In 2022, he and his wife Ann left the corporate system to open Miller Family Health and Wellness, an independent practice in the Blue Ridge Mountains devoted to prevention and the reversal of chronic disease. A farmer and rancher himself, Miller draws a direct line between a nation’s declining health and its growing disconnection from the land, the soil, and the people who produce its food. His charge to patients is blunt: demand personalized care, seek out providers who understand nutrition and lifestyle, and take personal responsibility for becoming the master of your own health.

Check out these related resources from IMA below, followed by the full video transcript.

• Hub: Medicine at 250 Years — Restoring the Roots of American Medicine

• Post: The Home Was the First Clinic: American Medicine Before the System

• Post: When Medicine Became a Profession: Medical Schools, Licensing, and the Rise of Scientific Authority

• Post: The Flexner Turning Point: How Scientific Medicine Raised Standards and Narrowed the Field

• Post: From Snake Oil to Big Pharma: The Long Battle Between Fraud, Innovation, Regulation, and Profit

• Video: Medicine at 250 Years: Putting Patients Back in Charge

Transcript

Dr. Brooke Miller: Hello, America. Happy 250 years. I’m Dr. Brooke Miller, a board-certified physician in family medicine. Along with my wife Ann, we own and operate Miller Family Health and Wellness, a small, privately owned, independent medical practice in Washington, Virginia, nestled in the beautiful Blue Ridge Mountains. Our practice’s focus is, just as the name implies, restoring health and wellness through prevention and reversal of chronic disease. We operate a patient-centric, patient-focused family medicine clinic, serving our small rural community and the surrounding areas.

As a Senior Fellow of the Independent Medical Alliance, a main goal is to help restore truth and trust, along with freedom and sovereignty, back into patient care.

During my 40 years of medicine, we’ve seen tremendous advances in the treatment of disease. We’ve become better at treating the sick and injured, but somehow we’ve regressed in the human aspect of patient care, as well as preventing and reversing chronic disease. Sadly, we now live in one of the sickest developed countries in the world.

Medical schools and residencies continue to turn out physicians that are highly trained to follow protocols and algorithms. One size fits all. Medicine based on guidelines generated by bureaucrats, insurance companies, and pharmaceutical companies. Very little time is taken to teach nutrition, with little emphasis on lifestyle and dietary modifications. All too often, care is unduly influenced by checking boxes and maximizing reimbursement. Many physicians no longer possess the confidence and skill to critically think, nor the time to sit, to listen, and to get to know their patients as individuals. While we’ve made advances in sick care, we are failing our patients in terms of compassion and the reversal and prevention of chronic disease.

As a young boy, I had a doctor who was born and raised in our community. He took care of the entire family. He knew each one of us, as well as our parents and grandparents. Few, if any, relied on insurance as payment. He was compassionate and a prominent member of our community. He not only took care of us, he cared for us.

In 2022, Ann and I took the giant leap, exiting the corporate medical system and starting our independent medical practice. We were determined to make a difference in our patients’ lives and our community. This takes time during each visit to listen, to educate, and to motivate patients to take the steps they need to in order to achieve their goals of health, wellness, and happiness. Each patient is treated as a sovereign individual with the will, the intelligence, and the right to determine their medical care, free from mandates and outside pressures.

I grew up in this small-town community. On the very same land we now live, ranch, and raise cattle. I live on a diversified farm with cattle, hogs, sheep, chickens, and horses. I learned the importance of hard work, self-reliance, personal responsibility, and, by the grace of God, freedom and liberty.

Much like independent medical practices, which have been negatively affected by the pressures of corporate medicine, insurance companies, and bureaucratic overreach, family farms and ranches have been devastated by the elimination of free markets by corporate monopolies, the decay of private property rights from government edicts, and harmful regulation. Sadly, due to economic pressure, many of the next generation are leaving family farms and ranches. It’s not coincidental that the more disconnected we get from the land and agriculture, the sicker we become. Tragically, today a large percentage of our population shares little to no connection to the land, the soil, and those that produce our food. Many fail to see that health and wellness start at the table.

As a family and emergency physician, I’ve seen the consequences of misguided dietary choices, where people choose the convenience of processed and ultra-processed foods over real, unadulterated foods. Too many seek food as entertainment to the palate without concern for real, long-term health consequences. As a nation, we are sicker, over-medicated, and more dependent than ever before. We spend more in health care dollars, yet have poorer outcomes. As the old saying goes, an ounce of prevention is worth a pound of cure. Indeed, this is true with health care.

Today, both doctors and patients are unhappy with the current state of medical care. It has become too impersonal, too cold, too sterile, and too rushed. We’ve lost patient confidence and trust. To regain that trust, we must treat patients as sovereign individuals, free from mandates and outside pressures. We must remember our oath and why we entered medicine. Resist medical tyranny. This will require sacrifice, individual strength, courage, and honor, just as the signers of the Declaration of Independence demonstrated 250 years ago.

As patients, I urge you to demand more: more personalized, individualized care from your provider. Seek out providers that understand the importance of diet, stress reduction, sleep, exercise, metabolic health, boosting the immune system, and lifestyle. If they don’t take the time to listen and hear your concerns, or teach you ways to improve your health through non-pharmacologic means, find one that will. Support independent medical practices where your doctor listens to and works for you, not a corporate or government entity. Get to know those that produce healthy whole foods, farmers and ranchers, people you can develop a relationship with and trust.

Be intentional in your daily life. Take personal responsibility. Educate yourself and heal your body and mind through healthy food choices, lifestyle modifications, and personal habits. Become the master of your destiny. Good health and wellness will surely follow.

God bless you all, and may God bless this nation. Thank you.

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The CDC calls VAERS “the nation’s early warning system for vaccine safety.” The system works by collecting reports of health problems that happen after vaccination, then watching for patterns. When a particular problem shows up more often after a particular shot than you’d expect by chance, that pattern is called a safety signal. A signal isn’t proof the vaccine caused the problem. It’s a flag that says: this deserves a closer look.

For more than 18 months during the COVID vaccine rollout, that system was missing hundreds of these signals. Not because the reports weren’t there, but because of how the FDA analyzed them. When a public records request finally forced the agency’s weekly signal reports into the open in January 2025, the data showed something strange: one vaccine was generating almost all the signals, while two others generated almost none.

Sen. Ron Johnson’s Permanent Subcommittee on Investigations went looking for why. Its April 29, 2026 hearing drew on 11 million pages of FDA and CDC records obtained by subpoena. The internal emails told a clear story. FDA staff were warned as early as December 2020 that their analysis method was hiding signals for certain vaccines. The scientists who built that method had already created a fix for the problem. The fix was never used, and the FDA analyst who kept sounding the alarm was told to stop.

Dr. David Wiseman, a research bioscientist who testified at the hearing, joins Dr. Cole to walk through what the data shows. His published analysis puts the number of lost signals at 763 at minimum. The emails explain how they went missing, and what the agency knew while it happened.

Meet the Experts

David Wiseman, PhD, MRPharmS

Research bioscientist. Dr. Wiseman’s career spans pharmacy, pharmacology, immunology, and experimental pathology, with decades of experience in pharmacovigilance and regulatory science. He has made more than 36 governmental submissions on vaccine issues and has testified before the Texas Senate and the U.S. Senate. His analysis of VAERS signal loss was published on ResearchGate in September 2025.

Ryan Cole, MD

IMA Head of Medical & Scientific Affairs; Senior Fellow, Pathology; Founder, Cole Diagnostics. Dr. Cole is a board-certified anatomic and clinical pathologist with extensive experience in diagnostics and laboratory medicine. His clinical and research work has focused on COVID-19 vaccine safety, tissue pathology, and immune system function.

1. The Numbers That Don’t Add Up

The records covered the FDA’s weekly signal reports from January 2021 through July 2022. To find signals, the FDA relies on a statistical method called Empirical Bayesian Data Mining. It scans every report and flags any vaccine-and-reaction pairing that shows up far more often than chance would predict.

One week’s report makes the pattern obvious. On April 29, 2022, the FDA logged 124 signals, split like this:

• Janssen: 110 signals

• Moderna: 6 signals

• Pfizer: 8 signals

That lopsided result, roughly nine to twenty-two times more Janssen signals than the other two vaccines, held steady week after week for the entire period.

The details made it stranger. Most of the few Pfizer and Moderna signals weren’t even medical problems. They were paperwork issues: a product prepared incorrectly, a dose given to someone the wrong age. The serious clinical signals, the ones involving real injuries, landed almost entirely on Janssen. A system working properly does not produce a result that lopsided.

So Dr. Wiseman checked the FDA’s numbers against other databases and the published research, and found the signals that should have been there. At least 763 of them, he calculated, had dropped out of the FDA’s analysis, and larger datasets push the count into the thousands. Every one was a potential risk the FDA was legally required to investigate. Under the rules for emergency-authorized products, the agency didn’t even have to prove the vaccine caused the harm to be obligated to look.

“These signals that were lost represent still mostly uninvestigated potential risk. FDA was legally required to consider without needing to determine causality.” — David Wiseman

The FDA’s own released data showed just 124 signals (far left). Adding back the signals lost to three separate flaws, explained in the next section, rebuilds the true count step by step to 887, with hundreds more borderline cases the FDA never examined at all. (Source: Wiseman, 2025)

2. How Signals Disappear

The biggest reason signals went missing has a name: masking. When two vaccines cause the same reaction at similar rates, the FDA’s method can let them hide each other, so a real problem looks normal.

Dr. Wiseman used an analogy from the hearing. Line up hemlock and arsenic next to a cup of tea, and both poisons obviously look dangerous. But secretly stir the arsenic into the tea first, then compare the hemlock against that spiked tea, and the hemlock suddenly looks harmless. You’re measuring one poison against a baseline that’s already poisoned.

Dr. Cole put it more simply: one zebra among a hundred kangaroos stands out. Add a second zebra to the group, then compare the first zebra against the whole herd, and it no longer looks out of place.

On the left, hemlock and arsenic each look dangerous when measured against a clean baseline (tea). On the right, arsenic has been mixed into the baseline itself, so hemlock now looks safe by comparison. This is masking: hiding one hazard by folding a similar one into the measuring stick. (Source: Wiseman, 2025)

Masking wasn’t the only problem. Dr. Wiseman found two more:

• Truancy: Hundreds of signals that appeared in other databases and in the published research were simply missing from the FDA’s records, with no explanation for where they went.

• Filtering: The FDA set the bar for what counts as a signal higher than the method’s own inventor recommended. A higher bar means fewer signals clear it, so real warnings got filtered out before anyone reviewed them.

3. What the FDA Knew and Chose Not to Fix

Here is what turns a statistical problem into a scandal: the people who built the FDA’s detection system were the ones who spotted the flaw. In a 2022 paper, three researchers laid out the masking problem plainly, and two of them were insiders. William DuMouchel invented the exact math method the FDA uses. Dr. Ana Szarfman brought that method into the agency and made it the standard for catching drug and vaccine problems. Their conclusion was damning: the method was hiding real signals, and the software already had a built-in setting that would fix it. When the inventors of a system tell you it’s broken, that carries weight.

And they weren’t the only warning. The internal record shows a steady drumbeat:

• December 2020: Dr. Szarfman flags the masking risk to FDA colleagues, before the vaccines are even widely rolled out.

• March 2021: She shares an analysis finding 49 examples of “extreme masking,” including hidden signals for sudden cardiac death and stroke.

• Same period: Another FDA official, Dr. David Menschik, runs his own check and confirms the problem independently.

• September 2021: Instead of fixing it, senior official Peter Marks reports that Dr. Szarfman “has been asked to cease and desist,” meaning she was ordered to stop.

Dr. Szarfman was blunt about what the broken method meant.

“I am not astonished that [FDA’s data mining system] was unable to detect these signals.” — Dr. Ana Szarfman, per internal communications shared by David Wiseman

The reason for shutting her down wasn’t scientific. It was about optics, as one internal email spelled out.

“Results from adjusting parameters that raise or lower sensitivity of the alerts as the vaccination campaign is underway could lead to confusion and have unintended consequences, e.g. regarding vaccine confidence.” — Dr. Zinderman, FDA, per internal communications shared by David Wiseman

The people paying the price were sitting across the table from Dr. Marks. Through 2021 and into 2022, vaccine-injured patients from the group React19 met with him and his staff, asking only to be believed. Marks told them, more than once, that VAERS showed no safety signals, even while the FDA’s own analysts were documenting that the system was hiding them. These were people who lined up for their shots, did what they were asked, and were told the system saw nothing wrong.

4. A Broken Early Warning System

The problem doesn’t stop with COVID. The same researchers warned that the flood of COVID vaccine reports now sitting in VAERS has damaged the database’s ability to catch problems with any future vaccine, like a smoke detector so clogged it may not go off for the next fire. At least three European studies of their own vaccine databases reached the same conclusion.

Put the pieces together, and the system is weak at every stage:

• The math method hides signals for vaccines that cause similar reactions.

• Only an estimated 1% of real adverse events ever get reported in the first place.

• When a fix was available, the FDA chose not to use it.

Dr. Marks himself understood what was at stake. In a line Dr. Wiseman read back to the Senate, Marks had written that failing to catch and communicate a serious vaccine problem “could impact confidence, not only in COVID vaccines, but in all vaccines.”

Sen. Johnson’s investigation is still open, and it’s not yet clear whether anyone will be held accountable. But the fix is not a mystery. It comes down to three things:

• Use the correct analysis settings the FDA already had access to.

• Protect the staff who report problems instead of silencing them.

• Release the safety data in full.

“What’s the point of even having a system if you’re not going to act on it… and now to know that your system’s broken, and you haven’t replaced your system.” — Ryan Cole

Looking Forward

The data, the emails, and the sworn testimony are public now. What Dr. Wiseman’s work makes clear is that this isn’t just history. The missing signals still haven’t been investigated, and the detection system still runs the same way it did. Getting the records released took years of effort. Whether it leads to a system that actually works is the next question, and the one worth watching.

Related Reading

• Post: New Study Shows How VAERS Buries Vaccine Harm

• Post: DARE-SAFE: A New Standard for Comparing Vaccine and Drug Safety

• Video: Balancing Technology and the Human Touch

• Preprint: Signal loss by truancy, masking, and filtering in FDA’s analysis of VAERS data

✍️ By Jenna McCarthy

A few weeks after my dad died, I had an OB-GYN appointment. I’d also just given birth to my first daughter, so I was an emotional, hormonal mess. Somewhere between the scale and the stirrups, my doctor casually asked how everything was going.

I burst into tears.

“Would you like me to write you a prescription for an antidepressant?” she asked gently.

I was sincerely taken aback. For context, I’m the least depressed person you’ll ever meet. That’s not a flex; it’s a fact. I regularly wake up at 4 a.m. not because I don’t enjoy sleep but because I love what I do in my waking hours so much that I can’t wait to get to it. My glass isn’t half-full; it’s pretty much overflowing. Sure, I have bad moods and bad days. I’ve cried over things that mattered and lost my temper over things that didn’t. (I once slammed a solid wood door so hard it split down the middle. True story.) But even when grief and postpartum hormones hit me all at once, I knew I wasn’t depressed. I was heartbroken.

It turns out, losing a parent can have that effect.

My dad was the first person I called from the delivery room. He was my friend, my idol, my landing pad, my biggest cheerleader. And then he was gone. That last part did not come with an instruction manual.

I didn’t want a pill or a treatment plan. I wanted to cry in my paper gown and then go home and hold my new baby. I wanted to understand how birth and death could press up against one another and not suffocate you. I wanted to miss my father and marvel at my daughter and I didn’t know how to do those things at the same time. I wanted to feel all the things, as contradictory and overwhelming and messy as they were.

My OB wasn’t one of those pill mills you hear about, either. She was a genuinely caring physician. She’d delivered my daughter mere weeks before this exchange. We’d been through a lot together. But she was practicing medicine in a culture that’s become remarkably uncomfortable with normal human suffering. And when the only tool in your medical kit is a prescription pad, every emotion becomes a diagnosis.

I’m not talking about catastrophic or debilitating suffering here. Just… life. If you can’t sleep, take this pill. Can’t focus? Try that one. If you’re anxious, you’re obviously undermedicated. Bored in the bedroom? Just supplement harder! Lonely? Sorry, you’re on your own—we don’t have a med for that yet. (Maybe try Tinder?)

