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.

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If you’d rather read the highlights first, my coverage of the panel is here:

The first follow-up on exactly what this panel set in motion, what the FDA’s April 16 announcement on testosterone actually does, and what still hasn’t moved is coming soon to . Stay tuned.

Until then,

Tiffany

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…

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a month 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.

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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.

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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.

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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?

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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.

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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…

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a year 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.

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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.

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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 confi…

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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…

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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 somethi…

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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.

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Remember when your doctor told you hormone replacement therapy would basically kill you? Well, funny story...

This week, HHS Secretary Robert F. Kennedy Jr. and FDA Commissioner Marty Makary stood up in front of hundreds of people (including Second Lady Usha Vance, actress/comedian Cheryl Hines, and ME there in blue 🥰) and said what amounted to:

“Oh, our bad. Turns out we’ve been wrong for 23 years.”

It’s not a direct quote.

But also... it’s pretty much spot on.

Here’s what happened.

In 2002, the Women’s Health Initiative published a study (and fueled a media frenzy) that made every woman in America throw her estrogen right in the trash.

The FDA slapped “black box warnings”- their nuclear option- on hormone replacement therapy sternly asserting very, very, VERY bad things would happen to naughty women who didn’t comply.

Prescriptions fell off a cliff. Millions white-knuckled their way through menopause because the alternative was death by breast cancer, obviously.

Except the study was gar…

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• You’re tired of institutions that treat you like a child.

• You look around and realize the people giving you advice have incentives that don’t align with yours.

• Maybe you just want to live a life you don’t hate.

Whatever brought you here, you’re in the right place if you’re looking for an upgrade for your mind.

Who this is for

Signal & Noise is for people who want to think clearly, live intentionally, and stop being quietly steered by bullshit systems that don’t serve them.

If you’re done outsourcing your brain to experts, algorithms, and cultural defaults you never chose… stay a while.

If you want clarity over comfort, agency over approval, and a life that’s unmistakably yours… you’ll feel at home here.

What I bring

I’ve lived in worlds that don’t usually overlap.

Poverty and the top 1%. NFL Cheerleading and Emergency Medicine. Healthcare executive and Entrepreneur. Germany, the US, the ER, DC b…

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