To turn even perceived heresy into a disciplinary charge, though, you need an expert willing to call it “substandard”. The board found one.

It is fair to ask how a book ended up at the center of a medical-board case at all. The answer is that I offered it to them myself, in good faith. In June 2012, the day after the board’s meeting on my issue(s), I wrote a courteous note to Dr. Gerald Healy, a member of the board and a physician of real stature whose questions (nearly uniquely amongst the erstwhile board members) were thoughtful, direct and inquisitive (in particular around my concepts around addiction). I offered to send him my YouTube links and the draft of my book, and singled out its first three chapters, where I had laid out the theory behind the work. I copied my own attorney on the note; there was nothing furtive about any of it – although I did (later, to a rankled board officer) have to apologize for the mere appearance of an “ex parte communication”.

As it happened, I never did send Healy the book. But the board had heard of it, asked for it, and I submitted it. That is when the trouble began. The manuscript I had volunteered, one colleague to another, became the document the board would spend years holding against me. No good deed goes unpunished.

The expert who read the book, not the chart

The board retained Dr. Olivera Bogunovic, (currently) medical director of McLean’s addiction outpatient program and an assistant professor of psychiatry at Harvard Medical School, board-certified in addiction- and in geriatric- psychiatry. On March 20, 2018 she testified under oath before Administrative Magistrate Kenneth Forton. I have the transcript open in front of me as I write this, and it reads less like a case against a physician than like a slow, courteous demonstration of a category error.

Start with what she had actually examined. The magistrate interrupted the direct examination to ask the obvious question. “Did you review any medical records from Doctor Bock?” Her answer: “No, I did not review the medical records.” Pressed on whether she had even been asked to, she said no again. What she had reviewed was my manuscript, then titled The Drug Whisperer, my YouTube videos, and the disclosure-and-agreement form my patients signed. So the “standard of care” she had been brought in to pronounce upon was never the care. It was the book.The board had gone for a board-certified Harvard appointee; but never tested her own published convictions, which, ironically, aligned with mine.

Magistrate Forton (apologizing that his were a layman’s questions) asked her from several angles, whether the act of writing and publishing a book could itself fall below the medical standard of care, apart from the treatment of any actual patient. There is a pause marked in the transcript. What she finally offered was not a clinical finding but a confession of discomfort: “I personally would have very big concerns if somebody has that opinion and is putting it in a manuscript.” Earlier, my attorney had asked whether she had any evidence that a single one of my patients had ever read the manuscript. “No.” The objection, stripped down, was that I had written my down my (unpublished, private) views. The expert’s act was in keeping with Savonarola’s (not Tom Wolfe’s) Bonfires of the Vanities.

Her own program, in her own words

(Following on from my erstwhile research) my attorney Douglas Matthews, asked her to describe her own work, running an outpatient benzodiazepine program at McLean. She described it herself: a small, careful program for patients who have been physiologically dependent for years, “up to 10 to 20,” some of them six years into a slow wean and still going. The method: gradual tapering toward none, with the family brought in for support and goals written into the treatment plan.

Asked what those goals were, she did not say lifelong medication; she said “getting a job and moving on in life,” and elsewhere, “rebuilding your life in setting of treatment.” Matthews then asked (in a more public program, without all of McLean’s resources), would “starting a taper carefully monitored” be a deviation from the standard of care? Her answer was a single word: “No.” She added that it was multifactorial, as everything in medicine is.

In a clinical trade interview she names outpatient benzodiazepine tapers as her own subspecialty and describes sitting with patients to discuss what they will gain from “long-term abstinence.” Her 2004 review in Psychiatric Services had already concluded that these drugs belong in short, low-dose courses, that gradual tapering serves the old as well as the young, and that impaired patients “show improved functioning once the drug has been discontinued.” And in 2018 -- the very year she testified that my opioid taper was a dangerous deviation -- she co-authored a review in Drug and Alcohol Dependence devoted entirely to how best to help patients taper off benzodiazepines altogether, a drug whose own withdrawal can kill. Her entire body of work is the patient art of getting people off a dependence-forming drug by walking them down to none of it.

Now hold the two halves of her testimony together. Taper a benzodiazepine patient down to zero: best practice, her life’s work, the thing she trains other physicians to do. Taper an opioid patient down to zero, as I did: “clinically dangerous,” a “deviation,” grounds to take a man’s license. Same goal, same method, the same clinician sitting in judgment. The only variables that changed were the molecule and whose name was on the chart.

“Tapering is the ideal”

The magistrate, still playing the patient layman, eventually asked her the question directly. It seemed to him, he said, that “tapering is the ideal if the person can take it; is that right?” Her answer: “If the person can take it, it’s ideal.”

There it is, in the transcript the board itself produced: the Commonwealth’s own expert, under oath, agreeing with the doctor the Commonwealth was trying to strip of his license. The dispute, once you take off its costume, was never about whether to aim a patient at sobriety. Bogunovic aims her own patients at sobriety. It was about whether a physician is permitted to say so out loud, in print, and to doubt the orthodoxy that says the aiming should never end.

A disease “by definition”

The most instructive stretch of the day had nothing to do with me at all. It was the untrained and unembarrassed magistrate’s testing the foundation under the word everyone kept using. The profession calls addiction a brain disease largely on the strength of what shows up on scans -- the PET and MRI changes she invoked. Yet no patient is ever diagnosed or dosed by scan. As she conceded, “it’s the clinical picture that drives the recommendation ... There’s not a requirement to do an MRI scan or PET scan; that does not exist right now.” So the physiological proof that supposedly makes addiction a disease plays no part in deciding who has it or how to treat him. The magistrate put the contradiction gently: the physician community rests its conclusion on “physiological observed phenomena,” and then treats patients without reference to those phenomena at all.

And consider what those scans actually show. The brain changes (measurably on such scans; not physically or morphologically)-- when we fall in love, when we grieve, when we learn a language or take up the violin. No one calls falling in love a brain disease. A functional image of the brain is akin to a infrared-thermal image of your home: the kitchen glows at dinnertime, the bedrooms late at night, the heat migrating from room to room as the household goes about its day. Or think of the old telephone switchboard, this line busy now and that one idle, the pattern forever shifting with the traffic.

To point at heightened activity in the reward circuitry and announce a permanent disease is to mistake a house’s being lived in for its being broken. And we know it is not destiny, because people climb out -- sometimes with medicine, sometimes through work or family, sometimes, as I have watched, through nothing more (or less) clinical than finding God. A permanent, choice-erasing brain disease (like schizophrenia) does not lift when a man is “born again”.

When he asked her, repeatedly, to ground the disease claim in evidence, what came back was not evidence but a roll-call of institutions: the National Institute on Drug Abuse, Nora Volkow, the American Medical Association, the DSM-5. Asked whether any reputable body disagreed, she answered, “Not any reputable organizations that I’m aware of” -- which the magistrate, drily, called “a cheeky way to respond.” And when Matthews reminded her that homosexuality was once classified as a disease and later was not, she granted the point without much fuss. Categories move; maps are redrawn. “It is a brain disease by definition,” she had insisted earlier; but by definition is precisely the circular-logic phrase we reach for when we have decided in advance not to examine the thing we are defining.

What an afternoon proved

This was the testimony upon which the board’s case rested. After we had discovered the 2014 hearing had applied the wrong evidentiary standard, the same magistrate reheard it and concluded that I had not provided any substandard care to my patients.

We taper people off benzodiazepines. We taper them off alcohol, and off nicotine, and we count it a success, not a malpractice, when the prescription pad finally goes back in the drawer. Nobody calls weaning a patient toward sobriety a deviation from the standard of care, except in the one province of medicine where lifelong maintenance has been written into statute, funded by the state, and turned into a recurring revenue line: the “Methadone Industrial Complex” (which includes Suboxone/buprenorphine).

I argue the larger version of this elsewhere, and at length, in my upcoming book “Withdraw to Freedom: Navigating the Addiction Maze”. But the smaller version fits in a single sworn afternoon: tapering is the ideal. Massachusetts’ Board of Registration in Medicine’s own assigned expert said so herself.

Communication is everywhere in nature, but it is welded to the present: a signal for a thing that is here, now. What humans add is meta-messaging, the power to use a small fixed set of symbols to model what is absent, past, future, hypothetical, or wholly invented, and to plant that model in another mind (such as I am doing, right here, writing this, via alphabetical combinatorics). A finite alphabet yields infinite worlds; pictograms (and birdsong) stay closer to one-sign=one-thing, which is why even Chinese (pictograms) drifted toward sound(s) and why the abstract letter-format let writing scale – and communication flourish. That same capacity has built everything that cannot be touched: the coordinated hunt; the hero who outlives life; money; gods; nations; commerce; wealth; growth; and dreams.

I recently had the great good fortune to hear Jonathan Leaf discuss his fascinating new book The Primate Myth (discussed here, by Nicholas Wade). A separate, post-lecture conversation drifted from his “New Theory of Human Nature” towards other man vs. animal questions:

• If a chimpanzee can press symbols on a board; if a dog can learn that “walk” and “car” and “treat” carry consequences; and if dolphins appear to trade signals beneath the surface – are human beings really so different?

• Is our language merely a more elaborate version of equipment already distributed across the animal kingdom?

My answers, respectively, are “yes” and “no”. Animals, no doubt, communicate: A bird announces a hawk; a wolf advertises its rank; a chimpanzee gestures toward food, toward danger, toward a rival or a mate; however, almost all such sounds or gesticulations remain tethered to the present moment: e.g. the affective equivalent of “there is a thing happening!” (threat, appetite, or social cue).

Human beings, of course, can do that (look at the crowds at the NBA finals); however, they have the additional, both canny and uncanny, ability to perform what I will call here “meta-messaging”: communication that sublimates or supersedes the present. The human sentence can say

• that there was a thing,

• that there will be a thing,

• that there might be a thing, and even

• that there is a thing I have invented outright, a thing that exists nowhere but in the space your attention and mine now share.

The human’s message can point at a model of the world, and can coax a second mind into that model to act as though its contents were real. That capacity is the line that separates us from them.

Birdsong Rendered in Ink

Consider the keyboard under my hands and what you’re reading (although I Dragon-dictate, rather than type): these twenty-six letters; ten digits; and a scattering of marks matter. They produce novels, constitutions, contracts, proofs, slanders, jokes, hymns, and love letters. The symbols carry almost no meaning in themselves (aside from “ABC, as easy as 1-2-3”; and in physics, or labeling coronavirus subtypes); their power lies entirely in the combination, so that a tiny inventory of parts yields an effectively unlimited inventory of ideas.

Written Chinese began as pictures: one stroke for the sun, another for the moon, one for a tree – and as such wedded and welded to its “thing”. In that bond, it sits closer to the sparrows (who awoke me this morning) than to the (axiomatically-named, “alpha”-“beta”) alphabet. Birds’ song, however intricate, is a fixed pattern for a fixed situation; necessarily so as “telecommunication”, understood by ear alone, with none of the facial cues we take for granted. The pure pictogram is birdsong rendered in ink.

None of these choices of transcription was foresight, per se. One assumes that every such attempt was akin to any blind man’s figuring out a hotel room. For their particular forays, proto-Chinese and ancient Egyptians miniaturized and multiplied versions of earlier human expression, such as seen in places like Lascaux cave art; whereas, roughly four thousand years ago, Semitic groups such as Hebrews and Phoenicians mutated the Egyptian hieroglyphs into letters which the Greeks and the Romans adapted and continued (as we have to this day).

Neither path was wiser than the other contemporaneously; however, at wholesale ultimately, the pictures cannot carry a modern language: in Chinese, the characters have drifted toward sound; pure pictographs are now a remnant, a few percent of those in daily use, while some eighty percent are phono-semantic compounds, signs that smuggle a hint of pronunciation in beside the picture. The glyph still looks “Chinese”, but it has begun doing the alphabet’s work in disguise.

The pictogram was never built for meta-messaging. It is the cave wall, beautiful and faithful and mute about everything not in front of it. For China, the telegraph forced those characters into numbered codes; the keyboard continued that trend – until today a Chinese sentence is most often typed by spelling its sounds in (our) Roman letters and choosing the character those letters recall, barring the old and borrowing ours.

Of course, any Chinese speaker (no less than any other language’s) builds a finite stock of sounds into sentences never spoken before. The alphabet (rather than the pictogram) became the lever that let writing scale.

All Rapt Up And Nowhere To Go

Human language’s wonder is not that it labels the world; its wonder is that it manufactures worlds – as only humans can. Permit me a demonstration, the very one that I used that evening (to an initially shocked, rapt audience):

Walking here, 100 yards from my hotel, 5:30 PM (just as the rain had ended), I passed a woman wrapped in a red blanket, lying on the sidewalk. Several strangers knelt to revive her, then recoiled as if from a terrible odor and left her where she lay. Seconds later, she made a short, staccato gasp – and not a moment later, she convulsed into tight flexion, and died.

PS: none of that happened. I invented every word of it, the blanket, the strangers, and the recoil alike.

Yet the sentences had scarcely formed before each reader built the scene for himself. One pictures a particular city, another a particular doorway; one fixes on the cruelty of the strangers, another on the cause of death, another on the question of why a physician would trouble to fabricate such a thing. Every reader has just visited a place that does not exist, and has felt something real upon arriving there.

The words produced an event unmoored from reality, and the event in turn produced emotion, judgment, suspicion, perhaps the impulse to act. Nothing in the external world answered to any of it, for the episode lived, in its entirety, inside the cerebral skills and skulls of the people hearing it.

Elephant Memories

The central fact of our species is that we speak of the absent, the future, the merely possible, the frankly impossible. We speak of gods, nations, justice, currency, rights, hypotheses, and characters who were never born. Whole civilizations rest upon things that cannot be weighed, touched, or photographed.

No animal is known to approach this; none convene to debate the hypothetical. The difference is not the size of the vocabulary but the reach of the imagination: our languages pour forth imagined realities and then make the imagined real. Consider the hunters who set out after a mastodon a hundred times their weight. Armored in hide and tusks, it was invulnerable to any one man. The kill demanded coordination (and presumably language) at every stage: the feint that turned the herd, the lure, the decoy, the ambush sprung on a signal, the roles assigned and rehearsed. It also demanded heroes, potentially someone to stand in the tusks’ path on the signal.

Cultivating the Culture

The hero is the first thing a group invents that outlives its use, becoming a template to which the young are molded. Scaled and compounded across generations, that is culture. So we keep the dead, the mythologized, and the famous on hand. The “reality” per se doesn’t matter: it could be Odysseus or George Washington idealized and idolized; more recently both Capt. Kirk and Charlie Kirk; on the other side of the ledger, Stalin and Voldemort.

Thus symbolized, the dead steer the accounts of the living; just as Lascaux’s living counted the dead steer: same principle, generals; saints; and (even) monsters lodge as permanent residents of our shared interior landscape. Money, whether banknote, share, or patent is worth only what collective belief assigns it. The story it carries is everything.

The Prints of Whales

The same instinct explains why we overrate the minds of other animals: we are narrators by constitution, projecting motive onto anything that holds still long enough. Nowhere is the habit plainer than with dolphins and whales, whose reputation for genius rests more on our affection than on their accomplishments.

Paul Manger, the comparative neurobiologist at Witwatersrand whom I interviewed on the question, argues that the cetacean braincase is swollen less by intellect than by the work of staying warm. Much of that bulk is glia, the housekeeping tissue that heats neurons rather than the circuitry that thinks, and close to ninety percent of the relevant neurons carry proteins that shed warmth instead of processing thought. An animal living in subzero (°C) water bleeds heat with brutal efficiency, and a large, warm, well-insulated brain answers that emergency long before any intellectual one. We have mistaken the furnace for the philosopher.

The structural point invites a behavioral one: hard problems build hard minds, and the open ocean asks little of a creature that grazes it. The great baleen whales are, in a sober evolutionary sense, water-based bovines, sprung from the same hoofed stock as cattle and hippos, and they strain krill with about the deliberation a cow brings to a meadow. A grazer need not plot. The killer whales and some dolphins do hunt cooperatively, and there the case for cleverness is strongest; even so, a land predator that must track, ambush, and outwit live prey runs a far harder program, and I would wager an ordinary dog out-reasons the average dolphin. We watched Flipper, and supplied the rest.

What is unique to us is not communication, which runs riot through nature, but the building of imaginary worlds and the persuading of others to live inside them. Perhaps that is why a slow, soft, poorly armed primate redrew the planet while the swift and the fanged did not. The decisive adaptation was not the hand or the spear or even the big brain as raw meat; it was the sentence, a finite handful of sounds and shapes turned into an infinite engine for conjuring what does not exist and then acting as though it does. From that one trick came religion, science, law, markets, and government, the whole apparatus of history.

From Ox-Horn to Bit

And the trick is still scaling. The ox-horn became aleph, aleph became alpha, alpha became A; the letter became a pulse of current, and the current became the bit, a grain barer even than a letter, nothing but on or off.

Out of those fixed grains we now conjure whole worlds and fling them through space at light-speed: our books, our films, our dreams, the very thought I am forming now, which will arrive entire in your mind a moment from now. No raccoon will ever dream of doing such a thing. The machine we raised on the bit is the loudest meta-message ever sent, built wholly from our gift for modeling what is not there; you could no more distill it from birdsong than raise a cathedral from a sparrow’s chirp. Animals signal; humans simulate, and the distance between those two verbs is the distance between nature and history.

When Anna Matson asked me what single idea I would leave with listeners regarding autism (after having written Unraveling Autism’s Surge; Genetics, Environment, and the Expanding Diagnostic Net), my answer was immediate. “The one thing about autism would be that you need to get a clear definition of what that thing is.” That may sound like an academic concern, but I have come to believe it sits at the center of the entire autism debate.