Every generation before ours expected life to include grief, rejection, boredom, awkwardness, menopause, memory lapses, nervousness, and the occasional existential crisis in the Costco checkout line. They didn’t enjoy these things any more than we do. They just didn’t assume they required medical intervention.

Today it’s: Worried or stressed? Here’s a benzo. Feeling extra tense? Try a muscle relaxant. Fidgety kid? There’s an ADHD drug for that. Before long, you’re being held together with adhesive strips and subscription services, wondering why the relief never lasts.

Our grandmothers didn’t have a name for half of what we medicate now. They learned how to cope the old-fashioned way: by coping. A hyperactive child got sent outside to run laps around the block. A breakup got you a casserole and orders to get out of the house. If you were bored, somebody handed you a rake. In the name of progress, we traded those skills for pills, apps, and appointments, which certainly have their place when those skills aren’t enough. But if we stop teaching resilience, patience, perspective, faith, friendship, and the ability to be the tiniest bit uncomfortable, what replaces them? A muscle you never use doesn’t get weak—it disappears. And if the only wisdom we have to pass down is “IDK, ask ChatGPT,” we’re all doomed.

The irony is that many of the emotions and experiences we’re hell-bent on eliminating are our bodies’ brilliant and innate way of communicating with us. Grief is powerful proof of how much we loved someone. Loneliness reminds us that we need other people. Boredom nudges us toward change. Anxiety is like an overzealous security system—prone to false alarms, but ultimately there to keep us safe. Not every unpleasant feeling is a bug. Sometimes it’s a feature.

Grief, when you don’t try to outrun it, does something subtle over time. It stops ambushing you quite so often. The waves don’t disappear, but they come with a little more space between them, a little less force behind them. You learn the difference between drowning and floating. You cry, a lot, and then one day you laugh—really laugh—without immediately feeling like you’ve betrayed something sacred. The pain doesn’t vanish; it changes shape. It becomes a quiet companion instead of a relentless intruder. And if you don’t let yourself go through that—if you numb it, rush it, or pathologize it—you don’t skip the pain. You just postpone it. And like an unpaid bill, grief has a way of collecting interest.

Modern medicine, to be clear, is one of humanity’s greatest achievements. We replace failing heart valves. We cure cancers that would have been death sentences twenty years ago. We transplant organs. We edit genes. The power and promise of science is literally astonishing. But that success has changed our expectations. Once medicine could cure so much, we began expecting it to cure everything. The result is that benign human experiences like forgetting where you left your keys or feeling nervous before a presentation are treated like five-alarm emergencies.

This is not a categorical diss on Pharma either. (I co-wrote The War on Ivermectin, which last time I checked is still a pharmaceutical product.) I have people I love dearly who swear they literally would be unable to get out of bed without their antidepressants. That’s what makes the distinction so important. Those medications exist for people whose brains are lying to them, telling them nothing will ever be okay again, even when that isn’t true. That wasn’t what was happening to me. My brain wasn’t lying. Losing someone you love hurts. Overwhelming sadness is the perfectly reasonable response to that pain.

Sometimes what we need isn’t a prescription—it’s permission. Permission to be sad without it being a diagnosis. Permission to let grief run its painful, unpredictable course instead of getting managed, medicated, or referred to a specialist. The reality is, we’ve gotten remarkably good at treating symptoms, and considerably less good at trusting signals. Sometimes the most appropriate response isn’t intervention—it’s attention. And the recognition that not every feeling needs to be fixed.

✍️ By Lynne Kristensen, IMA Senior Director of Communications & International Fellowship Program

American medicine has always lived with tension.

Patients need hope. They want answers. They seek relief from pain, fear, fatigue, infection, disability, and disease. When people are suffering, they are vulnerable to anyone who promises a cure.

That vulnerability has shaped the history of American medicine from the beginning.

In the 19th century, patent medicines and cure-alls flooded the marketplace. Patent medicines were the over-the-counter remedies of their day: bottled tonics, syrups, pills and liniments sold directly to the public, often with secret formulas and sweeping cure-all claims before modern drug regulation required clearer labeling, safety standards or proof of effectiveness.

These “cures” were sold in newspapers, traveling shows, storefronts, and mail-order catalogs. They promised relief for nearly every complaint. Some contained alcohol, opium, morphine, cocaine, mercury, or other powerful substances. Many contained little that would actually heal. ^[1]

Some were harmless. Some were addictive. Some were dangerous. Many were advertised with confidence that far exceeded the evidence behind them.

America has always had to protect patients from false promises.

But the story does not end with snake oil.

As medicine became more scientific, the old patent medicine world gave way to a more regulated pharmaceutical industry. That shift brought extraordinary advances. It also created new problems. The bottles changed. The advertising changed. The science became more sophisticated. The stakes became higher.

But the central question remained the same.

Who is medicine really serving?

Where “Snake Oil” Came From

The phrase “snake oil” did not begin as a symbol of fraud.

Its origins can be traced to Chinese laborers in the American West in the 19th century, including railroad workers who used traditional medicinal oils for sore muscles and aching joints. These preparations were reportedly made with oil from the Chinese water snake, which contained fatty acids that may have offered some anti-inflammatory benefit.^[3]

Over time, American traveling salesmen began selling their own versions of “snake oil,” often claiming it could treat pain, headaches and a wide range of other complaints. Many of these products contained little or no actual snake oil. The most famous example was Clark Stanley, the self-proclaimed “Rattlesnake King,” whose Snake Oil Liniment was later found by federal authorities to contain mineral oil, beef fat, red pepper and turpentine, but no snake oil.^[4]

That is how a term connected to a real traditional remedy became shorthand for deception and fraud. “Snake oil” came to represent the kind of medical marketing that exploits suffering by promising cures it cannot deliver.

This history matters because it reminds us that not every traditional remedy begins as fraud, and not every official-looking product deserves trust. The deeper issue is whether patients are being told the truth.

The Age of Patent Medicines

Before modern drug regulation, the American public had little protection from exaggerated medical claims.

Patent medicines were not always patented in the modern sense. The term often referred to proprietary formulas marketed directly to the public. Companies guarded their recipes and promoted them as secret remedies. Labels could be vague. Ingredients were often undisclosed. Advertising was emotional, persuasive, and often wildly misleading.

A bottle might claim to treat cough, nerves, pain, digestive trouble, women’s discomfort, weakness, or nearly any ailment of daily life. Testimonials were common. So were dramatic before-and-after claims. The public did not always know what it was buying.

For many families, these medicines were accessible in a way physicians were not. A doctor cost money. A clinic might be far away. A bottle on a shelf promised control.

That matters because the rise of patent medicines was not only a story of fraud. It was also a story of access, fear, and unmet need for the average American.

One of the most shocking examples was Mrs. Winslow’s Soothing Syrup, a popular 19th-century “cure” marketed to mothers for teething babies and fussy children. Advertisements claimed it could soothe the child, soften the gums, ease pain, cure wind colic and relieve diarrhea. What many parents did not know or understand was that the syrup contained morphine. It quieted children because it sedated them, placing infants at risk of poisoning, addiction and death. ^[2]

When people could not get clear answers or what we call informed consent today, they looked elsewhere.

When medicine feels distant, expensive, or dismissive, patients become more vulnerable to promises from outside the system.

That lesson still applies today.

Why Regulation Became Necessary

By the late 19th and early 20th centuries, public concern over adulterated drugs, mislabeled products, unsafe foods, and deceptive claims was growing. Investigative journalism helped expose abuses. Reformers pushed for federal oversight.

In 1906, Congress passed the Pure Food and Drugs Act. It prohibited interstate commerce in misbranded and adulterated foods and drugs and helped lay the foundation for modern federal drug regulation. ^[5]

This was a major turning point.

The law did not solve every problem, but it marked a shift in public expectations. Patients had a right to know what they were consuming. Companies could not be left entirely to police themselves. Medical products needed standards. Claims needed accountability.

Regulation, at its best, protects the vulnerable.

It helps ensure that medicines are what they claim to be. It creates consequences for deception and false advertising. It provides a framework for safety, labeling, manufacturing, and evidence.

This is the part of the story that must be acknowledged clearly. A free market without truth is not freedom for the patient. It is a marketplace of risk.

The Rise of the Pharmaceutical Era

As the 20th century progressed, pharmaceutical science changed medicine.

Drugs became more targeted. Manufacturing improved. Clinical research expanded. Antibiotics changed the treatment of infection. Insulin transformed diabetes from a rapidly fatal disease into a manageable condition for many patients. Anesthetics, pain medicines, cardiac drugs, anticoagulants, cancer therapies, psychiatric medications, and countless other treatments reshaped how medicine was practiced.

No doubt, these advances saved lives.

There is no honest history of medicine that denies the value of pharmaceutical innovation. Many patients are alive today because of drugs that did not exist a century ago. Many conditions once considered hopeless became treatable. Many surgeries became safer. Many infections became survivable.

The problem is not medicine in a bottle.

The problem is what happens when the bottle becomes the center of medicine.

A drug can be lifesaving. It can also be overused. It can be necessary. It can also become a substitute for asking why the patient became sick in the first place.

The history of pharmaceuticals is a history of both breakthrough and temptation.

Advertising, Influence, and the Patient

As the pharmaceutical industry grew, so did its influence.

Companies funded research, supported medical education, promoted drugs to physicians, advertised to consumers, and shaped public understanding of disease. Direct-to-consumer advertising became especially powerful in the United States, where patients could be encouraged to ask their doctors about specific medications by name.

This changed the exam room.

A patient might arrive having already been taught what condition to suspect and what drug to request. A physician might be asked to respond not only to symptoms, but also to marketing. The encounter could become shaped by messages designed outside the doctor-patient relationship.

The United States is one of only two high-income countries, along with New Zealand, that permits direct-to-consumer advertising of prescription drugs.^[6] In 2024, pharmaceutical companies spent more than $10 billion on U.S. drug advertising, including more than $5 billion on television ads alone.^[7] One analysis found that pharmaceutical ads made up nearly one-quarter of evening ad minutes on major news networks during the first five months of 2025.^[7] That level of spending raises an important question for patients: when Big Pharma is such a powerful advertiser, how does that influence the health stories the public sees, the questions reporters ask and the facts that receive sustained attention?

Advertising is not the same as education.

Education seeks to inform. Advertising seeks to persuade.

That distinction matters in medicine because the patient is often anxious, uncomfortable, and searching for hope. When drug marketing reaches the patient before a physician has had time to listen, the balance can shift.

The patient deserves truth, not manipulation.

The Opioid Lesson

Few modern examples reveal the danger of pharmaceutical overreach more clearly than the opioid crisis.

Pain is real. For many patients, it is devastating. Physicians needed better ways to treat it, and patients deserved compassion.

But aggressive promotion of opioid pain medications helped create a public health catastrophe. Claims about safety and addiction risk were too often minimized. Prescribing increased dramatically. Communities across the country suffered the consequences. ^[8]

The opioid crisis is not a lesson against treating pain.

It is a lesson against allowing commercial and financial incentives, institutional pressure, and incomplete evidence to drive care beyond what patients can safely bear.

It is also a lesson in humility.

Medical systems can embrace a message, repeat it, reward it, defend it, and later discover that the human cost was enormous.

Patients remember that.

Families remember that.

Trust is damaged when institutions refuse to admit how harm happened.

The New Snake Oil

Modern medicine may no longer come in the form a traveling salesman with a wagon full of miracle tonics. But the temptation is still familiar.

There are still exaggerated promises. There are still selective evidence and incentives that can distort judgment. There are still products marketed as simple answers to complex human problems.

Sometimes the false promise comes from outside mainstream medicine.

Sometimes it comes from inside it.

Today, the “new snake oil” also moves through social media feeds, where influencers can promote health and wellness products, protocols, supplements, devices and services with little meaningful oversight. For patients living with chronic pain, autoimmune symptoms, fatigue, metabolic dysfunction, hormone issues or other unresolved conditions, these messages can feel like long-awaited answers, especially when the institutional and corporatized medical system has failed to listen or help.

In that sense, the marketplace has come almost full circle. Once again, the average patient has direct access to a flood of health claims outside the exam room. Some may point people toward helpful ideas. Others are unverified, exaggerated or financially motivated.

Pew Research Center found that 36% of U.S. adults get health information from social media at least sometimes, while KFF found that 55% of adults use social media for health information and advice at least occasionally.^[9][10]

The problem is not that patients are searching.

The problem is that suffering people are often left to sort truth from marketing alone.

That is why IMA’s message is not simply anti-fraud in one direction. It is pro-truth in every direction.

Patients should be protected from dangerous claims, whether those claims come from a fringe salesman, a corporate campaign, a government-approved message, an influencer with financial motivations or an institutional protocol that ignores the complexity of the individual patient.

The standard should not be who has authority.

The standard should be truth, transparency, evidence, informed consent and respect for the doctor-patient relationship.

Innovation Without Idolatry

Pharmaceutical innovation is one of the major achievements of modern medicine. While it should be recognized and acknowledged, it should not be idolized either.

A healthy medical culture can be grateful for drugs without becoming dependent on them as the first and only answer. It can use medication wisely while still asking about nutrition, movement, sleep, stress, toxins, infection, metabolism, hormones, inflammation, environment, and family context.

This is where whole-person medicine becomes essential.

A patient is not a prescription waiting to be written. A diagnosis is not always a drug deficiency. Symptoms are not always the deepest story.

Sometimes medication is exactly what is needed.

Sometimes it is only one part of the answer.

Sometimes the better question is not, “What drug matches this symptom?”

It is, “Why is this person sick?”

Remember the Roots, Tell the Truth

From snake oil to Big Pharma, the lesson is not that all medicine outside the system is fraudulent or that all medicine inside the system is trustworthy.

The lesson is that patients need protection from deception wherever it appears.

They need physicians who are free to ask hard questions. They need honest evidence. They need full disclosure of risks and benefits. They need informed consent that is more than a signature on a form. They need care that does not reduce suffering to a sales opportunity.

American medicine at its best has always fought to separate healing from exploitation.

That fight is far from over and the enemy is often hard to clearly detect.

The next 250 years of medicine must protect innovation while resisting corruption. It must welcome discovery while refusing manipulation. It must use powerful tools without allowing profit to replace judgment.

Medicine should never be built on fear, pressure, or false promises.

It should be built on trust.

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Source Notes

• Oregon Health & Science University Historical Collections and Archives, “There’s a Cure for That: Historic Medicines and Cure-alls in America.” Used for historical context on patent medicines, cure-alls, aggressive advertising, consumer access before modern regulation and harmful ingredients including alcohol, morphine, opium, cocaine and mercury.

• Smithsonian National Museum of American History, “Rule Advertising Mrs. Winslow’s Soothing Syrup.” Used for background on the product’s marketing claims and documentation that it contained 65 mg of morphine per fluid ounce.

• Smithsonian Magazine, “How Snake Oil Became a Symbol of Fraud and Deception,” 2024. Used for background on the history of snake oil, Chinese laborers’ use of traditional medicinal oils and the term’s later association with fraud.

• Smithsonian Institution / National Museum of American History, “Clark Stanley’s Snake Oil Liniment.” Used for documentation of federal testing that found Stanley’s product contained mineral oil, a fatty compound thought to be from beef, capsaicin and turpentine, but no actual snake oil.

• U.S. Food and Drug Administration, “Part I: The 1906 Food and Drugs Act and Its Enforcement.” Used for historical background on the 1906 Pure Food and Drugs Act, early federal food and drug regulation, misbranding, adulteration, labeling requirements and enforcement challenges.

• Johns, L., “Patients as Consumers: Reflections on the FDA’s New Rule on Direct-to-Consumer Prescription Drug Advertisements,” PubMed Central, 2024. Used for background on direct-to-consumer prescription drug advertising being permitted in the United States and New Zealand among high-income countries, and for context on FDA advertising rules.

• Wisconsin Watch, “Did drug companies spend $10 billion on consumer ads?” 2025. Used for reported 2024 U.S. pharmaceutical advertising spending, TV ad spending and the analysis of pharmaceutical advertising minutes on major evening news programs.

• American Journal of Public Health / PubMed Central, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy,” by Art Van Zee, 2009. Used for background on the marketing of OxyContin, including promotional strategies and efforts to minimize addiction risk.

