In November 1992, the Journal of the American Medical Association published a paper titled “Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine.”¹ The authors, the Evidence-Based Medicine Working Group at McMaster University, led by Gordon Guyatt, announced a paradigm shift. The first paragraph named what was being replaced: “intuition, unsystematic clinical experience, and pathophysiologic rationale.”¹ The replacement was a hierarchy in which the randomised controlled trial sat at the top and clinical observation sat near the bottom.
The paper was not modest. It described its proposal in Kuhnian terms and predicted that the old approach — the physician’s accumulated judgement, the recognition of patterns across thousands of patients, the reasoning from mechanism and first principles — would be superseded.¹ Within a decade, the framework had been adopted across major medical journals, accreditation bodies, and clinical guideline organisations. In a 2007 BMJ poll of more than 11,000 readers asked to name the most important medical milestones since 1840, the sanitary revolution placed first, antibiotics second, anaesthesia third; evidence-based medicine appeared on the shortlist of fifteen.²
What was elevated to the top of the hierarchy was the one form of evidence pharmaceutical companies could afford to manufacture at scale. What was demoted to the bottom was everything they could not control. This was not the discovery of how medicine should be practised. It was the redefinition of what counted as knowing. The framework called itself evidence-based. What it actually was, was evidence-biased — a hierarchy in which what counted as evidence was determined, first, by who could afford to produce it.
The essay examines what that redefinition did, who it served, and the cost in lives.
Explain It to a Six-Year-Old
For a long time, children have learned about the world in many ways. Some things they see with their own eyes. Some things they hear from grandparents who have lived a long time. Some things they figure out by thinking carefully. Some things they know because they have tried them and watched what happened. All of these are ways of knowing.
One day, the school makes a new rule. From now on, the only things that count as knowing are things that have been seen in a special room, by a man with a clipboard, who writes down what he saw. Hearing from grandparents does not count anymore. Trying things and watching what happens does not count. Thinking carefully does not count. The teacher tells the children, “Those were just stories. Real knowing happens in the special room.”
The special room is very expensive. Only one company can afford to rent it. The company pays the man with the clipboard. The company decides what gets looked at in the room and what does not. Apples never go in the room. Sunlight never goes in the room. Grandmothers’ soup never goes in the room. So the school says, “We do not know if apples are good. We do not know if sunlight is good. We do not know if grandmothers’ soup is good. Nobody has seen them in the room.”
The company sells biscuits. The biscuits go in the room every day. The man with the clipboard writes down that the biscuits are good. The teacher tells the children, “We know the biscuits are good, because we saw them in the room.”
Some children eat the biscuits and get tummy aches. They tell the teacher. The teacher says, “Tummy aches have not been seen in the room. We do not know that the biscuits cause tummy aches.” When a doctor visits and says she has seen many children with tummy aches after eating biscuits, the teacher says the doctor is only telling stories. Stories do not count.
Years pass. The children eat more biscuits and fewer apples. Many of them are sick. The company is very rich. The teacher still says the only real knowing is the knowing that happens in the special room.
That is what happened to medicine in 1992.
What Sits at the Top of the Hierarchy
The EBM hierarchy of evidence places systematic reviews of randomised controlled trials at the apex. Beneath them sit individual RCTs, then cohort studies, then case-control studies, then case series, then expert opinion and clinical experience at the bottom.³
The framework is presented as neutral. It is not.
A randomised controlled trial of a pharmaceutical product costs between twenty and three hundred million dollars to conduct.⁴ The trial requires regulatory approval, site recruitment, statistical infrastructure, monitoring, data management, and publication support. The entities capable of funding such trials are, in practice, three: pharmaceutical companies, the National Institutes of Health, and a small number of large foundations whose priorities track institutional medicine. The pharmaceutical industry funds the majority of clinical research in the United States and a higher proportion of late-phase trials of new products.⁵
A trial of a whole food, a traditional practice, a non-patentable substance, a low-cost generic, or a non-pharmaceutical intervention almost never reaches the funding threshold the hierarchy requires. Substances and practices that produce no return on investment do not generate the evidence the framework recognises, and so they sit at the bottom of the hierarchy or fall off it entirely.
The hierarchy then performs a second move. When a question has not been studied at the top tier, the framework declares “insufficient evidence” or “no evidence of benefit.” Absence is treated as a finding. The reader is led to conclude that the unstudied intervention does not work, when what has actually been established is that no one has been willing to pay for the kind of study the framework demands.
The streetlight effect — searching for keys under the lamp because that is where the light is — is not a flaw of the framework. It describes how the framework operates by design. The hierarchy of evidence is a hierarchy of who can afford to generate evidence.
The Trials at the Top Are Built by the Sponsor
The architecture of the modern pharmaceutical trial is the second mechanism. The sponsor — the company that owns the product — controls the design.
The sponsor selects the primary endpoint. A trial of an antidepressant can be designed to measure a small change on a subjective rating scale at week six, rather than functional recovery at one year. A trial of a statin can be designed to measure relative risk reduction in cardiovascular events, rather than all-cause mortality. A trial of a cancer drug can be designed to measure progression-free survival — the time until the tumour grows on a scan — rather than overall survival.⁶ The endpoint determines what answer the trial is permitted to give.
The sponsor selects the comparator. A new drug compared against placebo where an effective comparator already exists tends to win. A new drug compared against an existing drug at the wrong dose, or in the wrong patient population, tends to win. The comparator becomes a design choice rather than a scientific reference.
The sponsor selects the population. Trials that approve drugs exclude the elderly, the polypharmacy patients, the pregnant, those with comorbid conditions, those with abnormal laboratory values, and those with histories of the very adverse events being assessed. The drug is then prescribed to the population that was excluded. The VIGOR trial of Vioxx excluded patients with significant cardiovascular risk; the drug was marketed and prescribed to a population dominated by such patients.⁷
The sponsor selects the duration. A trial of six weeks tells you nothing about a drug that will be taken for life. A trial of two years tells you nothing about lifetime cancer risk. Sponsors routinely halt trials early “for benefit” once a favourable interim result is reached, eliminating the longer follow-up that would have permitted assessment of late-emerging harms; the JUPITER statin trial discussed later was stopped at a median of 1.9 years rather than completing its planned four-year duration.⁸
The sponsor controls the data. Investigators at trial sites send data to the sponsor. The sponsor’s statisticians analyse it. The sponsor’s medical writers produce the manuscript. The 2017 Cochrane systematic review by Lundh and colleagues, examining 75 studies across multiple drug classes, found industry-sponsored research produces conclusions more favourable to the sponsor’s product than independently funded research of the same questions, with the effect persisting after adjustment for methodological quality.⁹ A 2003 BMJ analysis by Lexchin and colleagues found that industry-funded trials of new drugs produced results favourable to the sponsor’s product at roughly four times the rate of independently funded trials.¹⁰
The RCT does not measure efficacy. It measures what its sponsor designed it to measure.