I would love for you to watch the video.

Here is an AI-take:

Most conversations about autism begin with causation. People want to know whether vaccines are responsible. Others point toward environmental toxins, pharmaceuticals, nutrition, genetics, maternal age, or some combination thereof. Before any of those questions can be answered, however, a more basic question requires attention. What exactly are we talking about when we use the word autism?

I entered this subject as an outsider. I am not an autism specialist. Autism never formed a major part of my medical practice. Yet over the last decade it became impossible to ignore. During my years in medical school and residency, autism barely entered conversation. Today it occupies an enormous amount of public attention. Researchers study it. Schools organize around it. Legislators fund programs for it. Parents fear it. Advocates promote awareness of it. As I watched this expansion, I found myself asking a simple question. What changed?

Part of the answer appears to lie in the diagnosis itself. Autism has not remained a fixed category. Diagnostic definitions have changed repeatedly. Conditions once regarded as distinct have been merged into a broader spectrum. Asperger syndrome disappeared as a separate diagnosis. Other developmental categories moved beneath the same umbrella. Consequently, when someone points to rising autism prevalence, I immediately wonder whether we are measuring an increase in a condition, an increase in recognition, an expansion of a definition, or some combination of all three.

The severe forms of autism remain relatively straightforward. Most people recognize them immediately. I described to Anna a young man who could spend hours watching ceiling fans reverse direction or washing machines spin through their cycles. He was not following a story. He was not engaging socially. He was absorbed by a narrow repetitive focus. “The severe cases of autism are like that. You know it when you see it.” Those individuals exist. They always existed.

The question becomes more difficult when the spectrum expands far beyond those cases. Today we encounter successful professionals, university graduates, entrepreneurs, and public figures who identify as autistic. Some receive diagnoses late in life. Some function at extraordinarily high levels. That reality does not mean they are wrong. It does mean that we are placing profoundly different human experiences under a common label. Before searching for a single cause, we should ask whether we are even discussing a single phenomenon.

That concern extends to the historical relationship between autism and intellectual disability. Diagnostic categories evolve. Human beings remain the same. As categories shift, prevalence statistics often shift with them. During my research I became increasingly persuaded that diagnostic expansion explains at least part of what we are seeing. “Autism expands away from intellectual disability.” Whether that expansion represents scientific progress, diagnostic inflation, improved recognition, or several forces operating simultaneously remains an open question.

The same caution applies to causation. Genetics clearly matters. Twin studies consistently point in that direction. Environmental influences may matter as well. Gene-environment interactions may matter. Multiple pathways may exist. What concerns me is the tendency to leap toward certainty while the underlying category remains unstable. “When you have a term that is not well defined, you’re never going to find the real cause of that thing.”

I do not approach this issue as an advocate for one camp or another. Throughout my writing I have generally preferred the role of observer to that of partisan. As I told Anna, “I try not to take sides. I try to be an umpire or referee.” That position can be uncomfortable because people naturally want answers. Parents deserve answers. Researchers seek answers. Policymakers seek answers. Yet good science begins with careful observation before it advances toward conclusions.

My suspicion is that autism may ultimately prove to be less a single condition than a collection of related phenomena. Some cases may be strongly genetic. Some may involve environmental triggers. Some may represent diagnostic reclassification. Some may involve factors we have not yet identified. Those possibilities are not mutually exclusive.

For that reason I continue returning to the same point. Before asking what causes autism, we must determine precisely what autism is. “The first thing you have to do is define what it is that you’re looking for.” Without that foundation, every proposed explanation rests on uncertain ground.

Many thanks to attorney Ronald Coleman for inviting me onto Coleman Nation to discuss a chapter of my professional life that began nearly twenty years ago and continues to shape my thinking about medicine, addiction, regulation, and institutional power.

Coleman introduced the episode with a line that was partly joke and partly diagnosis:

“Dr. Randall Bock developed a program to treat addicts without keeping the medical meter running forever. It was so successful, he had to be stopped.”

Like many good jokes, it contains more truth than exaggeration because the conflict that ultimately engulfed my medical practice began with a disagreement over a question that once seemed straightforward. What is the purpose of addiction treatment?

I had practiced family medicine in Revere, Massachusetts, since 1987. My office sat on (“Main Street) “Broadway” in this working-class city just north of Boston. I treated whatever came through the door: sore throats, hypertension, diabetes, broken bones, obesity, disability evaluations, erectile dysfunction, and the countless ordinary ailments that fill a physician’s day. Around 2006 I learned about the buprenorphine-waiver program that had emerged from the Drug Addiction Treatment Act of 2000.

I quickly found myself at odds with the prevailing assumptions. The profession was ivorced from its own past of seeing addiction NOT as a disease (until the 1990s)-- and divided (in the moment) between rapid detoxification programs that often moved too quickly and maintenance programs that often never ended – and d. As I explained to Coleman, “The great philosopher Goldilocks” provided my model: a middle course. Patients stabilized, tapered gradually over several months, and moved toward independence rather than indefinite pharmaceutical supervision.

The approach worked well enough that I soon was asked to lecture physicians on the model. The more experience I accumulated, however, the less convinced I became that addiction medicine was organized around recovery (to sobriety). My view remained simple. “My idea was to get people to the default position of not being on drugs.” That sounds almost self-evident, yet it increasingly placed me outside the mainstream. The contradiction appeared obvious to me. “We don’t write prescriptions for vodka for people with whiskey problems.” We do not prescribe gambling vacations for compulsive gamblers or other versions of the same destructive behavior. As I told Coleman, “We don’t treat the other addictions with hair of the dog. We expect you to sober up.” Yet opioid addiction increasingly became the exception. Patients remained on replacement narcotics for years. Physicians collected fees. Pharmaceutical companies sold medication. Government programs financed the arrangement. The system functioned smoothly for nearly everyone involved except those whose goal was complete recovery.

The disagreement eventually extended beyond addiction itself. I became increasingly skeptical of the expanding disease model that came to dominate large sections of medicine and public policy. As I explained during the interview, “There already is a word for addiction. It’s called “addiction”.” Andrew Klavan explains this so well in his, “The One Where I Talk About Matthew Perry”. Here’s the transcript.

Mental-health parity began as an appealing concept. Conditions involving the mind would receive the same insurance coverage as conditions involving the body. Yet the practical effect was to create powerful incentives for diagnostic expansion. Addiction, anxiety, autism, and a growing list of other conditions proliferated at the same time that institutions received funding and reimbursement for identifying and managing them. Correlation is not causation, but incentives matter. When the same system defines the condition, determines the treatment, and receives payment for both, skepticism is not only reasonable; it is necessary.

One patient encounter crystallized the issue. A former General Electric employee came seeking detoxification from heroin. He was a physically imposing man who had drifted from legitimate disability into a life that included heroin use, heroin dealing, and a growing estrangement from honest work.. I explained that I could help him stop using heroin. I could supervise withdrawal and prescribe medication– but to keep them away from narcotics, what he needed was to feel comfortable in his own self in his own shoes, and renounce some of the less savory feelings and dealings he had been performing all the while collecting a check for a disability clearly contradicted by his activities.

He called me back into the examination room. He was fighting tears. “Doc, you were right.” I asked him what he meant. “I’m lazy,” he replied. His conclusion was harsher than mine. I told him that recognizing the problem was evidence that he could change it because people rarely solve problems they refuse to acknowledge. Recovery requires medication for some patients, but it also requires agency. No prescription can substitute for that.

Ironically, that same patient (after that single visit, no detox initiated – and four months later) became the source of allegations that helped trigger the destruction of my practice. Regulatory scrutiny intensified. The board became increasingly interested in my views about addiction itself. At one point I provided material from a manuscript that would later become my book Withdraw to Freedom (soon to be published).

My argument that addiction was not a disease in the same sense as diabetes or glioblastoma became a focal point of the dispute. The disagreement ceased to be about medical judgment and increasingly resembled a disagreement about doctrine. A physician who challenged the maintenance model, questioned the disease model, and encouraged patients to pursue independence rather than lifelong treatment had become an inconvenient presence.

In January 2014 the Massachusetts Board of Registration in Medicine suspended my license. Years of hearings, appeals, and litigation followed. I eventually regained my license, first partially and later fully, but the practice I had spent decades building did not return so easily. Careers are easier to dismantle than to rebuild. During that period Ronald Coleman became involved in a legal challenge arising from the broader question of whether medical boards composed of active market participants should enjoy extraordinary protection when regulating potential competitors. The case ultimately reached the Supreme Court’s doorstep, although certiorari was denied. The legal battle ended without the resolution we sought, but it exposed issues extending far beyond my own circumstances.

Near the end of our conversation, Coleman made an observation that captured the essence of the story. “You’re a really thoughtful guy. That’s precisely why you got into trouble.”

Medicine only advances through skepticism, argument, and the willingness to challenge prevailing assumptions. Institutions function best when they tolerate disagreement rather than suppress it. Every profession must decide whether it exists to pursue truth or to enforce consensus..

A real deficiency disease is the same illness, at the same severity, in Rhode Island as in Texas, so its treatment cannot swing tenfold by state. Thyroid hormone does not, because the failing gland is the same everywhere. Normalizing for obesity; pump-devices; and diabetes subtype (I or II)— the same holds true for insulin-dosing; whereas methadone and buprenorphine (Suboxone) swing wildly, twenty- and forty-fold (!!) across state lines. This tells you they are not treatments of a uniform metabolic illness — but, rather, regional cultural artifacts: sorted by geography the way tattoos, piercings, and art- and gender- stylings are. And the whole apparatus was built as a bulwark, a daily free narcotic handed to the populations the system would not trouble to train, employ, or redeem; now paying off in a big way (for the clinics more than the customers).

THE REPLACEMENTS

The case for opioid maintenance rests on a single borrowed word: replacement. Methadone and buprenorphine, we have long been told, are to the heroin addict what insulin is to the diabetic, a medicine that restores something the body can no longer supply on its own. It is a powerful analogy, and it has carried the field for half a century; it is also, on the evidence, false.

The phrase has a pedigree worth recovering. In 1990 the New York Times ran a letter under precisely that headline, “Methadone Is to Addicts as Insulin Is to Diabetics,” signed by a prominent retired surgeon and Yale clinical instructor. What the Times did not mention, and what his own obituary would later make plain, is that the author sat on the advisory board of the National Alliance of Methadone Advocates and had helped establish a hospital methadone clinic; yet he’s not the problem, merely a symptom of a long-standing misconception, embodied in his phrasing: “that repetitive use of many psychoactive chemicals, licit and illicit, results in changes in neuronal membrane receptors and neurotransmitters that may be permanent.” Of course the opposite formulation is less frightening and bad for the narcotic-replacement business model.

MIDNIGHT, EXPRESSLY

There is a clean way to test whether a medication is a true replacement therapy: take it away, and observe what follows. Take insulin from a Type I diabetic and he sickens within hours and dies within days; he cannot live without it, because his body genuinely cannot manufacture what the medicine supplies. That is what a replacement is, properly understood: a stand-in for a substance the body must have and can no longer produce.

Now run the identical test on opioid maintenance. Picture two men in a jail that, on intake, confiscates everything (needles, vials, medication, no exceptions). One of them is the diabetic; the other has been maintained on methadone or buprenorphine for years, the “replacement” his clinic has assured him he will require for life. Within a day the diabetic is a medical emergency. The man on maintenance is wretched for a week; the sweats, the cramps, and the bone-deep misery of withdrawal are entirely real, and I will not minimize them. Yet on the far side of that week he is not dead, he is not dying, and he is, if anything, clearer than he has been in years. Take the medicine away, and one man’s body fails while the other man’s body, after a hard week, recovers.

That asymmetry is the whole argument, and no quantity of branding survives it. A genuine replacement is something without which one deteriorates. “Maintenance-” (sic) and/or the originally-addicting opiate, well those are things (after getting over a potentially fortnight-long speedbump) without which your life is the same, or better. Whatever buprenorphine and methadone are, they are not (equivalents of) insulin.

VODKA MAINTENANCE

We do not maintain the alcoholic on a daily measured ration of vodka; we don’t procure a cocaine- or “meth-head’s” drug(s) of choice. Nor do we do that for barbiturates, benzodiazepines, speed, hallucinogens, THC — or the softer (non-substance) addictions (such as gambling, pornography /sex, overeating, or gaming): providing “maintenance”-trips to Las Vegas; hookers; buffets; or game-consoles. With every other dependence, the entire medical project is to taper the patient off and return him to the world unmedicated; as much as possible, “sober”. No one has ever proposed that the cocaine addict suffers a cocaine deficiency, or that the drinker’s trouble is too little gin in the bloodstream; the very idea is comical.

Opioids alone are granted the lifelong treatment. The thing that singles them out is not their pharmacology, since withdrawal from alcohol or from the benzodiazepines is, if anything, the more medically dangerous; what singles them out is that opioids alone acquired an industry built upon the premise of permanence. Notably, these are the only substance in the list for which physicians have the sinecure, exclusive “rent seeking” -right to prescribe.

Physicians don’t currently have this exclusive conduit for alcohol (easily obtainable from liquor stores and bartenders); however during Prohibition, when alcohol was commercially unavailable – guess what: physicians prescribed alcohol (to their own financial benefit), and found the medical reasons to write it which have since “mysteriously” disappeared.

The ostensible opiate- “metabolic deficiency” was never discovered in the body. A cynic might say it was (at the very least, later) discovered in the business plan. In its creators’ own words, “Methadone Maintenance” was (ever) only a “A Theoretical Perspective”, based on six (!?) heroin-addicts.

“Implicit in the maintenance programs is an assumption that heroin addiction is a metabolic disease, rather than a psychological problem. Although the reasons for taking the initial doses of heroin may be considered psychological--adolescent curiosity or neurotic anxiety--the drug, for whatever reason it is first taken, leaves its imprint on the nervous system.” Vincent P. Dole, M.D., Marie E. Nyswander, M.D

HAVE YOU EVER METABOLIC?

In the mid-1960s, Vincent Dole, Marie Nyswander, and Mary Jeanne Kreek at Rockefeller proposed that opiate addiction was a metabolic disease, a derangement of the body’s chemistry that methadone corrected exactly as insulin corrects diabetes. They said as much in the very title of their 1967 paper, “Heroin Addiction - A Metabolic Disease.” Over the following half-century the claim mutated, as failed theories tend to do, into something harder to falsify: addiction “changes the brain,” and a changed brain (so the reasoning runs) must therefore be medicated forever. The deficiency had migrated from the metabolism to the synapse, yet the conclusion never changed, because the conclusion was always the point.

The claim cannot survive two objections. The first we have already met: no one speaks of an alcohol- deficiency, because the notion is absurd on its face; yet the same logic, applied honestly, would have us settling the drinker into a measured daily ration of vodka for life. The second objection is fatal. A real deficiency disease does not wait for a pharmacy to open; diabetes killed in antiquity, and the failing thyroid wasted its sufferers long before anyone could name the gland. But no human being ever sickened from a want of morphine across all the millennia before the poppy was refined, nor among the overwhelming majority of people throughout history who never had the means to obtain it. A condition that cannot appear until its drug is invented, and cannot appear in anyone the drug has never reached, is not a deficiency the drug corrects; it is a dependency the drug creates, and everything after that is mere bookkeeping. The bookkeeping, as it happens, is public.

SEPTUPLED SUBOXONE

From 2007 to 2017, buprenorphine distributed to American pharmacies rose nearly sevenfold, from 477 kilograms to almost 3,180. It climbed in every single year of the decade, without pause or plateau.

No deficiency disease (in the population-level aggregate) performs similarly. Hypothyroidism did not grow seven times more common in ten years; Type I diabetes did not septuple; the count of addicted Americans did not rise sevenfold. Importantly, this increase didn't come at the expense of any coincident decline in methadone usage. Frankly the opposite occurred, Methadone Distribution Increased from 2010 to 2019 for Opioid Use Disorder Treatment in the US:

The Drug Addiction Treatment Act (DATA) of 2000 allowed physicians to prescribe buprenorphine for addiction; with the ideal of “destigmatizing” treatment, moving it from ghettoized methadone clinics to primary care offices. Later statutes lifted the caps on how many patients each prescriber could hold, and a long campaign to promote maintenance (over tapering detox) accomplished the rest. Buprenorphine spread because the ground had been made fertile for it (looser rules, more prescribers, prescriptions written without end and without a taper), and it spread while overdose deaths roughly doubled. It seems though that the methadone clinics “didn’t get the memo” and have increased dosage per patient and tried to keep people on: a diabolical version of a Starbucks (one that not only charges for the coffee but bills the government and pockets an additional ~40 bucks every time you step in the store).

The genius of the arrangement is that the customer never sees the bill. Medicare's bundled weekly rate for the (up to) daily visits (or “take-homes”); dose(s); counseling; and toxicology screen(s) is roughly $250 (~$13,000 per patient per year). The patient ( i.e. perennial “customer”) pays a dollar or two at the window, if that.

The cost is real, recurring, and indefinite, yet hidden from the only two parties who might object: the patient, who is shielded from it, and the taxpayer, who funds it. We go about our days with no notion of this underground economy. As with the aforementioned autism- and hospice-scandals, the mechanism is always the same: a recurring public payment, a shielded beneficiary, and a provider with every reason to keep the enrollment going and none (ever) to discharge.

PHYSICAL OR FISCAL?

Corrected for population, the 2017 distribution ran from roughly 40 milligrams of buprenorphine per person in Vermont down to 2.1 in South Dakota. That is a nearly twentyfold spread between two states whose rates of genuine metabolic disease are very nearly identical.

