patrick.net

https://www.coffeeandcovid.com/p/no-consensus-friday-october-17-2025

It is undeniable now that the Board of Health — one of the first big government public health agencies — ultimately lost the thread of its essential mission. By 1853, it had become another entrenched British bureaucracy with its own Byzantine politics, and was mostly concerned with its own power and the never-ending expansion of its budget. It wouldn’t be completely unfair to say even that cholera was good for business— if, that is, you were a government health agency in 1850s London.

At that time, the Board of Health focused on organizing and promoting large-scale, multi-year, expansive civil engineering projects intended to improve the city’s sewer systems. These massive projects provided countless opportunities for graft by politicians and extremely lucrative money-making opportunities for politically connected contractors.

Now, I know what you’re thinking. Surely, these improvements in the sewers helped with disease control, especially a disease like cholera, since it is actually transmitted in sewage, not in “miasma,” whatever that is.

That would be true, except for one thing. The problem was that the Board’s projects were designed to funnel the city’s raw, untreated sewage right into the Thames river — London’s main source of drinking water. Just as the United Nations did to Haiti in 2010, this practice helped spread the disease even faster, farther, and more efficiently than it would have done naturally.

In other words, the government solutions, based on the sound scientific consensus of the day, were actually killing the British faster and more effectively than the disease could ever have hoped to do on its own.

💉 Understanding this ugly background helps explain why John Snow’s wild idea — that cholera actually spreads by a pathogen in contaminated water, not “bad air” — was profoundly, politically, and scientifically threatening. Snow’s hypothesis threatened to expose the government’s destructive choices and worse, threatened to plug up the vast river of money flowing from the victims’ taxes to politically favored groups of the time, including scientists and bureaucrats infesting the nascent public health establishment.

It’s a good thing those kinds of perverse incentives could never happen now. Am I right? Hello? Buehler?

Contemporaneous scientific studies published in the Lancet in the 1850’s — still (for some reason) considered one of the world’s premier scientific medical journals — accepted the Board’s “miasma” theory as an established fact, constantly lauded the Board of Health’s gigantophilic sewage projects, demanded ever more government “sanitary oversight,” and more construction projects, and of course, relentless expansion of the Board’s already morbidly obese budget.

This, my friends, is the cookbook. It is a construction formula for how the slurry of scientific “consensus” becomes hardened into a deadly cement of politics, money, connections, invested interests, and intertwined incentives. ...

Immediately after Snow snagged the pump handle, SoHo’s cholera infections dropped sharply. Snow was right. Something in the water was making people sick. It was obvious.

And so, as you would expect, the Board of Health immediately re-evaluated its consensus theory, and started wholesale revising its approach to managing cholera. It stopped dumping raw sewage into the Thames, and everybody lived happily ever after.

Haha, of course, I am joking! What actually happened was that all the ministers and scientists at the Board of Health immediately undertook a concerted effort to discredit and destroy one John Snow.

If you can believe it, they tore into him even more fiercely than if he had been pushing ivermectin or bleach injections. If Snow had posted a video about his well experiment, YouTube would have taken it down immediately and deleted his account moments after the government would have accused Snow of literally killing grandma with his dangerous well idea.

Instead, the Board of Health continued to deny Snow’s water-transmission hypothesis for ten more years. During that time, cholera continued to have its way with Britain, ravaging the tiny island nation’s cities, needlessly killing thousands, or tens of thousands of taxpayers. Maybe more.

Those deaths, like so many others, lie right on public health’s doorstep. ...

In 1855, the Lancet — again, the world’s premier scientific medical journal — published a scathing editorial that, if Snow’s reputation had not already been completely destroyed, surely finished the job. The Lancet’s editorial supported the Board of Health’s commissioning of a special medical council to investigate not the water but Dr. John Snow.

The council’s “investigation” concluded that Snow’s core theory — that some unidentified pathogen in water transmitted cholera — was “scientifically unsound.” Actually, strike that, his idea was downright dangerous! It was intolerably dangerous disinformation, and was likely to mislead the public.

After all, science had reached a consensus that “miasma” caused cholera. Not germs.