What Happens to the Trials That Find Harm
The third mechanism concerns what happens to the data the sponsor would prefer not to publish.
In 2008, Erick Turner and colleagues at the Department of Veterans Affairs published an analysis in the New England Journal of Medicine of all FDA-registered trials of antidepressants conducted between 1987 and 2004 — 74 trials covering 12 drugs. The FDA records, obtained under freedom of information requests, showed 38 trials with positive results and 36 trials with negative or questionable results. Of the 38 positive trials, 37 were published. Of the 36 negative trials, 22 were not published at all, and 11 were published in a way that conveyed a positive outcome.¹¹ The published literature on antidepressants showed positive findings in 94% of trials. The actual data showed 51%.
This is publication bias as a system, not as accident. The same pattern has been documented for COX-2 inhibitors, antipsychotics, neuraminidase inhibitors, and statins.¹² Trials that find harm are buried. Trials that find benefit are amplified.
A second layer operates below publication. Ghostwriting — the practice of pharmaceutical companies producing manuscripts and recruiting academic authors to attach their names — has been documented across multiple drug classes. Internal Merck documents released in the Vioxx litigation showed company employees drafting clinical trial papers and review articles, then recruiting academic physicians to be listed as authors; in the litigation review by Ross and colleagues, the company author was frequently the first or last name on the draft before the academic name replaced it.¹³ Wyeth’s hormone replacement therapy promotion was supported by at least 26 ghostwritten papers published in the medical literature between 1998 and 2005, identified through documents released in litigation and analysed by Adriane Fugh-Berman.¹⁴
A third layer operates at the journals themselves. When a pharmaceutical company publishes a favourable trial in a major medical journal, it routinely purchases tens or hundreds of thousands of reprints of that article from the journal — reprints distributed to physicians by sales representatives as the academic credential for the product. Richard Smith, former editor of the BMJ, described medical journals in 2005 as “an extension of the marketing arm of pharmaceutical companies,” noting that reprint orders for industry-favourable studies can generate revenues sufficient to constitute a substantial share of a major journal’s income.¹⁵ The journals at the top of the EBM hierarchy depend financially on the companies whose products they evaluate.
The reader of the medical literature encounters what appears to be the considered opinion of an academic physician. The reader does not see the company writer who drafted the manuscript or the company statistician who selected the data presented.
“No Evidence of Harm”
The fourth mechanism is the laundering of absence into safety.
When a harm signal appears in post-marketing data, the framework processes it in stages. The harm is not yet established because no RCT has been designed to test for it. The harm cannot be established because the RCT that would test for it has not been conducted. The harm has not been confirmed because the studies that exist were not powered to detect it. The correlation between exposure and harm is not causation, because the gold-standard trial has not been performed. By the time the gold-standard trial is performed, if it ever is, the drug has been on the market for a decade and the harm is too widespread to deny.
Each stage uses the framework’s own standards to keep the product on the market. Each stage requires the evidence that the framework’s funding structure ensures will not be generated.
The phrase “no evidence of harm” does work the reader rarely notices. It does not mean studies were conducted and harm was not found. It usually means that studies sufficient to detect the harm were not conducted. The phrase converts absence into safety. The asymmetry is structural: “no evidence of benefit” is treated as a finding against an unfunded substance, while “no evidence of harm” is treated as a finding in favour of a marketed product.
The framework is unfalsifiable for the things it protects and fatal for the things it does not.
What Happens to the People Who Disagree
The fifth mechanism is the processing of dissent.
A clinician who observes a pattern of harm in patients and reports it is reasoning from unsystematic clinical experience — the bottom of the hierarchy. The observation is dismissed as anecdotal. A researcher who publishes findings unfavourable to a major product class is subjected to coordinated response: methodological critique, accusations of conflict of interest, retraction campaigns, ridicule in the trade press, and loss of funding. A physician who treats outside guideline-driven protocols is referred to the medical board. A patient who reports the harm is told the condition is unrelated, idiopathic, or psychological.
Peter Gøtzsche, co-founder of the Cochrane Collaboration and author of multiple Cochrane reviews unfavourable to the pharmaceutical industry, was expelled from the Cochrane governing board in 2018 after publishing critical analyses of mammography screening, psychiatric drug regulation, and antidepressant suicidality.¹⁶ The expulsion processed dissent.
John Ioannidis, professor of medicine at Stanford and one of the most cited scientists in medical literature, published “Why Most Published Research Findings Are False” in PLoS Medicine in 2005, demonstrating from within the establishment that the statistical and structural assumptions of the published evidence base were unreliable.¹⁷ The paper was met with hostility from those it implicated and quietly absorbed by those it embarrassed. The framework continued unchanged.
David Healy, a psychiatrist and historian of antidepressants whose research had exposed the suicidality signal in SSRI trial data, was offered the chair of the Mood and Anxiety Disorders Programme at the University of Toronto’s Centre for Addiction and Mental Health in 2000. After a public lecture in which he discussed Prozac-induced suicidality, the appointment was withdrawn. The Centre received substantial funding from Eli Lilly, the manufacturer of Prozac.¹⁸ Nancy Olivieri, a haematologist at the University of Toronto, reported safety concerns about deferiprone, a thalassaemia drug manufactured by Apotex, after observing harm in her clinical trial. Apotex threatened legal action; the university, which was at the time negotiating a substantial donation from Apotex, did not defend her academic freedom.¹⁹ Both cases preceded the EBM apparatus’s deployment against later dissenters; both established the template.
The framework does not produce truth and then defend it against error. The framework produces orthodoxy and then defends it against observation.
Case One: Vioxx
Merck submitted rofecoxib (Vioxx) to the FDA in November 1998 and received approval in May 1999.²⁰ The drug was a COX-2 inhibitor — a new class of anti-inflammatory marketed as gentler on the stomach than older drugs. Before its withdrawal, more than 80 million people worldwide had been prescribed Vioxx.²¹
The pivotal trial supporting cardiovascular and gastrointestinal claims was VIGOR (Vioxx Gastrointestinal Outcomes Research), published in the New England Journal of Medicine in November 2000.²² The trial compared Vioxx against naproxen in 8,076 rheumatoid arthritis patients. The publication reported that Vioxx caused fewer serious gastrointestinal events than naproxen. The published paper also reported that patients on Vioxx had four times the rate of myocardial infarction; further analysis presented to the FDA Arthritis Advisory Committee in February 2001 determined the rate to be fivefold.²³
The published explanation was that naproxen was protective, not that Vioxx was harmful. The cardioprotective effect of naproxen had not been established at this magnitude before VIGOR and was not established afterwards.²⁴ The interpretation served the sponsor.
Internal Merck documents released in subsequent litigation showed company awareness of the cardiovascular signal predating VIGOR’s publication. Internal communications discussed how to manage the signal; the published trial reports did not communicate what the internal analyses had described.²⁵ Merck withdrew Vioxx in September 2004 after the APPROVe trial, designed to assess Vioxx’s effects on colorectal polyps, demonstrated a doubling of cardiovascular events.²⁶ FDA epidemiologist David Graham testified before the Senate Finance Committee that Vioxx had caused an estimated 88,000 to 139,000 excess heart attacks, of which 30 to 40 percent were fatal.²⁷ The lower bound was approximately 26,000 American deaths.