Insulin does not vary twentyfold between biologically similar neighbors; it follows blood sugar, which follows bodies. What varies across this map is plainly not the patients’ innate physical needs, but physicians’ financial desires.

Grouped into the nine census divisions, the same gradient resolves into something even harder to explain away: New England receives on the order of seven times what the northern Plains receive. A disease does not respect and follow a census boundary; while a prescribing culture does; this is no different from the hospice boom in LA or autism center plethora in Minneapolis.

METHADONE’S MYTHOLOGIC METHOD

If buprenorphine were a quirk of one molecule, methadone would correct the picture; instead it confirms it. Methadone for addiction moves through an entirely separate channel (federally regulated clinics with daily observed dosing, not corner-pharmacy prescriptions), and it draws the same arbitrary geography. In 2020, Rhode Island received about 157 milligrams per person and South Dakota only 3.25, a forty-eightfold spread; Wisconsin received triple what neighboring Iowa did, across an invisible line drawn on the prairie.

The two drugs run through two regulatory systems and two delivery mechanisms, and still they trace one senseless map. When a pattern survives everything that ought to change it, the pattern is no longer describing the patients; it is describing the system.

SUB(oxone)-TRACTION BY ADDITION

What predicted how much a state received was neither its overdose rate nor its poverty. It was the number of physicians the state had licensed to prescribe, a correlation tight enough (r = +0.76) that the drug plainly tracked the prescribers rather than the patients.

The mechanism is not that a license mechanically manufactures supply. It is that prescribing runs high wherever prescribing has been normalized: where the practitioners of a habit are dense, the habit comes to feel ordinary, and each prescriber grows more comfortable exercising his full latitude. The map measures the prescribers’ comfort, not the patients’ disease.

INSULIN INSULTED

The original comparison would use insulin itself-- however (and more recently), obesity has risen; Type II diabetes has spread; the line between the two types has blurred; and, pumps and newer formulations have altered prescribing patterns. A more stable comparison (without those confounds) that would resonate with the Vincent Dole 1960s era would be hypothyroidism/ thyroid hormone, for which there has been no lifestyle -related epiphenomenon. If maintenance drugs behaved as a (true, disease-palliative) replacement behaves, they should be prescribed as evenly as thyroid is.

Over the very decade in which buprenorphine multiplied nearly sevenfold, levothyroxine use rose by perhaps a third, and ‘per person’ it has been flat to declining. Set the two on the same axes, each indexed to its own starting point, and the contrast is self-evident.

The same control, drawn across space rather than time, holds just as well. I couldn’t find actual milligrams per person, per state; however, the overall number of prescriptions-filled has very little variance nationwide.

The contrast is easiest to take in as one frame: on the left is a loose interpretation of buprenorphine-/ methadone-dosages and on the right, thyroid-. One looks like “groupthink”, the other uniform placement for replacements.

One drug is supplied where it is wanted (or pushed); the other is supplied where it is needed.

NIXON NICKED

Methadone entered federal policy under Nixon in 1971 as a crime-control measure carrying a built-in expiration date. The internal memoranda set the priorities in plain order (prevent crime first, produce taxpayers second, halt drug use third), and the office that administered the program was written into law with a statutory sunset of June 1975. Its own architect, Jerome Jaffe, treated the arrangement as provisional from the start; he expected the nation’s very willingness to fund treatment, rather than policing, to prove (in his own phrase) a transient phenomenon, and time proved him right. His successor at the drug office, Robert DuPont, went further, predicting in the mid-1970s that the methadone clinic as it then stood would soon vanish, giving way to the longer-acting LAAM. (synthetic opioid levomethadyl acetate).

Neither hope held, though not in the way either man supposed. The willingness to fund treatment did wane; the clinic itself, far from vanishing, hardened by the early 1970s into a standing institution with standing revenues, and it fended off the very things that might have supplanted it, e.g. LAAM would have cut by two-thirds the daily-visit economy the clinics ran on. The emergency measure outlived its sunset; the temporary became permanent; the alternatives that would have ended it were quietly starved. The clinic did not disappear; LAAM did (seemingly for political or economic not medical reasons, per se – only decades later was it incidentally found to have heart-rhythm issues, thus pulled from pharmacopeia(s) in the 2000s). No one had to be deceived for this to happen; a standing apparatus with a daily revenue stream defends itself as a matter of course, and the maps above are the long and inevitable sequelae of that defense.

Much as when alcohol was illegal and doctors found disease entities for which to prescribe alcohol, today’s opiate replacement therapy (via methadone or buprenorphine/ Suboxone) is a customer base, mistaken (sincerely by some, conveniently by others) for a disease.

Notes and sources

The metabolic-deficiency theory (primary sources). Dole VP, Nyswander ME, “Heroin Addiction - A Metabolic Disease,” Archives of Internal Medicine 1967;120(1):19-24. Dole VP, Nyswander ME, Kreek MJ, “Narcotic Blockade,” Archives of Internal Medicine 1966;118(4):304-309. Dole VP, Nyswander M, “A Medical Treatment for Diacetylmorphine (Heroin) Addiction,” JAMA 1965;193(8):646-650. For the history, see Courtwright DT, “The prepared mind: Marie Nyswander, methadone maintenance, and the metabolic theory of addiction,” Addiction 1997;92(3):257-265.

The modern “brain disease” restatement. Volkow ND, Koob GF, McLellan AT, “Neurobiologic Advances from the Brain Disease Model of Addiction,” New England Journal of Medicine 2016;374:363-371.

Distribution data. Buprenorphine and methadone figures: U.S. DEA, Automated Reports and Consolidated Ordering System (ARCOS) Retail Drug Summary Reports (2017 and 2020 reporting years); the buprenorphine analysis parallels Pashmineh Azar et al. on the same ARCOS data. Thyroid-hormone figures: CMS, Medicare Part D Prescribers by Geography and Drug (2024). Population denominators: U.S. Census Bureau. Every figure can be checked against the government’s own public records; the charts here were built from those public sources, not reproduced from any copyrighted figure.

The Nixon-era history. The Special Action Office for Drug Abuse Prevention and its 1975 statutory sunset; the policy memoranda on methadone’s crime-reduction rationale; and the documented resistance to LAAM. For an accessible account, see Emily Dufton, Addiction, Inc.: Medication-Assisted Treatment and America’s Forgotten War on Drugs (University of Chicago Press, 2026).

Adapted from Withdraw to Freedom: Navigating the Addiction Maze. (coming soon!!)

COVID (a bad influenza) was perhaps not the greatest, erstwhile danger (YMMV); rather it was the brisk transformation of freedom(s) into (mental as well as geographic) “lockdown”: a world in which everyone had to hold the same approved opinions, and submit to unelected global- and pompous national- authorities (that insisted it on ‘improving’ us). That is the (not always so) soft fascism of the mommy state. The WHO’s (proposed) Pandemic Treaty would make the arrangement permanent, and its own text gives the game away when it asks us to recognize "the importance of building trust and ensuring the timely sharing of information to prevent misinformation, disinformation and stigmatization.” We have already watched what these institutions do once they hold that power (to decide “truth”). It wasn’t pretty.

Living From Hanta Mouse

Three passengers died of Andes hantavirus this spring aboard the MV Hondius, a Dutch cruise ship that left Ushuaia for Antarctica on the first of April. The vessel carried a hundred and forty-seven people from twenty-three countries, confined together for weeks across the South Atlantic, and the virus that killed those three reached almost no one else; eleven cases were reported, and fewer than that were confirmed. Hantavirus lives in rodent droppings and, on rare occasions, passes from one gravely ill patient to a nurse standing too close. It does not move easily between people, and it never threatened the wider public. The World Health Organization said as much within days, conceding that this was never going to become a pandemic.

The story detonated across the world’s media anyway. It ran on Reuters and the Associated Press, and from those two wires it reached every newsroom on earth; British teams parachuted onto a remote South Atlantic island because a single resident there had fallen ill. David Bell, a physician who spent nine years inside the WHO, watched the spectacle and named the odd part of it. “The main unexpected thing about it is that it became a huge news story.” Thirty cases occur in the United States in an ordinary year, and somewhere between ten thousand and a hundred thousand occur worldwide, yet we hear of none of them. We heard about this one, in his reading, because “someone really wanted it to be a big news story.”

One (Avian?) Flu Over the Cuckoo's Nest

Set the recent frights in order and the rhythm gives itself away. Zika came before all of it; its central alarm, a supposed surge in microcephaly, is one I examined at length in Overturning Zika and in the American Journal of Medicine, and found far weaker than the headlines insisted. Then came COVID, then Mpox, then avian flu, then Mpox again, then hantavirus, and now an unusual Ebola variant in the Democratic Republic of the Congo. The names rotate while the cadence holds steady. Each fear arrives, fills the screen for a week, and recedes as the next one rises behind it. The pattern resembles a meteor shower of small plagues, a manufactured drumbeat that keeps a population braced for the emergency that justifies everything else.

The timing rewards attention. The WHO had just failed again to land the pathogen-sharing annex of its pandemic agreement, and African governments had been putting evidence ahead of the treaty while the World Health Assembly reconvened to press them. A frightening outbreak is useful in that room, and so is a product to sell. Moderna and a South Korean partner are developing a hantavirus vaccine, an almost impossible thing to market for a disease nobody had heard of and nobody feared. Fear is what closes that gap, and a vaccine for a disease no one fears is a product without a market until the fear arrives.

Bell connects the failed pandemic agreement, the World Health Assembly’s pressure on African states, and the Moderna hantavirus vaccine into a single picture of an industry that needs fear the way other industries need raw material.

Golden Bullions from Gelded Billions

The commercial logic explains the volume of the coverage. A drug company is not a charity, and Bell states its incentive without rancor: “the job of the CEO of Pfizer is to maximize return on investment for shareholders.” An antibiotic goes only to the patient who tests positive, but a vaccine operates on another scale altogether. “With a vaccine, you just give them to everyone, whether they’re sick or not,” and you give it again and again, and once you can mandate it, eight and a half billion people become the market. The institutions that prepare that market matter more than any single dose. Bell describes a WHO transformed from the inside: “WHO’s funding has shifted from predominantly states’ giving money ... to eighty percent of it being you have to do what we say with the money.” Bill Gates is now its largest funder, and Gavi and CEPI, both built to expand vaccine spending, supply much of the rest.

Vaccines Are the ‘Windows Vista’ of Medicine

The scale is the whole point, and the man who funds the WHO understands scale better than almost anyone alive. Vaccines are medications, and they ought to be weighed the way medications are weighed, one patient and one risk at a time. A vaccine, though, is the operating system of medicine, the Windows of the medicine cabinet, and Bill Gates made his fortune on a single insight, that the money was never in the boutique but in the universal install. You can build your own machine from parts and run something lean and chosen, the Linux libertarian’s pleasure of deciding for himself what goes on his own hardware. Most people never will, and that is the entire business model. They take the system that ships with the box, updated on a schedule they do not set, and the firm that ships it to everyone at once, and forbids the alternatives, holds a kind of power no boutique vendor could dream of. A medicine prescribed to everyone and every other choice proscribed for everyone are two halves of the same lever.

Your Lawyer Is Yours; Your Doctor Should Be Too

The same logic runs through the way the system would rather treat you. You can hire an attorney who answers to you alone, and your physician should be yours in exactly that sense, a counsel retained for one person and one set of circumstances. The arrangement they prefer is the reverse. It prefers you represented as a general class, the way a class action folds a million separate injuries into a single managed settlement, the way a population is dosed on one protocol regardless of the particular man standing in front of the doctor. Treating everyone as one classical population is cheaper, cleaner, and far more powerful, and it carries the additional convenience, from their side of the table, of disposing of that pesky individual choice.

No, One Health = No One’s Health

The treaty sits inside this machinery rather than beside it. Its language on misinformation reads as cooperation and works as control, because the bureaucrats will decide what the word means, and during COVID that same authority silenced physicians and scientists who questioned mandates, closures, and the laboratory-leak hypothesis. Its surveillance provisions, dressed in the language of One Health, point toward a permanent biosecurity posture in which emergency becomes the ordinary weather of life. Bell’s verdict reaches well past hantavirus, and it is the line worth keeping: “the pandemic agreement furthers what we saw in COVID, which is not public health.”

Bell argues that a vaccine deserves the same weighing of cost against benefit that any drug receives, the newborn at no risk of hepatitis B set against his own choice to take rabies vaccine while living in the Philippines. It is exactly the individual judgment the treaty would remove.

The Real Killers Stay Off Camera

Malaria takes roughly two thousand children every day, tuberculosis takes four thousand people, mostly young adults, and malnutrition weakens the rest while its funding falls and poor countries sink deeper into debt. Bell returns to the fact the spectacle is built to obscure: “poverty is the biggest driver of disease.”

Sickness follows state failure and want, not latitude and not temperature; Singapore sits on the equator and breeds no plagues, while the outbreaks rise out of Congo and the Central African Republic, where governance has collapsed. The cure was never a production line kept warm for a theoretical virus. The cure is sanitation, nutrition, and economies allowed to function, and the outbreak of the week points us everywhere but there.

Bell sets the arithmetic of attention against the arithmetic of death, noting that hantavirus, Ebola, and the rest have killed very few while malaria and tuberculosis take thousands every day in silence.

Unlike many constitutional scholars, Epstein’s legal education did not start with Supreme Court opinions; rather with Roman law, medieval law, Blackstone, and the English common-law tradition. He regards that background as essential because the framers of the Fourteenth Amendment inherited concepts that were already centuries old. Modern lawyers often start with contemporary assumptions and project them backward. Epstein prefers to start with the historical sources and move forward.

The Fourteenth Amendment speaks separately about persons and citizens. Epstein asks, “How can you understand what’s going on in this particular case unless you could figure out some meaningful distinction between the (two)?” Former slaves needed protection from arbitrary criminal prosecutions, confiscation of property, sham proceedings, and unequal treatment before the law as persons. Citizenship, however, answered the question of who belonge (historically rooted in allegiance rather than geography).

Americans often assume that birth within US territorial boundaries settles the matter; while Epstein argues earlier legal traditions (Roman law, English law, and early American practice) presented “citizenship (as) the exchange of loyalty for protection.” The citizen owed allegiance to the sovereign; the sovereign owed protection to the citizen.

The Naturalization Acts enacted by the early Congresses required residence, proof of good character, and renunciation of allegiance to another sovereign. It makes little sense to read the Fourteenth Amendment in a way that effectively renders those requirements meaningless. As he puts it, “the correct way of reading the two is to put them in harmony.” If Congress required formal naturalization procedures, why would mere location at birth suddenly become sufficient for acquiring the same status?

The modern doctrine rests largely upon the Supreme Court’s 1898 decision in Wong Kim Ark. Epstein believes that decision departed from both statutory law and historical practice. He argues that the Court relied upon an oversimplified version of English common law while overlooking the legal framework governing naturalization. In his view, “there is no common law of naturalization. It is always a statutory procedure.” The distinction is critical because citizenship, unlike ordinary common-law rights, was traditionally understood as an exercise of sovereign authority.

Epstein’s argument broadens the discussion beyond birthright citizenship to constitutional change. Many jurists describe themselves as originalists; yet constitutional law has evolved continuously. New institutions emerge, new practices develop, and courts adapt to changing circumstances. Epstein recognizes the pressure point: “they all claim originalism. And then when they discover originalism is consistent with things they do not like, nobody’s an originalist anymore!” The history of voting rights, federal authority, segregation, and countless other constitutional questions reveals doctrines that may be difficult to justify historically. Legal systems rarely operate as clean laboratories.

Epstein distinguishes between historical correctness and practical governance. He does not advocate stripping citizenship from people who have possessed it for decades. He recognizes that legal transitions require caution. At the same time, he argues that future applications present a separate question. If a constitutional doctrine lacks historical foundation, courts should at least acknowledge that fact before extending it indefinitely.

The controversy over birthright citizenship concerns the meaning of citizenship itself. Is citizenship fundamentally a matter of allegiance, political membership, and reciprocal obligation? Or is it primarily a matter of physical presence within geographic boundaries? The answer to that question determines much more than immigration policy. It shapes how a nation defines itself.

Epstein argues that there is “not a single shred of evidence anywhere in the entire record” supporting the claim that the original understanding of the Fourteenth Amendment created the modern doctrine of birthright citizenship. Whether the Supreme Court ultimately agrees remains uncertain. What Epstein has done is force the debate back onto historical terrain. Before deciding what citizenship ought to mean, Americans (and in particular nine Americans on the Supreme Court) should first understand what it meant when the constitutional language was written.

[many thanks to Jeffrey Varasano, whose guest article on my Substack, “Bringing Clarity to the Birthright Issue” did just that, and was useful in framing questions to the erudite professor.]

One of the stranger features of the criticism directed at the essay was the insistence that challenging vaccine maximalism automatically renders one “pro-vaccine.” Medicine does not operate meaningfully within such binary categories. No serious physician is simply pro-medication or anti-medication. Antibiotics belong in bacterial pneumonia and not viral bronchitis; corticosteroids save lives in some settings and create catastrophe in others. Morphine is invaluable under certain circumstances and disastrous under others. Clothing functions similarly: one wears ski clothing in a blizzard and removes it in the shower. The appropriateness lies not in the object itself but in context, proportion, timing, disease burden, patient susceptibility, and risk-benefit balance. Vaccines should be approached no differently -- individually, historically, and according to evidentiary quality rather than tribal allegiance.

Yet much of the reaction operated at the level of identity rather than analysis. Some readers appeared unable to tolerate the possibility that one could simultaneously distrust portions of institutional public health, criticize pharmaceutical influence, acknowledge vaccine injury as real, and still object to monocausal explanations for the entire autism epidemic. The modern mind increasingly demands moral sorting before intellectual engagement. One either joins the “safe and effective” camp or the “everything causes autism” camp; little conceptual space remains between them.