After its careful and scientific investigation of the Broad Street Well matter, and of its bank account balances, the Board’s committee finally concluded that Snow was dead wrong about that whole well thing. The well water had nothing whatsoever to do with cholera, it said. “After careful inquiry,” the Board sneered, “we see no reason to adopt this belief. We do not find it that the water was contaminated in the manner alleged.” ...

💉 Although Snow was finished, a spent force, the Board of Health wasn’t finished with its destructive rampage. They needed to make an example. To keep future upstarts like Snow from poking their heads above the group. So they spent the next five years making 100% sure that everyone knew exactly how much Snow had been talking out of his hat.

But dammit, the well. It stood in SoHo like a silent rebuke. There was a pesky problem—the residents of SoHo were obviously better. It was so obvious a child could see it. The Public wasn’t using the well, not like before, because they were infected with misinformation.

So the Board needed to nuke the whole well idea for good.

In 1854, they tacked toward a third way. This time, they admitted that maybe Snow wasn’t completely wrong, not exactly. He wasn’t right, either, don’t be silly. He’d just been lucky. He’d tumbled into a discovery, like a witless pig toppling into street manure. According to the British Lords of Public Health:

“Thus, if the Broad Street pump did actually become a source of disease to persons dwelling at a distance, we believe that this may have depended on other organic impurities than those exclusively referred to, and may have arisen, not in its containing choleraic excrements, but simply in the fact of its impure waters having participated in the atmospheric infection of the district.”

See? It was so simple. Even John Snow could see that cholera doesn’t infect people through contaminated water. It’s the other way around. The miasmas in the atmosphere must have infected the water. Duh! That should have been obvious. It had always been miasmas, just like their treasured consensus said.

At that point, John Snow had officially become not only misguided, but a dangerous fraud. Officially. As a matter of public record. Everybody who was anybody said so. Snow’s malfeasance became part of the permanent consensus itself. Now, they smugly said, Snow’s name would forevermore be synonymous with “dangerous moron.”

💉 It would take thirteen long years, until 1866, when another epidemiological great named William Farr finally proved that John Snow had been right all along about cholera. But it was too late for Snow. He died in 1858, disgraced, professionally ruined. He was only 45. He never lived to see his theory — his correct theory — overthrow the “consensus.”

Probably the first chapter in every modern textbook on epidemiology used in every medical school includes John Snow’s story. Well, not exactly. They include a carefully whitewashed and co-opted version of the story. Students memorize a moving story about great medical detective work and simple practical solutions like removing the Broad Street well’s pump handle.

In more honest textbooks, students might even learn about how unschooled anesthesiologists can sometimes help epidemiologists. Sometimes.

But there is not a single reference in any of those textbooks about the danger of scientific consensus, how John Snow defied The Science and found the truth, or the insane risks of mixing politics and money with science to create its bastard child, “Science!” with an exclamation point. There’s nothing at all in those textbooks about the poisonous miasma that results from mixing money and politics with science.

Which is too bad. Because, if you think about it, that’s really the most important part of Snow’s story. Frankly, I’m sick to death of hearing about “scientific consensus.” Scientific consensus is a blight. It’s a plague. Consensus is the opposite of science. “Scientific consensus” is an oxymoron, like saying “jumbo shrimp” or “seriously funny.”

But it’s not at all funny. ...

After Snow’s discovery, every single person who died was killed by consensus. Scientific consensus is a deadly disease all on its own.

The reason the textbooks obscure John Snow’s real story is because it cuts too close to the truth: that the thing we call “science” is often just politics wearing a stethoscope. Snow wasn’t defeated by disease. He was killed by the cure — money and politics shrouded in a fatal illusion of consensus.

And if you’ve somehow missed the whole point and still think it couldn’t happen again, well… for Heaven’s sake, take a look around.

Let’s all vow to always remember the real lesson John Snow taught us, that orthodoxy and consensus are the worst public health menaces of all.

