If I have to sign an “informed consent” form, I should probably be informed.

Fourteen pages of legal language on an iPad five minutes before a procedure doesn’t count.

There is a strangely common ritual in healthcare where you arrive for something that has been booked for weeks, sometimes months, and only after you have checked in, changed clothes, handed over your health and financial information, answered the same list of embarrassing questions multiple times, and mentally committed yourself to whatever is about to happen, someone hands you a screen.

“Just read through this and sign at the bottom.”

The document is enormous.

You’re anxious.

You start scrolling.

You spot the usual suspects that appear frequently in these forms ironically with zero insight into how likely it is they will happen to you as a result of whatever it is you are agreeing to. Bleeding, infection, stuff you can’t pronounce. Death.

But you’ve got no real framework to evaluate the scary shit you’re reading. Isn’t that what your doctor is supposed to help you figure out?

Paging Dr. House. Or literally anyone.

Next comes several paragraphs written in a dialect that appears to have been developed jointly by 19th century English bloodletters and corporate lawyers with no hope of informing anyone of anything.

Then there are the acknowledgements confirming that everything has been explained to you, statements confirming that you understand the risks, statements confirming that you had an opportunity to ask questions, and somewhere at the bottom, a little white rectangle just waiting for your finger.

Meanwhile, the nurse is standing next to you, usually annoyed, always in a hurry, waiting for the iPad back.

So you sign.

Congratulations. You have been informed.

Well, at least according to your paperwork you have.

The official idea of informed consent is of course, pretty sensible. The American Medical Association describes it as a process where communication between a doctor and patient leads to the patient agreeing to a particular intervention. The patient should receive information about what is being done, why it is being recommended, the risks and expected benefits, the alternatives available, and what happens if they choose to do nothing.

As much as I hate to agree with the AMA on anything, that sounds like a great description of informed consent to me.

The iPad signature is supposed to document that process — even when the process never actually occurs.

Somewhere along the way, the requirement for an honest dialogue has disappeared. The document has become the process. And unless you are lucky enough to receive treatment from a clinician who thinks your judgement matters as much as theirs, you aren’t going to get a fair chance to decide anything objectively.

Because once the paperwork becomes the process, it gets much easier to treat patient agreement as the goal instead of patient understanding. And understanding matters because the patient, not the clinician, is the person who ultimately has to decide and live with that decision.

Despite the “my body my choice” rhetoric, true medical freedom is rare. Clinicians who believe you have the right to accept or reject treatments as you see fit are also increasingly rare. In a world led by principles of paternalism and “trust the science,” it’s easy to overlook the nuisance of informed consent and bodily autonomy because, after all, doesn’t your doctor know best?

One of the things proven during the Covid pandemic is that the medical industrial complex is happy to skim on the “informed” part of the consent process.

Coercion is acceptable. Bullying is acceptable. Compliance is the goal.

And it’s easy to see how this happens. When you start from the assumption that patients cannot be trusted to make their own decisions, paternalism waltzes in easily. And once patients became little more than conduits for moving money through the system, their preferences mattered even less. If your treatment plan follows the recommendation of your professional organization or the CDC, then the informing and the consent are really more of a formality.

But a few crazies like me still think the distinction between consent and informed consent matters quite a lot.

Especially when the thing being authorized involves cutting you open, putting you under anesthesia, injecting a mix of genetic material, toxins and who-knows-what-else into your or your kid’s body, removing part of your body, or doing almost anything else that would get a stranger arrested if you had not agreed to it.

Timing matters too.

When and how a decision occurs changes how meaningful a decision can be. Consider the position you are in when the consent form usually appears.

Sometimes it’s an emergency – sure. But more often, you have known about the procedure for months.

Maybe you’ve taken time off work to be there. Maybe your partner drove you. Sometimes you have been fasting since midnight. You already paid. You have been thinking about the procedure for weeks. Or my favorite, you are sitting inside the surgical center wearing one of those gowns that somehow leaves your ass exposed regardless of how carefully you tie it.

Or perhaps it’s a routine office visit where the nurse pops in and tells you they are recommending a medication, injection, or vaccine you didn’t expect. But you’re there now, so you might as well get it.

Sometimes the pressure is subtle. Sometimes it isn’t. Often it has very little to do with helping you understand the medical decision in front of you.

You wouldn’t want a visit from CPS would you? Do you want your kid to kill their grandmother?

Consent is assumed.

Because the machinery has started moving.

Then someone hands you a document with a complete list of risks that sounds very different from everything you remember your doctor telling you.

After all, didn’t he say:

• this pill is “as safe as Tylenol.” We prescribe it every day.

• the anesthesia is low-risk, and you’ll be home by dinner.

• the procedure is necessary. No big deal. Something we do every day.

• the shot is totally “safe and effective.” Wouldn’t be FDA-approved if it wasn’t.

And after all, you don’t want to end up dead or hurt your child, your mom, or your grandmother.

Don’t you want to do the right thing?

Just. Sign. The. Form.

Technically, you can still say no. But psychologically, saying no has now become a much bigger lift than it would have been two days earlier while sitting on your couch or 2 months earlier in the doctor’s office if you were actually being given a real choice.

Is this how we would organize care if we wanted patients to consider their options?

It seems like how we’d organize it if the goal were to make agreement to whatever we say the path of least resistance.

Even federal guidance for research consent recognizes this problem. HHS says people should have sufficient opportunity to consider whether they want to participate, information should be given in language they can understand, and a signed form by itself does not constitute an adequate informed consent process.

A signed form does not constitute an adequate consent process.

So why does the signature receive so much more operational attention than the understanding behind it? And why are we pretending that checking the box means we did the job?

The real test of informed consent is not when the patient agrees with you. It’s when they don’t.

I’ve had many many conversations with patients at the bedside where I had a strong opinion about what I wanted the patient to choose.

A woman who declined the rabies vaccine after a bite from a wild animal. A nasty kidney infection where the patient declined IV antibiotics I thought he needed. Parents who insisted on giving their 5 year old Tamiflu to manage their anxiety putting him at risk.

Each of these cases I had a bias.

• Take the rabies vaccine

• Use the IV antibiotics

• Don’t give your kid Tamiflu just because they technically meet guidelines.

But it’s not about me, is it? My job is to explain what I believed the consequences of each option were, including doing nothing, answer the patient’s questions, make my recommendation clearly, and then let the patient choose. Which brings me back to the paperwork.

I understand why the paperwork exists. Medicine involves risk. Doctors and hospitals need records showing what was discussed. Memories are unreliable, disputes happen, and there needs to be some evidence that a patient agreed to treatment.

Keep the form, I guess.

I would just like the “informed” part to receive the same engineering effort as the “consent” part.

What I would actually want to know

I do not need fourteen pages simplified into a cartoon with smiling organs.

I can handle serious information. Most patients can.

What patients need is not less information. It’s more and better information. Give me the information that has potential to change decisions. The good the bad and the ugly of all sides.

Tell me what you are planning to do, what outcome you expect, the meaningful risks, how often those risks happen when useful estimates exist, the realistic alternatives, and what happens if I wait or choose to do nothing.

Tell me the risk of doing nothing. Tell me if there are alternatives. Tell me why this particular route is the one that you are recommending over others.

Acknowledge that while you may know more about the medicine, I know more about my values, my priorities, my tolerance for risk, and the life I have to live with the outcome.

Then give me enough time to think about it.

The importance of a risk also depends heavily on the person sitting in front of you. A complication affecting fine motor control has different implications for a concert pianist than it does for someone whose career depends very little on their hands. Medical ethics literature has made this point for years. Information becomes useful when it helps the actual patient make a decision according to their own circumstances.

That requires a conversation, not a form.

It can still be short.

“Here’s what we’re doing. Here are the main risks I want you to understand. Here are your other reasonable options. Here’s what I recommend and why. What questions do you have?”

Five minutes of that would probably inform me more than twenty minutes of silently scrolling through clauses written to survive a lawsuit.

Better still, send the material before the procedure.

If my appointment is on Friday, give me the information on Monday. Let me read it at home, Google the words I do not understand, talk to my partner, write down questions, and arrive knowing what I am agreeing to.

The document can contain all fourteen pages if fourteen pages are legally necessary. Put a plain-English page at the front explaining the information a normal person actually needs to make the decision.

Then, on Friday, ask me whether anything was unclear.

Healthcare already sends appointment reminders, fasting instructions, payment links, parking directions, intake questionnaires and automated texts telling me to arrive seventeen minutes early.

Surely we can also squeeze the actual decision somewhere into that sequence.

Did you understand it?

There is an easy way to find out whether somebody understood something. Could they explain it back to you?

If I am about to undergo a procedure and I can tell you roughly what is going to happen, why we are doing it, what the meaningful risks are, and what my alternatives were, you have pretty good evidence that information actually entered my brain.

If I immediately forget what I signed because I was speed-scrolling a document while a nurse hovered beside me, and a clinician wasn’t there to answer my questions anyway, the signature proves something much narrower.

It proves that my finger touched the screen.

This matters because informed consent comes from a very important idea. You own your body.

A doctor can recommend what they believe is best, and sometimes their recommendation will be extremely strong, but the final decision belongs to the person who has to live inside those consequences.

Even the AMA describes informed consent as fundamental in both medical ethics and law, and centers the patient’s ability to receive information, ask questions, and make a considered decision about their care. The Joint Commission similarly describes informed consent as a communication process and links patient understanding with safer, more engaged care.

That principle deserves a better user experience.

Emergencies are different, of course. If somebody arrives unconscious and will die without immediate treatment, nobody should stand around searching for the iPad. Medical ethics has long recognized exceptions where urgent care has to proceed before normal consent can happen. (Although I’d personally argue most emergencies exist outside of that bucket)

Most scheduled procedures have no such excuse.

We knew the appointment was coming.

We had the patient’s email address.

We had their phone number.

We had plenty of time.

And somehow the most important information still arrived at the moment when they were least likely to absorb it. Unlikely to question.

I would actually like to read my informed consent form. I’d like to use it as a tool to understand my options more thoroughly. Ask my doctor the questions that matter to me.

This is not complicated.

Assume I have the right to make decisions with my own body. Send it to me early. Write the important parts like a human being. Give me the numbers when the numbers are useful. Tell me what my other options are. Give me somewhere to ask questions without feeling like I am delaying an operating room full of people.

Treat me like the person making the decision, not the person whose signature you need.

Then, once I understand what I am agreeing to, hand me the iPad.

I’ll happily sign it.

27 pounds.

That’s apparently that’s what I gained while I wasn’t paying attention.

I didn’t think it would ever happen to me. I had an exercise science degree, medical training, and a decade of professional cheerleading on my resume. Not to mention I am the owner of a comprehensive list of strong, self-righteous opinions about how to fix the health of every other man, woman, and child in America. So I was immune, right?

(This is not my proudest moment.)

The scales actually fell from my eyes while I was changing into my swimsuit in front of my daughter a few months ago. Mundane, of course - I’ve done it a thousand times without thinking twice. But that day at the lake, for whatever reason, it was different. My face got all red, and I wanted to melt.

After months (maybe years) of denial, I looked at myself, (like really looked), and I saw what was real. And I’m not even really talking about my body, but more so about the huge chasm between what I preach and the way I was actually living my life from day to day.

At first glance my writing appears to be about health policy, but essentially it’s more about agency and personal responsibility. About refusing to outsource your health to a system that profits from your decline. I actually get paid to stand on stages and give interviews where I tell others that “no one is coming to save you.” That you become exactly what your daily decisions produce, and if you choose poorly, you become easier to exploit.

And boy, do you.

So there I stood in the changing room - displaying the evidence of countless cocktail parties, late-night work outings, sky-high cortisol, travel, and brunches right there on my body, plain as day, in front of the person who’d been studying me most closely for the past two decades.

Your kids learn from what you DO, not what you say. And suddenly I realized the message I was sending my child was that she could be a hypocrite too.

After I saw it, I couldn’t unsee it and things had to change -immediately. No waiting for the holidays to pass or for work to slow down.

I joined a gym and vowed to clean up my diet that week.

And that’s how I found myself standing on a scale for the first time in longer than I’ll admit in print. (Because pointing fingers at the FDA doesn’t leave much time to check in on your own issues.) But, it wasn’t a “scale” exactly - it was more of a fancy body composition analyzer called an InBody. And it was parked horrifically right smack in the middle of the weights floor.

I was NOT emotionally prepared for anything the InBody had to report.

For years I’d blamed my expanding muffin top on my “special time of the month,” or the glyphosate-smothered wheat that was slowing my digestion, or long overnight shifts in the ER, or the evils of politics and mainstream media that forced me to spend all of my free time fighting the system. I was in total victim mode - willing to blame literally anything but the shift in my own commitments to myself.

I got really good at making excuses. So on the rare occasions I did step on a scale, the number was never “real” to me anyway. Because, I was in my luteal phase, or I’d had too much salt, or, I don’t know… something.

But the InBody, in all its judgy judgment, reported the impossible: I weighed more than I ever had in my non-pregnant life. Almost as much as when I delivered my daughters. And more than I weighed on the drive home from the hospital with a newborn in the back seat. Both times.

I was mortified. (I still am, actually.)

Not about my body or the weight, but about how I had built an entire life and career around knowing how to manage this exact situation, with no knowledge gap and no (real) shortage of time, energy, or resources, and yet - I let it happen anyway.

A lot of us do.

Mostly because I think no one actually gains 27 pounds. You gain 1 pound, 27 times and you lie to yourself about what’s happening.

But part of me knew. You always know.

• I knew when someone sent me this photo (above) and I didn’t post it because it “didn’t look like me.”

• I knew when “I’m just not in the mood for jeans” appeared out of nowhere, then slowly took over my off-duty personality.

• I knew when I started wearing blazers to events that didn’t really call for blazers, because a jacket hides a lot.

• I especially knew when my girls started borrowing amazing things from my closet that previously I thought they had no business touching, let alone wearing - and I let them, because some part of me had already given up.

I told myself I’d do something about my habits and my health after life got less life-y. Even though a lifetime of paying attention had taught me that life never gets less life-y.

And as I stood there staring at the number, I finally understood that I was committed to weighing exactly what I weighed in that moment. I hadn’t “wanted” it - but my calendar and my love for pinot grigio combined with key lime pie had produced exactly what I was observing.

This was what I was committed to. This had been my choice.

I could argue that my hormones, my insulin resistance, my anxiety, and my environment made me do it (and there’s real truth in those stories), but then what? I would stay a victim. And how can you change what you don’t even control?

It had been my choice. And I would now choose differently.

Your doctor is not coming to the rescue.

Twenty years ago I was an overweight young military wife with a toddler in tow, dealing with PCOS, prediabetes, and a grocery budget that didn’t really cover groceries. And when I asked what I could do about these new diseases, my doctor shrugged.

The medical consensus at the time was essentially: “Bless your heart, here’s some drugs - hope you have good insurance. You’re gonna need it.”

No one ever told me that the way I was living my life might be contributing to my health issues. No one suggested I could do anything about it myself.

When I did finally decide the weight had to come off, it was so I could make the team, not heal myself, but only because I never imagined that healing myself was even possible, because if it were - wouldn’t Hopkins have told me?

I also had no idea how I’d do any of it. I just knew that I had to, and that I would.

So I read and experimented. And I failed. Then I failed more. I asked everyone who would talk to me who knew anything about how to get fit - and they helped. What finally worked for me was not-so-moderate: two-hour workouts twice a day, six days a week, eggs, canned tuna, canned chicken, chicken breasts, protein bars, and black coffee.

I lost 25 pounds in three months. Built a ton of muscle. Then made it through a grueling months-long audition process (and to the final round of the Ravens and the Redskins) before accepting my place in DC.

But something else happened. In spite of the medical system’s insistence that my recent diagnoses were “a lifelong sentence,” I accidentally reversed the “incurable” PCOS and prediabetes. They were gone, and I’d done it all by mistake, all by myself - a poor kid from middle-of-nowhere Louisiana.

And that moment changed everything in my life.

Although it was just a blip in the matrix, it was the moment the system tipped its hand. I never again believed that medicine was infallible or that “doctor knows best.” It was proof that nobody was coming to save me - not medicine, not a guru, not a program, not a drug. And that if I didn’t want to end up somewhere I didn’t want to be, I’d better do something different.

And that lesson stuck with me - as a mom, in the ER, in DC, in everything I write until - I could no longer see it.

You can’t fix what you don’t see, and I was blind.

What I think I know. And what I don’t.

Everything past this point is what I’m using to recover my body and my integrity. It’s the result of pattern recognition gained over twenty years in health and medicine - from doing this work first on myself, then running clinical research with Johns Hopkins (which is ironic, I know), directing a multi-state rollout of the CDC’s Diabetes Prevention Program (perhaps also a little ironic), and counseling patients in the ER.

It’s not a prescription, but just my way of thinking. And it’s certainly not gospel.

(If you want commandments, I suggest you ask God. I can’t help there.)

Non-commandment #1: Diet does the work. Exercise does the magic.

Almost everyone attempting to change falls into the same trap: trying to exercise their way out of what’s on their plate.

We all do this even though we know it doesn’t work.

But the math just doesn’t math. It takes about an hour of hard training to burn what you can eat, standing at the kitchen counter, in like ninety seconds. Nobody outruns their mouth. So if the weight has to come off, the food is where it happens.

But it’s not easy.

Largely because the companies that perfected cigarette addiction bought the American pantry in the 1980s and pointed all their craving science directly at you. And since that time, the fork has not really been a fair fight.

But if all of that’s true, then why bother with the gym at all?

Because diet is nothing but restriction. It’s just a list of “no’s”, all day long. And I’m not sure anyone can live happily on just “no” all the time. You need to DO something, and exercise is the thing you can DO. So while the pounds slowly move out, you can build what’s underneath - actively. And of course, both changes work together to make you healthier.

So the TL;DR is that diet changes make you smaller. Exercise makes you happier and hot.

Non-commandment #2: When you eat matters as much as what.

You mostly already know what to eat. You probably learned it from your grandparents. Stuff that is real is better than stuff that is fake. Stuff that has less sugar is better than stuff that has more. Less booze is better than too much. Just the basic stuff.

The lever that you may have never pulled is timing.

, the nephrologist (that’s a kidney doctor) who wrote The Obesity Code, has spent his career treating patients with type 2 diabetes, and his argument reorganized how I think about all of this. He argues that we’ve been so fixated on the plate, that we never look at the clock. And the clock really matters.

Every time you eat, insulin rises. Insulin is the hormone that tells your body to store instead of burn. So how clean your food is only answers half the equation. The other half is how often you’re sending that store signal. Eat six times a day, enjoy fat-free food (you remember Skittles are a fat-free food), and you never once let insulin fall low enough for your body to reach for its own fat. You can eat “perfectly” and still keep the “burn” door locked all day long.

This is why “six small meals to stoke your metabolism” might just be the worst mainstream advice of the last thirty years, and why the single change that has moved the needle most for me, every time I’ve needed it, has been building in these boring stretches with nothing on my plate at all.

But of course no one makes money from you consuming less - not the pharmaceutical industry, not the hospitals, not Big Food - so we don’t really talk about this concept much.

It’s worth asking yourself: how many hours a day is my body actually allowed to burn anything?

If the answer is “almost none,” you found a lever you can pull.

Non-commandment #3: The same timing concept applies to movement, in reverse.

Your muscles pull sugar out of your blood while you move. Frequent movement affects your body differently than one single sustained session does. And the effect is strongest right after you eat.

For example, a ten-minute walk after each meal may control blood sugar better than one long 1/2 hour gym session in the morning.