What fascinated me was not disagreement itself, which remains indispensable to science, but the asymmetry of skepticism. Weaknesses in studies suggesting vaccine harm were minimized as unfortunate imperfections surrounding an essentially obvious truth, whereas weaknesses in studies suggesting no association were treated as fatal disqualifications. The pattern felt familiar because many of us witnessed precisely the same asymmetry during COVID-era institutional medicine, only pointed in the opposite ideological direction. During the pandemic, institutional authorities frequently behaved as though uncertainty itself represented a threat requiring suppression. Now portions of the dissident ecosystem increasingly behave as though uncertainty represents betrayal.

Because the reactions exposed something larger than the autism debate itself, I decided to perform a small experiment. I submitted Rogers’s “Mapping the Entire Field of Autism Causation Studies in One Article” along with my own two pieces (the long-form survey “Unraveling Autism’s Surge” published in June 2025, and the more specifically Rogers- targeted “Escaping the Autism Rabbit Hole“) to Claude.AI and asked for a structured critique of logical strength, factual strength, and argumentation. I wanted to know whether the reasoning survived external scrutiny from a system with no emotional investment in the outcome and no tribal affiliation to defend. The resulting analysis was illuminating, and I have reproduced its principal passages below verbatim. They are quoted in the order Claude addressed them.

On Rogers’s “Mapping the Entire Field”

Claude began with the methodology question and was direct about what the structure of Rogers’s piece commits him to:

The piece is built around a tidy three-bucket structure: 22 no-link studies (dismissed wholesale), the gene and epigenetic literature (dismissed for failing to control for vaccines), and 6 vax-unvax studies (elevated as definitive). The structure is rhetorically clean, but the logic does most of its work through asymmetric standards rather than through engagement with evidence.

The central methodological standard Rogers applies is: studies that fail to control for vaccination status are “unreliable” and their conclusions can be set aside. Applied symmetrically, that standard is defensible. Applied as Rogers applies it, it is one-way. The 22 no-link studies are disqualified for lacking a fully unvaccinated comparison group, but the favored vax-unvax studies are not held to corresponding standards on healthcare-seeking behavior, recall bias, or selection bias.

On the heritability question -- which is the structural axis of disagreement between Rogers and me -- Claude identified a specific logical error:

The “no such thing as a genetic epidemic” argument is doing more work than it can bear. It is true that allele frequencies do not shift in a single generation. It is not true that this rules out high heritability, because heritability is a within-population statistic about the source of variance, not a claim about what drives changes in prevalence over time. Rogers uses the slogan to dismiss the entire heritability literature, but heritability and epidemic-driver are different questions and the slogan only addresses one of them. The 2-million-person Scandinavian registry studies (Sandin 2014, Bai 2019) that place heritability at 50–83% are simply not engaged.

On Rogers’s procedural commitments -- his pre-declared destination, his conflict-of-interest filter applied in one direction only, his treatment of the diagnostic-expansion question -- the analysis was unsparing:

Rogers pre-declares in the introduction that there is a “right answer,” names the destination (”a viable plan for how to stop the autism epidemic”), and then constructs a meta-method that arrives there. That is the definitional shape of circular reasoning. The framing “throw out any studies characterized by financial conflict of interest or fatally flawed study design, and see what patterns emerge” sounds procedural, but the operational definitions of “conflict” and “fatal flaw” are deployed only against studies pointing the wrong way.

A specific internal inconsistency: Rogers disqualifies industry-funded vaccine-safety research for conflict of interest, but Mawson and Jacob 2025 was funded by the National Vaccine Information Center, an explicitly anti-vaccine advocacy organization, and the earlier Mawson papers were funded by Generation Rescue, the McCarthy-Handley vaccine-autism advocacy group. Hooker is associated with the Children’s Health Defense network. Applied symmetrically, his own conflict-of-interest filter would remove most of his six holy-grail studies. The piece does not acknowledge this.

The diagnostic-expansion question, which is arguably the central methodological issue in autism epidemiology, is essentially absent. There is no DSM-revision discussion, no engagement with the documented California substitution from intellectual disability to autism, no treatment of the severity-distribution data showing growth concentrated at the mild end. A “map of the entire field” that omits the single largest documented contributor to measured prevalence change is not actually a map of the entire field.

On the rhetorical register of Rogers’s piece, Claude was specific about what tipped it from inquiry into something else:

The framing of opposing researchers as morally corrupt or captured: “doctors and scientists would go to jail or be hung from lampposts by angry parents of injured kids,” “an entire industry was created to cover up the autism epidemic,” “regulators were auditioning for a job with Pharma,” “captured mind, body, and spirit.” This is not a description of incentive structures, which would be legitimate; it is a description of motives. Once opposing researchers are categorized as bad-faith actors, their findings can be dismissed without engagement, which is exactly what the piece then does.

The closing language (”Blessings to the warriors,” “Prayers for everyone fighting to stop the iatrogenocide,” “Huzzah for everyone building the parallel society”) is movement language, not scientific language. “Iatrogenocide” presupposes the conclusion the piece claims to be establishing. The vocabulary is congregational, not investigative.

And the verdict:

A scientific argument tolerates the possibility that the answer is not the one the author expected. This piece does not. It names the destination at the start, curates the route, and arrives. The most telling line is in the introduction itself: “There is a way to move through all of the literature at a meta level that I believe leads to the right answer.” Science does not have a right answer in advance. Advocacy does.

On my “Unraveling Autism’s Surge”

The same scrutiny was then applied to my long-form June 2025 survey -- the one Robert Malone described in his preface as “a treatise, if you like, on the enigma scientists have labeled autism.” Claude’s analysis was favorable in several respects but did not spare the weaker sections. I reproduce both, because the point of the exercise is symmetrical scrutiny, not curated praise.

On the structural logic:

The piece’s central organizing move is what you’ve called the “definition precedes causation” principle, and it does real work here. Before causation can be assigned, the category being counted has to be stable, and the piece walks through the documented instability: Bleuler’s 1911 coinage, the 1970s British redefinition, DSM-III in 1980, DSM-IV in 1994 absorbing Asperger’s and PDD-NOS, DSM-5 in 2013 dropping the impairment requirement and removing the ASD/ADHD exclusion. The California intellectual-disability-to-autism substitution data, the Swedish severity-decline data, the deinstitutionalization timeline, the state-by-state incentive map, and the SSI allowance shift between 2004 and 2013 all converge on the same point. The logic is cumulative rather than reliant on any single finding, which makes it more robust than an argument that hinges on one study.

The treatment of heritability is logically careful in a way Rogers’s is not. You present the Hallmayer 38%, the Sandin 83–87%, the Gaugler 52%, and the Bai/Havdahl synthesis side by side, note the methodological tradeoffs, and conclude that more than half of risk is genetically set by birth without claiming certainty about the exact figure. That is how the literature actually behaves. Rogers picks Hallmayer as a single point estimate and treats it as having closed the question.

But the critique that followed mattered more to me than the praise:

Where the logic gets looser: the four-trendlines-in-lockstep section (opioids, autism, homelessness, divorce) is doing rhetorical work that the data can’t quite carry. You acknowledge this explicitly (”correlation is not causation, but when four trendlines rise in lockstep”), which is honest, but the section still invites a reader to draw causal inferences from co-temporal trends, which is exactly the kind of move you criticize Rogers for. It would be stronger framed as a research question than as an implied pattern.

The 1500% homelessness increase is a figure that depends heavily on what years and what definition you anchor to, and the causal connection to deinstitutionalization is contested in the homelessness literature. The number is defensible but the framing is doing more work than the number itself supports.

The Israeli ultra-Orthodox autism rate finding is real but the explanation is multicausal in the source literature (smaller diagnostic infrastructure, cultural reluctance to diagnose, larger family sizes, younger parental age, etc.), and the piece nods to that (”explanations vary”) but the placement under the vaccine-skepticism section invites a reader to weight vaccine avoidance more heavily than the source data licenses.

These are accurate criticisms. The trendlines section in particular reproduces, in a smaller register, the same co-temporal inference move I object to in vaccine-causation arguments, and I have not adequately defended why my version is methodologically different from his. The honest answer is that it isn’t entirely, and I will tighten it in any future revision.

On “Escaping the Autism Rabbit Hole”

The targeted critique of Rogers received its own audit. Claude identified what it regarded as the strongest single move and the weakest:

The piece is built around a clean two-question framework that does real argumentative work: (1) can specific genes be identified, and (2) what proportion of risk is genetic regardless of identification. Pointing out that Rogers answers only the first and treats it as closing the second is a genuine logical hit, not rhetoric. The observation that Rogers’s own trigger-based model requires a susceptibility profile to explain why identical exposures produce divergent outcomes is the strongest single move in the essay -- it shows the framework is internally incomplete, not just empirically contested.

The severity-distribution argument is the second strongest. If vaccines were the primary driver, growth should be roughly proportional across severity bands; instead it’s overwhelmingly concentrated at the mild end where diagnostic expansion would predict it. That’s a prediction-versus-data check, which is exactly the kind of falsificationist move that distinguishes argument from advocacy.

And the criticisms:

Where the logic is more vulnerable: the “bug” analogy is rhetorically vivid but does some work the evidence has to back up. If a reader doesn’t already grant the diagnostic-expansion premise, the analogy can read as begging the question.

One asymmetry worth flagging: the piece is appropriately tough on Rogers’s funding-conflict standard (NVIC funded Mawson and Jacob; Generation Rescue funded the earlier Mawson papers). It does not apply the same lens to the studies it favors. That’s defensible because the asymmetry-of-standards point is about Rogers, not a general claim that conflicts don’t exist on the other side. But a hostile reader could call it selective.

Both are fair, and both are improvements I will incorporate.

The synopsis

After examining the three pieces in sequence, Claude was asked to produce a one-page comparison. I reproduce it in full, because the contrast it draws is the actual subject of this essay:

Rogers’s piece is advocacy that draws selectively on the scientific literature and presents the selection as a complete map. The destination is pre-declared, the route is curated, and the standards are deployed in one direction.

Bock’s piece is a methodological critique that meets the basic criteria of scientific argumentation: it proposes falsifiable tests, applies them symmetrically, concedes what the opposing author got right, identifies a specific internal incoherence in the opposing framework, and reaches a multifactorial conclusion that does not foreclose further investigation.

On the dimension you asked about, scientific bona fides and logic, the two pieces are not close. One performs the structure of inquiry; the other performs the structure of conviction.

What this exposes

Rogers has done real work in some areas, and the regression-cases concern that animates much of his writing deserves more serious investigation than institutional medicine has historically given it. Vaccine safety science should tolerate far more open inquiry than it often has. Public-health institutions damaged their own credibility profoundly during COVID through censorship impulses, exaggerated certainty, politicized modeling, and repeated unwillingness to acknowledge uncertainty honestly. None of that is in dispute.

What is in dispute is whether the response to that institutional failure should be a mirror-image dogmatism that imports its own destination, curates evidence to support it, and treats methodological skepticism as betrayal when applied to favored conclusions. The Claude analysis identifies precisely this structure in Rogers’s piece, and identifies the same vulnerability (in a smaller form) in mine. The latter point matters more than the former. A piece that survived external scrutiny only by being judged against a worse piece would not deserve the survival. The trendlines-in-lockstep critique stings because it is correct.

The deeper question is what happens to dissident science when it begins picking teams. The COVID period produced a generation of writers who learned, with good reason, to distrust institutional authority. That distrust was earned. But distrust is not a method, and the substitution of one orthodoxy for another is not a correction of the original failure, it is a reproduction of it in mirror image. Once every disagreement becomes evidence of corruption and every complexity becomes evidence of concealment, scientific reasoning itself begins deteriorating into political theology. The vocabulary of “transitional justice” -- a phrase belonging properly to post-authoritarian tribunals, war-crimes proceedings, and truth commissions -- has no business in a still-open empirical question. Its presence is the tell that the question has already been answered for the author before the analysis begins.

Autism almost certainly does not represent a single phenomenon with a single explanation. Genetics, environment, diagnostic expansion, institutional incentives, educational classifications, service availability, and ascertainment practices all play roles whose proportions remain genuinely uncertain — and that uncertainty is the honest position, not a failure of nerve. The proportions remain uncertain. That uncertainty is not weakness; it is intellectual honesty. The deeper obligation of science is not loyalty to tribes, institutions, pharmaceutical companies, dissident influencers, or ideological camps. It is the disciplined effort to distinguish categories carefully, define terms honestly, weigh evidence proportionally, and remain willing to follow data even when the destination proves uncomfortable -- including when the discomfort is one’s own.

This old joke makes the point:

• A doctor and a lawyer, on safari, see a lion charging. The doctor despairs; the lawyer sheds his backpack. “Are you out of your mind?” the doctor asks. “You cannot outrun a lion.” The lawyer shrugs: “I only have to outrun you.”

Under pressure, people drop principle for expediency. That is the red-green alliance: the (necessarily temporary) marriage of radical leftists with Islamists. Their final visions are opposites: secularism, class struggle, and equality vs religious rule, hierarchy, and submission. The inimical, ironic, and ultimately suicidal “Gays for Gaza” makes the point. Yet common hatred creates a brief, ugly intimacy. History is littered with such marriages: in Iran in 1979, Marxists, liberals, and Islamists united against the Shah. Once he fell, the Islamists crushed the left. The men of the Koran more ruthless than the men of Marxian dialectics (as always).

Leftists view Islamists as useful muscle (numbers, passion, street power). Islamists view leftists as useful fools (legitimacy, media access, idiots in the West). The question is never whether the contradictions will surface; only “when” — and who ends up on the other’s menu.

Spain offers the present-day exhibit. At Bilbao Airport in the Basque Country, regional police recently clashed with returning supporters of the Global Sumud Gaza flotilla, who arrived waving Palestinian flags alongside Basque ones and were met with batons and arrests. The Basque Country itself spent decades scarred by Marxist-nationalist separatism and the violence of ETA, which the Spanish state spent forty years suppressing. The grievance industry recycles itself; only the flags change.

And of all European nations, Spain has the least standing to lecture Israel on religious war. The Iberian peninsula spent nearly eight centuries under Muslim rule, from the conquest of 711 to the fall of Granada in 1492.

The Spanish state was forged in the Reconquista; the very nation now lecturing Jerusalem owes its existence to a centuries-long religious war it eventually won. Yet Prime Minister Pedro Sánchez calls Israel’s defensive war a “genocide,” imposes a total arms embargo, recognizes a Palestinian state, and bars Israeli ministers from entering the country. The pot has not merely called the kettle black; it has forgotten it is a pot.

The historical amnesia is breathtaking. A country still managing Catalan and Basque separatism, a country whose Civil War within living memory killed hundreds of thousands and ended in four decades of dictatorship, a country whose sovereignty is now substantially mortgaged to Brussels, presumes to instruct a small democracy fighting for its existence on the eastern shore of the Mediterranean. The Spanish coalition government leans heavily on its hard-left partners; courting that bloc requires the Palestinian cause as currency. The leftists supply the slogans; the Islamists supply the demographic.

Because the demographic is real. Spain’s Muslim population has roughly doubled in three decades to about 2.5 million, with the largest concentration in Catalonia. With a native fertility rate near 1.1 and foreign-born population now above 20 percent, the arithmetic is not subtle. Spain has not yet traveled as far down the road as France or the United Kingdom; it is, however, well on its way. The leftists who today furnish the flotillas and the flag-burnings may discover, as their counterparts did in Tehran, that they were the muscle and never the management.

This is the joke’s second lesson. The lawyer believes he possesses superior strategic insight; he has identified both the threat and the slower runner. Almost everyone imagines himself the man removing the backpack. History occasionally reveals he was carrying it all along.

The Spanish progressive who today denounces Israel from the safety of a Madrid television studio is not the lawyer in the joke. He is the doctor, congratulating himself on his moral seriousness while the lion considers the menu.

Much of modern media rewards speed and rewards reaction even more; the more outrageous the better. “One thing about the internet is that it’s always hysterical.” Instead of joining this perpetual-outrage stampede, John Hinderaker “always tries… to go to original sources. If there’s a court decision that’s in the news” (after forty one years as a lawyer, he will) “read the court decision.”

Hinderaker argues that Americans increasingly occupy separate informational countries. The borders are invisible, but they are real enough. “Left and right are really living in different worlds,” Hinderaker notes, pointing out that National Review’s Dan McLaughlin has recently scoured campaign donation data by occupation and found a striking divide: the bluest professions are “arts administrator, professor of English, film editor, psychotherapist, museum curator, yoga instructor.” Truck drivers, farmers, contractors, and orthopedic surgeons lean the other way, but not as monolithically, not as uni-mind-blob.

“If you’re a structural engineer and you’re wrong, your bridge can fall down,” he notes. Physicians answer to physiology. Pilots answer to gravity. Electricians answer to sparks and smoke. Some occupations force correction because reality eventually sends an invoice. “There’s no penalty for being wrong,” he says of environments where ideas drift without direct consequence; and speaking of consequences: “Iran is a huge, huge problem,” he says, describing decades of leaders who prefer “to kick the can down the road and hope for the best.” Then comes a line connected with an analogy I had made earlier. “Iran is the four hundred pound problem and the Jews are the fingernails.” Large problems often remain untouched because smaller and more manageable targets feel easier.

Toward the end of the conversation we move into the strange economics of influence itself. Social media once looked like a local marketplace where ideas rose and fell among fellow citizens. Hinderaker suggests something more complicated may now be happening. I raise the possibility that pundits increasingly speak not only to an American audience but to a global one. A message that draws modest attention in Ohio might draw enormous attention in Malaysia, Pakistan, or Egypt.

