Brownstone Institute
Medicine in the Wilderness

From the Brownstone Institute
BY
I once was proud of my profession. I spent over 40 years as a clinician, educator, and researcher and for most of that time thought I was engaged in a noble calling. But all that has changed in the last 3 years. Medicine is lost in The Wilderness.
There were warning signals, to be sure. For many years I was heavily involved in medical associations on the local, state, and national levels. Gradually I became disillusioned when I saw that many of my colleagues who gravitated to this activity did not share my views. They enjoyed the politics of medicine. In fact, they enjoyed it too much. I lost interest. Perhaps in retrospect that was part of the problem. The policy of medicine gradually became the politics of medicine. And as is often the case, where there is politics there is also corruption.
Twenty years ago I was appointed as a technical advisor to a panel of the federal government. I was flown to Washington, housed in an upscale hotel and dined on fancy meals. I saw how intoxicating power can be. I began to somehow consider that I was special. The problem was I was expected to use my technical expertise to advise in a certain way. I realized, almost too late, what was going on. But I did realize it and was not reappointed to that position.
Looking back on it, this experience gave me a taste of how the events of the past three years came to be. I saw how money, power and flattery could cause physicians to shade their recommendations. It happened oh so gradually until one day, integrity was completely lost. The tragedy is that many times, those who lost it did not miss it.
I have come to realize that ethics and medicine have parted ways for many physicians, myself included. Things we once took for granted are gone…evaporated. We reached a point where, relating to COVID, attempts to treat disease were not just ignored but penalized. As a surgeon, I had operated under the obligation of giving Informed Consent to all my patients. I was expected to clearly explain the risks, benefits, and alternatives of my proposed course of action and allow the patient to make the decisions regarding their response to those recommendations. I could be sanctioned for failing in this obligation. However, in COVID, Informed Consent was criminalized…but only for that disease. Those who still felt an obligation to their patients were, and continue to be, vilified, slandered, fired from their position, and in some cases, prosecuted.
One would have thought that organized medicine, and academic medicine in particular, would have rallied to their defense, but that was not the case. They were the primary prosecutors. I shake my head when I think back to the days that I taught medical ethics to residents and medical students. One of the case studies involved discussing how accepting a lunch, or even a pen, from a drug company was unethical. Somehow, individuals who made life and death decisions were suspected of being bribed by a pen! And owning stock in a company and prescribing medications manufactured by that company were absolutely forbidden!
Now where are we? A good deal past the use of pens, for sure!
If a physician from even 10 years ago would look at the contents of most of our medical journals today, I am sure he or she would think they were reading fiction. These are the four articles that make up the Viewpoint section of the September 19, 2023 issue of the Journal of the American Medical Association.
- Affirmative Action Ruled Unconstitutional: Options for Building a Diverse Health Care Workforce
Eli Y. Adashi, MD, MS; Philip A. Gruppuso, MD; I. Glenn Cohen, JD
- The Supreme Court’s Rulings on Race Neutrality Threaten Progress in Medicine and Health
Harald Schmidt, PhD; Lawrence O. Gostin, JD; Michelle A. Williams, ScD
- The Supreme Court Decision on Affirmative Action—Fewer Black Physicians and More Health Disparities for Minoritized Groups
Valerie Montgomery Rice, MD; Martha L. Elks, MD, PhD; Mark Howse, PhD
- Holistic Admissions at UC Davis—Journey Toward Equity
Mark C. Henderson, MD; Tonya L. Fancher, MD; Susan Murin, MD
In order to truly understand the departure from what was the norm a mere 10 years ago, this is a link to the contents of the Viewpoint section in the September 18, 2013 issue:
- The HIPAA Conundrum in the Era of Mobile Health and Communications
C. Jason Wang, MD, PhD; Delphine J. Huang, MS
- A Trial-Based Approach to Statin Guidelines
Paul M Ridker, MD, MPH; Peter W. F. Wilson, MD
- Medicare Payment for Chronic Care Delivered in a Patient-Centered Medical Home
Andrew B. Bindman, MD; Jonathan D. Blum, MPP; Richard Kronick, PhD
- PEPFAR’s Antiprostitution Pledge Spending Power and Free Speech in Tension
Lawrence O. Gostin, JD
The difference in the tenor of the articles is striking, at least to me. In the current articles, the author’s primary focus seems to be finding ways to circumvent the rule of law. In 2013, the two articles that deal with a legislative focus explore how to comply with the rule of law. While some may claim that is a distinction without a difference, I would disagree. Something has changed! Change is inevitable, but is it always positive? Looking back on history, many nations have changed in response to internal and external pressure. Unfortunately, the majority of those changes have been negative.
