This is another in my occasional series on the pediatric trans industry.

Imagine a 14-year-old walks into a therapist’s office and announces she has bipolar disorder. She read about it online, she says. The symptoms match. She wants an antipsychotic prescription medication.

No competent therapist anywhere would write the prescription. The therapist would do what therapists are trained to do, explore family history, the circle of friends, the social media diet, the possibility that what the 14-year-old has concluded is bipolar disorder might be anxiety, depression, trauma, or simply the ordinary adolescent turbulence. That careful, skeptical, exploratory process is not an obstacle to good care. It is the care.

Now imagine the same 14-year-old announces instead that she is a boy.

In that case — and only in that case — the rules of therapy are inverted in the United States. The patient’s self-diagnosis is the diagnosis. The therapist’s job is to affirm it. And if a bill now moving through the California legislature becomes law, a therapist who asks too many questions could be sued for it — and minors can file claims until they turn 40.

Senate Bill 934: Litigation as Ideology Enforcement

This week, Senate Bill 934 cleared the California Assembly Judiciary Committee on a 7–3 party-line vote. The bill is authored by state Sen. Scott Wiener, a San Francisco Democrat now running for Nancy Pelosi’s congressional seat. The ultra-progressive lawmaker is responsible for several controversial bills, including measures restricting parental involvement in their children’s ‘gender affirming care’ and a separate effort to narrow sex-offender registration requirements.

Wiener’s latest bill allows former patients to bring malpractice suits against licensed therapists for so-called “conversion therapy.” It has a statute of limitations unlike almost anything else in civil law. Patients who were minors at the time of treatment can sue until they turn 40. Adults get 10 years from their last session, or five years from “discovering harm.” In other words, the moment they decide the therapy harmed them.

Plaintiffs can seek damages for medical expenses, mental health treatment, lost wages, pain and suffering, emotional distress, and loss of enjoyment of life. And, of course, attorney’s fees and, in cases of alleged fraud, punitive damages.

Wiener has been candid about why he authored the bill. In April, the Supreme Court ruled 8–1 in Chiles v. Salazar that state bans on talk therapy touching sexual orientation and gender identity must survive strict scrutiny. That is the Constitution’s most demanding test. Justice Gorsuch wrote the majority opinion, and the case was remanded to lower courts.

Chiles v. Salazar put California’s own 2012 ban, the nation’s first, on shaky legal ground. Wiener acknowledged as much to California Senate committee: there have “already been rumblings” of a legal challenge to the California law, “so here we are.”

What to do if the courts will not allow the state to ban a category of speech between therapists and patients? Wiener noted publicly that Gorsuch’s opinion did not cover malpractice suits and therefore he designed a statute-by-litigation workaround by which the state will make practicing standard talk therapy when it comes to gender, financially ruinous. What the First Amendment forbids by statute, SB 934 accomplishes by litigation exposure.

The Definitional Sleight of Hand

The bill’s defenders and sponsors include prominent LGBT advocacy groups, Equality California, Lambda Legal, the National Center for LGBTQ Rights, and the Trevor Project. They invoke the genuinely discredited practices that the phrase “conversion therapy” conjures: the aversion treatments, the oppressive religious boot camps, the electroshock horrors of decades past. Wiener slams it all as “psychological torture.”

Historically, that discredited legacy was abusive and is rightly condemned.

If SB 934 targeted only that, it would be unremarkable. Those practices are denounced by every major medical association, already banned for minors in California, and already grounds for professional discipline. Wiener has used that concept as a cudgel, saying the bill gives victims “the right to hold charlatans accountable for this debunked torture.”

But that is not how the bill is written. Its definition of prohibited “change efforts” sweeps in any attempt by a licensed mental health provider to direct a patient toward “a particular sexual orientation or a particular gender identity.”

That language is the critical hinge of the bill. The chilling effect isn’t a side effect but rather its mechanism. A therapist who spends six months helping a gender-distressed 13-year-old examine whether her confusion might be rooted in autism, internalized homophobia, or social contagion — and who watches that distress resolve without a single medical intervention — has, in the eyes of a plaintiff’s lawyer, “directed” the patient “toward” her birth-sex identity. That is not conversion therapy.

That is therapy. For every other condition in the diagnostic manual, it is called the standard of care.

The Chilling Effect Is the Point

Clinical psychologist Joseph Burgo said it plainly at last Tuesday’s committee hearing: “In supervising therapists today, I constantly hear their anxiety over their legal exposures or risks to their license if they do just that — practice traditional exploratory psychotherapy. These are not conversion therapists. These are honest clinicians who want to practice traditional psychotherapy with gender-distressed young people, but they’re afraid to do so.”

SB 934 bakes that fear into statute. Few therapists in private practice can absorb the cost of defending a malpractice suit, even a winning defense — and no malpractice insurer will look kindly on a clinician whose patient population carries a two-decade liability tail. The rational response for a therapist is to choose not to explore or question, not to have “watchful waiting,” what used to be considered the gold standard for treating minors with questions about their gender.

The safest path will be to affirm the child’s self-diagnosis, write a referral letter, and move the child along to the endocrinologist. The medical pipeline of puberty blockers, cross-sex hormones, and surgery becomes not just the path of least resistance, but the path of least litigation.

