Tuesday, July 28, 2026

 

Our

Fight for Freedom

NEVER ENDS!


Technocracy’s Digital ID Is Being Smuggled In On The Backs Of Children

Posted By: Patrick Wood

I have spent more than fifteen years analyzing technocracy as a system of rule by engineered administration, where the credential replaces the citizen, and the dashboard replaces the vote. Technocrats have their requirements, and they keep hammering on them until they get their way.

In all those years, how many times have we seen digital ID come up? Just about every year!

The fact is, Technocrats need digital identity to work. Without it, Technocracy is dead. You cannot administer what you cannot enumerate. You cannot meter, permission, or exclude a population that you cannot individually identify. Programmable money, social scoring, algorithmic governance, all of it waits on a unique, verified, machine-readable identity for every human being.

That is why the past twelve months deserve your full attention. The hinge pin for digital ID is being fitted right now, on both sides of the Atlantic, and the hand doing the fitting is wearing a child-safety armband. The Technocrat’s feigned concern for children is so patently hollow that it borders on child abuse.

First, The Age Check For Minors, Then ID For Everybody

Britain ran the experiment first, so watch this pattern.

In July 2025, the age-verification rules of the Online Safety Act took effect. To protect children, adults were suddenly required to upload government IDs or submit to face scans to reach lawful content on Reddit, X, and Discord. The public understood immediately what an “age check” really is. It is an identity check with a bedtime story attached.

The response was remarkable. VPN signups surged by more than a thousand percent within hours of enforcement. One provider compared the numbers to what it sees during civil unrest. Millions of ordinary Britons, no manifesto required, simply refused to show papers at the door of the internet. These weren’t extremists as the government maintained, but ordinary, run-of-the-mill citizens.

Two months later the government showed its hand. The Prime Minister announced a national digital ID, mandatory for the right to work. The pretext shifted from children to migrants, but the architecture was the same. No credential, no participation. That Prime Minister, Keir Starmer, happens to be a member of the elitist Trilateral Commission.

Then the public won the first round. Nearly three million people signed a petition against the scheme, one of the largest in parliamentary history. Opposition came from every direction at once, left and right, Scotland and Northern Ireland, and by January 2026, the government retreated to a “voluntary” ID. Read the fine print, though. Digital right-to-work checks are still on track to become effectively unavoidable. The ID is optional, just as cash is optional once every register goes card-only.

Now watch American Technocrats run the same play. In June 2026, the House passed the KIDS Act, a package that consolidated 14 separate child-safety bills into a single vote. Its defenders point to language disclaiming any age-verification mandate, and that language is real. But the liability standard does the work instead. Platforms face consequences if they “should have known” a user was a minor. No general counsel on earth reads that phrase and concludes the company should collect less identity data.

The Senate side is more revealing, even if there are doubts about passing. A package is being negotiated that would trade children’s online safety legislation for federal preemption of state AI laws. Sit with that switch-a-roo for a moment. The most powerful industry in history is offering to accept identity-adjacent rules for the public in exchange for removing safety rules for itself. The children are the currency, not the beneficiary.

Always Call Them Out By Name

Skeptics like Jeremy Boreing tell me Technocracy has no unified plans, names, or even an address. Here are three names (there are many more), and I invent nothing about any of them. The public record says it all.

Start with Sam Altman, because he skipped the pretexts and built His company, Tools for Humanity, that manufactures the Orb, a biometric device that scans human irises and issues a “proof of personhood.” The project’s founding white paper described the goal as “a globally-inclusive identity and financial network, owned by the majority of humanity.” Every human. That is the stated scope.

So far, the project has scanned millions of people across roughly 160 countries. It rolled thousands of Orbs into American cities in 2025. By this spring, it had struck verification partnerships with Tinder, Zoom, and DocuSign. Dating, work, and contracts: that is the connective tissue of ordinary life, and it is being wired to an eyeball scan.