I’m not saying that you shouldn’t do the 90-minute heavy lift (if that’s working for you, please continue). I’m just saying the quick walks after meals might be the most bang for your buck for your metabolism. I try to fit in a variety of activities throughout the day in addition to my formal workout.

It’s worth asking yourself: how long did I sit today? How long did I sit after eating? For most of us, the answer unfortunately is… “until the next meal.”

(Sigh)

Non-commandment #4: It’s going to take more than feels fair. Plan on it.

What’s required to get fit is way bigger than you want. The timeline is longer than you’d like. The workouts are more frequent, the weights are heavier, the walks are longer. The cheat meals are very few and far between.

It often looks like a complete overhaul of your life with more of everything at once.

Plus, when you lose weight, your body fights to get it back. Metabolism slows. Hunger hormones climb. The drive to move drops - you fidget less, you take the elevator, and you don’t even notice you’re doing it. Your body treats weight loss as a threat, because for most of human history, losing weight quickly meant trouble.

Again, Dr. Fung has some great ideas on how to minimize this effect in his books.

But the reality is that some weeks you’ll do everything right and you will get nothing back, and you’ll start wondering what’s wrong with you. Nothing is wrong with you. Your body is doing exactly what it was built to do.

Expect that fight and keep going.

Non-commandment #5: Losing is a sprint. But keeping it is a walk.

The intensity of getting fit is not particularly sustainable. But it doesn’t have to be.

Losing weight and maintaining weight are two different activities with different rules, and people fail because they play one with the other’s rules. The same is true with building muscle and maintaining it.

The woman who made that cheerleading team - with the two-a-days, the canned tuna, the whole shebang - was not doing something sustainable. It was never supposed to be. It was a sprint, with a finish line I could see.

People often get this wrong in both directions. Some expect gentle, sustainable habits to deliver dramatic results really quickly. Others get the results and then think they have to keep the brutal sprint going forever.

So decide, up front, what your goal is. Which one are you doing?

If you’re trying to lose, you’re allowed to do more than is sustainable long-term, because you’re not going to be doing it forever. If you’re maintaining, maybe that cheat meal actually IS aligned with your goals.

That permission is the part almost nobody gives themselves.

Non-commandment #6: Shrink the horizon. You only have to win this week.

A goal like “lose 27 pounds” is too big to wrap your arms around. You will never get out of bed at five in the morning for a number that far away.

So make it small enough to touch. (Could I lose a pound this week? Could I do one or two more reps next week than I did this week? Could I log my food for the next seven days?)

Whatever the goal is, make sure it’s achievable and measurable over a tiny timeline. And decide, in advance, what you’ll do if you hit goal and what you’ll do if you don’t.

A plan for a small adjustment helps morale survive the weigh-in: so maybe a long walk to support your progress, a skipped glass of wine with dinner, or finally trying your coffee without a packet of sweetness. Knowing what you’ll do if you don’t quite hit it, gives you a plan to move forward.

If it’s weight loss, know the number. Picture Friday’s weigh-in before it happens. Then run every decision through one question, all day long… Does this serve Friday’s weigh-in? The wine, the second helping, the skipped walk - does it serve Friday, yes or no.

It’s a small enough question that you can actually answer it, and small enough that you can actually win it. And the 27 takes care of itself while you’re busy winning weeks.

Non-commandment #7: You will have to adjust. Plan on that too.

Even if you are hitting goal week after week, what works today will eventually stop working.

You’ll hit a week where the plan produces nothing, or life detonates, or your body just shifts underneath you. When that happens, you don’t blow it up and quit. You just adjust, and you keep going.

Because the real skill here was always calibration. The ability to adjust fluidly. The people who win are never the ones who found “the perfect plan.” They’re the ones who keep adjusting instead of quitting.

Which is super annoying, but it’s also true.

So here’s MY plan.

Last time I did this, my life looked completely different. I had a toddler at home and a built-in support network.

I’d meet my friends at the gym and lift heavy from 5 to 7 every morning before a 5-credit-hour physics lecture at 8. Then spend afternoons at the park with my daughter, and back to the gym or the trails for another couple of hours in the evening.

I lost 1-2 pounds a week and added muscle the whole time. (I also missed way too many moments with my kid.)

That version of the plan is never coming back.

My life is different now. So is my body. I’m carrying a lot more muscle than when I started this journey in my early twenties, but it’s also much harder to add more, and change happens slower than it used to.

The motivation is different too. Twenty years ago I was committed to an audition date and therefore fine just white-knuckling it through the day. But now, I’m engaged in work that I love and projects that require deep thinking and attention. There is no timeline, and I’m just not willing to be that miserable.

So now I’m leaning into the example I want to set for my kiddos, the spiritual benefits I’ve found through fasting and prayer, and the radical acceptance that I am 27 pounds heavier because that is what I’ve been committed to - because that is what is.

Every item on the list below fuels me instead of draining me. Things that feel invigorating in this phase of my life made the cut, and things that take energy just to endure it - didn’t.

Specifically, here’s what I’ve been doing the past 4 weeks.

Weekdays: A power hour of work from 4 to 5am. (Otherwise I’m too attached to my phone and my running list of ongoing projects to actually focus on my workout. Know thyself.)

Lift heavy and stretch, 5 to 7am. I do a rotation of: Legs, Pull, Shoulders, Push & Glutes.

Then I shower, breakfast, ready to start the day by 8. I say no to meetings before noon (if I can help it) and I protect those hours for the work that requires more intense focus.

Lunchtime: Some movement of any flavor: a 7-minute workout from my 7-minute workout app, a quick 20-minute swim, or a 20-minute walk.

Evenings: I would love to fit in a movement block, but I haven’t figured out how to make it work yet, so I’m not.

Weekends: I’m trying to plan more active fun. Hikes, swimming, bike rides, walking - movement that doesn’t feel like work. I’m also capping my work time at 4 hours on Saturday and Sunday mornings, because the calendar is sort of where this whole thing went sideways the first time.

Food: My body does better on a lower-carb plan. When I eat higher carb, I find myself craving cookies, cupcakes, cannolis and booze. When I stay low carb, those cravings just don’t show up and that just feels better - so I’m going with that.

My typical menu looks like this.

Breakfast: Chicken meatballs + 3 eggs, coffee with heavy cream.

Lunch: Nutella-flavored protein (Transparent Labs, sweetened with stevia), PB2, and half a banana.

Dinner: Beef, salmon, or chicken and a veggie - any veggie, sometimes even the starchy ones like corn or squash.

Fasts: I’m also doing at least one 36-hour fast a week, on purpose. For me it looks like: eat dinner Saturday night, stop eating by 7pm. Fast and pray on Sunday. Eat breakfast Monday morning at 7am. Done.

I’ve come to lean on the stillness of those fasts instead of “enduring” them. That’s new for me too.

And that’s it. That’s my plan.

I’m not suggesting you do any of this - at all. I’m just telling you what I’m doing. And in between my other health and health policy writings, I’ll keep telling you what I’m doing - posting updates as I go, on what’s working, what isn’t, and what I’ve had to change to continue progressing.

Some of this plan won’t survive contact with real life, and that’s exactly how it’s supposed to work.

Final thoughts.

I don’t know how long it will take to get where I want to be.

My body has certainly responded favorably to these changes. Although some days it feels like it really hasn’t changed much.

But I am already different on the inside. So very much.

I feel proud of myself again. I feel in alignment with my integrity. I feel like a woman who does what she says. I feel peace. And that’s huge.

The change I wanted was never just a number on the scale. It was returning to the person my daughters can look up to. The one they’d want to emulate. Someone who lives what she preaches.

That’s the ultimate goal, and I’ve already achieved that.

I hope some of this resonated with you, and that you take what helps and ignore what doesn’t.

Until next time -

I’ve been quiet for several weeks now. It had nothing to do with writer’s block.

Marty Makary resigned his post as FDA Commissioner on a sunny Tuesday five weeks ago.

I was halfway across the country, sitting in hair and makeup with a friend, waiting for Marty to walk out and deliver the news. Neither of us said much. There wasn’t much to say.

When the moment came, I couldn’t watch.

Three days later goons walked , out of the building after she refused to sign a fake resignation, posting that she had been fired with “no regrets.”

(She wrote about her time at the agency and on being fired here)

By then, Vinay Prasad was already gone.

Three people who saved my sanity during the darkest, scariest time of my life (and certainly my career) swept out of the FDA within weeks, for what appears to have been the unforgivable sin of attempting to honestly regulate the industry they were appointed to oversee.

I keep trying to find a composed, measured way to describe how that felt, but I don’t have one.

I was devastated. Then angry. Then just numb.

I knew whatever I wrote next would be hard.

(Turns out it is.)

The problem was never figuring out what to say. What needs to be said is obvious.

The hardest blows MAHA has taken this year have not come from Pharma, legacy press, or any of the enemies we were prepared for.

They seem to have come from our own side:

• The recent FDA purge.

• Glyphosate (the chemical RFK Jr. built a legal legacy fighting) protected by executive order.

• Our own lawyers arguing Monsanto's side at the Supreme Court in one breath, then that states can strip religious accommodation from vaccine mandates in the next.

• $735 million committed by CDC to Pfizer to purchase Covid vaccines for infants and children.

And of course, Thomas Massie, one of the only Republicans who showed up to fight against any of it, losing the most expensive House primary in American history after many friendlies, including the Secretary of Defense, campaigned against him.

After 5 weeks of contemplation, I’ve decided to acknowledge the disappointments without participating in the friendly-fire. Not because the moves don’t deserve scrutiny, but because of who’s waiting to cash in.

The institutions who would benefit are the same crowd that spent the last decade sterilizing 9-year-olds, deifying pharmaceutical products, medicating suffering instead of solving it, and treating dissent as a threat to be eliminated at any price. The legacy-media health desks ran cover for all of it.

When those institutions are handed a coherent critique they don’t hear “ahhhh… a movement correcting course.” They hear something more like, “MAHA admits it was a fraud.”

So I’m opting out.

What hurts at the moment is that the people who seem to be working against us are not the swamp. They’re the people we believed cared about the same things we care about - regardless of which side owned the issue. The ones we helped put in place with our own hands and our own pocketbooks.

How do we get back on track?

I don’t know exactly, but I’m not the only one grappling with that question.

MAHA supporters are asking it in group chats, green rooms and the school pickup line. It’s the subject of so many conversations that drop to a near-whisper. And when the most loyal people in a movement begin to wonder whether their own side still believes what it said to get here, that’s a powerful signal to reassess.

I hope we take that opportunity.

Because when people feel betrayed they don’t immediately go out and vote for the other guy, but they do lose their vigor. They stop fighting to win. Eventually they just stay home. And when the votes and the money stay home, so does the influence those votes and dollars bought.

I don’t want that. I want change- and a healthy America.

MAHA’s promise was never “perfect, all at once.” It was “better, as fast as we can get there.”

By that measure we’ve gotten real things done like the food dyes, the nutrition guidelines, HRT relabeling, and honesty around gender issues.

And while I am an eternal optimist and usually have zero issues painting the glass half-full, I’m struggling with how to translate recent events into a story of missteps and misunderstandings.

As so often points out in her writing, policy fights are fierce and complex. Industry is a powerful force. And since I don’t know what I don’t know, I’m taking a breath to let the dust settle.

Here’s where I’m going instead-

For the next stretch, I’m leaning into the things I can write about clearly - without deciding in real time whether I’m defending the indefensible.

Why your hormones got dismissed for twenty years. The “settled science” your doctor never actually read. The supplement aisle that’s half snake oil, half life-changing suppressed research. What happens to your brain on an SSRI - and coming off one. The fight over what we’re allowed to say out loud, and who’s pulling the strings. The amazing things that happen when people gather. And how I clawed my own health back when the system had no answers.

Nothing should be too taboo to examine - vaccine injury, fecal transplants, the treatments your doctor dismisses and the ones they’ve never heard of.

I’ll come back to MAHA coverage. My mission hasn’t changed.

But right now, I’m processing. And I’d rather be honest with you than keep displaying a certainty I don’t have. Criticism from inside a movement is how it corrects course. But that only works if you’re honest with yourself first.

Midpandemic, I would come home from a run of nights in the ER, fall asleep on the couch for a few hours, and try to figure out how the hell we got here.

None of us went into medicine to hurt people, but the building I worked in ended up doing exactly that every single day. The hospital was always running out of beds, running out of staff, running out of time and the pretense that any of this was about the patient.

Marty Makary kept me sane.

He was a Johns Hopkins surgeon who had written a tell-all explainer describing the health care racket from the inside. He named the billing fiction. He named the pricing games. He named the patient as the product.

He said all of the naughty things out loud while still wearing his white coat - and he got away with it.

His courage is what drew so many of us to him.

Not his credentials (although they speak for themselves), but his willingness to say what the rest of us were watching from inside our own corners of the system and could not find the words to speak out loud. So when his name came up for FDA Commissioner, of course it brought hope. This time the truth-sayer would be the regulator - and oh what a world that would be. Someone with statistical savvy and ethics would lead. The man who wrote the book on accountability would sit in a seat where he could do something about it.

That was the dream anyway.

This afternoon he resigned.

Here is the simplest way to understand what happened:

The man in charge of regulating drugs got pushed out of his chair for the crime of trying to regulate.

Pharma came at him until he broke because, well… of course they did.

The Wall Street Journal editorial board ran half a dozen pieces hammering his stewardship of the agency. Career staff inside the building leaked against him to anyone who would listen. His friend and colleague, Vinay Prasad, was absolutely slandered in the press and then sent packing for enforcing scientific standards.

Each hit followed a threat to pharma. Each hit showed us who was in charge.

Marty held the line for fourteen months until he just couldn’t anymore.

You will hear other reasons because that’s part of how the game is played. They’ll write that it was his fault because he didn’t crack down hard enough on mifepristone for the social conservatives. Or he didn’t move fast enough to approve flavored vapes (even though flavored vapes don’t reduce harms from cigarette smoking and therefore are not allowed to be sold by law). You’ll read how MAHA wanted COVID shots pulled, and he didn’t pull them.

Was all of that Marty or was it the White House? We can’t know.

The cross-pressure is the camouflage, but the pharma pressure is the punch.

Within all of this noise is a signal worth paying attention to.

If doing the job gets you fired from the job, the job was never the job. The FDA does not exist to regulate drugs. It apparently exists to approve them.

And if that sounds familiar, you aren’t imagining it. Maybe you just read Jeffrey Tucker’s latest piece.

The agency was born captured.

Brownstone Institute’s Jeffrey Tucker (in addition to being wildly funny and undeniably the best-dressed man I’ve ever met) has a gift for spelling out truth. His article What If the FDA Were Eliminated outlines the origins and incentive structure nicely.

Five years ago it would have been intellectual porn - the kind of free-market thought experiment you turn over in a bar off the cobblestone streets of Cambridge for fun, but after living through the last fourteen months, it reads like a proposal that deserves a serious hearing.

Tucker’s argument is straightforward.

The FDA was not built to protect you from the drug companies. It was built at the urging of the drug companies to increase public trust so the public would take more drugs.

Tucker explains how its lineage runs through two acts of Congress, both lobbied for by the industries supposedly being regulated. In 1902, after contaminated vaccines killed children in St. Louis and Camden, the manufacturers themselves pushed for federal oversight to rebuild public trust and crowd out smaller competitors. The push was led by Parke-Davis, which Warner-Lambert acquired in 1970 and Pfizer absorbed in 2000.

Four years after Parke-Davis got its way, the meatpackers Upton Sinclair had just exposed in The Jungle took the same cue and lobbied for the Pure Food and Drug Act. Those two laws became the foundation of what we now call the FDA.

So the agency was indeed not “captured” by industry in recent times the way most Americans assume. It was actually born captured. Created to allow drug companies to succeed in furthering their push to sell more drugs. And every reformer who walks through the door is fighting the agency’s reason for existing.

Given that history, should it surprise anyone that the corruption outlives the people attempting to enforce standards?

The pattern didn’t end with the meatpackers. It continued.

In 1986, the vaccine industry won its liability shield by telling Congress it would otherwise face complete bankruptcy. The industry said, on the record, that due to the safety profile of vaccines which are given to healthy patients (and not as a treatment for disease) its products could not survive a normal market with normal liability. So they asked Congress to build a special market with special rules. As Tucker observes, under ordinary liability standards the cost of insuring these manufacturers would have made the whole enterprise unaffordable. The shield is still in place forty years later eliminating the pressure to improve or withdraw problematic formulas.

Born captured in 1902. A huge chunk indemnified in 1986.

Here’s how I see it: If Vinay Prasad and Marty Makary cannot lead reform of the agency, no one can.

They had the credentials. They had public backing. They had the Secretary. They had the entire health freedom movement in their corner. It wasn’t enough. The industry beat them.

Leading FDA was never the prize.

The media thinks they took something from us this afternoon. They didn’t.

They took a man out of a seat that was more of a leash than an opportunity.

The medical freedom movement that has been building around the agency for decades didn’t lose anything when he walked out the door.

What it did was confirm, in clearer terms than ever before, where the real fight actually is.

The fight is where you live.

You stopped trusting the morning news a long time ago. You started reading independent voices directly. You found a primary care doctor who does not take insurance, or you thought about it. You joined CrowdHealth or a healthshare, or you looked into one. You started buying meat from a farmer whose name you know. You talked to your kids about asking more questions. You read books and Substacks the algorithm did not put in front of you. You found me.

Every one of those choices is the movement.

Every one of them is happening outside of the FDA. Outside of Capitol Hill. Outside of the White House or any other government building.

What would it look like to have an FDA that was free to put the interests of the public over industry?

We don’t know. And we may never know.

The silver lining of the COVID response was that it was so illiterate, awful, and dumb that a lot of people woke up. The same thing is happening today.

It is so absurd that regulators would be pushed out for upholding the standards of science that more of us than ever are going to start asking the obvious questions:

Why do we even care about the FDA as it is? What would we even lose if this captured agency ceased to exist?

My answer is, I don’t really. And not much. And that is the part that should give you a little hope today instead of grief.

The parallel world we have been building has grown faster every single year the captured machinery has tried to crush it. They made Bobby Kennedy Jr. a household name by trying to silence him. They made Vinay Prasad a legend by smearing him. Every hit piece they ran against Marty this month is going to read, six months from now, like more proof of how screwed up things already are- emboldening us to choose differently.

The media and the pharma shills haven’t figured that out yet, but it’s real.

Here is what MAHA should do immediately: stop measuring wins by whose butt is in which seat. Vinay and Marty just proved that those particular seats are a waste of time. Start measuring wins by how many people are crossing into this alternative world we have been building outside them.

Let’s shift our focus to what will work:

State-level medical freedom laws that survive any administration in Washington. Direct-pay doctors and surgical centers who don’t answer to insurance companies. Cash-pay independent pharmacies. Real food sourced from people you can call by name. Real journalism funded by readers instead of pharma advertisers. Real science published outside the captured journals.

None of that requires the FDA Commissioner’s office.

All of it requires you.

Marty did the job for as long as a human being could do it from inside that building, and then he walked out so he could keep telling the truth from somewhere bigger. Somewhere they cannot fire him from. Somewhere he is free to speak without asking for permission.

The lesson is not that we failed.

The lesson is that the building was never going to let any of us succeed inside it, and the work was always going to have to be done somewhere else.

The building is not the movement, and no one is coming to save us. We have to save ourselves.

This article is going to appear like a detour from my usual musings. It isn’t. HHS hosted their first women’s health conference last month — I went for the policy. But somewhere between the panels and my second pinot, I found myself asking a different question entirely, and I haven’t been able to stop turning it over since: What does it mean to be a woman in 2026?