• Pew Research Center, “Health information from social media and AI rated more convenient than accurate,” 2026. Used for survey data showing that 36% of U.S. adults get health information from social media at least sometimes.

• KFF, “KFF Tracking Poll on Health Information and Trust: Health Information and Advice on Social Media,” 2025. Used for survey data showing that 55% of adults use social media to find health information and advice at least occasionally.

Additional Sources Consulted

• U.S. Food and Drug Administration, “How Chemists Pushed for Consumer Protection: The Food and Drugs Act of 1906,” by John P. Swann. Used for background on dangerous ingredients in early medicines and the law’s labeling requirements for substances such as alcohol, morphine, heroin and cocaine.

• National Library of Medicine, “Pure Food and Drugs.” Used for historical background on public concern over adulterated foods and medicines, the growth of federal drug controls, and the early history of U.S. food and drug regulation.

• AMA Journal of Ethics, “How FDA Failures Contributed to the Opioid Crisis,” by Andrew Kolodny, 2020. Used for context on opioid regulation, pharmaceutical promotion, prescribing patterns and the role of misleading opioid marketing in the broader public health crisis.

• U.S. Government Accountability Office, “OxyContin Abuse and Diversion and Efforts to Address the Problem,” 2003. Used for federal context on Purdue Pharma’s marketing of OxyContin, expanded sales efforts, prescribing for noncancer pain and early concerns about abuse and diversion.

• U.S. Food and Drug Administration, “80 Years of the Federal Food, Drug, and Cosmetic Act.” Used for context on the limitations of the 1906 law and the evolution of stronger federal drug oversight under later legislation.

The conversation turns to myocarditis in young people, who faced very low risk from COVID itself but, Dr. Cole notes, took on a documented risk of heart damage and lasting scarring from the shots. He closes with four practical steps for patients and families: document everything, file a retrospective VAERS report, find a physician willing to treat vaccine injury, and hold government to its own policies.

Check out these related resources from IMA below, followed by the full segment transcript.

• Webinar: Inside the VAERS Data

• Post: DARE-SAFE: A New Standard for Comparing Vaccine and Drug Safety

• Research: New Research Exposes the Flawed Study Behind Australia’s COVID Booster Policy

• Video: Dr. Angus Dalgleish on COVID Boosters and Cancer

Transcript

Angela Brown: New questions are emerging about what federal health officials knew during the COVID vaccine rollout and whether the public was given the full picture about possible safety concerns. A recent Senate review led by Senator Ron Johnson is bringing scrutiny to the Vaccine Adverse Event Reporting System, known as VAERS, and how reports of possible side effects were handled during the pandemic. Joining us now to discuss is Dr. Ryan Cole, Head of Medical and Scientific Affairs for the Independent Medical Alliance. Thank you so much for joining us this morning.

Dr. Ryan Cole: You bet, Angela. Thank you.

Angela Brown: So for people who may not be aware, what exactly is the Vaccine Adverse Event Reporting System? What is its role, and what did it do during the COVID vaccine rollout?

Dr. Ryan Cole: Sure. VAERS has existed for about 30 years. It’s an early reporting system to find safety signals. So it’s basically the canary in the coal mine. When adverse events do occur after the rollout of something new, we have something to report to, whether it’s a doctor, a family, or an individual.

Angela Brown: Okay, so something happens. People can report to this system?

Dr. Ryan Cole: Yes, they can.

Angela Brown: Senator Ron Johnson’s review has raised new questions about how possible safety signals were handled. What do you believe the public needs to know at this point, and what may not have been told at that time?

Dr. Ryan Cole: The important thing is that system does show those signals, and there was a coverup by the officials at FDA of the data that were coming in. So people lost the opportunity to make a risk-benefit choice, to have informed consent in terms of getting that shot or not, because we were seeing severe signals of harm that were covered up by the officials at the FDA, who knew as early as March of 2021 of things like sudden cardiac death, strokes, and pulmonary emboli, that’s clots to the lungs, things of that sort, which are life-threatening in nature. And yet officials in the government decided that we, the people, didn’t need to know that.

Angela Brown: Now, one of the issues here involves myocarditis, particularly among younger people. What do we know about those reports?

Dr. Ryan Cole: That’s the other concerning area. We knew that young people were at very low risk for COVID, yet these shots carried that risk of heart damage. And that heart damage, we found, can carry on with scarring later on in these young individuals. Again, it’s a canary in the coal mine. These young individuals should have been given the option to avoid something that had early safety warnings that were ignored.

Angela Brown: As more information continues to come to light on this, what should patients and families who still have questions about vaccines, or even possible side effects, be doing now?

Dr. Ryan Cole: Really quick: number one, document. Number two, it’s not too late to do a retrospective report to the VAERS system. History matters. Number three, find a friendly physician that will treat vaccine injury. And number four, always protect your rights, and make sure that you keep track of government, making sure that they stick to the policy that they have.

Angela Brown: All right. To learn more about the Independent Medical Alliance, visit imahealth.org. Thank you so much for joining us, Dr. Ryan Cole, Head of Medical and Scientific Affairs for the Independent Medical Alliance.

Her answer is balance: run state-of-the-art testing behind the scenes, then deliver the results with kindness and the energy of someone who genuinely cares. It’s the model she practices at The James Clinic, and the reason she founded Maverick Medical Ventures, which helps physicians leave a system she says has made the seven-minute visit the product and build independent practices where the doctor-patient relationship comes first.

Check out these related resources from IMA below, followed by the full video transcript.

• Hub: Medicine at 250 Years — Restoring the Roots of American Medicine

• Post: The Home Was the First Clinic: American Medicine Before the System

• Post: When Medicine Became a Profession: Medical Schools, Licensing, and the Rise of Scientific Authority

• Post: The Flexner Turning Point: How Scientific Medicine Raised Standards and Narrowed the Field

• Video: Medicine at 250 Years: Putting Patients Back in Charge

Transcript

Dr. Mollie James: As we celebrate 250 years of American healthcare, we have an interesting dichotomy facing us today. On the one hand, we have AI, we have advanced technology, we have these individualized precision care options that patients are looking for more and more. And if you look at the platforms that are taking over, most of medicine is looking at how we can do more with technology.

But on the other side is really my draw, which is the human element. As we get more techy, the human element is getting sterilized out of modern medicine. And I feel like this is really where system medicine is missing the mark. Because although patients want the upsides of the technology, they still want to be known like they were before in the olden days, like the family doctor. They want you to know their name. They want you to know what they do, who their family is, what their beliefs are, not just what their labs say.

They have questions. They want to be understood. When they come in with a cancer diagnosis, they don’t just want to know what are my tumor markers and how many rounds of chemotherapy do I need. They want to know, why did I get cancer in the first place? What are the risk factors that are unique to me that I can flip and switch?

This is one of the things that we’re doing in our clinic. And I think any clinic that wants to succeed moving forward has to really fight the urge to pull into a technology-only mode. They have to find the balance. Use the best of technology behind the scenes for the testing. We have state-of-the-art testing in my office. People want those answers. They want to know a lot about their biological health. What are my numbers and all of that? But they want it delivered with kindness and humanity and that energy of sitting in the room with someone who genuinely cares about them.

Unfortunately, the system has built a model that doesn’t cater to this. They have built a model in which the medical visit, the seven-minute visit, is the product, not the doctor-patient relationship.

We’re building Maverick Medical Ventures to help people who don’t feel satisfied providing care in the system, and for patients who don’t feel like they’re getting the care in the system that they want to have. We will help doctors leave the system and build independent practices so that we can deliver that kind of care that has the tech advantage in that old-school, genuine, caring environment that most patients are looking for.

So as we round the corner on 250 years in medicine, there is a way to bring the best of both together: to let patients have all the technology that they want at their fingertips, but deliver it in a way that you ask about their grandkids, you know when they’re going to church, and you can talk to them as a human being instead of a medical record number in the chart.

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✍️ By Lynne Kristensen, IMA Senior Director of Communications & International Fellowship Program

By the early 20th century, American medicine had a problem it could no longer ignore.

The country had medical schools, professional societies, hospitals, licensing boards, and scientific discoveries that were changing the practice of medicine. Yet medical education was still inconsistent. Some schools required serious study and clinical training. Others offered a much leaner path to a medical degree. Admission standards varied widely. Laboratory training was uneven and gaining essential clinical experience was not guaranteed.

Patients had reason to want better.

Medicine needed higher standards. It needed better-trained physicians in schools that could teach anatomy, pathology, chemistry, physiology, bacteriology, and bedside care with seriousness and discipline.

Then came the Flexner Report.

Published in 1910 by the Carnegie Foundation for the Advancement of Teaching, Abraham Flexner’s report became one of the most influential documents in the history of American medical education. Flexner visited medical schools throughout the United States and Canada and judged them by a model rooted in university-based science, laboratory training, hospital access, and rigorous admissions. ^[1]

The report helped change American medicine.

It also narrowed it.

That is why the Flexner Report matters so much in IMA’s Medicine at 250 Years project. It is not a simple story of good or bad. It is a turning point that brought needed reform while also helping define which forms of medicine would be considered legitimate, which schools would survive, and which voices would be pushed to the margins.

A System in Need of Reform

Before Flexner, medical education in America was widely fragmented.

Some institutions were serious and making improvements. Others were proprietary schools that heavily relied on tuition and had limited laboratory facilities, weak clinical access or low admission requirements. Students could graduate with very different levels of preparation depending on where they trained and studied.

This was not a minor problem. The public needed physicians who were capable, disciplined, and grounded in science. A medical degree needed to mean something.

Flexner’s report called out poor training with unusual bluntness. He argued that medical schools should be connected to universities, equipped with laboratories, supported by hospitals, and rooted in modern scientific study. The model he favored was influenced by institutions such as Johns Hopkins, which emphasized research, clinical training, and laboratory science. ^[2]

From one perspective, this was a necessary correction.

Medicine could not remain loose, unstable, and vulnerable to undertrained practitioners. Patients deserved better. The country needed a stronger educational foundation for physicians.

That is the part of the Flexner story that should be acknowledged honestly.

The Power to Define Legitimate Medicine

But reform is never only about improvement. It is also about power.

The Flexner Report did more than criticize weak medical schools. It helped define what counted as proper medical education. Schools that aligned with the university-based scientific model were elevated. Schools that did not, were placed under immense pressure. Many had to close in the years that followed.

This affected a wide range of institutions. Proprietary schools were hit hard. So were schools that trained women, Black, rural, and homeopathic physicians, as well as practitioners from other medical traditions and cultures.

Some of those schools were undoubtedly weak. Some deserved scrutiny. But others served communities that were already excluded from mainstream institutions. When those schools closed, the loss was not only academic. It shaped who could become a physician and which patients would have access to doctors who understood their lives.

The impact on Black medical education was especially profound. At the time of the report, several historically Black medical schools existed. After Flexner, only Howard University College of Medicine and Meharry Medical College survived as major institutions training Black physicians. Scholars have argued that these closures had long-term consequences for the Black physician workforce and for access to care in Black communities. ^[3]

This is one of the most important lessons of the Flexner era.

Raising standards can protect patients. But if reform closes doors without building better pathways, it can also deepen inequality.

What Was Gained

The gains in American medicine were real.

Medical education became more rigorous. Schools improved admissions requirements. Laboratory science became more central. Clinical training expanded. Physicians were expected to understand disease through anatomy, physiology, pathology, and bacteriology. Hospitals became more closely tied to teaching.

These modifications helped build the modern physician.

They also helped medicine move away from many dangerous practices that had persisted for generations. Scientific medicine made it easier to test ideas, compare outcomes, and reject treatments that did not work. It created a stronger foundation for surgery, infectious disease care, pharmacology, diagnostics, and public health.

For patients, this mattered.

A better-trained physician could recognize patterns more accurately. A stronger medical school could teach students to observe, question, and verify. A hospital-based education and clinical experience could expose young doctors to disease in ways a lecture room alone could not.

The Flexner Report did not create modern medicine by itself. But it accelerated a movement already underway.

It helped make medicine more serious.

What Was Lost

Yet something was lost as well.

As medical education became more standardized, the definition of medicine became narrower. Scientific legitimacy increasingly flowed through approved institutions, approved methods, approved schools, and approved authorities. Approaches outside the dominant model were often dismissed together, even when some deserved further study rather than wholesale rejection.

Various schools of healing—including homeopathy, osteopathy, naturopathic medicine, botanical medicine, and eclectic medicine—were affected differently. Some claims were unsupported. Some practices were ineffective. Some were dangerous.

But some reflected important instincts that modern medicine still struggles to recover. Treat the whole person. Look for root causes. Consider nutrition, environment, structure, lifestyle, family and resilience. Respect the patient’s experience. Understand that healing is not only the suppression of symptoms.

The problem was not that science advanced.

The problem was that science was sometimes treated as if it belonged only to one system, one hierarchy, or one approved way of thinking.

True science should not fear questions. It should invite them. It should test, refine, reject, rediscover, and remain humble enough to learn from what it once dismissed.

Carnegie, Philanthropy, and Influence

The Flexner Report was commissioned by the Carnegie Foundation for the Advancement of Teaching. That detail matters, but it should be reflected upon carefully.

While some may question his intentions for sponsoring the report, Carnegie no doubt considered its influence. Philanthropic institutions helped shape the future of medical education by defining what excellence looked like and which institutions deserved support.

After Flexner, major philanthropic organizations, including the Rockefeller-funded General Education Board, invested heavily in medical education and research. These efforts helped build modern academic medicine. They also helped concentrate authority in universities, laboratories, research hospitals, and elite institutions. ^[4]

That concentration had benefits. It produced better science, stronger training, and major advances.

It also meant that the future of medicine was increasingly shaped by powerful institutions rather than local communities, independent physicians, or diverse healing traditions.

This pattern still matters.

When funding, prestige, publication, policy, and institutional approval all move in the same direction, medicine can become less tolerant of independent thought. It can begin to confuse consensus with certainty. It can make it harder for physicians to question dominant assumptions, even when patients need them to.

The Independent Physician After Flexner

The Flexner era helped build the modern medical profession. But it also helped move the physician further into institutional systems.

The independent doctor did not disappear. Many continued to serve towns, families, rural communities, and urban neighborhoods with courage and dedication. But the path to legitimacy increasingly ran through centralized training, hospital affiliation, licensing structures, specialty recognition, and institutional approval.

This changed the physician’s role.

The doctor was no longer only a community steward. He was increasingly a credentialed professional within a larger system. That system could support him, but it could also constrain him.

Today, that tension has grown sharper. Physicians are more educated than ever. They have access to extraordinary tools. Yet many feel less free to practice according to conscience, judgment, and the needs of the individual patient.

The roots of American medicine remind us that a physician is not merely an agent of an institution.

A physician is entrusted with a patient, their health and their life.

Remember the Roots, Restore the Balance

The Flexner Report helped raise standards at a time when standards were needed. It pushed medical education toward scientific rigor. It helped expose weak schools and improve physician training.

Those gains should not be dismissed.

But the Flexner turning point also teaches us that reform can have unintended costs. It can centralize authority. It can narrow the field. It can close doors for communities already struggling for access. It can dismiss forms of knowledge that may contain wisdom worth studying.

The next 250 years of American medicine should not reject rigor. It should deepen it.

Real rigor requires science, but also humility. It requires evidence, but also open debate. It requires standards, but also conscience. It requires protection from fraud, but also protection for independent physicians who ask honest questions in service of their patients.

Medicine must be scientific.

It must also be free enough to keep learning.

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Source Notes

• Carnegie Foundation for the Advancement of Teaching, “Medical Education in the United States and Canada,” by Abraham Flexner, 1910. Used as the primary source for the Flexner Report, including its review of medical schools in the United States and Canada and its recommendations for university-based, laboratory-centered, scientifically grounded medical education.

• U.S. National Library of Medicine / PubMed, “Medical Education in the United States and Canada. From the Carnegie Foundation for the Advancement of Teaching, Bulletin Number Four, 1910,” by Abraham Flexner. Used as an indexed reference to the original Flexner Report and its significance as a landmark publication in American medical education.

