotes generously from the people doing the work — Susie Wiles, Karoline Leavitt, Brendan Carr, Ric Grenell, Ken Cuccinelli, Russ Vought, Joe Gebbia, and many others — and he quotes the critics too, often at length, before answering them.

For a book published by an author who is also a podcaster and Substack writer (The Sean Spicer Show; seanspicer.com), the prose is more substantive than I expected. There is a working journalist’s instinct here for documentary support. There is also — and I say this with appreciation — a clear refusal to apologize for the obvious: that Spicer is a friend of this administration, that he was the thirtieth White House Press Secretary, that he is writing as a partisan in the older and better sense of the word. He is a participant. He is a witness. And he tells you that on page one.

If you are looking for the dispassionate court historian’s account of Trump’s second term, this is not your book and never claimed to be. If you are looking for a thoroughly sourced, plainly written, in-house ledger of what has actually been done — kept by a man who was in the building for the first term and is in close conversation with the people in the building for the second — this is the best one currently in print.

Why the MAHA chapter is the heart of the book

For those of us in the MAHA coalition, Chapter 7 — “The MAHA Policy Blueprint” — is the centerpiece, and it is the chapter I want to spend the most time on, because Spicer gets it right in ways that are not trivial.

He opens not with a White House press release but with a 1995 New York magazine cover story titled “The Kennedy Who Matters.” The cover featured Robert F. Kennedy Jr. — then a darling of the progressive left, the man who Rolling Stone would later place on its 2009 list of “100 Agents of Change,” the lawyer who was building his reputation by holding industrial polluters accountable. Spicer’s point in opening this way is structural and important: Kennedy did not change. The political coalitions around him did. The man who has cared about public health since the 1990s, who has been hammering away at industrial corruption of the food and water supply for thirty years, is the same man who is now Secretary of Health and Human Services. What changed is which party was willing to put him in office to do the work.

This matters. It matters because the legacy media’s framing — that Kennedy is a “junk science” “anti-vaxxer” “conspiracy theorist” who has been “rejecting data” and “fueling distrust” — is, as Spicer correctly identifies, a framing that the legacy media has direct financial reasons to maintain. He walks through the numbers, and they are damning:

• The pharmaceutical and health products lobby, which had spent $341,316,466 in 2025 by year’s end, outspends every other lobby in Washington — by more than $100 million. (PhRMA alone spent $20.6 million in the first half of 2025; Pfizer $7.85 million; Merck $7.58 million.)

• The pharmaceutical ad market, per MediaRadar, contributed $10.8 billion to U.S. ad spend in 2024, with 59% going to TV. Linear TV alone took an estimated $5.12 billion in prescription drug ads from drugmakers in 2024 and $2.97 billion in just the first half of 2025.

• In March 2023 alone, pharmaceutical advertisers spent nearly $15 million on ABC World News Tonight with David Muir — a single thirty-minute newscast — and spent comparably across NBC Nightly News, Good Morning America, CBS Evening News, Today, and CBS Mornings.

• The top recipient of pharmaceutical industry contributions in the 2023–2024 cycle was former Vice President Kamala Harris, at $8,652,114. The top recipient in the 2019–2020 cycle was Joe Biden, at $9,002,834. The top recipient in 2015–2016 was Hillary Clinton.

Spicer’s interpretive frame on these numbers is the right one, and it is worth quoting because the framing is itself a contribution: “Big Pharma advertising is less about attracting new customers and more about buying silence from the news industry. In fact, it’s not just silence, but compliance.” Spicer understands what those of us who watched the COVID-19 pandemic from the inside watched in real time: that the legacy news outlets reporting on Kennedy’s nomination — Jake Tapper warning viewers “I hope you like measles,” the New Yorker running “The Junk Science of Robert F. Kennedy, Jr.” — were reporting on the man who threatens the single biggest single revenue stream in their business model. That is not a conflict of interest. That is the conflict of interest. And the American people, increasingly, can see it.

Spicer’s chapter then walks through what the MAHA team has actually accomplished in twelve months. He cites the White House’s published list, and the cumulative weight of it is genuinely striking when you put it down on the page in sequence:

• The MAHA Commission, established within weeks of inauguration, with an initial focus on childhood chronic disease.

• Roughly 35% of the American food industry has committed to eliminating artificial dyes — including Hershey, Kraft-Heinz, General Mills, JM Smucker, Conagra, Tyson, PepsiCo, Mars, McCormick, Sam’s Club, Nestlé, In-N-Out, and ice cream companies representing more than 90% of U.S. ice cream volume.

• HHS revived the Task Force on Safer Childhood Vaccines.

• Petroleum-based dyes (Red 40, Yellow 5, Blue 1) are being phased out of the food supply by end of 2026.

• COVID-19 vaccines have been removed from the recommended schedule for healthy children and pregnant women.

• The FDA, under Makary, is enforcing existing regulations on direct-to-consumer pharmaceutical advertising for the first time in three decades. Trump’s September 9, 2025 memorandum directs the FDA to require materially complete information that fairly balances benefits and risks.

• USDA Secretary Brooke Rollins has signed waivers restricting soda and energy drinks from food stamps in Nebraska — taxpayer dollars no longer subsidizing the consumption pattern that has produced a 41.64% adult obesity rate.

• Whole milk is being restored to schools.

• Steak & Shake has moved to 100% beef tallow and replaced its seed-oil “buttery blend” with Wisconsin butter. Coca-Cola is launching a U.S. cane sugar version. McCormick, Tyson, Mars, Nestlé, and Hershey are pulling synthetic dyes.

I am going to register, here, what every honest MAHA reader is going to feel reading this list: a kind of disorientation that the things we have been arguing for, in some cases for decades, are happening. The “GRAS loophole” — that “generally recognized as safe” self-certification regime under which thousands of food additives have entered the American food supply with effectively no FDA oversight — is being closed. Ultra-processed foods are being defined for regulatory purposes. The dietary guidelines are being reformed. The infant formula standards are being raised. The Surgeon General is being directed to launch screen-time initiatives. Direct-to-consumer pharmaceutical advertising — banned in every developed country except the United States and New Zealand — is being meaningfully regulated for the first time since 1962.

This is the policy program that those of us in the chronic-disease and food-safety community have been writing about for a generation. And here it is, on the books, with executive orders backing it.

Spicer also gets the team right, and that is not nothing. The roster he names — RFK Jr. at HHS, Marty Makary at FDA, Mehmet Oz at CMS, Jay Bhattacharya at NIH, Casey Means as Surgeon General nominee, Calley Means as the bridge between MAGA and MAHA, Jessica Reed Kraus as the chronicler — is the team. He calls Casey Means’ Good Energy “a central text in the growing Make America Healthy Again movement,” which is correct. He notes that Bhattacharya, “when the lockdowns took over America… was an outspoken critic of the liberal dogma that had engulfed his university and many parts of the country. The mainstream public health establishment dismissed him. Now he’s in charge.” That is the right register to strike, and Spicer strikes it.

He closes the chapter with University of Illinois polling data showing that 53% of “very conservative” Americans and 35% of “very liberal” Americans hold a “very positive” view of MAHA. The point — which is correct — is that this is not, fundamentally, a partisan project. It is a public health project that has been adopted by one party because the other party would not adopt it. Health policy, as Spicer puts it, “isn’t about profits. It’s about people. MAHA is real.”

I will say it plainly: this chapter alone is worth the price of the book for anyone who wants a clear, sourced, in-the-record narrative they can hand to a friend or family member who is still getting their MAHA news from CNN. It will not convince the dedicated opponent. It will, I think, genuinely help the curious skeptic.

The other chapters, briefly

The non-MAHA chapters do the same kind of documentary work, with varying degrees of depth.

Chapter 1 (Border) documents the closure of the southern border and the operationalization of deportation policy in the first year. The border-encounter numbers are what the numbers are; the change from the Biden-era figures is the change.

Chapter 2 (Trade and Tariffs) explains the Trump tariff structure — including the 145% tariffs on Chinese goods imposed in April 2025 and the resulting trade negotiations — and the case for reciprocal tariffs as the foundation of the “fair trade” doctrine.

Chapter 3 (NATO) documents the genuinely remarkable shift in allied defense spending: NATO members now committing to 5% of GDP for defense, with Spicer providing the specific commitments by country. The framing — that previous administrations let the alliance free-ride on American taxpayers and that Trump simply refused to keep doing it — is straightforward and correct.

Chapter 4 (Defense and Intelligence) covers the Tulsi Gabbard ODNI nomination, the renaming of the Department of Defense as the Department of War, and the operations against Iran’s nuclear program, the Maduro regime in Venezuela, and various drug cartels.

Chapter 5 (Law and Order) documents the 2025 murder rate decline — the largest single-year drop in recorded American history, reaching the lowest level in 125 years — and the federalization of public safety in Washington, D.C. The chapter lands with particular weight given the data.

Chapter 6 (Education, Not Indoctrination) is the chapter that most directly addresses what happened on September 10, 2025 at Utah Valley University, and the institutional reckoning at Harvard, Columbia, and Penn that has followed. Chris Rufo’s analysis of why elite universities are the strategic target — because they “establish the cultural signals that then flow downward to the university sector as a whole” — is given room to breathe. The Defending Women From Gender Ideology Extremism executive order is documented. The chapter is straightforward, and the prose carries genuine moral weight where it discusses Charlie Kirk.

Chapter 8 (DOGE, Finally) is the chapter that pleased me more than I expected. Spicer locates DOGE in a longer historical lineage — back to Reagan’s 1982 Grace Commission, the 1984 report that filled forty-seven volumes and twenty-three thousand pages and recommended 2,478 cost-cutting measures projected to save $424 billion over three years. The lineage matters because it makes clear that DOGE is not, as the legacy press would have it, an unprecedented assault on the administrative state. It is the latest iteration of a recurring Republican attempt — one Reagan got partway through before the bureaucracy beat him back — to do what Reagan called confronting the “unchecked cancer” of waste, fraud, abuse, and mismanagement. The chapter is honest about the fact that Trump and Musk’s January 2026 falling out complicated DOGE’s institutional trajectory, but it also documents what DOGE actually did before that point. The Cato Institute’s 2025 polling — that Americans now estimate 59 cents of every federal dollar is wasted, the highest figure ever recorded — gives the chapter its political backdrop.

Chapter 9 (Taking Back the Media) is the longest in the book and is, in some ways, the chapter where Spicer has the most personal investment. He is, after all, a former White House Press Secretary writing about the press. He documents the addition of nearly five hundred new media press passes (The Daily Wire, The Daily Signal, Right Side Broadcasting, Real America’s Voice, Lindell TV, podcasters, and Substack writers); the new media seat in the briefing room; the AP losing its special access for refusing to use “Gulf of America”; the FCC’s actions under Brendan Carr; the $16 million Paramount payment over the 60 Minutes edit and the $15 million Disney payment over the Stephanopoulos defamation. He is good — and pointed — on the Jake Tapper question of where Tapper was, exactly, between 2020 and 2024 when the legacy press was insisting that Joe Biden was running circles around Karine Jean-Pierre. The Glenn Greenwald material on The Intercept’s censorship of his Hunter Biden coverage is an honest inclusion — Greenwald is a man of the left, and Spicer treats him as a fellow truth-teller anyway. That instinct, that the truth is the truth regardless of which side a man’s quarrel with the establishment originates from, is the right instinct, and it is Trump 2.0’s instinct generally.

Chapter 10 (The Kirk Assassination) is the most difficult chapter in the book and is, I think, written with appropriate restraint. Spicer is not a stylist; he is a chronicler. The chapter does what a chronicler can do: it documents what happened, it places it in the context of the political-violence escalation of the last decade, and it refuses the easy temptation to reduce Charlie Kirk’s life to a political symbol. There is grief in the prose, and it is honestly registered.

The Conclusion and the Afterword on JD Vance are forward-looking. The afterword in particular is worth reading for anyone trying to think about what comes next. Vance is, on the substance, the most intellectually serious vice president the modern Republican Party has produced, and Spicer makes the case for him without overselling. The America 250 celebrations, the Patrick Henry and Howard Roark and Baron Haussmann references that Politico reached for in describing Trump’s architectural ambitions for Washington — these are the materials of a man who, in his second term, is thinking about what gets built and what lasts.

What a MAHA reader should know going in

I want to be honest in the way that, in our community, I have always tried to be honest, even when it costs.

This is a book by Sean Spicer. Spicer is a friend of MAHA in the broad sense — he gives the chapter its full due, he understands the stakes, he names the people, he runs the numbers. But he is not himself a MAHA principal. He is a MAGA institutionalist. He is writing from inside MAGA looking out at MAHA as one of MAGA’s coalition partners. That positioning produces some specific limits the reader will want to keep in mind.

First, the COVID-19 mRNA vaccines are touched on lightly. Spicer credits the executive order prohibiting federal funding for COVID-19 vaccine mandates in schools, and he credits the removal of COVID-19 vaccines from the recommended schedule for healthy children and pregnant women. Both are correct credits. But the deeper questions — about Operation Warp Speed, about the legal framework that suspended liability for vaccine manufacturers, about the lipid nanoparticle and IgG4 class-switch findings, about the regulatory capture that produced the EUA-to-BLA transition with no genuine safety review, about the ongoing question of myocarditis in young men — those questions are not in this book. That is not Spicer’s project. The book is a first-year ledger, not a reckoning. The reckoning, as I have argued elsewhere, is still ahead of us, and it will require its own chroniclers.

Second, the book leans, as a rhetorical matter, on the genre conventions of the campaign-trail bestseller — the punchy declarative sentence, the rhetorical question stacked next to its own answer (“Do you think these lobbyists are being paid to make America healthy? No, they are paid to make sure that these companies make money.”), the occasional Charlie Sheen quotation. Some readers will find this register congenial. Some will find it grates. It is the register of The Sean Spicer Show, and Spicer is who he is, and he is not, on this question, going to apologize for it. I did not, in the end, mind it. Your mileage may vary.

Third — and this is the only place I will register a substantive reservation — the book’s largest claim, repeated in its subtitle and throughout, is that the Trump 2.0 revolution will permanently transform America. I want this to be true. I am working, in my own small way, for it to be true. But the honest historical record on revolutions of this kind — the Reagan revolution included — is that the institutional counter-pressure of the administrative state, the legal academy, the credentialing professions, the legacy media, and the foundation-funded NGO archipelago is enormous, patient, and very good at outlasting its political opponents. Whether the changes Spicer documents become permanent depends on whether the next decade of personnel, judicial appointments, executive orders, and statutory codifications hold. The MAHA reforms are the most vulnerable in this respect, because they are the reforms most directly targeting the largest concentrated revenue streams in American commercial life. Big Pharma did not become Big Pharma by giving up. The book’s optimism on this point is real and it is earned in part. It is also, I think, slightly ahead of where the evidence currently warrants.

That is a friendly caution, not an objection. The book makes the right argument. The work of making the argument true is still in front of us.

What the book does that is genuinely valuable

Three things, beyond the policy ledger itself.

First, it gets the personnel right. The single most important argument Spicer makes — the one I would most want a curious reader to take away — is that Trump 2.0 differs from Trump 1.0 not principally in policy ambition but in personnel preparation. The four-year break gave the America First Policy Institute, Heritage’s Project 2025 coalition, and the various conservative-movement institutions the time to build a vetted bench. The single biggest lesson of Trump 1.0 was, as Spicer puts it, “not just getting the right people in, it was keeping the wrong people out.” That sentence is the thesis of this presidency, and Spicer is right to make it the thesis of the book. The MAHA team — Kennedy, Makary, Bhattacharya, Oz, Means — is the proof of concept. So is the absence, this time, of the John Boltons and Anthony Faucis.

Second, it documents the institutional realignment in real time. The renaming of the Department of Defense as the Department of War. The renaming of the Kennedy Center as the Donald J. Trump and John F. Kennedy Center. The Gulf of America. The triumphal arch for the 250th. The Joe Gebbia appointment as Chief Design Officer of the United States. The “Making Federal Architecture Beautiful Again” executive order. These are not, in isolation, the most important things this administration is doing. They are, in the aggregate, the cultural surface of the deeper restoration project, and Spicer is right to give them their due. Andrew Breitbart’s line — “politics is downstream of culture” — sits behind the chapter and gets the credit it deserves.