More recently than I’d like to admit, I walked into a women’s garden party expecting the usual.

(Ladies, you’ll recognize this.)

Lean in. Slay. Grind. And then collect those awards because, you know, you deserve it (or something). Just never admit that you have panic attacks and still cry in the shower on Sundays.

(Hi, I’m Tiffany, and I’ve attended approximately four hundred of these events.)

I’d been introduced to the host halfway across the country by a mutual friend. After one breakfast, two hours, and three coffees, I was hooked. Undeniably smitten and insatiably curious.

This woman was different — outspoken, confident, smart, captivating. The kind of woman you meet and immediately think: I don’t know why, but I need to be in her orbit.

She had a résumé that would make D.C. strivers cry tears of inadequacy in their leased European imports. But more than that, she projected an energy and a presence that made her résumé entirely irrelevant.

When she invited me to her home, I cleared my calendar and showed up — not really for the networking, but for her.

Enthusiasm aside, I was bracing myself for disappointment. I’ve known women like her. Women who’ve climbed that high always only have one sermon. It’s always the same one. And it’s awful.

So I had a plan. Hide my real self for as long as I could. Avoid excommunication before the appetizers. Try not to let any of my thoughtcrimes escape.

Namely, that I like being a woman. That men and women are different, not in a “bless her heart she’s confused” way, but in a biological, observable, not-up-for-debate way. That motherhood didn’t cage me, it elevated me. That I’m not a victim of my sex. And that if anyone’s getting a raw deal in this culture right now, I think it might be men (not us).

I’m not great at deception. I knew some piece of me would escape and she’d see someone who was not, and never would be, on her level. Someone weak. Someone who couldn’t evolve.

I hoped to push that eventuality as far into the future as possible.

She gathered us outside. A dozen women, organic herbal tea and gourmet chocolates in hand — and I settled in for the sermon I’d heard a hundred times.

I had my face ready. So ready. You know the one that says oh yes, absolutely, so empowering while your brain checks out and does something useful.

But the sermon never came.

Instead, she said women were falling apart. That we’d walked away from the most powerful thing about ourselves voluntarily because someone convinced us it was beneath us. She said the feminine roles we’d abandoned weren’t cages, they were where our power lived. And in our haste to win at girl-bossing or simply to keep the lights on and survive, we’d thrown our femininity directly into the garbage and lost our peace. We traded intuition, connection, and depth for the chance to prove ourselves in a masculine arena — fighting endless battles in corporate boardrooms and wondering why we were exhausted, empty, and had nothing left to give.

Not only had she thought the unthinkable, she’d said it out loud.

Unapologetically. In public.

I’d been running away from this knowing for years. I’d carried this feeling around secretly like it was something that made me the wrong kind of human. The wrong kind of woman. Someone wholly unworthy of mothering daughters.

I’d never been able to express it in words or even understand it fully, until someone who had already won all the masculine games I was still playing, sitting in a seat I wanted, with accomplishments I respected, from a life that I admired, said it out loud.

She said it plainly. Like it was obvious. Like it wasn’t crazy. Like it wasn’t something to whisper.

And in that moment, something in me broke.

Because she wasn’t just describing the world as she saw it. She was describing everything that was still wrong in my life.

The Programming

Here’s what feminism had actually installed in me personally.

Whatever needed doing (bills, decisions, the mental load of a household, the emotional weather of every relationship, the logistics of children and work and a life) had to be entirely on me. Not because help was unavailable, but because accepting help was shameful.

I had to do it all. By myself.

I had to make more money than the man I was with. I had to be the fittest and the prettiest. The one who remembered the appointments, packed the bags, noticed when the kids were off, managed the holidays, hosted the family, tracked the supplements, answered every email within the hour, and held the line on every standard in the house I’d silently set for myself. I had to demonstrate, every single day, that I could carry the entire weight of a life (well many lives, actually) — financial, emotional, logistical, spiritual — without flinching. Without asking. Without needing anything from anyone.

And THAT was the only way I could maybe one day be “enough.” But of course “enough” wasn’t achievable. In fact, “enough” wasn’t even definable.

There was no income, no title, no completed checklist, no inbox at zero, no beach body, no clean kitchen at midnight that would make me feel safe. And I had come to the conclusion that there never would be.

Not because I’m impossible to satisfy. (I mean, a little. But that’s normal, right?) But because at the end of every “enough” I could earn all by myself, I was still alone. Wholly responsible for my own safety, stability, peace, sanity and companionship. A position I am not (and will never be) comfortable in.

So what the heck was I supposed to do?

It felt hard and impossible. And not because I have a deep-seated self-esteem problem. Because no amount of winning was ever going to get me the thing I actually wanted: to be cared for, accepted and loved. To be poured into. To be held up by something larger than my own grip.

If, in my nature, true safety required the love and participation of others — a partner, a community, God — then by definition there was no destination I could reach that would let me exhale. None. Not a business, a body, a bank account or some sort of optimized morning routine. Not a perfectly run household.

No version of self-sufficiency was going to deliver the thing I actually needed.

And nobody’d ever told me that.

Nobody ever said the prize at the top of the ladder isn’t even the thing you’re looking for — and when you finally get to the top, there’s just more ladder.

All the while, the people in my life were behind me saying things like, let me take care of it. Do less. Breathe more. Sit down. Let me bring you dinner. Let me watch the kids. Let me make the phone call. Let me put a good word in for you. Let me help.

And I could. not. do. it.

I could not receive. Not from my partner or my friends or my family or even from God.

I’d internalized (down in my marrow) that needing anyone made me weak. That accepting made me a user. That a woman who lets others provide aid or comfort has already lost some invisible game, I didn’t even realize I was playing.

So I kept grinding.

Through the panic and the sleepless nights. Through the missed dinners and the canceled coffee dates. Through the loneliness of the “only-me”. Through the slow, draining of every soft thing about me.

And it cost me almost everything.

Patience. Joy. Energy. Intuition. Connection. God.

Softness, warmth, and the ability to feel — every feminine gift I’d been given got burned as fuel to keep my independence-engine running.

I was so busy proving I didn’t need anyone that I became someone I didn’t recognize. And I robbed the people who loved me of the chance to actually love me.

My partner couldn’t be what he wanted to be, a man who provides. My friends couldn’t be what they wanted to be, women who show up. God couldn’t be what He’s always been, a Father who takes care of His children.

Because I wouldn’t let any of them in.

My refusal to receive wasn’t protecting me. And it wasn’t protecting any of them. I was just hollowing out every relationship I had, and pretending I was doing everyone a favor.

Over time, the best parts of me just started dying.

What They Actually Did to Us

There is a distinction — and it matters — between having the ability to make money or take care of others, and protect your tribe and yourself, and having the mandate that this must be your highest calling for your entire life.

First-wave feminism understood this. It said: women should be able to vote, own property, work, earn, and not be treated as their husband’s legal furniture. That was (mostly) righteous.

But somewhere between suffrage and the present moment, the movement crossed a red line it never came back from. It stopped saying “women should have access to spaces” and started saying “masculine spaces are the only ones that matter.”

Motherhood got demoted.

Community got demoted.

Nurturing got reclassified as “internalized oppression.”

The woman who wanted to raise her children and tend her home and build the emotional life of a family and a community wasn’t making a choice — she was making the wrong choice. The consolation-prize choice. The choice of a woman who couldn’t cut it. And the woman who let her husband handle the bills, or her mother take the kids for the weekend, or her best friend bring her dinner when she was drowning — she wasn’t winning either. She was weak.

Modern feminism took the masculine standard — career achievement, economic output, public recognition — and declared it the only scoreboard that matters. Then it sent women onto a field we didn’t design to play a game we weren’t designed for, didn’t invent, didn’t even want to play in many cases, and tracked our performance on a board that doesn’t even have a column for the things we’re extraordinary at.

Feminism told us the only way to be a powerful woman was to embody a poorly-designed imitation of man with no team, no support, and no one to come home to.

But, in fact, women are not men. And that’s exactly what makes us special.

Women are uniquely positioned to feel and intuit — for themselves, for their partners, for their children, for the world — in ways that men simply can’t (or don’t) at least not as often.

It’s not a soft skill. It’s not a nice-to-have. It is a force that elevates every single person it touches. It’s what calls men to sacrifice their lives in order to protect us.

But that force can’t operate at full power when the woman carrying it is exhausted from trying to fulfill a role she was never designed to fill and forbidden from accepting the help that would let her sustain it. Eventually she runs out. She becomes the opposite of everything she was meant to be.

The woman who can’t receive becomes the woman who can’t give, not really anyway.

She becomes brittle and resentful. Angry and disconnected. Exhausted in a way that leaks out sideways at everyone around her.

She ages at 2x speed — snapping at her husband, being short with her kids, unavailable to her friends, and increasingly ineffective at work. She’s unable to be present in a room because half her brain is running the checklist of everything she still has to do alone tonight.

She becomes miserable and insufferable.

(And then she’s shamed for that too. Ask me how I know.)

When we can’t take care of our whole selves, we can’t feel whole.

We can’t relax into our bodies in a way that makes room for family, for the desire for sex, the desire to have children, for the desire for more. Chronic stress disrupts fertility in ways we don’t talk about enough. Because you cannot live in fight-or-flight and be open to creating (or nurturing) life at the same time.

Perhaps that’s why feminism told women their fertility was an obstacle to their “freedom.”

And the data confirm what our bodies already know:

In 2009, economists Betsey Stevenson and Justin Wolfers published a study through the National Bureau of Economic Research called “The Paradox of Declining Female Happiness.”

Over 35 years, as women gained more education, more income, more legal protection, more professional opportunity — everything the movement promised would set us free — women’s happiness declined. In absolute terms. And relative to men’s. In the 1970s, women were happier than men. By the late 2000s, that had reversed.

A 2024 study in the Journal of Population Economics found that women report worse mental health than men consistently across multiple measures of depression, anxiety, and negative affect.

We got everything feminism promised us —

And now one in four of us age 40+ are medicated (on antidepressants) to live through the result.

What We Left Behind

Women have a form of power that doesn’t photograph well, doesn’t go on a résumé, and doesn’t have a scholarship named after it.

The power to emotionally attune. To spiritually anchor. To build and hold the relational bonds that keep families from falling apart. To transmit culture and values and meaning across generations. To create the environment — in a home, a family, a community — where small humans become whole ones.

It’s women who remember the birthdays. Who set the table. Who show up with food when someone is sick, who remember that the neighbor’s husband just died and the new mom down the street hasn’t slept (or showered) in weeks. We are the connective tissue of civilization.

That work is the most important work in any civilization.

Everything else — the economy, the government, the institutions — it’s all downstream of the humans who were raised by someone present enough and whole enough to do it.

Let me be clear about what I’m saying:

Feminism didn’t just move women away from that work. It shamed us for wanting it. It built a culture where a woman who says “I want to raise my children and build a home” has to deliver that line like she’s entering a guilty plea. It shamed her. It made her a loser.

And eventually it left the post vacant. Because nobody filled it. Nobody could.

But it also did one more thing. It taught us that the connective tissue runs in only one direction… out. The same woman who shows up with food when someone is sick is never supposed to be the woman who lets someone show up for her when she is. The web only works if everyone in it is willing to be both ends of the rope. And we were trained to refuse one end of it entirely.

So we became the giver who never receives. And the giver who never receives doesn’t stay generous for long, because she can’t. So she starts keeping score in a marriage that was never supposed to have a scoreboard. She abandons her people, because she’s out of care to give. She brings her darkness home and lets it leak out all over the people she loves the most.

The childhood mental health crisis. The loneliness epidemic. The collapse of community. Marriages disintegrating. Wives running to TikTok to shame their men for not unloading the dishwasher. An entire generation being raised by screens because both parents are too depleted to be present. It’s all the predictable result of telling women to get out there and do everything on their own.

We look at the wreckage now and we act stunned, as if the consequences are some great mystery.

But they’re not a mystery. We left. We refused help. We abandoned the work that only we could do. Even the work we kept, we did on fumes — and the whole thing started falling apart right on schedule.

The Way Back (From Inside It)

I want to be honest. I have not arrived. I am not writing this from the other side with a neat little bow on my feminine transformation. I’m writing this from somewhere in the messy middle.

That amazing woman in D.C. didn’t tell me to quit my job and disappear into some caricature of domestic life.

I run a business. And I’m really good at it. I work with voices shaping this country —brilliant people who need my skills so they can keep changing history, while I help set the narrative. I build the relationships that get them in the right rooms and on the right screens. I write the words that help them change how ordinary people think about their health, their government, and their lives. That work matters. It’s the work the Lord has called me to.

I’m not asking anyone to go back to 1954. Because not every woman wants that. But the ones who want to be mothers, who want to receive care, who want to build a community and a home alongside a career or instead of one — deserve to want that and pursue it without shame.

What that DC powerhouse taught me was far more dangerous than any of that.

She taught me that the feminine is not a limitation to be overcome. It’s the most powerful thing about me. And she taught me something else — that letting other people in IS the feminine. That receiving IS the power. I’d been tricked into laying down the most powerful thing because someone convinced me it was something to be embarrassed by. And that if I wanted to become the biggest, most powerful version of myself: I had to learn to receive.

So I started listening to the thing I’d been ignoring my whole life — my intuition.

That knowing that had been there all along, buried under the grinding and the proving and the performing.

And trusting it felt sort of like saying “yes” to God.

Not in a church pew kind of way, but in an everyday life kind of way. It feels like clarity. I could suddenly see the design… men and women as different on purpose, not by accident, and women as the creators of the social fabric of the environment where we can all thrive.

Months after that garden party, she made a call on my behalf. Said my name in a room before I’d earned the right to be in it. She opened doors I hadn’t knocked on yet.

My first instinct was immediate and automatic: figure out how to pay her back. Quantify the debt. Earn it retroactively. Make absolutely sure nobody, including her, including me, could conclude that I ever needed help.

But I didn’t do any of that.

Instead, I said thank you. And I let it go (at least as best I could).

It sounds small, but it isn’t.

The woman who told me the truth about feminism over organic tea and good chocolate then demonstrated, without commentary, what a non-transactional feminine interaction actually looks like. She didn’t need me to zero out the ledger. She just wanted to be useful to someone she believed in.

And I have to learn how to let that be enough.

The programming doesn’t delete itself overnight. But the intensity of those feelings has diminished. And that’s progress.

More and more, I’m realizing that modern feminism didn’t free us.

It told us that we had to be something we should never be — a woman who faces life’s wins and struggles alone. And while we were busy proving we could do what men do, alone, we lost the ability to do what only we can do, together.

The wreckage isn’t theoretical — it’s in the happiness data, the divorce filings, the fertility clinics, and the faces of women who were promised they could have it all and ended up wondering why victory tastes like burnt garbage.

The answer isn’t going backward, because, well — it never is.

But the answer could be going deeper into the gifts and the power that were always ours, into community and love, into giving AND receiving, before someone convinced us to trade them for a seat at a table we didn’t build and didn’t really want to sit at.

I almost lost everything listening to the lie. God and the women who told me the truth pulled me back from a demise I’d carefully, proudly, painstakingly designed for myself.

And all I can say is I’m freaking grateful.

If this hit you somewhere real or if you read your own story somewhere in mine, please send it to a woman who needs to hear it. We should be allowed to be whoever we are.

Share

And if you’re not subscribed yet, come on in. We don’t do girl-boss pep talks here. We do a lot of health and health care. We do a lot of truth. Subscribe and join us.

Subscribe now

Leaving a broken system isn’t always the right thing to do. And staying in one isn’t always wrong.

That’s the part people don’t like to say out loud.

You already know which choice you gravitate to, but that doesn’t make it easy to admit - even to yourself.

You justify staying as being strategic. Not burning bridges. Waiting for the right moment. Making incremental change.

Or maybe your shame runs the other direction. You walked out, and you’ve spent the years since wondering whether “I couldn’t be complicit anymore” is actually integrity or just a story you tell yourself when it’s quiet enough for doubt to creep in.

Both of those shames are real. (Ask me how I know.)

Last week I wrote about Dr. Robert Malone resigning from ACIP - about When Winning Requires Sacrifice - what leaving costs, what it buys us, and what we owe the people willing to pay that price.

Malone News

When Winning Requires Sacrifice

Author: Tiffany Ryder…

Read more

7 months ago · 798 likes · 200 comments · Dr. Robert W. Malone

And then I posted again about my own experience leaving medicine.

Within six hours it had been reposted over 500 times - once every forty seconds - and by the following morning over 100,000 people had read it.

But the virality wasn’t the part that stayed with me. What stayed with me was who showed up in the replies.

A PharmD who left her career after her own child had neurological reactions to a medicine she routinely administered. With a decade of higher education on her resume, she knew the science. She saw it happen. She reported it. And she was told not to believe her own eyes. She lost everything long before she left.

A senior HR leader who walked away from her job, her retirement, her colleagues, and what she called “a very nice life” - with eighteen months left - because she refused to cooperate with a mandate she knew was wrong.

And then my friend and mentor, , who spent a decade in corporate banking while quietly losing his mind inside it. Two layoffs. Mental illness he does not soften when he talks about it. When he finally left, a former colleague told him he’d crossed over to the other side - unemployable. He knew, and he left anyway.

After gaining a bazillion subscribers and building a 7-figure business, he spends so much time with his family and his baby girls that his neighbors think he’s a bum or a felon and he just can’t find a job.

He doesn’t care. He’s happy. He finally feels like himself.

None of these people were trying to be heroes. They just hit a line they couldn’t cross.

I was one of them.

Except none of them hailed from the ER. None of them were talking about medicine. Because the truth about the choice to leave or stay isn’t actually about medicine at all.

Institutions are simply humans at scale. We know what’s real. We choose self-preservation anyway. Institutions do that too.

And that’s the mechanism underneath every single one of these stories. The pharmacist, the banker, the HR director - they all hit the same wall. The institution they trusted, the one they’d given decades of their life to, looked at the truth and chose itself. And then it asked them to do the same.

If you’ve been inside a system long enough, you don’t need me to explain how that works.

There’s the project that gets reassigned. The question that stops getting answered. The colleague who is suddenly, inexplicably less available. Nothing dramatic enough to point to. Just the slow withdrawal of the conditions that made it possible for you to do your job with any integrity, until you start to wonder if you imagined it- and then you realize you didn’t.

Tim wrote it cleanly, “you’re either part of the problem, or part of the solution,” but is that absolutely true?

Not everyone who engaged with my post felt it was.

This made me uncomfortable.

And if you’ve ever left something you built your life around, you’ve already had this conversation with yourself. Was it integrity or was it escape? Did you leave because you had to, or because staying and fighting was just harder than you were willing to admit?

Andrew Zywiec came down on one side and many agreed with him.

It’s a clean argument. And I understand why it resonates. And I actually feel it deeply myself. But brave isn’t clean.

The people who actually move the needle rarely fit the story we tell about them afterward - the one where the right choice was obvious and the person who made it knew exactly what they were doing.

That’s not how it works. That’s never how it works.

There are three ways people answer the question of what-to-do-once-ya-know:

Some people leave. They decide that participation is its own form of consent and they withdraw it, absorbing everything that comes with that - the lost income, the colleagues who stop calling, the identity they built carefully over years that is suddenly past tense. The pharmacist lost almost everything two decades before anyone was ready to listen. The HR director gave up her retirement with eighteen months to go. Their credibility now comes precisely from the fact that they have nothing institutional left to protect. You can’t threaten someone who already gave it up.

