Jurisdictional Science and the Collapse of Medical Legitimacy

Recently, significant policy changes at the federal level have begun moving the country back toward informed consent and individualized medical care. For the first time in decades, federal health agencies are retreating from long-entrenched models of coercion and centralized control, openly acknowledging the limits of what they know. The renewed emphasis on transparency, shared clinical decision-making, and rejection of one-size-fits-all medicine should feel like a long-overdue correction.

For those of us living in California, however, the moment is bittersweet.

Just as the federal system begins to correct course, California and other coastal blue states are doubling down on the very coercive model that failed so catastrophically during COVID—while insisting, with growing urgency, that they alone are “protecting science.”

Much of the country now processes health information through tribal allegiance rather than evidence. Yet the federal message at this moment is one most Americans should welcome: demand transparency, reject blind compliance, and recognize that society-wide “health” measures have not delivered the health they promised. 

Instead, each time the U.S. Department of Health and Human Services (HHS) articulates this shift, California’s response is immediate—denunciation, dismissal, and rigid defense of a status quo that has served corporate interests well and public health poorly.

Two populations now occupy the same country, receiving the same announcements and drawing opposite conclusions about reality itself. What we are witnessing is not merely a policy dispute. It is the collapse of medical legitimacy.

The Federal Shift

Over the past year, federal policy has begun reversing some of the pandemic’s most destructive patterns. Coercion and pay-for-performance schemes are giving way—however imperfectly—to shared clinical decision-making and patient autonomy.

In January 2026, the CDC significantly reduced the number of vaccines treated as universally recommended, restoring shared decision-making as the governing standard for several interventions previously treated as defaults. At the same time, the Centers for Medicare and Medicaid Services (CMS) began dismantling compliance-driven “quality metrics” that financially rewarded vaccination coercion rather than individualized care.

Federal leadership has also begun speaking more openly about uncertainty, risk trade-offs, and the moral necessity of transparency. What unites these changes is an acknowledgment many families and clinicians learned the hard way during COVID: healthcare must be individualized, patients must be informed, and consent must matter.

The Blue-State Revolt

Instead of welcoming this return to medical ethics, California and its allied blue states responded with institutional entrenchment.

Through nakedly political regional alliances, ideologically-entrenched state legislation, and coercive reimbursement structures, California has moved to insulate its pandemic-era model from federal reform—locking centralized authority into law while continuing to rely on financial incentives that leave parents little room for genuine consent. The result is a parallel public-health system designed to preserve COVID-era compliance even as federal institutions reopen the door to individualized care.

This is not a disagreement over details. It is an explicit rejection of the federal shift toward patient autonomy.

What Maintaining the “Status Quo” Requires

To preserve this regime while branding themselves as guardians of “science,” blue-state institutions must now perform an increasingly difficult maneuver: treating the federal government’s own internal record as illegitimate.

That record is no longer ambiguous.

In a late-2025 email from the FDA’s Center for Biologics Evaluation and Research, Vinay Prasad—signing as “CBER Director”—reported that career staff “have found that at least 10 children have died after and because of receiving COVID-19 vaccination.” He asked why these deaths were not reviewed in real time, noting that reports from 2021 through 2024 had been ignored for years.

He described myocarditis as a vaccine-induced safety signal recognized abroad before U.S. agencies, noted that CDC leadership publicly denied the signal in language many insiders felt was “dishonest and manipulative,” and stated that the FDA delayed acknowledging it until after extending authorization to boys ages 12–15.

His conclusion was stark: “It is horrifying to consider that the U.S. vaccine regulation, including our actions, may have harmed more children than we saved. This requires humility and introspection.”

This is not abstract uncertainty. It is an internal account of recognized harm, delayed acknowledgment, and coercive policy built on false claims of certainty.