Among those who testified against the bill was Jonni Skinner, a 23-year-old detransitioner. Skinner grew up in a devoutly religious family in small-town Michigan. He described being a feminine boy who constantly was bullied and later diagnosed with high-functioning autism. Skinner told lawmakers he encountered trans influencers online as a teen: “They said, ‘Change your body and your life gets better. Don’t, and it gets worse.’”

Skinner told the committee that doctors told his mother that he would kill himself if he was not allowed to transition. The therapy he needed, the kind that might have asked and challenged whether an autistic, gender-nonconforming, bullied kid was actually a girl, is precisely the therapy SB 934 makes legally radioactive.

A child like Skinner has no comparable remedy. The bill creates a 22-year window to sue any therapist who counsels caution. Meanwhile, it is not intended to create an equivalent window to sue the clinic that prescribed puberty blockers, cross-sex hormones, or irreversible surgical interventions to a confused minor. Under SB 934, it is caution that carries potential liability. The scalpel may not.

How We Got Here

None of this happened overnight. Two years ago, I traced the history in “Who Put the Kids in Charge?” — how gender dysphoria entered the diagnostic manual only in 2013, the first time the disorder was applied to minors; how a Dutch protocol built on a handful of patients, and underwritten in part by a pharmaceutical company holding a puberty-blocker patent, became the global template; and how American gender clinics adopted the most permissive interpretation of it, multiplying from a single Boston clinic to dozens of dedicated pediatric gender centers over a decade.

The therapist’s predicament was then compounded by the profession’s own gatekeepers. In 2024, the American Psychiatric Association published Gender-Affirming Psychiatric Care, the first textbook of its kind — and, as I wrote in the New York Post, it is less a clinical reference than a handbook for affirmation-only practice. Its 26 chapters, each featuring at least one author who identifies as transgender, non-binary, or “gender-expansive,” instruct the next generation of psychiatrists that their role is to affirm, facilitate, and refer — not to explore. A young clinician trained on that textbook, practicing under SB 934, will not need to worry about the law’s liability because that clinician will only wave patients as fast as possible from the therapy couch into the pediatric gender pipeline.

The Rest of the World Is Walking This Back

What makes California’s timing so remarkable is that it comes as the countries that pioneered pediatric gender medicine are retreating from it. England’s National Health Service, following the landmark Cass Review’s conclusion that the evidence base for youth gender medicine is “remarkably weak,” ended the routine prescription of puberty blockers for minors and closed its Tavistock clinic for pediatric patients. Sweden and Finland — early adopters of the Dutch protocol — have restricted hormonal interventions for adolescents and restored psychotherapy as the first-line response to gender distress.

In other words, the careful, exploratory approach that SB 934 would expose to two decades of litigation risk is the approach now recommended by the health authorities of the very nations that invented this field. California is not protecting children from a discredited fringe practice. It is threatening therapists for practicing what is becoming, everywhere but here, the international clinical consensus.

What Is Next

I have no quarrel with protecting genuine victims. Anyone subjected to the coercive, shame-based practices that deserve the name conversion therapy should have their day in court, and the bill’s authors could have written a statute narrowly targeting exactly that. They chose not to. The breadth of the definition is not sloppy drafting; it is the mechanism by design.

A legislature that wanted to protect gender-distressed children would want more therapy for them, not less — more time, more questions, more of the in-depth analysis and skepticism that we demand from clinicians treating every other condition a child might claim to have. SB 934 delivers the opposite: a legal regime in which the only safe thing a California therapist can say to a confused 13-year-old is yes.

The bill now moves toward a floor vote in a legislature where its passage is assured and a governor’s signature is likely. What Sen. Wiener may not expect is a future wave of lawsuits from a constituency he seems not to be watching: detransitioners now reaching adulthood. Under the bill’s own language, after all, a clinic that fast-tracked a child toward a particular “gender identity” — complete with new pronouns, blockers, and a medical roadmap — has arguably committed the very offense the statute creates.

I expect some creative plaintiffs’ lawyers to notice. And they might use the statute to seek damages from the clinicians and institutions that moved children at warp speed into a medical system that left them with lifelong consequences.

California will then discover it has built a weapon that points both ways.

Treasury Secretary Scott Bessent stood at the White House podium this past Thursday and held up a mock design: a $250 bill bearing Donald Trump’s portrait. “I don’t think there’s anything untoward about it,” he said. The bill, he added, would honor the president serving during America’s 250th anniversary. Congress just needs to pass the legislation, and Treasury will print it.

Before going any further, let me be direct about something: this argument is not about Donald Trump. Supporters who admire him may find it entirely fitting that the president in office during America's 250th anniversary should appear on a new bill. Critics who oppose him may find the idea an affront. Both reactions are beside the point. My objection would be identical if the president were Biden, Obama, or any future Democrat or Republican. The problem is not whose face is on the bill. The problem is opening the door at all — because once it is open, every future president will be able to walk through it.

With that said, what has actually been happening inside the Bureau of Engraving and Printing over the past year is considerably more troubling than the headline.