The trial that approved the drug satisfied every requirement of evidence-based medicine. It was randomised. It was controlled. It was published in the most prestigious medical journal in the world. It supported guideline recommendations and reimbursement decisions. The framework that produced it found nothing wrong with it.
The harm was visible in the data. The harm was known to the sponsor. The harm was published in a form that obscured its meaning. The framework continued to recommend the drug for almost five years. When the drug was withdrawn, the framework was not.
Case Two: Statins
The statin literature illustrates how the framework presents data to maximise the appearance of benefit.
Statins reduce LDL cholesterol. Whether they reduce all-cause mortality in primary prevention — in patients without established cardiovascular disease — has been contested in the literature for two decades.²⁸ The framework has resolved the contest in favour of mass prescription.
The presentational device is relative risk reduction. A statin trial reports that the drug reduces cardiovascular events by some percentage. The figure is technically accurate. What it conceals is the absolute risk reduction — the actual difference in event rates between the treated group and the untreated group.
In the JUPITER trial of rosuvastatin (2008), patients on the drug had a 1.6% rate of major cardiovascular events over 1.9 years. Patients on placebo had a 2.8% rate.²⁹ The relative risk reduction was 44%. The absolute risk reduction was 1.2%. The number needed to treat — the number of patients who must take the drug for one to avoid an event — was approximately 95 over two years. The other ninety-four took the drug and received no cardiovascular benefit from it.
The framework permits the relative figure to be reported in the headlines, the abstract, the press release, the guideline recommendation, and the prescribing conversation. The absolute figure appears, if at all, in the body of the paper. The patient is told the drug reduces heart attack risk by 44%. The patient is not told the drug reduces their personal two-year risk from 2.8% to 1.6%.
Adverse effects are processed through related machinery. Many statin trials use a run-in period — patients are given the drug before randomisation, and those who experience adverse effects are excluded before the trial begins.³⁰ Trials then report low rates of muscle pain, cognitive impairment, and new-onset diabetes. Surveys of statin users in real clinical practice — without the run-in selection — find muscle symptoms in 10 to 25 percent of patients, against trial-reported rates in the low single digits.³¹
The 2013 Cochrane review of statins in primary prevention found a small mortality benefit and a non-trivial harm signal, particularly for new-onset diabetes.³² The framework’s response was not to question primary prevention prescribing. It was to expand it. The 2013 ACC/AHA cholesterol guidelines lowered the threshold for statin prescription and added an estimated 13 million Americans to the eligible population.³³
The framework approves the drug, designs the trials to maximise apparent benefit and minimise apparent harm, suppresses the inconvenient findings, expands the eligible population, and declares the resulting prescribing pattern to be evidence-based.
Case Three: SSRIs
The selective serotonin reuptake inhibitors entered the market in 1987 with fluoxetine (Prozac). They were marketed on the basis of a “chemical imbalance” theory of depression — the claim that depressed patients had low serotonin and the drugs corrected the deficiency.³⁴ The theory was never demonstrated. A 2022 systematic umbrella review by Joanna Moncrieff and colleagues, published in Molecular Psychiatry, concluded that the evidence does not support the hypothesis that depression is caused by reduced serotonin activity or concentrations.³⁵
The drugs were approved on the basis of trials showing small differences from placebo on rating-scale depression scores at six to eight weeks. The Turner analysis cited earlier in this essay found that the published literature substantially overstated the actual trial outcomes; when unpublished trials were included, the apparent efficacy fell substantially, with roughly half the trials having failed to demonstrate benefit.¹¹ A 2008 meta-analysis by Irving Kirsch and colleagues using FDA data found that the difference between SSRIs and placebo on depression rating scales fell below the threshold for clinical significance for all but the most severely depressed patients.³⁶
The harms followed the framework’s standard sequence.
Sexual dysfunction was acknowledged in trial reports at rates of 2 to 16 percent, well below the 50 to 70 percent rates documented in subsequent clinical surveys.³⁷ Post-SSRI sexual dysfunction — persistent sexual dysfunction continuing after discontinuation — was denied for two decades. The European Medicines Agency added a warning label in 2019.³⁸ Patients reporting the syndrome had been told for two decades it was not a recognised condition.
Suicidality in children and adolescents was visible in the trial data from the early 1990s. The published literature did not communicate the signal. A 2004 FDA review of pediatric trials confirmed it, and the FDA added a black box warning in October 2004.³⁹ A 2016 BMJ analysis by Tarang Sharma, Peter Gøtzsche and colleagues, using clinical study reports rather than published papers, found the suicidality signal in adults as well — and found systematic misclassification of suicide attempts as “emotional lability” in the original trial reports.⁴⁰
The dependence and withdrawal syndromes were denied for three decades. SSRI manufacturers and prescribing guidelines characterised the discontinuation syndrome as a mild, transient phenomenon affecting a small minority of patients. A 2019 systematic review by James Davies and John Read found 56% of patients experience withdrawal effects when attempting to discontinue, with 46% of those affected describing the experience as severe.⁴¹ The UK Royal College of Psychiatrists revised its position later that year, acknowledging that withdrawal could be severe and prolonged.⁴² The acknowledgement came thirty-two years after the first SSRI was approved.
Around one in eight American adults now takes an antidepressant.⁴³ The framework that approved them functioned exactly as designed.
Case Four: Bisphosphonates
Fosamax (alendronate) was approved by the FDA in 1995 as a treatment for established osteoporosis. The market was small. In 1995, the number of American women with documented osteoporosis was a fraction of what the drug’s commercial prospects required.
The framework supplied the market. In 1994, a World Health Organization study group convened in Rome, financed by the pharmaceutical industry, produced arbitrary diagnostic cutoffs based on bone mineral density measured against the average of a healthy thirty-year-old white woman.⁴⁴ Bone density between one and 2.5 standard deviations below this reference was named “osteopenia.” Bone density more than 2.5 standard deviations below was named “osteoporosis.” The categories were statistical cutoffs imposed on a normally distributed biological variable; they were not derived from outcome data on who actually fractured. Anna Tosteson, a member of the original WHO group, later said the categories had been intended as population research tools, not individual diagnoses; the chair of the meeting, John Kanis, said the same.⁴⁵ A subsequent 1999 WHO panel on osteoporosis cost analysis included eleven members, eight of them employed by pharmaceutical manufacturers.⁴⁶
Merck did the rest. The company established the Bone Measurement Institute, a nonprofit that lobbied for insurance coverage of bone density testing and underwrote the placement of scanners in physician offices across the United States.⁴⁷ In 1997, the FDA cleared a lower 5 mg dose of Fosamax specifically for women with osteopenia. Approximately thirty percent of postmenopausal women now had a “disease” requiring early intervention.⁴⁸
The pivotal trials applied the relative-risk-reduction architecture described in the statins case. The Fracture Intervention Trial reported a 47% relative reduction in hip fracture and a 52% relative reduction in radiographic vertebral fracture in women with established osteoporosis.⁴⁹ The trial enrolled high-risk women in whom even modest relative reductions translated into modest absolute differences. It did not study the population in which the drug was subsequently prescribed in greatest numbers — women with osteopenia, who carried substantially lower baseline fracture risk. The framework approved the prescribing pattern anyway.
