Brownstone Institute
The Experts Still Pushing Coerced Jabs
Medical ethics is about protecting society from medical malfeasance and the self-interest of the humans whom we trust to manage health. It is therefore disturbing when prominent people, in a prominent journal, tear up the concept of medical ethics and human rights norms. It is worse when they ignore broad swathes of evidence, and misrepresent their own sources to do so.
On July 8th 2022, The Lancet published a ‘Viewpoint’ article online: “Effectiveness of vaccination mandates in improving uptake of COVID-19 vaccines in the USA.” The article, which acknowledges the controversial nature of vaccine mandates, primarily concludes that coercing people to take a medical product, and reducing options for refusal, increases product uptake.
It further concludes that the best way to implement such mandates is for employers and educational institutions to threaten job security and the right to education.
The use of coercion goes against the established ethics and morals of Public Health, and could be argued to be anti-health. In this case, the article justifies it by stating that “the current evidence regarding the safety of COVID-19 vaccines in adults is sufficient to support mandates.” However, it offers scant evidence to back this assertion, and ignores all evidenceto the contrary. They apparently consider the ability to work and support a family, or gain formal education, as something that is to be granted or taken away, not a human right.
The Lancet was once a credible journal with a rigorous policy of peer review. However, in this article it appears to have dropped its former standards, promoting medical fascism (coercion, threat and division to achieve compliance with authority) without insisting on a rigorous evidence base to justify such an approach. This suggests an attempt to normalize such approaches in mainstream public health.
Past experience has shown us where fascism behind a façade of public health can lead. The sterilization campaigns aimed at coloured and low-income populations of the US Eugenicist era, and the extensions of similar programs under Nazism in 1930s and 1940s Europe, relied heavily on the normalization of such approaches.
Leading public health voices from Johns Hopkins School of Public Health and other institutions championed a public health approach of sanitizing populations rather than environments, encouraging the idea of a tiered society where health ‘experts’ determine the rights and medical management of those deemed less worthy.
Avoiding the discomfort of evidence
The authors of this Lancet paper, ranging from academics and medical consultants to the daughter of a prominent politician, attempt to rewrite human rights in medicine as if precedent never existed. Their argument for coercion in mass vaccination recognizes that ‘vaccine mandates,’ whether issued by governments, employers or schools, all involve a loss of rights. No serious attempt is made to provide a medical justification for mass vaccination with a non-transmission-blocking vaccine.
The paper focuses on the premise that coercion, commonly considered a form of force, makes humans do things they would not otherwise do. Banning fellow humans from making their own health choices on pain of loss of normal participation in society has an impact on increasing vaccine uptake. This is hardly a revelation to any thinking human, but clearly important enough to justify publication in The Lancet.
The article links to evidence of vaccine mandates used for state school entry that show higher compliance when the right of religious and personal belief exemption is removed, or where onerous requirements for exemptions are put in place. Leaving ethical questions aside, the obvious lack of similarity between the authors’ predicate childhood vaccinations that block transmission and COVID-19 vaccines that have minimal impact on transmission, and may even promote it, is ignored. The one mandated adult vaccine predicate referenced in the article, the influenza vaccine, provides only a 2.5% reduction in pneumonia ‘when the (mandated) vaccine was well matched to circulating strains’ in the reference quoted.
When raising the sacking of non-vaccinated workers, the authors seem comfortable with the approach but coy in admitting its consequences. Their admission that “a few large US employers have terminated hundreds of workers for non-compliance references an article in Money magazine which actually paints a bleaker picture, characterizing it as a ‘great resignation.’
The authors will also have been aware of mass layoffs by large employers such as New York City (over 9,000 sacked or placed on leave), the US Department of Defense (DoD, which sacked 3,400), Kaiser Permanente (laid off 2,200), and the tens of thousands of staff lost from the UK care-home sector . Extrapolated across countries and society to actually provide credible data may have been too uncomfortable for the authors and Lancet editors.