According to reporting by the Washington Post, based on four current and former bureau employees, two Treasury Department political appointees — U.S. Treasurer Brandon Beach and his senior adviser Mike Brown — spent months last year repeatedly pressuring bureau staff to develop prototype designs for the bill, despite the fact that federal law explicitly forbids it. In August and September, Beach personally delivered mock-up designs to bureau staff, including one showing Trump's face centered between his own signature and Bessent's. The artist behind the design, British painter Iain Alexander, told the Post he had spoken directly with Trump about it — and that the president endorsed specific changes, including adding the colors of the American flag.

When the bureau’s director, Patty Solimene — a 24-year Army veteran and the agency’s first female head — pushed back, noting that the law prohibits this and that designing security features for any new bill takes years, she was removed from her position. Three words in her departure statement said everything: “Not my choice.”

The administration did not wait for Congress. It pressured career staff and removed the official who said no — all before a single vote has been cast on the legislation.

BREAKING 160 YEARS OF DEMOCRATIC TRADITION

The ban on living persons appearing on U.S. currency has been in place since 1866. It is not an accident or an archaic formality. It was written in direct response to a scandal uncannily similar to this one: a mid-level Treasury official named Spencer Clark put his own face on a 5-cent note, provoking outrage in Congress and the passage of what became known as the Thayer Amendment.

Congress understood what it meant when the machinery of money was turned into a personal monument. Currency is a civic document. Every American touches it, carries it, depends on it. Whose face appears on it is a statement about what — and who — the country belongs to.

The proposed legislation does not simply carve out a one-time commemorative exception. It amends the Federal Reserve Act to allow any living president to appear on currency going forward. That is a permanent structural change — one that would hold through every future administration, popular or otherwise. The president who benefits from that precedent next time may not be the one any given reader voted for. Once that door opens, it will not easily close.

THE MONEY LAUNDERING QUESTION NO ONE IS ASKING

There is a second issue receiving almost no coverage, and it deserves serious scrutiny: a $250 bill would be a significant asset to the underground cash economy.

The rest of the world has been moving in the opposite direction on high-denomination notes for exactly this reason. In 2016, the European Central Bank voted to discontinue the €500 note — then worth roughly $575 — explicitly because it “could facilitate illicit activities.” Europol documented the note turning up repeatedly in drug trafficking, money laundering, and terrorism financing investigations. Criminals reportedly traded the notes above face value in some underworld markets simply because of their portability.

That same year, a Harvard study — authored by Peter Sands, former CEO of Standard Chartered — called explicitly for phasing out the $100 bill alongside the €500 note, arguing that high-denomination bills “play little role in the functioning of the legitimate economy, yet a key role in the underground economy.” Canada had already pulled its $1,000 bill from circulation in 2000 for exactly the same reason.

Now the United States wants to introduce a $250 bill — 2.5 times the value of the current largest denomination — at a moment when anti-money laundering frameworks are supposed to be tightening. The administration has offered no analysis of what a new high-denomination bill would mean for financial crime enforcement. Nobody has asked for one.

WHAT THIS ADDS UP TO

Bessent’s word choice Thursday was telling. He said there was nothing “untoward” about the proposal. “Untoward” is a social category — it’s about appearances, optics, propriety. The questions raised here are not about optics.

They are about whether political appointees can pressure career staff to violate federal law and face no consequences. They are about whether the official who cited the law and was removed will be the last. They are about a 160-year guardrail against personalizing national currency being dismantled through an amendment to the Federal Reserve Act. And they are about whether the United States is about to give the underground cash economy its most portable instrument in decades — without a single hearing on the subject.

These objections do not belong to one party or one side of the debate over this president. They belong to anyone who thinks the rules that constrain power should apply regardless of who holds it.

Congress has not yet acted on the legislation. It should think carefully before it does. And the press should not let this one dissolve into the daily noise in the meantime.

The two teenagers who opened fire at the Islamic Center of San Diego mosque left a 75-page manifesto that is the clearest and most chilling portrait yet of what online radicalization is doing to kids.

Eighteen-year-old Caleb Liam Vazquez of Chula Vista and 17-year-old Cain Lee Clark of San Diego livestreamed the attack to Discord. Their 75-page document contained both of their separate manifestos, with a title built like a flag: The New Crusade: Sons of Tarrant — a tribute to Brenton Tarrant, the white supremacist who slaughtered 51 Muslims in two New Zealand mosques in 2019.

These two boys did not invent a worldview. They inherited one — assembled, piece by piece, from the open sewer of the modern internet.

That is the part of this story that should keep parents awake. The *Sons of Tarrant* manifesto is not the work of a single ideology with a single grievance. It is, in every meaningful sense, the kitchen sink — every poisonous current of the last f…

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There is a word for what is happening in Miami Beach right now. It is not “civil rights litigation.” It is not “accountability.” It is not even, in any meaningful sense, “free speech advocacy.”

The word is lawfare.

And if you believe in open political debate — regardless of where you stand on Israel, Gaza, or anything else — what is unfolding in South Florida should alarm you deeply.