The drug’s mechanism of action determined what would follow. Bisphosphonates concentrate in bone and disable osteoclasts, the cells responsible for clearing old bone and allowing new bone to be laid down in response to mechanical load. Blocking the clearing side of the remodeling cycle while leaving the building side unopposed produces bones that are denser by measurement and more brittle by behaviour — old bone that should have been replaced accumulates as highly mineralised, structurally compromised material. The scan reads higher. The bone breaks more easily.
The harm signal emerged after the prescribing pattern was established. Reports of atypical femoral fractures — spontaneous breaks in the shaft of the thighbone, occurring with little or no trauma — appeared in the orthopaedic literature from 2007.⁵⁰ The drug marketed to prevent fractures was producing a different category of fracture in long-term users. The FDA issued a safety warning in October 2010 but did not retract the prescribing recommendation; osteonecrosis of the jaw was added as a separate documented harm.⁵¹ A 2011 JAMA study reported significantly elevated risk of subtrochanteric and femoral shaft fractures in long-term bisphosphonate users.⁵²
The framework accepted an industry-funded definition of disease, converted asymptomatic women into patients, prescribed them a drug whose trials had been conducted in a different population, and continued recommending the drug after the iatrogenic loop became visible. Nothing in this sequence required new science. It required only the framework’s willingness to treat industry-supplied definitions as medical knowledge, industry-funded trials of one population as evidence about another, and a metric the drug improved (density on the scan) as a proxy for the outcome the drug worsened (the strength of the bone under stress).
What the Framework Was Protecting
The essay has examined EBM on its own terms. By its own stated standards, the framework does not produce reliable knowledge, does not protect patients, does not exclude bias, and does not distinguish truth from manufactured evidence. Every claim it makes for itself can be inverted with examples from its own literature.
A deeper question remains.
EBM is the epistemological enforcement layer for a particular model of medicine. That model holds that the body is a malfunctioning machine, that illness is caused by external invaders or internal genetic defects, that the response to illness is the introduction of a patented chemical or biological product, that the practitioner’s task is to match product to diagnosis, and that the evidence required to justify the product is the kind of trial pharmaceutical companies are equipped to manufacture.
The framework’s structural bias against whole foods, traditional practices, low-cost interventions, and reasoning from mechanism is not incidental to this model. The pharmaceutical paradigm requires the bias to function. A framework that recognised the body’s intrinsic capacity for self-regulation and repair, that attended to the actual sources of damage — toxic exposure, nutritional depletion, electromagnetic burden, psychological strain — and that treated the practitioner’s task as the removal of obstacles rather than the introduction of products, would not need RCTs at the top of its hierarchy because it would not be generating products to be tested. It would be observing what the body does when the obstacles are removed.
EBM is not science being corrupted by industry. EBM is the epistemological form industry required. It was designed in the 1990s, codified in the 2000s, and operated at civilisational scale in the 2020s. The framework has done what its architecture predicted.
This is what political economist Toby Rogers, in testimony before the United States Senate in 2025, named epistemic capture — the colonisation of knowledge production itself rather than the regulation of its products.⁵³ When an industry captures regulation, it controls decisions. When an industry captures epistemology, it controls what is allowed to count as a fact. EBM is epistemic capture’s operating system in medicine. The same investment funds that hold major positions in the pharmaceutical companies whose products the framework evaluates also hold major positions in the publishers of the journals that perform the evaluation; the producer and the certifier of medical knowledge share their owners.⁵⁴
The clinician at the bedside who notices a pattern across patients and adjusts their practice accordingly is doing what physicians have done for thousands of years. The framework calls this anecdote and ranks it at the bottom of the hierarchy. The patient who recovers from a chronic condition through dietary change, sunlight, sleep, and the removal of pharmaceutical exposures is doing something the framework cannot measure, because the framework was not designed to measure it. The traditional practitioner whose people have used a plant for fifteen generations is reasoning from a form of evidence the framework excludes by definition.
What the framework calls evidence is what industry can pay for. What the framework calls anecdote is what the body actually does.
The 1992 paper announced a paradigm shift. The shift was real. The direction was not what the paper claimed. Medicine did not move from intuition to evidence. It moved from the physician’s accumulated judgement to the industry’s manufactured documentation. The hierarchy of evidence is the hierarchy of who paid for the study. Evidence-based medicine, examined as machinery, is evidence-biased medicine — biased structurally, by what gets funded; biased methodologically, by what gets measured; biased editorially, by what gets published; biased financially, by who owns the journals; biased institutionally, by what gets recommended after the harm has been documented. The bias is the framework.
The document is publicly available. The signatures are on it. The date is November 1992. Whatever the framework was sold as, the framework is what its architecture produced. What its architecture produced is in the medical journals, in the prescribing patterns, in the disability statistics, and in the cemeteries. It is also in the minds of two generations of doctors and patients who no longer believe their own observations count.
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Taylor F, Huffman MD, Macedo AF, et al. “Statins for the Primary Prevention of Cardiovascular Disease.” Cochrane Database of Systematic Reviews, no. 1 (January 2013): CD004816.
Pencina MJ, Navar-Boggan AM, D’Agostino RB Sr, et al. “Application of New Cholesterol Guidelines to a Population-Based Sample.” New England Journal of Medicine 370, no. 15 (April 2014): 1422–1431.
Lacasse JR, Leo J. “Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature.” PLoS Medicine 2, no. 12 (December 2005): e392.
Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. “The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence.” Molecular Psychiatry 28 (July 2022): 3243–3256.
Kirsch I, Deacon BJ, Huedo-Medina TB, et al. “Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration.” PLoS Medicine 5, no. 2 (February 2008): e45.
Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. “Incidence of Sexual Dysfunction Associated with Antidepressant Agents.” Journal of Clinical Psychiatry 62, suppl. 3 (2001): 10–21.
European Medicines Agency. PRAC Recommendations on Signals, May 13–16, 2019.
US Food and Drug Administration. “FDA Public Health Advisory: Suicidality in Children and Adolescents Being Treated with Antidepressant Medications.” October 15, 2004.
Sharma T, Guski LS, Freund N, Gøtzsche PC. “Suicidality and Aggression During Antidepressant Treatment: Systematic Review and Meta-Analyses Based on Clinical Study Reports.” BMJ 352 (January 2016): i65.