Some people stay. They make the opposite calculation - that two inches of movement from inside the room is worth more than any amount of noise from outside of it. The meetings no one will ever hear about. The relationships built over years. The strategic silence on the things that would get them removed, because they understand that if they leave, someone else sits down in their place. And if this is you, you’ve swallowed things that cost you something real. You’ve made peace with being misunderstood by people you respect, because you’ve decided the access is worth the price, and some days you’re sure about that. Some days, if you’re honest, you’re not. But it’s an act of courage.

Some people stay… until they can’t — and then leave in a way that changes something permanently on the way out. The soon-to-be-former Chief Medical and Scientific Officer of the FDA, Vinay Prasad, is a great example of this. He spent years inside medical institutions building credibility that’s nearly impossible to earn and can be destroyed in an afternoon. He survived pressure campaigns, public attacks, and the specific kind of slow institutional friction designed to make a person decide the fight isn’t worth it.

And when the choice came to hold-the-line or go-along-to-get-along, he chose the fight. He’s leaving in a way that makes it impossible to pretend certain things haven’t happened - not as an act of self-destruction, but as a final deliberate use of whatever runway he has left. There are people who will never forgive him for it. There are people who are better off because of it. Both of those things are probably true at the same time. (Which is usually how it goes with the people who actually change something meaningful.)

None of these are opposing camps. They’re different roles in the same fight, and the fight needs all of them.

• The ones who leave make the silence visible. They give language and permission to the people still inside who are wondering, with some private relief, if they are the only one who’ve noticed what’s happening.

• The ones who stay hold the seat so that when the window opens, someone worth listening to is still sitting in that room.

• The ones who blow the door off on the way out make it impossible for the institution to pretend none of it happened.

The system benefits enormously when these people turn on each other (as they often do). When the ones who left call the ones who stayed sellouts, and the ones who stayed call the ones who left self-indulgent.

The system wants those arguments running on a loop, because they threaten no one and they change nothing and they keep everyone so busy pointing fingers that they don’t look at what’s happening inside the system itself.

And if you’re like me and you find yourself judging one of those groups a little too quickly or too harshly- it’s really worth asking which part of your own decision you are trying to justify.

You already know which group you are part of. Not the group that sounds better when you explain it to someone else, but the real one. The one you come back to when there’s no one watching.

And what I’m suggesting, is just own it.

All the way.

The shame you’re carrying, whichever direction it runs, belongs to the system. Not to you. Not to those who recognize the system for what it is. The person who left didn’t abandon anyone. And the person who stayed isn’t selling out. The person who’s still deciding isn’t a coward.

Brave is gray. It has always been.

The institutions want you to believe otherwise. They want you to believe there’s a bright clean line between the heroes and the sellouts - because people chasing a bright clean line are a lot easier to control than people who have made their peace with the gray.

Stop performing the version of yourself that fits more comfortably into whatever conversation you’re in. Because the reformers who actually change things are the ones who stop apologizing for exactly what they are.

You don’t have to ask yourself who you are, because you already know.

The only question left is whether you’re going to stop pretending that you don’t - and what it’s going to cost you when you do.

Subscribe now

I have been careful about vaccines - not because I don’t have thoughts.

I have a lot of thoughts.

I’ve watched hundreds of hours of ACIP meetings. I’ve read the studies. I practiced emergency medicine through Covid. I’ve sat across from mothers telling me what happened to their child at a well-visit and then watched myself say the words “the CDC says vaccines are safe and effective” because that was what I was trained to say, and I didn’t have much better to offer.

I have been careful because the cost of not being careful in this particular conversation (even simply admitting that we don’t know what we don’t know), has historically cost your career, your credibility, and your inbox.

I wrote about it once, carefully, and the response was instructive.

Then President Trump walked up to a podium with Marty Makary, Jay Bhattacharya, Dr. Oz, and Dorothy Fink and said what many of us have been thinking for years. That there seem to be some things we don’t fully know. That the effects of one vaccine are likely different from the effects of six vaccines given all at once. That medications taken during pregnancy or given to infants could have unintended biological effects. That perhaps there are treatments that could provide real symptom improvement in autistic kids that are yet to be discovered or recommended.

Not a wellness influencer or some fringe blogger - the freaking President of the United States. With the FDA Commissioner, the CMS Administrator and the NIH Director standing behind him.

That press conference happened less than 24 hours before I sat down with Ray Kober for this episode of Broken Healthcare. So when he asked me what I thought — I told him.

My daughter had a seizure the day of her well-visit. An series of MRIs showed progressive demyelination - the result of some inflammatory or autoimmune process I was told.

“We don’t know if she’ll develop normally. We don’t know what caused this to happen, and we know you asked about her vaccinations that morning, but we know it wasn’t related those. Vaccines don’t cause this.”

I was a young mom with no medical training and I believed them.

It took me years - and a medical degree, and years of hearing that same story come out of other mothers’ mouths while I stood on the other side of the exam table — to understand what had actually happened in that conversation.

The actual truth was, they didn’t know. They just weren’t willing to say so.

And that’s the part that makes me the angriest. Not the uncertainty, because uncertainty is honest. But the certainty performed in the presence of uncertainty that has cost us everything - including trust in public health.

Forty to seventy percent of mothers of autistic children believe a vaccine appointment preceded the change in their child. You can argue about the science on causation all you want. You cannot argue that we know anything definitively or that those women deserved to be dismissed.

Ray and I also got into what the actual ACIP data looks like up close — small sample sizes, safety follow-up windows of four to five days, the hepatitis B birth dose debate that the American Academy of Pediatrics was so opposed to they refused to show up and make their case. We talked about what public health was actually supposed to do versus what it did during COVID.

And we talked about why the people screaming loudest to stop asking questions are the ones with the most to lose if anyone finds an answer.

Here’s the link to the White House briefing. The full conversation is below. Ray Kober is a great interviewer — he pushes, he follows up, he doesn’t let things slide. This one went places.

If this is the first time you’re reading Signal & Noise — this is what we do here. Not telling you what to think. Giving you the information the other outlets won’t touch and letting you decide. Subscribe if you want more of it.

Subscribe now

And if you’re curious about what happened with my daughter. That’s here below.

Men die 6.5 years earlier than women. They have higher mortality in 9 of the 10 leading causes of death. They use healthcare resources 69% less than women.

And yet, we’ve spent approximately zero political capital addressing any of this — despite the economic burden of ignoring it approaching $500 billion a year.

That’s changing.

The FDA just held its first-ever men’s health panel — and has finally started the conversation.

I sat down with Carrie Abbott last week to talk through what I heard in that room.

We discuss the testosterone data that’s been buried under decades of a myth born from a study so small and so old it has no business still driving clinical decisions in 2025. And newer research from the VA which tracked over 80,000 men with low testosterone and found that the men who restored their levels to normal had a 56% lower risk of all-cause mortality compared to those who didn’t.

Testosterone isn’t just about sex drive.

It’s about the diabetic whose foot won’t heal, the 68-year-old who breaks a hip and never walks independently again, the man who tells his doctor he just “doesn’t feel like himself anymore” — and gets told that’s normal for his age.

Supplementation isn’t for everyone and comes with risks to fertility, but ignoring testosterone altogether is a costly alternative—in dollars and in lives.

It’s worth learning as much as you can.

Listen here

We asked the FDA to say no to Pharma.

I do not mean we asked politely.

I mean we built a regulatory agency whose entire function is to tell the most profitable industry in the world that it cannot do what it wants. We staffed it. We funded it. We gave it authority. We call this public health infrastructure.

The name is the thing we did.

We did not build anything to protect it when Pharma pushed back.

Pharma pushed back. This was not a surprise. This was not a betrayal. A company told no by a regulator will attempt to remove the regulator. This is not corruption. This is a business model. Corruption implies deviation from the norm.

This is the norm.

Pharma funds the media. Not as a side arrangement. As the operating budget. Pharmaceutical advertising is the financial infrastructure of American health journalism. The news about the FDA is brought to you by the companies the FDA regulates. This is disclosed in the fine print.

The fine print is the point.

When the FDA says no, the media covers the FDA. The coverage is not about the regulation. The coverage is about the regulator. This is more efficient. A regulation can be debated on the merits. A regulator can be destroyed on character.

One of those outcomes is reversible.

Vinay Prasad’s job is to tell Pharma no. The media’s job is to make that impossible. The Wall Street Journal ran sexual harassment allegations against him. The allegations didn’t exist. The original story ran everywhere. The correction came nineteen days later. Quietly. On page six. Nineteen days is not a correction. Nineteen days is a strategy.

Prasad is leaving. The strategy worked.

Marty Makary’s job is to tell Pharma no. The media is coming for Marty Makary. Tracy Beth Høeg’s job is to tell Pharma no. The media is coming for Tracy Beth Høeg. The playbook does not change.

The strategy works.

We watch this happen. We call it bias. We write about it. We post about it. We describe the mechanism in great detail to people who already understand the mechanism. Pharma is not threatened by people who understand what Pharma is doing.

Understanding the mechanism is not the same as breaking it.

Two things break the mechanism. The mechanism is not broken.

Leadership cover breaks it.

The President. The White House. Every health agency head. The entire administration standing behind the regulator when the regulator says no. Not a statement. Not a spokesperson. A wall. FDA leaders who know they will not be abandoned can hold the line. FDA leaders who are not sure will manage their exposure instead. They will do as much good as they can without being shown the door. This is a rational response to an irrational situation.

Public outcry moves leadership.

It must be loud enough to be unavoidable. Unavoidable means abandoning the regulator costs more than protecting the industry. Unavoidable means silence is no longer politically safe.

Neither eliminates the attacks. The attacks don’t need to be eliminated. The attacks need to be survivable. Public outcry makes them so.

You now have a choice.

You can know this, and know that you know it, and watch what happens next. The show is well-produced. The outrage cycles are timed. The corrections run on page six. Nineteen days later, if you’re lucky. There is a version of this where you live a perfectly comfortable life and the FDA never regulates anything that matters and you never have to do anything about it.

Or you can get loud enough that protecting Pharma costs more than it’s worth.

Those are the only two options. Pick one.

Subscribe now

At 21, a doctor told me I had PCOS and pre-diabetes and then handed me a Metformin prescription.

“This is just what you’ll have to live with,” she said.

So I did. Until I didn’t.

(Turns out eating real food and moving your body is a treatment plan. Who knew?)

But that was the first time a strange thought crossed my mind. Maybe the people who say they know how this works… don’t actually know anything about how this works.

Hmm.

Years later — after the NFL, foreign medical school, PA school, the ER, and COVID — I read The Price We Pay by Dr. Marty Makary and suddenly understood things I hadn’t been able to articulate before.

• Why I’d been handed a pill instead of a lifestyle prescription.

• Why my employment contract said I wasn’t allowed to tell patients that a cash-pay clinic existed across the street.

• And 1000 other horrific, uncomfortably true things about medicine, and the system we call ‘health care’.

(I’m still looking for a word to describe it that doesn’t start with an F-, but haven’t found one yet)

Somewhere along the way, a realization crystallized.

I could keep saving people one-by-one in the ER, but if I did, I could never fix what was actually breaking them. So I left.

And that’s the real story behind this episode.

In this conversation, Troy Reichert and Dr. Jonathan Bushman gave me the space to tell the full, messy, nonlinear version — the NFL years, the diagnosis that reversed itself, the ER shifts where the incentives finally became impossible to ignore, and the moment I realized something most clinicians eventually confront:

• We can hold someone’s hand.

• We can stabilize them.

• Sometimes we can even save them.

But we can’t repair a system that was never designed for patients to win.

And that raises a much bigger question…Why are patients losing in the first place?

Watch the full conversation below.

If you’re new here, this episode is a good place to start.

It’s the origin story behind everything I’m working on now — helping people understand the system they’re navigating (and paying for), and helping clinicians speak honestly about the one they’re working inside.

Because once you understand how the incentives actually work…the entire healthcare landscape suddenly makes a lot more sense.

And don’t we deserve to know?

Subscribe now

Somewhere in America, a mother is sitting at her kitchen table reading a press release from a pharmaceutical company. It says they’ve developed a treatment for her son’s lethal disease.

The language is familiar: unprecedented, transformative, paradigm-shifting. And it’s the first thing that has sounded like hope to her in years.

The company knows something she doesn’t. Their clinical trial data isn’t actually as good as the headline implies. But she won’t know that for a while yet.

How could she?

As she reads, she can feel her body losing control. She clutches her hands in front of her chest and holds her breath. She’s shaking violently as the tears begin to spill over.

The patient advocacy group that emailed her the press release receives funding from the drug company. But she doesn’t know that either.

How could she?

She sobs. Deep heaves that start at her core.

What she knows too well is that her son is getting worse — and this document is the first thing that has made her feel something other than helpless since the diagnosis.

She thanks God over and over. She won’t sleep that night.

Tomorrow she will call her congressman and next month she will sit across from a federal regulator, holding a picture of her boy, while he tries to explain that the data doesn’t actually mean what she’s been told.

The press will photograph the mother’s tears. They will not photograph the data.

The pharmaceutical company will use the photograph of the mother to tell the story.

So will everyone else.

It’s how it works. Not sometimes. Almost every time.

It’s the most reliable communications playbook in American industry, and it has been running for decades, often funded by companies that charge millions for drugs that don’t work - or worse.

If that doesn’t make you sick, please stop reading. This piece isn’t for you.

What Happened to Vinay Prasad

Now let me tell you about someone who tried to stop it. Someone I respect.

Vinay Prasad is a rare thing in American medicine: a credentialed insider. Honest. Brave. He’s tenured, published, and despite his outspoken nature (or perhaps because of it) - taken seriously by the institutions that matter.

He made a choice a long time ago to say out loud what his colleagues whisper at the bar after conferences - that the drugs getting approved are often backed by evidence so thin you could read their press release right through it. That companies have learned to completely game the system by picking the right surrogate marker, designing the trial against a weak comparator, manufacturing excitement for the New York Times, and converting that excitement into approval before anyone answers the harder question: does this actually help the patient?

In many cases, those paying attention know the answer reveals itself (often years too late) to be a definitive, ‘no’.

Prasad spent years saying this (and more) bravely and loudly from the outside. Then, in May 2025, the Trump administration gave him the chance to do something about it. He was appointed Chief Medical and Scientific Officer of the FDA and Director of the Center for Biologics Evaluation and Research (CBER) — the division that oversees vaccines, gene therapies, and blood products.

His job was simple: make sure the drugs the FDA approves actually work.

Not “moved a number that doesn’t matter on a lab report” work. Actually work. Meaning patients live longer. Patients feel better. Patients stop getting worse. He held that line.

The machine came for him. Because every approval decision in that office can be worth billions.

The Playbook

Notably, at least three times in ten months, Prasad made a decision the science supported and the industry couldn’t tolerate. And three times, the same playbook ran.

One company’s gene therapy became embroiled in controversy after deaths were reported among patients who received the treatment — including boys in a population that had not been represented in the original study. When regulators asked the company to pause distribution while the safety questions were reviewed, a political influencer attacked Prasad fiercely from inside the tent within days. The pressure escalated quickly. Prasad resigned briefly and returned to the role roughly two weeks later - but by that time, it was too late - that narrative had already been written.

Another company designed a vaccine trial using a comparator the CDC’s own advisory committee doesn’t recommend for the population being studied. By that point, everyone knew Prasad wanted real science. What showed up instead was the usual. When Prasad rejected the application — and signed the rejection himself, which almost never happens — the company released his letter to reporters. Unsurprisingly every major outlet ran a personality story with the framing that benefited you-know-who. And of course, his actual objection (the actual science) was in paragraph nineteen - if it was mentioned at all.

A third company ran a randomized trial of its millions-of-dollars-per-patient brain injection. The trial design meant it couldn’t show whether the drug actually helped patients. Yet the company’s alternative analysis claimed a 60–75% benefit. Both cannot be true. When the FDA asked for a proper trial the usual suspects showed up portraying Prasad as a literal monster blocking life-saving treatment.

Same playbook. Funded, coordinated, deployed in real time.

And every time, there was a mother at the kitchen table. Reading the press release. Believing the hope. Turning to social media. Being used.

The truth is entirely negotiable.

On February 11th, during the second debacle mentioned above, the Wall Street Journal published a story alleging Prasad was under investigation for — among other things — sexual harassment.

Nineteen days later, the paper issued a correction stating that an HHS spokesman had confirmed that no allegations of sexual harassment had actually been filed against Prasad, and their earlier version of the article had been incorrect.

A blurb added to an article that had been published already for weeks.

It’s worth noting that in modern media cycles, nineteen days is an eternity. Long enough for every outlet that picked it up to bake it into the story. Long enough to become the first page of every Google search for a man with a family and a career.

Long enough to do exactly, what I suppose, it was designed to do.

In those nineteen days, there was no official rebuttal. Not even from Prasad himself. No rapid response. Not one credible, positioned voice went on the record to say: this is false, there are no such reports, here is what this man actually did, and here is perhaps why the people who want him gone might be willing to fabricate allegations to make it happen.

The story spread.

None of This Changes a Harder Truth

A small part of this is on Vinay of course.

I say that because nothing is ever entirely one-sided. I also say it with buckets of respect, and I mean it.

What he attempted to do at the FDA was brave and necessary. And the fact that someone can be so right on the data and still not survive the institutional backlash should terrify all of us.

The person who takes over for him needs to understand something this tragedy revealed: the science is the floor, not the ceiling. The ceiling has always been coalition. And for whatever reason, Vinay struggled to bring enough people along with him to stand behind his excellent work.

A federal agency the size of the FDA will not change its direction just because evidence standards are now being upheld, because it’s never just about being correct — it’s about building alignment across thousands of people who have been operating under different rules for years.

The career staff at the FDA are not all captured by the system- they can’t be. Many of them must have spent years watching weak science get approved and quietly wishing someone would challenge it. Those people should have been powerful allies for Prasad, but for whatever reason they remained silent or turned away.

This issue will continue to threaten progress until it is solved by Commissioner Makary and whoever replaces Prasad. I have confidence it will be righted with time.

What Needs to Exist

The honest people who lead these agencies shouldn’t have to do this alone.

Modern regulatory fights are fought as much in the information ecosystem as they are in advisory committees and briefing documents. It is not a criticism of any individual to say that the communications infrastructure this movement needs does not yet exist.

But the question is, who builds it?

That question is no longer abstract. It has a body count — not only in lives lost, but also in reformers destroyed, in policies reversed, in mothers lied to, and in patients that will be harmed in the future.

So I am speaking directly now to every MAHA-adjacent organization, policy group, PAC, and advocacy operation that raises money on the promise of reforming American health care.

If you want to win — actually win, not just rally the base and cash the checks — the base cannot be the only battlefield. The base is already with you. We believe.

The fight must now be brought to the unfriendly media and to the persuadable middle. The mother at the kitchen table. The reporter on deadline who will write whatever story she’s handed because no one’s given her a better one. The voter who sees “Regulator Blocks Life-saving Drug” in a headline and takes it at face value because no one — not one person — has made the counter-case in language he can understand.

Reaching those people requires a professional, full-scope operation.

• Credible insiders with clinical and policy credentials positioned to speak to mainstream outlets, not just friendly podcasts.

• Rapid response capability that can reframe a false narrative within hours, not weeks.

• Science translated into language a reporter on deadline and a mother at a kitchen table can both follow.

• Message coordination between the people doing the reform work inside government and the people explaining it outside — within every ethical and legal boundary (and there are many), but within those boundaries there is an enormous amount of work that is simply not yet being done.

This is not optional anymore. It’s the whole mission.

This is how the other side has been winning, and until we match it, we will keep watching our people get destroyed in public while the companies that massage the data celebrate.