Let’s Start With What Actually Happened

Last September, Jewish Voice for Peace South Florida filed a civil rights lawsuit against the City of Miami Beach, Mayor Steven Meiner, and Commissioner David Suarez, alleging that the city’s anti-protest ordinance was unconstitutionally designed to suppress pro-Palestinian …

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and I have published a new essay in Skeptic examining what has changed about antisemitism since October 7.

It has not simply increased in volume—it has shed its inhibitions. The stigma has collapsed.

We write:

“Expressions that would have ended careers a decade ago now generate applause, clicks, and campaign donations. Language that would trigger immediate condemnation if directed at other minorities is routinely excused, contextualized, or ignored when directed at Jews. Hostility that once hid at the margins has migrated inward—into campuses, political platforms, cultural institutions, and digital ecosystems. The result is an old hatred on steroids—newly unmoored from consequence.”

The normalization has taken shape through two distinct but mutually reinforcing channels.

On the left: Israel is framed as inherently illegitimate — hostility becomes an ethical obligation. The line between Jews and Israelis keeps disappearing.

On the right: Jews reemerge as omnipotent puppet masters — orchest…

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There are moments in a long-running public scandal when history seems to write the coda itself.

Last week, while much of the national press barely noticed, Joss Sackler, wife of former Purdue Pharma board member David Sackler, appeared in federal court in Miami and pleaded guilty to obstructing a federal grand jury investigation. She admitted deleting WhatsApp messages that would have shown she was the intended recipient of prescription painkillers seized by U.S. Customs and Border Protection at Miami International Airport in June 2024. Sackler was addicted at the time to the opioids that had helped ignite the deadliest prescription drug crisis in American history while simultaneously creating a multi-billion-dollar empire for the family into which she had married. She is scheduled for sentencing in July and faces a statutory maximum of 20 years, though the guidelines are expected to call for a far lighter sentence.

That would be a sad story in almost any family.

In this family, it is something more.

Her husband, David Sackler, is the son of Richard Sackler, the former Purdue president and chief executive, and he served on Purdue’s board before the company entered bankruptcy.

I have written extensively about the Sacklers, Purdue, and OxyContin, including in my book Pharma: Greed, Lies, and the Poisoning of America, and in follow-up reporting and commentary in the New York Times and here on Just the Facts. I argued then, and I believe now, that the people who directed Purdue deserved at the very least a criminal investigation commensurate with the scale of the lethal catastrophe they had sparked.

Instead, Purdue Pharma, the corporate entity, pleaded guilty in 2020 to federal conspiracy and fraud charges related to its business practices. It had pled guilty in 2007 to a felony charge of misbranding OxyContin with the intent to defraud or mislead. But no member of the Sackler family has ever been criminally charged for Purdue’s conduct.

That remains one of the great failures of accountability in modern American public health.

The opioid epidemic has killed on a scale that is often forgotten. The Associated Press, using federal data, reported that more than 900,000 deaths in the United States have been connected to opioid overdose since 1999. The early wave was driven by prescription opioids, led by OxyContin, and followed by heroin and then fentanyl.

Those numbers are not abstractions. They are parents who never came home. Children found dead in bedrooms. Veterans. Nurses. Construction workers. Teenagers. Grandmothers. People who were prescribed pills after surgery. People who were told their pain could be safely controlled. Patients who trusted doctors, who believed drug labels, who had faith in a system that had already been compromised. I have met and talked to many of the families of the victims. For every person who died from an opioid overdose, there are relatives and friends whose lives have forever been changed.

For years, many of those families fought the Sacklers in court, in bankruptcy proceedings, in the press, and in public memory. They demanded something more than money. They wanted admissions and accountability. Many wanted the Sackler name to stop floating above the wreckage, insulated by trusts, lawyers, philanthropy, and the antiseptic language of civil settlements.

Instead, what they finally received was a flawed multibillion-dollar bankruptcy deal. On May 1, 2026, a $7.4 billion national Purdue and Sackler settlement became legally effective. It is the messy and unsatisfying conclusion to a decade of litigation over Purdue’s and the Sacklers’ role in fueling the opioid crisis. The Sackler family owners are required to contribute at least $6.5 billion, Purdue is being replaced by Knoa Pharma, the Sacklers are barred from selling opioids in the United States, and more than 30 million documents related to Purdue’s opioid business are to be made public.

That is a tiny measure of accountability. But it is not the accountability for which the families fought.

It does not bring back the dead nor restore hollowed-out communities. It does not erase the years Purdue spent turning pain into profit. It does not answer the question that has haunted this story from the beginning: how can a company plead guilty to crimes of such consequence while the people who controlled and profited from it avoid criminal charges?

That is what makes the Joss Sackler case so grimly arresting.

It is not justice in any legal sense for the victims of OxyContin nor a substitute for the prosecutions that never came. It is not a reason to mock a person who says she suffered from addiction. Addiction is not a punchline or a moral failure.

But the symbolism is inescapable.

The epidemic that Purdue helped unleash did not stop at the gates of privilege. It did not care about the security guards, the private schools, the family offices, the wealth managers, the art collections, the high-end philanthropy, or the careful legal architecture built to preserve Sackler family fortunes. It did not care whether someone was sleeping under a highway overpass or living inside one of America’s most notorious fortunes.