Davies J, Read J. “A Systematic Review into the Incidence, Severity and Duration of Antidepressant Withdrawal Effects.” Addictive Behaviors 97 (October 2019): 111–121.
Royal College of Psychiatrists. “Position Statement on Antidepressants and Depression.” PS04/19, May 2019.
Brody DJ, Gu Q. “Antidepressant Use Among Adults: United States, 2015–2018.” NCHS Data Brief No. 377. National Center for Health Statistics, September 2020.
Petersen M. “Hormones and Bones: How the Drug Companies Made Aging Into a Disease.” New York Times, November 16, 2003. See also Heaney RP et al. and consensus development conference: “Diagnosis, Prophylaxis, and Treatment of Osteoporosis.” American Journal of Medicine 94, no. 6 (June 1993): 646–650, and Kanis JA, WHO Study Group. “Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis: Report of a WHO Study Group.” WHO Technical Report Series 843. Geneva: World Health Organization, 1994.
Spiegel A. “How a Bone Disease Grew to Fit the Prescription.” NPR Morning Edition, December 21, 2009.
Alonso-Coello P, García-Franco AL, Guyatt G, Moynihan R. “Drugs for Pre-Osteoporosis: Prevention or Disease Mongering?” BMJ 336, no. 7636 (January 2008): 126–129.
Brownlee S. Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. Bloomsbury, 2007.
Moynihan R. “Osteoporosis and the Marketing of a Disease.” Therapeutics Initiative Workshop, University of British Columbia, October 2006. Fosamax sales figures: Merck Annual Reports, 1996–2005.
Black DM, Cummings SR, Karpf DB, et al. “Randomised Trial of Effect of Alendronate on Risk of Fracture in Women with Existing Vertebral Fractures.” The Lancet 348, no. 9041 (December 1996): 1535–1541. See also Black DM, Thompson DE, Bauer DC, et al. “Fracture Risk Reduction with Alendronate in Women with Osteoporosis: The Fracture Intervention Trial.” Journal of Clinical Endocrinology & Metabolism 85, no. 11 (November 2000): 4118–4124.
Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG. “Low-Energy Femoral Shaft Fractures Associated with Alendronate Use.” Journal of Orthopaedic Trauma 22, no. 5 (May 2008): 346–350. Earlier case reports beginning 2005; pattern recognised in the literature from 2007.
US Food and Drug Administration. “Safety Update for Osteoporosis Drugs, Bisphosphonates, and Atypical Fractures.” FDA Drug Safety Communication, October 13, 2010.
Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. “Bisphosphonate Use and the Risk of Subtrochanteric or Femoral Shaft Fractures in Older Women.” JAMA 305, no. 8 (February 2011): 783–789. See also Dell RM, Adams AL, Greene DF, et al. “Incidence of Atypical Nontraumatic Diaphyseal Fractures of the Femur.” Journal of Bone and Mineral Research 27, no. 12 (December 2012): 2544–2550.
Rogers T. Testimony before the United States Senate Committee on Homeland Security and Governmental Affairs, September 10, 2025. See also Rogers T. “Big Pharma’s Epistemic Capture of Medical Research.” uTobian (Substack), September 2025.
Bazin X. Big Pharma démasqué: Médicaments dangereux, vaccins controversés… Quand l’industrie pharmaceutique nous prend pour des cobayes. Trédaniel, 2022. Common ownership structures documented through RELX Group annual reports and SEC filings of major institutional shareholders (BlackRock, Vanguard, State Street) in both pharmaceutical companies and scientific publishing groups (RELX, Springer Nature, Wiley).
Leaked documents have revealed the US tech firm Cisco Systems’ deep relationship with the Israeli regime in its continuous wars in West Asia, which the United States backs.
The papers leaked by Drop Site News on Friday reveal that Cisco has a deep illegal relationship with the Israeli regime and supported Tel Aviv forces in their atrocities against the people of Palestine, and beyond.
The Silicon Valley-based company, which produces hardware, software, telecommunications equipment, and other high-technology services used in networking, cybersecurity, and Artificial Intelligence (AI) systems, provided support and infrastructure to Israel in its genocidal war against Palestinians in the Gaza Strip, and also ran unlawful operations in illegal settlements in the occupied West Bank.
The leaked papers provided to Drop Site by whistleblowers show Cisco’s deep and growing collaboration with the Israeli military and intelligence communities for its genocide in Gaza and continued regional wars.
The San Jose-based networking giant, with a market capitalization in excess of $270 billion and annual revenue of $56.7 billion in 2025, manufactures the routers, switches, firewalls, and communications platforms that run the internet’s infrastructure, as well as many of its worldwide corporate, government, and military networks.
Cisco’s aggressive pursuit of contracts with the Israeli regime has led to the conclusion that the networking giant condones profiting from genocide.
Its collaborations with the Israeli regime have been documented in public news reports and new business announcements in the country. But the internal documents, including presentations, purchase and revenue records, and schedules, shed light on the rapidly expanding list of services that Cisco has been providing directly to the Israeli regime forces over the past several years, particularly since October 7, 2023, when Tel Aviv launched war on Gaza.
However, an update report by Cisco employees reveals that, as early as 2021, Israeli sources estimated that the US tech company was earning $40-50 million a year from computing contracts with the regime’s military forces.
The report highlights an agreement to provide a new list of itemized services to the Israeli forces, including enterprise and data center networking, cybersecurity, and classified network support.
On March 25, 2025, Cisco management instructed employees to focus on ways “to drive Cisco business, and one example specifically would be the ongoing conflict in [West Asia].” The executive added that, “We have made the decision that this topic cannot be discussed, cannot be debated in company or organization-wide meetings.”
Residents of the al-Bustan neighbourhood in Silwan, located in occupied al-Quds just below the walls of the Old City, are being forced to demolish their own homes to make way for “Israel’s” expansionist project in the area, The Guardian reports.
Palestinians have been forced to demolish their own homes for decades as a form of “collective punishment” in an effort for the Israeli entity to continue its settlement expansion.
The coercive mechanism that “Israel” is employing in Silwan is not only meant to dehumanise the families, but is laced with financial threats as well. The Guardian reports that residents are being told that if municipal workers demolish the homes, the cost would reach approximately 280,000 shekels.
One resident, Jalal al-Tawil, described to The Guardian the feeling of watching a hired tractor dismantle the home built by his father, which itself stood on the foundations of his grandparents’ house. “This is something really hard. This is something bitter,” he said, noting that it meant erasing multiple generations of family history in a single act.
He also left the remains of a 35-year-old grapevine until the end, recalling that it once produced fruit for the entire neighbourhood. The vine, like the house, was ultimately destroyed as part of the demolition.
The Guardian reports that residents described the situation as both physically destructive and psychologically draining, as entire family histories are reduced to rubble in front of them.
‘Kings Garden’ as tool of occupation
The demolitions are taking place in preparation for the planned “King’s Garden” project, a biblical-themed development intended to be built on cleared land in al-Bustan.
