The Court Physician of the Therapeutic State

I have been asked many times what to read to understand how American biomedical science was captured. People expect me to recommend a virology textbook, or perhaps a regulatory primer. I do not. I tell them to read Murray Rothbard. Rothbard, the late Austrian-school economist and libertarian theorist, never wrote about Anthony Fauci. He died in 1995, when Dr. Fauci had been director of the National Institute of Allergy and Infectious Diseases for only eleven years and was still mostly known to those of us inside the AIDS-research community. But Rothbard had spent his career describing, with unusual analytical clarity, the precise machinery that would, over the following three decades, produce the figure of Fauci, and the catastrophe of 2020. He gave us the diagnostic vocabulary before we knew we needed it. I write this essay as a participant-observer. I was there at the Salk Institute in the late 1980s. I conceived of the underlying mRNA platform technology that was eventually deployed, against my warnings, in the Operation Warp Speed countermeasures. I sat in NIH working groups during the early COVID response. I watched colleagues I had known for decades reinvent themselves as compliance officers for a narrative. And I watched, as Robert F. Kennedy Jr. has documented exhaustively in The Real Anthony Fauci and The Wuhan Cover-Up, the deliberate construction of a pharmaceutical-biosecurity apparatus that has now metastasized through every organ of the federal research enterprise. Rothbard would not have been surprised. He would have been grim, but not surprised. What follows is my attempt to read these two manuscripts (the public record they assemble, and the half-century of institutional decay they describe) through the lens he handed us. Rothbard drew a distinction that almost no one in our public conversation can hold in their head for more than a sentence at a time. Science, in the older sense of scientia, correct knowledge, is the human activity of inquiring honestly into the structure of reality. Scientism is the use of the prestige of science to compel obedience. The first is a method. The second is a posture. The first proceeds by conjecture, falsification, and replication. The second proceeds by accreditation, gatekeeping, and excommunication. For most of his career, Dr. Fauci was the most powerful working practitioner of scientism in the world. I want to be precise about this charge. I am not saying he was uneducated, or that he never did legitimate science as a young clinician. I am saying that the role he occupied for thirty-eight years at NIAID, and the manner in which he occupied it, was structurally incompatible with science as a free inquiry. The role was a priestly one. The famous formulation, “attacks on me are really attacks on science,” was not a slip of the tongue. It was a precise statement of his self-understanding, and an unintentionally perfect illustration of Rothbard’s distinction. A scientist welcomes attacks; that is what a scientist is. Only a priest of scientism can find a personal critique to be a sacrilege. The Kennedy manuscripts document this priestly posture in extraordinary granularity: the suppression of repurposed therapeutics during the COVID period; the campaign against any clinician (Kory, McCullough, Risch, Bhattacharya, Kulldorff, and yes, myself among many others) who proposed alternative hypotheses; the orchestration of the Lancet and Nature Medicine statements on the origins of SARS-CoV-2 to short-circuit a debate that had not yet happened. This is not how science behaves. This is how a magisterium behaves. Rothbard’s contribution was to insist that scientism is the natural product of a particular institutional arrangement. Wherever you place a single bureaucracy in charge of allocating research funding for an entire scientific field, you will, eventually, get scientism. You will not get it because the bureaucrat is wicked. You will get it because the incentive gradients of the position itself reward conformity, public-relations management, and the suppression of paradigm-threatening lines of inquiry. The institution selects for the disposition. Fauci is what the chair he sat in produces. Here is the part of Rothbard that mainstream commentators have never been able to absorb, and that Kennedy’s books finally make legible to a broader public: the National Institutes of Health is not a neutral funder of the scientific community. It is a monopsony. It is the dominant (in many subfields, the only) buyer of biomedical research labor in the United States. And like all monopsonies, it sets the terms. A word on the term, because it is unfamiliar to most readers and indispensable to what follows. Monopoly is the condition in which a single seller controls a market and can therefore set the price at which goods are sold. Monopsony is its mirror image: a single buyer controls the market and can therefore set the price at which goods, services, or labor are purchased. The word comes from the Greek monos (single) and opsōnia (purchasing of provisions). The classical examples are a coal-mining town with one mining company that hires every available miner, or a defense ministry that is the only legal buyer of fighter jets. In each case the buyer is not constrained by competition, because there is no competition; the seller, whether a worker or a manufacturer, must accept the buyer’s terms or exit the field entirely. NIH, and within NIH the NIAID Fauci built, occupies precisely this structural position with respect to American biomedical researchers. There is, for most subfields and most career stages, no realistic alternative funder. A young virologist who wishes to do virology in the United States either receives an NIH grant or finds another line of work. The buyer dictates not only price but the substantive direction of inquiry: what may be studied, what may be published, and what conclusions may be safely reached. Rothbard’s analysis of state R&D was elementary: when the price system is replaced by political allocation, you do not get a better outcome than the market would have produced. You get a different outcome: one that reflects the preferences of the political allocator rather than the preferences of the patients, clinicians, and curious investigators who would have constituted the market. State science does not fail because bureaucrats are stupid. It fails because their feedback signal is wrong. They are graded by Congress, by the press, by the pharmaceutical lobby, and by their own professional networks. They are not graded by whether the research they fund actually heals anyone. Run this analysis through the Fauci-era NIAID and the picture is devastating. Kennedy documents (and the inventories of NIH grants confirm) that under Fauci’s tenure the agency’s portfolio shifted decisively toward two priorities: vaccines (especially novel-platform vaccines with patent protections) and “biodefense” (especially gain-of-function work on potential pandemic pathogens). It shifted away from chronic-disease etiology, toxicology, environmental medicine, nutrition, and the hard work of asking why the post-1986 American child is so much sicker than the pre-1986 American child. Kennedy’s marshalling of the data on this point is unanswerable: the explosion of allergic, autoimmune, neurodevelopmental, and metabolic disease in the cohort that grew up under Fauci’s NIAID is a public-health catastrophe whose causes the responsible agency has shown no interest in investigating. Rothbard would have predicted this exactly. The chronic-disease question has no patentable answer; therefore the institution has no incentive to ask it. The shift toward biodefense is the more sinister half of the story, and Kennedy’s Wuhan Cover-Up is the indispensable text. After the 2001 anthrax letters (a domestic event whose attribution remains contested, and whose immediate political effect was to install the biosecurity faction at the commanding h…