It is a vivid reminder that addiction spares no one.

One of the reasons the Sacklers became a symbol of the opioid crisis was because they insisted, for so long, that the harms of OxyContin were someone else’s problem. Bad doctors. Needy patients. Criminal diversion. Personal weakness. Misuse and abuse. Anything but the predictable outcome of a business model that pushed a powerful opioid with catastrophic consequences.

Now, in a bitter historical turn, the opioid crisis has reached inside the family perimeter.

That does not make Joss Sackler responsible for Purdue’s decisions. Her lawyer is right that her case is legally separate from Purdue Pharma and other members of the Sackler family. That distinction matters. She pleaded guilty to her own conduct, not to Purdue’s.

But journalism is not only about legal distinctions. It is also about meaning. And the meaning here is unavoidable.

The family whose fortune was inseparable from OxyContin now has a member of its inner circle standing in federal court, acknowledging conduct tied to her own opioid addiction. That fact landed with force among the online communities of relatives and friends who lost loved ones to OxyContin and spent years demanding justice. For them, while it was not the justice they had sought, it seemed a kind of karmic reckoning.

I understand why.

For decades, America treated addiction as something that happened to other people. Purdue initially concentrated much of it Oxycontin marketing in the rural and blue-collar towns through Appalachia. Those were people who could be dismissed from a distance. And Purdue advanced the assumption that respectable medical treatment could not possibly create the kind of addiction associated with street drugs. That a pill prescribed by a doctor, promoted by a major pharmaceutical company, and wrapped in the language of pain relief must be safe enough.

That lie helped build a fortune and the wreckage is still with us.

The people who wanted criminal accountability for Purdue’s leaders did not get it. But the criminal justice system has now reached a woman who married into that same family, and it is a lesson that the forces unleashed by the family greed did not remain neatly contained. It exposes the fiction that wealth can build a wall high enough to keep consequence out.

I hope Joss Sackler has recovered. I mean that sincerely. Addiction is a disease, and recovery should be available to everyone, whether they live in a mansion or a shelter. But I also hope this story is not allowed to disappear as a strange footnote. It belongs in the larger record of the Sackler and Purdue saga because it reveals something essential about addiction and power. The opioid crisis was never only about drugs. It was about who gets believed. Millions of ordinary Americans learned that lesson the hardest way possible.

Now, in the family that set the fire, the story has come home.

I’m working now on several longer-form pieces, and those will arrive here as usual.

But I also wanted to flag something for readers who mostly see my work only when it lands in their inbox: I’ve been writing quite a bit on Substack Notes. These are often quicker, more immediate observations on a wide range of subjects — pieces that may not become full columns but are still part of the conversation I’m having with readers.

I realize many of you mainly follow my reporting when a longer piece arrives by email. So this is simply a reminder that a lot of my day-to-day writing is happening on Notes.

You can find my recent Notes here: https://substack.com/@posner/notes

No need to do anything differently if you prefer the longer essays in your inbox. But if you want to see the shorter, more immediate posts as well, Notes is the place to check.

Thanks, as always, for reading.

Gerald

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The near-miss at the White House Correspondents’ Dinner put a spotlight on a flaw in American government that has been hiding in plain sight. Seven of the top eight senior officials in the presidential line of succession attended that dinner. Had catastrophe struck the president, vice president and House speaker, the next man in line was 92-year-old Sen. Chuck Grassley, the president pro tempore of the Senate, at home in Iowa.

This is a constitutional roulette wheel, not a sensible continuity plan.

The current line of succession comes from the Presidential Succession Act of 1947. After Franklin Roosevelt died and Harry Truman became president, Truman urged Congress to revise the old succession statute. His argument was simple: If both the president and vice president were gone, the next successor should be an elected official rather than a Cabinet officer chosen by the president. Congress agreed, placing the speaker of the House after the vice president, then the Senate president pro te…

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Not merely present. Not quietly publishing on the margins. Thriving.

As of April 2026, Tate’s month-old Substack profile shows more than 1.1 million subscribers and a top spot on the platform’s new-bestseller rankings. In other words, this is not a case of Substack reluctantly tolerating a controversial user in some forgotten corner of the internet. This is a case of Substack visibly rewarding him with prominence.

That matters.

Because Andrew Tate is not controversial in the ordinary sense of the word. He is not simply a dissident thinker, an inconvenient columnist, or a writer with unfashionable politics. He is a man whose “red-pill” ideology is built on misogyny, domination, humiliation, and the monetization of resentment toward women. He has been accused for years of helping normalize a poisonous culture online, especially for young men and boys. YouTube, Facebook and Instagram have …

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Today, as the Trump administration makes a historic move by reclassifying state-licensed medical marijuana from Schedule I to Schedule III, I wanted to resend this piece. Whatever your view of today’s change, it is impossible to understand the current debate without knowing how marijuana ended up in Schedule I in the first place. That history is far less familiar than it should be.

Cannabis is not killing 100,000 American annually, the number of opioid overdose and poisoning victims. So why does the federal government list it along with heroin, LSD and ecstasy, as a Schedule I narcotic, the most dangerous category of the Controlled Substance Act? It ranks ahead of lethal Schedule II drugs such as fentanyl and OxyContin.