There’s a structural reason the government may not be in a position to lead this work - even when it wants to. As much as it pains me to admit winning elections requires coalitions, and coalitions require compromises — often with the very industry interests that reform threatens.

Those debts don’t disappear on Inauguration Day. MAHA-aligned outside organizations answer to none of that. Their donors came to this fight specifically to win it. So if the government can’t, or won’t, fund this then it falls to us.

To every person who has seen the truth about how this system works and can’t unsee it. To every organization that claims this calling. If we see the work that needs to be done and we don’t build the infrastructure to protect the people doing it, then we are not a movement. We are simply an audience playing games that make us feel good about ourselves while accepting defeat and calling it ‘activism.’

This has to go both ways of course. The best surrogate operation in the world is useless if the leaders inside government don’t want it. Which means supporting the unglamorous work of crafting the narratives that make reform durable instead of dramatic. Our organizations can help build it. But our leaders will have to support it.

To the Next Vinay Prasad

Vinay Prasad’s science was right. His regulatory instincts were right. The system he challenged had a playbook. He didn’t.

He’s leaving the FDA ten months in, reputation shredded by lies and spin while the drug companies and newspapers that tell the public what to think, continue playing fast and loose with the facts - in all regards.

On Friday, when Prasad’s exit was announced, the biotech ETF rallied on the news. Which tells you everything you need to know about who thinks they won this battle.

And somewhere tonight, a mother is sitting at her kitchen table.

• She’s reading a press release.

• She doesn’t know the trial wasn’t good enough.

• She doesn’t know the advocacy groups are funded by the drug company.

• She doesn’t know that one of the last people trying to protect her son just got run out of Washington.

All she knows is that someone finally gave her hope. And she may find out that it was false hope in the most painful way possible.

She deserves better than this. We all do.

To Vinay Prasad, I’m truly sorry.

To the next Vinay Prasad, we see you. And this time, God willing, we’ll support you better. We’ve learned. And you won’t have to walk in alone.

And if you want to read more, catch up on last week’s article here:

I never wanted to be a health writer.

I just wanted to be useful — which for a long time meant practicing in an ER, telling scared patients the truth about what was happening to their bodies.

What I didn’t expect is that leaving clinical medicine and transitioning to communications would put me closer to the root of the problem than I ever was inside the hospital - but that’s exactly what happened.

The MAHA movement is doing amazing, historic work — on the food system, on hormone therapy, on FDA evidentiary standards.

But most Americans have no idea it’s happening. Not because the policy is failing. Because the story isn’t being told.

And we’re letting it happen.

That’s what this conversation (and the article below) are about.

Let me know what you think.

I spent the COVID years in emergency medicine; I left because I couldn’t stomach what happened to my patients after I saved them.

Great work is done in the ER - and then comes the billing, the bankruptcies, the slow destruction of an entire human.

This past week felt eerily similar. Except instead of patients’ lives being destroyed when it’s over, it was the policy machine meant to save them. I watched monumental work get torn down the moment it left the press room.

The MAHA movement has the best health policy team in a generation. Hands down.

Marty Makary at FDA is a serious person doing serious work. Jay Bhattacharya is bringing intellectual rigor back to the NIH. Bobby Kennedy is reshaping HHS in ways that would have been fantasy two years ago.

The food dye phaseout is real. The GRAS reform is real. The dietary guidelines overhaul is real. Here’s what’s also real: none of it matters if the only people telling the story are the ones trying to kill it.

This was the worst week MAHA has had since MAHA became a thing - not because things went sideways on policy, but because the communications infrastructure supporting these agencies is either broken or doesn’t exist. I watched at least four separate wins (or at worst defensible decisions) get turned into headlines that read like the whole movement is a scam.

It shouldn’t have happened. It’s a misrepresentation. And the most maddening part is that every single one was preventable.

Let’s walk through them one by one.

Then I’ll share exactly what needs to happen if we don’t want to lose the MAHA base and the midterms in the next 9 months. Because as amazing as our leadership is, and as incredible as their work product is, the narrative is closer to the edge than the policy wins would suggest - and that gap is exactly what the opposition is exploiting.

Let’s start with the biggest punch in the gut.

1. Glyphosate: There’s No Good Way to Spin This, So Stop Trying

Let’s just be honest.

The President signed an executive order (EO) invoking the Defense Production Act to expand domestic glyphosate production that is being widely viewed as increasing pressure for manufacturer’s immunity. Bobby Kennedy - the man who won a $289 million verdict against Monsanto - defended it.

There’s no spinning this news after-the-fact for the MAHA base.

We’re too informed and we’re quick to call bullsh*t. Without a plausible explanation before a shock like this, it’s over. But before we move on, let’s chat about what I assume is the President’s underlying logic.

The U.S. imports a significant amount of its glyphosate from China, there’s essentially one domestic producer, Bayer, and Bayer threatened to pull glyphosate from the American market entirely without litigation protection. So while I hate this EO with everything inside me, a national security argument in favor of it really does exist.

But this is THE chemical. The one MAHA knows all too well.

It’s what powerhouse Kelly Ryerson has organized her whole life around. And what the Food Babe, Vani Hari’s, audience of millions cares about more than anything. It’s what Dave Murphy - Kennedy’s own former campaign finance director - called a “strategic mistake” and “election liability” that will cost midterm seats.

So why did it drop with no warning? But more importantly, why did it drop at all?

Here’s my working theory.

When you’re constantly on defense - when every policy announcement gets twisted, when every FDA action gets framed as a betrayal, when every personnel move becomes a crisis - you run out of political capital. Period. You start making trades you shouldn’t have to make. You stop being able to protect the things that matter most because you’ve already spent your credibility budget putting out fires that never should have started.

Fires exactly like this one.

Glyphosate is the bill that came due after a year of letting the other side - the people who care about defeating anything adjacent to Donald J. Trump more than they care about the chronic disease epidemic killing our kids - tell the MAHA story.

And nobody - not one single person fighting for the kids - got ahead of it.

No surrogate appeared on a podcast the day before the EO dropped to explain the China supply chain vulnerability. No MAHA-friendly voice got briefed on the national security angle so they could prepare their audience for what was sure to be a disappointment.

Kennedy is the most credible voice in the room on this issue. After all, he’s spent a lifetime suing industry and fighting against the proliferation of harmful chemicals like glyphosate. And that is exactly why he deserved a prepared audience.

Instead, his credibility became the liability — an entirely preventable tragedy.

The predictable result is, of course, a viral clip of Kennedy saying “I believe glyphosate causes cancer” on a podcast last month, playing on a split screen next to his defense of the EO. Thomas Massie - a Republican - drafting legislation to undo it within days. MAHA moms flooding social media with “we do not consent to being poisoned” banners.

It doesn’t matter if Massie’s bill goes anywhere or if the MAHA moms get traction. The optics hurt badly.

The only path forward now is to acknowledge the hurt, explain the situation honestly, and show the base what you’re going to do next. But that requires a communications operation that actually functions. Without a significant change, course correction seems unlikely.

2. The FDA Dye Story: An Actual Win That Got Reported as a Broken Promise

This one makes me want to put my head through drywall.

On February 5, the FDA announced that companies can now label products “no artificial colors” when they’ve eliminated petroleum-based dyes.

I know because the press release is still sitting in my inbox.

They approved beetroot red. They expanded spirulina extract. They sent a letter to industry reminding them that all color additives have to meet safety standards.

This is actual progress.

It’s the FDA doing exactly what they said they would do in record time. It’s Makary moving the ball forward on one of MAHA’s core promises to its base. The phaseout timeline is holding. Companies are reformulating. The tracker on FDA’s website shows real movement.

So what do the headlines report?

• “Anger as Trump’s FDA retreats from plan to ban artificial colors in food.”

• “Another broken promise from Secretary Kennedy and President Trump.”

• The EWG said Kennedy “settles for handshake deals with Big Food.”

Here’s what actually happened: the FDA cannot snap its fingers and ban six color additives. Revoking a color additive authorization under the FFDCA requires formal rulemaking - scientific evidence, public comment periods, legal review… blah, blah, blah. The process is designed to be slow.

The voluntary phaseout approach, combined with expedited approval of natural alternatives, is genuinely the fastest path to getting these chemicals out of the food supply. More than twenty-five states have pending legislation. Companies representing the vast majority of the market have made public commitments.

But nobody explained any of that to the public.

Not immediately before the announcement. Not during. And by the time the defensive statements came out, the narrative was already set.

Here’s how it reads: Kennedy promised a ban, Kennedy delivered a handshake.

It’s exactly what happens when you have a Secretary and a Commissioner who understand regulatory science inside and out - but don’t have a communications team that can translate that regulatory science into a story the public can follow.

If this pattern continues, it risks becoming MAHA’s undoing.

The fix is so simple it’s painful.

You put two or three (or twenty) experts on podcasts and cable TV the week before the announcement. You share the dirty details with health policy reporters at major outlets, make the insights really juicy. You engage with influencers and supporters with large platforms - not to coerce them, but to make sure they are informed. You make everyone feel special. Give them ‘insider’ access.

In addition to the influencers who speak to the base, you need credentialed voices who can walk onto NPR or CNN and explain the regulatory science without sounding like they’re reading a press release. The outlets shaping the ‘broken promise’ narrative aren’t going to be moved by a mom blogger, and neither will the persuadable middle — but they will listen to and engage with a former FDA advisor or policy wonk who can translate the FFDCA into English.

And so the story is built.

“Here’s what the FDA can and can’t do legally. Here’s how we’re getting around that. Here’s why a voluntary phaseout is faster than a ban. Here’s the tracker showing which companies have committed. And here’s what’s coming next.”

Then when the announcement drops, the frame already exists. Instead of “broken promise,” the story is that change is happening “faster than anyone expected.”

That didn’t happen here; it’s a freaking shame. An actual win became a wound. A disaster to be defended instead of a victory.

For no damn good reason.

3. Vinay Prasad raised the bar. Nobody showed up to tell the story.

I want to be really careful here because this one has been covered with the subtlety of a flamethrower and most of the coverage is wrong.

Vinay Prasad, the director of CBER at FDA, sent a refuse-to-file letter back to Moderna on their mRNA flu vaccine application. He said the trial design didn’t reflect the best available standard of care. His own review team and the director of the Office of Vaccines Research and Review disagreed. An internal memo argued against his decision. The press went nuclear.

Here’s what actually happened: Prasad raised the evidentiary bar. As he should have. That’s it.

He looked at a trial that used a standard-dose flu vaccine as the comparator when higher-efficacy options exist, and he said that’s not good enough.

In plain English: Moderna designed a naughty study that made their product look better by testing it against a crappier, weaker flu shot. And Prasad called them on their bullsh*t.

Yes, prior FDA leadership had agreed to Moderna’s trial design before Prasad arrived. That’s Moderna’s loudest talking point, and it’s technically true. It’s also not the win they think it is. The prior standard was weak. Approving a comparator that doesn’t reflect the best available option for patients isn’t scientific rigor - it’s institutional garbage, actually. Prasad corrected the issue.

You can argue the process was disruptive. You cannot argue the science was wrong. The idea that we should demand rigorous comparators for new vaccines is not radical. It’s exactly how science is supposed to work.

Days later, FDA agreed to accept the application under a split pathway, full approval for ages 50-64 and accelerated approval for 65+ with a post-marketing study requirement. That landing actually preserved the core of Prasad’s position for the population that matters most. The higher standard held where it needed to hold. But because nobody explained that, the coverage read as a cave, not a compromise.

But none of that nuance was conveyed to the public.

What was reported was: rogue FDA official overrules staff, embarrasses the agency, gets dragged before the President, caves under pressure. STAT called it “one more sign of chaos.” The Wall Street Journal dropped a story about sexual harassment complaints (which they later ‘corrected’ on March 2 as reported by Jessica Adams @RxRegA - see below) and $65,000 in commuting costs on the same news cycle.

It predictably turned into a personality story — not a policy story. Because when the opposition is the only one writing the narrative, that’s what you get.

This is a communications failure at the agency level. If Prasad’s position was defensible — and it was — then the groundwork for that defense needed to be laid before the refuse-to-file letter went out.

Now, there’s a real constraint here: no one at the agency can breathe a word of market-moving material information in advance. Which means no one outside FDA could have been told what was coming. But that constraint doesn’t prevent the agency from doing two things that would have changed the entire trajectory of this story.

First, brief a handful of key MAHA-aligned surrogates — experts, not press — on what refuse-to-file letters are generally. Maybe they already know, but remind them. Make sure they know the ins and outs of how the process works. Why comparator selection matters. Why raising the bar on vaccine approvals is consistent with demanding better evidence.

None of this has anything to do with disclosure. It’s not “here’s what we’re about to do,” but “here’s how this mechanism works and why it exists” as part of an ongoing campaign to educate the voices that have the capacity to speak on FDA policy.

Second, have talking points written inside the agency before the news drops, ready to disseminate the moment news becomes public. The experts who’ve already been educated on this process (and others) will connect the dots quickly. They don’t need to be told what’s going to happen — they need to be properly equipped with a framework to explain what it all means when it does, and then have access to platforms to shout from.

Again, those surrogates need to be more than voices just speaking to the MAHA base. That matters — but it’s not enough when the narrative is being written by STAT and the New York Times. Those outlets aren’t going to recalibrate their coverage because a health influencer posted a thread, but what they will take seriously is credentialed insiders — epidemiologists, former White House or Capitol Hill health advisors, researchers and clinicians who understand trial design and can explain why a weak comparator is bad science.

They should be booked on major platforms so they can speak to what really happened: Prasad raised the bar, the process was messy, and the outcome was good for the American people.

There is an entire ecosystem of these supporters. Clinicians, policy architects, public health professionals with the credentials and the independence to be credible to skeptical audiences. They are ready and willing to mobilize.

What they need is what any effective communications operation would give them: a briefing, a booking, and a set of talking points they can make their own.

With that infrastructure in place, when Moderna inevitably pushes back — and did anyone imagine they wouldn’t, or that mainstream media wouldn’t immediately take their side? — the coverage isn’t “FDA in chaos.” It’s “FDA holds the line.”

Because all comms games aside, that’s exactly what happened. The FDA defended good science — exactly like MAHA voted for them to do.

With no comms infrastructure in place, a legitimate scientific and regulatory position got buried under a personality narrative the opposition amplified to avoid having to argue the facts.

Marty Makary should not have had to field questions from the President of the United States about this- not when FDA did the right thing.

That call happened because comms failed - because everyone was surprised and the story was allowed to metastasize for days without any proactive counter-narrative.

4. Jay Bhattacharya Running Two Agencies: The Questions We Should Have Already Answered

Jay Bhattacharya was named acting CDC director this week, while continuing to run the NIH. This is unprecedented of course - no one person has led both agencies simultaneously in modern history.

I don’t think it’s a bad decision. It may very well be the best one for this moment.

Bhattacharya has become a stabilizing presence while many others in the administration have embraced a disruptor role. It’s hard to argue against him as a person you’d want overseeing a transition of any kind.

But the optics are a problem.

And the reason they’re a problem is the same reason everything else this week is a problem: nobody answered the obvious questions before the critics asked them.

Why don’t we have a permanent CDC director? How will one person manage two agencies headquartered more than 600 miles apart? What does this mean for career staff at CDC who have already been through multiple leadership changes in under a year? Several NIH institutes remain without permanent directors - is anyone going to fix that?

These are not hostile questions. They are reasonable questions that supporters and critics need answered. And when the administration doesn’t answer them, the New York Times does - by quoting former CDC officials saying it can’t be done, by counting the leadership vacancies, by framing it as evidence that the health agencies are in freefall.

And it’s not just legacy outlets. New media are echoing their concerns.

The reframe is obvious to me: Bhattacharya is uniquely positioned to align NIH’s research priorities with CDC’s public health mission. His dual role is temporary and intentional. A permanent CDC nominee is being vetted and will be announced soon. In the meantime, here’s what he’s focused on at both agencies: boom, boom, boom.

That’s it. That’s the whole play. Four or five sentences, delivered proactively, kills the story or at least turns the volume down.

Instead, silence, then Axios announces. And then the vacuum fills with exactly what you’d expect.

Subscribe now

What Has to Change

Four failures. One week. And they all have the same root cause.

There is no professional health policy communications operation protecting the MAHA agenda. There is no surrogate network. There is no pre-bunking strategy. There is no rapid response with enough health policy fluency to translate regulatory decisions into narratives the public can follow.

This is what a successful operation would look like. It’s not complicated. And it has to be built.

Surrogates. Every major policy announcement needs people who are briefed, trained, and pre-booked on media before the announcement drops. Not just administration officials. Real people. Influencers, parents, advocates who speak to specific audiences. The MAHA base doesn’t trust government spokespeople. It’s a strength of ours. It’s part of our charm. We trust people who look like us and talk about things we care about from outside of the institutions. A lot of those real people are grateful for MAHA leadership and are happy to help. Bring them along. Leverage their earnest support.

But there’s a second tier that’s just as critical — and it’s being completely ignored. Influencers and advocates move the base, but they don’t move the press or the persuadable middle. The outlets writing the “chaos” and “broken promise” headlines respond to credentials — to people whose CVs force editors to take the call. Former clinicians who walked away from the system. Policy architects who helped write the rules. Public health professionals with enough independence to be credible on hostile ground.

These people aren’t hypothetical. They’re already in the movement. They just haven’t been catalogued or asked. When the New York Times or STAT or CNN needs a quote, these are the people who should be in their inboxes already. Why isn’t agency comms maintaining a list of these voices? Why aren’t they helping to place them on the very platforms where the narrative is being lost? This is not a lack of resources problem - the support is there; it’s a strategy vacuum.

Pre-bunking. If you know a decision is going to generate a specific objection, you address the objection before (or at least immediately when) the decision is public. The FDA dye story needed someone explaining the rulemaking constraints a week ahead. The Prasad decision needed prepared talking points (and an educated group of people to be called on) when the RTF letter was submitted. The Bhattacharya appointment needed a proactive rollout with answers to the few questions everyone was going to ask as soon as he was announced.

Rapid response with policy fluency. The FDA dye story required someone who understands the difference between enforcement discretion and a color additive revocation under the FFDCA. The Moderna story required someone who can explain comparators. The glyphosate story required someone who can hold the China supply chain argument and the cancer epidemiology in the same sentence.

Who is finding the MAHA experts, briefing them and getting them on cable news?

Makary and Kennedy can’t be expected to reform the health agencies by day and do endless cable news hits by night. MAHA is a big tent but no one seems to be recruiting and preparing the army. We can’t expect our leaders to do all of the work and then sell it- alone. Not because they won’t try, but because it won’t work. We have scores of highly capable, highly motivated warriors. They just need notice and education. Provide the ecosystem with the tools they need to shine and there’s no way to lose.

Influencer intelligence. Kelly Ryerson, Vani Hari, Dave Murphy - these are the voices that reach the MAHA base directly. We know them. We trust them. Instead of blindsiding them, let them frame the story. Because when they turn, the base turns. The administration should have ongoing relationships with every major MAHA influencer - not to control them, but to educate them and make sure they have context before they react publicly. Nobody called Kelly before the glyphosate EO. That created an entirely predictable disaster. This is exactly how you lose trust - and the midterms.

Midterm framing. The 2026 midterms are the clock. Every MAHA policy action needs to be evaluated on whether the communications around it will strengthen or weaken the base heading into November. Right now, every compromise is being converted into evidence that the movement was a campaign gimmick. It’s an existential threat.

The Bottom Line

The people doing MAHA policy work are doing extraordinary things under extraordinary pressure.