High efficacy and safety are an obvious (though on their own, insufficient) prerequisite for any mandated product. This entire area of safety is dealt with by stating; “The current evidence on the safety of COVID-19 vaccines in adults is sufficient to support mandates,” supported by a single study comparing vaccinated individuals 1-3 weeks and 3-6 weeks post-vaccination, revealing low levels of myocardial infarction, appendicitis and stroke.
The claim that “widespread administration in adults has quickly generated a large evidence base supporting the vaccines’ safety, including evidence from active surveillance studies” suggests that both the authors and The Lancet are unaware of the VAERS and Eudravigilance databases set up for exactly this purpose. No mention is made of growing data on myocarditis, menstrual irregularities, or the excess all-cause mortality and severe outcomes in vaccinated groups in the Pfizer randomised control trials on which the FDA emergency registration was based. Were The Lancet’s reviewers unaware of these sources?
The sole reference to vaccine efficacy discusses COVID-19 ventilated patient outcomes, It ignores the period to 14 days post-previous dose that Pfizer acknowledges can be associated with immune suppression. Fenton et al. have noted that classing a vaccinated person as unvaccinated in the first 14 days post-injection has profound impacts on vaccine effectiveness data.
Ignoring the awkwardness of reality
Post-infection immunity in the unvaccinated is a threat to arguments for mandates. The authors disingenuously state that “evidence suggests that the immunity produced by natural infection varies by individual, and that people with previous infection benefit from vaccination. New variants further undercut the case for adequacy of previous infection.
Two references are used here: one from a study in Qatar and the other a study from Kentucky. The Qatar study finds that “the protection of previous infection against hospitalization or death caused by reinfection appeared to be robust, regardless of variant,” whilst the Kentucky study found Covid reinfection was reduced by vaccination over a 2-month period in the months soon after vaccination, prior to the waning and then reversal of this protection as demonstrated in studies of longer duration elsewhere.
The vast breadth of evidence on relative effectiveness of post-infection immunity is ignored. Either the authors failed to read their references and are unaware of waning and of the vast literature on post-infection immunity, or they do not consider demonstration of efficacy important for coerced medical treatments.
In a previous era, or in a previously credible medical journal, an argument for coercion to support a medical procedure would have required very high standards of evidence of efficacy and safety. It is arguing for the abrogation of fundamental principles such as informed consent that are at the core of modern medical ethics. Failure to address well-known contrary data should prevent an article from even reaching the peer-review stage.
Degrading public health degrades society
We are left with a paper stating that coercion is a good path to increase compliance for a product that does not reduce community infection risk, and has potentially serious side effects. Ignoring both of these aspects of COVID-19 vaccines is a poor approach to justifying mass vaccination. The sole nod to any human rights concern – “Some objectors argue mandates represent undue encroachment on individual liberty” – is an interesting way to characterize removal of the right to income, education and the ability to socialize with others.
Although all these rights are recognized under the Universal Declaration for Human Rights, the authors and The Lancetconsider them insufficiently serious to dwell upon.
Public health has been down this road before. We have seen the path society takes when basic public health principles are subverted to achieve an aim that some perceive as ‘good.’ We have also seen how most health professionals will comply, however horrific the actions involved. There is no reason to believe that this round of medical fascism will end differently.
We rely on medical journals such as The Lancet to apply at least the same standards to the purveyors of such doctrines as they do to others and demand a rational and honest evidence base. Anything less would raise legitimate questions as to the role the journal is taking in promoting these doctrines, and their place in a free, evidence-based and rights-respecting society.
This piece written in cooperation with Domini Gordon who coordinates the Open Science program for PANDA.
Author
From the Brownstone Institute
A walk through a dozen convenience stores in Montgomery County, Pennsylvania, says a lot about how US nicotine policy actually works. Only about one in eight nicotine-pouch products for sale is legal. The rest are unauthorized—but they’re not all the same. Some are brightly branded, with uncertain ingredients, not approved by any Western regulator, and clearly aimed at impulse buyers. Others—like Sweden’s NOAT—are the opposite: muted, well-made, adult-oriented, and already approved for sale in Europe.