Third, it tells the truth about the legacy media in a way that is going to age well. The pharmaceutical advertising numbers I quoted above are not new. The COVID-era press cover-up of Biden’s decline is not, at this point, contested. The CCDH-and-Censorship-Industrial-Complex story has been told elsewhere, including in litigation. But Spicer puts it all in one place, in a book a general reader can hand to their parent or their cousin who is still trying to figure out what happened. That is a service.

A final word

I am going to recommend Trump 2.0. I am going to recommend it especially to MAHA-curious readers who want the policy receipts in a single accessible volume; to MAGA-aligned readers who want a clear-eyed first-year accounting from someone who has been in the building since 2016; and to anyone who is trying to understand why the United States of 2026 looks so different from the United States of 2024, and why the difference is not, principally, a matter of personality.

It is not a perfect book. It is, in places, a bestseller-genre book — punchy, declarative, occasionally too pleased with its own jokes. It is also, in the chapters that matter most for those of us in this movement, a serious one. The MAHA chapter in particular is the best summary I have read of what this administration’s public-health team has accomplished in twelve months. I would put it in the hands of anyone who is trying to understand the moment.

Sean Spicer was, before any of this, the thirtieth White House Press Secretary. He has, in Trump 2.0, written the kind of book a press secretary writes when the press secretary believes — correctly, in this case — that the work being done is real, the people doing it are serious, and the chronicle ought to be kept.

The chronicle is kept here. It is honest within its genre. It is more rigorously sourced than its surface signals. And the MAHA chapter, in particular, is going to do real work for the movement.

Buy it. Read it. Hand it to someone who hasn’t yet figured out what is happening.

The best, as the foreword promises, is yet to come — but a great deal has already been done, and Spicer has done the service of writing it down.

Sean Spicer, Trump 2.0: The Revolution That Will Permanently Transform America. With a foreword by President Donald J. Trump. Regnery / Skyhorse Publishing, March 2026. 288 pages, hardcover. ISBN 978-1-5107-8620-2.

Available via Amazon

JGM

The Senator the mRNA Industry Built

Two weeks from now, on May 16, 2026, Louisiana Republicans will vote in a closed primary that has become the single most consequential intra-party election of the second Trump term. Senator Bill Cassidy, who has held the seat since 2015, is fighting for his political life against three challengers. They are Congresswoman Julia Letlow, who carries President Trump’s complete and total endorsement and the endorsement of Governor Jeff Landry; State Treasurer John Fleming, the former congressman; and Mark Spencer.

The most recent Emerson College poll, released April 26, shows Fleming at 28 percent, Letlow at 27 percent, and Cassidy at 21 percent. Twenty-two percent of voters remain undecided. The senator’s path to the runoff is narrow and getting narrower.

A development from the past 72 hours bears registration before the substantive argument begins. On April 29, 2026, the United States Supreme Court ruled in Louisiana v. Callais that the state’s current congressional map was an unconstitutional racial gerrymander. The day after the decision, Governor Landry signed an Executive Order suspending the closed-party primaries for U.S. House races only until July 15, 2026, or until the Legislature redraws the maps. Secretary of State Nancy Landry’s official statement made clear that all other races on the May 16 ballot would proceed as scheduled.

Senator Cassidy’s public reaction to the governor’s decision is itself worth registering. Within hours of Landry’s executive order, Cassidy posted on X that “the governor’s decision to move ahead with the Senate race during a confusing time is disappointing.” It is an unusual move for an incumbent senator to publicly object to his own state’s governor for proceeding with his primary on the originally scheduled date.

The reason it happened is straightforward enough: Cassidy is running third on the most recent polling, and a delay of his primary into July or later would have given him weeks to consolidate institutional support, allow national press attention to shift, and possibly insulate him from the redistricting drama that is dominating Louisiana political coverage. Governor Landry, who has endorsed Letlow, declined to extend that lifeline. The senator’s “disappointing” statement, directed at his own state’s Republican governor two weeks before voting, is the response of a man who knows the math.

A great deal has been written about why this primary matters. Most of the coverage has focused on the obvious: Cassidy’s 2021 vote to convict Donald Trump in the second impeachment trial, the President’s resulting determination to drive him from the Senate, the spectacle of an incumbent Republican facing a credible primary challenge in a state Trump carried by twenty-two points. That is the political surface of the story.

The deeper story, the one that should matter to anyone who has followed the MAHA movement’s first fifteen months in federal power, is something the political coverage has barely touched. Bill Cassidy is not just a Republican who voted to convict Trump. He is the senator most directly responsible, on the documented record, for the institutional containment of Secretary Kennedy’s MAHA agenda.

He is the senator the mRNA industry’s principal lobbying organization has been engaging with since July 2023, before Kennedy was even nominated. And he is the senator who, in February 2026, used his Senate HELP Committee chairmanship to publicly confront NIH Director Jay Bhattacharya over the very mRNA grant terminations and contract cancellations that the President’s own Health and Human Services secretary had ordered.

This essay lays out the documentary record. It argues that the record, fairly read, makes Cassidy’s primary defeat not just a Trump loyalty question but a substantive policy question, a question about whether the MAHA agenda will continue to be contained by a Senate health committee chair operating in alignment with the very industry incumbents the agenda was elected to confront.

Louisiana voters have an opportunity, on May 16, to settle that question.

The Cassidy Confirmation Conditions

The contained-MAHA story begins on February 13, 2025, the day Bill Cassidy announced he would vote to confirm Robert F. Kennedy Jr. as Secretary of Health and Human Services. The vote was 52 to 48. Cassidy was the deciding Republican; without his vote, the nomination would have failed. The Senate health committee chairman had spent the preceding weeks publicly wavering, and his eventual yes was conditioned on what he described as “a series of promises from Kennedy aimed at protecting faith in vaccines.”

Those promises, as Cassidy later detailed in his floor remarks and in subsequent interviews, included commitments that the Kennedy HHS would maintain unchanged the existing CDC vaccine schedule, would not seek to remove vaccines already on the recommended schedule without conducting evidence-based reviews, would maintain the existing Vaccine Adverse Event Reporting System rather than replacing it, would seek Senate input before making major changes to the Advisory Committee on Immunization Practices, and would refrain from using HHS authority to discourage childhood vaccination broadly.

Every one of those conditions was structured to preserve, in its essentials, the pre-2025 vaccine-policy status quo, the status quo that the MAHA movement’s most committed adherents, including the millions of Americans who voted for Trump-Kennedy on the explicit promise of vaccine-policy reform, had been organizing against for fifteen years.

The Cassidy conditions were not, in retrospect, the act of a skeptical senator preserving institutional integrity. They were the act of a senator with a specific structural relationship to the mRNA-platform pharmaceutical industry, exacting policy concessions on that industry’s behalf as the price of allowing Kennedy’s confirmation to proceed.

The Alliance for mRNA Medicines

In November 2023, more than a year before Kennedy was nominated, a new pharmaceutical-industry trade association quietly registered itself in Washington. Its name is the Alliance for mRNA Medicines (AMM). Its founding members numbered thirty-one. Its operational vehicle was Leavitt Partners, the Washington consulting firm founded by former HHS Secretary Mike Leavitt, under George W. Bush. Its Executive Director, Clay Alspach, is a Leavitt Partners principal and former Chief Health Counsel for the House Energy and Commerce Committee under Representative Fred Upton, where he led the committee’s work on the 21st Century Cures Act and other major health legislation.

The Alliance for mRNA Medicines did not exist to lobby for the mRNA platform’s continued commercial viability against competitive threats from other pharmaceutical platforms. It existed to lobby for the platform’s continued regulatory and political insulation against the mRNA-skeptical political movement that, by November 2023, was clearly emerging as a major force in American politics.

AMM’s first inaugural Washington meetings, which the organization itself documented on its LinkedIn account on July 27, 2023, four months before its formal founding, were not held with random congressional offices. They were held with a specific list of officials whose positions on mRNA platform policy mattered.

The list, as AMM publicly disclosed: Senator Bill Cassidy. Representative Brett Guthrie. Then-FDA Center for Biologics Evaluation and Research Director Peter Marks. Cancer Moonshot leadership. White House Office of Science and Technology Policy leadership. Senior staff for Senators Gary Peters and Bob Casey.

Senator Cassidy was on that list before the Alliance for mRNA Medicines had its formal founding meeting. He was on that list because his position on mRNA platform policy mattered to the industry building the lobbying organization that would be deployed against the MAHA movement’s agenda eighteen months later. The senator and the trade association have been documented as engaging with each other since July 2023, before Kennedy was nominated, before Trump’s 2024 victory was assured, before Cassidy cast the confirmation vote that placed Kennedy at the head of HHS subject to the conditions Cassidy himself had extracted. It does not appear that his clear conflict of interest was disclosed to the Senate at the time of the vote, or the public at large.

By late April 2026, AMM’s membership has grown from those original thirty-one members to more than one hundred. Moderna and Merck were added to the public membership roster in the period since the Kennedy HHS confirmation.

The trade association has continued to engage with Senator Cassidy’s office throughout the period the MAHA agenda has been advancing. AMM’s news platform amplified Cassidy’s February 3, 2026 Senate HELP Committee hearing on NIH modernization, the hearing at which Cassidy publicly confronted NIH Director Bhattacharya over the cancellation of $500 million in HHS mRNA contracts and the termination of mRNA research grants the Kennedy HHS had determined did not meet evidentiary standards. At no time during this hearing, did Cassidy disclose his affiliation with AMM.

This is a documented chronology. Every claim in the preceding paragraphs is sourceable to AMM’s own public communications, to Leavitt Partners’ corporate disclosures, to LegiStorm’s lobbyist-registration database, to the Senate HELP Committee’s published hearing record, to Cassidy’s own February 3, 2026 press release, and to contemporaneous reporting by Science magazine, by Holland and Knight, and by the trade press. None of it is contested.

What is contested is what the chronology means. I will offer my reading.

What the Documented Chronology Means

A senator the mRNA industry has been engaging with since July 2023 cast the deciding Republican vote to confirm Robert F. Kennedy Jr. as HHS Secretary on the condition that Kennedy preserve the pre-2025 vaccine-policy status quo. After the confirmation, that same senator, chairing the Senate committee with oversight over HHS, has used his chairmanship to challenge the Kennedy HHS at every major decision point the MAHA agenda has required.

When the reconstituted Advisory Committee on Immunization Practices voted in September 2025 to end the universal recommendation that newborns receive the hepatitis B vaccine on the day of birth, Cassidy publicly called the decision “a mistake” and signaled openness to legislation that would constrain the ACIP’s reform authority.

When Vinay Prasad, the new FDA CBER Director, issued the November 2025 memorandum identifying ten of ninety-six pediatric VAERS deaths as related to COVID-19 vaccination, Cassidy described the memo as having “diverged from standard pharmacovigilance practice” and called for senate hearings on the FDA’s pharmacovigilance methodology under the new HHS leadership.

When the AAP v. Kennedy preliminary injunction was issued by Judge Brian Murphy on March 16, 2026, Cassidy did not publicly defend the Kennedy HHS’s reform program; he registered concern about the injunction’s procedural findings while declining to take a position on the underlying ACIP reconstitution.

When the Kennedy HHS announced the cancellation of $500 million in mRNA contracts in early February 2026, Cassidy convened a Senate HELP hearing which he publicly confronted NIH Director Bhattacharya on the record.

This is not the conduct of a senator skeptically supervising an HHS Secretary he had reluctantly voted to confirm. This is the conduct of a senator using his committee chairmanship to advance a specific policy position, the position the Alliance for mRNA Medicines has been advocating since July 2023.

I do not claim that AMM bought Senator Cassidy’s vote. I claim something narrower and harder to refute: the documented chronology establishes a pattern of alignment between Senator Cassidy and the mRNA-industry lobbying organization that is, on the documentary record alone, structurally consistent with the regulatory-capture analytical framework the MAHA movement was elected to confront.

The senator is on the wrong side of MAHA. Supporters of the MAHA agenda represent a decisive majority of his Republican primary electorate, who voted for MAHA-aligned change in November 2024.

The May 16 Choice

President Trump endorsed Julia Letlow on January 17, 2026, preemptively, before she had announced her candidacy. He called her a “Great Star” and a “TOTAL WINNER” and wrote, in characteristic punctuation, “RUN, JULIA, RUN!!!” Three days later, on January 20, Letlow announced her candidacy at a closed-door business breakfast in Baton Rouge. Governor Jeff Landry has endorsed her. The America First political infrastructure has aligned around her candidacy

Letlow is, what Cassidy is not: a member of Congress who has consistently supported the Trump administration’s agenda across the issue spectrum, including the MAHA agenda’s component policy positions. She has voted for the major appropriations vehicles supporting the Kennedy HHS reform program. She has not publicly broken with Secretary Kennedy on a single major decision. She has not, to public knowledge, met with the Alliance for mRNA Medicines or its operational principals. She has the policy positioning Louisiana Republicans voted for in 2024 and the willingness to defend that positioning under pressure.

State Treasurer John Fleming, the former congressman, is also running. Fleming has substantial conservative credentials and would not be a bad senator. But the analytical case for ending Cassidy’s career rests on the specific documentation this essay has laid out, and the analytical case for replacing him with Letlow rests on the endorsement structure: Trump, Landry, and the America First coalition has aligned around her candidacy specifically.

A vote for Letlow on May 16 is the clearest available signal that Louisiana Republicans want their senator to be aligned with the MAHA agenda rather than aligned against it. A vote for Fleming, on current polling, risks splitting the anti-Cassidy vote in ways that could let the senator survive into the runoff with a structural advantage from incumbent name recognition.

I make this case as the author of the recently completed “The Chronic Rebellion” (Authors Drs. Robert and Jill Malone), a definitive history book that comprehensively documents the MAHA movement’s first fifteen months in federal power. The research performed for the book strongly supports this assessment. The case is not about Donald Trump’s grievances, though those are real and the President is entitled to them. The case is about the specific structural relationship between Senator Cassidy and the lobbying organization that has been working against the policy agenda the President and Secretary Kennedy were elected to advance.

A senator who entered an alliance with the mRNA-industry lobbying organization in July 2023, who used his confirmation-vote leverage to extract conditions structured to preserve the pre-2025 status quo that lobbying organization was protecting. Who has used his committee chairmanship in 2025–2026 to publicly challenge the Kennedy HHS at every major decision point of the reform program. This is a senator who should not be returned to the Senate for a third six-year term.

Louisiana Republicans have the opportunity, on May 16, to end Bill Cassidy’s career by electing Julia Letlow. The opportunity exists in this specific election because of an unusual conjunction of factors: a presidentially-endorsed challenger with the coalition needed to consolidate the anti-Cassidy vote, a primary calendar that places the decision two weeks before the Memorial Day weekend, and Julia Letlow’s pro-MAHA record, which is supported by Republican voters.

The opportunity will not return. Cassidy’s structural advantages: incumbent fundraising, committee chairmanship, NRSC backing, the support of Senate Majority Leader Thune, will not be matched in any subsequent election. If he survives the primary on May 16, he survives for six more years. The MAHA agenda will spend those six years contained by a Senate health committee chairman whose alignment with the lobbying organization opposing that agenda is documentary fact, regardless of whether the causal chain is established.

The choice for Louisiana voters on May 16 is whether to let that happen, or whether to use the closed primary the state has scheduled to make sure it does not.

I urge Louisiana Republicans to vote for Julia Letlow.

Robert W. Malone, MD, MS

May 2, 2026

The documentary record on the Alliance for mRNA Medicines and Senator Cassidy is laid out at greater length, with full source citations, in Chapter 13 of The Chronic Rebellion: How American Parents Built the MAHA Movement Out of Their Children’s Illness, forthcoming in 2026 prior to the midterm election.

A Note for Louisiana Readers: Five Days Before the Primary

The argument this essay has made about Senator Cassidy applies, in different forms, at every level of American governance. The same trusted-association networks, professional-society infrastructures, and coordinated-policy-distribution mechanisms that shape federal vaccine policy also shape what happens in fifty state legislatures. The lobbying organization documented here is one node in a larger architecture, and that architecture operates as visibly in Baton Rouge as it does in Washington.