• Journal of the National Medical Association / PubMed Central, “The Forgotten History of Defunct Black Medical Schools in the 19th and 20th Centuries and the Impact of the Flexner Report,” by Eric H. Harley, 2006. Used for background on historically Black medical schools, the closures of several Black medical institutions after Flexner, and the long-term impact on the Black physician workforce and underserved communities.

• The Rockefeller Foundation, “Our History.” Used for background on the role of philanthropic institutions in 20th-century medical education, public health, and the development of modern academic medicine.

• JAMA Network Open, “Projected Estimates of African American Medical Graduates of Closed Historically Black Medical Schools,” 2020. Used for additional context on the long-term consequences of historically Black medical school closures and their effect on the number of Black physicians in the United States.

• AMA Journal of Ethics, “How Should We Respond to Racist Legacies in Health Professions Education Originating in the Flexner Report?” 2021. Used for ethical and historical context on the Flexner Report’s legacy, including racial inequities in medical education and the need to address institutional consequences.

• National Library of Medicine / PubMed Central, “Osteopathic Medicine: Past and Present.” Used for general context on osteopathic medicine as one of the medical traditions that developed outside the dominant allopathic model and later gained broader professional recognition.

American medicine did not begin as a system. It began in homes, sick rooms, and small communities, where the first diagnostic tool was knowing the patient by name. Before illness was met by institutions, it was met by family, by faith, by observation, and by a local physician who knew every member of the household.

The anniversary is a reason to celebrate. It is also a reason to ask what got lost along the way. Four physicians trace the arc from kitchen-table care to institutional control, from the doctor who sat at the bedside to the system that put a portal, an insurance rule, and a 10-minute timer between them.

Meet the Experts

Dr. Joseph Varon

Professor of Medicine; President and Chief Medical Officer, IMA. Dr. Varon is a critical care physician, prolific medical researcher, and internationally recognized expert in acute care medicine. He trained at Stanford and has practiced for nearly four decades.

Dr. Kat Lindley

Director of IMA Fellowship Program; Senior Fellow, Family Medicine. Dr. Lindley is a board-certified family physician who has practiced at the university, corporate, hospital, and rural levels. She now runs a direct primary care practice in Texas and has been a leading advocate for physician independence and informed consent.

Dr. Lynn Fynn

Retired infectious disease specialist focused on clinical research. Dr. Fynn holds patents in novel therapeutic formulations and has developed supplement formulations used by professional athletes worldwide.

Dr. Ryan Cole

IMA Head of Medical & Scientific Affairs; Senior Fellow, Pathology. Dr. Cole is a board-certified pathologist and founder of Cole Diagnostics. He brings decades of experience in tissue diagnostics and a commitment to restoring physician independence and patient-centered care.

1. The First Clinic Was the Home

The sick person in early American medicine was not a chart, a claim, or a number in a portal. They were a neighbor, a mother, a child, a friend. Care was local, personal, and built on a relationship that existed before anyone got sick.

That relationship is not just nostalgia. Dr. Varon described what drew him to medicine in the first place.

“I wanted to be the doctor that would go to your home, would talk to you, would know your family, would know everybody’s illnesses. I wanted that relationship.” — Dr. Joseph Varon

Dr. Lindley lives that model now. She carries a stethoscope and otoscope in her car and has been known to examine patients in a parking lot at a football game. After years inside the system, she returned to independent rural family medicine.

“I fell in love with medicine again, because that’s what medicine is supposed to be. It’s supposed to be my patient and me together in a room without this third party.” — Dr. Kat Lindley

The point is not to romanticize 1776 medicine. It was limited, inconsistent, sometimes dangerous. But before institutions arrived, care was built on something that still matters: knowing the person.

2. What 250 Years Built, and What Got Lost

The panel was clear: 250 years of American medicine produced genuine breakthroughs. Transplants, cured cancers, ICU technologies that save lives. The progress is real, and dismissing it is not the point.

The point is what grew up around it. Insurance companies, pharmacy benefit managers, CMS protocols, and 10-minute appointment windows now sit between the physician and the patient. Dr. Lindley described a Medicare patient whose hemoglobin A1C went out of control because a PBM changed the insulin formulary. The patient could no longer afford the medication that had kept him stable for years. The failure was not clinical. It was structural.

Dr. Lindley described the physician as a steward: someone who advises, guides, and cheers the patient on, but ultimately respects that the patient decides.

“Two hundred and fifty years later, we’re losing that beauty of the physician-patient relationship, unfortunately.” — Dr. Joseph Varon

3. When One Voice Replaces the Conversation

Bloodletting probably killed George Washington. Mercury purges were standard care. Medical consensus has been wrong before, and Dr. Varon argued that every generation must be willing to examine its own assumptions with honesty. The lesson from early medicine is not to reject progress. It is to stay humble about what we think we know.

The panel applied that principle directly to recent history. Dr. Fynn focused on the structural problem of concentrated institutional power, pointing to Dr. Anthony Fauci’s 38-year tenure as NIAID director. During that time, she argued, a single official shaped which scientists received funding, which therapeutics were fast-tracked, and which were buried, while simultaneously influencing public messaging, intelligence assessments, and pandemic policy.

“That’s not a public health official. That’s a public health king. Our constitution doesn’t provide for one of those.” — Dr. Lynn Fynn

The panel’s concern was not partisan. It was architectural. When institutional design allows any one person to become indispensable, Dr. Fynn argued, another version of the same problem is always waiting in the wings.

4. The Questions Honest Medicine Must Ask

Dr. Fynn cited a JAMA study reporting that 60 percent of excess mortality among young adults, roughly 11,000 deaths in a single year, was coded as “other natural causes.” That residual category offers no explanation. It is, as she put it, a medical admission of ignorance.

The questions she argued demand investigation: whether repeated spike protein exposure from any source played a role in accelerating cardiovascular disease in younger populations, whether natural immunity was suppressed to justify mandates, and why autopsy rates have collapsed. Dr. Varon noted that hospitals once required a percentage of deaths to be autopsied for accreditation, a standard that no longer exists. Families now pay out of pocket.

Dr. Fynn framed the responsible position plainly: we do not know what is driving these numbers, but the numbers demand investigation. The fact that asking the question is considered controversial tells you something about the state of modern medicine.

“Young people dying unexpectedly deserve more than just a residual category in a JAMA table. They deserve an honest investigation into why they died.” — Dr. Lynn Fynn

5. Restoring the Roots

The health freedom movement got some things right over the past several years: early treatment advocacy, resistance to mandates without informed consent, and the willingness to question enforced consensus. But Dr. Varon pushed the panel on where it needs to sharpen. The movement cannot be defined only by what it opposes. Trust is built through honesty, transparency, and the willingness to have difficult conversations, not through shouting louder.

Dr. Lindley argued that alternative systems need to be built with one foot still in the existing one. She has been outside the traditional insurance model since 2017 but maintains her licenses, CME, and regulatory compliance. Direct primary care, direct specialty care, and cash-price surgical centers are all expanding.

Dr. Fynn returned to the foundational principle: the patient’s body, the patient’s decision. The physician advises and informs. The state protects the right to choose. Even a bad choice is still the patient’s right.

Asked what American medicine should restore first, each panelist gave a one-word answer. Dr. Lindley: the patient-physician relationship. Dr. Fynn: trust in institutions. Dr. Varon: honesty and transparency. Dr. Cole: humility.

The Next 250 Years

The founders of this country were not consensus-seekers. They argued, disagreed, and pushed forward. The next era of American medicine will require the same courage: the willingness to have hard conversations, to admit what went wrong, and to rebuild around the relationship that started it all.

Related Reading

• Post: The Home Was the First Clinic: American Medicine Before the System

• Video: Why the Next Era Must Restore Trust

• More to come in our 250 Years of Medicine series!

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Dr. Lindley’s answer is a return to medicine’s roots. In her practice, she and the patient make every decision together, the arrangement she argues the nation’s founders envisioned, with patient, family, and faith at the center of care. Her prescription is straightforward: promote independent practice, teach patients what care actually costs outside the insurance maze, and get back to one doctor and one patient in charge of every healthcare decision.

Check out these related resources from IMA below, followed by the full video transcript.

• Post: The Home Was the First Clinic: American Medicine Before the System

• Post: When Medicine Became a Profession: Medical Schools, Licensing, and the Rise of Scientific Authority

Transcript

Dr. Kat Lindley: My name is Dr. Kat Lindley, and I’m a family physician in Texas. I’m also Director of the Fellows at the Independent Medical Alliance and Fellow in Family Medicine.

My journey to where I am today took several years. For many years I practiced within the system: at a university setting, different health clinics, and a rural health care center. And at one point I decided that I wanted to open my own private practice. I didn’t want to do that from the beginning. I was a little bit resistant, because I figured being my own boss has its own headaches.

But what I realized along the way is that the system itself is really set up for failure, because you have different agencies almost in the room with the patient and yourself. You have the insurance companies dictating what you have to do, the pharmacy benefit managers deciding what type of medications patients can have, and the government with the protocols and things like that. And in all of this, there’s so much noise, but the one person who gets lost is the patient.

When I opened my own practice, I opened it in a small town. It was really a challenge for me, but also a learning curve to realize how the system is broken. The first day I opened the practice, I actually stayed in my office by myself until five o’clock, and I didn’t have any patients at the time. And it dawned on me a few days into it: why am I doing this? Why am I staying in the office if I don’t have the patients?

I’ve developed a practice where essentially the patient can always reach out to me. They can be seen in the office; we can do phone calls, whatever makes most sense for myself and the patient. And they’re the ones that really should be in charge of their healthcare. They are the ones that should be challenging the doctors on things that are happening when it comes to their healthcare.

The system itself is really not set up that way. The system currently promotes corporate practice of medicine, where you have many physicians who have left private practice and are part of a healthcare system. Once you’re part of a healthcare system, the system itself tells you what you’re supposed to do. You’re supposed to refer patients to their places for radiology, or if they have certain insurance, you can only send them to this pharmacy. And many times patients are left struggling to figure out what they’re supposed to do.

I would say that the best way that we can approach the current healthcare system in the United States is to promote more independent practices like my own. Mine is direct primary care. It’s the patient and myself. We make all the decisions together. And I always give examples of how you can get blood work and radiology outside of the system for much cheaper than if you use your insurance and deductible. Those are the things that patients need to learn, and those are the things that the system should actually teach the patients. A lot of times patients have to spend a lot of money on their care. And then you have a family of four with deductibles and things like that, and it gets really, really expensive. I think we have forgotten that medicine itself is supposed to be a decision-making process between patient and physician.

What can we do? How do we make the system better? That’s something that I get asked often. And I feel the best way to do that is for people to take charge of their health. You have to understand the struggles you’re going through. And there are many different policies that we can work on, but what we must work on the most is creating an environment where the physician can be independent so that the patient and physician can make decisions on their own without interference from the insurance or the government, the Centers for Medicare and Medicaid, and others. Because in all this quest to make things “better,” and I’ll put quotation marks around “better,” I’m not sure it is better. We have lost the sense of who is the most important. And at the center of healthcare and medicine is always the patient.

This is a very special time in the history of this country. We are about to celebrate 250 years of the Constitution and American history. I would say that the vision that our forefathers had when it comes to medicine is for the patient, the family, and our faith to be at the center of healthcare. And as we all know, it’s really not. Right now we’re struggling with different, I like to call them, third parties in the examining rooms with us when we’re making these decisions. And that’s not what it was ever meant to be.

What we need to do is celebrate the pioneering spirit of this country and go back to our roots. And our roots are doctor and patient making decisions for the bettering of the patient, for their healthcare, for the good lifestyle they want to have. We have seen in these past couple of years the return of eating better foods, and taking accountability. And the same has to happen in medicine. We need to get back to one doctor, your family doctor, your internal medicine doctor, who knows you, who knows your family, and who shares your values. And we need to get back to that time when only the two of you are the ones in charge of your healthcare and the healthcare decision-making.

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✍️ By Lynne Kristensen, IMA Senior Director of Communications & International Fellowship Program

In the first article in this series, we looked at the earliest roots of American medicine. Care began in the home. It was shaped by midwives, household remedies, local physicians, family responsibility, faith, and community trust.

But American medicine did not remain at the bedside forever.

Over time, care moved into lecture halls, laboratories, hospitals, and professional institutions. Physicians were no longer trained only by apprenticeship. Medical schools began to define the path. Licensing, clinical standards, and institutional authority gradually reshaped what it meant to practice medicine.

Much of this transformation was necessary. Some of it was lifesaving.

Medicine needed rigor. It needed anatomy, chemistry, pathology, public health, hospital experience, and scientific accountability. The loosely organized world of early American healing held real wisdom, but it also left patients vulnerable to poor training, dangerous remedies, inconsistent care, and even outright fraud.

Still, every transformation comes with a cost.

As medicine became more professional, it became more centralized. As it became more scientific, it sometimes became less personal. As it gained authority, it began to define more narrowly who could heal, what counted as legitimate knowledge, and which voices were allowed to be trusted.

The question for America at 250 Years is not whether medicine should be scientific. It must be. The question is whether medicine can preserve scientific rigor without losing the independent physician, the informed patient, and the human relationship at the center of care.

The First American Medical Schools

Formal medical education in America began before the nation itself. In 1765, the College of Philadelphia, now the University of Pennsylvania, became the first medical school in the American colonies. Students enrolled for anatomical lectures and instruction in the theory and practice of medicine. The school’s founder, John Morgan, had studied in Europe and returned with a vision for formal medical training modeled in part on Edinburgh and London.^[1]

This was a turning point. Medicine was beginning to move beyond apprenticeship alone. Students would study anatomy, theory, practice, and eventually clinical care. Pennsylvania Hospital, founded in 1751, also became an important site of clinical instruction for early medical students.^[2]

The emergence of medical schools reflected an important truth. Good intentions were not enough. A physician needed disciplined training. Anatomy mattered. Observation mattered. Clinical experience mattered. Standards mattered.

This was the good side of professionalization. It helped move medicine away from guesswork and toward organized knowledge for the growing population in the New World.

But from the beginning, access to this emerging profession was limited. Formal medicine was largely controlled by men, often those with social standing, money, and educational access. Women were mostly excluded. So were many Black Americans, Indigenous healers, midwives, enslaved people with practical healing knowledge, and non-mainstream practitioners.

As medical institutions gained power, they also began deciding who belonged inside the profession and who would be left outside it.

Medicine and the American Republic

The professionalization of medicine unfolded alongside the formation of the United States itself. That timing matters.

The founding generation understood health as more than a private concern. It was part of civic life. A healthy people were better able to work, raise families, serve communities, think independently, and participate in the life of the republic.

Benjamin Franklin was not a physician, but he embodied part of this founding-era health ethic. He promoted moderation, practical wisdom, civic responsibility, and empirical curiosity. His well-known maxim from Poor Richard’s Almanack, “Early to bed and early to rise, makes a man healthy, wealthy, and wise,” captured a broader belief that personal habits and public flourishing were connected.

That founding-era instinct is worth recovering.

Prevention was not a fringe idea. Personal responsibility was not separate from health. Practical evidence mattered. Health was not merely the absence of disease. It was connected to self-governance, resilience, and the ability to live freely.

Medicine at its best supports that kind of freedom. It helps people live with agency, dignity, responsibility, and strength.

The Rise of Professional Standards

By the 19th century, the need for reform was clear.

American medical training was uneven. Some schools were serious. Others were proprietary institutions with limited requirements. Many doctors learned through apprenticeships of varying quality. Medical sects competed for patients. Patent medicines and cure-alls flooded the marketplace.

The public had reason to be skeptical.

In 1847, the American Medical Association was founded after Nathan Smith Davis called for a national medical convention. According to the AMA’s own history, its early goals included scientific advancement, standards for medical education, medical ethics, and improved public health.^[3]

These were legitimate goals. A nation could not build trustworthy medicine on chaotic training and unregulated claims. Patients deserved physicians who were well educated, clinically competent, and ethically accountable.

The problem was not the desire for standards.

The problem was what can happen when standards become gatekeeping. Professional authority can become institutional power. Centralized organizations can begin to confuse their own approval with the full measure of truth.

Medicine needed reform. But reform also began to consolidate power.

Scientific Breakthroughs Changed Everything

The 19th century brought breakthroughs that changed the direction of medicine.