Governments elsewhere saw the danger in the Orb. Brazil banned the project outright. Indonesia, the Philippines, and Thailand halted it, citing consent violations and the recruitment of poor communities paid for their eyeballs. It expands anyway. And savor the business model. The man whose AI floods the internet with convincing bots now sells the only antidote, proof that you are not a bot. He built the disease, he owns the cure, and the cure is a global biometric registry.

Marc Andreessen shows you the financing. His firm, Andreessen Horowitz, was an early and repeated backer of Altman’s identity project, participating in the funding rounds that built the Orb network. At the same time, Andreessen and his partners helped bankroll Leading the Future, one of the largest super PACs in the history of technology politics. Its purpose is to elect politicians who will preempt and dismantle state-level AI regulation, the very preemption now being traded for kids’ safety bills in the Senate.

Follow both hands at once. One hand funds the infrastructure that credentials every human. The other funds the campaign to strip oversight from the machines. Deregulate the algorithms, register the people. You do not need to infer this from whispers. It is written in funding announcements and FEC filings.

Peter Thiel supplies the government side of the pincer. The company he co-founded, Palantir, saw its federal contracts nearly double to roughly a billion dollars in 2025, spanning ICE, the IRS, and the Pentagon. A March 2025 executive order instructed agencies to eliminate “information silos,” which is bureaucratese for merging the data files. Reporting throughout 2025 and 2026 placed Palantir at the center of efforts to link tax records, Social Security data, health claims, and immigration status across agencies.

Even a Republican congressman, Warren Davidson, said the quiet part aloud. Combining those data points, he warned, “essentially creates a digital ID.” Notice the form it takes. No card in your wallet, no enrollment ceremony. A dossier assembled on the server side, which is the one kind of digital identity nobody ever asks you to consent to. Britain knows the pattern too. Palantir won the contract to consolidate NHS patient data, nearly half a billion pounds, over loud objections from privacy campaigners.

Three men, three vectors, and this is the tip of the iceberg. Altman builds the credential. Andreessen finances it while defunding oversight. Thiel fuses the state’s records behind it. Do they meet in a smoke-filled room? They do not need to. Interests that align coordinate themselves, and that self-coordination is exactly what makes technocracy durable. It requires no conspiracy, only convergence.

It’s Always The Children

Notice what none of these projects leads with. Control never introduces itself as control. Digital ID never arrives as a demand. It arrives as a favor. Protect the children. Stop the bots. Catch the fraudsters. Secure the border.

Each rationale is genuinely sympathetic, which is exactly why each is selected. The children are the most effective of all, because no politician survives a vote against “child safety.” So the age check becomes the wedge, the wedge becomes the norm, and the norm carries the full system in behind it.”

Britain presented a timetable of 14 months from age checks to a national ID proposal.

The Pushback Is Working, So Get Busy While Time Remains

Here is the part the doom alarmists leave out, and it matters. The public keeps winning.

Britain repealed Blair’s ID cards in 2011. The mandatory BritCard was gutted in four months by petition signatures and cross-party revolt, Farage and Corbyn objecting in the same season. Brazil threw the Orb out of the country and fined it for coming back. Even in Washington, the bill that actually passed the House had its most speech-restrictive provision stripped out first, and nearly a hundred advocacy groups fought it from one side while civil liberties groups fought it from the other.

Every one of those victories came from ordinary people making noise: signing, calling, refusing, switching on a VPN as an act of quiet defiance. The architects of these systems are patient, but they are not invincible, and they retreat every single time the public notices before the concrete sets.

If Britain’s voluntary ID stays genuinely voluntary through 2029, if American age checks stay confined to explicit-content sites, if World ID never becomes a de facto requirement for work or platforms, then the hinge-pin reading loses force, and I will be happy to say so in print.

But watch the edge, because that is where this gets decided. The right-to-work check that quietly requires the “optional” credential. The liability rule that makes identity collection the cheapest legal insurance. The platform partnership that turns an iris scan from a novelty into a prerequisite. The pin does not get hammered in. It gets slid in, one sympathetic millimeter at a time. Don’t fall for it!