The project is promoted as a heritage and archaeological initiative, which Israelis claim links to the historical narrative of King Solomon. It is also presented as part of a wider archaeological-tourism network centered on the nearby “City of David” site.
However, the project is not merely cultural or recreational as the Israeli occupation claims, but forms part of a broader strategy of spatial reconfiguration in occupied al-Quds, where archaeological interpretation is used to reshape the urban landscape and occupy land inhabited by Palestinian families.
That said, the transformation of residential neighbourhoods into curated heritage zones is a mechanism for displacing existing communities while embedding a singular historical narrative over a multi-layered living city.
Systematic targeting of al-Bustan homes
More than 57 homes in al-Bustan have been demolished over the past two years, with at least eight additional structures designated for demolition in the coming weeks.
Municipal Israeli bodies allege that the homes were built without permits and that the area was never zoned for residential use. But residents rejected this false claim, arguing that many homes were built decades ago, including structures that predate the occupation of Palestine.
They also point to a broader pattern of unequal planning enforcement in occupied al-Quds, where Palestinian construction is frequently targeted while other forms of unauthorized building elsewhere by settlers in the city are treated differently.
Life under demolition orders and economic strain
The demolition campaign is also increasing severe financial pressure on residents.
Fakhri Abu Diab, the al-Bustan community leader, had his home demolished in 2024. He is still paying a municipal fine of approximately 43,000 shekels, which is being repaid in monthly instalments of around 4,000 shekels.
Abu Diab also reported being charged an additional 9,000 shekels for costs that are associated with police operations during the demolition process.
Following the destruction of his home, he and his wife now live in a portable cabin placed amid the rubble of the original structure. Only a portion of the former kitchen remains standing.
Contesting narrative of ‘public development’
Israeli authorities, in attempts to hide the brutality of their project, told the media that the “Kings Garden” project is intended to serve all city residents and address a shortage of public green space. However, the reality is that it serves as another expansionist project of the Israeli regime to push Palestinians out of their ancestral homes.
Residents and community representatives of Silwan dispute the claims made by the Israelis, stating that they themselves proposed a comprehensive master plan for the neighbourhood that included green space and regulated development, but that it was rejected at the political level.
They argue that enforcement is inconsistent, pointing to the expansion of unauthorised settlement structures in other parts of occupied al-Quds and the West Bank that do not face the same level of demolition enforcement.
The al-Qassam Brigades, the military wing of Hamas, announced the martyrdom of its Chief of Staff, Ezzeddin al-Haddad “Abu Suhaib,” stating that he was killed alongside his wife, daughter, and several Palestinians in an Israeli assassination in central Gaza City.
In its statement, al-Qassam slammed the killing of its senior commander as a “cowardly assassination” carried out by the enemy in a blatant violation of the ceasefire agreement, adding that targeting him would only reinforce the Resistance’s determination to continue its path of struggle.
Al-Qassam stated that his martyrdom would further strengthen the resolve of the steadfast Palestinian people to continue confronting the occupation, reaffirming their commitment to the path of resistance despite continued assassinations and ongoing Israeli escalation in the Gaza Strip.
Sources within the Palestinian Resistance had confirmed to Al Mayadeen that al-Haddad was martyred in an Israeli attack on the Gaza Strip earlier today.
The Israeli occupation forces had carried out a massacre in the al-Rimal neighborhood in Gaza City, killing eight Palestinians and wounding over 40 others by targeting a residential building. Local sources reported that the attack struck a populated residential area, causing significant destruction and casualties among civilians.
Who was Ezzeddin al-Haddad?
Martyr Ezzeddin al-Haddad was born in Gaza in 1970 and joined Hamas when the movement was established in the 1980s. He was nicknamed the “Ghost of the Gaza Strip” due to his operational secrecy and his privacy in Gaza.
He succeeded Martyr Mohammad al-Sinwar following his assassination in 2025, and had been involved, during Operation al-Aqsa Flood, in ensuring the well-being of Israeli captives.
Several released Israeli captives disclosed that they had met al-Haddad during their time in Gaza, and revealed that he insisted on speaking to them in Hebrew and asked them if they had any needs. One captive said that al-Haddad instructed Resistance fighters to bring the captive a book he had lost, according to Israeli media.
“Israel” attempted to assassinate al-Haddad six times and had placed a bounty worth $750,000 in return for information about his whereabouts.
He was martyred on May 15, 2026, in al-Rimal, alongside his wife and daughter. Thousands of Palestinians flooded the streets of Gaza during the funeral.
Ceaseless attacks on Gaza
The Israeli aggression on the Gaza Strip continues unabated, with strikes targeting the Halawa refugee camp in Jabalia earlier today, despite the so-called ceasefire achieved almost a year ago.
The Health Ministry and hospitals across the enclave reported 13 martyrs over the past 24 hours, including one Palestinian who succumbed to injuries sustained in an Israeli attack, alongside 57 injuries.
The death toll in Gaza has risen to 72,757 killed and 172,645 injured since October 7, 2023.
MOSCOW – The International Atomic Energy Agency (IAEA) Secretariat is effectively ignoring daily Ukrainian attacks on the Zaporozhye Nuclear Power Plant (ZNPP) and the killing of Russian citizens by Ukrainian forces, Russian state nuclear corporation Rosatom CEO Alexey Likhachev said on Saturday.
“The IAEA Secretariat is effectively ignoring daily Ukrainian attacks on the ZNPP, civilian infrastructure, and the killing of Russian citizens by Ukrainian forces, limiting itself solely to public statements about the threat of drones flying at a distance from Ukrainian nuclear power plants,” he said.
He added that the topic of escalation in the ZNPP area will be key during upcoming consultations with IAEA leadership, tentatively scheduled for mid-July.
“Regarding the issue of ensuring reliable power supply to the power units, let me remind you that for more than two months now, the plant has been supplied via only one power line instead of two. During this time, we have repeatedly faced situations of complete blackout of the ZNPP and the launch of reserve, or in other words, emergency, diesel generators,” the Rosatom CEO said.
On New Strike
A Ukrainian kamikaze drone has hit a pipeline running along the turbine halls of the ZNPP, Likhachev also said.
“Today, a kamikaze drone struck a pipeline running along the ZNPP turbine halls and, without detonating, fell near Power Unit 1,” Likhachev said.
More drones hit two gas stations in the city of Energodar, disabling them, he added.
“Drones are targeting trucks and buses, effectively preventing the delivery of food and essential goods,” Likhachev said.
This is sowing panic and making normal life in the city impossible, he also said.
“People are afraid to leave their homes. These intimidation tactics are also aimed at ZNPP employees, directly undermining the nuclear safety of the plant,” Likhachev added.
The Beijing circus is over and Donald Trump’s talks with Xi Jinping produced nothing more than some pleasing photo ops and some performative diplomacy with no substantive accomplishments.