Back in 2019, before the Great COVID disaster, Baffy and associates warned us of a change that was occurring in medical and scientific publishing. They observed the concentration of medical and scientific publishing in the hands of a few very large corporations which answered to stakeholders with conflicting interests:
Because the use of complex digital tools and rapidly growing electronic databases require advanced computing skills, Internet-based mega-companies such as Google (Mountainview, Calif), Amazon (Seattle, Wash), Facebook (Menlo Park, Calif), and Apple (Cupertino, Calif) may become interested in spearheading further transformation and outcompete current stakeholders in scholarly communication and develop more user-friendly tools. Such developments could potentially lead to a few large entities controlling the gateways to scientific knowledge, a sobering thought…
Scientific publishing has been a highly profitable industry, and there is little doubt that financial interests will continue to drive its transformation. However, the academic community has a fundamental stake in this process and should understand the trajectories of change to protect enduring values, embrace promising developments, and make scholarly communication increasingly inclusive and efficient.
It would seem the authors were amazingly prescient, as their world has come to pass. Medicine seems, at least to me, to have become the Willing Servant of an Unholy Trinity of Big Pharma, Big Tech and Big Politics. Medical publication and medical education have become more interested in ideology and propaganda than healing, more interested in class than the individual. It is the very antithesis of the concepts contained in the Hippocratic Oath. Although the proponents of the transformation may claim it is being done for a “greater good,” that excuse has been used before in medicine of some nations of the last century. When sanity returned, that excuse was repudiated.
Society now finds itself a passenger on a ship which has been taken over by ideologues. The ship is heading for the rocks. Lookouts stationed high above can see the disaster unfolding and urgently inform the captain of the ship. The captain solves the problem by throwing the lookouts overboard.
This is the dystopian world in which we now live.
Brownstone Institute
If the President in the White House can’t make changes, who’s in charge?

From the Brownstone Institute
By
Who Controls the Administrative State?
President Trump on March 20, 2025, ordered the following: “The Secretary of Education shall, to the maximum extent appropriate and permitted by law, take all necessary steps to facilitate the closure of the Department of Education.”
That is interesting language: to “take all necessary steps to facilitate the closure” is not the same as closing it. And what is “permitted by law” is precisely what is in dispute.
It is meant to feel like abolition, and the media reported it as such, but it is not even close. This is not Trump’s fault. The supposed authoritarian has his hands tied in many directions, even over agencies he supposedly controls, the actions of which he must ultimately bear responsibility.
The Department of Education is an executive agency, created by Congress in 1979. Trump wants it gone forever. So do his voters. Can he do that? No but can he destaff the place and scatter its functions? No one knows for sure. Who decides? Presumably the highest court, eventually.
How this is decided – whether the president is actually in charge or really just a symbolic figure like the King of Sweden – affects not just this one destructive agency but hundreds more. Indeed, the fate of the whole of freedom and functioning of constitutional republics may depend on the answer.
All burning questions of politics today turn on who or what is in charge of the administrative state. No one knows the answer and this is for a reason. The main functioning of the modern state falls to a beast that does not exist in the Constitution.
The public mind has never had great love for bureaucracies. Consistent with Max Weber’s worry, they have put society in an impenetrable “iron cage” built of bloodless rationalism, needling edicts, corporatist corruption, and never-ending empire-building checked by neither budgetary restraint nor plebiscite.
Today’s full consciousness of the authority and ubiquity of the administrative state is rather new. The term itself is a mouthful and doesn’t come close to describing the breadth and depth of the problem, including its root systems and retail branches. The new awareness is that neither the people nor their elected representatives are really in charge of the regime under which we live, which betrays the whole political promise of the Enlightenment.
This dawning awareness is probably 100 years late. The machinery of what is popularly known as the “deep state” – I’ve argued there are deep, middle, and shallow layers – has been growing in the US since the inception of the civil service in 1883 and thoroughly entrenched over two world wars and countless crises at home and abroad.
The edifice of compulsion and control is indescribably huge. No one can agree precisely on how many agencies there are or how many people work for them, much less how many institutions and individuals work on contract for them, either directly or indirectly. And that is just the public face; the subterranean branch is far more elusive.
The revolt against them all came with the Covid controls, when everyone was surrounded on all sides by forces outside our purview and about which the politicians knew not much at all. Then those same institutional forces appear to be involved in overturning the rule of a very popular politician whom they tried to stop from gaining a second term.
The combination of this series of outrages – what Jefferson in his Declaration called “a long train of abuses and usurpations, pursuing invariably the same Object” – has led to a torrent of awareness. This has translated into political action.