Marijuana’s inclusion on Schedule I was not the result of medical studies or clinical testing. It was instead political payback from Richard Nixon, who was miffed that a commission he had appointed to study marijuana, returned with a recommendation to decriminalize the drug. In Pharma, I tell the story of how that happened from an insider’s perspective, the view of Michael Sonnenreich, then a young Department of Justice attorney. In 1969 Sonnenreich had singlehandedly rewritten the federal guidebook to the nation’s drug laws (Handbook of Federal Narcotic and Dangerous Drug Laws).

John Dean, later of Watergate notoriety, was then an associate deputy serving under John Mitchell, Nixon’s attorney general. Dean had been an associate staff director to LBJ’s National Commission on Reform of Federal Criminal Laws. After Sonnenreich had rewritten the drug law handbook, Dean asked him to meet with the attorney general.

What follows is an excerpt from Pharma about how marijuana ended up on the strictest drug schedule in America. An added bonus that it also includes the lobbying efforts of Arthur Sackler (yes, the same Sackler family as OxyContin infamy) for his client, Hoffman La Roche. Sackler wanted to keep Roche’s blockbuster benzos, Valium and Librium, off any of the Controlled Substance Act’s schedules.

Today’s move to Schedule III doesn’t erase the political origins of prohibition, but it does adjust a half-century-old policy rooted more in resentment than evidence.

When Sonnenreich and Mitchell met, he told the attorney general that the “drug laws are archaic” and the enforcement and regulatory framework was a confusing and sometimes contradictory hodgepodge of laws and amendments that had been cobbled together over the decades. In 1951 Congress instituted the first mandatory minimum sentences for drug convictions and barred probation for first offenses. Five years later a different Congress increased the minimum jail terms. In 1965, faced with a wave of unknown psychedelic drugs, it criminalized manufacturing or possessing those hallucinogens and gave HEW enforcement responsibility.

None of the laws addressed treatment, Sonnenreich told Mitchell. He believed it was not enough for reforms to curb supply. They should also cut the demand for drugs. Mitchell asked Sonnenreich if he would meet with Nixon.

“Of course, I’d be willing to talk to the president.”

A few days later in the Oval Office, Sonnenreich told Nixon about his idea for a commission to examine existing laws before making any final recommendations. Nixon liked that. Sonnenreich was transferred to the Bureau of Narcotics and Dangerous Drugs. There, as deputy chief counsel, he began drafting what would become the heart of the Controlled Substances Act. He established “schedules” by which drugs were listed, balancing their medical usefulness, if any, against their potential for abuse.

Sonnenreich was thirty-one years old and liked his work. He expected to spend his career in government service. “My wife and I were happy; we had no problem in wanting more. We did everything we wanted to do.… One day this guy comes in with some Roche people and he says to me that ‘If you schedule Librium or Valium, we’re gonna challenge this, we’re gonna challenge that.’”

It was Arthur Sackler. Sonnenreich had never heard of him.

“I welcome your challenge, it makes my day,” Sonnenreich replied.

Sackler again warned that Roche would battle any effort to restrict the sale of its drugs.

“I’m going to do something better,” said Sonnenreich. “I’m going to file an administrative action to put your drugs under control and put them on the three times prescription rule [a controlled substance limited to a maximum of three refills].”

When Sonnenreich later held that administrative hearing to determine whether Roche’s benzodiazepines should be covered in one of the Controlled Substances Act schedules, he recalls “they had all the big law firms there, the biggest D.C. powerhouses. They were wrong if they thought that might scare me. They didn’t understand I was having a good time. They had just irritated me so much. I was still getting paid the same $7,900 a year, it didn’t make any difference to me.” Sonnenreich and the Justice Department won the administrative action. “Arthur was obviously very, very upset,” he recalls.

Sonnenreich’s draft of the Controlled Substances Act was at the heart of sweeping reorganization legislation—the Comprehensive Drug Abuse Prevention and Control Act—that the Nixon administration submitted to Congress in early 1970.

In creating four schedules of “controlled substances,” Sonnenreich had in part relied on extensive research and guidelines set out earlier that year by the World Health Organization. The public initially misinterpreted those schedules to think the drugs were listed in order of danger. Sonnenreich had instead balanced the potential for abuse with whether a drug had “any currently accepted medical use.” Although Cicely Saunders was then praising heroin as an effective pain reliever at her London hospice, it was judged to have no medical benefit. There was grim evidence of its abuse between hospital admissions and deaths from overdoses. It, along with LSD and ecstasy, were on Schedule I. So was marijuana, although that was a political compromise. The assistant secretary of health had suggested it be placed there temporarily until Nixon appointed a commission to recommend a final status.

Cocaine, methamphetamine, oxycodone, and fentanyl at least had demonstrated medical uses—cocaine in dental surgery as a topical anesthetic—and were listed on Schedule II, although they had a risk of “severe psychological or physical dependence.” Drugs on Schedule III were those with recognized therapeutic benefits but with a moderate risk of “physical or high psychological dependence.” That is where Miltown, along with amphetamines and barbiturates, was put. Schedule IV was designed to include combination drugs that had a “low potential for abuse.”