On Monday, May 11, 2026, five days before the primary, I will be speaking in Baton Rouge at an event hosted by Citizens for a New Louisiana, the state-level government-accountability organization that has spent the last several years documenting how policy is shaped in Louisiana before bills are ever filed.

The event is titled Champions of Change Baton Rouge: How Policy Really Gets Made. It runs from 6:00 to 8:00 PM at the City Club of Baton Rouge, 355 North Boulevard. I will be sharing the program with Noah Wall of the State Leadership Initiative, whose work examines how policy is developed, packaged, and distributed across all fifty states through trusted associations and professional networks, often moving in coordinated ways that are not immediately visible to the public.

Wall’s analytical framework and mine converge on the same structural question: how do the institutional networks operating between elected officials and the citizens those officials are supposed to represent actually shape what becomes law? The federal-level chronology this essay has laid out is one answer. The state-level chronology Wall and I will discuss in Baton Rouge on May 11 is another. For Louisiana voters preparing to cast their ballot on May 16, the connection should be obvious: the same dynamics that produced a senator structurally aligned with the mRNA-industry lobbying organization are also operating, in different forms, at the statehouse. Understanding the mechanism is the first step toward changing the outcome.

Tickets are $125 for general admission, with table sponsorship options available at $1,500, $2,500, and $5,000 levels. Seating is limited and the event has historically sold out. Information and registration are at newlouisiana.org, or by calling Citizens for a New Louisiana at (225) 242-9742. If you are a Louisiana reader of this Substack, and especially if you are a Baton Rouge–area reader who has been following this analytical thread across multiple essays, I would be glad to see you in the room on May 11. We will have a great deal to talk about, and the timing, five days before the most consequential intra-party Senate primary in the country, could not be more relevant.

In case you were wondering, I did not ask for and will not be receiving any honorarium or compensation for this appearance other than my travel and lodging expenses. It has been my pleasure and honor to have traveled to Louisiana many times to support the MAHA moms and the Health Freedom movement (with and independently from Secretary Kennedy), and consider Governor Landry a good friend of both Jill and myself. As a fellow equestrian, he always asks us about how our horses are doing.

It may sound like a small gripe, but when did looking like you do not care become the norm?

What is even more striking is who it shows up in. Young, single women. The group that, not long ago, took pride in presenting themselves well. Now you see the opposite. Little attention to appearance, little attention to health, little evidence of discipline in how they care for their own bodies. Poor diet, no exercise, and an overall posture of disengagement.

It gets dismissed as rebellion or some cultural statement. I do not buy that. What I see, as a woman, is something much simpler. It is easier to give up than to do the work. Easier to opt out than to invest in yourself.

Then comes the next step. Blame men for not measuring up. Raise standards while lowering effort. Walk away from dating. Walk away from marriage. Convince yourself you do not need a family. Replace it with a tight circle of friends and a pet or two for companionship.

And call that independence.

It is not independence. It is retreat.

And it is profoundly sad.

Participation trophies…

What used to be called indulgence has been rebranded in softer language. Permissive parenting. Gentle parenting. Soft parenting. The labels sound thoughtful, even compassionate. The outcomes tell a different story. Expectations lowered. Boundaries blurred. Rewards handed out with little connection to effort or achievement. Whether it is children or even pets, the impulse to placate has replaced the responsibility to teach.

Across homes and classrooms, a cultural shift has taken hold. Comfort is prioritized over discipline. Validation is handed out in place of accountability. Standards that once prepared young people to function in the real world have been quietly dismantled.

We now have a generation of young adults for whom an easy A is the norm. Not earned through mastery, but granted for showing up. Participation, not preparation. Presence, not performance.

At the same time, they are being told a story. From social media, from peers, and too often from the adults around them. That being unwell confers status. That victimhood brings recognition. That hard work is for those who failed to game the system. That society owes them. Not just opportunity, but outcomes. Resources, money, subsidized housing, endless concessions. The able-bodied are told their role is to provide, not to build. To redistribute, not to create.

This is not the old “me” generation. This is something different. A worldview that assigns moral authority to grievance and treats dependency as virtue.

The result is predictable. Young adults who are unprepared for the demands of real life. Unprepared for responsibility, for resilience, for the basic discipline required to sustain a career, a relationship, or a family. And deep down, many of them know it.

Because opting out is easier. Easier to lean into anxiety, depression, or disengagement than to confront difficulty. Easier to remain on the couch than to step into a world that demands effort. For many, especially young women, the consequences are already visible. Delayed families. Fragile relationships. Metabolic disease. Careers that never quite launch.

This did not happen by accident. It traces back to parenting. To the choices made, repeated, and normalized over years.

Perhaps this generation will recognize what was lost and choose differently when it is their turn. Perhaps they will rediscover the value of discipline, responsibility, and earned success.

Have a great weekend everyone!

JGM

President Trump withdrew the Casey Means nomination yesterday afternoon, blamed Senator Cassidy, and within minutes named Dr. Nicole B. Saphier of Memorial Sloan Kettering Cancer Center as his third Surgeon General nominee in fifteen months. The first MAHA-base reaction I have seen, online and in my inbox, has been something between “who?” and “Fox News pick - sellout.” I want to push back on the second reaction before it hardens, because the documentary record on Saphier is genuinely more interesting than the press coverage has so far conveyed, and the right MAHA reading of her is not the obvious one.

This piece is a working assessment, not a verdict. The Senate confirmation process is going to surface more than the public record currently shows. What follows is what I have been able to learn in the twenty-four hours since the nomination, the parts of her record that bear directly on MAHA’s questions, and the things I think are worth watching as she goes through the committee.

The fact that reframes the rest

Saphier wrote a book called Make America Healthy Again in 2020.

That is not a typo, and it is not a coincidence. The full title is Make America Healthy Again: How Bad Behavior and Big Government Caused a Trillion-Dollar Crisis. It came out from HarperCollins’s Broadside Books imprint on April 21, 2020, and it was a national bestseller. The argument is that American healthcare spending has spiraled past seventeen percent of GDP because the system reimburses acute-care intervention rather than prevention, and because Americans themselves have allowed personal-responsibility habits: diet, alcohol, sedentary lifestyle, to drive the chronic-disease curve that the federal architecture is then asked to manage. Her data points include the figures the MAHA movement has been citing for two years: roughly eighty percent of cardiovascular disease and forty percent of all cancer cases preventable through lifestyle change; nearly one in five American deaths associated with poor diet; the federal government spending over a trillion dollars annually on healthcare. She makes those points five years before “Make America Healthy Again” was the political brand of an HHS Secretary.

The book is not Kennedy’s book. The causal emphasis is different. Saphier writes from a Fox-News-aligned conservative-health-policy register, and her policy targets are the Affordable Care Act, Medicare-for-all proposals, and third-party-payer fee-for-service incentives. Kennedy’s targets, when MAHA was forming, were environmental toxins, agricultural chemistry, pharmaceutical regulatory capture, and the autism epidemic. Both frameworks land on the same operational fact: that American chronic-disease costs are the principal public-health problem of the period and that the federal architecture is structurally mismatched to addressing it, but they get there through different doors.

Here is the thing that matters for MAHA. The vocabulary was already in the conservative-health-policy bloodstream before Kennedy took it up. There was a 2020 conservative-health-policy book using exactly that title, with exactly that diagnostic premise, and it was a bestseller. The MAHA movement did not invent the framing; it organized a much broader political coalition around a framing that was already partly there. Saphier was one of the people writing in that register before the political brand consolidated.

That is a fact worth sitting with.

Her clinical record, briefly

Before I get to vaccines and the question MAHA most cares about, the credential summary, because the press has not laid this out cleanly.

Saphier was born in Phoenix in 1982 and raised in Scottsdale. Her father is an attorney; her mother is a licensed counselor who worked with children who had experienced abuse and mental illness. She did her bachelor’s at Arizona State University, then went to Ross University School of Medicine in Dominica for her MD, graduating in 2008. From there she did a five-year diagnostic-radiology residency at Maricopa Integrated Health Systems in Arizona, then a subspecialty Oncologic Imaging Fellowship at Mayo Clinic Arizona with a focus in breast imaging. She is a diplomate of the American Board of Radiology.

Her current position is Director of Breast Imaging at Memorial Sloan Kettering Cancer Center’s Monmouth, New Jersey facility, with concurrent service as Interim Director of Breast Imaging at MSK Basking Ridge. She has a substantive peer-reviewed publication record, co-author on multiple papers in the radiology and oncologic-imaging literature, including recent work on artificial-intelligence applications in breast MRI, deep-learning approaches to breast-imaging triage, and image-guided localization techniques.

She also has the advisory-and-policy work that a serious Surgeon General nominee needs to have. She has served on the CDC’s Advisory Committee on Breast Cancer in Young Women. She sits on advisory committees to the New Jersey Department of Health. She is on the executive and legislative committees of the Radiological Society of New Jersey.

Some critics will note that Ross University is a Caribbean medical school and that this is “lower tier” than the Ivy League pipeline. I would urge MAHA readers not to make that argument. The Caribbean-medical-school path is one of the most common pathways into American medicine for first-generation and non-traditional students, and Saphier’s subsequent career: five-year residency, Mayo Clinic fellowship, MSK directorship, board certification, peer-reviewed publications, is the record of a serious cancer specialist. The Ross University detail will appear in critical coverage; the appropriate response is the documentary record of what she did after.

The personal-biography element that will recur in coverage is that she had her oldest son in high school, kept the pregnancy, and has framed the experience publicly as her own decision to choose life rather than abortion; a framing she has connected to her broader advocacy on patient autonomy and personal responsibility. She is married to Dr. Paul Saphier, an endovascular neurosurgeon. They have three sons together.

She has been a Fox News Channel medical contributor since 2018, with regular appearances on Fox & Friends, The Five, Outnumbered, and Mornings with Maria, and occasional commentary on Fox Business and MSNBC.

The vaccine question, told straight

This is the part MAHA readers care about most, and it is the part where Saphier’s record is most genuinely mixed. I want to lay it out as it is, not as either side of the coalition would prefer to read it.

In February 2021, Saphier wrote a Fox News opinion piece supporting the Pfizer and Moderna mRNA COVID-19 vaccines for elderly and high-risk populations. She cited the Israeli population-protection data, by then the Israeli health ministry was reporting that the mRNA vaccines were 98.9 percent effective at preventing COVID-19 death among elderly populations, and made the case that prioritizing the elderly and long-term-care populations was the right epidemiological allocation. She was not equivocating on the vaccines for those populations. She supported them.

In October 2022, when the Biden White House and CDC were pushing the bivalent COVID-19 booster as the answer for healthy children ages five and older, Saphier turned hard against the recommendation. She went on Fox News and called the booster rollout “a political stunt.” She argued that the safety and benefit data did not support universal pediatric administration, that ninety percent of children had already either had COVID or been previously vaccinated, that natural immunity was widespread, and that the demonstrated risk-benefit calculation for healthy young people did not support the recommendation. This was not a fringe position; it was substantially the same critique that came from Marty Makary, Vinay Prasad, and Jay Bhattacharya during the same period. But it is on the public record under her byline, in her own words, in 2022.

In February 2025, during the West Texas measles outbreak, Saphier did a Fox News Digital piece on MMR that is the single most relevant documentary item for understanding her current position. She endorsed the MMR vaccine as “important and lifesaving.” She also said that for parents who are concerned, it is acceptable to delay specific shots through the developmental window during which signs of autism would typically present, roughly ages one to three, so that parents can make their own decision with their pediatrician. She framed the conversation as one that should be between doctor and patient, and said that during COVID the CDC and many healthcare professionals “really took away” that conversation. And in the same piece, she expressed hope that the MAHA movement’s vaccine-safety-surveillance work would “give parents the confidence they need to continue with the vaccine programs.”

Read as a totality, the position is what I would call moderate-MAHA. She is pro-individual-vaccine on the merits. She is supportive of parental autonomy on schedule. She is critical of universal pediatric mandates absent benefit data. She is explicitly sympathetic to MAHA’s vaccine-safety-surveillance reform agenda. She is not, in any reading I can construct from the documentary record, an anti-vaccine voice in the medical-freedom register that, say, Children’s Health Defense operates in. She is also not, in any reading I can construct, a CDC-establishment-defending voice of the kind Cassidy is looking for.

Whether that is enough for Cassidy is the operative question. My honest answer is that I do not know. The COVID-pediatric-booster criticism is going to come up at her hearing. The “political stunt” line will come up. So will the autism-developmental-window framing. Cassidy is going to want to know whether she would, as Surgeon General, recommend MMR universally on the existing CDC schedule, and what she would say about a parent who chose the delay-through-the-autism-window path she has publicly endorsed. She has answers for those questions. Whether they are the answers Cassidy wants is what we are about to find out.

What the nomination signals

If you read the press coverage straight, the story is: MAHA’s Surgeon General pick failed; the administration retreated to a Fox News pick to get the seat filled. There is something to that reading, but it misses what is actually interesting.

The nomination does several things at once.

It preserves the chronic-disease-and-prevention framework that has been the most popular part of the MAHA agenda. Saphier wrote a book about it. Her appointment is a signal that the Surgeon General’s office, under this administration, is going to be organized around that framework regardless of who occupies it. That matters for the food-and-chemical regulatory work, for the medical-school nutrition-training initiative, for the Dietary Guidelines posture, and for the broader public-communications register the office sets.

It moves the vaccine question off the front of the Surgeon General’s portfolio. Casey Means’s nomination put vaccines at the center of the confirmation fight, and the Senate Republicans most committed to the existing vaccine paradigm — Cassidy, Murkowski, Collins — refused to advance her. Saphier’s record is mixed enough on vaccines that it is harder to organize a “this nominee will undermine American vaccination rates” objection around her. That is a tactical retreat, but it is also a recognition that the Surgeon General’s office is not, structurally, the right tool for the vaccine reform fight. Vaccine policy runs through ACIP, CDC, FDA, and the litigation in AAP v. Kennedy. The Surgeon General sets public-communications register. Putting a moderate-MAHA radiologist in that seat is not the loss the framing presents it as.

It also gives the administration a Surgeon General with a mainstream-credentialed cancer specialty, which is the kind of credential that travels well in mainstream press coverage and in physician-community engagement. The mainstream-medical community is not going to embrace this nomination — they will note the Ross University degree and the Fox News record, and the editorial pages will run their usual coverage. But Saphier’s clinical work at MSK is real, her peer-reviewed publication record is real, and her advisory-committee history is real. These are not small things. The press shop will be working with stronger material than they had on Means.

The hard question, on the MAHA side, is whether the chronic-disease-and-prevention framework Saphier brings, distinct from Kennedy’s environmental and pharmaceutical-capture framing in its specific causal emphases, counts as a continuation of the agenda or as a narrowing of it. The honest answer is that it is some of both. The food-and-chronic-disease half of MAHA is fully consistent with the framework Saphier was already articulating in 2020. The vaccine-policy half, the medical-freedom register, and the environmental-toxin and pharmaceutical-capture critiques are not her register. She will not, as Surgeon General, be the voice for those parts of the agenda. That work runs elsewhere in the department, and it has run elsewhere in the department for the entire fifteen months of this administration.

What I am watching

A few things are going to tell us, over the next sixty days, what this nomination actually means in practice.

The first is whether Cassidy schedules a hearing. He did not schedule a vote on Means; he scheduled a hearing and let it die. Whether he treats Saphier the same way will be the immediate signal. The Trump Truth Social attack on Cassidy was unusual in its directness, calling Cassidy “very disloyal,” referencing the 2021 impeachment vote, endorsing Cassidy’s primary challenger Julia Letlow, and Cassidy’s response will tell us whether he is willing to be the Republican senator who blocks a second consecutive Surgeon General nominee. The political math has changed since February. Cassidy is in a primary fight, and the calculation that protected him through the Means hearing may not protect him through the Saphier hearing.