“Consensus is the business of politics. Science, on the contrary, requires only one investigator who happens to be right.” — author Michael Crichton.

https://www.youtube.com/watch?v=3aewaff1494

https://www.youtube.com/watch?v=eB_vfKA85po

https://www.coffeeandcovid.com/p/science-cafe-thursday-december-4

Don’t take my word for it. Take the word of the people who actually ran the journals. In 2015 —the same year the Paxil story broke— former Lancet Editor-in-Chief Richard Horton finally snapped, and blurted out the truth like he was confessing to siphoning gas from his neighbor’s lawn mower:

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue.”

Perhaps half. Half! That’s not a statistical signal or a confidence interval. It’s a crime scene report.

Even the BMJ’s own former head editor, Fiona Godlee, admitted the field is “corrupted.” And not in the cute, old-fashioned way where the guy at the lab sneaks home a spare beaker. She meant intellectually corrupted— results engineered, journals captive, entire fields shaped by whoever has the fattest budget for “research support.”

Third: former New England Journal of Medicine Editor Marcia Angell (who spent twenty years guarding the temple) finally conceded the high priests were selling edible miracles in bulk:

“It is simply no longer possible to believe much of the clinical research that is published… I take no pleasure in this conclusion.”

It’s not possible to believe the research! That’s from the editor of the New England Journal of Medicine, not some random TikTok alien theorist.

Finally, there’s controversial mathematician John Ioannidis, who coldly and logically ran the numbers. His famous 2005 paper, “Why Most Published Research Findings Are False” now has an eye-watering 3.3 million views and 9,000 citations. Ioannidis calmly proved, with data and statistics, and without sarcasm (showing heroic self-restraint), that modern research is structured so that false results are the expected output.

https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.0020124

... And yet— medical authorities still lecture the public about “trusting the science” like a drunk uncle insisting he can drive. Paxil isn’t a ghost of scandals past. It’s a preview of the operating system we all lived under during the pandemic.

Bought studies. Captured journals. Silenced critics. Manufactured consensus. Same structure, bigger budget.

But the Paxil scandal may serve as more than a gruesome relic of the past. It could be a sign, an ignition point for a full-blown reckoning with what many now openly call “junk science.” More optimistically, just this year, Secretary Kennedy, FDA Commissioner Dr. Makary, and NIH Director Dr. Jay Bhattacharya all began pushing a radical overhaul of how medical science gets published. ...

At the heart of their plan: dismantle the luxury-journal cartel that has long protected industry-funded papers, restricted publication to a tiny oligopoly of gatekeepers, and rewarded pro-pharma results over truth. Under the terrific Make America Healthy Again Commission (MAHA) report —chaired by RFK— the administration pledged to “realign incentives,” restore transparency, and prioritize “gold-standard science, not special interests.”

As part of that effort, the newly confirmed NIH director (Bhattacharya) and FDA chief (Makary) aren’t just going through the motions. One of the very first things they did, racing right out of the starting gate, was to launch a competing journal explicitly meant to challenge the gatekeepers. Politico Pro, February:

https://subscriber.politicopro.com/article/2025/02/trump-nominees-launch-science-journal-amid-washington-data-debate-00204191 (paywall)

It would be a massive understatement to say the big federal health agencies and their billions in annual grants direct the conversation. If nothing else, the impending shift in NIH standards at least threatens to end the corrupt old system, wherein pharmaceutical companies laundered regulatory influence using taxpayer-funded grant money, and top-tier journals translated that into prestige, citations, and sales pitches disguised as “clinical guidance.”

If anything, the pandemic proved how much worse things can get when you combine corrupted research with political power and real-time censorship. You might consider Paxil as the prototype.* Covid was the industrial release version. ...

Maybe the saddest part of all is how numb and unselfaware the establishment has become. Horton, Angell, Godlee, Ioannidis— they didn’t whisper. They shouted. And nobody with power wanted to hear it, because the money was good and the machine was running smoothly.

Last year saw Ioannidis walking around Stanford Mall. Absolutely sure it was him, mostly from having seen his picture, but also because he works only a few blocks away. I like it when I can prove to myself that people I read about on the internet actually exist, even if in just a small way like that chance sighting.