The food supply is changing. The regulatory posture at FDA is shifting. The research priorities at NIH are being realigned. This is real, and it’s historic.

But movements can’t survive on policy. They need more than that. They need everyday people to be able to understand the narrative (and rally behind it) without having to quit their day job.

And right now, that work isn’t happening. Not enough by our people.

The MAHA narrative is being written by people who want it to fail. By the same institutions kept in business by the corporations that have decimated our health.

But it doesn’t have to be that way.

The work is being done. The hero stories are there. The wins are real. Someone just has to tell the story.

The communications machine needs to be reinforced quickly. By people who understand both the policy and what’s at stake if they get it wrong.

The midterms are nine months away. The clock is already running.

NIH spends $50 billion a year funding research - most of which doesn’t hold up under scientific scrutiny. Pharmaceutical companies publicly admit they can only replicate a small fraction of landmark studies they use to develop drugs. And your doctor makes clinical decisions about your treatment based on study outcomes that often amount to no more than fairy tales. (See HRT.)

But until recently, nobody with power seemed to give a sh*t about the reproducibility crisis - at least until NIH Director Jay Bhattacharya decided to make it his problem.

And I know you might be thinking:

The knowledge that studies can’t be replicated must be new or someone would have done something. It isn’t.

Maybe the problem’s being exaggerated or made up. It’s not.

Unfortunately there are receipts. Timestamped ones. And they prove my claim is far from conspiratorial.

Over a decade ago Amgen tried to reproduce the outcomes of 53 high-impact cancer studies. They confirmed only six. That’s 11%. Similarly Bayer went after 67 studies. They replicated 24%.

The studies tested weren’t obscure papers in bottom-tier journals. They were the most important ones. The kind that drug companies use as the foundation for billion-dollar development programs. The kind that professional organizations use to justify updating clinical guidelines. And the kind that the ‘trust the science’ doctors cite when they tell you with absolute certainty (and a side of arrogance) what will or won’t cure your ills.

In contrast to these studies what IS verifiable is that a majority of scientific work (65-89% depending on who and how you ask) falls apart when someone actually tries to repeat it.

And THAT is a BFD.

It’s also why I decided it was worth my time to cancel a day of work to sit in a ballroom of the iconic DC Willard hotel as Jay Bhattacharya and his leadership team laid out three specific reforms designed to fix this mess.

As I sat in that room, I couldn’t help but think through all of the falsehoods I’ve been told as a patient, as a mom, as well as those I was taught throughout my many years of study, and have shared with my own patients from a place of authority.

• Screenings I swore saved lives (but don’t).

• Diseases I said couldn’t be reversed (but can).

• Medications I promised were necessary (but aren’t).

The confidence. The certainty I carried in my words. Because… well, science.

And it made me wonder how much pain and suffering has been caused by our reliance on a knowledge base built on studies that never replicated?

Which begs another question.

Who the heck is Jay Bhattacharya and why should you care anyway?

If you don’t know the name, you should.

Bhattacharya is a Stanford health economist and epidemiologist who spent the last five years being called every name in the book for having the audacity to suggest that locking healthy people (especially children) in their homes might cause more harm than good.

In October 2020, he co-authored the Great Barrington Declaration with Martin Kulldorff and Sunetra Gupta. The declaration argued for “focused protection” - shield the vulnerable, let everyone else live their lives, build natural immunity in low-risk populations.

The response from the public health establishment was swift and vicious.

Francis Collins, then-director of NIH, called it a “fringe” position in an email to Anthony Fauci. He explicitly wrote they needed a 'quick and devastating takedown' of its premises.

Never mind that Bhattacharya’s credentials included a Stanford faculty position, an MD from Stanford, a PhD in economics, and decades of research on health policy and infectious disease epidemiology.

Never mind that history has vindicated pretty much everything in that declaration.

He was “fringe” because he disagreed with the approved narrative and he wouldn’t just shut up about it.

Fast forward to 2025. President Trump appoints Bhattacharya as NIH Director. And the same people who spent years calling him a dangerous conspiracy theorist are now watching him run the agency that tried to destroy his reputation.

And what’s he focused on? Not revenge. Not settling scores. (He made that crystal clear much to the dismay of many in attendance.)

Instead he’s locked in on: the replication crisis.

Bhattacharya shared his concern that we’ve built a scientific enterprise that rewards novelty over reliability.

“Researchers are incentivized to produce exciting findings, not reproducible ones. The result is a literature full of studies that look impressive on paper but fall apart when anyone tries to build on them.”

He’s not wrong.

Forget all the jargon and think about what that means practically.

Medical research operates on a foundational assumption: if a study gets published in a peer-reviewed journal, other scientists should be able to repeat the experiment and get similar results. That’s how science is supposed to work. You don’t just trust one team’s findings - you verify them.

Except we don’t. We cite them. We build on them. We develop drugs based on them. We write clinical guidelines from them. We tell patients with complete confidence that “the science shows...”

And nobody bothers to check.

Why the System Produces a Surprising Amount of Garbage

The incentive structure is perfectly designed to create unreliable research.

Researchers get hired, promoted, and funded based on publications. The more papers, the better. Novel findings get published. Negative and confirmatory studies don’t.

Nobody gets tenure for replicating someone else’s work and reporting “yep, it still works.” Nobody gets grant money for trying to repeat a study and finding it doesn’t hold up. Academic journals have zero interest in publishing negative results of any kind. Replication attempts don’t generate headlines.

Have you ever seen an article in the New York Times that says, “Different Group of Researchers Do Same Thing Other Guy Did and It Worked Again.”? Of course not. Because nobody reads that article. Nobody wins awards for it. It doesn’t drive impact factors. It doesn’t advance careers.

So researchers optimize for what gets rewarded: flashy, novel, positive findings.

The result? Publication bias. P-hacking (torturing data until it confesses). Outcome switching (reporting different results than you said you’d measure). Methodological sloppiness that goes undetected because nobody ever tries to replicate the work.

It’s not that most researchers are dishonest. It’s that they’re operating in a system that rewards speed and novelty over rigor and reproducibility.

Vinay Prasad, a hematologist-oncologist who is now serving as Chief Scientific and Medical Officer at FDA, spent years documenting these failures in cancer research. He’s written: 'We don't incentivize truth, we incentivize discovery.' Scientists have 'betrayed the social contract,' he argues - they're 'happy to swallow up billions of dollars in grants' but aren't 'fundamentally interested in whether or not they're delivering true results.'

He’s right. And Bhattacharya knows it.

What Actually Being Done About It

The reforms he announced in that beautiful ballroom are straightforward - almost embarrassingly basic:

First: Fund replication studies directly. NIH will allocate dedicated funding for researchers to replicate high-impact studies. Not new discoveries. Not novel findings. Just “let’s verify if this foundational research actually holds up.”

This matters because right now, there’s essentially no funding mechanism for replication work. If you’re a researcher and you want to repeat someone else’s study to confirm it, you’re doing it on your own time with your own resources. That’s not sustainable. Bhattacharya’s proposing to change the selection process to make replication a funded priority.

Second: Create publication venues for replication studies AND negative findings. Right now, if you try to replicate someone else’s study - whether it works or it doesn’t - there’s nowhere to publish that. And if your own hypothesis fails? Same problem. Journals reject both as “not interesting enough.” They “don’t advance the field.”

Bhattacharya’s pushing for dedicated journals and platforms that will publish replication attempts AND the experiments that didn’t work. Because if the only studies that get published are the ones where everything went right, the literature isn’t showing us reality and it’s nothing more than a highlight reel.

He put it this way, “I have a drawer full of hypotheses that failed. I should be able to publish them and put them in a journal somewhere.” Why? Because we learn from those studies too.

The goal is to make the literature actually reflect what happens when you DO science - not just the subset of experiments that confirmed exactly what the researcher hoped they would.

Third: Change how we measure research success. Stop evaluating researchers purely by publication count. Start giving them credit when other scientists think their work is important enough to replicate.

Right now, if someone wants to replicate your study, you view it as a threat. Bhattacharya wants to flip that: being worth replicating should be a career asset, a sign you did something significant enough to verify.

This is the reform that could genuinely transform the system. Right now, there’s zero downside to publishing flashy findings that don’t replicate. Your paper gets cited. You get promoted. By the time someone figures out your study doesn’t hold up, you’ve already moved on to the next grant.

But if being replicable becomes a metric of success - if transparency and rigor get rewarded in career advancement - the incentives shift entirely. Researchers will optimize for work that others can verify, not just work that sounds impressive.

These aren’t radical ideas. They’re embarrassingly basic principles of how science should work.

The fact that it took until now for NIH to implement them tells you everything about how completely broken the incentive structure has been.

This Matters Beyond Academic Journals

Every treatment your doctor recommends is based on research.

Every clinical guideline. Every standard of care. Every confident statement about what will or won’t help you.

If the underlying research doesn’t replicate, then what?

I think about the absolute confidence with which doctors speak. “The research is clear.” “The science says.” “We know with 100% certainty.”

How much of that certainty was built on studies that would fall apart the moment someone tried to repeat them?

How many patients have been told their treatment was “evidence-based” when the evidence was unreliable?

How many people have suffered through interventions that didn’t work because nobody bothered to check if the original study held up?

How many patients were gaslit when their lived experiences didn’t match what the research “clearly showed” - research that was never replicated?

The Irony That Keeps Me Entertained

What makes Bhattacharya’s appointment so perfect to me is that the same institution that tried to destroy his reputation for questioning COVID orthodoxy is now being led by him - and he’s using that position to address one of the fundamental problems that made COVID policy so disastrous in the first place.

The replication crisis isn’t separate from the COVID policy failures. It’s actually the same problem - too much hubris, too little questioning.

During COVID, we built public health policy on models that were never validated and studies that were never replicated. When people questioned the evidence, they were suppressed rather than engaged.

Vaccine effectiveness was overclaimed - officials stated vaccinated people wouldn’t get or spread COVID, people who questioned if that was accurate lost everything. Those claims were demonstrably wrong within months. But those who were punished didn't get their jobs or platforms back for being right. Fear and modeling drove policy without anyone checking if the assumptions held up in the real world. The negative effects on children & adults, touching every aspect of life, are still being counted.

Bhattacharya lived through this. He questioned the evidence behind lockdowns and was professionally attacked instead of scientifically engaged. He wasn’t alone. Those who questioned were censored, deplatformed, and professionally destroyed - often by the very institutions now admitting their claims were totally unreliable.

So watching him use his position to fix the underlying incentive structures that produce unreliable research is a special treat. Because he’s someone who understands exactly where the system was broken and has educated ideas on how to fix it.

Will It Work?

I don’t know.

Changing academic incentive structures is hard. Journals won’t want to publish negative findings. Researchers won’t want their work evaluated by whether it replicates. Universities won’t want to change tenure criteria.

There will be pushback. There will be excuses. There will be accusations of partisanship. There will be arguments that this approach stifles innovation or discourages risk-taking or makes research too conservative.

But here’s what is clear: the current system produces research that doesn’t replicate most of the time, and until now nobody with power was willing to fix it.

Bhattacharya is.

That’s where ‘better’ starts.

For the first time in my career, I’m watching someone in a position of authority acknowledge the problem and enact real solutions - not just better messaging or more funding, but actual structural reforms that address the broken incentive systems.

Will these reforms solve everything? No.

But they’re a hell of a lot better than what we’ve had for the last fifty years, which was basically: produce unreliable research, publish only positive findings, never check if anything replicates, attack anyone who questions it, then act shocked when the whole enterprise falls apart.

Maybe I’m naive. Maybe these reforms will get watered down or blocked or implemented so poorly they don’t matter.

But right now, watching someone who was professionally destroyed for questioning orthodoxy use his authority to fix the system that tried to destroy him?

I’ll take it.

It’s the first genuinely hopeful thing I’ve seen happen to institutional research science in a very long time.

And I pray it continues.

Listen to Jay’s recent NYT interview here:

Read Vinay’s article on the reproducibility crisis here:

Vinay Prasad's Observations and Thoughts

The reproducibility crisis and what it means for the NIH

When we say science doesn't reproduce, what does that mean…

Read more

2 years ago · 233 likes · 10 comments · Vinay Prasad

“We have a men’s health crisis in this country.”

Well, that’s something I thought I’d never hear a senior government official say out loud.

2 days ago the Assistant Secretary for Health, Admiral Brian Christine, stood in front of an FDA panel and said it unapologetically.

Then he showed us the numbers.

Men die 6.5 years earlier than women. They have higher mortality rates in 9 of the 10 leading causes of death. 44% don’t get an annual physical. They use healthcare resources 69% less than women.

And 100 men per day take their own lives. Almost 80% of all suicides are male.

Six million men experience depression annually- roughly the same as women- but only 25% seek treatment.

The economic burden of ignoring all this? Almost $500 billion a year.

I sat surrounded by some of the top urologists, endocrinologists, and researchers in the country and thought, this should be front-page news.

But instead, of course, almost no one covered it.

Let me tell you what was said.

We talked a lot about testosterone.

When most people hear “testosterone therapy,” they think sex. Erectile dysfunction. Some guy trying to relive his twenties.

But that framing costs men their lives.

Testosterone deficiency isn’t just some sex problem. It’s a metabolic problem. A cardiovascular problem. A bone problem. A mortality problem.

Just take a look at the numbers presented by Dr. Mohit Khera.

Men with low testosterone are.

• 17% more likely to have cardiovascular disease

• 50% more likely to have diabetes

• 50% more likely to break a bone

• 69% more likely to have obesity

• 86% more likely to suffer from depression

In the ER, I treated the downstream consequences every shift. The diabetic whose foot ulcer won’t heal. The 68-year-old who broke a hip and will never walk independently again. The guy having his second heart attack at 55

But what I didn’t realize until much later is that many of those cases trace back to a condition we aren’t even screening for - and actively shame men for even asking about.

Entirely treatable testosterone deficiency.

But doesn’t testosterone replacement do more harm than good?

The panel addressed this question over and over.

They walked through studies that should have changed medicine years ago.

The biggest one (TRAVERSE) looked at 5,246 men. Gold-standard research. Published in the New England Journal of Medicine in 2023.

What they found was that proper testosterone replacement therapy (TRT) didn’t actually cause a lot of the horrible things that we’ve always told men it does. Didn’t cause heart attacks. Didn’t cause prostate cancer. Didn’t make urinary problems worse.

The VA also looked into TRT. They tracked over 80,000 men with low testosterone and found that TRT that normalized testosterone was associated with 56% lower ‘all-cause mortality.’

In plain English:

Here’s some data that haunts me personally given how often I’ve admitted these men from the ER:

• 1 in 4 men over 50 develop osteoporosis.

• Two-thirds of elderly men who break a hip have low T.

• And when an elderly man breaks his hip, there’s a 1 in 3 chance he’s dead within a year.

One in three. And we’re still not paying attention.

The Fairy Tale That Started It All

Dr. Abraham Morgentaler from Harvard didn’t mince words.

He called the demonization of testosterone “a tragedy,” the dismissal of men suffering from it “a scandal,” and the failure to teach it to medical students “a stain on my generation of medical educators.”

Then he explained where the fear came from.

In 1941, Charles Huggins- who would later win a Nobel Prize for his research- claimed testosterone acted as a “prostate cancer accelerator.”

His evidence? Well. One patient. Treated for less than three weeks.

For 60 years, the entire medical establishment operated on that assumption.

And over the last 30 years, the evidence has repeatedly, uniformly, and overwhelmingly shown it to be false. Not a single large trial shows increased prostate cancer risk. Several show decreased risk.

But the narrative still lives on as false narratives often do.

“FOLLOW THE SCIENCE,” they scream.

Well, we’re finally trying, and Morgentaler’s conclusion left no room for doubt.

The FDA finally removed the cardiovascular warning in February 2025.

But the prostate warnings remain on the label- based on one man studied for less than three weeks in 1941 and despite buckets of evidence since that states the opposite.

We should look into that.

And now for the ‘controlled substance’ absurdity

Testosterone- the hormone your body makes naturally- is classified as a Schedule 3 controlled substance. Right alongside ketamine. More tightly regulated than benzodiazepines. With zero evidence of dependency at replacement doses.

The Anabolic Steroid Control Act of 1990 that initiated the testosterone lockdown was a political response to Olympic doping scandals and bodybuilding culture.

The images that drove this policy? Terminator, Rambo, Ben Johnson losing his medal.

Culture was the “scientific basis” for treating testosterone like a narcotic.

Weird.

And like many examples of government regulation: it didn’t even work.

Within 10 years, illicit steroid use exceeded pre-legislation levels, but no one ever thought to revisit.

What it did do was create a gauntlet for the 60-year-old man seeking legitimate treatment.

One panelist described it well.

The whole process takes someone seeking medical care and makes them feel like an addict.

And for what purpose? Who are we saving here?

Meanwhile, estrogen, progesterone, thyroid hormone, cortisol, growth hormone- all free from bullshit restrictions. Testosterone is the only natural hormone treated like a street drug.

What This Information Means For You

If you’re a man- or if you love one- here’s what that room full of experts agreed on:

Get tested. Testosterone should be part of routine bloodwork, like cholesterol and blood sugar. If you’re over 40, get a baseline. If you have diabetes, obesity, metabolic syndrome, or depression, get tested now.

The benefits are real. For men who are deficient, testosterone therapy can improve bone density, blood sugar control, mood- and according to the VA data maybe even the likelihood of living a longer life.

Many risks were overblown. The prostate cancer fear was based on one patient in 1941. The cardiovascular warnings were removed earlier this year after major trials showed no increased risk.

This risk is serious and real. Testosterone can shut down sperm production quickly, even at low doses. If you’re younger and might want kids, you need to discuss this before starting treatment. There are ways to manage it, but you have to plan ahead.

What needs to change. Remove the outdated prostate warnings. Take testosterone off Schedule 3. Eliminate the FDA requirement for a clinician to know why a man has low T before treating him (the one that excludes 89% of men with low testosterone from approved treatment.)

Final thoughts.

There are many ways to raise testosterone ranging from lifting heavy and reducing stress to prescription treatments, but knowing more about it and what your baseline is helps YOU make better decisions with your doctor (and maybe your trainer) to get where you need to be. And by all means, avoid the online supplements and pop-up T clinics. Those are NOT your best options.

Admiral Christine told us he was flying back to Washington after Thanksgiving a few weeks ago, sitting in plain clothes next to two women he didn’t know.

During the flight, one started talking to the other about the recent FDA changes to hormone therapy labeling for women. Two strangers, caught in the wild just chatting about how the government was finally telling them the truth.

Imagine that.

Four weeks ago, the FDA admitted they’d been wrong about hormone replacement therapy in women for 23 years. And they fixed it. I was proud.

Having been in the room when those decisions were announced (sitting across from the Second Lady!! *swoon*), I wrote about the experience in an article you can find here.

Now this week, the FDA acknowledged the parallel disaster for men, and that’s a good thing. Because that’s how we move forward.

But the remaining question is whether FDA and HHS will launch a National Men’s Health Initiative and actually do what is necessary to serve our nation’s men - or whether we’ll be stuck waiting another 23 years.

My take? It must be now. Men are running out of time.

Subscribe now

If you enjoyed this article, please consider sharing it with a friend (or your doctor). And here’s the link to the YT video of the FDA Panel’s full discussion. Check it out.

Last night a physician famous for fighting “misinformation” called me a liar to half a million people. Then turned off comments so I couldn’t post my source.

Let me back up.

Earlier this week, I published a piece questioning why certain prominent scientists refuse to debate their work and instead choose friendly media interviews. I named names. I called the behavior weak. Because it is.