The Technocrats that I have tracked for fifteen years have names, funding rounds, federal contracts, and a floor vote. Every victory so far came because people spoke up before the concrete set. Speak up now, while it is still wet.

Sunday, July 26, 2026

 

The

Permanent Portfolio Fund

(PRPFX)

Real Diversification    


  •   Gold
  •   Silver
  •   Swiss Franc Assets
  •   Real Estate and 
  • Natural Resource Stocks
  •   Aggressive Growth Stocks
  •   Dollar Assets**

DYI:  The U.S. stock market is massively overvalued real diversification is needed in order to maintain your gains and have the possibility of future positive returns as well.

Many followers buy The Permanent Portfolio fund as a substitute for the short term bond (cash) portion and then buy or sell the other assets as shown by DYI’s model portfolio.

**Dollar assets is bills, notes, and bonds of both U.S. government and corporate denomination.  

   Updated Monthly

AGGRESSIVE PORTFOLIO - ACTIVE ALLOCATION - 7/1/26

Active Allocation Bands (excluding cash) 0% to 50%
41% - Cash -Short Term Bond Index - VBIRX
35% -Gold- Global Capital Cycles Fund - VGPMX **
 24% -Lt. Bonds- Long Term Bond Index - VBLTX
 0% -Stocks- Total Stock Market Index - VTSAX
[See Disclaimer]
** Vanguard's Global Capital Cycles Fund maintains 25%+ in precious metal equities the remainder are domestic or international companies they believe will perform well during times of world wide stress or economic declines.  

 This blog site is not a registered financial advisor, broker or securities dealer and The Dividend Yield Investor is not responsible for what you do with your money.
This site strives for the highest standards of accuracy; however ERRORS AND OMISSIONS ARE ACCEPTED!
The Dividend Yield Investor is a blog site for entertainment and educational purposes ONLY.
The Dividend Yield Investor shall not be held liable for any loss and/or damages from the information herein.
Use this site at your own risk.

PAST PERFORMANCE IS NO GUARANTEE OF FUTURE RESULTS. 


Supreme Court Guts the Deep State

The Supreme Court just gutted one of the load bearing walls of the deep state, voting 6 to 3 to let Trump fire thousands of independent bureaucrats who effectively run the country with minimal oversight from the voters. 

Could we see the day when voters actually decide what happens to them?

Last week the Supreme Court decided the long-anticipated Trump v Slaughter case, which revisits a 90 year precedent called Humphrey’s Executor that insulated independent agencies from dismissal by the president.

This matters because independent agencies control some of the most important policy levers in the federal government, including the FTC that was at issue in Slaughter, which can block corporate mergers.

The SEC, CFTC, and FDIC, which control financial markets and banking insurance, the FCC who controls free speech, FEC for elections, NLRB for unions. FERC for energy markets. EEOC for affirmative action; and USITC that controls much of trade policy.

That’s a substantial part of the federal government, all outside the control of the President. Meaning outside the control of voters, whose only influence is the president and Congress they elect. But with the Filibuster paralyzing Congress that boils down to only the President.

Slaughter put the ball back in voter’s hands.

The Progressive Deep State

So the background is socialist Progressives waged a century long jihad to take the government away from voters and turn it into a self-licking ice-cream cone that serves the Progressive revolution.

The landmark moment was the 1883 Pendleton Act that established an independent bureaucracy insulated from political -- hence voter -- control. The excuse was to fight corruption -- which of course is as strong as ever. And the result was voters became spectators while federal workers became an occupying army.

The Deep State was born.

And that Deep State consolidated into so-called independent boards starting with the Interstate Commerce Commission in 1887 that unconstitutionally regulated business, then took off in FDR’s socialist New Deal, with dozens of agencies created to rule the country without voters.

