There are many people who say they view any sort of paternalistic behavior with suspicion. But one obvious example of paternalistic behavior would be banning vaccines that people want to receive based on vague concerns of unproven harm. An even better example might be creating a site called realfood.gov, instructing the American people that only some kinds of food are "real" and you should ideally only eat "real" food.

So if someone says they oppose paternalism in public health and yet supports the Trump administration's public health efforts, I'm not sure how to avoid the conclusion that they're lying.

Having lived through it myself, I found the government’s actions extremely mild when compared to something like what ICE has been up to. Zero people were directly killed by authorities because of Covid noncompliance.

From my perspective, it’s hysteria borne out of the difference in requirements for urban health policy vs. rural health policy, and the fact that rural people quite often travel through urban areas (e.g. airports).

Talk to anyone from Wyoming and ask what Covid was like during the worst days, and then talk to an ER doctor who worked in New York City.

Cynically, I want to blame it on the absurd lack of empathy of rural Americans and a complete lack of ability to imagine day-to-day lifestyles that do not match their own.

Were there a few scandals? For sure, I will not deny that. But I have the distinct urge to invent time travel for the hemmers, hawers, and devil’s advocates and transport them to New York Presbyterian in April of 2020.

Edit: I also have to credit rightwing media, of course, for capitalizing on the opportunity to manufacture a wedge issue that every American had an armchair opinion of. Chicken and egg, of course, but media ghouls will be media ghouls.

How is discussion on HN different from the leadership levels at FDA?

Very different. Decisions with enormous health implications, enormous financial implications, are made at FDA.

At HN, most people are here to learn, here to understand more.

Vinay Prasad is a fraud, completely unfit for the leadership role he was placed into, making baffling and arbitrary decisions on his own, overturning those with far more experience, knowledge and expertise.

If a HN comment gets things wrong, a few people might be misinformed, if they are credulous enough to not double check things.

When the FDA makes decisions like they have been making, thousands to millions of peoples' lives are worse off, and billions in capital is wasted.

Discussion forums of all sorts are incredibly valuable, even when they get things wrong. I have lots of complaints about the overhyping of, say, CRISPR, especially on HN, but whatever, it's a far far higher signal-to-noise than a random person I meet around town. Mention you work on drug development for big pharma to the random person and they think you're evil, at least HN is less likely to have that basic misconception.

So you don’t agree with their point and saw fit to draw out a response that fingerpoints at the the side that’s over the intolerance of the non-scientifically bound members of society? Great high horse fam.

That might be true for some of them, but unfortunately I know a few anti vaxxers who also happen to be atheists. They just believe all the various conspiracy theories about vaccines.

Both VRBPAC and CDC's ACIP did remarkably good work during the pandemic under enormous pressure - what specific complaints do you have? They got safe and effective vaccines out there fast, did a really reasonable job of balancing the cost benefit w.r.t. side effects of both j&j's and the somewhat elevated myo/pericarditis risk from moderna's vaccine in young men, etc.

Be specific?

(I have complaints - I thought Dr. Meissner was wrongheaded about opposing allowing EUA to extend to pediatric populations. But the committee as a whole functioned well and balanced the urgency of the situation with the need for voluminous data.)