The second is what Saphier says about MAHA at her hearing. She has been sympathetic in her published commentary, but the confirmation register is different from the Fox News register, and she has not been asked, on the record, the questions a Senate hearing will put to her. Will she defend the Kennedy ACIP reform record? Will she defend the AAP v. Kennedy injunction-stay litigation? Will she defend the September 22 acetaminophen and folinic-acid announcements? These are not the Surgeon General’s portfolio in the strict sense, but they are the questions the hearing will use to test her relationship to the rest of the department. Her answers will tell us how she will function alongside Kennedy.

The third is what happens with the AAP v. Kennedy appeal. The federal government filed its Notice of Appeal yesterday morning, sixteen days before the appellate window expired. The government’s posture toward the appeal — whether the administration treats the First Circuit as a serious recovery opportunity or as an institutional minimum required to preserve the record, will tell us how committed the administration remains to the original ACIP restructuring. Saphier’s nomination, on the same day, sits inside that broader administrative posture. If the administration is treating both the appeal and the Surgeon General nomination as commitments to be defended on the merits, that is one reading. If the administration is treating both as institutional housekeeping, that is a different reading. I do not know yet which it is.

A note on the register I am writing in

Some readers have asked me, on Substack and on X, why I do not write in the harder register some MAHA voices use. The answer is the one this piece embodies: the documentary record on Saphier is mixed in ways the harder register cannot accommodate. She is not the MAHA Warrior the administration nominated when it nominated Means. She is also not the establishment-physician sellout the harder register would have to make her in order to dismiss the nomination. She is a credentialed cancer specialist who wrote the MAHA case under the MAHA title five years before MAHA was a political brand, who has a mixed but defensible vaccine record, who is sympathetic to the parts of the MAHA agenda that have the broadest public support, and who is going to be the third Surgeon General nominee the administration tries to push through a Republican Senate that has already refused two.

That is the actual situation. The right MAHA response is to look at it clearly, support what is supportable, ask the right questions at the hearing, and reserve judgment until the record on the floor is fuller than the record we have today.

The chronic-disease epidemic in American children is not going to be solved by any Surgeon General. It is going to be solved by the broader political and cultural realignment that the MAHA movement is one part of. Saphier, on the documentary record, is part of that realignment. Whether she is the right person for this particular seat at this particular moment is the question her confirmation hearing is about to test.

I will be watching, and I will write more when there is more to say.

There’s a particular kind of book that arrives at exactly the right cultural moment, and Shira Boehler’s One Scan Saved My Life is one of them. A healthy, forty-three-year-old mother of four — a runner, a never-smoker, the daughter of a pulmonologist — gets blindsided by stage I lung adenocarcinoma. The only reason she’s alive to tell us about it is because her husband nagged her into a preventive scan that wasn’t covered by insurance, wasn’t recommended by any guideline, and wouldn’t have happened at all if she’d left her care entirely to the system. If that doesn’t crystallize the case for taking your health back into your own hands, nothing will.

For readers sympathetic to the Make America Healthy Again movement, this book is going to land with unusual force, and the reasons are worth spelling out plainly.

The story itself is the argument. Boehler did everything “right” by the conventional playbook. She ran six miles a day. She ate well. She avoided cigarettes — her dad, a pulmonologist, drilled that into her. She kept up with her annual scans for the cancers women are told to worry about. And a tumor was still growing in her lung that, on the trajectory she was on, would likely have killed her by the time symptoms appeared. The federal screening guidelines — the USPSTF criteria that gatekeep insurance reimbursement — would never have caught her, because they were built around a 20-pack-year smoker stereotype that increasingly fails to describe who is actually getting this disease. A full quarter of lung cancer deaths now occur in never-smokers. Two-thirds of newly diagnosed lung cancer patients don’t qualify for screening under current rules. Boehler quotes a Northwestern study showing exactly that, and the implication is unavoidable: the system isn’t catching the people it’s killing.

That’s a deeply MAHA-resonant indictment, and Boehler makes it without political theatrics. She isn’t picking a fight — she’s just telling the truth about what the data show.

On environmental causes, the book is better than most. Conservative and MAHA readers who’ve grown weary of the pharmaceutical-industrial framing of every illness will appreciate that Boehler takes radon seriously as the second-leading cause of lung cancer and the leading cause in never-smokers — a fact most Americans have never heard, and one the public health establishment has been remarkably quiet about. She walks readers through home testing, mitigation systems, and the patchwork of state disclosure laws. She covers occupational and household exposures: asbestos, silica, vinyl chloride, cooking-fume aldehydes, particulates from unventilated stovetops. She raises the unanswered question of why Asian-American never-smoking women are getting lung cancer at higher rates than their cigarette-smoking male relatives — a genuine mystery that suggests something environmental, hormonal, or genetic that mainstream research has been slow to chase. This is the kind of curious, root-cause thinking MAHA has been calling for, and it’s a welcome change from “take this pill, don’t ask questions.”

The endorsement page tells you who’s paying attention. This isn’t a partisan book. Tony Robbins is on the praise page next to Andy Slavitt (Obama’s CMS head) next to Dr. Mehmet Oz (Trump’s CMS administrator). In her acknowledgments, Boehler thanks Secretary Kennedy and Stephanie Spear directly, writing that they showed her “prevention is not a partisan issue, it is an American issue.” That sentiment is the whole game. When a 43-year-old never-smoking mother of four walks into a fight for early detection and finds RFK Jr., Dr. Oz, the previous administration’s officials, and CEOs all picking up the phone, that’s a coalition worth noticing. Skyhorse Publishing — RFK Jr.’s longtime publisher and one of the few houses willing to put out heterodox health and policy titles — putting this book out is itself a small data point about where the energy is in this conversation.

What conservative readers will love most: she trusts patients. The book’s spine is the conviction that you, the patient, have to advocate for yourself — and that the spouse, parent, or friend who pushes you toward a scan you don’t want may be the person who saves your life. Boehler’s husband is the hero of the opening chapters precisely because he refused to accept her “I’m fine, leave me alone” pushback. There is something deeply countercultural about a book that says: doctors miss things, guidelines are years behind, and your family’s instincts about your body matter. That’s the kind of common sense the medical establishment has spent decades training out of people, and it’s refreshing to see it championed by someone who grew up in a house full of physicians.

The book also takes the stigma issue seriously in a way that should resonate with anyone who’s watched the public-health apparatus moralize at ordinary Americans. Boehler is candid that lung cancer is treated as a “deserved disease” — the assumption being that anyone who gets it must have brought it on themselves through bad behavior. Her friend Donnita Butler, an Air Force and Navy veteran who battled smoking addiction while raising two boys alone in rural Maine (a radon hot zone, no less), offers some of the most honest writing in the book about how that contempt actually plays out for working-class Americans. Conservative readers who have been watching progressive public-health culture lecture rural and lower-income communities for a decade will recognize this dynamic immediately.

Now, the harder part — where MAHA readers may want to apply healthy skepticism.

The book’s policy ask leans heavily toward expanded federal screening programs and insurance mandates, holding up Australia’s centrally administered national lung-screening program as the model. This is where instincts will diverge. Universal screening genuinely does save lives — the data on stage-I detection are overwhelming — but a reader committed to medical freedom and limited government will want to ask: do we get there by expanding CMS coverage and leaning harder on USPSTF rules, or by lowering the cost of cash-pay scans, deregulating mobile imaging, and letting the market deliver $200 LDCTs the way it delivered urgent-care clinics? Boehler raises both possibilities but is more comfortable with the centralized solution than some readers will be.

There’s also a tension worth naming around the wellness-tech angle. The story begins with a $1,000-to-$5,000 full-body Prenuvo-style MRI, and the praise page features the CEO of Function Health — companies whose business model depends on bypassing insurance and selling preventive scans directly to people who can afford them. For MAHA readers, this cuts both ways. On one hand, it’s a beautiful illustration of what happens when patients can pay cash for the care the system denies them — a free-market success story embedded in a memoir about institutional failure. On the other, the book sometimes blurs into something close to advertising for premium concierge medicine, and an honest reader has to acknowledge that the same scan that saved Shira Boehler’s life is financially out of reach for the rural single mother she’d most like to help. Boehler clearly knows this — she comes back to access and equity repeatedly — but the resolution she offers (have insurance cover it) is one path, not the only one.

A few smaller notes. The radon and environmental chapters are strong but could go further; readers attuned to broader environmental-health concerns may wish she’d dug into air pollution, particulate exposure from gas stoves, and indoor air quality more aggressively. The chapter on biomarker and blood testing is genuinely exciting — Galleri-style multi-cancer early detection assays really are coming, and they may eventually do for cancer what home pregnancy tests did for obstetrics — but readers will want to keep an eye on how the FDA approval pathway and insurance mandates around these tools shake out, because that’s where bureaucratic capture tends to happen.

The bottom line. This is a brave, well-reported, and uncommonly readable book about a disease most of us have been quietly assuming we don’t need to worry about. Boehler is an unusually likable narrator — funny, self-deprecating, openly terrified, pragmatic — and she’s done the homework: dozens of interviews with surgeons, radiologists, epidemiologists, and survivors, with citations to back it up. For a conservative or MAHA-aligned reader, the most valuable takeaways are not the policy recommendations but the underlying convictions: that prevention matters more than treatment, that early detection should be normalized for everyone (not just smokers), that environmental exposures like radon deserve far more public attention, that patients and their families need to advocate aggressively because the system won’t, and that the federal screening guidelines we’ve inherited are badly out of date for the disease as it actually presents in 2026.

If you take one thing from this book, let it be the practical one: get a radon test for your house this week, ask your doctor about a low-dose CT if you have any reason at all to be concerned, and don’t let an outdated guideline talk you out of a scan you can afford to pay for out of pocket. As Boehler herself puts it, cancer doesn’t care about your demographics, your lifestyle, or your assumptions. The least we can do is stop pretending it does.

Recommended, with the caveats above, for anyone who believes American health policy is overdue for a rethink — and for anyone with lungs.

Available for purchase on Amazon at this link.

In 2021, Congress passed an infrastructure law, and inside it sits a requirement that future vehicles include technology capable of detecting impaired driving. The stated goal is simple. If a driver is drunk or clearly unsafe, the vehicle should be able to prevent operation. That is the mandate. It does not authorize remote control, and it was signed by Joe Biden, not Donald Trump.

The way this shows up is not as a single device but as a stack of systems that already exist. Cameras inside the cabin track your eyes, your face, your attention. Sensors read steering inputs, braking patterns, and lane position. Newer systems are being built to detect alcohol passively through breath or even through your skin on the wheel. The car is no longer just a machine you operate. It is a system that watches you, evaluates you, and increasingly decides whether you are fit to use it.

Call things by their proper name. This is not a switch someone flips from afar. This is a shift from mechanical control to software governance. The car becomes an intermediary between you and your own mobility.

At first, it arrives quietly. It starts in higher-end vehicles and works its way down. It is marketed as safety, convenience, and common sense. Insurance companies offer discounts if you agree to monitoring. Most people say yes. Why not save a few hundred dollars? Over time, the discount becomes the baseline. Opting out starts to cost you. Driving an older car, free of monitoring devices, will cost you, or maybe even make you uninsurable. The “choice” remains on paper, but in practice it fades.

This is a slow ratchet. The frog put in a pot of water as the heat is slowly turned up. Before he knows it and can jump out, he has been boiled alive. Control does not have to be imposed directly when it can be engineered through incentives. If your premiums, your financing, and eventually your access to services and cars depend on how a system scores your behavior, then the system does not need a kill switch. It already has leverage.

Private companies are central to this. Insurers like Progressive Corporation and Allstate are already building models around continuous driver monitoring. Today, it is framed as a discount program. Tomorrow, it becomes a pricing standard. You are free to opt out in the same way you are free to pay significantly more. That is not coercion in the legal sense, but it is pressure in the real world. Is it just a matter of time before “vintage” cars require higher premiums or are even uninsurable?

This is where the constitutional layer matters, and also where many people misunderstand it. The United States Constitution and the Bill of Rights were designed to limit government power, not the reach of private corporations. If a manufacturer installs monitoring in your vehicle and you agree to it through a contract, you are not dealing with state action in the traditional sense. That means many of the Constitutional protections people assume are there do not apply in a straightforward way.

The Fourth Amendment protects against unreasonable searches and seizures by the government. It does not shield data that you have allowed a company to collect. That becomes especially important if that data is later accessed by law enforcement.

Courts have pushed back on warrantless tracking in some contexts, but the boundary between private data and government access continues to be eroded by Congress and the courts.

The Fifth Amendment raises a different issue. If your own vehicle is recording behavior that could be interpreted as impairment or unsafe driving, and that data is later used against you, the line between observation and self-incrimination begins to blur. Again, not settled law, but not a trivial question.

There is also a quieter risk that has nothing to do with policy and everything to do with data. Once you normalize continuous in-cabin monitoring and behavioral scoring, you create a stream of highly personal information that has value well beyond safety. That makes it a target. If that data is hacked, leaked, or sold, it does not take much imagination to see how it could be misused. Detailed records of where you drive, how you behave, and even how you look or react behind the wheel could be exposed publicly or used to pressure, embarrass, or coerce.

Even without a breach, interpretation is not neutral. A medical event, a panic response, or a real threat, such as a carjacking, can appear to an algorithm as impairment. Stress, confusion, or erratic movement under duress may be flagged as unsafe driving.

The deeper problem is not any single amendment. It is the gradual erosion of autonomy through systems that operate just outside the traditional constraints of the Constitution. You do not need a new statute to restrict behavior if you can shape incentives or even mandates, so that companies can get people to restrict themselves.

A great deal can happen through contracts, pricing models, and industry standards. Private actors can create a system where monitoring is technically voluntary but practically unavoidable. Where opting out carries a real cost. Where data collected for safety quietly becomes data used for pricing, for liability, for access.

The space between direct government control and pure private choice is wide, and it is in that space that this system is likely to evolve.

The fork in the road is still ahead. In a constrained version, these systems stay focused on clear impairment, and the data remains tightly limited.

In the more likely version, the data layer expands because it is valuable, and once something is valuable, it is rarely left unused or monetized.

The mistake is to look for a dramatic moment when control arrives. It does not work that way. It accumulates. A discount here, a requirement there, a default setting that most people never change. Over time, the relationship between you and your vehicle is no longer direct. It is mediated by software, data, and incentives.

The real question is not whether someone can flip a switch and stop your car. It is whether you still meaningfully control the terms under which you are allowed to drive it.

Representative Thomas Massie moved to force the issue directly, not with rhetoric or a direct overhaul of the bill, but with a funding cutoff. In January 2026, he introduced an amendment to the federal spending bill (H.R. 7148) that would have prohibited any federal funds from being used to implement or enforce the impaired-driving technology mandate buried in the 2021 infrastructure law. In plain terms, it was a defunding effort. No money, no rollout. The amendment failed, 164–268, which means the mandate continues forward on its current path.

What makes that vote politically revealing is not just that it failed, but who helped defeat it. Fifty-seven Republicans joined 211 Democrats to vote against Massie’s amendment and keep funding in place. Among the Republicans who voted no were names that span the party’s establishment wing, including Mark Amodei, Don Bacon, Stephanie Bice, Ken Calvert, Tom Cole, Mario Diaz-Balart, Brian Fitzpatrick, Andrew Garbarino, John James, Mike Kelly, Jen Kiggans, Mike Lawler, and Frank Lucas, among others. You can see the full official roll call here: House Roll Call Vote 43 (H.R. 7148 Amendment)

That vote tells you everything you need to know. The fight is not hypothetical. It is happening in appropriations bills and procedural votes, where programs live or die. And when push comes to shove, a nontrivial bloc of Republicans is willing to keep the funding stream intact, even for a program that is a step toward expanded monitoring inside privately owned vehicles.

The word RINO gets thrown around too easily. But here the line is not rhetorical. It is clear. Those Congresscritters who stand in the way of personal freedom are the same ones who treat the Bill of Rights as a relic instead of a constraint.

JGM

Why Substack hates Malone News … and me

There is a simpler explanation than most people want to admit, and it has very little to do with subscriber counts, writing quality, or even real-world influence.

It has everything to do with signaling.