Anesthesia transformed surgery. In 1846, the public demonstration of ether anesthesia at Massachusetts General Hospital became one of the defining moments in modern surgical history. Surgery had once been limited by agony and speed. With anesthesia, it could become more deliberate, complex, and humane.^[4]

Germ theory and antiseptic surgery would later transform the understanding of infection. Hospitals, once feared by many as places of death, increasingly became centers of training, innovation, surgery, and specialized care.

These advances deserve to be celebrated. They were not mere institutional victories. They relieved suffering. They saved lives. They made once-impossible procedures possible.

But they also changed the center of gravity.

Medicine moved further from the home and more deeply into hospitals, laboratories, universities, and professional societies. The physician became more formally trained and more scientifically grounded. He also became more shaped by institutions.

That shift brought progress. It also changed the relationship between doctor and patient.

Women in Medicine: Excluded, Then Essential

The story of professionalization must include the women who were kept outside formal medicine and the women who forced the door open.

For generations, women carried much of the practical burden of care in homes and communities. They attended births. They nursed the sick. They prepared remedies. They preserved household medical knowledge.

Yet when medicine became formalized, women were often excluded from the professional path.

Elizabeth Blackwell changed history in 1849 when she graduated from Geneva Medical College and became the first woman in America to earn an M.D. degree. She later supported medical education for women and helped establish the New York Infirmary in 1857, creating opportunities for women physicians who were often denied internships and training elsewhere.^[5]

Her story reveals a paradox. Women had always been central to healing, but they had to fight to be recognized as physicians.

As medicine became more professional, it gained scientific legitimacy. At the same time, it risked losing contact with caregiving traditions that women had long sustained.

Any serious effort to restore the roots of American medicine must honor both. It must honor the scientific physician. It must also honor the caregiving inheritance of women, families, nurses, midwives, and community healers.

The Hospital and the Loss of the Whole Picture

Hospitals and medical schools gave physicians tools they could not have acquired in isolation or rural communities. Doctors could observe disease more closely. They could study anatomy, learn pathology, perform surgery, and compare cases. Over time, these institutions helped create a shared body of medical knowledge.

But institutional medicine also changed how patients were seen.

In the home, the patient was inseparable from context. In the hospital, the patient increasingly became a case. In the classroom, the disease could become the object of study. In the laboratory, the body could be analyzed in parts.

These developments were scientifically useful. They also encouraged fragmentation.

The whole person could be divided into organ systems, specialties, diagnoses, and later, billing codes. The more powerful medicine became, the easier it became to mistake the part for the whole.

That tension remains with us today.

Specialization has saved lives. It has also left many patients feeling that no one is looking at the full picture. One doctor sees the heart. Another sees the hormones. Another sees the gut. Another sees the immune system. Another sees the mental health symptoms. Another sees the medication list.

The patient is left trying to assemble the story alone.

The roots of American medicine remind us that the whole person must never disappear behind the disease.

The Cost of Centralized Authority

Professionalization created accountability. It also created hierarchy.

Licensing boards, medical societies, hospitals, universities, and later accrediting bodies increasingly determined who could practice, what could be taught, and what counted as acceptable medicine.

While the intention to protect patients from incompetence and fraud is important to note, overseeing entities were able to put some protections in place. Such that fraud should be exposed and dangerous claims should be challenged. Poor training should not be tolerated.

But the same machinery can also suppress legitimate disagreement. It can discourage innovation outside dominant institutions. It can marginalize independent physicians. It can dismiss approaches that deserve careful study rather than reflexive rejection.

This is where IMA’s mission becomes especially important.

The answer to medical fraud is not blind trust in centralized authority. The answer is transparency, evidence, open debate, ethical standards, informed consent, and protection of the doctor-patient relationship.

Remember the Roots, Preserve the Rigor

American medicine became a profession because it had to.

Patients needed better-trained physicians. Surgery needed anesthesia and technique. Infection needed scientific understanding. Public health needed organization for a new and rapidly expanding country. Medical education needed standards.

We should be grateful for those advances.

But medicine now faces a different kind of crisis. Many patients do not feel known. Many physicians do not feel free. Many families do not feel fully informed.

Doctors are often pressured to follow protocols that may not reflect the complexity of the individual patient. Patients sense when medicine has become too close to corporate incentives, government directives, and institutional control.

The next 250 years should not abandon professional medicine. They should redeem it.

That means preserving what professionalization gave us. Science. Training. Ethics. Accountability. Innovation. Standards that protect patients from harm.

But it also means restoring what professionalization too often crowded out. The independent physician. The informed patient. The family. The community. Clinical judgment. Humility. Prevention. Whole-person care.

Medicine became a profession.

Now it must remember that it is still a calling.

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Source Notes

• University of Pennsylvania Archives & Records Center, “Brief History: School of Medicine”. Used for the founding of the first medical school in the 13 American colonies, including the 1765 enrollment of students for anatomical lectures and instruction in “the theory and practice of physik,” as well as the role of John Morgan and European medical education influences.

• Perelman School of Medicine at the University of Pennsylvania, “Perelman School of Medicine History Timeline”. Used for background on Pennsylvania Hospital, founded in 1751, and its role as an early site of clinical instruction for medical students, as well as early medical education and 18th-century practices such as bloodletting.

• American Medical Association, “AMA History”. Used for the founding of the American Medical Association in 1847 and its early goals related to scientific advancement, standards for medical education, medical ethics and improved public health.

• National Institutes of Health / PubMed Central, “The Ether Dome and the First Public Demonstration of Surgical Anesthesia”. Used for background on the 1846 public demonstration of ether anesthesia at Massachusetts General Hospital and its significance in the history of surgery.

• National Institutes of Health / National Library of Medicine, “Biography: Dr. Elizabeth Blackwell”. Used for Elizabeth Blackwell becoming the first woman in America to receive an M.D. degree from an American medical school in 1849 and founding the New York Infirmary for Women and Children in 1857.

The Independent Medical Alliance (IMA), a national coalition of independent doctors, healthcare providers, and researchers, today welcomed the Department of Health and Human Services’ decision to terminate the COVID-19 Emergency Use Authorization declarations, calling it a long overdue correction to a regulatory shortcut that should never have been allowed to run for six years. HHS announced today that the EUA declarations for COVID-19 drugs, biological products, and medical devices will be terminated, with the declaration for drugs and biologics winding down over 12 months and the device declaration over 180 days. The original declarations took effect in March 2020, devices on March 24 and drugs and biological products on March 27, meaning the underlying authority has remained in place for more than six years. The EUAs for the Pfizer and Moderna COVID-19 vaccines were already rescinded in 2025, well before today’s broader termination.

“This is a step in the right direction that frankly should have happened years ago,” said Dr. Joseph Varon, President and Chief Medical Officer of the IMA. “COVID-19 products authorized under emergency use never underwent the same scrutiny required of fully licensed drugs and devices, and that has resulted in catastrophic harm to patients.”

Since 2021, the frontline doctors and researchers of the IMA and others raised significant alarms about a growing number of cardiac and other adverse events resulting from the rushed mRNA shot, injuries that regulators were slow to acknowledge publicly, and in some cases deliberately hid or obscured data reflecting these vaccine injuries.

“The harm caused is the predictable result of a system that allowed big corporations to rush these products onto the market,” continued Dr. Varon. “We applaud HHS for repealing the rest of these EUAs, but a 12-month sunset is too long. If the public health emergency justifying these authorizations no longer exists, there is no medical reason a product needs another full year of authorized use before transitioning through ordinary regulatory pathways.”

✍️ By Lynne Kristensen, IMA Senior Director of Communications & International Fellowship Program

As America approaches its 250th anniversary, it is worth remembering that American medicine did not begin as a system. It began in homes, churches, kitchens, sickrooms, childbirthing rooms, farms, and small communities where illness was not first met by institutions, but by family, faith, observation, practical remedies, and, when available, a local healer or physician.

This is not a call to romanticize the past. Medicine in 1776 was often limited, inconsistent, and sometimes dangerous. Physicians had few reliable tools. Many treatments were based on theories that would later be rejected. Patients were bled, purged, blistered, dosed with mercury, given opium preparations, or treated with remedies that were more forceful than effective.^[1]

And yet, there is something about early American medicine that deserves to be remembered. Before medicine became centralized, corporatized, and protocol-driven, care was deeply human. It was relational. It was local. It was personal. The sick person was not a chart or a claim. They were a neighbor, a mother, a father, a child, a parishioner, a farmer, a friend.

The first clinic was the home.

Care Began at the Bedside

For the average American in the late 18th century, illness usually began and was first addressed within the household. Families relied on inherited knowledge, home remedies, herbal preparations, rest, food, prayer, and the experience of women who often served as the first guardians of health. Midwives, grandmothers, and local healers held practical knowledge about childbirth, fevers, wounds, digestive complaints, pain, and seasonal illness.^[2]

In many communities, especially rural ones, trained physicians were not immediately available. Distance, cost, weather, transportation, and social class all shaped access to care. When a doctor was available, he often came to the patient. The sickroom was not yet a clinical space. It was the patient’s own world: the home, the family, the environment, along with the habits and the social reality in which illness unfolded.

That setting mattered. The physician saw more than symptoms. He saw the patient’s circumstances. He saw the family. He saw whether food was available, whether the home was cold, whether the patient was isolated, whether work demands were severe, whether childbirth had left a mother depleted, whether grief, exhaustion, or poverty had weakened the body’s ability to recover.

Modern medicine has gained extraordinary capabilities, but it has often lost this proximity. Today, patients are usually asked to enter the system on the system’s terms. They sit in waiting rooms, answer standardized questions, move through electronic portals, and receive care shaped by insurance rules, institutional policies, and limited appointment times.

The old model was imperfect, but it understood one essential truth: care begins by knowing the person.

The Role of Midwives, Women Healers, and Household Knowledge

Any honest history of American medicine must acknowledge the central role of women. Long before women were formally accepted into the medical profession, they were practicing care in homes and communities. Midwives were essential figures in colonial and early American life, and in many places they were among the most trusted and accessible health practitioners. OHSU’s history of midwifery notes that women-centered childbirth care was central in colonial America and that midwives came from many backgrounds, including enslaved Black women who served as midwives in the antebellum South.^[3]

Midwives did more than attend births. In many communities, they advised families, helped manage women’s health, provided practical remedies, and served as a bridge between household care and more formal medical intervention. A historical source from North Carolina notes that in the 18th century, people often consulted a midwife rather than a physician for illness or ailments, and in more remote areas, a midwife could be the only medical expert available.

This matters for IMA’s Medicine at 250 Years project because the roots of American medicine were never purely institutional. They were familial, female, community-based, and practical. They were built around trust.

When modern medicine became more professionalized, much of that knowledge was dismissed as informal or unscientific. Some of it undoubtedly needed scrutiny. But the wholesale dismissal of household wisdom, women’s healing roles, traditional remedies, and patient experience also narrowed the meaning of medicine.

The future should not require medicine to choose between science and wisdom. It should require the humility to study both.

Healing Was Local, Natural, and Spiritual

Early American care also included herbal and botanical remedies. Colonial-era medicine made use of plants, roots, barks, tinctures, teas, and purgatives. Some botanical remedies were based on European traditions; others drew from Indigenous knowledge, African healing traditions, and local adaptation to the American environment.^[4]

This does not mean every natural remedy was safe or effective. The word “natural” has never automatically meant harmless. Some herbal preparations were powerful, toxic, contaminated, or misused. But the instinct behind much of household medicine was important: support the body, observe patterns, use what is available, and treat the person in context.

Faith also played an important role. For many Americans, illness was not understood only as a mechanical malfunction. It was a moment of vulnerability, fear, family, and prayer. Churches, clergy, neighbors, and communities often helped carry the sick through illness and death.

Modern medicine does not need to become religious medicine. But it should remember that patients are not merely biological systems. They are human beings with values, beliefs, and sources of strength. For many patients, faith and community remain part of healing, resilience, and decision-making today. A medical system that ignores those realities risks misunderstanding the whole person it is trying to treat.

The Limits and Harms of Early Medicine

The roots of American medicine were human, but they were not always healing. Early physicians often worked within humoral theory, which understood disease as imbalance or impurity within the body. Treatments were designed to remove or rebalance what was thought to be harmful through bleeding, purging, sweating, vomiting, blistering, and other forceful interventions.^[5]

Mercury was commonly used. So were purgatives and emetics. Opium preparations were used for pain, sleep, cough, diarrhea and distress. Bloodletting remained common for many conditions and was not broadly discredited until the late 19th century.^[6]

These practices are a warning. Medical consensus can be wrong. A treatment can be widely accepted, taught, defended, and used by respected physicians—and yet still later be recognized as harmful.

That lesson should not make us anti-medicine. It should make us humble.

The honest physician knows that every era is tempted to confuse confidence with truth. Every medical generation looks back at the previous one and sees error. The question is whether we are willing to look at our own era with the same clarity.

The Doctor as Steward

For all its limitations, early American medicine preserved a role we desperately need to recover: the physician as steward.

A steward is not merely a technician. A steward is entrusted with something sacred. In medicine, that sacred trust is the vulnerable patient, the family, the truth, and the physician’s duty to act according to conscience and clinical judgment.

The community doctor did not have all the answers. Oftentimes, he had too few. But he was expected to show up. He was expected to know the family. He was expected to bear witness. He was expected to serve.

Today, physicians have far more knowledge and far better tools. But many are trapped in systems that make it harder to practice as stewards. They are asked to document more, see more patients in less time, follow more protocols, satisfy more administrative demands, and subordinate clinical judgment to institutional policy, payer requirements, or algorithmic pathways.

Patients feel this loss. They know when they are being processed instead of heard. They know when the doctor is rushed. They know when the computer has become the third person in the room.

The first article in this series begins here because this is the foundation: before medicine was a system, it was a relationship.

Remember the Roots, Shape the Future

Returning to the roots of American medicine does not mean returning to bloodletting, mercury, or medical guesswork. It does not mean rejecting antibiotics, surgery, diagnostics, emergency medicine, anesthesia, or the extraordinary advances that have saved millions of lives.

It means remembering that science without relationship is incomplete, and never truly “settled.” Technology without trust is insufficient. Protocols without judgment are dangerous. Systems without humanity are not healing systems at all.

The home was the first clinic. The family was the first care team. The community was the first health network. The physician, when called, entered the patient’s life as a guest, witness, and steward.

As America looks toward its next 250 years, medicine should not simply ask what more it can do. It should ask what it must restore.

The answer begins with the patient, the physician, the family, and the trust between them.

Source Notes

• The Encyclopedia of Greater Philadelphia, “Medicine (Colonial Era)”. Background on colonial-era medicine, including humoral theory, bleeding, purging, vomiting, mercury, botanical remedies, and the role of Philadelphia in early American medical development.

• Oregon Health & Science University Center for Women’s Health, “A Brief History of Midwifery in America”. Background on midwifery in colonial America, women-centered childbirth care, midwives traveling to homes, and the role of midwives as community care providers.

• Oregon Health & Science University Historical Collections and Archives, “There’s a Cure for That: Historic Medicines and Cure-alls in America”. Historical context on patent medicines, bloodletting, purges, laxatives, mercury, opium, alcohol-containing remedies, and the accessibility of patent medicines compared with physician care.

• U.S. National Library of Medicine / PubMed, “Medicine in the American Revolution”. Historical context on colonial and Revolutionary-era medical care, including depletion practices such as bleeding, purging, sweating, blistering, and vomiting, as well as common drugs such as opium and cinchona bark.

• National Institutes of Health / National Library of Medicine, “Plants and Medicine: The National Library of Medicine’s Herbal Pharmacopeia”. Background on the long history of botanical and herbal remedies in medicine.

Followers of IMA will know that repurposed drugs like ivermectin and fenbendazole are part of our ever-expanding cancer treatment guidance. Now, that guidance is under pressure from the largest oncology society in America.

In June 2026, the American Society of Clinical Oncology published a clinical notice recommending against the use of ivermectin and fenbendazole for cancer treatment outside of clinical trials. ASCO’s message to oncologists: patients are finding these drugs through social media, and that is a safety problem.

IMA’s Chief Scientific Officer Dr. Paul Marik sees it differently. In a detailed response on Substack, he argues that ASCO is overlooking the evidence that does exist and holding these drugs to a standard that only well-funded pharmaceutical products can realistically meet.