One of those names was Peter Hotez.

He didn’t like that.

His response was a quote tweet to his 400,000+ followers claiming “No one told me” about a $2 million charity offer to debate on Joe Rogan.

Here’s the problem: I have video of him being told exactly that figure - ironically on an interview titled “Why science isn’t up for debate” (which is completely on-brand for both AMA and Dr. Hotez but that’s a story for another day).

It’s on camera. In a formal interview. They discussed it at length.

Todd Unger said it directly to his face: “that amount quickly grew to $2 million.”

Hotez didn’t correct him. He talked about the situation extensively. Now he claims ignorance.

Hotez took the cowardly road, retreating to his ‘fans’ like the elite “experts” almost always do.

He untagged me from the post so I wouldn’t be notified. He turned off replies so I couldn’t respond with my source. He leveraged his platform to discredit me to 400,000 people while ensuring I couldn’t show the receipts.

This isn’t just a physician who ‘made a mistake.’

It’s the behavior of a media-trained professional who knows exactly how these platforms work- and is using that knowledge to punch down and hide.

This isn’t about me and it’s not an isolated incident.

Let’s look at Paul Offit.

Last week he appeared on CNN to discuss the CDC’s ‘hepatitis B’ meeting. He told viewers that, in fact, he “wasn’t invited” to present at the ACIP meeting happening that very day.

That claim was false.

According to documents obtained by journalist , CDC officials had contacted Offit repeatedly — emails, phone calls, a formal speaker request through his hospital’s booking system. The system confirmed receipt.

He didn’t respond to any of it. Then went on national television and said the invitation never happened.

But he wasn’t done.

In the same interview, he claimed Hepatitis B is transmitted through casual contact like ‘sharing towels’ and ‘nail-clippers’ which is in no way consistent with CDC guidance on transmission spanning decades.

He conflated the toxicity of oral consumption of aluminum with injection of aluminum.

He claimed that “50% of people in this country have chronic hepatitis B.” If that were true, 165 million Americans would be infected.

The real number is about 0.3%.

And of course they didn’t.

One could assume that was the point.

As reported by Dr. Damasi, there were many falsehoods expressed in that short interview. And there were other concerning elements regarding a lack of disclosure of conflicts of interest. Those are outlined clearly (and well-sourced). I’ve included the link below.

The pattern

Two prominent physicians. Many documentable lies. All delivered with the confidence that comes from knowing legacy media won’t check the receipts and truth can be drowned out.

This is what it looks like when professionals become media players first and clinicians second.

When doctors play it fast and loose with the truth.

We are living through the lowest public trust in medicine in modern history and every week I hear the same explanation from people in public health: it’s misinformation.

It’s social media. It’s outsiders poisoning the well.

Maybe.

Or maybe it’s self-inflicted and ongoing.

• When a physician lies on camera and faces no consequences — that erodes trust.

• When experts refuse to debate their positions and instead attack (or hide from) anyone who questions them — that erodes trust.

• When the people we’re told to believe behave like politicians instead of scientists — that erodes trust.

I’m not asking anyone to change their position on any medical intervention. That’s not what this is about.

I’m asking a simpler question: Why are physicians lying about verifiable facts?

And even more important: Why are we letting them get away with it.

Public health should be about patients and truth.

Not politics or media tactics.

I believe in science. Real science — the kind that shows its work, welcomes scrutiny, and updates when evidence changes.

That is NOT what I’m seeing from the loudest voices in the room.

What I’m seeing is credentialed people leveraging institutional power to avoid accountability.

That’s not how confident people behave. That’s how people behave when they know their position won’t survive scrutiny.

The ask

I’m not asking for Hotez to be canceled. I’m not asking for Offit to lose his platform.

I’m asking for the same standard we’d apply to anyone else.

• If you claim to fight misinformation, you don’t get to spread it.

• If you claim to value debate, you don’t get to hide from it.

• If you claim to speak for science, you don’t get to lie about what happened on camera.

Trust in medicine is collapsing. We keep blaming outsiders.

Maybe it’s time to look within.

The Hotez AMA video is linked here. The unedited Offit CNN video is embedded here in Dr. Demasi’s article. Watch it yourself. Decide who’s telling the truth.

Aaron Siri was invited to address ACIP last week. And according to ACIP secretary Mina Zadeh, so were vaccine industry experts Paul Offit and Peter Hotez.

Siri showed up. Offit and Hotez did not.

That’s the summary. But it’s not the whole story.

ACIP - the Advisory Committee on Immunization Practices - is the body that sets vaccine recommendations for every American child. Last week, they reconsidered the hepatitis B birth dose - objectively a minor policy change,- but one that many people, including Offit and Hotez - were extremely upset about.

Siri, an attorney who has spent years representing vaccine-injured families, delivered a 90-minute presentation questioning the evidentiary basis for the childhood vaccine schedule.

The cornerstone of his arguments were:

1. Most vaccines on the schedule have not been tested for safety against an inert placebo making safety claims unreliable.

2. Trial sizes for vaccines have been under-powered or inadequate (not big enough) to determine safety with confidence.

3. Follow-up periods are too short to catch developmental effects during critical stages of infancy and childhood.

Most people after hearing these concerns understandably want to know more. And you certainly don’t need a PhD to start furrowing your brow and asking more questions.

But of course, the media, predictably, melted down at his inclusion.

But what they didn’t seem to focus on was that Paul Offit and Peter Hotez — the two most prominent defenders of the vaccine schedule — were formally invited to present alongside Siri.

In the same room. With equal time. And they skipped.

They were given the chance to eviscerate Siri’s arguments, expose his errors and 'save the children’ they claim to care about.

But they chose not to engage.

Here’s how it played out.

Well, ACIP voted that day.

8-3 to roll back the hepatitis B birth dose recommendation that had been in place for years.

Offit and Hotez knew the vote wasn’t ‘scheduled for next month.’ Or postponed ‘until further review.’

Everyone knew it was scheduled for THAT day.

And even with that knowledge they chose to rage to a TV audience while the actual decision happened without their input.

It was weird.

They avoided the room where it mattered. The room where votes were cast.

Whatever you think of the outcome (or of the original question for that matter), the result was the opposite of what Offit and Hotez claimed to want.

They said children would die. And then they let it happen without showing up to the fight.

But why?

The Story of Two Men Too Principled to Attend

Let’s chat really quickly about Paul Offit.

Here’s Google’s summary:

“Dr. Paul Offit is a renowned pediatrician, virologist, and vaccine expert. He served on the FDA’s vaccine advisory committee (VRBPAC) for years but was removed in September 2025, known for co-inventing the RotaTeq rotavirus vaccine and advocating for vaccines. He directs the Vaccine Education Center at CHOP and teaches at UPenn.”

I’d add that he is also a former ACIP committee member and spends so much time on CNN that I often forget he doesn’t work there too (but I guess… maybe he does?).

Notably RotaShield the precursor to Offit’s RotaTeq was added to the childhood vaccination schedule prior to being yanked from the market because it was actually injuring and killing a subset of babies by causing this thing called intussusception.

Intussusception is a sort of ‘telescoping’ of the intestines that causes bowel obstructions and sometimes death.

That disaster cleared the field for Offit’s own vaccine, RotaTeq, which was in development at the time RotaShield was originally approved.

We can assume Offit is clearly aware of this history.

So what are we to think when a man who intimately understands that vaccines are not inherently all ‘safe and effective’ drugs, and have, in fact, at times been proven to cause serious harms - even deaths, refuses to show up to defend the science behind the childhood vaccine schedule in the room where votes are cast and instead goes to the media to issue talking points...?

I’m not sure what to think exactly. But I have more questions than answers.

Now, Peter Hotez.

Hotez wrote books about vaccines. He calls vaccine skeptics “anti-science aggressors.” He fashions himself a warrior for truth in a post-truth world.

In 2023, notably Joe Rogan offered Hotez $100,000 — eventually bid up to over $2 million for charity — to debate RFK Jr. on his podcast.

Hotez refused that too.

Fleeing debate doesn’t appear to be an exception for these men. It’s a consistent strategy.

The Excuses (Such As They Are)

Hotez told the AP he declined because, “ACIP appears to have shifted its mission away from science and evidence-based medicine.”

Offit told STAT: “I don’t want to legitimize what I think is an illegitimate process. I don’t want to be part of a process that gives bad advice, that’s putting children in harm’s way.”

But here’s what that looks like to an outsider.

• They’re happy to “legitimize” friendly media outlets — networks that take millions in pharma advertising and couldn’t challenge them if they tried.

• The venue is “illegitimate” when it’s comprised of their peers, and someone might just ask them a question.

And just in case you may have seen an argument about how perhaps they’re just prioritizing ‘reach,’ note that a cable news hit might get 500,000 viewers on a REALLY good night, but Rogan — who Hotez refused — gets 10-15 million views per episode.

The ‘reaching the masses’ excuse doesn’t hold up either. It collapses the moment you do basic math.

It’s not about that and I’m not sure it ever was.

The Common Sense Test

You don’t need a science degree to see what’s happening here. You just need some common sense and logic.

If someone tells you your house is on fire, then refuses to show you the smoke - you’re allowed to ask questions.

If a doctor says an intervention will save your life, then refuses to explain how it works or let you examine the evidence - you’re allowed to be skeptical.

If the nation’s most prominent vaccine defenders say children will die without their guidance, then skip the one meeting where they could have actually prevented those deaths - you’re allowed to wonder why.

This is a prosecutor who calls the defendant a murderer, then refuses to show up to trial because he doesn’t like the judge.

If you have the evidence, you show up.

Period.

Pick Your Explanation

I’m not here to tell you what’s in Offit’s or Hotez’s heads.

Maybe they’re cowards. Maybe they’re arrogant. Maybe they calculated that a strategic retreat was smarter than a public loss. Maybe they have something to hide.

Pick whichever explanation you find most plausible.

“I don’t want to legitimize the process.”

Seriously?

Is that what YOU would say if you thought kids were dying? Of course not.

You would crawl through broken glass and bang on tables.

You would do anything and everything you could to stop the carnage.

You would show up and freaking try.

I know I sure would.

What Bothers Me Most

When someone asks “were the trials long enough to detect developmental effects?” — that’s not ‘spreading vaccine hesitancy.’ It’s just due diligence. It’s good science.

Or when Mark Cuban asks a respected scientist speaking against mandates how many kids she’s comfortable ‘allowing to die’ in the spirit of medical freedom — that’s a legitimate question too.

Both questions deserve answers. Both questioners deserve engagement.

And that’s part of what ACIP is there for. But until recently only one flavor of inquiry has been allowed.

And the public has noticed.

ACIP should be a room where serious people ask serious questions like “where is the safety data,” and “how many children will die without this?” and then hash it out in front of, and with, the people making decisions.

THAT IS SCIENCE.

Offit and Hotez refused to perform science. They refused to be in that room.

And it seems like they don’t want inquiry.

They just want compliance.

Look at what actually happened.

Aaron Siri walked into that room knowing many despise him. He presented his case despite Senator Bill Cassidy tweeting false accusations against him and launching attacks.

He put his arguments on the record, subject to challenge, in front of the people who would vote that very same day because he believes this is a fight worth having.

Offit and Hotez sat in TV studios, talking to hosts who couldn’t push back if their lives depended on it, complaining that the process was “illegitimate” - while that process reached a conclusion without them.

One side showed up. The other side hid. And that tells you everything you need to know.

What This Means for You

I’ve spent years entrenched in medicine and policy.

I’ve watched this playbook before - experts who demand trust while refusing scrutiny, who invoke ‘children’s lives’ but won’t defend their positions under pressure.

The refusal to engage IS the message.

Science is about asking questions.

And these guys appear to be incompetent, arrogant or afraid of the answers.

But I guess time will tell.

Subscribe now

P.S. If this resonated, share it. People should be armed with the data that allows them to make decisions for themselves and for their families.

On Friday, November 28, 2025, while we were all still recovering from eating too much turkey, an internal FDA memo was leaked to the press.

The media coverage has been chaotic. Critics are calling it dangerous. Defenders are calling it historic. Most Americans have no idea what actually happened or why it matters.

Let me explain.

Dr. , Chief Medical and Scientific Officer at FDA, who also directs the FDA’s vaccine division, sent an internal email to his staff.

TLDR:

Career FDA staff reviewed reports of pediatric deaths following COVID-19 vaccination and determined that at least 10 children died “after and because of” receiving the vaccine.

These deaths were reported to VAERS- the Vaccine Adverse Event Reporting System- between 2021 and 2024.

For years, apparently they just sat there. No one investigated them. Until now.

Prasad asked career staff at the FDA’s Office of Biostatistics and Pharmacovigilance to analyze 96 pediatric deaths reported to VAERS. Using standard causality assessment- a scale ranging from “certain” to “unlikely”- they determined that no fewer than 10 were related to vaccination. The attribution categories were “likely,” “probable,” or “possible.”

The investigation was initiated by Dr. , a senior advisor at FDA, and the formal causality analysis was conducted by career staff at the Office of Biostatistics and Pharmacovigilance - who agreed with her findings.

Prasad himself acknowledges this is almost certainly an undercount.

VAERS requires a motivated person to fill out tedious paperwork to submit a report. Most don’t bother. The barrier to submission is high. If anything, deaths are underreported, not overreported.

This is entirely consistent with my personal experience practicing in the ER through Covid.

When hospitals were understaffed from policy-driven layoffs and patients were dying of heart attacks in the hallways after 24+ hour waits, filing a tedious VAERS report that might get you fired wasn’t at the top of anyone’s list.

Ask me how I know.

Why this matters to you

If you’re a patient or a parent, here’s what you need to understand about what Prasad’s memo admits:

1. COVID-19 vaccines have killed American children. Not theoretically. Not possibly. Likely. Career FDA staff reviewed the cases and made causality determinations. This is the agency responsible for vaccine safety saying this. It’s worth noting that (so far) they’ve only admitted it to their internal team (remember the memo was leaked), but I expect something official will surface soon.

2. Deaths were reported years ago and ignored. The memo asks a devastating question: “Why did it take until 2025 to perform this analysis?” And that’s exactly the right frame. Deaths were reported between 2021 and 2024. No one looked. For four years, the safety system we are told protects your children collected reports and did nothing with them. That’s a problem.

3. We don’t actually know if vaccinating healthy children saved more lives than it cost. The memo is blunt about this: “We do not have reliable data estimating the absolute benefit regarding severe disease and death in healthy children from vaccine receipt.” The FDA never required manufacturers to prove, in randomized trials, that vaccinating children improved outcomes in that group. They approved based on antibody data- not clinical results and it is undeniably true that kids were at MUCH lower risk than other age groups and that the vaccine did not, in fact, prevent transmission negating the 3rd party benefit/ “don’t you love your grandma” arguments.

4. Children were coerced into receiving this vaccine. School mandates. Daycare requirements. Parental workplace mandates that affected family decisions. The memo calls these mandates “coercive and unethical.” Children who faced “tremendously low risk of death” from COVID were required to take a vaccine that could- and apparently did- result in death. This. Is. An. Ethics. Disaster.

The question no one wants to ask

The also memo poses an unthinkable possibility:

Finally, the head of the FDA’s vaccine division is saying that the agency’s own actions- the approvals, the recommendations, the policies that enabled mandates- may have killed more healthy children than COVID-19 would have- a thought many of us have had and lost sleep over these past 5 years.

The mainstream media is screeching: “YOU DON’T EVEN KNOW IF THAT’S TRUE! “

And they’re right for once.

But that’s also the entire point:

• We don’t know because no one required the studies that would tell us before they used the power of the state to force compliance.

• We don’t know because no one investigated the deaths that were reported as if they preferred to NOT know why they happened.

• We don’t know because the FDA, for 4 years, didn’t do its job which we all pay for and trusted them to do.

What the critics are saying (and why they’re wrong)

The criticism has been loud and immediate. Let me address the main objections:

1. “VAERS can’t prove causation.”

Correct. VAERS is used for signal detection. You see a signal in passive surveillance, then you investigate it with rigorous methods. That’s exactly what’s happening finally. The critics are demanding gold-standard scientific proof and a peer-reviewed study before they want to allow for deeper investigation- which is how you prevent knowledge, not acquire it.

2. “Anyone can submit to VAERS.”

Yep. And then career FDA staff review the reports and make causality determinations using standardized methodology. That’s what’s happening here. The “anyone can submit” part isn’t the end of the process- it’s the beginning.

3. “He didn’t release the data.”

Not yet. The memo was an internal communication to staff announcing what had been found so far and what was being done about it. It was leaked. FDA is not finished talking about this- well, actually, if we’re honest, they haven’t even officially started.

4. “This will fuel vaccine hesitancy.”

Maybe. But you know what actually fuels vaccine hesitancy? Overselling. Mandates. Refusing to acknowledge trade-offs. Calling anyone who asked questions “anti-vax.” Trust in the FDA is already at historic lows. The cover-up approach didn’t work. Maybe transparency will.

The path forward

Here’s what an honest FDA looks like: See a signal. Investigate it. Communicate the findings. Adjust recommendations based on evidence. Be transparent about uncertainty.

That’s what’s happening now. A signal was found. It’s being investigated. Rigorous analysis will follow. Standards are being raised.

The critics want to go back to the old way: ignore signals, approve based on antibodies, dismiss anyone who asks questions, maintain public confidence through bullying or silence rather than transparency.

• That approach gave us mandates without evidence.

• That approach gave us four years of ignored death reports.

• That approach destroyed public trust in the very institutions designed to protect us.

Prasad’s memo ends with an invitation:

That’s what science looks like. Not certainty. Not silence. Not “trust us.” Open debate. Rigorous evidence. Honest uncertainty.

Your children deserve better than what the FDA gave them throughout Covid. This memo is the beginning of better.

What you can do

Read the memo yourself. It’s been published in full. Don’t rely on headlines or hot takes. Read what it actually says.

Ask questions. If your pediatrician recommends the Covid vaccine, ask: What’s the evidence for clinical benefit in my child’s age group? What are the known risks? Is this based on randomized trial data or antibody studies?

Demand transparency. Support reforms that require actual evidence, not just promises. I believe the FDA should prove vaccines work before recommending them- not after. But what do you think?

Ask yourself why someone would oppose an investigation. Think about these kids. They had names. They had parents. They had stuffies they loved and birthdays they’ll never celebrate. They were at low risk for death from the disease we were trying to prevent and they died.

• Don’t you want to know more about what happened?

• Don’t you want agencies finding out if their deaths were caused by a pharmaceutical product that we forced them to take?

• Don’t you want to know if lives were saved because our kids took a risk?

Who would fight getting the answers to those questions? What would their motives be to do so?

Because everyone opposing an investigation is doing just that - fighting for silence and uncertainty.

That’s what propaganda and “vaccine religion” looks like, not science.

That’s what totalitarianism looks like, not liberalism or free will or informed consent.

We deserve an FDA that pays attention. And now they are. That’s not the scandal. That’s the beginning of accountability.

Subscribe now

If you enjoyed this article please like, subscribe and consider sharing it. Read the full text of Prasad’s memo here.

Last Thanksgiving, I spent 20 minutes hiding in my uncle’s garage pretending to take an important phone call.

The call? Oh it was very important.

Checking my email. Twice. Then scrolling through weather forecasts for cities I don’t live in.

Inside the house, 30 people were having the “MOST wonderful time of the year.”

Outside, I was Googling “how long is socially acceptable to be on a work call during Thanksgiving.”

If this sounds familiar, welcome to the club nobody wanted to join but here we are anyway.

