On December 4th and 5th 2025, the country had the opportunity to observe two vastly different worldviews on display as the Advisory Committee on Immunization Practice (ACIP) of the US Centers for Disease Control and Prevention debated changing the over 30-year recommendation for universal administration of the hepatitis B vaccine for every newborn. On an 8-3 vote, the ACIP voted:
to recommend individual-based decision-making for parents deciding whether to give the hepatitis B vaccine, including the birth dose, to infants born to women who test negative for the virus. For those infants not receiving the birth dose, ACIP suggested in its recommendation that the initial dose be administered no earlier than two months of age.
Individual-based decision-making, known on the CDC immunization schedules as shared clinical decision-making, means that parents and health care providers should consider vaccine benefits, vaccine risks, and infection risks, and that parents consult with their health care provider and decide when or if their child will begin the hepatitis B vaccine series. The committee said parents and health care providers should consider whether there are infection risks such as a household member who has hepatitis B or frequent contact with persons who have emigrated from areas where hepatitis B is common.
ACIP also voted to recommend that when evaluating the need for a subsequent hepatitis B vaccine dose in children, parents should consult with health care providers to decide whether to test antibody levels to hepatitis surface antigen to evaluate adequacy of protection through serology results.
It should be noted that individual-based decision-making used to be known as Informed Consent. As a physician and surgeon, I was ethically and legally bound to explain the risks, benefits, and alternatives of any proposed treatment plan and allow the patient or a competent legal guardian to decide whether or not to accept my recommendation. That all went out the window with Covid, where an attempt to obtain true Informed Consent was penalized if any treatment other than that recommended by numerous (and sometimes conflicting and ever-changing) “official” organizations was discussed.
The ACIP decision was widely criticized by medical organizations and sympathetic news organizations. They emphasized that the hepatitis B vaccine was “universally recognized as safe and effective.” On the surface, that sounded like the voice of authority, and it is what is known as an Argument From Authority. The problem is that such an argument is also often false. The article in the hyperlink quotes no less of a scientist as Carl Sagan in discussing an Argument From Authority:
One of the great commandments of science is, ‘Mistrust arguments from authority.’…Too many such arguments have proved too painfully wrong. Authorities must prove their contentions like everybody else.”
To my observation, those insisting that this injection MUST be given to every newborn have failed in that proof. Some of the dissenters on the committee and virtually all the speakers representing organized healthcare were seemingly completely oblivious to the questions of safety. The inclusion of Aaron Siri as a speaker prior to the vote was ridiculed by some that he was “only a lawyer” and not an expert on health care. Yet I found this lawyer to be significantly more credible than my colleagues or other so-called experts on vaccine safety. They really should read his book before making statements that are so easily refuted.
Randomized Placebo Controlled Clinical Trials were touted as the Gold Standard of care in shooting down any talk of treatment of Covid with such agents as hydroxychloroquine and ivermectin but seem, by the same people, to now be an insult when they are suggested for any “vaccine.” Siri reviewed the “clinical trial” upon which the HB vaccine was based. The verbiage is from the package insert which can be downloaded here;
6.1 Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared to rates in the clinical trials of another vaccine and may not reflect the rates observed in practice.
In three clinical studies, 434 doses of RECOMBIVAX HB, 5 mcg, were administered to 147 healthy infants and children (up to 10 years of age) who were monitored for 5 days after each dose. Injection site reactions and systemic adverse reactions were reported following 0.2% and 10.4% of the injections, respectively. The most frequently reported systemic adverse reactions (>1% injections), in decreasing order of frequency, were irritability, fever (101°F oral equivalent), diarrhea, fatigue/weakness, diminished appetite, and rhinitis.
Safety for universal use of this agent in newborns was based on 5 days of observation of 147 children up to age 10! This is incredible. To suggest this is “science” is ludicrous. You can’t find something if you don’t look for it!
Other authors, such as Yaffa Shir-Raz and Toby Rogers have presented with much more precision the scientific arguments against the universal recommendation for this agent in all newborns, and I point to them for more in depth analysis.
This whole experience brought to memory a book I read in 1971 as a first-year medical student. It spoke to me in a very personal way then and continues even today. Maybe especially today…The Citadel is a novel published in 1937 by A.J. Cronin, himself a physician. The following is from the review on Amazon:
“The Citadel follows the life of Andrew Manson, a young and idealistic Scottish doctor, as he navigates the challenges of practicing medicine across interwar Wales and England. Based on Cronin’s own experiences as a physician, The Citadel boldly confronts traditional medical ethics and has been noted as one of the inspirations for the formation of the National Health Service. The Citadel has been adapted into several successful film, radio, and television productions around the world, including the Oscar-nominated 1938 film starring Ralph Donat, Rosalind Russell, Ralph Richardson, and Rex Harrison.”