This is not an argument for patients to self-prescribe or replace standard oncology care. It is an argument about which kinds of evidence count and who gets to decide.

What ASCO Said—and What It Leaves Out

ASCO’s notice states that there is “no robust, peer-reviewed clinical evidence” that these agents are safe or effective for any human cancer, and that well-designed clinical trials are needed. It points to just one in-progress trial and one planned trial.

What the notice does not address, according to Dr. Marik, is everything else: the preclinical research, the mechanistic studies, the pharmacologic data, the observational clinical experience, and the growing body of real-world outcomes. ASCO focused on what is absent. It did not engage with what is present.

Dr. Marik identifies three reasons the standard ASCO is demanding does not fit these therapies:

• Cost: A phase III oncology randomized controlled trial (RCT) can cost hundreds of millions of dollars. For patented drugs that generate billions in revenue, that investment makes sense. For cheap generics and nutraceuticals, there is often no one willing to fund it. The absence of trials is not proof that the drugs do not work.

• Complexity: Cancer protocols built from repurposed drugs may use five, ten, or fifteen agents at once, each targeting a different pathway. Testing every combination in separate RCTs is logistically impossible.

• Real-world mismatch: RCT patients are carefully selected. Many real-world cancer patients are older, sicker, and managing multiple conditions. The patients actually using repurposed drugs are the ones least likely to qualify for the trials being demanded.

Marik points to efforts like the Care Oncology Clinic’s METRICS study as a more realistic model: track structured outcomes from patients on a defined protocol and compare survival against expected benchmarks.

“Demanding a large RCT before even considering low-cost therapies may sound scientific, but it can function as a gatekeeping strategy.” — Dr. Paul Marik

A Better Way to Study These Drugs

The alternative Dr. Marik proposes is not weaker evidence. It is different evidence: track real patients, document outcomes carefully, compare results against matched populations, and replicate independently. Studies in the New England Journal of Medicine and a Cochrane review have shown that well-designed observational studies can produce results comparable to randomized trials.

If you were with IMA during COVID, this will feel familiar. Inexpensive repurposed drugs dismissed not because the science was settled, but because they didn’t fit the system. That fight is now playing out in cancer care.

“The goal should not be to lower scientific standards. The goal should be to use the right standard for the right question.” — Dr. Paul Marik

Dr. Marik’s argument is ultimately about clinician freedom: the ability to consider all reasonable options for individual patients, especially adjunctive therapies supported by biology, clinical experience, and real-world outcomes.

The question is whether medicine is willing to consider the full spectrum of credible evidence when caring for individual patients. At IMA, we believe scientific rigor and clinical judgment should complement one another, not compete. Patients deserve physicians who can thoughtfully evaluate every reasonable option in pursuit of the best possible outcome.

Related Reading

• Hub: Cancer Resource Hub

• Video: Cancer Care: Preventing Cancer — The ROOT Protocols

• Guide: The Approach to Repurposed Drugs for Cancer

• Monograph: Cancer Care: Repurposed Drugs & Metabolic Interventions

• Post: Why Randomized Controlled Trials Are Poorly Suited to Testing Repurposed Drugs and Nutraceuticals in Cancer (Dr. Marik’s full Substack response)

What should patients know as cancer care continues to evolve? In this week’s webinar, Dr. Ryan Cole is joined by Dr. Paul Marik for a practical discussion on smarter, more affordable interventions in cancer care. The conversation looks beyond the tumor itself, focusing on the questions patients can bring to their medical team as they navigate treatment, surgery, and long-term support.

The research keeps moving, and so do IMA’s cancer care guides. This week’s webinar reflects the latest updates in an ongoing conversation, one that has grown sharper as Dr. Marik and the team continue working through the evidence on metabolism, immune function, repurposed drugs, and the perioperative window most oncologists still are not addressing.

Dr. Cole and Dr. Marik discuss why individualized treatment decisions matter more than protocol defaults, how vitamin D dosing guidance and repurposed drug cycling have shifted based on new data and patient feedback, and what patients should know about the window around surgery, when a handful of inexpensive interventions may help reduce the risk of metastatic spread.

Meet the Experts

Dr. Paul Marik

Pulmonary and Critical Care Specialist; Chief Scientific Officer, IMA. Dr. Marik is one of the most published critical care physicians in the world and a co-founder of IMA. His work on inflammation, immune function, and repurposed drugs has shaped IMA’s cancer care guides, including the newly expanded perioperative guide. He writes regularly at his Substack.

Dr. Ryan Cole

IMA Head of Medical & Scientific Affairs; Senior Fellow, Pathology; Founder, Cole Diagnostics. Dr. Cole brings pathology-level context on tumor biology, adhesion mechanisms, and diagnostic markers. His current research focus includes the role of light and circadian biology in disease prevention.

1. Beyond the Tumor: Why Individualized Care Starts with Lifestyle

The first conversation most oncologists skip is the one about what the patient can control. What you eat, how you sleep, whether you get outside, and how you manage stress: these things change the environment your cancer lives in, and the evidence behind them is not small. Glucose control alone changes the metabolic environment the tumor depends on. But according to Dr. Marik, most oncologists still dismiss the question entirely.

“The patient walks into the office of the oncologist and says, what can I eat? The oncologist says, doesn’t matter. Chocolates, cake, crispies. And we know that is categorically absolutely false.”

Dr. Paul Marik

Meanwhile, the default in most practices remains high-dose pulsed chemotherapy, which suppresses the natural killer cells, T cells, and macrophages the body needs for cancer surveillance. For some cancers, that tradeoff makes sense: Hodgkin’s lymphoma, testicular cancer, and certain leukemias have strong treatment records with conventional chemo. For many others, Dr. Marik argued, it does not. Dr. Cole’s own mother, 83, ended up septic and in the ICU for weeks after chemotherapy suppressed her neutrophils following a double mastectomy.

Alternatives exist. Metronomic chemotherapy is continuous, low-dose, taken orally, and targets the tumor microenvironment without broadly suppressing the immune system. It has published evidence in breast and colorectal cancers and can run alongside repurposed drugs and nutraceuticals. The point is not to reject chemotherapy. The point is that individualized care starts before any drug enters the conversation, and the system rarely gives patients that chance.

2. Vitamin D and Repurposed Drugs: What’s Changing

IMA’s vitamin D guidance and repurposed drug recommendations have both shifted since these topics last came up on the webinar.

Vitamin D

Nearly every cancer patient Dr. Marik encounters has a vitamin D level below 20 ng/mL. The geographic data tells the same story: as populations move farther from the equator and get less sun, cancer rates climb. Supplementation studies confirm that restoring adequate levels reduces risk. This is not theoretical, Dr. Marik emphasized. This is published, reproducible data.

The dosing framework both physicians endorsed:

• General population: around 50 ng/mL

• Cancer patients: 75 to 100 ng/mL

• Aggressive protocols (Coimbra): up to 150 ng/mL, with parathyroid hormone and calcium monitoring

At higher levels, K2 and magnesium are essential to keep calcium from leaching into circulation.

Dr. Cole added a practical layer from his work on circadian biology. Morning sunlight in the first two hours after sunrise activates clock genes that upregulate P53, a key tumor suppressor, along with protective melanin and retinol pathways. For people with darker skin types in northern latitudes, the need is significantly greater because higher natural melanin acts like a built-in SPF 50. Sunshine also delivers benefits supplementation cannot replicate: nitric oxide production, lower blood pressure, and reduced reactive oxygen species. But most patients still need oral vitamin D to reach protective levels.

“You have to think of vitamin D like fuel in your car tank. You burn through it every day. And when your body is revved because it’s fighting cancer, you’re going to burn through it faster.”

Dr. Ryan Cole

Repurposed Drugs

Cancer cells are metabolically flexible. Target one pathway, and they reroute to another, which is why single-agent approaches do not work. Dr. Marik’s “metabolic trap” framework addresses this by targeting at least five major metabolic pathways simultaneously, cutting off the cell’s ability to shift fuel sources.

Two practical updates from this conversation:

• Cycling has been revised: the previous recommendation to alternate doxycycline and mebendazole monthly did not work for every patient. The approach is now individualized.

• Ivermectin dosing is not one-size-fits-all: start at the lowest dose, follow the patient, adjust based on response and tolerance.

Large randomized controlled trials for these combinations will likely never happen. The drugs are generic, the designs are complex, and nobody is funding them. But the observational evidence is substantial. Dr. Cole shared the case of a physician colleague with myeloma whose cancer markers normalized on mebendazole after standard chemotherapy failed. When he told his oncologist, the response was blunt: “It’s not going to change my care.”

“The science is not settled. We’re learning all the time. I learn something new every day. It’s really important not to be dogmatic.”

Dr. Paul Marik

3. The Perioperative Window: Reducing Metastatic Risk Around Surgery

Surgery for cancer dislodges malignant cells into the bloodstream. This can be measured directly: circulating cancer cell counts rise after surgical procedures. Those dislodged cells can travel through the bloodstream, embed in distant tissues, and establish metastases months or years later. The evidence supporting this is not emerging science, Dr. Marik stressed. It is well-established across peer-reviewed literature.

Dr. Marik outlined four interventions with published evidence for reducing perioperative metastatic risk. All of them are inexpensive.

Modified Citrus Pectin

• Derived from orange peel; binds Galectin-3, a protein cancer cells use to stick to blood vessel walls and burrow into surrounding tissue

• No known contraindications

• Must be taken on an empty stomach with no food or other medications (it forms a gel that binds indiscriminately)

Propranolol

• A beta blocker that modulates the adrenergic stress response, helping the immune system target circulating cancer cells after surgery

• Safe at low doses

• Patients should notify the anesthesiologist so heart rate effects can be accounted for

Celecoxib (Celebrex)

• A COX-2 inhibitor that disrupts the inflammatory mediators tumors need to embed in tissue

• Should be avoided in patients with active coronary artery disease

Cimetidine

• An H2 blocker originally developed for peptic ulcer disease

• Has specific evidence in colorectal cancer surgery, where it affects immune function, endothelial adhesion, and the molecules cancer cells use to anchor in new tissue

Timing: begin two weeks before surgery and continue for three to six months afterward. Cost: roughly $30 to $40 per month.

“Every single patient who is undergoing a surgical procedure for a malignant tumor should receive these safe, effective drugs to reduce the risk of metastases.”

Dr. Paul Marik

What the Pathology Shows

Dr. Cole explained why these interventions matter at the cellular level. Adhesion molecules like ICAM (intracellular adhesion molecule) act as cellular Velcro, holding tumor cells in place. When a cancer loses these molecules, its cells become free-floating and capable of metastatic spread. Specialized stains can detect this loss, which is one reason diagnostic biopsy data matters when planning the perioperative approach.

The question of whether biopsies themselves carry a similar risk came up during the audience Q&A. Dr. Cole’s assessment: the risk is significantly lower with biopsies than with full surgery, especially for small-gauge needle biopsies. But for more invasive procedures, both physicians recommended using the same perioperative interventions. The cost of doing so is trivial. The potential benefit is not.

When metastatic treatment costs are considered in comparison, the math becomes hard to ignore. Complex interventions for bone, lung, or brain metastases are among the most expensive in medicine.

“I think it’s medical malpractice to perform surgery on a patient for cancer without giving the patient these pre-operative drugs to reduce the risk of metastatic spread.”

Dr. Paul Marik

Knowledge, Hope, and Teamwork

Dr. Marik’s closing framework applies to everything covered in this week’s webinar. Patients need knowledge of their specific disease, hope that better options exist, and a medical team willing to work with them as partners. They cannot navigate cancer care alone, and they should not have to. But they also cannot afford to remain passive while someone else decides the course.

🎓 Introducing IMA Academy

Both Dr. Marik and Dr. Cole have lectures available on the IMA Academy, now live at academy.imahealth.org. The platform launches with more than 225 lectures across 56 faculty members, including all 15 sessions from the 2026 IMA Conference in Dallas. Healthcare professionals can earn 12 CME credits, and a new course on adjunctive cancer therapy is in development for later this year.

Visit IMA Academy →

Related Reading

• Monograph: Cancer Care

• New Guide: Perioperative Repurposed Drugs to Reduce Metastases

• Hub: IMA Cancer Resource Hub

• Course: IMA Academy

The conversation expands into the broader biology of aging. Dr. Cole explains how senescent “zombie cells” accumulate over time, driving chronic inflammation without serving a purpose, and how natural compounds like quercetin and fisetin, found in apple peels, strawberries, and dark berries, are being explored to clear them. He also highlights the role of mitochondrial health and light therapy in restoring cellular energy.

We appreciate the feedback from our community on this segment. The Independent Medical Alliance and Dr. Ryan Cole reject the characterization that discussing an experimental therapy constitutes an endorsement of that therapy.

This interview addressed a novel gene therapy that has entered early human trials and sought to explain the underlying science and potential implications to the public. Physicians have a responsibility to discuss emerging medical developments, especially those that may generate significant public interest and ethical questions.

IMA remains committed to scientific integrity, informed consent, transparency, and rigorous evidence-based evaluation of all medical interventions. We have consistently maintained that new therapies, whether pharmaceuticals, biologics, vaccines, or gene-based technologies, must be subjected to careful scrutiny regarding both their potential benefits and their risks.

Legitimate questions concerning the safety, efficacy, and long-term consequences of experimental therapies deserve thoughtful scientific debate. Such questions should be addressed through data, peer-reviewed research, and open discourse rather than through personal attacks or mischaracterizations of intent.

Our position has not changed: science advances through inquiry, transparency, and respectful debate. Discussing an emerging therapy is not synonymous with promoting, endorsing, or recommending it.

— Dr. Joseph Varon, Chief Executive Officer, Independent Medical Alliance

Check out these related resources from IMA below, followed by the full segment transcript.

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• Webinar: The Oral Microbiome: What Your Mouth Reveals About Your Health

Transcript

Jan Jeffcoat: The search for the fountain of youth may have taken a major step forward. A new experimental gene therapy is giving researchers hope they may one day be able to slow or even reverse the effects of aging. Joining us now is Dr. Ryan Cole, Head of Medical and Scientific Affairs at the Independent Medical Alliance and Senior Fellow in Pathology. Good morning to you, sir. Great to see you as always.

Dr. Ryan Cole: Good morning, Jan.

Jan Jeffcoat: What is this new gene therapy? How’s it designed, and how big of a breakthrough could this be if it lives up to its promise?

Dr. Ryan Cole: This is an experimental therapy. It’s based on the work of Dr. Yamanaka, who is a Nobel Prize winner back in 2012. He won the Nobel Prize in Medicine, and it’s an injection into the eye. It’s being explored right now for age-related conditions like glaucoma as well as ischemic stroke of the eye. It’s based on giving instructions to the cells to make three proteins — not just to protect them, but to bring back their youthful activity and their youthful form. The trial will take five years, so it’s going to be a while till we get the results, but it showed promising results in mice and primates, and hence it’s been allowed to move on to human trials.

Jan Jeffcoat: And when folks hear the phrase “reverse aging,” it always sounds too good to be true. So what do scientists actually mean by that? How much of this is real science versus future possibility?

Dr. Ryan Cole: That’s a great question. It’s not science fiction like we’re trying to turn the fountain of youth clock back to us being children again. It’s basically turning on little tags that we have on our DNA that over time have like a dimmer switch on them. So when we’re trying to reverse aging, it’s basically taking that dimmer switch off and making these tags on the DNA active again so that the cells can function more normally.

Jan Jeffcoat: So this research, as you mentioned, is focused on eye disease. But are there other areas of aging research that you think are medically interesting or worth paying attention to?

Dr. Ryan Cole: Absolutely. We have certain types of cells in our body — as we age, or from injury or stress, or just time — that become senescent, or basically they become like zombie cells. They hang around, they cause chronic inflammation, but they don’t really serve a purpose. So there are certain medications that are being explored for this. One is an old leukemia drug. But there are natural compounds like quercetin that you find in apple peels, onions, dark berries, capers, broccoli, kale — some of the things kids don’t want to eat. But those, as well as something called fisetin, which we find in strawberries, apples, and persimmons — so maybe an apple a day does keep the doctor away. But yeah, some of these compounds will take these aging cells and make them go away.

Jan Jeffcoat: Can you just eat the food you just mentioned, or is it better to take that compound?