Hinderaker does not dismiss the idea, but he adds another layer. “A huge amount of his seeming influence and the propagation of his ideas was not coming from actual human beings here in the United States.” He points instead toward “bots originating in places like Pakistan and Nigeria and Malaysia.” The audience itself may not always be real. That possibility changes the picture considerably. People once worried about newspapers shaping public opinion. Now there are questions about whether invisible software and distant actors help shape it.

Hinderaker's Minnesota observation lands close to ground I have been working for some time. When a diagnosis quietly opens doors to services, accommodations, disability payments, classroom resources, and institutional funding, the diagnostic net widens; the widening then gets reported as a rising rate.

I have argued the full case, genetic weighting, environmental triggers, and substantial diagnostic expansion, in Unraveling Autism’s Surge: Genetics, Environment, and the Expanding Diagnostic Net, and the narrower incentive argument in Fraudtism: Unmasking the Incentive-Driven Surge in Autism Diagnoses. For readers who want the vaccines question handled without the usual tribal scripts, The Daily Sceptic ran my version in February: The Truth About Autism and Vaccines Doesn’t Suit Either Side. What Hinderaker is watching at the program-administration level and what I have been watching at the bedside and chart level are the same phenomenon viewed through different windows.

The principle extends beyond medicine. Pundits, bloggers, and politicians move through systems of incentives just as physicians and insurers do. Attention is its own currency; outrage its own market; followers, clicks, and influence become forms of compensation. Hinderaker raises concerns of the drift of Tucker Carlson, Candace Owens, and Megyn Kelly from (Reagan-era, e g) conservatism into more provocative and sometimes conspiratorial territory. Whether that drift reflects conviction, audience capture, or simple ambition remains open. The same species that responds to disability payments also responds to applause, status, and reach. Systems mirror the incentives embedded in them, and people follow the trail of rewards whether the currency arrives as dollars, attention, or affirmation.

It was the ‘A’ Train, on a weekend afternoon (1972, decades after Duke Ellington’s glorifying it) and I was a junior at the Horace Mann School riding downtown alone. This is something I routinely did from Riverdale (“the nice part of the Bronx”), hopping the bus at 254th St., and switching to the train at 207th St., Inwood, upper Manhattan.

Onto my otherwise empty subway car, two “youths” about my age got on at 125th Street (Harlem). One sat down on either side of me. I knew immediately what was happening.

This was probably their regular routine, a weekend afternoon gig worked over and over on what amounted to the perfect crime: an empty express car on the longest gap in the system, 125th Street all the way down to 59th Street at Columbus Circle, 3.35 miles with seven local stations skipped entirely. No witnesses, just a conductor several cars away and obviously no cameras, in an era in which “filming” meant literally having film.

As any train slows into this (underground) 125th St. station, the lit interiors zip by. An empty car with a single rider is ideal, and if the right door doesn’t line up it was easy enough (in those days) to saunter through the cars, later on. Mine was found immediately. Ordinarily, someone older, a woman with a handbag, someone who looks wealthy and unlikely to fight back an easier mark might be preferable; however, if “burglars can’t be choosers” – apparently, this thin crop of an impecunious teenager would suffice.

Right off the bat, I signaled and verbalized my acquiescence: whatever I had on hand would soon be theirs, no problem; yet my alternate plan was brewing: obfuscate, elongate, engage, feed their vanity— then escape. They were brazen enough to do this in the middle of the day – (perhaps an irrelevancy in a perpetually-lit, subterranean, sleepless system).

Subway Psychotherapy

The smarter one was on my right; he was the one leaning in, talking, running the operation. The other one, the “muscle”, stared off at the ads with patient detachment. To the “boss”, I directed my newfound (and feigned) curiosity: why me, why now. I asked questions, engaged his ego; self-justifications-- and then made the philosophical case: I was going to become a doctor. This signal event could determine my future level of optimism and energy; conversely bring on cynicism about those who claimed to be in need.

He started to defend himself, which meant he started to talk, and once he was talking he was mine to work with. The standard, solipsistic self-justifications of socialist stripe came out: the system, the odds stacked against him. I kept my eyes locked on his, subway psychotherapy: validating just enough to keep him going, because I could feel ‘The Muscle’ guy’s shifting now and then, not enough to act -- but enough to remind me the clock was running.

I told the Boss, “you are smart enough (to run an operation like this one); pursue a career in management; start at a convenience store; see what happens. Meanwhile, the “ghosted” station platforms -- 116th, 110th, 103rd, with their brief pulses of light’s inverting the windows’ monotone monochrome black-- time-spaced the conversation. 96th, 86th, 81st, each was a greater mercy that I could only acknowledge peripherally; but when 72nd eventually slid by, with only 59th next. I was already coiling without showing it, eyes still on his, still nodding-- yet, when the doors cracked, I was on the move, through the widening gap, then abruptly left: up the stairs three at a time, three flights – bursting out onto Central Park West, continuing to sprint, due north along the park wall; not looking back for five blocks. When I finally did, there was no Boss, no Muscle; nobody but the normal everybody: those in quiet promenade, no spring in their step, only a step into Spring, by the park.

Lessons from the Floor

Looking back, what I did required a certain nerve; not of confrontation but of staying loose; projecting a calm that allowed the subterfuge, pretending negotiation while quietly calculating an exit. Maybe the Boss knew that, but accepted a genuine audience: his self-justifications heard; his intelligence acknowledged. He got “personal interview therapy” and I got to keep my wallet.

It wasn’t the only time the same instinct saved me. In the 1980s I had converted a Boston factory space-- with help: building partition walls, sheet-rocking; incorporating “found” -materials; turning it into premises so fashionable (The J. Geils Band’s) Peter Wolf tried to rent a portion. The timing didn’t work, because I had previously made the mistake of renting that spot to an enthusiastic photographer able at the time to hide his alcoholic dissolution. Months behind on rent and deteriorating badly, he would not leave. Someone advised me simply to raise the rent, whereupon supposedly he would “wake up, smell the coffee”. Dream on. Instead, push came to shove, literally, when one afternoon he burst through my double doors from the common hallway.

As with the subway car, there was nobody else around. Throwing punches, he came at me well-lubricated but not well-aimed. I feinted high, dropped for the legs, took him down, got him in a half-nelson. I had him on the floor, face up, staring at my aquarium’s fishes but not yet sleeping with them. Conversely, he threatened to kill me if /when I released him. At this point, I was a practicing physician, and knew that hurting him badly meant a court case, which would inevitably have the medical credo, “First, Do No Harm” yielding sympathy for this unworthy dual perpetrator and victim. Again my exit strategy involved waiting. Technology had not quite caught up to our needs. Cell phones were not yet a “thing”, and the landline remained unreachable without my first releasing him.

My arm grew tired. His head was clearing. I held on; endured his venomous bile and bad breath; kept him in check— but without the time-to-endpoint certainty of those subway platforms’ countdown. By stroke of luck, the third tenant showed up an hour into this stalled cage fight. With the police summoned, my captive got arrested whereupon I got a rest. Once the photographoholic dropped from sight, I dropped the charges.

Wrestling and Early Instincts

These traits evolved gradually. When I was 12, my older brother (not that nice to begin with) double-whammied me: with both a year of wrestling under his belt, and his under-his-belt testosterone’s kicking in and kicking me. Countless afternoons after school that year included his pinning (puny, prepubertal, pre-wrestling) me to the carpet, with the water-torture “bonus” of his letting his spit drool extend toward my face and laughing when he failed to suck it back in time.

There was no better reason to join the wrestling team than that. I had my chance in ninth grade. Additionally, having skipped an early grade had effectively “shrunk” me relative to my (newer but older) classmates. I had spent years finding mental angles to compensate for physical disadvantage. Wrestling’s Coach Quinn imparted much-needed lessons, including this: that technique defeats mass more often than people expect.

Trump’s Real Training Ground

This is the environment in which Trump operates, and for which his critics consistently fail to account. A friend of mine (Princeton-educated) recently posted a photograph taken in the aftermath of the WH Correspondents Dinner assassination-attempt which showed Trump officials’ exhibiting sang-froid and confidence. My friend inferred their composure as evidence of complicity in a false-flag sympathy-generating “plot.” This is both psychological projection and a ‘tell’: it reveals him as someone unlikely to remain calm under pressure; unlikely to have come under fire.

There are similar conspiracy theories over the Butler, Pennsylvania assassination attempt, which left a supporter dead and Mr Trump a quarter-inch from the same fate. His ability to withstand that, then stand with his supporters, is seared into memory; except for those who cannot process it and reach for some other explanation.

People forget his attending the New York Military Academy. NYMA. I know the place slightly, from one visit under unusual circumstances. Freshman year, wrestling season, real influenza (body aches, the particular exhaustion where keeping your head upright feels like an achievement), and Coach Quinn put me in anyway as a replacement. His math was explicit: getting pinned cost five points, a loss only three. Stay off your shoulder blades, earn the two-point difference. “Bock-y,” he said, “just don’t get pinned.”

Cadets in uniform ringed the mat. A wrestler named Giunta competed in the middleweights, apparently one of the state’s best that year; I didn’t understand the name but it lodged in my memory, so that years later my encountering the word “junta” always brought him back, which struck me as a funny kind of irony. I wrestled in something close to a fugue state, pure stubbornness, arching my back, staying off my shoulder blades, responding to leverage with leverage. I was being beaten. When the buzzer sounded I was still up, not pinned. Coach Quinn and the team avoided losing two points. I don’t remember if that wound up being decisive.

Trump spent five years at the New York Military Academy, sent up the Hudson as a wealthy but unruly Queens kid. First-year cadets ate meals squared-off, forks lifted at right angles; their rooms inspected before breakfast. That Academy teaches pragmatism, strategy, and response. His arriving resistant and leaving exultant (as a captain) is impressive and speaks to character.

What tends to get omitted in the average Trump assessment is not accidental. The focus stays on the gold fixtures, the financial roller coaster, the divorces, the exaggerated accusations culminating in a caricature of boorish bluster and blind luck.

The NYMA years are inconvenient because they suggest structure, discipline, and adaptation under pressure; the very traits that do not fit the preferred narrative. Using those as a focus, Trump's subsequent through-line is not hard to see. Real estate at scale is not passive. It entails iterative negotiations’ occurring under shifting constraints, financing, zoning, counterparties, timing. Casinos add regulatory complexity and risk layering. Politics multiplies that further.

War and energy markets are another order of magnitude, but not categorically dissimilar. The recent sequencing: Venezuela first, then Iran — with the oil calculus in mind, is not random. It reflects an understanding of leverage, tactics, and command: seeing oil supply, sanctions, and antipodal chokepoints as pieces on the same board, not separate games.

The Common Thread

My own examples are smaller, but the pattern is recognizable. I am a physician. I took over a clinic a hospital system had built for close to a million dollars and run into the ground in under a year; seven or eight siloed specialists, each doing a fraction of a job, none coordinating. I stripped it down to two medical assistants, learned X-rays, EKGs, phlebotomy, built billing in-house.

Later, when the building went into foreclosure, I acquired it without a down payment by working through the second-mortgage holder, an avenue other bidders ignored. When my clinic’s lease eventually came up, I was in the dual position of being both the hospital’s landlord and subtenant—so when its lease term ended, consolidated accordingly: watermelon-seed pressure-jettisoning the middle layer and taking possession of the clinic entire, after a settlement payment for the X-ray room equipment. These are not heroic acts; they are exercises in seeing the geometry of a situation and acting.

That is the common thread. You are in motion, information incomplete, time limited, stakes uneven. You buy time when you can, press when you must, and recognize when holding position is no longer possible.

The harder question is what you do once you have someone down. The ‘A’ train, the South Boston floor, the Iran War— the question is the same: you cannot hold forever; your arms tire, your opponent’s head clears— and sooner or later you decide how hard to press, knowing the consequences extend.

That judgment does not come from classrooms. It comes from situations where the geometry is real and the only resource is your mind’s moving faster than your fears’.

Postscript

A note on Horace Mann: it is an expensive private school, and my parents were not wealthy people. My father was a solo attorney; five of us lived in a 1.5 bedroom rent-controlled apartment in Riverdale. My Boston grandfather offered to cover my older brother’s and my tuition but his dying within a year of that offer necessitated my grandmother's retracting the offer, newly widowed and understandably cautious. My parents paid full freight after that, no scholarship (we represented the wrong demographic for the aid available even then to Black and Latino students), and there were years when the bills fell behind and I was pulled from school with a vague invented illness until the account was settled. Trump had the financial wherewithal to attend somewhere softer. His father chose the harder pill. Whatever the reasoning, it appears he made the most of it. That, in the end, is the only thing that matters: not where the difficulty comes from, but what you do with it.

Paying taxes should not require a forensic investigation into your own bank. I spent two hours trying to resolve a simple payment error across Intuit, Green Dot Bank, and a municipal portal. The system rejected the transaction with the cryptic message “INVALID ACCOUNT NUMBER STRUCTURE.” The account exists, the funds are there, the numbers were copied exactly as shown; yet no one could explain what made the structure invalid or how to fix it.

From Traditional Banking to the Closed Loop

My business finances now live largely inside QuickBooks Online, which has steadily pulled transactions away from my traditional TD Bank account and into its partner, Green Dot Bank. The arrangement centralizes payments and simplifies bookkeeping, replacing paper with a neat digital trail. It also shifts control: money moves fluidly inside the ecosystem, but becomes uncertain the moment it must leave for an ordinary external obligation like a tax bill.

The Economics of the Float

What’s more interesting is the economics of that flow. QuickBooks, Venmo, stored-value card networks, and their kin make real money on the microscopic time-intervals between debit and settlement — hours, sometimes days. Multiplied by billions of instances, it becomes a perfectly legal business model that looks suspiciously like day-trading on other people’s money. It isn’t quite check-kiting (the funds are actually there), yet it shares the same temporal advantage: your held money works for the holder, and the longer the hold-up, the better it works.

Banks live and die on net interest income. Holding payments even a little longer gives them more time to earn on deposit balances that can reach into the billions or trillions. In the past, banks practiced “remote disbursement,” intentionally routing checks through distant branches or slower networks purely to extend the float. That practice has largely faded domestically, yet the incentive remains: systems still opt out of faster rails when it suits them.

Pop culture captured the instinct decades ago. In Superman III, Richard Pryor’s character quietly diverts half-cent neglected leftovers from payroll rounding into his own account. Office Space recycled this “salami slicing” concept: shaving off pieces too small to notice until the aggregate becomes meaningful: slivers become a meal.

Who Profits from Slow Payments? Why faster payments could upend the economics of payments and why finance is dragging its feet. Banks live and die on net interest income -- the difference between how much interest they make from deposits (loans, investments, etc.) and how much interest they pay to depositors. Managing deposit balances is a multibillion (sometimes trillion) dollar game, so holding on to payments for a little bit longer gives banks more time to earn interest. In the past, banks would purposefully set up branches in far away locations (“remote disbursement”) or purposefully route transactions through slower networks just to earn extra interest income.... Purposefully routing still exists, to an extent, as banks opt out of faster payment networks or financial institutions cut checks rather than transfer funds electronically.

That mechanism doesn’t trouble me in principle. Every payment network lives on timing, spread, and scale; banks have never been charities. What does trouble me is the asymmetry. Inside the ecosystem the money moves like liquid. The moment those same funds must exit for a straightforward external obligation, the conduit turns opaque, resistant, oddly fragile — a controlled gate.

Navigating the Maze

The city’s payment portal charges a punitive fee for debit/credit cards and pushes “electronic checks.” Green Dot nowhere promotes this option, but I eventually dug out the routing and account numbers. I organized the parcels’ payments, entered the numbers (minus hyphens, spaces, etc.), and was told the payment was completed, only to find a few days later in my inbox a note from the city with the cryptic message: “INVALID ACCOUNT NUMBER STRUCTURE.”

which they could never fully explain and fobbed off on the bank. Thus, the ‘frivolity began.

The city, for its part, defers to the bank and offers no explanation beyond the original error. So, I tried the obvious next step, which was to go directly to Green Dot Bank itself. That door does not really open. The website invites you to log in /create an account; yet the credentials it accepts do not map to anything I have (the QuickBooks-issued card).

Rather than reroute everything through TD Bank, I tried to puzzle it out through QuickBooks’ Through the Looking Glass “HELP”. The process is like trying to score on a punt return. I skirted through in between all of the various AI chatbot defenses, then deked layers of poor-grammar offshore agents. There is no audible “ping,” so multitasking occasionally dropped the session.

I clutched my case number as close as the punt-returner’s pigskin; nonetheless, each new agent required the full identity rigmarole, despite the numeric talisman’s repetition. Context evaporated with every escalation. The only exit was the dreaded telephone call-- Kafkaesque cacophony of hold music and disappearing accountability.

I prefer written trails precisely because long number chains get mangled in speech. “Can you spell your email address again? Was that an M or an N?” The question, “ What constitutes an ‘INVALID ACCOUNT NUMBER STRUCTURE’”, remains simple and generic; yet through each inner ring of Intuit’s nonintuitive, internal Inferno never was clarified. I had precisely copied down my 15 digit account number (leaving out the dashes). All I wanted to know was what I had done wrong in doing so.

Eventually I reverse-crossed the Intuit (Inuit) Bering Strait land bridge into Green Dot Bank (or at least someone who claimed to represent it) within Asia itself, although not quite Shangri-La. I could hardly believe the agent’s un-professionalism. She spoke in a clipped, rapid Urdu-or-Hindi semblance of English against a background of multiple kids and caretakers, clearly working from home.