Yet in the United States, NOAT has been told to stop selling. In September 2025, the Food and Drug Administration (FDA) issued the company a warning letter for offering nicotine pouches without marketing authorization. That might make sense if the products were dangerous, but they appear to be among the safest on the market: mild flavors, low nicotine levels, and recyclable paper packaging. In Europe, regulators consider them acceptable. In America, they’re banned. The decision looks, at best, strange—and possibly arbitrary.
What the Market Shows
My October 2025 audit was straightforward. I visited twelve stores and recorded every distinct pouch product visible for sale at the counter. If the item matched one of the twenty ZYN products that the FDA authorized in January, it was counted as legal. Everything else was counted as illegal.
Two of the stores told me they had recently received FDA letters and had already removed most illegal stock. The other ten stores were still dominated by unauthorized products—more than 93 percent of what was on display. Across all twelve locations, about 12 percent of products were legal ZYN, and about 88 percent were not.
The illegal share wasn’t uniform. Many of the unauthorized products were clearly high-nicotine imports with flashy names like Loop, Velo, and Zimo. These products may be fine, but some are probably high in contaminants, and a few often with very high nicotine levels. Others were subdued, plainly meant for adult users. NOAT was a good example of that second group: simple packaging, oat-based filler, restrained flavoring, and branding that makes no effort to look “cool.” It’s the kind of product any regulator serious about harm reduction would welcome.
Enforcement Works
To the FDA’s credit, enforcement does make a difference. The two stores that received official letters quickly pulled their illegal stock. That mirrors the agency’s broader efforts this year: new import alerts to detain unauthorized tobacco products at the border (see also Import Alert 98-06), and hundreds of warning letters to retailers, importers, and distributors.
But effective enforcement can’t solve a supply problem. The list of legal nicotine-pouch products is still extremely short—only a narrow range of ZYN items. Adults who want more variety, or stores that want to meet that demand, inevitably turn to gray-market suppliers. The more limited the legal catalog, the more the illegal market thrives.
Why the NOAT Decision Appears Bizarre
The FDA’s own actions make the situation hard to explain. In January 2025, it authorized twenty ZYN products after finding that they contained far fewer harmful chemicals than cigarettes and could help adult smokers switch. That was progress. But nine months later, the FDA has approved nothing else—while sending a warning letter to NOAT, arguably the least youth-oriented pouch line in the world.
The outcome is bad for legal sellers and public health. ZYN is legal; a handful of clearly risky, high-nicotine imports continue to circulate; and a mild, adult-market brand that meets European safety and labeling rules is banned. Officially, NOAT’s problem is procedural—it lacks a marketing order. But in practical terms, the FDA is punishing the very design choices it claims to value: simplicity, low appeal to minors, and clean ingredients.
This approach also ignores the differences in actual risk. Studies consistently show that nicotine pouches have far fewer toxins than cigarettes and far less variability than many vapes. The biggest pouch concerns are uneven nicotine levels and occasional traces of tobacco-specific nitrosamines, depending on manufacturing quality. The serious contamination issues—heavy metals and inconsistent dosage—belong mostly to disposable vapes, particularly the flood of unregulated imports from China. Treating all “unauthorized” products as equally bad blurs those distinctions and undermines proportional enforcement.
A Better Balance: Enforce Upstream, Widen the Legal Path
My small Montgomery County survey suggests a simple formula for improvement.
First, keep enforcement targeted and focused on suppliers, not just clerks. Warning letters clearly change behavior at the store level, but the biggest impact will come from auditing distributors and importers, and stopping bad shipments before they reach retail shelves.
Second, make compliance easy. A single-page list of authorized nicotine-pouch products—currently the twenty approved ZYN items—should be posted in every store and attached to distributor invoices. Point-of-sale systems can block barcodes for anything not on the list, and retailers could affirm, once a year, that they stock only approved items.
Third, widen the legal lane. The FDA launched a pilot program in September 2025 to speed review of new pouch applications. That program should spell out exactly what evidence is needed—chemical data, toxicology, nicotine release rates, and behavioral studies—and make timely decisions. If products like NOAT meet those standards, they should be authorized quickly. Legal competition among adult-oriented brands will crowd out the sketchy imports far faster than enforcement alone.