What was notably missing from the statute sent to Congress was any mention of Librium and Valium. Sonnenreich had expected they would later be added to the same category as Miltown, the industry’s original mild tranquilizer. Roche, however, argued that could not happen while its judicial appeal of the FDA’s effort to regulate more strictly the benzos was still pending. A new round of administrative hearings attempted to settle the matter once and for all. Neil Chayet, the founder of the Law-Medicine Institute at Boston University and a member of the National Institute of Mental Health’s Narcotic Addiction and Drug Abuse Committee, appeared in hearings as “an expert in legal medicine.” He set forth Roche’s position: Valium and Librium were not “drugs of abuse in the usual sense.” Roche even presented eleven letters from police departments that stated that none had seen criminal problems associated with either Valium or Librium.

Roche’s lobbying worked. When Congress passed the law in the fall of 1970 it had a fifth grouping, what some called “the Roche schedule.” It covered drugs with the lowest potential for abuse, and it included Valium, Librium, and a few codeine-cased cough syrups that contained codeine.

As Congress debated the bill, Neil Chayet called Sonnenreich. The two had been Harvard law school classmates. Chayet said he did legal work for Arthur Sackler and suggested the next time Sonnenreich was in New York, Sackler would like to meet him “to discuss Roche’s drugs and federal oversight.”

“Why should I meet with that idiot?” Sonnenreich replied. (“Those are the types of things you say when you’re very young,” Sonnenreich told the author).

Shortly after that conversation, Sonnenreich visited New York. Chayet arranged a dinner at Sackler’s sprawling apartment at United Nations Plaza. The twin thirty-eight-story towers had opened only a couple of years earlier and had been designed by the same architects who did the United Nations. Sonnenreich knew it was home to some of New York’s most prominent families.

“We had dinner,” recalls Sonnenreich, “and during the discussion Arthur got frustrated and started yelling at me. Well, I don’t respond well to being yelled at and I yelled back. Marietta was there and she got up from the table and left the room. Neil sat there quietly. And Arthur and I went on arguing for several hours. I had all the confidence and cockiness of a young guy and I kept telling him he was an ‘old dog who didn’t know the new things that had to be done.’ He was trying hard to persuade me that I was wrong on the regulations. Neither of us convinced the other.”

The next day, when Sonnenreich was back at the Department of Justice, Sackler’s secretary called.

“I got on the phone.”

“You know I like you,” Sackler started. “I would like you one day, if you leave the government, to do some work for me. Think about it.”

“I am going to stay in the government,” Sonnenreich told him. “This is what I’m happy doing, this is where I’m staying.”

Sonnenreich’s career was moving fast. Nixon had embraced Sonnenreich’s idea of a national commission to study and recommend how the government should address marijuana. Going into private practice did not entice him.

The president appointed nine of the thirteen members on the National Commission on Marihuana and Drug Abuse. They included doctors, academics, psychiatrists, and attorneys. The congressional leadership appointed two U.S. senators, and two congressmen. Former Republican governor of Pennsylvania Raymond Shafer was its chairman (it was mostly referred to later as the Shafer Commission). Nixon tapped Sonnenreich to become the executive director, in charge of a staff of seventy-six.

Nixon expected that the conservative Republican majority with which he had stacked the Shafer Commission would return with an uncompromising finding about the dangers of marijuana. Instead, after eighteen months of testimony from dozens of experts, Sonnenreich and Shafer knew they had reached a conclusion that Nixon was not likely to embrace: they had not found evidence that marijuana was physically addictive, nor was it a gateway drug.

“When I told them at the White House what we were planning to say,” Sonnenreich told the author, “they thought I was crazy. They could not understand that we were going to recommend decriminalization.”

“You need to take marijuana out of the criminal justice system,” Sonnenreich argued in vain. “These young people are not criminals. You are degrading the criminal system. It can’t handle all of them.”

Sonnenreich was not a proponent of the drug but thought criminalizing it was the wrong solution. He pointed out when Nixon had come into office, the government “spent a total of $66.4 million for the entire federal effort in the drug abuse area.” That ballooned to $796.3 million by 1972, and for the next budget it would exceed $1 billion.

The administration hard-liners were furious with the interim report. They feared the public would interpret decriminalization as an endorsement for using marijuana. “From that moment on,” Sonnenreich told the author, “I was cut off from the White House.”

The Shafer Commission did not finish its final report, with 3,700 pages of appendices, until 1973. Nixon ignored its recommendations.1

Excerpt from PHARMA: Greed, Lies, and the Poisoning of America, by Gerald Posner (pp. 254-259). Avid Reader Press / Simon & Schuster. Kindle Edition.

This is a somewhat different kind of post for Just the Facts.

Many of you come here for my reporting on current events and investigative stories. Others may have found me through one of my books. But I suspect a fair number of subscribers are not familiar with the full body of my work, much less the role my wife, , has played in every one of those books.

So today I wanted to share something more personal. It is also, I hope, a glimpse into the real world of publishing and long-form investigative nonfiction as I have lived it. I’ll be back soon with the reporting I’m working on now. But in the meantime, I thought it was worth opening a window onto the story behind the books, and behind the name on the cover.