Holidays are sold to us like this beautiful Norman Rockwell painting where everyone’s laughing, the turkey is perfect and Grandma’s telling heartwarming stories while snow gently falls outside-

But the reality is more like being trapped in a sensory theme park designed by someone who grew up alone in the woods and never experienced overstimulation.

I’ve never, NEVER really enjoyed them.

47 conversations happening simultaneously, kids using the hallway as a racetrack, someone burning something in the kitchen (it’s always something), your dad telling the same story for the 18th consecutive year, someone in another room criticizing their spouse (loudly)… all while Mariah Carey sings on an infinite loop that would make even her own family go insane.

You smile. You laugh. You pretend you’re having a blast, and you mentally calculate how long until you can GTFO without seeming rude.

The greeting card industry has been lying to us

Here’s what the ‘holiday industrial complex’ doesn’t tell you… at least 25% of people have brains that are not enjoying any of this (I suspect it’s more, but I’m biased)

Call it ADHD. Autism. Asperger’s. Or my favorite… simply “My brain does its own thing and it’s not what yours does, but that doesn’t make me an a-hole.”

A lot of our brains just aren’t wired for the performance art that holidays seem to demand.

We can’t just flip the social switch to “on” and keep it there for 16 hours.

We can’t ignore all the noise any more than you can ignore a fire alarm. We can’t fake enthusiasm for small talk about weather patterns and cousin Terry’s new car.

But for some reason no one wants to acknowledge the following…

The rest of the year, the traits that make holidays horrific are the EXACT traits that make us exceptional.

That hyperfocus that lets you work on a project for 10 hours straight without checking your phone once?

At work, people call that “dedication” and “drive.”

You get promoted for that.

But at Thanksgiving dinner when your uncle wants to discuss his golf handicap for 45 minutes and your brain decides to leave the building to think about a coding problem from last Tuesday?

Well, that just makes people think you’re rude.

And that sensitivity that helps you pick up on patterns before anyone else notices?

In business, that’s called “strategic thinking.” You spot trends before they become obvious. You notice details that save projects.

At a holiday party with competing conversations, flickering fluorescent lights and your aunt’s perfume that drowns out all language and sense of time… it’s overly stimulating and mostly just a weird version of hell.

You can’t fake it. Your brain refuses to pretend. You need an escape route and you need it now.

Holidays are designed for a different operating system. Unfortunately, one you aren’t running.

I get it. It sucks.

I don’t have it all figured out, but here’s what I’ve found that helps.

The charade isn’t working anyway

I spent years perfecting the fake smile. The “I’m fine” response. The performance of enjoyment while internally screaming.

Turns out, nobody was buying it.

My mom would pull me aside: “Are you okay? You seem off.”

My sister: “You look tired. Are you not having fun?”

Turns out I’m a terrible actor. Most of us are.

We’re sitting there thinking we’re fooling everyone, and our families are watching us like “why is she being so weird?”

You’re miserable. They’re confused. And everyone loses.

So last year, I tried something different: honesty.

Radical, I know.

What actually works (and I tested all of this)

Keep your routines sacred

Last Christmas, while on a group vaca, I told my family: “I need to go for a run. Every morning. It’s non-negotiable for me, but I can do it as early as you need me to so I don’t make waves in the schedule.”

My mom’s response? “No worries. I’ll have coffee ready when you get back.”

That’s it. No drama. No guilt trip.

Hummmm…

That morning run kept me sane for the entire visit. Without it, I would’ve been a disaster by day three.

Your meditation? Do it. Your coffee ritual? Do it. That thing that keeps you functional? Do it.

Stop negotiating and sweating the small stuff. Communicate and do you. It’s fine (for real).

Use your tools without shame (but with awareness)

I bought noise-canceling headphones specifically for family gatherings.

Best $200 I ever spent.

When people are casually chatting and I just need a minute to think, I find a spot to relax and put them on for 10 minutes. Sometimes I’m listening to music. Sometimes I’m just sitting there in silence while people think I’m on a call.

Now, do I care that my aunt might think it’s a little rude? Honestly, I do.

I don’t want to hurt her feelings.

But here’s what I’ve learned: I can either take a few minutes of space and then be genuinely pleasant and engaged for the next 4 hours, or I can skip it and be increasingly resentful for the entire visit.

Which version of me would she actually prefer to spend time with?

When I frame it that way, the choice is obvious.

Other tools that work include…

• stepping outside for “fresh air” (and yes, scrolling your phone in peace),

• taking a “quick rest” (hanging in a quiet room for a few minutes),

• volunteering to “run to the store” (driving around alone listening to podcasts).

The key is not framing these as escapes from your family.

Tell people how you’re wired before things go sideways

Here’s what I said last year:

“I’m noticing big gatherings sometimes drain my battery. I might need to go to bed a little earlier than everyone else.”

My dad’s response? “That makes sense. Do what you need to do.”

My sister? “Oh thank God, I thought it was just me.”

Turns out half the family feels the same way, but everyone was pretending.

Will everyone understand? No.

My aunt thinks I’m being “difficult.” She’s always thought that. Nothing I do will change her mind.

But most people appreciate the honesty. They’d rather know what’s actually going on than wonder why you seem miserable.

Create activities that don’t require constant small talk

2 Christmases ago, instead of sitting around the living room in awkward silence punctuated by forced conversation, I suggested we do a puzzle.

A 1,000-piece puzzle. And I hate puzzles.

It was awesome.

Everyone had something to focus on besides each other. We were still together. We were still connecting.

But the pressure to constantly ‘perform conversation’ was gone.

Other things that work: board games, baking together, going for walks, watching movies, building Lego sets, literally anything with structure.

Unstructured “quality time” is the enemy of neurodivergent or type A workaholics like myself.

We tend to need activities, not ambient socializing.

Make it happen.

Be honest because it’s better for everyone

What changed everything for me was realizing that being honest about what’s enjoyable isn’t just good for me, it’s good for everyone.

When I show up depleted and fake my way through a marathon gathering, nobody really wins.

My family gets a zombie version of me who’s physically present but mentally gone. I’m miserable. They sense something’s off but don’t know what. It’s weird.

When I’m honest about participating for a shorter chunk of time, suddenly I can actually show up. I’m engaged. I’m laughing at jokes. I’m asking real questions and listening to answers.

Last year, my uncle wanted to debate healthcare. Instead of either engaging (and ruining both our days) or just dodging it, I said: “Let’s have fun instead of getting all worked up if that’s okay. Tell me about your Colorado trip. I’ve been wanting to hear about it.”

He totally got it. We had a great conversation about hiking instead of a terrible one about vaccine mandates. Win-win.

When my mom wanted me to visit three houses in one day, I said: “I really want to give everyone quality time. If I do three stops, I’ll be fried by stop three. Can we do a real visit at your place, and I’ll catch Aunt Angie later this week when I can actually enjoy it?”

She appreciated that more than me showing up irritable and distracted.

Yes. People actually prefer honesty over martyrdom. Who knew?

Honesty creates better holidays for everyone

My holidays look different now.

I spend Christmas morning alone with a workout and coffee before seeing anyone.

I often leave family gatherings earlier than most people, but I communicate it:

“Heading out you guys - it’s past my bedtime! Had so much fun. Thanks for having me.”

I say no to some events especially as my social calendar fills up. And I offer alternatives: “Can’t do the big party, but want to grab coffee Tuesday? I’d love to actually catch up.”

When I stopped pretending and started being honest- while staying warm and offering alternatives- something weird happened.

My relationships got better.

My family started being more honest about their own needs. My sister admitted she hates hosting but feels obligated. My dad admitted he’d rather do a small Thanksgiving than a huge one. My mom admitted she finds Christmas exhausting and would love to switch things up sometimes.

Your honesty gives other people permission to be honest too.

The actual insight here

Being you during the holidays isn’t about being difficult or high-maintenance.

It’s about being honest enough to create real connection instead of performing fake enjoyment.

Most people appreciate directness. “I need to leave in an hour” is easier to work with than watching someone slowly die inside while pretending they’re fine.

“I’m going to step outside for a few minutes to check on something” is better than seeming checked out and irritable for the rest of the night.

“I can’t do the big party but I’d love to see you one-on-one” creates better connection than forcing yourself through an after work event that drains you.

The people who care about you want you to be honest. They’d rather adjust than watch you suffer.

And the people who get mad at you? They were always going to be difficult. This just helped you figure it out faster.

So this year, try radical honesty. Tell people what you need. Explain why. Offer alternatives. Stay warm. Be clear.

Stop protecting everyone from reality. They can handle it.

I often forget to take my own advice, but when I remember, I often discover that honesty doesn’t ruin relationships- it improves them.

Real connection requires real communication. And real communication requires telling the truth about who you are and what you need.

Oh and your family might surprise you.

Mine sure did.

Subscribe now

So here’s a fun story about how I learned that doctors wearing white coats can lie to your face with absolute confidence while having exactly ZERO evidence to back up what they’re saying.

(Spoiler alert: it happened to me twice. Because apparently I’m a slow learner.)

But first - yesterday, something genuinely remarkable happened.

The CDC - the same agency that has spent literal decades telling parents with the certainty of Moses descending from Mount Sinai that vaccines do not cause autism - quietly updated their website to admit they never actually had the evidence to make that claim.

I’ll wait while you re-read that sentence.

The CDC’s updated webpage now admits what they’ve denied for decades: the science was never settled. Oops.

The new language is stunning in its honesty: “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism.”

They go further. They admit this connection “has not been properly and thoroughly studied by the scientific community.” They cite multiple authoritative reviews - from 1991, 2012, and 2021 - all concluding the evidence was “inadequate to accept or reject” a causal relationship.

Translation for those in the back: FOR DECADES, THEY’VE BEEN STATING AS SETTLED FACT SOMETHING THE ACTUAL EVIDENCE NEVER SUPPORTED.

If you’re a parent who was gaslit, dismissed, or shamed for asking whether your child’s reaction might be connected to something they received hours before - this admission matters.

Because the doctor wearing the white coat who told you with absolute certainty “it definitely wasn’t that” was lying. Maybe not intentionally.

But my kindergarten teacher SWORE on all of my Skittles that stating as fact something that has never been established is, in fact, a dirty, dirty lie.

I know this personally. Because I lived it twice. (See: slow learner, above.)

The Day My Kid Went Blue

Years ago, I took my daughter to the pediatrician for routine shots. Standard good mom stuff. That afternoon, she went down for a nap.

She woke up having a seizure.

I remember walking into her room and screaming because I didn’t know what to do. She was blue and shaking, and I couldn’t stop it. “Febrile seizure,” they said, despite the fact that she HAD NO FEVER. “It’ll pass.”

Dear Reader, it did not pass.

The episodes continued. Eventually she ended up at Johns Hopkins Hospital Pediatric Neurology - presumably some of the smartest brains in the baby brain business. My sweet little one was sedated and placed into an MRI machine multiple times over the following months.

Their diagnosis: the nerve cells in her brain were “spontaneously demyelinating” - the protective coating on her nerves was breaking down ‘spontaneously.’ They couldn’t say why.

I had obvious questions:

• Would she die?

• Would it get worse?

• Could it correct itself?

• Why did this happen at all?

• What would it mean for her life?

And the one that seemed most obvious to literally anyone with functioning, healthy curiosity: Did it have anything to do with the medicines she got that morning - because she was scheduled for more.

Here’s what I got from presumably some of the best pediatric neurologists in the world:

“Look, we don’t know what will happen or what set it off. We do know that if this continues to progress, it won’t be good. All we can do is wait and see. There is no treatment. There is no cure. No, we don’t know what caused it, but it definitely was NOT THE VACCINES - they simply don’t do this.”

That last part - delivered with absolute confidence. Zero hedge. Complete certainty.

And that was the end of my questioning. Some very smart doctor wearing a white coat said it wasn’t the vax, so it couldn’t be.

(Kids - if you’re reading this - yes, I was gullible. I know.)

Plot Twist: I’m Also a Slow Learner About My Own Body

Fast forward a few years. I’m living in Europe, dancing professionally, traveling the world and getting frequent infections.

I’m not sleeping, eating exclusively at restaurants, practicing all day & performing every night.

After like the 4th doctor visit, my doctor offered me an experimental vax to prevent these infections. She told me it would ‘strengthen my immune response’ and end my misery. I asked about risks. She told me vaccines are incredibly safe, and I had nothing to worry about.

The consent form was in German - detailed, technical, intimidating. But signing was the only way to get my “magic drug,” so I skimmed, signed, took the shot and headed home.

The chills started that night. Then fever. Then body aches that made me feel like I’d been hit by a truck.

Over the coming weeks and months, the fever became intermittent and new symptoms appeared - food intolerances, horrific reflux, nausea, massive stomach bloating.

Over the next six months, I got worse. I had to stop traveling, then stopped performing, then took a leave of absence, lost over 20 pounds.

I weighed 98 pounds but still had to wear maternity jeans because of how my stomach would bloat. I was pale, had no energy and looked like a walking skeleton.

I was in and out of doctors’ offices, desperately searching for answers.

It was during that very dark time that I started reading everything I could find. Prescription inserts. Toxicity data on EPA and CDC websites. Research studies used to approve medications and the ones used to debunk “conspiracy theories” about risk.

The more actual data I consumed, the more I realized: no definitive conclusion could be made.

And above all, I realized that the confidence with which I’d been told it was “crazy” to think my daughter’s reaction could be associated with something given to her less than 6 hours before a neurological meltdown was totally unfounded.

The physician should have had zero confidence in that statement. The temporal association alone was reason enough not to dismiss the possibility.

What Honesty Actually Sounds Like (Spoiler: It’s never “we have no idea, but we’re certain it’s not that”)

Many years later, as a clinician myself, I now know that to utter the words: “We don’t know what caused xyz but we know with 100% certainty that it wasn’t THAT” is complete bullshit.

It’s not science. It’s just dogma and shilling masquerading as smarts.

Real science says: “We don’t know what caused your daughter’s reaction. The timing is concerning, and we should document it. We should study whether there’s a pattern with what happens to other kids. Here’s what we do know…, here’s what we don’t know…, and here’s how we’ll monitor going forward…”

That’s honesty. That’s integrity. And it’s what builds trust.

But that’s not what we got. Not for my daughter. Not for me. Not for millions of other patients.

Instead, we got certainty where none existed. We got dismissal. We got shaming. We got told not to question. We got called names for asking obvious questions.

And now - decades after I was told with absolute confidence that my questions were unfounded - the CDC admits they never had the evidence to support that confidence in the first place.

The Burden of Proof Bait-and-Switch

This week, my X feed brought me a fascinating tweet that perfectly captures the sleight of hand that’s been happening for decades.

Oh Dr. Glaucomflecken…

The framing here sounds scientific - until you realize what’s being mandated and who’s doing the mandating.

Dr. Glaucomflecken, a physician with a large social media following, posted: “’Vaccines don’t cause autism’ has never been proven.” But we don’t have to.

His point? That’s just ‘not how science works’

If I say “sunning your perineum twice per day increases your IQ by 10 points,” he argued, I haven’t proven anything. The burden of proof is on me to prove my claim, not on everyone else to disprove it.

Sounds reasonable, right?

It’s also where his argument falls apart completely:

• I’m not forcing anyone to sun their perineum.

• I’m not threatening to fire them or keep them from attending school unless they comply with said ‘perineum-sunning’ protocol.

• I’m not using the power of government and medical institutions to mandate that every parent follow the recommendation.

But that’s exactly what’s happening with childhood immunization schedules and vaccine mandates across the board.

If you are forcing me to take a pharmaceutical product to keep my job, if you are threatening to exclude my child from education unless they comply, if you are using institutional power to mandate an intervention - then yes, the burden of proof absolutely IS on you to prove it’s safe.

When something is compulsory or strongly coerced through institutional requirements, the burden of proof flips entirely.

You don’t get to say “well, you haven’t proven it causes harm” when you’re the one wielding the power of the state to force compliance.

If these interventions were truly voluntary - if parents could freely choose without coercion, without school exclusions, without social shaming - then fine, the burden of proof framework might apply differently.

But when you’re using institutional force? When doctors are telling parents with absolute certainty that something is safe when the evidence doesn’t support that certainty? When health agencies are making definitive claims they can’t back up?

No. That’s coercion and dishonesty.

And as the CDC just admitted: they never had that proof. They just acted like they did for decades while dismissing anyone who dared to ask questions.

Why This Actually Matters (Beyond Vindication, Though That’s Nice Too)

This isn’t about proving anything causes autism. The data on that question remains genuinely uncertain - which is exactly the point.

What matters is what happens when institutions prioritize protecting their authority over protecting the truth.

When you tell parents with absolute certainty something you cannot prove, and then dismiss their lived experiences when they don’t align with your narrative, you don’t build trust. You destroy it.

When you shame people for asking legitimate scientific questions because you’re afraid of where those questions might lead, you’re not defending science. You’re defending dogma.

When you mandate interventions while simultaneously refusing to study potential harms, you’re not practicing evidence-based medicine.

You’re actually practicing evidence-resistant authoritarianism.

The CDC now admits what many of us learned the hard way: The science was never as settled as they claimed. Multiple authoritative bodies - including the Institute of Medicine in 1991, 2012, and the Agency for Healthcare Research and Quality in 2021 - all concluded the evidence was “inadequate to accept or reject” a causal relationship.

That’s not anti-anything hysteria. That’s what the actual scientific reviews said.

Yet for decades, parents were told the science was settled. Doctors were trained to dismiss concerns with absolute confidence. Researchers who wanted to investigate were ostracized. And anyone who dared to question was labeled dangerous, anti-science, a threat to public health.

Subscribe now

What Happens When Institutions Finally Tell the Truth

Did a vaccine cause my child’s neurological crisis? I don’t know.

Did a vaccine cause mine? I don’t know.

But the fact that I don’t know - and that the CDC now admits they don’t know either - is the entire point.

The problem was never the uncertainty. The problem was pretending certainty existed when it didn’t.

The problem was wielding institutional power to mandate interventions while refusing to acknowledge legitimate questions about safety.

The problem was telling parents their lived experiences didn’t matter because they contradicted the approved narrative.

This CDC revision isn’t an ending. It’s a beginning.

The agency now says HHS has launched “a comprehensive assessment” into the causes of autism, including investigations into “plausible biologic mechanisms and potential causal links.”

This is what honest science looks like. Not blanket denials. Not certainty where none exists. But genuine investigation into legitimate questions.

Because here’s what we know for certain: When institutions project false certainty to protect their authority rather than admitting uncertainty to pursue truth, everyone loses.

When doctors dismiss parents’ concerns with confidence unsupported by evidence, trust erodes.

When health agencies use their power to mandate interventions while refusing to study potential harms, they’re not executing science - they’re executing coercion.

Pay attention to the people who don’t allow questions to be asked. Pay attention to those who mistake defending their authority for defending science. Pay attention to those who demand you prove harm while they mandate interventions without proving safety.

Real science is a dynamic process, an ever-changing iteration of best practices. It requires humility. It requires updating when evidence changes - or when we finally admit the evidence was never as strong as we claimed.

My child didn’t die. Thankfully, neither did I. I found answers through my own research and recovered.

But how many others were dismissed? How many parents were gaslit? How many children didn’t get the investigation they deserved because asking questions became heresy?

The CDC’s quiet admission this week changes nothing about what happened to us. But it validates what we knew all along:

Science was never settled. The questions were always legitimate. And the certainty used to silence us was always a lie.

Until next time

-Tiffany

PS: If you made it to the end please ‘like’ or comment, so more people have the opportunity to read it.

PPS: Until then I’ll be here waiting for my apology from Hopkins, not holding my breath.