Over the weekend, Substack hosted its high-profile “New Media Party” during White House Correspondents’ Dinner weekend. This was not just another cocktail gathering. It was a carefully curated room. A statement about what “new media” is supposed to look like when presented to Washington, to legacy press, and to power.

And that is where the disconnect begins.

The Malone News subscription base is large by any reasonable metric. Hundreds of thousands of subscribers. Deep engagement. A loyal readership that does not just skim headlines but actually reads, shares, and acts. By the numbers, it sits comfortably in the upper tier of the platform.

But that is not the currency being spent in a room like that.

The real currency is legibility to the system.

The invite list tilted toward a specific type of writer. Former legacy and mostly journalists who migrated to Substack but still speak the language of institutions and don’t advocate too strongly for conservative principles. Who was invited? Policy and tech commentators who circulate comfortably in think tanks, venture circles, and media panels. Creator personalities who bring energy without bringing risk. And, perhaps most importantly, people who are already embedded in the Substack social network, cross-promoting, collaborating, and showing up in the same rooms, over and over again. Promoted substackers that feature a familiar frame of reference over content.

I am not alone in being isolated from Substack promotions. Jeffrey Tucker, Alex Berenson, and I are three accounts that two independent AI analyses identified as outside the inner circle and not receiving amplification from the Substack leadership. This is just another form of shadow-banning of those who speak truth to power. So, what else is new?

This is not accidental. It is brand construction.

Substack is trying to tell a story about itself. Not as a rebellion, but as an evolution. Not as a break from the system, but as its next iteration. The platform wants to be seen as the future of journalism, not its adversary.

That story requires a certain kind of protagonist.

Writers who challenge institutions in controlled, acceptable ways can be featured. Writers who question assumptions while remaining inside the bounds of polite discourse can be elevated. Even contrarians are welcome, as long as they remain within a range that does not disrupt the room.

But there is a line.

And Malone News sits on the other side of it.

The publication is not just “heterodox.” It is openly adversarial to major public health narratives, to pharmaceutical industry practices, and to the institutional frameworks that dominated the COVID era. Whether one agrees with those positions or not is almost beside the point. What matters is how they are perceived in a high-visibility, mixed-audience environment.

In that context, the issue is not reach. It is risk.

A curated event tied to the White House Correspondents’ Dinner is not the place where organizers experiment with reputational ambiguity. The goal is a room that feels coherent, controlled, and aligned with the image being projected outward. That means minimizing the chance of friction, controversy, or uncomfortable conversations that could spill beyond the venue’s walls.

So the filtering happens quietly.

Not through public criteria. Not through transparent standards. But through network pathways, personal connections, and an unspoken understanding of who fits the narrative and who does not.

There is another factor that matters more than most people realize. The social graph.

Substack is not just a publishing platform. It is a network. Invitations tend to flow through that network. Writers who collaborate, who appear on each other’s podcasts and broadcasts, who share audiences and relationships, naturally end up in the same physical spaces. Those who operate outside that web, even if they are larger or more influential in absolute terms, often remain invisible when lists are made.

Malone.News has a large audience, but it is not deeply interwoven with the Substack-to-Substack ecosystem or the Washington media circuit. It operates in a parallel lane. That independence is a strength in one sense, but it comes with a cost in environments that are driven by proximity and familiarity. In other words, the insider club.

Put all of that together, and the outcome is predictable.

It is not that Substack “hates” malone.news in any literal sense (they apparently just hate their politics). That framing is emotionally satisfying, but analytically incomplete. What is really happening is more structural.

The platform is curating a version of “new media” that is:

• Connected to existing power centers

• Acceptable within institutional frameworks

• Networked within its own internal ecosystem

• Safe enough to showcase in front of Washington

Basically, they are recreating the old media, just on a newer, more hip social networking platform.

Malone News does not check those boxes. Not because it lacks influence, but because it represents a different kind of influence. One that is less dependent on institutional validation and less interested in maintaining alignment with it.

And that kind of independence does not translate well into curated rooms designed for signaling.

The irony is that exclusion from that room does not indicate weakness. It indicates the opposite. A different audience. A different network. A different center of gravity.

In the end, the question is not why Malone News was not invited, we all know why.

The question is what kind of media ecosystem requires that kind of filtering in the first place?

The new media ecosystem. Same as the old media ecosystem.

Did you expect anything different?

RWM/JGM

I glanced at the headlines this morning on Google and saw a pattern - not a single MSM "news" outlet called this an assassination attempt or even an "alleged" assassination attempt.
Instead, this is what is in the headlines: "alleged" gunman, "shooting suspect," "shooter," and "dinner gunman."
The propaganda and spin never end.

Case in point - The Washington Post is still evil.

Is that a paper or a cloth mask on Taylor Lorenz? It makes a difference, as one is so much better than the other, right?

Cause we all know that cloth looks so much classier when wearing formal attire - paper just looks cheap. (snigger).

Credit where credit is due, President Trump won the battle of the genders for us…

“Murder chicken” - well, we had a rooster like that once.

Robert flew out from Dulles Airport on Friday, spoke at the Autism conference in San Diego and flew back on a red-eye, arriving here at 6:30 AM today. Thirty-six hours of stress - and if anyone asks, no he doesn’t usually get paid for doing events. It is his way of being a good citizen and giving back.

When he wasn’t involved in the conference, he was putting the finishing touches on a manuscript.

As I write this, he is now out feeding the farm family.

For being an “old-man” - his stamina is amazing. But then he never stops pushing himself. Staying busy, mentally engaged, and active are important elements to staying young in the heart and mind.

Anyway, super glad to have him home. Feeding the horses, cattle and poultry in the rain by myself yesterday was a b*tch!

With gratitude for him and all of you - my community in the comments section,

JGM

Not everyone can grow their own food, and even committed gardeners and homesteaders cannot produce everything they need. Sourcing is the bridge: the set of choices you make when you buy rather than grow.

Below are some concrete ideas for improving your and your family’s diet and living a higher-quality life:

Find your local farmers. Farmers’ markets are the obvious starting point, but they are not the only ones. Many farms sell directly through CSA arrangements, roadside stands, on-farm stores, or informal networks of regular customers. Buying directly from a farmer you know and can ask questions of is categorically different from buying a product with a label that claims “farm fresh.” We buy a quarter of a cow at a time from a neighboring farmer whose practices we know and trust. The animal is grass-finished, processed locally by a small-scale butcher, packaged and labeled. A quarter cow lasts us nearly a year. The per-pound cost for high-quality, pasture-raised beef is lower than what we would pay for equivalent cuts at a specialty grocery store, and dramatically richer in terms of what we know about the animal.

Understand what the labels mean and do not mean. “Natural” has no regulatory definition in the United States and conveys nothing about how an animal was raised. “Free range” for poultry requires access to the outdoors but does not specify how much access or what the birds ate. “Grass fed” without “grass-finished” may describe an animal that grazed early in life and was fed grain for the last months before slaughter, which is when the fat profile of the meat is largely determined. “USDA Organic” prohibits synthetic pesticides and antibiotics and requires outdoor access for livestock, but does not mandate a particular diet or stocking density. None of these labels are worthless, but none should be mistaken for guarantees. The closer you can get to knowing the farmer, the less you need to decode the label.

Build a pantry that reduces dependency on convenience food. Much of what drives ultra-processed food consumption is not preference but logistics. People reach for a box of cereal or a bag of chips not because they want it more than real food, but because it is there and the alternative takes effort they do not currently have. The solution is changing what is in the house. A well-stocked pantry centered on whole ingredients (dried legumes, organic grains, canned tomatoes, quality olive oil, nuts, frozen vegetables, meat in the freezer) eliminates most of the scenarios in which processed food is the path of least resistance.

Buy organic for the highest-risk categories. If a full organic diet is not financially feasible, prioritize the items where the case is strongest, given glyphosate use patterns. Conventionally grown oats, wheat, chickpeas, and lentils are among the crops most routinely treated with pre-harvest desiccant applications. Conventionally grown soy and corn are almost universally from herbicide-tolerant varieties and carry correspondingly higher residue profiles. For these categories, the cost premium for organic is worth paying.

A note about Stevia:

Robert and I rarely use sugar these days, but we do love sweet, iced tea. I use stevia as a single-ingredient sweetener: “Micro Ingredients Pure Organic Stevia Powder," which I buy on Amazon, since most grocery shops don’t carry it. As it is pure, it takes about an 1/8th of a teaspoon to sweeten a cup of liquid.

Why you might ask, does this matter?

Most of what is sold as “stevia” these days is not a crushed leaf from Stevia rebaudiana but a highly refined extract blended with other ingredients so it looks and behaves like sugar in a teaspoon. That is where the story gets interesting. To tame the intensity and bitterness, manufacturers bulk it out with things like erythritol, dextrose, maltodextrin, or fibers such as inulin. In other words, you are not really buying a plant, you are buying a formulation. None of these additives are there by accident. They are there to make it pour, measure, and taste like sugar, because pure stevia extract on its own would have you wondering what just happened to your coffee.

Now, from a regulatory standpoint, these additives generally clear safety thresholds. But that does not make them metabolically irrelevant. Dextrose and maltodextrin can raise blood sugar, which is a bit ironic for a product marketed as a sugar alternative.

Sugar alcohols like erythritol have been treated as the “clean” option for years, but more recent data have raised questions about potential links between higher circulating levels and cardiovascular risk, including clotting pathways. That is not settled science, but it is enough to make one pause before dumping it into everything from morning coffee to evening dessert. And for some people, erythritol also comes with the less glamorous side effect of gastrointestinal distress, which tends to be a fairly reliable teacher.

Another ultra-processed product wearing a health halo

So the issue is not that stevia is inherently dangerous. It is what we call stevia that has often become another ultra-processed product wearing a health halo. If your goal is to avoid blood sugar swings and reduce reliance on processed inputs, many of these blends work against you in subtle ways. As with most things in nutrition, the dose, the context, and reading the label matter. If it looks like sugar, pours like sugar, and tastes like sugar, there is usually a reason, and it is not because it is just a leaf.

A final note about Stevia: I do have the gene that causes me to experience a bitter aftertaste. But over time, I have developed a tolerance for it, or maybe I have just had COVID one too many times and have lost much of my ability to smell...

Still, even I can taste that this particular brand of Stevia mentioned above truly has a milder aftertaste than most.

It does require a bit more mixing and definitely mixes better in hot liquid than cold. Still, having to mix it a bit more, is a small price to pay for ingesting a single-use ingredient, rather than an ultra-processed look-alike.

JGM

A few photos of the farm from yesterday:

The one-year-old peaboys have been let out of the coop and are now enjoying the big, bad world.

Oso, the protector of all things avian, finds them great company.

Prince Caspian, - papa of the above birds - in all his finery.

I will be spending the afternoon doing one last round of edits of our new book, as the publisher’s editor has now completed her edits.

Our big news is that the book will be for for Amazon pre-sales on Monday!

JGM

We live near Charlottesville, and were deeply affected by the rallies/marches and riots there. The car ramming into a crowd, causing the death of the young college student, was profoundly disturbing. I can still see that video in my head.

Yet, it was the lies they told about President Trump and his remarks regarding C-ville, being edited by almost all mainstream media, that raised more questions about how truthful the MSM really is.

Then came the SPLC indictment this week.

So, if you are already red-pilled, as we are, about what happened, reading Steve Cortes’ account below of his time at CNN during this period and how they managed to silence him regarding the Charlottesville incident takes it a step further.

From the article:

So…the end result is that America endured years of propaganda that convinced a large segment of the population – in contravention of the facts – that their president supported violent hate merchants. Even worse, masses of unskeptical Americans, who consume only legacy media content, believed that the entire America First populist movement was based on bigotry, rather than patriotism.

Now, nearly a decade later, the truth is revealed about the deception that lay beneath that grand lie. There was a layer of duplicity here that is almost difficult to fathom. Only true Marxists could excuse this level of propaganda. The SPLC created hate groups and activities like the Charlottesville rally, and the complicit media then weaponized these concocted offenses by spreading outright lies about Trump’s reaction to the staged events.

I myself played a role in this saga regarding Charlottesville, best explained by a timeline:

March 2019 – After more than a year serving as a contributor on CNN, I grew tired of the near-nightly lies told about Charlottesville during the primetime hits when I was on-air. I tried my best to debunk the myth, but was routinely shouted down, and even “benched” for short periods for daring to tell the truth. So…I wrote a column at RealClearPolitics with the exact Trump transcript and precise citations.

April 2019 – Joe Biden launched his 2020 presidential campaign based entirely upon the Charlottesville lie, claiming that the “bulging veins” of the racists convinced him to run for the White House.

August 2019 – Dennis Prager had read my RealClearPolitics article and had me on his radio show repeatedly to discuss what we branded as the “Charlottesville Hoax.” He also asked me to narrate a five-minute video for his online platform, PragerU, debunking the hoax, which went mega-viral, with well over 10 million total views.

September 2019 – CNN removed me from the air. Rebecca Kutler, now the head of MSNOW and then the director of talent at CNN, expressly told me that the permanent “benching” was because of the Charlottesville video, even though I was clearly allowed to make such online videos, per the terms of my contract. I asked to be released so that I could do TV elsewhere, and she refused. In other words, they paid me to be silent, to stay on the sidelines.

December 2019 – I was released from CNN.

June 2024 – Supposedly objective “fact-checking” site Snopes finally admits the clear reality of the full transcripts and video evidence that Trump never praised bigots at Charlottesville.

April 2026 – The Southern Poverty Law Center was indicted for millions of dollars in secret payments to racists to foment and organize racial unrest and events, including the Charlottesville event itself.

This entire sad saga matters. First, it unveils the systemic duplicity of the left in America. Because their demand for “hate” far exceeds the actual supply, they had to pay to manufacture bigotry, so that they then could oppose it. Second, the record reveals that lies build upon lies, while the truth remains, inherently, emancipating.

Whatever any citizen thinks of Donald Trump, the entire madness of Charlottesville represents a preventable and despicable tragedy. The actions of the SPLC were criminal and mafia-like. A young woman, Heather Heyer, lost her life because of this mayhem. More broadly, millions of Americans bought into an insidious lie and believed it for years, doing grave damage to the cohesion of our society. Only a full accounting, now, can begin the process of healing and truth-telling.

Next month, will be heading out to Louisiana for Robert to speak at a Citizens for a New Louisiana event on May 11th.

Please consider joining us - the organizers of this group include people who have fought hard against mandates and for vaccine choice. These are the people that convinced Bobby and myself to fly out to Baton Rouge on multiple occasions in 2021 and 2022 to speak truth to power in the state house. Their and all of our work changed the minds of state legislators on these issues, helped get Gov. Landry elected and so much more.

EVENT TICKETS

JGM

While perusing the medical literature this morning, two newly published papers stood out as very important.

I have written a synopsis explaining why each is important, followed by the abstract itself.

Are Clouds a Neglected Reservoir of Pesticides?

Environ Sci Technol . 2025 Oct 14;59(40):21579-21588.

doi: 10.1021/acs.est.5c03787. Epub 2025 Sep 8.

Synposis: This paper takes a step back and asks a deceptively simple question. Where do pesticides actually go after we spray them? The answer, it turns out, is not just soil and water. The authors point to clouds as an overlooked reservoir. Pesticides can evaporate, hitch a ride on atmospheric particles, and end up in cloud water, where they persist and undergo chemical changes. From there, they do not just disappear. They can be transported long distances and eventually fall back to earth in rain, effectively redistributing agricultural chemicals far beyond where they were originally applied.

What makes this important is the implication. We tend to think of pesticide exposure as local and controllable. This work suggests it is far more diffuse and dynamic. The atmosphere is not just a passive conduit. It is an active chemical environment that can transform these compounds and extend their reach. In practical terms, that means ecosystems and populations far removed from direct agricultural use may still be exposed. It is a reminder that once these chemicals are released, they do not respect boundaries, and our current models of exposure may be underestimating both the scale and the persistence of the problem.