By 1946 this occupying army won the right to effectively write law in the Administrative Procedure Act, then wrangled itself near-immunity from being fired in the 1978 Civil Service Reform Act.

Bringing us to today, where almost 90% of laws are written by bureaucrats, not by elected politicians. And, until last week, there’s nothing you can do about it.

Giving Power Back to Voters

Slaughter now joins a parade of recent decisions turning the tide, including Seila, Collins, and Loper Bright that give Presidents more control over bureaucrats while giving Congress a bigger role in actually writing the laws that, according to the Constitution, they alone are supposed to write.

There's miles to go:  On the very same day the Court stayed Trump’s firing of Fed member Lisa Cook -- allegedly on a technicality but possibly revealing a reluctance to let elected presidents control the unconstitutional Federal Reserve that all but controls the economy.

Meanwhile, while Loper and now Slaughter have dramatically reshuffled the cards, federal rulemaking, court deference, and federal worker protections remain stubborn and will need multiple decisions to root out.

What is Next?

In the near term Trump can purge independent agencies so they stop sabotaging his agenda, while agencies like FTC and SEC are likely to pull back on major regulatory pushes to keep their heads down.

But zooming out we could see major reductions in the regulatory tax on the economy that studies imply could double or quadruple wages -- Starbucks and dog-walkers would be making six figures.

And assuming the firing of Fed member Lisa Cook firing is refiled with the technicalities fixed, we could even see a Federal Reserve that actually answers to the people it’s abused for 113 years and counting.



Thursday, July 23, 2026


Breaks

The 5% Barrier!

Current Yield

As of 7-23-2026

6.01%

VCLTVanguard Long-Term Corporate Bond ETF

DYI:  Bond yields continue to climb (as bond prices fall) an excellent starting point for individuals who are dollar cost averaging.  Lump sums (especially for those retired) beware as bond prices could fall further, however, for those with a 10 year time horizon (dollar cost averaging) is an excellent way to bridge over the time horizon waiting for stock market valuations to come back down to earth.


 

Bubble

News

Navigating Lost Decades
Published on 03/30/2026
Source: Market Mosaic Daily, by CMT Association

"Stocks for the long run" has become axiomatic in investment management. The premise is straightforward: over sufficiently long horizons, equity returns reliably exceed inflation and alternative asset classes, rewarding patient investors who maintain exposure through inevitable periods of volatility. This framework underpins the majority of retirement planning, the growth of passive investment vehicles, and the standard advice dispensed to individual investors: stay invested, do not attempt to time the market, and trust in the long-term equity risk premium.

The conventional wisdom that equities reliably reward patient investors over long horizons obscures a critical historical pattern: secular bear markets, or "lost decades," have consumed approximately 35% of U.S. equity market history since 1871. 

During these extended periods, buy-and-hold investors experienced negative or negligible real returns spanning 13 to 25 years, while simultaneously enduring drawdowns of 50% to 77% along the way. This paper examines 155 years of equity market data from Robert Shiller’s authoritative dataset maintained at Yale University to demonstrate that lost decades are structural features of equity markets rather than statistical anomalies.

Current market conditions warrant particular attention. 
The Cyclically Adjusted Price-to-Earnings ratio (CAPE) currently resides near the 99th percentile across 155 years of observations. 

Historically, valuation extremes have coincided with environments in which forward returns became more variable and downside risk more asymmetric.

While valuation measures such as CAPE have demonstrated meaningful long-term relationships with subsequent returns, they do not reliably identify the timing of market turning points. Instead, they provide important context regarding the vulnerability of long-term return expectations and the potential for regime transitions to occur.

The historical record, however, reveals uncomfortable exceptions to this comfortable narrative. In modern market history, U.S. equity investors experienced three extended periods during which buy-and-hold strategies delivered negligible or negative real returns: 

1929 to 1954 (25 years), 1966 to 1982 (16 years), and 2000 to 2013 (13 years). 

These "lost decades" consumed 54 years of market history—approximately 35% of the period since 1871. 