When I asked where this Green Dot “office” might be, she obfuscated with “Southeast Asia,” prompting my unspoken thought of ‘Red Dot Bank’. What followed was pure subcontinental subroutine subterfuge: scripted security theater delivered at machine-gun speed while I slowed her down digit-by-digit to avoid transcription errors. After five rounds of shibboleth-shaming, she declared “verification failed”, offered no clue which datum had tripped the wire. She refused any path to correction. My plea to speak to a supervisor fell on daycare-distracted ears.

When the System Fails

Systems built on float absorb your money effortlessly. Disgorging it, however, feels like an impossible win at a three-card Monte table. My two-hour ordeal ended exactly where it began: the account, the funds, and the pathway all exist — yet the structure fails, and no one will explain why.

From Vaulted Trust to Digital Shadows

A traditional bank such as TD still provides a place, a person, and a visible chain of accountability. Just yesterday, walking an old-style suburban Main Street, I passed this handsome early-20th-century bank building: solid limestone façade, grand arched windows, vaulted ceilings over the seale vault, and the quiet grace and solidity that once signaled unbreakable trust in money; its vaunted value. Blue dance-center banners now flutter outside where young girls twirl, and float (in a different sense) across the floor to music at the very spot where bank managers once delivered steely-eyed assessments of credit-worthiness.

The newer fintech model removes both personal and personnel anchors and replaces them with efficiency, scale, and cost savings. When it works, it feels seamless. When it fails, it offers no center and no responsible party. You are left in a repeating loop where each participant recites a line and exits stage left while your problem remains unchanged.

Time to Push Back

It is past time to push back. Fintech partnerships that enjoy the privileges of banking must be held to the same standards of transparency, validation tools, and customer accountability that traditional banks have long been required to meet. Regulators should demand symmetric flows: easy in, easy out; clear error codes with actionable fixes; and genuine, continuous human escalation paths instead of global call-center roulette. Until then, the maze remains profitable, and the kite keeps floating-- on your dime, not theirs.

(an imaginary) Baseball Gazette, December 2, 1960.

The Lament

The "popular vote" lament has irritated me for decades. Every time a Democrat loses a presidential election and steps to a microphone to note, with great solemnity, that he (Al Gore) or she (Hillary Clinton) won the popular vote (as though this transforms defeat into something more dignified, or the winner into something less legitimate), I feel the same thing: this is not a constitutional argument, but rather a weaponized, excuse-making, non-consoling, pseudo-consolation speech. It conceals dereliction of duty and civility-- these latter, both qualities at the core of continuity of a constitutional republic, i.e. “our democracy”.

The complaint is also, at its core, a confession of both arrogance and ignorance -- ignorance of the rules– and of basic sportsmanship, including what it means to be an adult in a competitive arena, embodying the “civility” pathognomonic of “civilization”. You lost. The other side won. These are not provisional statements awaiting correction by a different metric; they are the result, delivered according to rules that were posted before the first vote was cast.

Bill Belichick, who knows something about winning, said it plainly: “To live in the past is to die in the present,“ adding: “You get the job done or you don’t.” He is also cognizant that the other team gets paid too -- and this is the point that popular vote mourners perpetually miss. The other side has professionals, strategists, and a reading of the map that may simply be better than yours on a given day, but beyond strategy there is something even more humbling: the voters themselves, given an actual choice between two actual human beings, made a decision.

They found Gore wooden and remote, Clinton sanctimonious and entitled -- and they were not wrong to find these things, because likability is not a trivial variable in a democracy; it is close to the central one. There is a reason the taller candidate wins more often than not, a reason people spoke for decades about which candidate they would rather have a beer with, a reason Nixon’s five o’clock shadow and stiff affect next to a tanned and relaxed Kennedy may have decided the first televised debate and possibly the presidency. The voters are not a malfunctioning machine producing the wrong output; they are the point. And when they choose the other person, the gracious and adult response is to ask what you failed to offer them -- not to produce a different column of arithmetic and insist it should have counted instead.

The Dignified Losers

Consider the men who had actual grounds for grievance and said nothing. Samuel Tilden won the popular vote in 1876 by more than 260,000 votes, led in the Electoral College going into the final count, and watched as a partisan commission voted 8-7 along party lines to hand Rutherford B. Hayes the presidency two days before inauguration -- a resolution so dubious it has been called the Compromise of 1877 ever since. Tilden accepted it.

Richard Nixon privately believed Daley’s Chicago machine had stolen Illinois for Kennedy -- and the evidence was not thin, with precincts reporting more ballots than registered voters, the cemeteries alliteratively aligning with the “-D” in “death.” His staff urged him to contest; he declined, putting the country above his ambition. The mainstream press has since deployed Nixon’s concession selectively and cynically: invoking his graciousness as a cudgel against Republicans who contest results, while elsewhere publishing pieces dismissing his fraud concerns as paranoid myth whenever that framing serves the other purpose. The argument cannot run in both directions, but intellectual consistency has never been the strong suit of an institution whose instinct is to protect one party’s victories and delegitimize the other’s. These were men with real arguments who chose the republic over their grievances -- a standard that Gore and Clinton, with their thinner cases and louder complaints, conspicuously failed to meet.

What followed Gore’s and Clinton’s losses was something different in kind: not the dignified acceptance of a hard result, but an organized, sustained effort retroactively to delegitimize the winner by pointing to a number that was never the measure of anything. The sequencing is not accidental. Google Trends data shows that searches for “popular vote” spiked immediately after Hillary’s defeat, with searches for “illegitimate president” following within weeks -- not mourning, but methodology; the popular vote remonstrations’ reliably preceding the illegitimate president demonstrations with a lag time of roughly one month. There was a similar (but attenuated) confluence of spike-and-lag in 2020, given Biden’s lockdown-era mail-in ballot bonanza.

One month after the election, the Associated Press ran a story headlined “Clinton wins popular vote by nearly 2.9 million” as a legitimacy weapon, complete with beatific photo.

Associated Press, December 22, 2016 -- one month after the election. The headline treated Clinton as a winner. The math treated Trump as provisional.

“The vote total discrepancy between Democratic nominee Clinton and Trump has fueled arguments by some Democrats that the election process is undemocratic and an intense lobbying push to convince electors to cast their votes against Trump.”

This is what the popular vote argument actually is when stripped of its constitutional costume: not a principled objection but an opening move.

Within weeks of the election, a coordinated campaign emerged to lobby Republican electors to defect, deny Trump the 270 votes he had legitimately won, and throw the election to the House of Representatives or simply to someone else. Harvard Law professor Lawrence Lessig stood up a nonprofit called the Electors Trust to provide free and confidential legal cover for any elector willing to vote against Trump. Hollywood produced YouTube videos pleading with Republican electors to defect. Michael Moore offered personally to pay the fines of any elector whose state penalized him for going faithless. A Change.org petition demanding the Electoral College hand the presidency to Clinton gathered nearly five million signatures. The justification throughout was the popular vote -- Clinton had won it, therefore Trump’s victory was somehow provisional, a clerical error awaiting correction.

Hillary Clinton's first brush with high-stakes constitutional proceedings ended with her dismissal from the House Judiciary Committee's Watergate staff in 1974 by her supervisor Jerry Zeifman. The specific offense was her seeking to deny Nixon his right to counsel during the impeachment inquiry.

I have had a sports analogy in mind for years that makes the whole absurdity undeniable. I mentioned it recently in passing to a friend who has literally run for office (successfully) and treats electoral maps the way other people treat box scores. This, he said, “is the clearest explanation of the Electoral College I have ever heard. Write that piece before I do.” So here it is.

The Scoreboard Doesn’t Lie

I was twelve the day I learned that leaving early is its own kind of loss. It was 1968 at what shortly-thereafter (and famously) earned the sobriquet, "The Heidi Game”: My friends and I had scraped to get to Queens’ Shea Stadium. Jets fans in that unique season were (rightfully validated) believers, so up 14 points, with minutes to go, we made the expedient decision to beat the crowd to the #7 Flushing-line subway-car. Oakland upset the Jets (and us). If you judged the whole season based on that one devastating loss, you’d clearly be missing the point, which (fortunately) Broadway Joe Namath didn’t. His (dare we say Trump-level) brashness and bravado continued apace, and he confidently predicted the AFL’s first Super Bowl victory a few months later. And then (like Trump) pulled off the upset.

A single losing instance within a larger set may not have great import. Sports hammer this lesson. My (newer “hometown”) Celtics in the Paul Pierce era (2002) performed a single-game “miracle” comeback, yet lost the series to Jason Kidd’s Nets. In a battle between my youthful and later allegiances, the Yankees clubbed the Red Sox 19-8 to go up 3-0 in the 2004 ALCS, with history’s verdict seemingly achieved; however, with the batted baseball being neither hand grenade nor horseshoe, ...well, you know the rest.

The 1960 World Series made the same point, if anything more dramatically. The Yankees’ Mickey Mantle, Bobby Richardson, and rookie Roger Maris had formed a new Murderers’ Row, potently and periodically pounding Pirates pitchers 16-3, 10-0, and 12-0, producing 55 total runs to Pittsburgh’s 27; and yet none of it (not the dominance, not the margin, not the sheer cumulative weight of those numbers) meant anything when Bill Mazeroski stepped to the plate in the bottom of the ninth inning of Game Seven and hit the pitch that ended it. That home run is the only thing anyone remembers from that Series, because it is the only thing that counted.

Trump was Mazeroski. He hit the ball over the wall in the places that decided the game (Michigan, Wisconsin, Pennsylvania) while his opponents were busy assuming those places had already been won -- the tabulating of popular vote runs came later, in the postmortem weeping, once the scoreboard showed something they hadn’t prepared themselves to see. As the old expression goes, “assume” makes an ass out of you and me; and on election night 2016, the Democratic Party discovered this in real time, state by state, as the map turned red in places their models had colored safely blue.

Series: 4-3 Pirates. The scoreboard tells the whole story.

The Game Being Played

Nobody running a presidential campaign is trying to win the popular vote. Campaigns allocate every dollar, every rally, every surrogate appearance, and every advertising buy according to one question: which states are winnable and which are not. Massachusetts is that 16-0 Yankee blowout -- effectively decided before the seventh inning stretch, with the backup catcher on the mound and the ace reliever safely in the bullpen for a game that will actually matter. Those of us in Massachusetts watch presidential elections the way astronauts watch weather on Earth: visible, occasionally dramatic, and occurring at a remove that makes our participation largely ceremonial. No candidate buys airtime here; no operative from either side loses sleep over it. Drive an hour north into New Hampshire, however, and suddenly the ace is warming up, the manager is pacing, and both campaigns are treating every precinct as though the presidency depends on it -- because in that state, it might. That is rational game theory: resources directed toward contests that remain genuinely open, which is precisely what the system was designed to produce.

Post-facto popular vote complaints are the sour grapes of maudlin Monday-morning quarterbacks sporting a false costume of principle. Gore’s and Clinton’s campaigns were not optimizing for raw national totals but for states, and each failed to win the states that mattered. In Clinton’s case, states that had voted Democratic for decades were treated as entitlements rather than battlegrounds, the campaign reportedly spending more energy vetting future administration personnel than persuading actual voters. That is the Heidi Game error: leaving the stadium before the clock runs out because the outcome feels certain. Trump won Michigan by fewer than 11,000 votes. Overconfidence sabotaged; hilarity ensued.

The United States was founded as a union of distinct states (closer to small nations than administrative districts), each with its own legal traditions, political character, and in several cases its own founding religious identity: Maryland as a Catholic refuge, Pennsylvania shaped by Quaker principles, Massachusetts still carrying its Puritan DNA. The word “state” was not administrative shorthand; it meant what it meant in the European context from which the founders drew -- as in our State Department’s handling of foreign nations -- a distinct political entity with its own constitution, character, and claim to self-governance. What the federal Constitution did was anneal these entities into a union, asking each to sacrifice certain external prerogatives (mutual defense, interstate commerce) to the collective while retaining their essential identities. *(see postscript)

At Olympic hockey events, crowds chant “USA! USA!” -- but the full phrase “United States of America” was never intended to supersede or dissolve the constituent states. The emphasis, in its original conception, was the United STATES of America. Had the founders intended a single undifferentiated polity, they might simply have called it “Great America” (patterning after Great Britain) and been done with it. The Electoral College reflects the original architecture, not the revised pronunciation. Critics who complain that Vermont and Wyoming receive a disproportionate share of electoral weight by virtue of their small populations are missing precisely this point: the system was designed to respect those distinctions. Good fences, as Robert Frost said, make good neighbors. The founders, who knew something about neighbors who had just tried to kill them, built the fences deliberately. Pop all the separators out of bubblewrap and you do not have a better-protected package; only an ineffectual, flat sheet of plastic.

Remove the Firewall

Brazil elects its president by straight popular vote with no state-level firewall. The wave rolls through unimpeded; the Electoral College holds it back.

For a glimpse of what the alternative produces, consider Brazil, which elects its president by straight popular vote with no state-level firewall -- and which in 2022 demonstrated exactly what happens when you remove the structural breaks. The criminally convicted Luiz Inácio Lula da Silva made his comeback not by persuading a broad and varied country but by flooding the zone in the poorer northern and northeastern states, where the correlation between poverty, patronage politics, and left-wing voting is so stark that observers speak openly of “two Brazils” -- one productive, institutionally serious, and trending right; the other dependent, clientelist, and delivering overwhelming margins for whoever promises the most. The problem is not simply that more people live in the north; if we were counting cupcakes in a box, more boxes would mean more cupcakes and that would be fine. But elections are not cupcakes, and in places where institutional weakness, compromised voter rolls, and deeply entrenched patron-client relationships make it possible to conjure votes rather than merely earn them, larger units mean larger opportunities for manipulation at scale.

You can police a precinct, audit a county, contest a state; but a national popular vote total is a single enormous pool into which corruption can pour freely and invisibly. People always game whatever rules exist; the question is which rules make the gaming harder. The Electoral College forces a candidate to be broadly persuasive across a wide and varied landscape; remove it, and you do not get a fairer election -- you get a different and more gameable one, with the same human instinct for exploitation aimed at a larger and far less protected target.

The remedy for anyone who genuinely believes the system is wrong is written into the Constitution itself: make the argument, build the coalition, and pursue the amendment process, which is hard by design and appropriately so. What is not available, to anyone arguing in good faith, is the claim that a different result should obtain under rules by which nobody was playing. The Yankees did not attempt to overturn the 1960 World Series result by emphasizing, retroactively, runs scored; Mazeroski won it by crossing home plate in the game (and in the manner) that counted. The presidency works the same way -- and no amount of postmortem arithmetic changes who crossed it first.

Watergate-era Hillary Clinton, here imagined as Counsel for the New York Yankees: arguing that their 55-27 run advantage should override the Series result,

*POSTSCRIPT

A knowledgeable friend writes:

“The original 13 states would never have agreed to the union without the power of the electoral college. The small states knew they would be crushed by the larger states without that protection. Nothing has changed. The popular vote crowd know that if they convince NY, CA and a couple of other of the largest states, they could ignore the rest of us, and probably not just every four years. It takes a certain kind of cynicism, arrogance, entitlement, ambition, and ignorance to advocate for a popular vote in the US. “

separately: ((Thanks to @tombuckley))

There is a saying in medicine that the worst thing you can be is an interesting case, and there are some corollaries potentially with my “interesting career”. I believe I’ve made lemonade from certain lemons (as discussed in Authority Magazine; BREAKING BAD Medicine; and in the course of a legal odyssey’s certiorari petition to SCOTUS), arriving at what I considered a settled chapter of my professional biography. I’m back practicing medicine, albeit part-time (in men’s sexual health) and actively doing medical investigative journalism.

So when a longtime Facebook contact recently acted as though she had uncovered something urgent and damning (complete with the full siren-emoji, BREAKING-news Babylon Bee satirizes), my first reaction was something closer to bewilderment than anger.

The proceedings mentioned had been resolved publicly and on the record. A genuinely concerned friend, even a critical one, sends a private note. Instead we have something calibrated for self-gratification as scoop-reporter, self-styled David, victorious over Goliath.

A genuine friend asked her the obvious, “how can something from (2014 and) 2019 be considered news?” I contacted Eleanor, offered my phone number, suggested a video call, sent documentation. She responded in writing, declined every invitation to speak or appear on camera, and then (ultimately) blocked me. Her given raison d’être for posting this now was her (supposed) circle of unnamed Boston physician-friends who were apparently skeptical of my subsequent court-, and board- victories’ reversing and ablating the erstwhile, wrongful suspension(s). NB, here’s my rebuttal to her charges

Consider two possibilities: either this is a real (~80 year old woman) with a gaggle of conveniently geo-fenced Bock-skeptic comrades-- or it is someone else(where) entirely who fed a few search-results into a chatbot and generated details that makes a hit-job sound credible. The refusal to get on a call fits either scenario, but which one better?

Eleanor and I had been Facebook friends for over a decade, and her page carries enough photographs and personal history to earn trust; but that is precisely the point. A decade of accumulated credibility among real followers is exactly what makes an account valuable the moment its original owner becomes unavailable to tend it. Followers have no way of knowing the difference (a reason to consider doing so), and that vulnerability is what prompted this piece.

There is another octogenarian figure in my feed, without question previously sharp-tongued and opinionated; yet with those characteristics now ‘on steroids’, he produces inflammatory, rabid, anti-Semitic content – without coming up for air: no breaks for grandkids, jokes, snowstorms, or cat pics— merely the JOOOOS(!), full-time.

He always had a soupçon of Ezra Pound(-sand, please) and Céline’s NDSAP-sympathies, but those were outweighed by his literary anecdotes, historical references, and family reminiscences. It may just be some senility’s currently uncovering the worst parts of what always was there; however, the distance between who he was and what the account now generates is wide enough to make the question worth asking seriously: are some oldsters’ accounts Trojan horses? How can you know if/ when a long-established Friend-profile is no longer inhabited by your friend?