A distinguishing mark of Trump’s second term has been an optically concerted effort, at least initially, to take control of and then curb administrative state power, more so than any executive in living memory. At every step in these efforts, there has been some barrier, even many on all sides.
There are at least 100 legal challenges making their way through courts. District judges are striking down Trump’s ability to fire workers, redirect funding, curb responsibilities, and otherwise change the way they do business.
Even the signature early achievement of DOGE – the shuttering of USAID – has been stopped by a judge with an attempt to reverse it. A judge has even dared tell the Trump administration who it can and cannot hire at USAID.
Not a day goes by when the New York Times does not manufacture some maudlin defense of the put-upon minions of the tax-funded managerial class. In this worldview, the agencies are always right, whereas any elected or appointed person seeking to rein them in or terminate them is attacking the public interest.
After all, as it turns out, legacy media and the administrative state have worked together for at least a century to cobble together what was conventionally called “the news.” Where would the NYT or the whole legacy media otherwise be?
So ferocious has been the pushback against even the paltry successes and often cosmetic reforms of MAGA/MAHA/DOGE that vigilantes have engaged in terrorism against Teslas and their owners. Not even returning astronauts from being “lost in space” has redeemed Elon Musk from the wrath of the ruling class. Hating him and his companies is the “new thing” for NPCs, on a long list that began with masks, shots, supporting Ukraine, and surgical rights for gender dysphoria.
What is really at stake, more so than any issue in American life (and this applies to states around the world) – far more than any ideological battles over left and right, red and blue, or race and class – is the status, power, and security of the administrative state itself and all its works.
We claim to support democracy yet all the while, empires of command-and-control have arisen among us. The victims have only one mechanism available to fight back: the vote. Can that work? We do not yet know. This question will likely be decided by the highest court.
All of which is awkward. It is impossible to get around this US government organizational chart. All but a handful of agencies live under the category of the executive branch. Article 2, Section 1, says: “The executive Power shall be vested in a President of the United States of America.”

Does the president control the whole of the executive branch in a meaningful way? One would think so. It’s impossible to understand how it could be otherwise. The chief executive is…the chief executive. He is held responsible for what these agencies do – we certainly blasted away at the Trump administration in the first term for everything that happened under his watch. In that case, and if the buck really does stop at the Oval Office desk, the president must have some modicum of control beyond the ability to tag a marionette to get the best parking spot at the agency.
What is the alternative to presidential oversight and management of the agencies listed in this branch of government? They run themselves? That claim means nothing in practice.
For an agency to be deemed “independent” turns out to mean codependency with the industries regulated, subsidized, penalized, or otherwise impacted by its operations. HUD does housing development, FDA does pharmaceuticals, DOA does farming, DOL does unions, DOE does oil and turbines, DOD does tanks and bombs, FAA does airlines, and so on It goes forever.
That’s what “independence” means in practice: total acquiescence to industrial cartels, trade groups, and behind-the-scenes systems of payola, blackmail, and graft, while the powerless among the people live with the results. This much we have learned and cannot unlearn.
That is precisely the problem that cries out for a solution. The solution of elections seems reasonable only if the people we elected actually have the authority over the thing they seek to reform.
There are criticisms of the idea of executive control of executive agencies, which is really nothing other than the system the Founders established.
First, conceding more power to the president raises fears that he will behave like a dictator, a fear that is legitimate. Partisan supporters of Trump won’t be happy when the precedent is cited to reverse Trump’s political priorities and the agencies turn on red-state voters in revenge.
That problem is solved by dismantling agency power itself, which, interestingly, is mostly what Trump’s executive orders have sought to achieve and which the courts and media have worked to stop.
Second, one worries about the return of the “spoils system,” the supposedly corrupt system by which the president hands out favors to friends in the form of emoluments, a practice the establishment of the civil service was supposed to stop.
In reality, the new system of the early 20th century fixed nothing but only added another layer, a permanent ruling class to participate more fully in a new type of spoils system that operated now under the cloak of science and efficiency.
Honestly, can we really compare the petty thievery of Tammany Hall to the global depredations of USAID?
Third, it is said that presidential control of agencies threatens to erode checks and balances. The obvious response is the organizational chart above. That happened long ago as Congress created and funded agency after agency from the Wilson to the Biden administration, all under executive control.
Congress perhaps wanted the administrative state to be an unannounced and unaccountable fourth branch, but nothing in the founding documents created or imagined such a thing.
If you are worried about being dominated and destroyed by a ravenous beast, the best approach is not to adopt one, feed it to adulthood, train it to attack and eat people, and then unleash it.