From the Wikipedia entry:
“Cronin once stated in an interview, ‘I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug … The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system.’”
Medical school always had its own set of peculiar struggles, as, I suppose, does everything. Certainly, Basic Training in the military is an eye-opener. What makes medical school unique is the profound contrast of the reality with the ideal. Like many students, perhaps most, I entered medicine with a profound sense of the magnitude of what I was doing. It had a “spiritual” element, almost as though I was entering a religious order and now would be taking on the mantle of responsibility that was more than just a job. I had read the Oath of Hippocrates and could sense the heavy responsibility that had been felt by the ancients and the duty that this road would take.
It would serve no purpose to recount those years in detail. Suffice it to say that, like those of Andrew Manson, the protagonist in The Citadel, my experiences were intense. They ranged from the utter heights to the deepest depths. The metal of my character was refined and amalgamated in ways difficult to fully understand, even now. I graduated having many of the same feelings described by Cronin in the interview referenced above. I was conscious of my own mortality. I understood what it was like to make mistakes, but over all of it I had a firm desire to really make a difference in a system that was filled with obstacles.
The worst aspects of medical education have improved significantly since the time I spent there. The 40-bed wards are gone. Attending physicians take a more active role in the care of patients. Medical students and resident physicians no longer spend an exhausting 80 hours or more a week in patient care. There are (or perhaps I only thought there were) multiple safety measures in place for patients and those caring for them. But those are the externals. Has the internal moral compass really changed? Certainly, it has in many individuals, but what about collectively in our profession? Up until Covid, I thought that we had made real progress in things. Now I am not so sure.
Consider those who told their patients during Covid, “I would sooner watch you die than give you hydroxychloroquine.” Had their moral compass changed? What about the medical leaders who allowed patients to die without trying ivermectin, despite the pleas of their family? Did their moral compass change? Or those who treated the unvaccinated as lepers? The medical ethicists who championed denying care to those unvaccinated? How about the late-night comic who said this:
Or those in the audience of that comic who thought this was outrageously hysterical? True, he was not a healthcare professional, but the problems we see run very deep in our society.
Or how about the governmental officials who promulgated the CARES Act and PREP Act that shielded those who denied this care? You can read about them in The Courage to Face COVID-19 by John Leake and Peter McCullough, MD.
How about those leaders of academic medicine, presidents of medical organizations, medical school Deans and Chief Medical Officers who went along with this? Did the monetary compensation for following protocols that were known to be faulty play a role in these decisions? What about those who received no monetary compensation, but still went along with things they knew, or should have known, to be wrong?
What would A.J. Cronin say about Covid? We don’t have to look hard at all, as the books and articles have already been written! Search on these authors to see: John Leake, Peter McCullough, Scott Atlas, Aaron Siri, Paul Alexander, Peter and Ginger Bregin, Harvey Risch, Pierre Kory, Robert F. Kennedy, Jr., Naomi Wolf, Alex Berenson, Robert Malone, Zev Zelenko, Mark McDonald, Sabine Hazan, Jay Bhattacharya, Martin Kulldorff, George Fareed and Brian Tyson and many, many others. I apologize to anybody not listed, but in truth the list could go on for pages.
The point is, we DO have individuals ringing the same bell that Cronin rang back in 1937. We have many courageous people who are doing what needs to be done, and pointing out what Cronin mentioned in that interview reported in Wikipedia.
Unfortunately, those individuals, as well as those on the ACIP who voted to stop a dangerous practice, have reaped not praise, but scorn, from organized medicine and a biased press. I think if A.J. Cronin were alive today, he would be among the first to congratulate those who, like him opposed the current status quo of:
the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug…The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system.
In a prior Substack (Amnesty? NO! We Need Accountability! November 3, 2022) I wrote:
When I was a child playing games, I noticed that there were individuals who, when they were losing, wanted to stop and “call it a draw.” Well, those children grew up and are with us today as adults. They are the ones who, when faced with some egregious action on the part of someone with whom they agree, blurt out “Well, both sides do it!” The truth of the matter is that both sides do not do it and unless we have the courage to accept that, we will continue to make very, very bad mistakes as a society.
I pointed out the three groups of people involved in the Covid Disaster:
- The victims
- The architects
- The enablers
The victims need restoration and compensation. Jobs need to be restored. Members of the military, hospital workers, and first responders need full reinstatement. Although this has begun, some will never be adequately compensated. Of course, for those who died needlessly, and their families, compensation is beyond a possibility. So is restoration of the lost loves, years of education, lifetimes of work for a goal and so, so much that was wiped out for, what it turns out, no good reason.