For investors whose accumulation or distribution phases coincided with these regimes, the theoretical long-term equity premium provided cold comfort.

The assertion that "stocks always win in the long run" is empirically false. But how long? Stocks usually win in the long run, but the exceptions are neither rare nor brief. 

A 16% probability of sub-3% real returns over 20 years represents a one-in-six chance that two full decades of an investor’s prime accumulation years deliver essentially nothing, representing a meaningful risk for retirement planning.

DYI:  I’ve been pounding the table for longer than I care to admit as the market as measured by the S&P 500 has increased in price producing breath taking returns since 2009.


At this time IMO it is not the return on money but the return of your money!  I’m not going to go through all of the valuation metrics highlighting the massive overvaluation for the U.S. stock market as that has been covered (and will continue to be covered) in my blog. 

For those whose only savings is a 401k, Thrift Savings Plan, and/or Roth IRA that only has stocks and bond investments choosing a significantly heavier allocation to short and long term bonds is warranted IMO. 

Individuals soon to be retired may want to use DYI’s formulas for the 4 primary asset categories and/or the purchase of annuities along with monies in The Permanent Portfolio Fund symbol PRPFX that has a reasonable possibility of delivering returns greater than short term bond investments.

Updated Monthly

AGGRESSIVE PORTFOLIO - ACTIVE ALLOCATION - 6/1/26

Active Allocation Bands (excluding cash) 0% to 50%
48% - Cash -Short Term Bond Index - VBIRX
28% -Gold- Global Capital Cycles Fund - VGPMX **
 24% -Lt. Bonds- Long Term Bond Index - VBLTX
 0% -Stocks- Total Stock Market Index - VTSAX
[See Disclaimer]
** Vanguard's Global Capital Cycles Fund maintains 25%+ in precious metal equities the remainder are domestic or international companies they believe will perform well during times of world wide stress or economic declines.  

Disclaimer

This blog site is not a registered financial advisor, broker or securities dealer and The Dividend Yield Investor is not responsible for what you do with your money.
This site strives for the highest standards of accuracy; however ERRORS AND OMISSIONS ARE ACCEPTED!
The Dividend Yield Investor is a blog site for entertainment and educational purposes ONLY.
The Dividend Yield Investor shall not be held liable for any loss and/or damages from the information herein.
Use this site at your own risk.

PAST PERFORMANCE IS NO GUARANTEE OF FUTURE RESULTS.

 

Medical

Industrial Complex

Pharma’s Stranglehold on Medical Education

Your health is not a priority.



2026

Medical research is captured by the pharmaceutical industry. Medical education is how that captured research gets transmitted to doctors—and the influence doesn’t stop at the medical journals. It extends into every aspect of how doctors are trained, from their first day of medical school all the way through the continuing education they are required to complete throughout their careers.

This doesn’t mean that every doctor is corrupt, but it does mean that the institutions responsible for training doctors are overwhelmingly influenced by the pharmaceutical industry—and that influence shapes what doctors are taught, what information they are exposed to, and what treatments they are encouraged to use.

Medical school

Medical school is subject to pharmaceutical industry influence at every level. It begins with the accreditation bodies that decide what medical schools are required to teach, and extends to the administrators who set institutional priorities, the faculty who deliver the curriculum, the content that is included or excluded, and even the informal culture that shapes what students absorb outside formal instruction.

This capture wasn’t inevitable. Before it could happen, medical education had to be centralized.

That centralization largely began in 1910 with the Flexner Report. Funded by the Carnegie Foundation and supported by the Rockefeller Institute, it led to a sweeping reform of American medical education. Medical schools that did not conform to a single standardized model of medicine were closed or forced to adapt. Within two decades, roughly half of all medical schools in the United States had shut down.

When medical education was spread across hundreds of competing schools with competing approaches to medicine, no single set of institutions could define what doctors learned. Once the system was narrowed, influencing a small number of institutions was enough to shape it.