Abstract (from the paper)

Pesticide contamination is a growing and alarming concern for both the environment and human health. Widely used in agriculture to control pests and disease carriers, pesticides undergo extensive long-range atmospheric transport in the gas phase, in aerosols, and, as shown here, in clouds. We measured the concentration of 32 pesticides at the puy de Dôme observatory (France) in the sub μg L^-1 to μg L^-1 range in cloud water, largely arising from regional to long-range transport that also involves pesticides currently banned for agricultural use in France. Half of the samples showed a total concentration of pesticides of over 0.5 μg L^-1, which is the European drinking water limit. If 2,4-dinitrophenol, which can also be produced by photochemical reactions, is excluded, two samples still present a total concentration of over 0.5 μg L^-1. The frequent detection of pesticides in rainwater may thus depend on their presence in clouds as well as atmospheric washout. Estimates of pesticides’ quantity in clouds over France, ranging from 6.4 ± 3.2 to 139 ± 75 tons, suggest that their amounts in the cloud aqueous phase are potentially high and that these compounds would affect areas that are not directly impacted by agricultural activities.

Modifiable risk factors and risk of schizophrenia and bipolar disorder across severities of genetic risk

J Affect Disord. 2026 Apr 13:407:121800.

DOI: 10.1016/j.jad.2026.121800 , Online ahead of print.

Synopsis: This study tackles a question that comes up again and again in psychiatry: how much of serious mental illness is “genetic destiny,” and how much is influenced by the way we live? The authors looked at schizophrenia and bipolar disorder, and instead of treating genetics as all-or-nothing, they stratified people by genetic risk using polygenic scores. Then they asked a very practical question. Do modifiable factors still matter if your genetic risk is high? The answer, in short, is yes. Across the board, lifestyle and environmental factors such as metabolic health, substance use, and other behavioral risks were associated with increased odds of developing these disorders, and that relationship held even in people with higher genetic susceptibility.

What makes this work important is that it pushes back on a fatalistic narrative. Genetic risk is real, but it is not a fixed sentence. The data suggest that modifiable exposures can either amplify or mitigate that baseline risk. In other words, the trajectory toward schizophrenia or bipolar disorder appears to be shaped by an interaction between biology and environment, not dictated by DNA alone. For clinicians and patients, that is a meaningful shift. It implies that prevention and risk reduction are not theoretical. They are actionable, even in those who carry a heavier genetic load.

Abstract (from the paper)

Background: Schizophrenia (SCZ) and bipolar disorder (BD) are severe, globally prevalent mental illnesses, influenced by genetic and modifiable risk factors. The brain care score (BCS) is a validated tool comprising 12 modifiable factors across physical, lifestyle, and social-emotional domains, each linked to brain health. This study examines how BCS relates to SCZ or BD risk across different genetic risk levels, quantified by polygenic risk scores (PRS).

Methods: Using UK Biobank data, we calculated BCS and PRS scores, and identified incident SCZ and BD cases. Cox proportional hazards models evaluated associations between BCS and SCZ or BD risk. Interaction and stratified analyses assessed how this association varies across genetic risk levels. Contributions of BCS domains were also evaluated.

Results: Among 299,665 participants, 331 SCZ and 787 BD cases were identified over a median 13.7-year follow-up. In low-PRS individuals, higher BCS significantly reduced SCZ risk, particularly in lifestyle (HR = 0.87, P = 0.027) and social-emotional domains (HR = 0.47, P < 0.001). In high-PRS individuals, no overall BCS-SCZ association was observed, though the social-emotional domain remained protective (HR = 0.56, P < 0.001). For BD, low-PRS groups showed stronger BCS protection, especially in lifestyle (HR = 0.91, P = 0.017) and social-emotional domains (HR = 0.44, P < 0.001). In high-PRS groups, BCS protection was attenuated, but remained significant in the social-emotional domain (HR = 0.50, P < 0.001). Sensitivity analysis supported these findings.

Conclusion: Improving lifestyle and social-emotional health can significantly reduce SCZ and BD risk, with effects influenced by genetic risk. Enhancing social emotional health provides protective effects across all genetic risk levels, highlighting it as a key preventive measure.

JGM

The European Union is advancing a sweeping rewrite of its seed laws under the banner of Plant Reproductive Material regulation (PRM). We are told this is about modernization, safety, and disease control. That sounds reasonable until you look at what the policy actually does and who it benefits.

What it does is shift control. What it benefits is scale. And what it tells us, if we are paying attention, is a great deal about how power now flows in the Western world.

The Heart of the Matter: Subsidiarity

There is a principle older than the European Union, older than the American republic, older even than the modern nation-state. It holds that decisions should be made as close to the individual as possible. Catholics call it subsidiarity. Americans express a similar instinct through federalism and a preference for local control, or just common sense. It rests on a simple observation. The people closest to a problem usually understand it best, live with its consequences most directly, and have the strongest reason to get it right.

Agriculture is the perfect example. A farmer in Provence knows his soil, his climate, his pests, and his market in ways no official in Brussels ever will. A gardener in Bavaria who has spent twenty years selecting a tomato variety for her specific plot knows things that cannot be captured in any database. A smallholder in Sicily adapting a wheat cultivar to drought conditions is doing real work, and doing it better than any centralized authority could direct.

For ten thousand years, people have saved, selected, traded, and improved seeds through networks of farmers, gardeners and local breeders. This is not a quaint hobby. It is the foundation of agricultural civilization. Nearly every crop we depend on came from this quiet, decentralized work. The diversity in our fields and on our plates exists because millions of ordinary people, without asking permission from anyone, did the patient work of selection and exchange.

The Plant Reproductive Material regulation turns this ancient order on its head. It presumes that seeds must be authorized from above before they can circulate below. It treats the default activity of human agriculture, the saving and sharing of seed, as something requiring a permission slip from a bureaucrat. This is not a minor tweak. It is a philosophical reversal. It moves the presumption of legitimacy from the grower to the regulator.

Conservatives understand why this matters. Power concentrated at a distance is power removed from accountability. A village that governs its own seed exchange answers to itself. A continent that governs seed exchange from Brussels answers to no one the farmer will ever meet. The regulation does not just impose costs, though it does that, and severely. It transfers authority. It takes what was local and makes it central. It takes what was free and makes it licensed. That transfer is the whole point, even when nobody says so out loud.

The Compliance Cost Trap

The way this transfer happens is clever in its indirection. The regulation does not ban seed saving. It does not send inspectors to kitchen gardens. What it does is set up a registration and certification regime whose fixed costs land with crushing weight on small actors.

A multinational seed company spreads compliance across global product lines and billion-dollar revenues. The paperwork, the testing, the legal departments, all of it becomes a rounding error on the balance sheet. For a small regional breeder, a farmer-owned cooperative, or an individual who has developed a locally adapted variety worth sharing, the same requirements are impossible. The rules apply equally. The burden does not.

This is how consolidation works in modern regulatory states. Not by decree. Not by nationalization. But by the steady piling on of compliance costs that quietly strangle everyone who cannot absorb them. The small operator is not forbidden from participating. He is simply priced out. The result looks like market forces but is actually the predictable outcome of rules designed to favor scale.

Bayer, having swallowed Monsanto, now controls one of the largest seed and trait portfolios on the planet. Corteva and Syngenta round out an oligopoly that increasingly decides what gets bred, what gets distributed, and what ends up in farmers’ fields. This is not what superior seeds winning in open competition looks like. It is what a regulatory environment looks like when it rewards the kind of operation these firms run and punishes the kind of operation small nurserymen run. The PRM regulation tightens that ratchet another turn.

The Disease Argument Deserves a Full Burial

Defenders of the regulation reach reflexively for the disease argument. Seeds, we are told, can carry pathogens. Therefore they must be tracked, certified, and controlled. This argument gets tossed around so casually that it often escapes scrutiny. It should not.

Seed-borne diseases are real. Nobody disputes this. Wheat bunt, loose smut, bacterial blight in beans, and certain viruses in tomatoes and peppers have been known for over a century. They are in every agronomy textbook. The question is not whether they exist. The question is whether they justify a sweeping expansion of centralized control over seed distribution across an entire continent.

They do not. And the evidence against the argument is overwhelming.

First, these diseases are already managed, and managed well, through targeted practices that have worked for generations. Hot water treatment for brassicas. Fungicidal treatment for cereals. Visual inspection and roguing. Certified disease-free stock where it matters most. Crop rotation. Resistant varieties. These methods work. They have worked for decades. They do not require a continental registration regime to function.

Second, and more damning, the big disease pressures in modern agriculture do not come from gardeners trading bean seeds at a village market. They come from globalized industrial supply chains moving plant material at enormous volume across enormous distances. Xylella fastidiosa did not arrive in European olive groves because a grandmother shared cuttings. Tomato brown rugose fruit virus did not spread through heirloom seed exchanges. These pathogens rode in on commercial shipments, through industrial nurseries, through exactly the channels the PRM regulation treats as trustworthy while it tightens the screws on the channels that have historically been the safest.

The science here is not ambiguous. Large, uniform, monocultural plantings are disease amplifiers. Genetically diverse, locally adapted, small-scale plantings are disease buffers. When a wheat blast outbreak hits a region where every field grows the same three varieties, the losses are catastrophic. When the same pathogen runs into a landscape of dozens of locally adapted cultivars with different resistance profiles, it burns out. Diversity is the immune system of agriculture. The PRM regulation, by privileging uniformity, weakens that immune system in the name of protecting it.

Third, the disease rationale proves too much. If seed exchange among small producers really posed the threat claimed, we would expect to see disease outbreaks traced back to farmer seed networks. We do not. Decades of epidemiological data across Europe show that seed-saving communities and regional breeders are not significant disease vectors. The history simply does not support the theory on which the regulation rests on.

Fourth, where seed-borne disease risk genuinely exists, it can be handled with proportionate measures. None of this requires a wholesale restructuring of European seed law. A scalpel is available. Brussels has chosen a sledgehammer.

When a stated rationale cannot carry the weight of the policy it supposedly justifies, honest observers should ask what the policy is actually for. The disease argument is not the reason for the PRM regulation. It is the cover for it.

The Commission’s Pattern of Overreach

The Plant Reproductive Material regulation (PRM) does not arrive in a vacuum. It arrives as the latest example of a governance pattern that has become impossible to miss for anyone paying attention.

The European Commission is, by design, one of the most insulated major executive bodies in the democratic world. Its commissioners are nominated by national governments and confirmed by the European Parliament, which gives it a thin veneer of democratic legitimacy. But no European voter has ever cast a ballot for a Commission President. No citizen of any member state can remove a commissioner at the ballot box. The Commission proposes the legislation, shepherds it through passage, and then enforces it, all while sitting at a safe distance from the people whose lives it governs.

This setup was defensible when the European project stuck to coordinating trade and reducing tariffs. It becomes a lot harder to defend as the Commission’s reach expands into agriculture, energy, speech, finance, migration, public health, and now the contents of a gardener’s seed packet.

Consider the pattern.

During COVID, the Commission oversaw the rollout of digital health certificates that conditioned free movement, one of the founding rights of European citizenship, on medical compliance. The system was pitched as temporary and voluntary. In practice, it showed how fast centralized authority could gate fundamental freedoms behind bureaucratic credentials when institutions decided a crisis warranted it.

The Commission’s procurement of COVID vaccines, particularly the Pfizer contracts negotiated in part through text messages between Commission President von der Leyen and Pfizer’s CEO, remains shrouded in opacity. The European Ombudsman found maladministration in the refusal to release the communications. The European Court of Justice has since ruled against the Commission on transparency grounds. Billions of euros in public money, and the Commission fought to keep the paper trail hidden. This is not the conduct of an institution that sees itself as accountable to the public.

On migration, the Commission has pursued infringement proceedings against member states, Hungary and Poland most prominently, whose elected governments enacted border policies reflecting the clear preferences of their own citizens. The message was unmistakable. Democratic mandates at the national level would not be allowed to override directives from Brussels, and failure to comply incurs financial penalties. National electorates, the citizens of these nations, were told, in effect, that their votes could be overridden by an institution they did not elect. And in the typical wrap-up smear, those governments that rejected the Commission’s edicts got labeled “far-right” by the European mainstream media, with American outlets dutifully picking up the trope.

In speech, the Digital Services Act extends the Commission's authority over online content moderation across the entire bloc of nations, with censorship of political discourse, individual free speech, and press freedom that is only now coming into focus.

On energy, Commission mandates for “green energy” solutions have driven policies that have caused both industrial and household energy shortages and price rises in recent years, with costs borne by ordinary Europeans rather than the officials who designed the policies.

The PRM regulation fits this pattern precisely. An unelected executive body proposes detailed rules governing a domain that has historically been managed by farmers and local communities. The rules are dressed up in technical language that hides their practical effect. Compliance is enforced through penalties that fall hardest on those least able to absorb them. National parliaments have a limited ability to amend or reject regulations once they are adopted. The affected citizens, the farmers, gardeners, and small breeders, have essentially no direct recourse.

This is not democracy in any meaningful sense. It is not even the constitutional republicanism that served the Western tradition for centuries. It is administrative governance by a body that has slipped the leash of popular accountability. The seed regulation is just the latest territory this governance model has claimed.

Why Americans Should Be Watching Closely

It is tempting for American readers to look at all this as a European problem. It is not. It is a preview.

The regulatory architecture being built in Brussels does not stay in Brussels. It spreads through international harmonization efforts, through trade agreements, through the quiet coordination among agencies that increasingly defines global governance. When the EU sets a precedent for centralized seed control, that precedent becomes a reference point. When the EU shows that disease rhetoric can justify consolidation of agricultural authority, that playbook becomes available to regulators everywhere.

Americans who doubt this should look at the patterns already visible in their own country.

Raw milk, legal to produce and consume for all of human history until very recently, is now a prosecutable offense in many states, enforced through armed raids on small dairies. The justification is disease. The effect is consolidation.

Small-scale egg producers face escalating regulatory requirements that large industrial operations absorb with ease. The justification is disease. The effect is consolidation.

Independent slaughterhouses have collapsed from roughly fifteen hundred in the 1970s to a few hundred today, squeezed out by USDA regulations whose compliance costs are trivial for Tyson and Cargill and fatal for the local butcher. The justification is food safety. The effect is consolidation.

Cottage food laws vary wildly by state, with many jurisdictions restricting the sale of home-baked goods through byzantine licensing schemes. The justification is public health. The effect is consolidation.

Backyard poultry flocks have been culled by the millions under avian influenza protocols, with compensation structures that favor large commercial operations over small producers. The justification is disease. The effect is consolidation.

Furthermore, topical antibiotics for animal wound care have been removed from the market because the FDA needed to harmonize with the European Union. These U.S. regulators argued that export competitiveness and global alignment required these products to be banned from domestic sales.

The seed regulations have not yet arrived in the United States in the European form. Patent law, utility patents on seeds, licensing restrictions enforced by firms like Bayer, and the ongoing erosion of farmers’ traditional seed-saving rights through contract law have already done much of the same work through different mechanisms. The American path to seed consolidation has run through intellectual property rather than regulatory registration, but the destination is the same.

And when the Europeans finish building their apparatus, American regulators will have a ready-made template. They will cite European standards. They will invoke harmonization. They will talk about disease, safety, and modernization. The arguments will be familiar because they are always the same arguments. The outcome will be familiar because it is always the same outcome.

The American conservative instinct to defend local knowledge, local authority, and local self-sufficiency is not nostalgia. It is not a preference for the rustic over the modern. It is a recognition, grounded in hard experience, that when the capacity to feed yourself is surrendered to distant institutions, something essential about citizenship goes with it. A people who need permission to plant are not a free people. A nation whose seed stock is controlled by four corporations and a regulatory bureaucracy is not a sovereign nation, whatever its flag may say.

What Is Actually at Stake

The seed is the smallest unit of agricultural freedom. It is also the most fundamental. Everything else in the food system, the farm, the market, the table, flows from the question of who controls the seed.

For ten thousand years, the answer was simple. Whoever plants it. That answer built civilization. It sustained diversity. It produced the abundance we inherited. It let communities adapt to their particular conditions and survive shocks that uniform systems could not weather.

The answer the European Commission is now proposing is different. Whoever registers it, certifies it, and pays the fees. That answer will, over time, hollow out the agricultural diversity of an entire continent. It will transfer the productive capacity of European agriculture from the many to the few. It will wipe out, through economic gravity rather than outright prohibition, the small breeders and regional varieties that have been the quiet engine of agricultural resilience.