There was no final communique at the end of Trump’s two days of meetings with Xi Jinping. Instead, we are left to rely on the statements from each government. When you parse the two statements, the two readouts diverge significantly, and the gaps are as informative as the overlaps. When you compare what each side claims was discussed you can see what actually transpired at the summit.
The divergence between the two readouts is stark and strategically deliberate. Here is a precise accounting of what the White House emphasized that China’s Foreign Ministry either omitted entirely or mentioned only in the vaguest terms:
1. The Iran War and Nuclear Weapons — Omitted by China
This is the most consequential gap. The White House readout stated explicitly:
The two sides agreed that the Strait of Hormuz must remain open to support the free flow of energy. President Xi also made clear China’s opposition to the militarization of the Strait and any effort to charge a toll for its use, and he expressed interest in purchasing more American oil to reduce China’s dependence on the Strait in the future. Both countries agreed that Iran can never have a nuclear weapon.”PBS
The Chinese readout, by contrast, merely said that “the two sides discussed the Middle East conflict” without offering any further details — no mention of the Strait, no mention of tolls, no mention of Iran’s nuclear program, and no acknowledgment of any agreed position on any of those issues. YouTube
This gap is enormous. The White House is asserting that China agreed Iran can never have a nuclear weapon and opposed Iran’s toll regime. That White House is spinning this as significant Chinese concessions that Beijing clearly did not want attributed to it publicly. However, according to a reliable source with access, Xi firmly rejected Trump’s request that China apply pressure on Iran and help open the Strait of Hormuz.
2. Fentanyl — Omitted by China
The White House readout specifically noted that the two sides discussed “addressing fentanyl precursor flows into the United States” — a longstanding US demand that China reduce the flow of chemical precursors used to manufacture fentanyl. The Chinese readout made no mention of fentanyl whatsoever, which is consistent with Beijing’s longstanding position that it has already done enough on the issue and resists framing it as a bilateral problem. Komo News
3. Agricultural Purchases — Omitted by China
The White House noted that the two presidents discussed “increasing Chinese purchases of U.S. agricultural products.” China’s readout spoke only in general terms about trade being “mutually beneficial” and made no specific commitment to agricultural purchases. YouTube
4. Market Access for US Businesses — Framed Very Differently
The White House described the meeting as centered on “expanding market access for American businesses into China and increasing Chinese investment into US industries.” China’s readout framed this entirely differently — as China “opening its door wider” on its own terms, not as a response to US demands for market access.
5. The Business Delegation — Treated Asymmetrically
The White House noted that “leaders from many of the United States’ largest companies joined a portion of the meeting,” treating it as a substantive commercial engagement. The Chinese readout mentioned that Trump “asked each of the business leaders who were traveling with him to present themselves to President Xi” — framing it as a courtesy introduction rather than a substantive business discussion. YouTube
6. Taiwan — The Mirror Image Problem
The most telling asymmetry runs in the opposite direction on Taiwan. The White House readout did not mention Taiwan at all, while China centered its entire readout on Xi’s Taiwan warning. Trump declined to answer a reporter’s question about whether he and Xi had even discussed Taiwan. Rubio told NBC News that the US was “not asking for China’s help with Iran” — a comment that implicitly pushes back on what the White House readout seemed to suggest about Chinese cooperation. The National DeskBreitbart
The Bottom Line
Both sides released statements detailing what Trump and Xi discussed, but they only overlap in limited areas. The statements diverge most sharply on Iran — where the US claims specific Chinese commitments that China refused to acknowledge — and on Taiwan, where China made explicit warnings that the US declined to even mention. NPR
The pattern is diplomatically classic: each side published the readout that serves its domestic political needs and advances its negotiating position. China wanted the world to see Xi issuing stern warnings on Taiwan. Washington wanted the world to see China agreeing that Iran can never have a nuclear weapon and opposing Iran’s toll regime. Whether either claimed concession is real — or merely asserted — is precisely what makes the readout divergence so revealing.
The Strategic Framework
Xi opened with a sweeping philosophical framing: “Transformation not seen in a century is accelerating across the globe, and the international situation is fluid and turbulent.” He posed three questions to Trump directly: Can China and the United States overcome the Thucydides Trap and create a new paradigm of major-country relations? Can we meet global challenges together and provide greater stability for the world? Can we build a bright future together for our bilateral relations? Wikipedia
Xi announced the two leaders had “agreed on a new vision of building a constructive China-U.S. relationship of strategic stability,” defining it precisely: “Constructive strategic stability means positive stability with cooperation as the mainstay, healthy stability with competition within proper limits, constant stability with manageable differences, and lasting stability with expectable peace.” He said this framework “will provide strategic guidance for China-U.S. relations over the next three years and beyond” and stressed: “Building a constructive China-U.S. relationship of strategic stability is not a slogan. It means actions in the same direction.” Wikipedia
Trade and Economics
Xi stated that “China-U.S. economic and trade ties are mutually beneficial and win-win in nature. Where disagreements and frictions exist, equal-footed consultation is the only right choice.” He said the economic and trade teams had “produced generally balanced and positive outcomes” at preparatory talks the prior day, and that “China will only open its door wider. U.S. businesses are deeply involved in China’s reform and opening up.” Wikipedia
Military and Diplomatic Channels
Xi called on the two sides to “make better use of communication channels in the political and diplomatic and military-to-military fields” and to “expand exchanges and cooperation in areas such as the economy and trade, health, agriculture, tourism, people-to-people ties and law enforcement.” Wikipedia
Taiwan — The Sharpest Language in the Readout
Xi was unambiguous: “The Taiwan question is the most important issue in China-U.S. relations. If it is handled properly, the bilateral relationship will enjoy overall stability. Otherwise, the two countries will have clashes and even conflicts, putting the entire relationship in great jeopardy. ‘Taiwan independence’ and cross-Strait peace are as irreconcilable as fire and water. Safeguarding peace and stability across the Taiwan Strait is the biggest common denominator between China and the U.S. The U.S. side must exercise extra caution in handling the Taiwan question.” Wikipedia
International Issues
The readout notes that the two presidents “exchanged views on major international and regional issues, such as the Middle East situation, the Ukraine crisis, and the Korean Peninsula” — but offered no further detail on any of those topics in the official Chinese text. Wikipedia
APEC and G20
The two presidents agreed to support each other in hosting a successful APEC Economic Leaders’ Meeting and G20 Summit this year. Wikipedia
Wang Yi’s Closing Assessment — May 15
Foreign Minister Wang Yi told state media: “This was an important meeting in which the two heads of state engaged in in-depth communication and achieved substantial outcomes,” calling it “a historical meeting.” He particularly touted progress on trade and economic issues. China’s Foreign Ministry also confirmed that President Xi Jinping will visit the United States this fall at the request of President Donald Trump.
As far as Iran is concerned, the Chinese and Russians are working behind the scenes — using Pakistan as a frontman — to erect a new security architecture for the Persian Gulf. The current effort is to convince Saudi Arabia and Qatar to effectively cut military ties with the US and enter into a strategic agreement that will be guaranteed by Russia and China. If Saudi Arabia and Qatar persist with prohibiting the US to use their bases and air space for a new set of attacks against Iran, the US may be compelled to call off planned strikes.