Rockefeller Medicine Men (1979) by E. Richard Brown, an exposé on how corporate philanthropy centralized medical education and cemented industry control.
Rockefeller Medicine Men (1979) by E. Richard Brown, an exposé on how corporate philanthropy centralized medical education and cemented industry control.

Accreditation

The Liaison Committee on Medical Education (LCME) determines what every MD-granting school must teach. Without LCME accreditation, students cannot access federal loans, sit for licensing exams, or enter residency. The LCME is jointly sponsored by the Association of American Medical Colleges (AAMC) and American Medical Association (AMA). The AMA receives tens of millions of dollars from pharmaceutical advertising, grants, and partnerships—and generates hundreds of millions more through its control of the billing codes and physician databases that pharmaceutical companies rely on to reach prescribing doctors. The AAMC represents medical schools whose department chairs have extensive industry ties. LCME committee members are drawn from these institutions.

Leadership & faculty

A 2007 JAMA study found 60% of academic department chairs had financial relationships with industry. Department chairs set curriculum, control hiring, and shape institutional culture—and they also teach. Of the hundreds of thousands of physicians in the U.S. who receive industry payments annually, academic leaders and department chairs are consistently among the highest-paid recipients.

These relationships extend beyond individual faculty. Pharmaceutical companies also fund medical schools through grants, donations, sponsored programs, research partnerships, and endowed chairs.

Curriculum

The preclinical curriculum is heavily weighted toward pharmacology, while nutrition receives roughly 20 hours of teaching across four years of medical school.

Students memorize large volumes of drugs and their side effects, while largely neglecting the skills needed to evaluate the evidence behind what they are taught. A 2007 JAMA study found that medical residents often struggle with basic statistical concepts—skills that would allow them to identify when a clinical trial is designed to make a drug look better than it actually is. Industry-funded trials routinely use techniques that inflate apparent benefits, such as measuring a lab value instead of whether patients actually live longer or feel better, or running trials too short to detect long-term harms—techniques many medical students are never trained to recognize.

A 2018 AJOB Empirical Bioethics study found widespread undisclosed industry conflicts among textbook authors across multiple specialties, including many who also served as advisors or speakers for pharmaceutical companies. A 2021 study in Community Mental Health Journal found that most editors and authors of major psychopharmacology textbooks had received industry payments, totaling over $11 million among a small group of contributors. Even core reference materials used in training come from pharmaceutical companies with direct commercial interests, such as the Merck Manual, widely used in medical education and published by Merck, which also manufactures many of the drugs it describes.

The goal for medical students is to learn what will be tested—regardless of whether it’s true. The exams required to become a licensed physician place enormous emphasis on drug knowledge, treating it as a core measure of medical competence. The committees that write these licensing exams are governed by physicians drawn from the same academic institutions whose department chairs and faculty have extensive industry relationships.

Hidden curriculum

Beyond what is formally taught in the classroom, students also learn from the culture and practices of the institutions around them. The hidden curriculum is the unwritten signals that tell students what is rewarded, what is tolerated, and what is expected. It works through role models, evaluations, career opportunities, and everyday institutional practices rather than explicit instruction. A 2005 JAMA study found that the average medical student is exposed to pharmaceutical industry marketing once every week. Many of the physicians teaching them have documented industry ties. Students learn by watching those in authority positions, and what they observe becomes what they interpret as standard care. Students who question prescribing norms face poorer evaluations and damaged career prospects.

Residency

Residency is where prescribing habits are formed for life. After four years of medical school, new doctors enter three to seven years of supervised training in their chosen specialty. The pharmaceutical industry is embedded throughout this training.

Accreditation

The Accreditation Council for Graduate Medical Education (ACGME) sets the standards for all residency programs. The ACGME is governed by representatives from the AMA, AAMC, and the American Hospital Association—organizations with extensive industry ties. The curriculum residents must complete is shaped by requirements set by these organizations.