And it will establish the precedent, the legal architecture, and the rhetorical playbook for doing the same thing everywhere else.

The garden is not a hobby. The farm is not just a business. The seed is not just a commodity. They are the material foundation of a free people’s ability to feed itself without asking permission. When that foundation is regulated out of reach, the independence built on it goes with it.

If you think this will stay on foreign shores, I have a bridge in Brooklyn you might want to invest in. Americans watching this unfold in Europe are not looking at a foreign curiosity. They are watching a dress rehearsal. The question is whether they will recognize the performance when it opens on their own stage, and whether, by then, it will still be possible to close the show.

JGM/RWM

Every so often, a paper comes along that does more than add another data point. It forces you to reconsider the assumptions sitting quietly underneath modern medical practice. This newly published study in Molecular Psychiatry is one of those papers.

This large U.S. study of over 6 million pregnancies found that commonly prescribed medications that interfere with cholesterol synthesis during pregnancy were associated with a roughly 47 percent increased risk of autism in offspring.

• Roughly 11 percent of pregnant women were prescribed at least one of these drugs found to be linked to Autism.

• Autism was diagnosed in 3.8 percent of children overall

• That rate rose to about 5 percent in exposed pregnancies

• Use of these medications increased from 4.6 percent of pregnancies in 2014 to 16.8 percent in 2023

And importantly, this is not a niche exposure.

If you take the findings at face value and run the numbers, the scale becomes harder to ignore. In this dataset of 6.1 million pregnancies, about 11 percent of women were exposed to these drugs, and the autism rate rose from roughly 3.7 percent in unexposed pregnancies to about 5 percent in exposed pregnancies. That difference of about 1.3 percentage points translates into roughly 9,000 to 9,500 additional autism cases within the study cohort alone.

Because this dataset represents about one third of U.S. births over the same time period, a simple extrapolation suggests on the order of 25,000 to 30,000 additional autism cases nationally over the past decade, or roughly 2,500 to 3,000 per year.

These drugs have been on the market for much longer, and most have been prescribed during pregnancy for decades. This increase in autism cases in this study only documents the rise seen during the last decade, as these drugs have increased in use.

The drugs involved are among the most commonly prescribed in medicine:

• SSRIs: fluoxetine, sertraline

• Antipsychotics: aripiprazole, haloperidol

• Beta blockers: metoprolol, propranolol, nebivolol

• Statins: atorvastatin, simvastatin, rosuvastatin, pravastatin

• Others: trazodone, bupropion, buspirone

Roughly 11 percent of pregnant women were prescribed at least one of these drugs.

Different purposes. Different specialties. Same underlying biochemical effect.

They interfere with cholesterol synthesis.

At first glance, the question seems almost too simple. What happens when pregnant women are prescribed medications that interfere with cholesterol synthesis? It is the kind of question that should have been asked long ago. Instead, it has largely been ignored.

Cholesterol has spent decades cast as the villain in modern medicine. Lower it. Block it. Suppress it. That messaging has become so ingrained that it is rarely questioned. But that framing collapses when you look at fetal development. Cholesterol is not optional. It is fundamental. It is required for cell membranes, myelination, synapse formation, and the signaling pathways that guide brain development. The developing brain is one of the most cholesterol-dependent systems in biology.

We already know what happens when that system is disrupted. Genetic disorders that impair cholesterol synthesis provide a clear window. In Smith-Lemli-Opitz syndrome, where the final step of cholesterol production is impaired, developmental abnormalities are common, and autism is frequently part of the picture. Roughly three quarters of affected individuals meet criteria for autism spectrum disorder. That is not a subtle signal. It is a strong biological precedent.

What this new paper proposes is uncomfortable in its simplicity. What if we have been recreating a version of that same disruption, not through genetics, but through routine pharmacology?

The authors examined a class of medications that share a common effect. They interfere with sterol biosynthesis. These are not obscure or rarely used drugs. They include SSRIs such as fluoxetine and sertraline, antipsychotics such as aripiprazole, beta blockers such as metoprolol and propranolol, and statins such as atorvastatin and simvastatin. They are among the most commonly prescribed medications in the United States. They are part of everyday clinical practice.

The scale of the study matters. More than six million pregnancies were analyzed, spanning all fifty states over nearly a decade. This is not a narrow or selective dataset. If a consistent pattern appears here, it is unlikely to be dismissed as statistical noise.

And a pattern does appear. Exposure to at least one of these medications during pregnancy was associated with a forty-seven percent increase in autism diagnoses in the offspring. That alone would draw attention. What makes the finding more difficult to ignore is what comes next. The risk increases as more of these medications are used together. By the time four or more are prescribed concurrently, the signal more than doubles.

That is not random variation. It is a dose response pattern. The more the pathway is disrupted, the stronger the signal becomes.

At the same time, prescribing patterns have been moving steadily in the opposite direction of caution. The proportion of pregnant women receiving at least one of these medications increased from 4.6 percent in 2014 to 16.8 percent in 2023. That is a profound shift in how pregnancy is managed. What was once approached with restraint is now approached with increasing pharmacologic intervention.

What makes this study particularly compelling is the convergence of its findings. These medications differ in their primary purpose.

• Some treat depression.

• Some manage blood pressure.

• Some target lipid metabolism.

They are chemically distinct and clinically unrelated. Yet they share one biochemical effect. They interfere with cholesterol synthesis. The signal tracks with that shared mechanism.

That raises a difficult question. Are we looking at a collection of unrelated associations, or are we seeing the imprint of a single disrupted pathway?

The standard response is to invoke confounding. Maternal depression, anxiety, metabolic disease, and other underlying conditions are all associated with developmental outcomes. That is true, and it must be considered. But those conditions do not all converge on a single biochemical pathway. These drugs do. The consistency of the signal across different drug classes suggests that something more fundamental may be at work.

This paper identifies a biologically plausible mechanism, demonstrates a large-scale population signal, and shows that the signal strengthens with increasing exposure.

There is also a quieter point embedded in the paper. Many of these medications already carry warnings regarding pregnancy. Those warnings exist, but they are often buried in dense labeling and rarely translated into clear discussions about developmental biology. For many of these drugs, there is no warning label about ingesting them during pregnancy. The conversation is usually reduced to a simple phrase. The benefits outweigh the risks. Sometimes that is true. But that statement is not the same as saying there is no risk. And as it turns out, the benefits of these drugs most likely do not outweigh the risks, and tens of thousands of our children are paying the price for that bad advice.

Who is responsible for that bad advice? Who will make it right for these kids and their families? Certainly not the pharmaceutical companies, which profited from prescription sales of these drugs during pregnancy. Profits that amount to billions of dollars for Big Pharma.

What this study ultimately does is reopen a question that should never have been closed. If you interfere with one of the most fundamental building blocks of human development, why would you expect there to be no downstream consequences?

Medicine has seen this pattern before. A widely accepted practice persists for years, sometimes decades, before its risks are fully understood. Because modern medicine is often not as benign as physicians and large pharmaceutical corporations like to pretend it is.

What happens next depends on whether we are willing to follow the answer wherever it leads.

JGM/RWM

So, last night, we were watching a lovely documentary called Alex Polizzi’s Secret Italy on Amazon. The series has a segment on the island of Sardinia, and one interesting fact is how many centenarians live there. However, another interesting fact is that the islanders still eat a lot of organ meat of all types. Nothing is wasted from the animal, and it is all on display in the local markets, where butchers work on site. A far cry from the centralized, industrialized slaughterhouses, where such delicacies are used for pet food. The truth is that organ meat is good for you, and it is a shame that it has fallen out of favor in our so wealthy, we don’t have to eat that shat, nation.

Organ meats, what we used to simply call offal, are among the most nutrient-dense foods available. Not slightly better than muscle meat, but in many cases an order of magnitude richer in key vitamins, minerals, and biologically active compounds. When used intelligently, they can close nutritional gaps that are otherwise very difficult to address through diet alone.

Let’s start with the obvious objection, because everyone thinks it.

“Yes, but the liver filters toxins.”

True. It is a filtration and processing organ. But that does not mean it stores toxins like a sponge sitting under your sink. The liver’s job is to transform, neutralize, and export toxins. It does not warehouse them. Those compounds are either broken down and excreted through bile or urine, or they circulate and are handled elsewhere.

If you are worried about accumulation, fat is a much more likely place for persistent compounds to reside than liver tissue itself. What the liver does store, very efficiently, are nutrients. That is why predators go for it first.

So no, eating liver is not the dietary equivalent of licking a water filter. It's more like the equivalent of a multi-vitamin.

Why liver deserves a place on the plate

Liver, whether beef or chicken, is arguably the most concentrated nutritional package you can get from an animal.

It delivers:

• Vitamin A in the form of retinol, ready to use, not something your body has to convert

• Vitamin B12 in levels that make most foods look anemic by comparison

• Folate in its natural form, not synthetic folic acid

• Copper and choline, both critical and often under-consumed

Beef liver tends to be more concentrated and robust in flavor. Chicken liver is milder, easier for most people to tolerate, and still remarkably dense nutritionally. If you are easing into this, chicken liver is the gateway drug.

Energy, brain, and metabolic throughput

Liver is loaded with B vitamins, especially B12, B2, and B6. These are central to:

• Mitochondrial energy production

• Neurotransmitter synthesis

Choline, which is abundant in liver, supports:

• Brain development and function

• Liver health itself

• Cell membrane integrity

If you are running a high-demand system, physically or cognitively, these are not optional inputs.

Blood building and oxygen transport

Liver brings together:

• Heme iron, which your body absorbs efficiently

• Copper, which helps regulate iron metabolism

That combination matters. You can take iron supplements all day long, but without the supporting cofactors, the system does not run properly. Liver supports the whole pathway.

This becomes particularly relevant in:

• Iron deficiency anemia

• Pregnancy

• Growth and recovery

Immune and reproductive health

Vitamin A from liver plays a central role in:

• Immune signaling

• Maintaining the integrity of gut and lung linings

Add in zinc and selenium from organ meats more broadly, and you are supporting:

• Immune function

• Hormonal balance

This is systems biology, not isolated nutrients.

A brief word about taste and reality

Now, none of this matters if you cannot get it past your fork.

Liver has a reputation. Some of it deserved. Some of it based on childhood trauma involving overcooked slabs of something that tasted like a boot soaked in iron.

There are ways around this:

• Do not overcook it.

• Mix small amounts into ground beef. Online “ancestral” meat shops specialize in grass-fed ground organ meat and beef sales. This is an easy way to ease into eating organ meat.

• Use, or even better, make, pâté, which is civilization’s way of making liver not only tolerable but actually enjoyable. Chicken livers are cheap and very tasty in pâté. Pâté is easy to make and keeps for several days. It is so tasty, you might even try serving it at a party!

• The classic liver and onions (try using calf’s liver) is pretty darn tasty. Especially with ketchup.

Start small. You do not need a plate of it. An ounce or two once or twice a week will move the needle.

The larger point

Muscle meat gives you protein and calories. Liver gives you the cofactors that allow your system to function at a higher level.

And despite what you may have been told, you are not eating a toxin sponge. You are eating the metabolic control center of the animal. The place where the nutrients are stored.

JGM

Brownstone Institute’s second retreat at Polyface Farms is a chance to join us (Robert and I will both be speaking) in an exciting adventure on a real working farm, to learn from the best minds on the subjects of health and food freedom, and discover what a huge difference authenticity can make to rediscover core truths. This event shows the why and the way.

The event begins on Friday morning with an early morning registration and a delicious breakfast and ends Saturday afternoon.

Polyface Farm: On Friday and Saturday, August 28th and 29th, Brownstone will host their annual Polyface Retreat at Polyface Farm in Swoope, Virginia.

RETREAT: REGISTER NOW.

Tickets for the VIP dinner August 28 are still available, but going fast. Eight are left. TICKETS.

The year is 1950. Your doctor lights a cigarette and tells you smoking is fine. He read it in a study. He is telling the truth about having read it. He does not know, or is not saying, that the study was funded by the tobacco industry.

The year is 1958. Your doctor tells you to eat less fat. The evidence is contested. The contestation is not in the public messaging. The food industry has been helpful in clarifying which findings deserve attention. Some researchers who published contradictory data have been quietly defunded. Ancel Keys is on the cover of Time magazine.

The year is 1962. Your doctor prescribes thalidomide to your pregnant wife for morning sickness. It has been approved. The FDA gave it the green light in Europe [JGM - factcheck, EU regulators did that]. Twelve thousand children will be born with severe limb malformations before anyone in an official capacity acknowledges the problem. The families are told the drug was safe. The drug was approved. Both of these things remain true.

The year is 1972. Your doctor prescribes Valium. Britain is in the grip of a benzodiazepine wave that will last two decades. The dependency risk is known internally. It is not shared. Your doctor is not lying to you. He was not told either.

The year is 1999. Your doctor prescribes Vioxx for your arthritis. It is newer than ibuprofen, well-tolerated, and Merck has a study showing it works. Merck also has internal data suggesting it roughly doubles the risk of heart attack. This data will not reach your doctor for four more years. Fifty thousand people are estimated to have died in the interim. Merck eventually settles for 4.85 billion dollars. No criminal charges are brought.

The year is 2002. Your doctor prescribes OxyContin. Purdue Pharma trained its sales representatives to tell doctors the addiction risk was less than one percent. That figure came from a letter, not a study. The letter was about patients with terminal cancer on short-term doses in hospital settings. Your doctor is a GP with a patient who has a bad back. Nobody draws a distinction. Nobody is required to.

The year is 2008. Your doctor checks your cholesterol. Your LDL is elevated. You are prescribed a statin. Nobody mentions that the number needed to treat for primary prevention is approximately 250. Nobody mentions that the muscle deterioration you'll notice over the next two years is listed as a rare side effect rather than a documented pattern affecting a meaningful percentage of patients. The trial that informed the prescription was funded by the manufacturer.

Now it is today.

Your doctor has new guidelines. New studies. New consensus.

He is confident.

He has always been confident.

The confidence has never been the problem.

The confidence is, in fact, precisely the problem.

-From: Sama Hoole @SamaHoole on X

That would be US AID or… USAID

JGM

Yesterday we had a gentleman here named Charles to redo the hot-wire on the fences, and not realizing that our stallion Quartz had already been let into the pasture, he and I went in to discuss what needed to be done. As we were talking, Quartz wandered over and noticed that the gate had been left half open. As he was pondering his next life decision,…

Read more

”You don't need therapy, you need to build a deck”

"Don't trust nobody who's nice to you but rude to the waiter."

Another wam day here - Rob is already sweating outside doing chores and I am soon to join him!

Have a great day folks!

JGM

Comments prepared in support of my upcoming presentation at the Autism Health Conference 2026

You can register to attend here.

This updated essay now incorporates findings from Autism Res. 2018 May;11(5):788-797. doi: 10.1002/aur.1943. Epub 2018 Mar 10. “Onset patterns in autism: Variation across informants, methods, and timing”

If you are raising a severely autistic child, especially a nonspeaking one, you have probably spent years navigating a medical and scientific establishment that often felt dismissive of your observations, your instincts, and your questions. You have watched your child struggle. And many of you watched something change around the time of a vaccination appointment. Your child was developing. Then, in the days or weeks that followed a vaccine visit, something shifted. Language that was emerging went quiet. Eye contact that was growing became rare. A child who had been turning toward the world seemed to turn away from it.

You reported this to your pediatrician and were told it was a coincidence. You found other parents who described the same sequence of events and were told you were part of a community built on fear. You were handed studies and told the question was settled. But the question did not feel settled, because you were there. You saw what you saw.

This piece takes that observation seriously. Not because parental observation is infallible, and not because the science supports every conclusion drawn from it, but because a pattern reported independently by thousands of families across decades and across countries is not nothing. It is a signal that deserves honest engagement rather than dismissal. The goal here is to examine what science actually knows, what it does not know, and where the honest uncertainties lie.