The market

Social media accounts are bought and sold openly, with escrow services, buyer protection, and detailed listings showing follower counts, engagement rates, and account age. FameSwap,Flippa, SocialTradia, and SWAPD handle these transactions every day. One documented Facebook group with fifty-four thousand members sold for twenty-five hundred dollars. What transfers in these deals is not the account itself but the audience, the algorithmic history, and the credibility the original owner spent years building. Most of it is legal, if against platform terms of service.

The elderly account is a special case. A real, educated, credentialed person posting consistently in a specific community for a decade builds something a manufactured account cannot replicate: genuine provenance. The followers chose to be there based on a real person’s real opinions. That trust is not available any other way. And unlike a business account, an elderly person’s personal Facebook page has no lawyer, no manager, nobody watching what gets posted after the original owner’s circumstances change. It is unguarded in a way that makes it particularly attractive to whoever might want to use it.

Key-Man Risk: A Business Idea

My security alarm technician knew everything about my system; every repair, every sensor, every customer he had ever served. When he died the business died with him. Every customer started over from scratch with someone new. The value evaporated not because it was not real but because there was no vessel to hold it.

A lawyer/friend’s father ran an accounting practice doing over twenty million dollars gross. When he died suddenly, she inherited essentially nothing; the value lived in him, in his relationships, in what his clients knew about him specifically, and none of it transferred. The business did not survive him by even one fiscal quarter.

During my medical diaspora, 20-teens, I tried to build a business around exactly this problem: a structured repository of relationships, client data, and institutional knowledge that would otherwise die with the owner, available to pass to a successor or sell before it went stale, the “key man problem”.

What stopped us was human nature: people became depressed discussing their own (inevitable) demise. Business succession planning is prudent and widely ignored. The insight survives. We pivoted the business, sold it (at a mild loss) – and this opportunity remains: creating the “nuclear football” of essential business data that will keep the company afloat during crisis, long enough to be passed either to an interested friend or relative, or sold on the open marketplace.

Vultures and algorithms

Bankruptcy courts maintain public databases of companies in insolvency proceedings, and among the assets listed are often operating websites with years of accumulated domain authority and search engine ranking. Some, crafty or unscrupulous, monitor those databases for the moment a domain lapses and buy it immediately, inheriting and redirect traffic, for fun and profit.

The social media equivalent is the same proposition. The algorithmic weight of years of engagement accrues. The only question is who remains at the keyboard.

The platform blind spot

The DMV retests elderly drivers because a license is not a permanent grant; it is a periodically revalidated certification that the conditions under which it was issued still obtain. Facebook retests nothing. Google has quietly built an inactive-account manager that allows users to designate what happens after a period of inactivity. Absent is any commercial incentive for platforms to implement such, since active accounts generate engagement regardless of who is running it, and engagement is what platforms sell.

Platforms could require periodic reverification for accounts above a certain age or follower threshold. Estate attorneys could treat social media accounts as assets requiring succession planning, as some already do with domain names and email lists.

What will probably happen is nothing, for the same reason my small business succession venture found no takers: the people most affected are least motivated to act. The elderly account that gets handed off, purchased, or simply operated by whoever has the password will keep functioning as a vessel of borrowed trust, wearing the face and history of an old (and old) friend.

People confident in what they have posted do not generally need to remove and block the subject of their posts. Whether that was good old (or neither old nor good) Eleanor, I don’t know. In the event, her followers were exposed to content not meant for contentment; rather (re)purposed for clicks. Siren emojis may be proper but ironic alarms.

This image captures two competing systems of gravity: on one side, the NBA operates like a comet, where temporary decline is intentional and even necessary, a controlled dive toward the sun that builds energy for a later ascent; on the other, the welfare and homeless industrial complex behaves more like a black hole, where support accumulates but escape becomes harder, pulling people, resources, and institutions into a stable but stagnant orbit. The difference is not compassion versus indifference, but incentive design: one system rewards being bad now so you can get better later, while the other too often rewards staying bad, turning what should be a bridge into a destination.

PRIORITIZE “LATER” — OR PAY FOR “NOW”

There is a simple piece of advice that the comedian Jimmy Carr gives that is more serious than it sounds. “Prioritize ‘LATER”. Invest now; something better happens, down the line. Religion asks you to sacrifice now for a future reward. Raising children requires years of effort before any ‘payoff”(if any) is visible. Financial investing is the same story. You defer gratification, accept constraint, and hope to emerge stronger.

THE COMET

NBA front offices understand this principle better than most policymakers: every spring, a portion of the league stops playing for the present (literally – having missed the playoffs; and figuratively, in its jockeying for the future). Even the players feel the friction. Giannis Antetokounmpo is healthy and wants to play, but has been benched. The Bucks are losing buckets, Bucks, and bucks, now -- to make more of each, later.

The system rewards that (combination of malfeasance and) patience, via a welfare-like spoils system: best assets going to the worst teams. Certain teams offload current assets with one eye (or both) on the draft lottery. This (sad and erstwhile boring) behavior encapsulates “deferred ambition”.

The best way to describe it is comet-orbital. A team drops its trajectory on purpose, makes a tight pass near the sun, and uses that proximity to gain speed for a later breakout. LeBron James reshaped Cleveland. At various junctures, David Robinson, Tim Duncan, and now Victor Wembanyama have resuscitated moribund San Antonio Spurs teams.

Certainly there are occasional top-draft-pick misses (Michael Olowokandi, Anthony Bennett); however, you don’t often get top-flight talent like Luka Dončić, Anthony Edwards, Michael Jordan, Shaquille O’Neal, and Kyrie Irving without initial misfortune and failed seasons that lead to even the possibility of getting the “lottery luck” of narrow, high-draft apertures. A team descends, but it does so with a plan to rise. Occasionally, team “pre-fails” by offloading a top asset, banking on the future failure of the aging star traded, Thus, the Boston Celtics got Jayson Tatum and Jaylen Brown, after the post-Paul Pierce/ Kevin Garnett Brooklyn Nets crash-- and OKC’s Sam Presti has created a perpetual motion lottery-pick machine from everybody else’s erstwhile shortsightedness, beginning with the Clippers’ desperation for Paul George.

THE BLACK HOLE

I saw a very different version of this dynamic when I was doing disability evaluations in a blue-collar near-suburb of Boston. There was nothing abstract about it. Patients would come in sent by the state, and my job was to determine what they could and could not do. The presentations became familiar very quickly. Neck braces, careful movements, slowed gestures, controlled expressions of pain. Everything suggested limitation.

Then I would watch them leave. I had a clear view of the parking lot from a back window, and that window (often) told the truth more reliably than the exam room. The same man who could not turn his neck inside would remove the brace, get into his car, and rotate easily to back out. A patient who insisted he could not bend might drop something and pick it up without hesitation.

I began writing (in the disability-evaluation reports) what I actually saw. I emphasized capability. If a man was missing two fingers but had been stocking shelves, I wrote that he could still stock shelves. If a patient had undergone back surgery and the structure had been corrected, I wrote that he could return to work in some capacity. My instinct was that work was better for him, better for his dignity, and better for the system as a whole.

One patient came back later to thank me. He was sincere, almost relieved, and told me how much he appreciated my approving his disability. I remember the moment clearly because I had done the opposite. I had documented his capabilities, not his limitations. It did not matter. The state’s disability bureaucracy had delivered a result more in tune with its own growth, its own “business model” of creating more “clients”.

Soon after, the Commonwealth’s UMass-operated disability board made its expectations explicit: do not reference what happens outside the exam; do not emphasize what a patient can do; stay within the narrow diagnostic frame. That meant removing precisely the information that might have gently nudged someone back toward work.

WHEN “LATER” NEVER ARRIVES

This pattern was articulated in 1980 by Thomas Sowell in a debate with Pennsylvania’s Secretary of Welfare, Helen O’Banion.

“What the welfare system and other kinds of governmental programs are doing is paying people to fail. In so far as they fail, they receive the money; in so far as they succeed even to a moderate extent, the money is taken away. You are subsidizing people to fail in their own private lives and become more dependent upon the handouts. This is even extended into the school systems where they will give money to schools with low scores; in so far as the school improves its education, the money is taken away. You don’t have to make people behave that way; you simply subsidize it.”

That instinct has since scaled into what is best described as the homeless industrial complex. The term is blunt, but it captures the structure. As funding for homelessness, addiction, and mental health has increased, the problems themselves have expanded in many jurisdictions. This is not because no one is trying. It is because the system is built around sustaining itself rather than resolving the underlying condition.

An entire ecosystem forms around the money. Providers, administrators, nonprofits, consultants, outreach teams, advocacy groups. Each one has a role, and many individuals within those roles are well-intentioned. Yet the system as a whole aligns around continuity. If homelessness declines sharply, funding contracts. If addiction recedes, programs shrink. If disability rolls fall, administrative demand drops. Stability comes from persistence, not resolution.

This is where the analogy shifts from comet to black hole. In the NBA, a team dives, gathers energy, and escapes on a new trajectory. The system explicitly rewards that delayed payoff. In the welfare and homelessness framework, the incentives often pull in the opposite direction. Benefits stack in a way that can approximate a working income, as analyses from groups like the Cato Institute have shown. When you factor in the costs of working, leaving the system can look like an immediate loss.

So people do what rational actors do. They remain. They settle into orbit. The system supports them, but it does not propel them. It does not ask them to prioritize later; it makes staying now the safer choice.

At the same time, diagnostic categories expand. Autism, ADHD, anxiety, addiction, and a growing range of classifications broaden their boundaries. Some of this reflects genuine recognition. Some of it aligns with funding streams and reimbursement structures. Where there is a category, there is a claim. Where there is a claim, there is money. The system grows alongside the problem it is meant to solve.

Looking back, what I saw through that back window in the 1990s feels like an early signal. The incentives were already in place. They have only intensified. The difference between the NBA and the welfare state is not that one has distortion and the other does not. It is that one converts short-term loss into long-term gain, while the other too often converts support into a permanent holding pattern.

She began with every advantage. Raised in Marin County as the daughter of an investment manager, she moved through Stanford with honors, added an MBA, competed in varsity athletics, and entered Hollywood with access and momentum. She dated George Clooney (early 2000s) and secured an appearance on Mad Men. By her early thirties, she occupied a position that, for most people, would represent arrival rather than aspiration.

Yet, in 2005, at age 31, this mature Stanford-grad went alone to Harvey Weinstein’s suite at the Peninsula Hotel in Beverly Hills for what she described as a professional meeting (and he called “transactional sex”). 17 years later, she later alleged that he had raped her there and then.

In the interim though, (2007)— while involved with then–San Francisco Mayor Gavin Newsom— she contacted Weinstein, seeking advice on handling fallout from Newsom’s affair with a subordinate’s wife. When proximity to power (including any personal peninsulae) offers advantage, her boundaries are flexible.

Now, comfortably ensconced, her language hardens into moral clarity (particularly on sexual dynamics, and particularly guided towards California’s youth). To wit, her films Miss Representation and The Mask You Live In condemn precisely the power imbalances and male behavior (admixed with – and in pursuit of (her) feminine wiles) with which she engaged so instrumentally and professionally profitably. Her Representation Project accepted funding from PG&E which needed to curry favor with hubby Gavin, the governor. This is potentially legal, but certainly shady.

In 2023, Open The Books revealed that her nonprofit licensed the films and curricula to California public schools for roughly $1.5 million in fees; districts streamed the content (including graphic discussions of bondage and group sex) to students as “education.” The Newsoms thus turned her ideological output into a direct revenue stream through the very state power her husband controls

She talks of giving her sons dolls, rewriting bedtime stories by changing male protagonists to female ones, and her children to “red states” to witness racism and misogyny firsthand (as though progressive California offered perfect insulation). In April 2026 she escalated further, framing President Trump’s personnel decisions (including firings of Pam Bondi and others) part of a “war on all women” and a return to a “straitjacket of femininity” that exists only to serve men. Ordinary politics becomes moral pathology; traditional roles become oppression.

The pattern is consistent: ambition that treats powerful men as tools when useful, then pivots to moral condemnation when the narrative demands it. The ideology appears secondary; it supplies the language and posture needed to sustain relevance and moral superiority. Marriage to a rising politician, four children, Sundance premieres, and elite credentials do not quiet the need for the spotlight. Instead they raise the baseline from which she must continually assert herself (through pronoun swaps in children’s books, public lectures on gender, and sweeping diagnoses of national “wars on women”).

This craven edge is what makes her grandstanding grating. It is not mere restlessness. It is the demonstrated willingness to cross lines most people would instinctively avoid (even at 31, with every advantage and no excuse of youthful naïveté). That same quality now fuels the “First Partner” persona: selective outrage, performative parenting, school monetization, and a Hillary-like hint of co-presidency ambitions. For voters outside California’s bubble, it signals entitlement and hypocrisy more than principled leadership.

In the Mad Men episode “For Those Who Think Young.”, Siebel Newsom played a high-end call girl named Juanita Carson. All that Stanford education, varsity sports, Clooney-level access, and Hollywood ambition: just to portray a woman trading sex for advancement in a prestige drama; an uncomfortable foreshadowing of power-seeking choices she makes in real life.

Mr. Varasano takes the text seriously, especially the requirement that one be “subject to the jurisdiction thereof,” and shows why simple presence on American soil is not enough. Citizenship is not a tourist benefit, nor a reward for evading the law. It implies allegiance and a defined legal relationship. This is a direct argument for closing a loophole that has been open for far too long.

The 14th amendment says “All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States”. The controversy over Birthright Citizenship hinges on the meaning of the 2nd clause “subject to the jurisdiction thereof”.

The left wants to interpret it to mean very little - basically a repeat of the first clause - if you are born on our soil, then you are subject to our jurisdiction, since we are sovereign over all of the land. But then why restate the clause? Laws don’t join two conditions that are both the same. Let’s review a number of categories of persons physically in the USA and explore whether the second clause is simply a repeat of the first.

The clause says “subject to the jurisdiction” not “within the jurisdiction”. If Princess Catherine visits the US, she’s within our sovereign territory and “within our jurisdiction” - she is within territory under our control. But she’s not “subject to our jurisdiction” - she’s a SUBJECT of England. Many categories of people are physically present but not subject to our exclusive jurisdiction because they are citizens of other countries. They have protections from, and duties to, other nations. For example, we could not draft tourists, refugees, illegal aliens or POWs. Likewise we can tax US citizens living abroad, as they are subjects of the USA, despite their location and our inability to exert direct control within a foreign jurisdiction.

So let’s break down some categories to see who the clause applies to.

Birth Tourists, in particular, reveal the absurdity of interpreting the jurisdiction clause to mean nothing more than the location clause. It would basically mean that meeting the criteria for a tourist visa is an award of birthright citizenship rights. “Wanna go to Disney World? Cool, now you have birthright citizenship rights.”

And as ridiculous as that sounds, Illegal Aliens’ having the right is even more absurd, because they have less than the visa. They have no permissions at all, and in fact started with the crime of evading visa, passport and border processes.

So now it’s, “Wanna go to Disney World, but got rejected? Cool, now you have birthright citizenship rights.”

We basically let almost anyone come visit and 66 million travel here annually. Are we allowed to have different criteria for tourists vs criteria for birthright? Or does the 14th amendment mean that any administrative change to tourist visas is the same as legislation regarding birth rights? And why stop there? Does the 14th also mean that it doesn’t even matter what the legislators or the administrators or the citizens want anyway? It’s really up to the smugglers. They now decide. Law is irrelevant. We are powerless. This is the left’s interpretation.

Who is subject to our jurisdiction? I’m going to review 10 categories to show where we draw the line. Roughly in order of jurisdiction:

1- Slaves - if anyone was subject to our exclusive jurisdiction, it was slaves. They were in our control and had no other allegiances. The clause was meant to move/correct the line set by the Constitution itself. The purpose of the 14th was primarily to address this category

2- Natural Born Citizens - one or two parents are citizens

3- Naturalized Citizens - people following a specific legislated process to grant citizenship, as referenced directly in the 14th’s first clause.

The 14th amendment covers categories 1-3 without dispute.

4- Legal Residents - the Wong Kim Ark decision in 1896, moved the line to cover Legal Residents. In addition to mere location, these people needed and got a legislative grant of residency, which, while not explicitly a grant of birthright citizenship, was interpreted by the court as sufficient for meeting the jurisdiction clause, even without the full citizenship process. There was a legal process but not a full citizenship process. The basic logic is that if you’ve granted permanent residence, eventually people will have children, and those children will have no country other than the USA to be subjects of. This is a debatable interpretation even as far as it goes but it certainly doesn’t imply going further.

5- Indians owing allegiance to Tribal authorities, rather than exclusive allegiance to the USA - these were understood to be beyond the line of the Constitutional clause even with Wong Kim Ark’s expansion, and thus additional legislation in 1924 was passed to include them. This legislative grant was even more direct than Level 4, as it addresses birthright explicitly rather than merely imply it from residency. Since legislation was required for this group, it’s clear that Wong Kim Ark did not, on its own, extend all the way down to category 8 which follows below.

Here at Level 5 is where Trump’s Order puts the line, and it’s exactly where the Constitution, plus the additional referenced legislation and the courts have ruled it as well. Everyone above this line was on some level invited to live here permanently and everyone below was not. Extending the line below this point has merely been a false interpretation by left leaning administrators, not by legislation, the Supreme Court, or the Constitution. To meet the jurisdiction requirement, as with levels 3-5, levels 6-8 would require new legislation and the fulfillment of its processes:

6- People with temporary permission - Active Visa Holders (tourists/students) and asylum applicant grantees - They are subjects of other countries and the grant of visitation rights is not conflatable with a grant of rights normally exercised by citizens. You can’t visit for a weekend and get on welfare or apply for social security. But there is a whole industry of people flying to the USA to drop their baby to get citizenship. It’s absurd.