Dr. Ryan Cole: I think eating a healthy diet is one of the most important things. And we’re also exploring mitochondrial health. We’ve talked before about the importance of different light therapies to restore the activity of these little powerhouses of our cells. So there are a lot of areas of research.

Jan Jeffcoat: All right. And for more information on this and other medical research from the Independent Medical Alliance, you can go to imahealth.org. Dr. Ryan Cole, always a pleasure talking to you, sir. Thanks for joining us this morning.

Against that evidence, defenders of mass vaccination have leaned on one core claim: even if the vaccines carried risks, they prevented death.

A major government-funded study from Australia made that claim in unusually strong terms. Published in The Lancet in 2023, the study examined more than 3.8 million adults aged 65 and older and concluded that COVID vaccination was “highly effective” against COVID death. A fourth dose, the authors reported, showed vaccine effectiveness above 84%. The Australian government still cites the study to support annual booster recommendations for people over 65.

A new analysis published in the Journal of Independent Medicine puts those claims to a basic plausibility test.

The authors, Clare Pain, a medical journalist and former statistician, Dr. Mark Jones, Associate Professor of Biostatistics at Bond University, and Dr. Christopher Neil, a cardiologist and independent researcher, compared the Lancet study’s findings against Australia’s own official death statistics. Their conclusion is simple: the numbers require believing something that is not mathematically plausible.

“On one side of the coin, you’ve got a study saying that the vaccine was given to almost everyone and reduced all-cause mortality by 50%. But then the official data said that in that population, the all-cause mortality was higher than expected by 13%.” — Mark Jones

📖 Read and Download the Full Paper

The Claim That COVID-19 Vaccination Protected Australians from All-Cause Mortality Is Not Plausible (JIM Vol. 2, No. 3, 2026) — Author: Clare M. Pain, Christopher Neil and Mark Jones

The Study Behind Australia’s Booster Policy

The study in question, by Liu et al. (2023), compared outcomes for 3.7 million vaccinated Australians aged 65 and older with roughly 165,000 who were unvaccinated. More than 95% of the elderly population had received at least one dose.

This was an observational study, not a randomized controlled trial. The vaccinated and unvaccinated groups were not randomly assigned. In a country where nearly everyone in this age group complied with vaccination recommendations, the small group that remained unvaccinated was likely different in important ways, including health status, behavior, access to care, and baseline risk of death.

Yet Liu et al. concluded that a recent fourth dose provided vaccine effectiveness above 84% against COVID death. The study also reported that vaccination reduced all-cause mortality by 57.5% within three months of a fourth dose.

The authors reported large reductions in death from cancer (66.6%), dementia (41.2%), heart disease (43.4%), cerebrovascular disease (42.5%), and respiratory disease (57.3%).

A COVID vaccine was not designed to prevent death from cancer, dementia, or heart disease. Some of these conditions develop over years. Some take years to become fatal. Yet the study’s reported protective effect appeared across nearly every major category of death.

When a COVID vaccine appears to protect against COVID, cancer, dementia, and heart disease at similar rates, the most likely explanation is not that the vaccine prevents nearly every major cause of death.

The more likely explanation is that something went wrong in the analysis.

One number makes the problem impossible to ignore: the Australian Bureau of Statistics reported 13% excess mortality among people 65 and older in 2022.

If vaccination cut all-cause mortality roughly in half in a population where more than 95% were vaccinated, excess mortality should have moved sharply downward.

Instead, it rose to the highest level in nearly a century.

The 121% Problem

Pain, Neil, and Jones put a number on that contradiction.

Using Liu et al.’s own claims, they calculated a weighted average vaccine effectiveness of 51.2% against all-cause mortality. Then they asked the obvious question:

If that level of protection was real, what would excess mortality have been in Australia without vaccination?

The answer: 121%. More than double the expected number of deaths.

Two independent lines of evidence show why the figure is not plausible.

First, the global comparison. In 2020, COVID swept through unvaccinated populations around the world. Across 28 OECD countries, the median excess mortality among people 65 and older was 11.9%. Mexico was the highest at 52.7%, a clear outlier. The next highest was Poland at 25%.

No country came close to 121%.

And those countries were hit before vaccination, during the earlier and more severe phases of the pandemic, not during the Omicron period Australia faced in 2022.

Second, Australia’s own mortality history. Death rate data going back to 1935 shows that the highest annual excess death rate before COVID was 7.5%, recorded in 1942 during World War II. In 2022, Australia reached 12.8%, the highest level in 87 years.

Liu et al.’s results require accepting that without vaccination, the 2022 spike would have been nearly 10 times higher.

“Liu et al. are asking us to accept that if their claims about the effects on all-cause mortality are true, then that spike in 2022 would have been nearly 10 times higher. Well, we think this is just not plausible.” — Clare Pain

Even when the authors ran sensitivity analyses accounting for healthy and unhealthy vaccinee effects, the implied excess mortality remained extreme: 112% and 126%.

And Then There’s Cancer and Dementia

The all-cause mortality claim was already difficult to accept. Liu et al. went further.

The study reported that a fourth COVID booster reduced cancer deaths by 66.6% and dementia deaths by 41.2% within three months.

The authors suggested that COVID infection can worsen cardiovascular and respiratory conditions, meaning vaccination might indirectly reduce deaths in those categories. But that explanation does not resolve the problem.

The vaccine provided only limited protection from infection. Seroprevalence data showed prior COVID infection among Australians aged 70 and older rose from 6.4% in February 2022 to 51.4% by November 2022, regardless of vaccination status.

Severe disease was also uncommon. Only 1.9% of infections led to hospitalization.

That is not enough to explain large reductions in deaths from cardiovascular and respiratory conditions. It does even less to explain sharp reductions in deaths from cancer or dementia.

Liu et al. acknowledged that “uncontrolled confounding by behavioural aspects associated with vaccine uptake” could explain their findings.

They reached the vaccine-effectiveness conclusion anyway.

From Flawed Data to Flawed Policy

The all-cause mortality results are almost certainly an artifact of methodology, not evidence that COVID vaccination prevents death from all causes.

The same methodology was used to estimate COVID-specific mortality. If the all-cause mortality findings are distorted, then the study’s central conclusion, that the vaccines were “highly effective” against COVID death, becomes harder to trust.

Despite this, the study continues to support Australian government recommendations that people 65 and older receive annual COVID boosters.

Pain, Neil, and Jones first submitted their critique to The Lancet, where the original Liu et al. study appeared. It was rejected. They pressed further. The editor asked for more information. They provided it.

The response: their data was “too preliminary” to publish.

“We’re very grateful that this study and our letter in March have been published by JIM because without that, our concerns about this claim of the effect on all-cause mortality just wouldn’t have seen the light of day.” — Clare Pain

The full study is available open-access at journalofindependentmedicine.org.

Related Reading

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• Guide: COVID Vaccine Harm: What the Data Shows

• Journal: Journal of Independent Medicine

By Dr. Joseph Varon (published by Brownstone Institute)

A Room Full of Questions

A few days ago, I spent time with a remarkable group of people from many professions and backgrounds, the Brownstone Fellows and Scholars. Some were physicians, others were scientists, economists, historians, attorneys, writers, and scholars. They often disagreed, sometimes strongly. But as I listened, I noticed something rare these days: people felt comfortable asking questions without needing immediate answers.

That moment stayed with me after the gathering. On my flight home, I thought about why the atmosphere felt so refreshing. It was not because everyone was brilliant, though many were, or because they all agreed. In fact, it was the opposite. What stood out was their willingness to explore uncertainty without feeling threatened. No one rushed to settle debates, simplify complex topics, or force every discussion to a final answer.

This experience reminded me of a lesson I have learned many times in medicine. The most important questions often do not have easy answers. As I get older, I am less impressed by certainty and more by curiosity. Certainty can feel safe, but curiosity is what helps us grow. It keeps us learning, questioning, and most of all, humble.

Today, people often confuse certainty with wisdom. Confidence is rewarded in public discussions, on television, and on social media. The person who sounds most sure is often seen as the expert. But in my experience, confidence and wisdom do not always go together. Some of the wisest people I know are quick to admit what they do not know.

Medicine’s Long Lesson in Humility

I have spent much of my adult life working in intensive care units. Critical care teaches lessons that no textbook can fully explain. At first, every physician thinks knowledge is the key to success. We study, memorize facts, and learn protocols. Knowledge is important, but medicine eventually teaches us something else: knowledge alone is not enough.

The ICU is a tough teacher. It shows us that people are more complex than any model or algorithm. Some patients arrive very sick and recover when we least expect it. Others seem stable but get worse. Every experienced ICU doctor has stories that stay with them for years, cases that seemed simple but were not, diagnoses that changed with new information, treatments that failed, and recoveries that seemed impossible.

When I started my career, I thought experience would eventually remove uncertainty. I believed that with enough years, I could predict outcomes more accurately. In some ways, this is true. Experience does improve judgment and helps us spot warning signs. But it also brings something else: humility.

The more years I spent in medicine, the more I saw how much we still do not know. Experience did not erase uncertainty; it showed me how often it remains. Good doctors learn to make decisions even when they do not have all the facts. They act with confidence but admit they might not see the whole picture. This balance is one of the most important and least recognized parts of medicine.

I often tell medical students that medicine is not about certainty, but about probability. We look at evidence, weigh risks, and make the best choices we can with what we know. Patients sometimes think doctors are more certain than we really are. In truth, much of medicine is about working in the gray areas. The real challenge is not getting rid of uncertainty but learning to work with it.

Over time, I have grown wary of people who seem completely certain about complex topics. This does not mean they are always wrong, but life has taught me to be careful when someone acts as if a complicated issue is fully settled. Reality is rarely that simple, and people are not either.

The Privilege of Being Wrong

One of the most valuable lessons medicine teaches is something that sounds counterintuitive. I am specifically talking about learning that being wrong can be a privilege, even if it sounds surprising. Otherwise, a clinician is either fooling himself/herself or attempting to fool everyone else. We have all made diagnoses that later proved incorrect. We have all developed treatment plans that required revision. We have all encountered situations where reality contradicted our expectations.

The goal in medicine is not to avoid mistakes, because that is impossible. The real goal is to notice our mistakes quickly enough to help the patient. Medicine is about constantly updating what we know as new information comes in. We start with ideas, collect data, adjust our thinking, and revise our conclusions, over and over again.

Outside of medicine, however, being wrong is often treated as a personal failure. People hold on to their opinions even when evidence suggests they should reconsider. Public figures are criticized for changing their minds, and institutions may avoid admitting mistakes. Sometimes, organizations care more about looking credible than about finding the truth. Advancement requires it. Medical advancement requires it. Personal growth requires it. Every meaningful discovery begins with the possibility that our previous understanding was incomplete. The individuals who continue learning throughout their lives are often not those most committed to being right. They are those most willing to discover where they might be wrong.

The Modern Obsession with Certainty

Looking beyond medicine, it is clear that modern society is very attached to certainty. We seem less comfortable with uncertainty. People expect every issue to have a clear answer and every question to have a quick conclusion. Complex situations are often reduced to two sides.

This is understandable. Certainty feels good and reduces anxiety. It helps us organize a complicated world into manageable categories. But comfort and truth do not always go together. And my meeting this past weekend proved this to be the case.

Many of society’s biggest issues involve competing values, incomplete information, and tough tradeoffs. Public health, economics, education, ethics, technology, and government are all complex and do not have simple answers. Still, public discussions often act as if certainty is easy to find.

Social media has amplified this tendency. Indeed, social media makes this problem worse. Nuance is hard to find in places that reward speed and emotion. People who sound completely confident get more attention than those who admit uncertainty. Over time, this encourages conviction instead of careful thought policy. They influence how people think. They influence how institutions behave. They influence how conversations occur. Questions increasingly become viewed as challenges rather than opportunities. Disagreement becomes evidence of disloyalty rather than evidence of intellectual engagement. Maybe the biggest loss in this environment is curiosity.

Curiosity as a Virtue

Sometimes I think children understand science better than adults do. Anyone who has spent time around young children knows this. They ask endless questions: Why is the sky blue? Why do people get sick? Why do stars shine? Why do things fall? Their curiosity has no limits. They do not care about looking smart or asking the wrong question. They just want to understand.

As adults, in general, we start to care more about defending what we know than exploring what we do not. We learn which questions are safe to ask and which are not. We find out that curiosity can make people uncomfortable. Over time, many of us hold back, not because questions are forbidden, but because asking them can have consequences.

This is unfortunate, because curiosity has driven almost every important advance in human history. Scientific discoveries, medical breakthroughs, and philosophical insights all come from curiosity. It is not just an intellectual virtue—it is a deeply human one.

People who keep asking questions throughout life stay intellectually alive. They keep learning, adapting, and growing. Most importantly, they stay open to the idea that there is always more to learn. Brownstone scholars clearly keep asking questions.

Why Uncertainty Matters

The older I get, the more I see that uncertainty has an important role. It reminds us of our limits, keeps us humble, and encourages us to keep learning.

This does not mean we should avoid decisions. Doctors cannot delay treatment forever, and leaders cannot put off choices. Life requires action. But we can act with humility. We can make decisions while admitting uncertainty, hold beliefs while staying open to new information, and be confident without being stubborn.

The best intellectual environments are not the ones where everyone agrees. They are places where people can disagree without hostility, where questions are welcome, evidence is examined honestly, and curiosity is encouraged. These places are rare now, which makes them even more valuable.

Maybe that is why those recent conversations with this unique group of individuals stayed with me. What impressed me was not that people had all the answers—no one does—but that they kept asking questions. In a world focused on certainty, they stayed curious.

The Questions That Remain

Looking back on my career, my time as both doctor and, in some instances, even as a patient, and all the people I have met, I keep coming back to one idea. The future of science, medicine, education, and maybe even society depends more on our curiosity than our confidence. Expertise, experience, and knowledge all matter, but nothing can replace the willingness to ask hard questions.

Every important discovery starts with uncertainty. Every scientific breakthrough begins with doubt. Every time we learn, it is because we realize there is more to know. In a world that values quick answers and strong opinions, having the courage to stay uncertain may be one of our greatest virtues. Uncertainty is not always comfortable, but it is often where truth begins. Maybe the best gift we can give future generations is not a set of answers, but the freedom and courage to keep asking questions.

About Dr. Joseph Varon

Dr. Joseph Varon is a critical care physician, professor, and president and chief medical officer of the Independent Medical Alliance. He has authored over 1000 peer-reviewed publications and serves as editor-in-chief of the Journal of Independent Medicine. You can read more of Dr. Varon’s IMA posts here.

👉 Support Independent Medicine

Seventy-five percent of the Western population is estimated to be magnesium deficient. One billion people are low in vitamin D. Two billion don’t get enough zinc. These aren’t obscure conditions. They’re the nutritional baseline for most of the people reading this.

The numbers are striking, but the real problem is quieter. Most of these deficiencies never get flagged. Conventional lab ranges are built on population averages, which means a result can read “normal” while the body is running well below what it needs. Fatigue, brain fog, hair loss, anxiety: the symptoms trace back to nutrient gaps hiding inside a normal range.

Dr. Kristina Carman’s updated From A to Zinc guide is IMA’s most comprehensive free nutritional resource: more than 80 pages covering over 70 nutrients, now broken into six companion guides. Dr. Carman and Dr. Ryan Cole use the guide as a springboard for a practical conversation about which deficiencies matter most, why supplement form determines whether it works, and what common medications may be silently stripping from your body.

Meet the Experts

Kristina Carman, ND, NT, IFM

IMA Senior Fellow, Nutritional and Holistic Health. Dr. Carman is a naturopathic doctor, registered nutritional therapist, and functional medicine practitioner based in South Carolina. She is the author of the From A to Zinc guide and multiple IMA patient and practitioner resources covering nutrition, hormone health, and integrative care.

Ryan Cole, MD

IMA Head of Medical & Scientific Affairs; Senior Fellow, Pathology; Founder, Cole Diagnostics. A board-certified pathologist, Dr. Cole brings a lab-science lens to the conversation, explaining how conventional reference ranges are constructed and why “normal” often falls short of optimal.

1. “Normal” Doesn’t Mean Optimal

A lab reference range represents two standard deviations from a regional population mean. If that population is largely unhealthy, the mean shifts downward and “normal” starts to include people who are functionally deficient.