The Covid years taught us to fear the power of the agencies and those who control them not just nationally but globally. The question now is two-fold: what can be done about it and how to get from here to there?
Trump’s executive order on the Department of Education illustrates the point precisely. His administration is so uncertain of what it does and can control, even of agencies that are wholly executive agencies, listed clearly under the heading of executive agencies, that it has to dodge and weave practical and legal barriers and land mines, even in its own supposed executive pronouncements, even to urge what might amount to be minor reforms.
Whoever is in charge of such a system, it is clearly not the people.
Brownstone Institute
The New Enthusiasm for Slaughter

From the Brownstone Institute
By
What War Means
My mother once told me how my father still woke up screaming in the night years after I was born, decades after the Second World War (WWII) ended. I had not known – probably like most children of those who fought. For him, it was visions of his friends going down in burning aircraft – other bombers of his squadron off north Australia – and to be helpless, watching, as they burnt and fell. Few born after that war could really appreciate what their fathers, and mothers, went through.
Early in the movie Saving Private Ryan, there is an extended D-Day scene of the front doors of the landing craft opening on the Normandy beaches, and all those inside being torn apart by bullets. It happens to one landing craft after another. Bankers, teachers, students, and farmers being ripped in pieces and their guts spilling out whilst they, still alive, call for help that cannot come. That is what happens when a machine gun opens up through the open door of a landing craft, or an armored personnel carrier, of a group sent to secure a tree line.
It is what a lot of politicians are calling for now.
People with shares in the arms industry become a little richer every time one of those shells is fired and has to be replaced. They gain financially, and often politically, from bodies being ripped open. This is what we call war. It is increasingly popular as a political strategy, though generally for others and the children of others.
Of course, the effects of war go beyond the dismembering and lonely death of many of those fighting. Massacres of civilians and rape of women can become common, as brutality enables humans to be seen as unwanted objects. If all this sounds abstract, apply it to your loved ones and think what that would mean.
I believe there can be just wars, and this is not a discussion about the evil of war, or who is right or wrong in current wars. Just a recognition that war is something worth avoiding, despite its apparent popularity amongst many leaders and our media.
The EU Reverses Its Focus
When the Brexit vote determined that Britain would leave the European Union (EU), I, like many, despaired. We should learn from history, and the EU’s existence had coincided with the longest period of peace between Western European States in well over 2,000 years.
Leaving the EU seemed to be risking this success. Surely, it is better to work together, to talk and cooperate with old enemies, in a constructive way? The media, and the political left, center, and much of the right seemed at that time, all of nine years ago, to agree. Or so the story went.
We now face a new reality as the EU leadership scrambles to justify continuing a war. Not only continuing, but they had been staunchly refusing to even countenance discussion on ending the killing. It has taken a new regime from across the ocean, a subject of European mockery, to do that.
In Europe, and in parts of American politics, something is going on that is very different from the question of whether current wars are just or unjust. It is an apparent belief that advocacy for continued war is virtuous. Talking to leaders of an opposing country in a war that is killing Europeans by the tens of thousands has been seen as traitorous. Those proposing to view the issues from both sides are somehow “far right.”
The EU, once intended as an instrument to end war, now has a European rearmament strategy. The irony seems lost on both its leaders and its media. Arguments such as “peace through strength” are pathetic when accompanied by censorship, propaganda, and a refusal to talk.
As US Vice-President JD Vance recently asked European leaders, what values are they actually defending?
Europe’s Need for Outside Help
A lack of experience of war does not seem sufficient to explain the current enthusiasm to continue them. Architects of WWII in Europe had certainly experienced the carnage of the First World War. Apart from the financial incentives that human slaughter can bring, there are also political ideologies that enable the mass death of others to be turned into an abstract and even positive idea.
Those dying must be seen to be from a different class, of different intelligence, or otherwise justifiable fodder to feed the cause of the Rules-Based Order or whatever other slogan can distinguish an ‘us’ from a ‘them’…While the current incarnation seems more of a class thing than a geographical or nationalistic one, European history is ripe with variations of both.
Europe appears to be back where it used to be, the aristocracy burning the serfs when not visiting each other’s clubs. Shallow thinking has the day, and the media have adapted themselves accordingly. Democracy means ensuring that only the right people get into power.
Dismembered European corpses and terrorized children are just part of maintaining this ideological purity. War is acceptable once more. Let’s hope such leaders and ideologies can be sidelined by those beyond Europe who are willing to give peace a chance.
There is no virtue in the promotion of mass death. Europe, with its leadership, will benefit from outside help and basic education. It would benefit even further from leadership that values the lives of its people.
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