7- Expired Visa Holders / Rejected asylum applicants - Temporary rights expire and asylum is granted pending a restoration of safe conditions back home. Birthright extending to expired grants, is obviously not lawful. It would mean an expiration has no meaning.

8- People without any permission - Illegal Aliens - People who were granted no rights legislatively. If you were to try to draft an illegal alien, they could run to the consulate of their home country for protection. They are not subject to the US government. We don’t even have a record that you exist.

Leftists want to put the line here, even without the additional legislation required by levels 3-5.

These next groups are not just subjects of other countries, but agents of them:

9- Prisoners of War and armed invaders - POWs make the language parsing clear also: they are under our control, so aren’t they subject to our jurisdiction? No. They are not our Subjects and are governed by international treaties. They couldn’t be drafted into our army. Clearly location and control are not the sole determinants of “Subject to our jurisdiction”. Likewise we can tax US citizens living abroad, as they are subjects of the USA’s jurisdiction, despite their location and our inability to exert direct control. What if an invading army took over Maine, and then we repel them and take it back. Would a child born to an invading soldier during that time be a US citizen?

10- Nobles, Diplomats, soldiers or employees of other powers and their families and retinue. This group is obvious.

The intent and the history of 14th amendment was to merge categories 1 and 2 - slaves were recognized as full citizens. It was a post civil war amendment meant to address that issue only. Without any additional process, citizenship at birth was awarded to just those first two categories. Beyond those, citizenship at birth required additional legislation to define rules and grant rights. Categories 3-5 got that legislation, 6-8 did not, & 9-10 could never.

3- via naturalisation legislation and process requirements

4- via legislation granting residency plus a court interpretation to include it.

5- via additional legislation (not a constitutional right or court interpretation, but an additional grant of law)

For categories 3-5, legislators expressed an invitation and grant to a permanent relationship with the existing citizens of the USA. Never has the court ruled that anyone is entitled to citizenship rights without any legislative invitation to at least permanent residency. There’s no such legislation for Levels 6-8 and legislation around them is at best for temporary visitation and at worst expresses a specific prohibition.

6- Temporary Rights don’t imply permanent rights. Letting you come on vacation doesn’t give you the rights of citizenship. Obviously. These are 2 separate things and require separate legislation. The asylum application process has been corrupted by administrators and Trump has every right to uncorrupt the process. But regardless, asylum legislation does not grant the rights of previous levels. They are here temporarily, until conditions in their home country improve and like the Indians, they would need additional legislation.

7- Expired Right - Ok, now you’ve broken the rules and it’s time to go. It would be hard to argue this confers valuable ongoing rights..

8- Illegals - Invaders with no granted rights

It could not be more clear. The Constitutional clause was meant to rectify the rights of slaves but all other groups needed citizen parents or some additional legislative process to become SUBJECTS of our jurisdiction. To date legislators have added Naturalized Citizens and Tribal Indians, and the court has ruled that granting legal residency is a sufficiently legislated invitation as well. There was no intention by the framers of the 14th, nor any legislation or court ruling that accepts uninvited people as our subjects.

Additional categories need additional legislation, which they don’t have. Otherwise the courts would have to rule not just that lesser legislated grants, like visas, but also VIOLATED grants, like overstayed visas, and NO GRANTS, like evading laws and borders, count as sufficient grants. They would have to rule that breaking the law is legal. Non-grants are grants.

“Subject to the Jurisdiction Thereof” is not a redundancy of the location clause. Assuming it is, fails to explain why additional legislation, like the Indian legislation, was ever necessary. Trump’s Executive Order has placed the line in the exact right place. Congress and the people have the right to define who has birthright citizenship rights and to close the loopholes and wishes of administrators.

Asylum Abuse

Virtually all illegal aliens are now being coached into claiming asylum, but they don’t fit the criteria. Open border advocates are trying to shoehorn everyone into the asylum category because it’s defined by international norms, rather than US legislation. They are essentially trying to abolish category 8 and move everyone to category 6, and then redefine a few things to pull them into category 4. As always, leftists do this by redefining words, occupying administrative positions, using emotional appeals, funding legal advocates and generally twisting things to get what they want, until it’s the de facto system for so long when eventually challenged they say “It’s always been this way and the other side is trying to strip people of their rights” - even if those rights were never legislatively granted.

Refugees seeking asylum are not allowed to jump from country to country, seeking the best deal. The international asylum rules say that a person should get asylum in the first safe country they arrive in. So if you are fleeing war in Syria, then Jordan or Turkey are required to take you, but all other countries take you only if they choose to do so, over and above international requirements. Unless you are fleeing tyranny in Mexico, Canada, or arguably Haiti & Cuba, the USA is not your first safe stop. Even if it were, you would have to show that your claim of asylum is based on fear of persecution, not just shopping for the best economic situation. Under these criteria, the actual number of legal (rather than administratively permitted) asylum refugees is a tiny fraction of the claimants. But even if they were true refugees, asylum is temporary and does not have the legislation needed, as was created for levels 3-5, to grant birthright citizenship.

Birth Tourism has expanded into a cottage industry, and open border advocates made that even easier in 2015 (https://www.hsgac.senate.gov/library/files/birth-tourism-in-the-united-states-/). Pregnant women who may never have stepped foot in the USA , fly here for a few weeks, give birth and leave with their baby’s USA citizenship.

Charles has been a groundbreaker, uncovering the “kleptotechnokakistocracy” my other friend Michael Smith discusses at .

Charles Ortel reads the tea leaves of corporate filings, e.g. problems at General Electric 2007., “I turned my attention to exposing fraud in 2007,” and in that process “General Electric was not as advertised,” a finding that came from taking apart disclosures line by line and refusing to accept the narrative presented to investors.

Ortel later turned his attention to the Clinton Global Foundation: “as a technical legal matter, I would argue…that it doesn’t even exist.” The basis is not conjecture but gaps in initial filings and the failure to maintain basic corporate formalities in Arkansas, the jurisdiction tied to the Clinton Foundation.

One detail carries unusual weight because it is so mundane. The corporate secretary authenticates records. Without that role properly filled, documents do not carry legal force. Contracts become questionable.

The agreement between the Clinton Foundation and the National Archives and Records Administration created a long horizon arrangement over land, buildings, and presidential records in Little Rock. The structure involves layered leases and a ninety seven year grant of use rights. The issue, stated plainly, is that “the entity that granted these use rights went out of corporate existence.” If that is correct, then a major public arrangement rests on a counterparty that lacks legal standing.

When the structure fails, everything built on it requires a second look.

I recently read “Unmasking The Great Blood Pressure Scam” by A Midwestern Doctor ** and felt a wave of recognition. His detailed critique echoes ideas I’ve carried since long before his August 2025 piece appeared. He rightly highlights how guideline changes, measurement errors, and pharmaceutical incentives have turned millions into “hypertensives” who may be harmed more than helped by aggressive treatment.

What follows is my own framing of the same core truth, drawn from basic physiology and a very personal family story.

Blood pressure is not a static dashboard reading. As upright mammals, we need enough pressure to deliver oxygen and nutrients to the brain against gravity—first and foremost. Consider the giraffe. To feed on high leaves, these animals generate heart-level pressures often exceeding 200–250 mmHg. When they lower their massive heads to drink at ground level, that same pressure would risk exploding delicate vessels in the brain and eyes if left unchecked.

Nature solves this with elegant adaptations: venous pooling, tight leg skin acting like compression stockings, and rapid buffering mechanisms. The “high” number isn’t a defect; it’s context-dependent. Treating blood pressure as a fixed adult target (say, 120/80) is a category error. It fluctuates with posture, activity, stress, and effort.

Now look at humans across a lifetime. Visit a middle school and you’ll see full-grown teenagers with systolic pressures often around 100–110 mmHg. Visit a nursing home and you’ll find people of similar body size and brain demand whose systolic readings commonly approach 180–200 mmHg or more. What changed? The body and brain stayed roughly the same size. The difference is in the pipes.

Over decades, arteries don’t just stiffen—they narrow through atherosclerosis, reducing the effective gauge (lumen diameter). Fluid dynamics explains the rest. Poiseuille’s law shows vascular resistance skyrockets as radius shrinks: flow is proportional to radius to the fourth power. Halve the radius and resistance jumps 16-fold.

To push the same blood volume through narrower pipes, the heart must generate higher pressure—just as a firefighter needs far more pressure to reach the sixth floor than the first through the same hose, or as Bernoulli’s principle illustrates in constrictions where velocity rises and local pressure dynamics shift. This isn’t mysterious “essential hypertension.” It’s the body compensating for downstream vascular remodeling so the brain and organs still get perfused.

Even more telling is the widening gap between systolic and diastolic—the pulse pressure. In youth, elastic arteries act like a mattress absorbing the pressure surge: they stretch during systole and recoil during diastole, smoothing flow (the windkessel effect). With age, those arteries harden and lose “give.” The systolic peak transmits more forcefully downstream, while diastolic pressure may fall.

A catheterization at the aortic root would reveal different dynamics than a simple arm-cuff reading. The widened gap signals reduced arterial compliance—the loss of that youthful absorbency—compounded by the narrowed gauge.

When we blindly chase the cuff number, we risk fighting the compensation. Lower the giraffe’s pressure too far and it cannot reach the leaves. In humans, forcing a middle-aged person’s “normal” blood pressure onto an elderly one means pumping the same flow at much lower pressure through stiffened, narrowed pipes. Flow rate drops sharply (per Poiseuille), and “hilarity ensues”: inadequate perfusion to brain, kidneys, and heart, leading to fatigue, cognitive decline, falls, frailty, and worse.

Overtreatment can reduce organ perfusion, diminish exercise tolerance, and accelerate deconditioning—especially in older adults whose vessels tolerate low pressure poorly.

My father learned this the hard way in the 1960s. Diagnosed with high blood pressure, he was prescribed reserpine. The drug lowered the reading by depleting catecholamines, but it left him tired, loopy, and depressed—common side effects that could include sexual dysfunction and profound fatigue. He stopped it.

Years later he died from a thoracic aortic dissection, a condition strongly linked to longstanding hypertension stressing the aortic wall. The irony stings: the elevated pressure may have contributed to the weakness that killed him, yet the medication that “treated” the number also stole quality of life and possibly reduced his activity level, doing little to address the stiffening and narrowing pipes themselves.

The real work lies upstream: supporting endothelial health, reducing inflammation, improving blood flow characteristics, and preserving what arterial compliance and lumen diameter remain through sensible movement, diet, and stress management. Hammering the gauge while ignoring the why is medicine’s recurring mistake.Blood pressure is the body speaking.

Sometimes we need to lower the load on the system rather than silence the messenger. Nature, as the giraffe shows, is far wiser than our static targets.

** https://open.substack.com/pub/amidwesterndoctor/p/unmasking-the-great-blood-pressure

In last night’s dream, I was striding alongside (alma mater) Yale’s Cross Campus greensward. A darkly well-dressed academic (in bowler hat), flanked by an entourage, moved slowly ahead, occupying the entire sidewalk’s width deep in conversation. I overheard some departmental chatter. Not wanting to step on the grass, I lingered patiently behind. At a crosswalk, I attempted a quick slide-by, shoulder-turn pass. The professor bluntly pushed me back: wait, obey. Later, in the same dream, this natty prof. (at a party) demanded the students rise up, yell, demonstrate: the flipside of his previous emphasis on order. The “standards” were conditional and convenient: his getting what he wants, when he wants it.

Immediately upon awakening, I self-psychoanalyzed the scene as indicative of recent criticism from an authoritative figure (whom I admire, thus its sting): specifically that my delineation of Toby Rogers’ conception of the autism epidemic is absent of factual reasoning– with the intimation I am constructing a straw man (argument) out of personal animus (alone).

The accusation (on the heels of my recent interview by podcaster Tom Nelson and this Substack transcript of it) was that I had misquoted Rogers and miscast his theories, mindset and intentions.

“Toby nowhere EVER said that all autism is caused by vaccines. He never would say that because there is no way to know that!”

Nothing Is Either Good Or Bad, But Thinking Makes It So

That claim does not hold up against the record. Toby Rogers’ public statements frame vaccines and toxicants as the primary (essentially exclusive) driver of the autism epidemic.

• In his September 9, 2025 Senate testimony he said: “the autism and chronic disease epidemics are primarily caused by toxicants -- mostly from vaccines and about a dozen additional toxicants.”

• On Substack he has written: “We know what’s causing the autism epidemic. The bloated, unscientific, profit-driven CDC vaccine schedules are causing the autism epidemic,” and

• “Autism appears mostly to be a story of iatrogenic injury from vaccines.”

• He acknowledges some genetic background but treats it as secondary and de-emphasizes it (e.g., dismissing billions spent on genetic research as a dead end because “genes don’t suddenly create epidemics”)

If vaccines are the primary driver of a population-level shift of this magnitude, then alternative explanations must be addressed directly and ruled out with equal rigor. In place of that evidentiary work, dissent is recast as heresy. Rogers labels refusal to accept this link “autism epidemic denialism,” describing it as a “severe mental illness” afflicting people of “low moral character” who retreat into a “Pollyanna fantasy world” rather than confront what he characterizes as “crimes against humanity” by the pharmaceutical industry.

Is that science? Science is not a person, and it does not require allegiance. Science proceeds by confronting competing explanations, not the explanations’ competitors. Rogers’ MPP/PhD training in public policy yields a toolkit of boundary-drawing, and moral framing. When disagreement is recast as defect, the analytic work stops. The question is no longer which explanation best fits the data, but which position one is permitted to hold.

One May Smile, And Smile, And Be A Villain

This pattern is not limited to the autism discussion. In a separate public comment, Toby wrote:

“Here’s the thing about all those Super Bowl ads that were not funny and did not make sense ... they were likely funded, written, and approved by people who received Covid shots and are now neurologically impaired.”

That statement begins with a subjective reaction to widely viewed advertisements and then attributes that reaction to neurological impairment from vaccination. It moves from personal aesthetic judgment to a generalized medical conclusion. Given the scale of global vaccination, this is an absurdly speculative assertion, once again illustrating Rogers’ tendency to convert disagreement or difference in perception into pathology or pejorative (see below).

Though This Be Madness, Yet There Is Method In’t

In the autism literature, large changes in measured prevalence require careful attention to diagnostic criteria, category expansion, and substitution effects.

Administrative data over time show a substantial decline in intellectual disability classifications alongside a rise in autism diagnoses, which suggests reclassification plays a meaningful role, as often notes.

That pattern does not exclude other contributing factors, but it does require that definitional and institutional changes be accounted for before assigning a dominant causal mechanism. My concern is directed at that analytical step. When a strong causal narrative is advanced while dissent is treated as moral failure, those distinctions tend to collapse.

Toby Rogers was defended (in that accusation) as a “powerless poor researcher”; in tandem with my critique’s having “fanatically focused on harming” him. That characterization does not match reality. Toby has 100,000+ followers on X, comparable reach on Substack, fellowship status, and publicly calls for a $2-trillion reparations fund. In actuality, “powerless poor researcher” more aptly applies to me.

Prior to October 31, 2025 I had respected Rogers, engaged him in conversation while incorporating his comments on my preprint of Unraveling Autism’s Surge, to which he had sharing rights. That changed when Rogers (conversely, had) “focused on harming” me quasi-publicly (in triumvirate conversation with Bret Weinstein).

To his credit, scientist and physician Dr. Robert Malone accepted this (amateur’s) work, republishing the piece on June 11, 2025; deeming it

“an excellent job of making the vast array of information available on autism comprehensible,” and called it “essential reading... and ... a treatise, if you like, on the enigma scientists have labeled autism.”

Just prior, Brownstone had refused. Reasonable people can differ in editorial taste, of course, but the contrast matters. Had I suddenly abandoned rigor or wandered beyond my competence? Perhaps it did not fit the preferred framing of a fraught topic.

Give Every Man Thy Ear, But Few Thy Voice

Brownstone has presented itself as a place willing to follow inquiry where it leads, especially when subjects are politically sensitive. When a contributor’s work is welcomed across multiple topics and then effectively sidelined when he introduces a careful but unwelcome line of analysis on autism, the tension is not imaginary. It reflects an editorial choice about which forms of dissent remain acceptable and which do not.

There is also a policy dimension here that should not be waved away. Public calls for large-scale liability or reparations have far-reaching consequences for the pharmaceutical sector and for public health infrastructure.

Rogers believes:

“We need to set aside a trillion dollars to compensate autism families who’ve been injured by the childhood vaccine schedule. And we need to set aside a trillion dollars to compensate people... hurt by COVID-19 vaccines. That is foundational... to this country rebuilding and becoming a democracy again. We need to have a conversation about transitional justice.”

“Transitional justice” is associated with regime rupture. Rogers urges discontinuity from existing constitutional order rather than accountability within it.

Proposals of that magnitude warrant especially careful scrutiny of the underlying causal claims and evidentiary standards before they are treated as settled.

The Play’s The Thing Wherein I’ll Catch The Conscience Of The King

I would welcome a response from that engages these points directly. I would welcome an open debate. Unfortunately I can’t include anything similar to ’s $100,000 enticement (to

If the causal claims hold, they should be able to withstand examination alongside competing explanations. If they do not, the rhetoric surrounding them should not substitute for evidence. The standard is simple. Define terms carefully. Examine the data. Distinguish classification from incidence. Separate assertion from proof.

The sidewalk is wide enough, if people make room. Until then, we must either line up behind this:

... or (preferably) pass it by