Specialty societies

Between the accreditation bodies and the training programs sit the specialty societies—the American College of Cardiology, the American Psychiatric Association, the American Diabetes Association, and others. These organizations create educational materials, host annual conferences, publish journals, and influence the curricula that residency programs follow—and they’re heavily shaped by industry funding. The American Heart Association receives $40 million annually from pharmaceutical and device companies. The American Diabetes Association receives tens of millions. The educational content that reaches residents—conference presentations, training modules, board review materials—is produced by organizations structurally shaped by funding from the companies whose products are being taught.

Industry influence in residency training

Residency training sessions, teaching rounds, and discussion meetings are often sponsored by pharmaceutical companies. Food, materials, and speakers are frequently provided by the company whose product is being discussed. Pharmaceutical representatives are allowed into many training programs, where they provide free samples, meals, and educational materials.

Free samples of prescription drugs influence prescribing behavior. A 2017 BMJ Open review found that accepting free samples is associated with residents prescribing more expensive brand-name drugs instead of cheaper, equally effective alternatives.

Even where direct access by sales representatives is restricted, the influence continues through educational funding and sponsored programs. A 2000 JAMA review found that physician-industry interactions are linked to more frequent prescribing, higher costs, and lower-quality prescribing decisions. A 2005 Journal of General Internal Medicine review found the same pattern specifically among residents: exposure to pharmaceutical representatives was associated with increased prescribing of the promoted drugs.

The mechanism is not large payments. A 2016 JAMA Internal Medicine study analyzing federal payment data and prescription records found that a single industry-sponsored meal costing less than $20 was associated with higher rates of prescribing the promoted brand-name drug. The industry does not need to buy doctors outright. Lunch is sufficient.

How training shapes prescribing

Residents practice under the supervision of senior physicians in clinical training environments. Many of these physicians have industry ties. A 2013 BMJ study found that physicians trained at institutions with stricter limits on pharmaceutical marketing prescribed fewer newly marketed and heavily promoted drugs years later in independent practice. A 2020 Health Affairs study found that restricting pharmaceutical marketing in medical school was associated with lower opioid prescribing. When exposure to pharmaceutical marketing and industry influence during training is reduced, future prescribing behavior changes in predictable ways. The habits formed during training are not temporary. They persist. The drugs residents learn to prescribe become the drugs they prescribe for decades.

Continuing medical education (CME)

After residency, after the decade-plus journey from pre-med to practicing physician, the indoctrination continues—for their entire career. Continuing medical education is mandatory for doctors to keep their medical license. Fail to accumulate enough credits, and you cannot practice. And it's the pharmaceutical industry that has historically funded and continues to exert substantial influence over the majority of this mandatory education.

Industry funding

At its peak in 2006, direct commercial support accounted for over 60% of all CME funding in the United States. While subsequent regulatory changes reduced the percentage of direct funding by pharma, the industry adapted by rerouting its money into advertising, exhibition fees, and targeted sponsorships of the clinical instruction hours that medical schools depend on to stay solvent.

Medical education companies, which derive 80% of their revenue from pharmaceutical companies, also determine which courses receive CME credit, adding another layer of industry-shaped gatekeeping between funding and accreditation.

The illusion of independence

The Accreditation Council for Continuing Medical Education (ACCME) rules state that industry funders cannot control content. In practice, CME providers depend on industry funding. They know which topics and which speakers attract funding and which do not. They do not need to be told what to avoid. The incentive structure does the work automatically. Speakers know who pays them. If a speaker develops a reputation for discussing drug harms too candidly or presenting non-pharmacologic alternatives too enthusiastically, the speaking invitations stop.

A former pharmaceutical sales representative with nearly two decades of experience put it bluntly:

“Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment by tracking prescriptions before and after their presentations. If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.”

15–25% of pharmaceutical marketing budgets are physician speaking fees—“education” in name, marketing in reality. No explicit instructions are needed—the incentives are sufficient.