The architects need investigation, prosecution, and if found guilty, punishment. But what about the enablers? Certainly, there is a continuum of enablers, and they need rehabilitation if possible. At one end of the spectrum are those who saw what was happening, knew it was wrong, but did not intervene out of fear of the repercussions. What do we do with those who saw the injustices of the past few years but did nothing to stop them? In a recent Brownstone essay, Steven Kritz explored this in more detail.
Our lesson should be the need to value critical thinking, courage, ethical behavior, and moral reasoning in those we accept into training in the health professions, and even more, in those who advance to leadership positions. The actual study of leadership needs to be a part of education in the health professions.
This should be by no means only a preparation for leadership IN medicine. We need to understand that a physician should not be a “treater of disease” but a “leader of patients!”
We as physicians need to look to the nursing profession, as they have done a much better job than we physicians have. We must make a conscious effort to form healthcare “Communities of Practice” that are composed of groups of vertically and horizontally integrated professionals. Those just entering, those in active practice, and those in retirement can utilize such a Community of Practice for the effective transgenerational transfer of both tacit and explicit knowledge. We may be able to attempt to restore the soul to medicine….
As I watched these two days of hearings, I realized we have a long…a very long…way to go. We have learned so little. In this Brownstone essay, Bret Swanson recounts how little has in fact been learned. Those who clamored about “The Science” during Covid even now fail to see “Their Science” was “NO Science.” The same mistakes that led to unimaginable harm during Covid may be being made again, right in front of our eyes, regarding vaccine policy. We have made a start, but it must be expanded and continued.
Why is this? From a Systems-Science point of view, we really need to understand why healthcare professionals seem to have such a difficulty in learning! Over twenty years ago Anita Tucker and Amy Edmonson explored the difficulty hospitals encounter in learning from mistakes. Numerous articles such as this one discuss the difficulty physicians have in learning from individual mistakes. There even have been studies regarding health policy mistakes, although this recent one seems to be mired in a squishy middle ground that limits accountability. It seems equivalent to calling a lie a “misstatement of fact.”
Let me be clear: in my opinion those “experts” who have made horrendous errors in judgment and do not learn from them (this is critical) should forfeit their position as experts. We need to listen to those who “got it right” from the beginning, especially since many of them paid such a dear price for their honesty and integrity.
Would we continue to invest our retirement account with an advisor who continually lost our money? Or would we at least explore other options? Coaches are fired all the time for a losing season. If we do that with our money and our sports teams, why don’t we do it with those responsible for our very lives??
This is NOT to say that one mistake and you are out! Exactly the opposite. We want people who learn from small mistakes as those people are the ones who will find the optimum ways forward. When I learned to drive a car, my Dad told me that I should keep my hands on the wheel and make small corrections to deal with the imperfections in the road. In that way, large corrections will become less frequent and will avoid possible bad outcomes. He said, “You see, the road is not level, and rain, mud, snow or the occasional animal will limit your ability to know ahead of time the exact track you should take. Making the small corrections frequently will avoid problems. Trust me.”
And I did. You see, my Dad never went to college but he knew about what decades later would be called a Complex Adaptive System. Driving a car is more than just the sum of the parts. The road, the weather, the car, and my reflexes all would operate together, very rapidly and not in a totally predictable fashion. Constant reevaluation is necessary.
Public health policy must likewise be seen as operating in a Complex Adaptive System. Much of the results of implementation will not be able to be decided with certainty ahead of time! The Predictability Horizon in a Complex Adaptive System is very, very short. It is imperative that the response of the system be carefully and frequently monitored. We can no longer bury the signals that can warn us of “something we had not anticipated ahead of time,” because those will always be there! While models are indeed useful, they must constantly be updated with the changing and very short Predictability Horizon.
Training in Public Health and Health Policy must include an understanding of Complexity Science and Nonlinear Dynamical System Theory if we are to avoid the catastrophic errors of the past 5 years. Clinical training in medicine or nursing may be helpful but should NOT be the only path. This may fly in the face of those who have only been trained in the “scientific method” of the past, but if we are truly going to operate on “evidence-based decision-making” it MUST be done. We can’t afford to dismiss people like Aaron Siri and Retsef Levi whose brilliance and expertise complements our own. Medicine and Public Health can no longer live in a silo, no matter how “safe” that may feel.
The future can be bright, but it will not happen without our intentionality in how we direct it.
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