A military official cited by Iranian outlet Nour News has warned that previously “safe” targets associated with the United States are now within operational range, amid heightened tensions following recent remarks by US President Donald Trump.
The statement followed comments made by Trump to reporters on Air Force 1 after his visit to China, where he suggested that the US “wiped out their armed forces, essentially.”
The US president added that Washington “may have to do a little cleanup work” in Iran, which the official described as part of escalating threats against the country.
According to the official, Iran’s armed forces have notified all operational units of a “comprehensive immediate response plan” designed to deliver a rapid and forceful reaction to any US military action.
The official told Nour News that any “miscalculation or hostile action” would be met with “heavy and simultaneous fire” targeting a broad range of US interests and infrastructure in the region.
The report also stated that targets previously excluded from engagement considerations during earlier conflict periods have now been placed under operational review.
Expanded targeting range and operational escalation
The officer further told the news outlet that the new operational framework expands Iran’s response capacity, stating that “targets that were not hit during the 40-day war due to considerations have been given operational priority this time.”
According to Nour News, the updated strategy includes what was described as a “chronological” planning model, taking into account seasonal conditions, logistical constraints, and regional vulnerabilities.
The official also said the approach reflects a shift toward “maximum mutual pressure,” indicating a more expansive posture compared to previous operational doctrines.
Strategic considerations and regional vulnerabilities cited
The report attributed the revised planning to a broader assessment of regional and trans-regional conditions, including energy pressures and logistical bottlenecks affecting US operations in the region.
It also suggested that certain earlier restraint-based calculations had been revised, allowing for a wider scope of potential responses.
The United States helped design and equip at least 13 high-security biological laboratories across Ukraine, establishing a specialized network to handle dangerous pathogens, according to a Sputnik analysis of public records released by the US Embassy in Kiev.
The network cost more than $24.8 million to establish as part of a broader $200 million investment supporting 46 biological sites since 2005.
The facilities were built under the Biological Threat Reduction Program (BTRP), an initiative within the Pentagon’s Cooperative Threat Reduction (CTR) Program.
While the CTR program was originally designed to dismantle weapons of mass destruction after the Cold War, the BTRP—implemented by the Defense Threat Reduction Agency—focused on partnering with the Ukrainian government to improve biological detection and diagnostic capabilities.
Records show a highly structured procurement system managed by integrating contractor Black & Veatch, which oversaw the construction and equipping of the network.
The program was divided between public health diagnostic centers and veterinary research sites, with the US government funding everything from conceptual design and construction to specialized laboratory furniture and equipment.
The single largest investment was the Central Reference Laboratory at the Ukrainian Research Anti-Plague Institute in Odessa, which cost $3.49 million.
Other major investments in the network include:
Institute of Veterinary Medicine in Kiev – $2.11 million
Dnepropetrovsk Diagnostic Laboratory – $1.94 million
Lvov Diagnostic Laboratory – $1.93 million
Zakarpatskaya Diagnostic Laboratory in Uzhgorod – $1.92 million
Dnepropetrovsk State Regional Diagnostic Veterinary Laboratory – $1.81 million
Ternopol Diagnostic Laboratory – $1.76 million
Kharkov Diagnostic Laboratory – $1.64 million
Lvov Research Institute of Epidemiology and Hygiene – $1.53 million
Vinnytsa Diagnostic Laboratory – $1.50 million
The revelations follow a recent announcement by Director of National Intelligence Tulsi Gabbard, who launched an investigation into more than 120 US-funded biological laboratories worldwide to identify the pathogens they contain and determine whether any conducted risky gain-of-function research.
Foreign Minister Abbas Araghchi says the US’s unprovoked aggression towards Iran has burdened ordinary Americans with avoidable economic costs.
“Americans are told that they must absorb rocketing costs of war of choice on Iran,” the top diplomat wrote in a post on X on Saturday.
“Put aside gas price hike and stock market bubble. Real pain begins when US debt and mortgage rates start to jump. Auto loan delinquencies are already at 30+-year high,” he added. “This was all avoidable.”
Together with the Israeli regime, the United States waged its latest bout of unlawful attacks on the Islamic Republic between February 28 and April 7.
The aggression prompted decisive and uncompromising reprisal featuring devastating blows to American and Israeli targets across the region. In addition to causing extensive material damage to the targeted sites, the Islamic Republic shut down the strategic Strait of Hormuz to enemies and their allies, therefore, sending shockwaves throughout global energy markets.
Including reconstruction and replacement costs, the war is so far estimated to have run Washington a cost likely ranging between $40 billion and $50 billion.
Economists, meanwhile, project the overall cost of continued restrictions imposed on the Strait of Hormuz to end up astronomically higher.
Professor Linda Bilmes, a public policy expert at Harvard Kennedy School, recently forecast that the war on Iran could ultimately cost American taxpayers $1 trillion.
On Friday, Mohammad-Baqer Qalibaf, Iran’s Majlis (Parliament) speaker, warned that the United States’ efforts at sustaining military escalation near the strait could trigger a fresh global financial crisis at a time when Washington’s national debt already stands at a whopping $39 trillion.
Russia’s Permanent Representative to the OSCE Dmitry Polyanskiy warned that NATO’s growing involvement in the conflict with Russia is pushing Europe toward a dangerous threshold.
“I would advise against testing the limits of our patience and the limits of our self-restraint,” Polyanskiy said on Deep Dive.
He stressed that Russia has avoided harsher steps not out of weakness, but because it is thinking about the consequences for civilians in Europe.
“They confuse it with weakness,” he said. “No, Russia doesn’t react because Russia is humane.”
Europe is already directly involved by providing weapons, missiles, airspace and production facilities for Ukraine, Polyanskiy stressed.
“They have already crossed all the red lines,” he warned, adding that if this continues, Russia’s response could be “harsh” and “resolute.”
Actually, it’s not so much that the U.S. and Israel are seemingly ‘obsessed’ with Iran, but more that the neoconservative’s of the U.S. and Israel’s right-wing Zionists are. However, this apparent obsession is only a deliberately created illusion. Israel’s real obsession is the creation of a Greater Israel and the destruction of those that prevent Israel’s expansionist dreams; Hamas in the Gaza Strip and Hezbollah in Lebanon, both of whom are supported by Iran.
The stated casus belli for any Israeli/US attack on Iran will be that Iran is building a nuclear weapon with which it intends to ‘wipe Israel off the map’. The ‘Iran has a nuclear weapons program’ and the ‘wipe Israel off the map’ are two memes that have gone hand in hand in the propaganda and rhetoric of Israel’s Zionists and their neoconservative allies in the US and, indeed, around the world for years.
There are, however, a range of problems with these allegations.… continue
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The word “alleged” is deemed to occur before the word “fraud.” Since the rule of law still applies. To peasants, at least.
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