Recognition of systemic failure was reinforced in early 2026, when Dr. Tracy Beth Hoeg released a comprehensive assessment comparing the U.S. childhood immunization schedule with those of peer nations. The report found that high vaccination rates are maintained abroad without mandates; that manufacturers face weak incentives to rigorously study adverse effects; and that regulators lack sufficient high-quality data to adequately characterize the safety of individual vaccines, combinations, or the cumulative childhood schedule. It links the collapse of public trust during COVID to mandates and false public claims about immunity, transmission, and certainty unsupported by evidence.

These admissions place blue-state health authorities in an untenable position. Engaging them honestly would require explaining why coercive policies persist in their states despite acknowledged harms and weak evidentiary foundations. Instead of engaging honestly, blue-state officials have chosen to go on the offensive—ridiculing reformers and pretending, quite disingenuously, that the federal changes themselves lack evidentiary support.

The American Academy of Pediatrics has taken the conflict into court, challenging recent federal vaccine policy changes and the reconstitution of the CDC’s Advisory Committee on Immunization Practices (ACIP). Among its objections is that a return to shared clinical decision-making would require physicians to spend more time discussing vaccines with patients—reducing efficiency and revenue. The admission is telling: what is being defended is not disease prevention, but a compliance-based model of medicine that treats informed consent as a burden on their time rather than an ethical obligation. 

When “Science” Becomes Jurisdiction

For decades, state vaccine mandates developed in reliance on the CDC’s universal recommendations. Because federal guidance almost always expanded rather than contracted, the alignment between federal review and state policy was rarely tested.

That alignment is now breaking. Federal health agencies are withdrawing universal recommendations for certain interventions, yet some states have chosen to retain those same interventions as mandates anyway. Guidance that once flowed from federal scientific review into state policy is now being overridden by it. What was framed as evidence-based public health has become state-enforced coercion applied despite federal reassessment. “Science” no longer functions as a shared evidentiary standard. It becomes jurisdictional—defined not by evolving evidence, but by the political authority of the state enforcing it.

While states do retain broad police powers over public health, what is emerging here is not a good-faith regulatory disagreement—it is ideological entrenchment of a coercive model despite mounting evidence of harm, uncertainty, and the undeniable reality that American children are not healthier.

For families, the divide is personal and destabilizing. A decision treated as individualized in one state becomes compulsory in another. A COVID vaccine no longer universally recommended federally remains aggressively promoted for children and young adults, even as its risks are now well recognized.

Clinicians are caught in the same contradiction. In blue states, physicians and nurses are expected to administer interventions federal agencies have stepped back from—following internal admissions of weak evidence or unresolved safety concerns—while pretending those admissions do not exist. Their choice becomes stark: comply with institutional mandates or risk financial penalties, regulatory pressure, patient loss, and legal exposure. Medical judgment is dictated by geography and politics, even when conscience and the federal record point elsewhere.

When scientific guidance becomes dependent on jurisdiction, legitimacy collapses.

Where This Ends

We have seen this before. During COVID, when Florida reopened while California remained under sweeping lockdowns, the contradiction was impossible to ignore. If we were truly “following the science together,” such divergent realities could not coexist.

This same dynamic is returning. As federal agencies move—however imperfectly—toward individualized care, blue states are hardening into zones of medical compulsion. Patients who dissent increasingly experience healthcare not as care, but as confrontation. Many will respond as others before them have: move, opt out, build parallel systems, and disengage entirely from institutions they no longer trust. 

Public health should not produce this level of social fracture. The federal shift toward transparency and shared decision-making is deeply needed—but it is only a beginning. Medicine does not become ethical until it is voluntary. Informed consent cannot survive in the presence of coercion.

By refusing even this limited return of authority to patients, blue-state institutions reveal their priority: preserving control, not restoring trust. If they realign with federal guidance only when political leadership shifts, it will not mark a restoration of legitimacy. It will confirm what this moment has already revealed—that for many public-health authorities, “science” functions less as a standard of evidence than as a badge of political loyalty.

It is a choice that cannot endure.

But before it collapses, it will inflict lasting harm—on patients, clinicians, and the public’s remaining trust in medicine itself.