The Bottom Line
Enforcement matters, and the data show it works—where it happens. But the legal market is too narrow to protect consumers or encourage innovation. The current regime leaves a few ZYN products as lonely legal islands in a sea of gray-market pouches that range from sensible to reckless.
The FDA’s treatment of NOAT stands out as a case study in inconsistency: a quiet, adult-focused brand approved in Europe yet effectively banned in the US, while flashier and riskier options continue to slip through. That’s not a public-health victory; it’s a missed opportunity.
If the goal is to help adult smokers move to lower-risk products while keeping youth use low, the path forward is clear: enforce smartly, make compliance easy, and give good products a fair shot. Right now, we’re doing the first part well—but failing at the second and third. It’s time to fix that.
Author
From the Brownstone Institute
Cigarettes kill nearly half a million Americans each year. Everyone knows it, including the Food and Drug Administration. Yet while the most lethal nicotine product remains on sale in every gas station, the FDA continues to block or delay far safer alternatives.
Nicotine pouches—small, smokeless packets tucked under the lip—deliver nicotine without burning tobacco. They eliminate the tar, carbon monoxide, and carcinogens that make cigarettes so deadly. The logic of harm reduction couldn’t be clearer: if smokers can get nicotine without smoke, millions of lives could be saved.
Sweden has already proven the point. Through widespread use of snus and nicotine pouches, the country has cut daily smoking to about 5 percent, the lowest rate in Europe. Lung-cancer deaths are less than half the continental average. This “Swedish Experience” shows that when adults are given safer options, they switch voluntarily—no prohibition required.
In the United States, however, the FDA’s tobacco division has turned this logic on its head. Since Congress gave it sweeping authority in 2009, the agency has demanded that every new product undergo a Premarket Tobacco Product Application, or PMTA, proving it is “appropriate for the protection of public health.” That sounds reasonable until you see how the process works.
Manufacturers must spend millions on speculative modeling about how their products might affect every segment of society—smokers, nonsmokers, youth, and future generations—before they can even reach the market. Unsurprisingly, almost all PMTAs have been denied or shelved. Reduced-risk products sit in limbo while Marlboros and Newports remain untouched.
Only this January did the agency relent slightly, authorizing 20 ZYN nicotine-pouch products made by Swedish Match, now owned by Philip Morris. The FDA admitted the obvious: “The data show that these specific products are appropriate for the protection of public health.” The toxic-chemical levels were far lower than in cigarettes, and adult smokers were more likely to switch than teens were to start.
The decision should have been a turning point. Instead, it exposed the double standard. Other pouch makers—especially smaller firms from Sweden and the US, such as NOAT—remain locked out of the legal market even when their products meet the same technical standards.
The FDA’s inaction has created a black market dominated by unregulated imports, many from China. According to my own research, roughly 85 percent of pouches now sold in convenience stores are technically illegal.
The agency claims that this heavy-handed approach protects kids. But youth pouch use in the US remains very low—about 1.5 percent of high-school students according to the latest National Youth Tobacco Survey—while nearly 30 million American adults still smoke. Denying safer products to millions of addicted adults because a tiny fraction of teens might experiment is the opposite of public-health logic.
There’s a better path. The FDA should base its decisions on science, not fear. If a product dramatically reduces exposure to harmful chemicals, meets strict packaging and marketing standards, and enforces Tobacco 21 age verification, it should be allowed on the market. Population-level effects can be monitored afterward through real-world data on switching and youth use. That’s how drug and vaccine regulation already works.
Sweden’s evidence shows the results of a pragmatic approach: a near-smoke-free society achieved through consumer choice, not coercion. The FDA’s own approval of ZYN proves that such products can meet its legal standard for protecting public health. The next step is consistency—apply the same rules to everyone.
Combustion, not nicotine, is the killer. Until the FDA acts on that simple truth, it will keep protecting the cigarette industry it was supposed to regulate.
Author
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