* * *

The Microstroke Hypothesis: Where It Comes From

The microstroke hypothesis proposes that vaccine-induced inflammation could, in some infants, cause tiny subclinical injuries to blood vessels in the brain. These would be too small to show up on standard imaging but potentially significant enough to affect neurodevelopment. It is not a mainstream scientific position. No major medical body endorses it, and there is no direct imaging evidence that it occurs.

But the hypothesis is not invented from nothing. It draws on real biology.

THE ALUMINUM QUESTION

Researchers at INSERM (Institut National de la Santé et de la Recherche Médicale, France’s national health research agency), led by Romain Gherardi, have published peer-reviewed work showing that aluminum from vaccine adjuvants can be taken up by immune cells and transported to brain tissue in animal models [1,2]. Once there, it triggers microglial activation and neuroinflammation. Critics note that the animal doses differ from human vaccine schedules, and that human brain accumulation has not been directly demonstrated. The research is real, the debate about its relevance is legitimate, and the question has not been fully resolved.

THE INFLAMMATORY PATHWAY

Vaccines work by triggering an immune response. That response includes a transient surge of inflammatory cytokines. This is not a side effect; it is the mechanism. What is genuinely uncertain is whether, in a small subset of infants with particular genetic vulnerabilities, this cytokine surge could be exaggerated enough to temporarily compromise the blood-brain barrier. The blood-brain barrier in infants is less mature than in adults. The biology here is plausible at a theoretical level. It has not been demonstrated at vaccine doses.

VITT: PROOF THAT THE IMMUNE SYSTEM CAN AFFECT CEREBRAL VESSELS

One of the more important developments in recent years was the documented discovery of VITT (Vaccine-Induced Immune Thrombocytopenia and Thrombosis), a rare thrombotic complication of adenoviral vector COVID-19 (coronavirus disease 2019) vaccines [3]. This condition involves immune-mediated clotting, including in cerebral blood vessels. It was initially missed, then denied, then confirmed. It matters not because it is directly analogous to childhood vaccine injury, but because it established beyond doubt that vaccine-induced immune mechanisms can, in rare cases, affect brain vasculature. The possibility space is not zero.

WHAT THE EVIDENCE ACTUALLY SUPPORTS The most defensible version of the microstroke hypothesis is not a general claim about all vaccines in all children. It is a narrower claim: that children with specific genetic vulnerabilities, including immune dysregulation or mitochondrial disorders, might respond atypically to immune activation, potentially experiencing neurological effects that most children do not. This subgroup model is unproven but not biologically incoherent.

* * *

The Autism Connection: What Is Plausible and What Is Not

The microstroke hypothesis, if it has any relevance to autism, operates through a specific neurobiological mechanism and deserves to be evaluated on its own terms, separate from the broader and long-contested public debate over vaccines and autism. The question here is not about that debate. It is about whether inflammation-mediated cerebrovascular injury is a plausible pathway to neurodevelopmental harm in a susceptible subset of children.

The dominant scientific hypothesis holds that autism’s origins are largely prenatal. Prospective studies of infants at high genetic risk for autism, watched from birth, show measurable differences in brain development and social attention within the first months of life, well before vaccination could play any role. This represents the mainstream position and poses a genuine challenge to broad postnatal vaccine-injury models of autism. It is worth noting, however, that a hypothesis being dominant is not the same as it being complete. The prenatal origin framework accounts well for many autistic individuals but has more difficulty explaining regressive presentations, and researchers continue to investigate what additional factors may shape outcomes after birth.

WHERE THE QUESTION REMAINS GENUINELY OPEN

Regressive autism is different. It has long been estimated that roughly 20 to 30 percent of autistic children develop typically and then lose skills, often language and social engagement, somewhere between 12 and 24 months. But a landmark 2018 study by Ozonoff and colleagues at the UC Davis MIND Institute suggests that figure is almost certainly a significant undercount — and the reason why matters enormously for how we interpret parental reports [10].

Ozonoff’s team followed 230 infants from 6 months to 36 months, measuring social development at each visit using four different methods. What they found challenges the conventional picture directly. When clinicians rated children at each visit using dimensional frequency scales — measuring how often social behaviors actually occurred — 88 percent of children who later received an autism diagnosis showed a regressive pattern: initially normal social engagement that progressively declined. When parents used the same prospective, real-time dimensional method, 69 percent showed the same declining trajectory. Critically, at six months of age there were no measurable differences between infants who would develop autism and those who would not. The divergence began around 12 months and widened from there [10].

The critical finding is what happened when the same parents were asked retrospectively — at age 36 months — whether their child had lost skills. Only 29 percent reported regression. The children had not changed. The measurement method had. Asking parents to make a categorical yes-or-no judgment about skill loss, especially looking back in time, dramatically undercounts what they actually observed in real time. Parents who would not explicitly say their child “lost skills” when asked categorically were simultaneously rating the frequency of those same behaviors in a way that showed unmistakable decline. They were right about what they saw. The standard instruments were not capturing it.

This has direct implications for how parental accounts of vaccine-adjacent regression have been received. If the standard instruments used to assess autism onset dramatically undercount regression, and if parents’ real-time observations are actually more accurate than retrospective structured interviews, then dismissing parental reports on the grounds that they conflict with standardized assessments has the methodology backwards. The instrument was inadequate, not the parent. The regression they described was real. The unresolved scientific question is not whether the regression occurred but what caused it.

This distinction matters. For too long, the response from the medical establishment has been to challenge the parents’ account rather than to engage the mechanism. That is not good science, and it has damaged trust in ways that will take a long time to repair. The honest position is to acknowledge the reported pattern, take it seriously as an observation, and invest in the research needed to understand it.

Autistic brains, examined postmortem, show neuroinflammatory signatures, activated microglia, elevated cytokines, and white matter abnormalities [4,5]. These findings are consistent with what you might expect from microvascular injury, though they almost certainly have other explanations as well. The point is not that vaccines caused these findings, but that the brain biology of autism involves immune and vascular components that researchers are still working to understand.

Regressive autism may be the rule, not the exception — and the standard tools used to measure it have been systematically undercounting what parents actually observed in real time.

The most credible narrow claim, and it is narrow, is that in a subgroup of children with underlying immune or metabolic vulnerabilities, a strong immune activation event, possibly including vaccination, could act as a trigger for neurological regression in children already on a susceptible developmental trajectory. This has not been demonstrated. It has not been ruled out.

* * *

The Locked-In Hypothesis: A Different Kind of Hope

Whatever one believes about the causes of autism, there is a question that matters enormously for families right now: for nonspeaking autistic children, is the absence of communication a reflection of absent thought, or is it a reflection of a motor system that cannot reliably carry thought into the world?

This is the locked-in hypothesis. And here, the neuroscience offers something genuinely encouraging.

WHAT THE BRAIN RESEARCH SHOWS

Apraxia of speech is a well-documented condition in which a person knows what they want to say but cannot reliably execute the motor sequence required to say it. The brain regions implicated in autism, the supplementary motor area, the basal ganglia, the cerebellum, are precisely the regions involved in motor initiation and sequencing. Postmortem studies of autistic brains consistently show Purkinje cell loss in the cerebellum, a region critical for the timing and coordination of voluntary movement, including speech [6,7].

Eye-tracking studies, which assess comprehension without requiring any motor output, have found language understanding in some nonspeaking autistic individuals that far exceeds what behavioral testing would predict. Neuroimaging during language tasks has shown activation patterns inconsistent with global cognitive impairment. These findings do not prove that every nonspeaking autistic person has intact cognition. They do suggest that standard assessments, which rely heavily on verbal and fine motor responses, may systematically underestimate what is happening inside these children’s minds.

Some nonspeaking autistic individuals who later gained communication access have described years of awareness without any means of expressing it. These accounts are internally consistent, sophisticated, and in some cases verifiable. They deserve to be taken seriously.

LETTER BOARDS AND EMERGING COMMUNICATION METHODS

It is important to be honest about the controversies here, because parents deserve accurate information.

Facilitated communication, in which a facilitator physically supports a person’s hand while they point to letters, has been shown in controlled research to reflect the facilitator’s output rather than the communicator’s [8]. The facilitator is not consciously fabricating; the mechanism is the ideomotor effect, the same phenomenon behind Ouija boards. This is not a fringe finding. It is a well-replicated result, and FC (facilitated communication) has caused real harm to families through false accusations and misdirected hope.

But there are newer approaches that operate differently in principle. The Rapid Prompting Method (RPM) and Spelling to Communicate (S2C) explicitly work toward independent pointing, with the goal of fading physical support entirely. Some practitioners conduct message-passing tests to verify independence. Some individuals using these methods have transitioned to fully independent communication and gone on to write books, give public talks, and advocate for themselves in ways that could not plausibly be attributed to a facilitator.

These methods are not yet validated by the kind of large controlled trials that would satisfy a skeptical scientific audience. That is a real limitation and families should know it. But the methods are not equivalent to FC, the evidence is not uniformly negative, and the stakes for getting this wrong in either direction are enormous.

THE CORE UNANSWERED QUESTION We do not know how many nonspeaking autistic individuals have intact cognition that standard assessment cannot reach. This is one of the most important unanswered questions in autism research, and it has been inadequately studied, partly because the political environment around these questions has made honest inquiry more difficult than it should be.

* * *

New Medicines on the Horizon

The communication barrier is not the only frontier where the outlook is changing. For the first time in the history of autism medicine, researchers are developing compounds that target the core social symptoms of the disorder, not just the behavioral symptoms that have always been easiest to manage pharmacologically. This is a meaningful shift, and families deserve to know about it.

Currently approved medications for autism, risperidone and aripiprazole, address irritability and agitation. They carry significant side effect burdens and do nothing for the social and communicative dimensions of the condition that most affect quality of life. For decades, this was considered the ceiling. It no longer is.

A PROMISING EXAMPLE: L1-79

One of the most advanced compounds in this new generation is L1-79, developed by Yamo Pharmaceuticals. It works through a mechanism that would have seemed counterintuitive even a decade ago: rather than adding to neurotransmitter activity, it reduces it. Specifically, L1-79 inhibits tyrosine hydroxylase, the enzyme that controls the rate of dopamine and norepinephrine production in the brain. The scientific rationale is that many autistic individuals, particularly those with more severe presentations, have an overactive catecholamine system, and that excess signaling through these pathways contributes to the social communication deficits and excitatory imbalances that define the disorder.

The drug is not without precedent. The L-isomer of the same molecule, metyrosine, is already FDA (Food and Drug Administration)-approved for pheochromocytoma, a condition involving catecholamine excess. L1-79 uses a racemic formulation adapted for use in autism, giving it a pharmacological foundation that is established even if the application is new.

The clinical results, presented in full at the International Society for Autism Research (INSAR) conference in 2025, are the most compelling data yet seen for a compound targeting core autism symptoms [9]. In a rigorous 12-week, double-blind, placebo-controlled crossover study of 58 adolescents and young adults, L1-79 produced a 7.94-point advantage over placebo on the Vineland Adaptive Behavior Scales socialization score. The minimal clinically important difference for that instrument is 4 points. The drug nearly doubled it. Families participating in the trial also reported meaningful improvements in what they identified as the three most bothersome symptoms of their child’s autism. There were no serious adverse events. No one dropped out because of side effects.

The FDA granted L1-79 Fast Track Designation in 2018, reflecting the agency’s recognition that there is a serious unmet need in this population [9]. Phase 3 trials are now in preparation. That is not a guarantee of approval, and the path from Phase 2 to the pharmacy shelf is long and often disappointing. But the direction of travel is real, and it points somewhere new.

L1-79 is one example among several compounds now in development that approach autism differently, targeting neurobiological mechanisms rather than suppressing surface behaviors. The field is not where families deserve it to be. But it is moving, and it is moving in a direction shaped by a growing scientific understanding that the brains of autistic individuals are not simply broken versions of neurotypical brains, but are organized differently in ways that specific, targeted interventions may be able to address.

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What We Owe These Children

Parents of nonspeaking autistic children have often been told, implicitly or explicitly, that their child is not “in there” in the way they sense. They have been handed devastating prognoses based on assessments that may not capture what these children actually know and feel. Many have spent years grieving a connection they were told was not possible.

The science does not yet tell us with certainty how many of these children have rich inner lives waiting for a reliable path out. But it tells us enough to know that presuming they do not is not the conservative scientific position. It is its own kind of risk. A child with intact cognition who is treated as cognitively absent suffers a harm that is profound and largely invisible.

The emerging evidence around motor-speech dissociation, the documented cases of nonspeaking individuals who found their voice through letter boards and augmentative communication, and the neuroimaging data suggesting preserved language networks in some nonverbal autistic individuals all point in the same direction: the story is not over. The barrier may be at the output, not at the source.

For families, the practical implication is worth sitting with. If your nonspeaking child is in there, aware, understanding more than they can show, then every interaction you have with them, every book you read aloud, every conversation you have in their presence, every moment you treat them as a full person, matters in ways you may not be able to measure yet. And the work being done to build reliable, independently verifiable communication pathways for this population is among the most important work in autism today.

A Note to Parents Who Have Questions

If you have watched your child and felt that the official answers did not fit what you observed, you are not irrational. Some of the most important scientific questions about autism remain genuinely open. The research community is not infallible, and the history of medicine includes many cases where parental observation preceded scientific confirmation by years or decades.

At the same time, the most important thing for your child right now is not resolving debates about causation. It is finding every possible way to presume their competence, to offer them tools for expression, and to meet them where they are.

The locked-in hypothesis, if it holds for your child, means that what you have always sensed is true: they are there. They have been there all along. And the distance between you may be shorter than anyone has told you.

Science is slowly learning to find them. Do not stop looking.

References

[1] Khan Z, Combadière C, Authier FJ, et al. Slow CCL2-dependent translocation of biopersistent particles from muscle to brain. BMC Medicine. 2013;11:99. https://link.springer.com/article/10.1186/1741-7015-11-99

[2] Gherardi RK, Eidi H, Crépeaux G, Authier FJ, Cadusseau J. Biopersistence and Brain Translocation of Aluminum Adjuvants of Vaccines. Frontiers in Neurology. 2015;6:4. https://www.frontiersin.org/articles/10.3389/fneur.2015.00004/full

[3] Pavord S, Scully M, Hunt BJ, et al. Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis. New England Journal of Medicine. 2021;385:1680-1689. https://www.nejm.org/doi/full/10.1056/NEJMoa2109908

[4] Vargas DL, Nascimbene C, Krishnan C, Zimmerman AW, Pardo CA. Neuroglial activation and neuroinflammation in the brain of patients with autism. Annals of Neurology. 2005;57(1):67-81. https://pubmed.ncbi.nlm.nih.gov/15546155/

[5] Morgan JT, Chana G, Pardo CA, et al. Microglial activation and increased microglial density observed in the dorsolateral prefrontal cortex in autism. Biological Psychiatry. 2010;68(4):368-376. https://pubmed.ncbi.nlm.nih.gov/20674603/

[6] Bauman ML, Kemper TL. Histoanatomic observations of the brain in early infantile autism. Neurology. 1985;35(6):866-874. https://pubmed.ncbi.nlm.nih.gov/4000488/

[7] Whitney ER, Kemper TL, Bauman ML, Rosene DL, Blatt GJ. Cerebellar Purkinje cells are reduced in a subpopulation of autistic brains: a stereological experiment using calbindin-D28k. Cerebellum. 2008;7(3):406-416. https://pubmed.ncbi.nlm.nih.gov/18701892/

[8] American Psychological Association. Resolution on Facilitated Communication. 1994; reaffirmed 2016. https://www.apa.org/about/policy/facilitated-communication

[9] Yamo Pharmaceuticals. Yamo Pharma Presents Statistically Significant Phase 2 Autism Results for L1-79 at INSAR 2025. GlobeNewswire. May 8, 2025. https://www.globenewswire.com/news-release/2025/05/08/3077235/0/en/Yamo-Pharma-Presents-Statistically-Significant-Phase-2-Autism-Results-for-L1-79-at-INSAR-2025.html

[10] Ozonoff S, Gangi D, Hanzel EP, et al. Onset Patterns in Autism: Variation Across Informants, Methods, and Timing. Autism Research. 2018;11(5):788–797. https://pubmed.ncbi.nlm.nih.gov/29446233/