“Most people don’t understand that a lab range is two standard deviations in both directions. You look at that bell curve and you’re told you’re normal when you may be on the bottom. Don’t just trust your doctor when he or she says, ‘Oh, you’re normal.’ Ask them, am I optimal?” — Dr. Ryan Cole

Dr. Carman emphasized that subclinical deficiency is where most people live. The deficiency isn’t severe enough to trigger a clinical diagnosis, but it’s enough to cause real symptoms: fatigue despite adequate sleep, brain fog, poor wound healing, anxiety, hair loss, or trouble regulating body temperature.

The pattern repeats across the nutrients discussed in this episode:

• Magnesium: Involved in over 300 enzymatic functions. Depleted by stress, alcohol, coffee, and sugar. Serum magnesium doesn’t reflect tissue stores; a red blood cell magnesium test or a 24-hour magnesium challenge is more reliable.

• Vitamin D: Functional targets are 60–80+ ng/mL. Conventional labs often consider 30–37 ng/mL “normal.” Genetic variants in the vitamin D receptor can make it difficult for some individuals to reach optimal levels regardless of supplementation.

• Iron (ferritin): Conventional labs flag ferritin below 12–20. Functional targets are 50–100. A ferritin of 22 won’t get flagged, but it can drive fatigue, hair loss, depression, restless legs, and difficulty regulating body temperature.

• Zinc: Two billion people globally are deficient. Essential for immune function, wound healing, testosterone production, and skin health. Absorption is impaired by phytates in grains, legumes, nuts, and seeds.

2. The Form That Determines Whether a Supplement Works

Not all supplements are created equal, and the form of a nutrient determines how much of it your body can actually use.

The clearest example is magnesium. Magnesium oxide, the most commonly sold form, has roughly 4% bioavailability. Dr. Carman hears the same complaint constantly: patients taking magnesium who feel no different. When they switch to a more bioavailable form matched to their needs, the difference is unmistakable.

“If you’re taking an appropriate amount of magnesium, the right forms for you, you will absolutely know, because it is such a magnificent magic mineral.” — Dr. Kristina Carman

Different forms serve different purposes:

• Magnesium threonate: Crosses the blood-brain barrier. Studied for cognition, depression, anxiety, and traumatic brain injury. Can be stimulating if taken too close to bedtime.

• Magnesium glycinate (bisglycinate): Calming for the parasympathetic nervous system. Helpful for sleep onset and disrupted sleep patterns. May be too sedating for some.

• Magnesium citrate: Osmotic effect makes it useful for constipation and detox protocols. Poor systemic absorption.

The same principle holds for B12 (cyanocobalamin vs. active methylcobalamin), folate (synthetic folic acid vs. methylfolate), and curcumin (standard vs. liposomal forms that are 29 times more bioavailable). Fat-soluble vitamins like D3 and K2 need to be taken with dietary fat to absorb properly.

Dr. Cole offered a reframe on vitamin D that captures the stakes: “It’s not a vitamin. It is a pro-hormone. It has that unfortunate mislabel, but you burn through it every day like fuel in a car tank.”

3. What Your Medications May Be Depleting

Many of the most commonly prescribed medications deplete the same nutrients the body is already struggling to maintain. Dr. Carman and Dr. Cole walked through the biggest offenders:

• Statins: Deplete CoQ10, carnitine, magnesium, dolichol, and fat-soluble vitamins (D, K2, E, A). CoQ10 is required by every mitochondrion in the cell. Dr. Cole noted that the same enzyme the drug blocks is also responsible for CoQ10 synthesis.

• Metformin: Depletes B12, CoQ10, and magnesium. Long-term depletion is frequently missed in routine care.

• PPIs (proton pump inhibitors): Deplete B12, magnesium, zinc, and iron. Dr. Carman noted that most cases diagnosed as “high acid” are actually low stomach acid with a motility or signaling issue. Many patients stay on PPIs for 15 to 25 years with no reassessment.

• Oral contraceptive pill: Depletes B6, B12, folate, magnesium, zinc, and selenium. Dr. Carman pointed out that the pill doesn’t regulate hormones; it turns off hormone production entirely.

• SSRIs: Deplete B12, folate, and CoQ10. Disrupt the gut microbiome. Dr. Cole added that many SSRIs contain fluorinated molecules, which can also deplete iodine over time.

• Antibiotics: Disrupt the gut microbiome and deplete B vitamins. Dr. Carman cited research showing that a single 10-day course of antibiotics can take up to six months for the microbiome to rebalance.

The framing here matters. Dr. Cole’s mother was saved by antibiotics in the ICU the week of this recording. The conversation isn’t anti-medication. It’s about informed use and asking the questions that often don’t get asked.

“Don’t be afraid to ask your doctors: Why am I on this? How long do I need to be on this? What are my other options? And what’s the exit plan?” — Dr. Kristina Carman

4. The Gut Is the Gatekeeper

Even the right supplement in the right form can fail if the gut isn’t absorbing it. Dr. Carman and Dr. Cole kept circling back to this point throughout the episode: gut health is the foundation that everything else depends on.

Intestinal permeability (leaky gut) impairs vitamin D absorption. Low stomach acid impairs B12 conversion, zinc uptake, and iron absorption. Disrupted gut bacteria interfere with iron status and the serotonin pathway, since 90% of the body’s serotonin is produced in the gut.

Both speakers emphasized a food-first philosophy. Chewing food thoroughly signals the full digestive cascade. Drinking large amounts of fluid with meals dilutes stomach acid and impairs the process. Dr. Cole added that staying well hydrated throughout the day helps prevent overeating at mealtime and supports natural GLP-1 activation.

“Food is everything. It will signal, and it’s the messenger to every single one of the cells in your body.” — Dr. Kristina Carman

Eating nutrient-dense, whole foods close to nature remains the single most impactful step. Dr. Cole flagged glyphosate as a factor that strips minerals from food and recommended organic produce when possible, using the Clean Fifteen and Dirty Dozen lists to prioritize.

5. Where to Start

Dr. Carman and Dr. Cole both emphasized a measured approach: get labs first, then supplement thoughtfully.

If you do nothing else, the foundational trio they recommend starting with:

• Vitamin D3 + K2: Test your baseline, then dose to reach 60–80 ng/mL. Take with dietary fat for absorption. Magnesium is a required cofactor but should be taken separately.

• Magnesium: Choose a bioavailable form matched to your needs (glycinate for sleep, threonate for cognition). The right form at the right dose will make itself known.

• Omega-3 (EPA/DHA): A good-quality fish oil or marine-based omega-3. Quality matters; cheap supplements may pass through unabsorbed.

A quality multivitamin can fill additional gaps, but Dr. Carman was clear: spend the money on supplements that use bioavailable forms. Discount products often pass through unabsorbed.

The bigger principle is that no supplement protocol outperforms a poor lifestyle. Food comes first. Sleep, stress management, and movement form the base. Supplements are the targeted layer on top.

“This isn’t an anti-medicine conversation, and it isn’t a pro-supplement conversation. There’s a Goldilocks zone for everyone, and everyone is slightly different.” — Dr. Ryan Cole

Finding Your Goldilocks Zone

Dr. Carman and Dr. Cole closed by noting that they could easily fill another hour, and a Part Two focused on supplement timing and longevity nutrients is already in the works. In the meantime, the From A to Zinc guide and its six companion guides cover the full range of what this episode could only introduce. Download them, bring them to your next practitioner visit, and start asking better questions about what your body actually needs.

Related Reading

• Guide: Vitamins 101

• Guide: Minerals 101

• Guide: Amino Acids 101

• Guide: Antioxidants & Plant Compounds

• Guide: Gut & Metabolic Support

• Guide: Hormonal & Longevity Support

In the video above, Dr. Elfenbein tells his story in his own words. IMA previously hosted him for The Price of Medical Courage, a webinar covering the full story behind his prosecution and what it means for physician autonomy. The open letter, signed by IMA President Dr. Joseph Varon, calls on the DOJ to exercise prosecutorial restraint and bring the case to a just resolution. Read and share the full letter below.

Open Letter to Acting Attorney General Todd Blanche

RE: Request for Prosecutorial Review and Just Resolution in the Case of Dr. Ron Elfenbein

Dear Acting Attorney General Blanche,

We write on behalf of physicians, patients, and medical advocates who believe the Department of Justice should exercise its discretion with restraint, fairness, and a clear commitment to the public interest. We respectfully urge your office to reexamine the case of Dr. Ron Elfenbein and to consider dismissing the matter or otherwise bringing it to a just and final resolution.

Dr. Elfenbein is a Maryland emergency medicine physician who provided care during the COVID-19 public health emergency and publicly advocated for clinical autonomy, timely treatment, and patient-centered decision-making at a moment when medical judgment was often constrained by shifting federal policy. His case has become a symbol of the dangers that arise when disputed billing interpretations are transformed into criminal exposure.

The public record shows that Dr. Elfenbein was prosecuted in connection with claims involving COVID-19 testing and related billing practices—and that the case has already been through significant and prolonged litigation. The fact that this matter remains active, with a new trial possible, only heightens the need for careful review of whether continued prosecution serves the interests of justice.

This case appears to reflect a troubling use of federal power against a physician who provided care during a public health emergency, followed by prolonged criminal exposure despite the real possibility that the conduct at issue arose from a disputed and technically complex billing interpretation rather than from classic fraud. In such circumstances, continued prosecution risks reinforcing the perception that disagreement with government policy can be transformed into criminal liability, especially when the underlying services were actually provided and the dispute turns on how ambiguous billing rules should be read.

Our review of the matter suggests that this is not a straightforward fraud case, but rather a dispute over complex and ambiguous billing codes in a setting where the underlying medical services were in fact rendered. That is the kind of issue more appropriately addressed through civil or administrative channels, not the full force of federal criminal prosecution.

It is also notable that Dr. Elfenbein’s defense has drawn support from physician organizations, including the American Medical Association, the Maryland State Medical Society, and the Association of American Physicians and Surgeons. Their involvement suggests that this case has prompted serious concern across a range of medical voices, not simply within Dr. Elfenbein’s immediate legal team, and that experienced clinicians and physician advocates view the prosecution as an unwarranted criminalization of disputed medical judgment and billing interpretation.

The Independent Medical Alliance (IMA) has long supported physicians who are unfairly penalized for exercising independent clinical judgment, speaking honestly, and placing patients first. In that spirit, we respectfully ask that you review this case with an eye toward the principles of proportionality, prosecutorial restraint, and due process, and that you use your office’s discretion to ensure Dr. Elfenbein receives fair treatment. Because the matter remains unresolved and time is of the essence, we ask for prompt attention.

Respectfully,

Joseph Varon, MD, FACP, FCCP, FCCM
President and Chief Medical Officer
Independent Medical Alliance

For and on behalf of the
Independent Medical Alliance (IMA)
Representing more than 12,000 physicians, clinicians, scientists, and healthcare professionals

For most patients with a solid tumor, surgery is the definitive step: remove the cancer, recover, move on.

What’s rarely explained is that surgery itself can change the biology of cancer. It can spill tumor cells into the bloodstream. It can lower immune defenses at the moment they’re needed most. And it can set the stage for a recurrence that surfaces years later.

Patients are often told a recurrence is just something that “may happen.” But the perioperative window is a moment where smart, low-risk steps may tip the odds the other way.

IMA Chief Scientific Officer Dr. Paul Marik built this guide to do exactly that. It’s a practical companion to his Cancer Care monograph, written for the oncologist or integrative physician on the patient’s team, and for the patient who wants to bring it to them.

“Almost anyone who is going to have a surgical intervention to remove a cancer should consider this therapy, and the protocol is outlined in our guidance.” — Dr. Paul Marik

📘 About This Guide

This guide was authored by Dr. Paul Marik, IMA Chief Scientific Officer, to translate the science behind perioperative interventions into action a clinician can use.

It’s one of a growing library of focused companion guides to the Cancer Care monograph. Related companions include:

• The Approach to Repurposed Drugs for Cancer

• Targeting Cancer Stem Cells

• Stopping the 10 Deadliest Cancers

The full monograph carries the detailed evidence and references. This guide delivers immediate insight into a critical, often overlooked step in cancer care. As the guide itself notes, care should be supervised by an integrative clinician; this is not a protocol for patients to run on their own.

🧬 Why Surgery Can Accelerate Metastasis

Surgery is the right step for most solid tumors. The problem is what the operation does to the surrounding biology in the process. Removing a tumor disrupts the tissue and blood vessels around it, which can spill cancer cells into the bloodstream or seed them into the chest or abdominal cavity.

At the same time, surgery sets off a chain of signals that work in the cancer’s favor:

• Cancer cells spill into the blood or lymphatic system as the tumor is disturbed.

• Inflammatory cytokines surge (interleukin-1 and interleukin-6) in the body’s normal response to a wound.

• Immune defenses drop at the exact moment they’re most needed.

• COX-2 activity spikes, an inflammatory enzyme that fuels new blood vessel growth and helps circulating cancer cells stick to vessel walls.

Together these create conditions where a circulating tumor cell is far more likely to stick, survive, and settle somewhere new. Researchers call this sequence the metastatic cascade.

⏳ Why Recurrence Can Surface Years Later

A recurrence isn’t random, and it isn’t always quick. A cancer cell that survives the journey has to multiply to roughly a billion cells before it’s even detectable on a scan, about 30 doublings. Depending on the tumor, a single doubling can take anywhere from weeks to years.

That math explains something patients are rarely told: metastases from a slow-growing tumor can stay invisible for a decade after a “successful” operation.

The guide points to a striking example. In an analysis of women with breast cancer, surgery clearly improved early survival, but the data showed a spike in mortality around year eight in the surgery group, a pattern not seen in those who didn’t have surgery. The takeaway isn’t that surgery is the wrong choice. It’s that the perioperative window deserves a deliberate plan to counter each mechanism surgery sets in motion.

💊 The Four-Drug Perioperative Protocol

The guide focuses on four repurposed medications, all inexpensive, widely available, and well-characterized. Each targets a different way surgery helps cancer spread.

✅ Modified Citrus Pectin (MCP)

• Blocks galectin-3, the adhesion molecule cancer cells use to clump together and latch onto blood vessel walls.

• In lab and animal studies, reduced metastasis by 40 to 90%, and inhibited cancer cell adhesion and invasion by up to 95% in vitro.

• Safe, non-toxic, and taken orally. Human trials are still needed to confirm the perioperative benefit.

✅ Propranolol (beta-blocker)

• Dampens the stress-adrenaline signaling that drives cancer spread, and improves immune cell infiltration into tumors.

• A 2025 systematic review of 31 studies found propranolol may improve outcomes, especially when given around the time of surgery.

• Works best paired with a COX-2 inhibitor.

✅ COX-2 Inhibitors (e.g., ketorolac, etodolac)

• Blunt the post-surgical inflammatory surge that helps cancer cells take hold.

• In the COMPIT trial, perioperative propranolol plus a COX-2 inhibitor cut 5-year recurrence in colorectal cancer patients from 50% to 12.5%.

• Selective COX-2 inhibitors don’t raise perioperative bleeding risk, but should be reserved for patients with a favorable cardiovascular profile.

✅ Cimetidine (H2 blocker)

• Prevents tumor cells from attaching to blood vessel walls by suppressing E-selectin.

• In colorectal cancer, improved 10-year survival from 49.8% to 84.6%.

• A benefit unique to cimetidine; other H2 blockers like famotidine and ranitidine don’t show the same effect.

📋 Suggested Perioperative Protocol

🌟 Turning Risk Into Opportunity

Surgery doesn’t just remove cancer. It opens a window. That window can leave a patient vulnerable, or, with the right plan, it can become a point of protection.

The four-drug protocol is the core, but the guide notes it fits naturally alongside other metabolic strategies IMA covers elsewhere, including omega-3 fatty acids, melatonin, vitamin D, and perioperative fasting. (That’s why you’ll see a few of them in the summary graphic below.)

This is a message both patients and providers deserve to hear. The summary infographic below is built to share.

📚 More Cancer Care Resources

• Monograph: Cancer Care

• Hub: IMA Cancer Resource Hub

• Guide: The Approach to Repurposed Drugs for Cancer

• Guide: Cancer Resistance

• Guide: The Metabolic Trap

• Guide: Dietary Interventions in Cancer

• Guide: Cancer Nutrition Guide