Readers see a single name on a book cover and assume authorship is a solitary act.

It rarely is.

Over the past four decades, I have written 13 books. My name is on the spine of each one, and with that I have gotten the the praise and the criticism. But anyone who knows me well knows tho…

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Readers come to Just the Facts for many different reasons.

Some of you subscribed because of Pharma. Others because of my reporting on the pediatric gender debate, antisemitism, and the business of journalism and publishing. But many of you are also here because of Case Closed and the continuing arguments over who killed President Kennedy.

So I wanted to pass along a brief note for that part of my readership, and for anyone else who may want to revisit the evidence.

For the next few days, Open Road Media has put the digital editions of Case Closed on sale for $2.99.

This is the updated edition, with my 60th-anniversary afterword reviewing newly released JFK files and assessing the 2023 account by former Secret Service agent Paul Landis.

More than three decades after I first published the book, my view has not changed. The case still points overwhelmingly to Oswald, and the core evidence remains far stronger than the mythology built up around it.

For those who want to revisit the cas…

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I wanted to share a new interview I did with because it gave me the chance to talk about something that has been on my mind for a long time: why straightforward, evidence-based journalism now feels rarer than it should.

Over the years, I have reported on subjects as different as the Kennedy assassination, the opioid epidemic, Vatican finances, and, more recently the medicalization of children under the banner of gender medicine. Different stories, different stakes, different worlds. But the method has always required the same discipline. Follow the evidence wherever it leads. Do not begin with a preferred conclusion. Do not tailor the facts to fit an approved narrative. Do the reporting first, and accept where it takes you.

That ought to be the most ordinary description of journalism imaginable. Instead, it increasingly feels like the standard of a bygone era.

Too much reporting today is shaped before the real work even begins. Some stories are softened while others are narrowed…

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There are mistakes, and then there are mistakes that tell a much larger story.

The New York Times has corrected its embarrassing print headline that described NATO as the North AmericanTreaty Organization rather than the North Atlantic Treaty Organization.

Ordinarily, a correction would end the matter. News organizations are human enterprises. Errors happen, especially as copy desks are stretched and the pressure to publish quickly is relentless.

But this was not just a stray copyediting error. It deserves more than a shrug and a technical fix.

The problem here is not merely that someone in production failed to catch a glaringly mistaken headline. The problem is that the erroneous headline appears to reflect the underlying conceptual frame of the article itself.

That is what makes this episode so revealing.

The byline was by Steven Erlanger, one of the paper’s most experienced foreign correspondents, a deeply accomplished reporter with decades of coverage across Europe, diplomacy, war, and …

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A year ago today, a conversation I had with Ben Shapiro about the JFK assassination went viral. That did not surprise me nearly as much as the reason it happened. More than six decades after President Kennedy was murdered in Dallas, the case still exerts a strong gravitational pull on the American imagination. It is not simply that people remain interested. It is that so many still resist the most basic conclusion supported by the overwhelming evidence: Lee Harvey Oswald killed John F. Kennedy.

That should not still be controversial. Yet it is.

I have reported for decades on real and imagined conspiracies. There is an important difference. Real conspiracies leave evidence trails. People meet, talk, plan, and conceal. Eventually one of them slips, financial records surface, witnesses emerge. The lies do not remain perfectly sealed forever. As an attorney, I understand …

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As someone who has followed this trial closely—and as a lawyer—I wanted to share a concise analysis of why I believe the Los Angeles jury’s decision against Meta and Google is groundbreaking.

In reporting last month, I described this case as “the internet on trial.” With today’s verdict, that framing is no longer theoretical.

This is the first time a jury has imposed liability not for content, but for platform design—recommendation systems, autoplay, and other engagement features.

That fundamental shift will have significant implications well beyond this case.

I’ve written a brief breakdown here:

https://substack.com/@posner/note/c-233193489?r=3glpf&utm_source=notes-share-action&utm_medium=web

I’ll continue tracking this closely as it moves through appeals and related cases.

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On this day in 2010, in the middle of the most consequential healthcare debate in a generation, the United States Senate took up a question so jarring it sounds almost fabricated:

Should the federal government pay for erectile dysfunction drugs for convicted sex offenders?

I did not stumble on this as a curiosity hunt. I found it the way many revealing details in Washington surface—buried deep in research. While working through pharmaceutical policy and reimbursement decisions, I encountered references to a little-remembered amendment offered during the Affordable Care Act debate. I went back and followed the Senate proceedings as they unfolded.

What emerged was not just an odd legislative footnote. It was a case study in political dysfunction—and the paralysis that grips Congress.

The amendment, introduced by Senator Tom Coburn, sought to bar federal funds from being used to pay for erectile dysfunction drugs for convict…

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Twelve years ago, there was a moment that now feels like a relic from another era.

The international print edition of The New York Times in Pakistan ran with a conspicuous blank space where a major story should have appeared. The article—detailing how elements within Pakistan had helped Osama bin Laden evade capture—had been removed by local authorities.

The absence was the story.

It was censorship in its most literal form: remove the text, leave the void. A visible act of suppression, that even at the time, felt like something already outdated.

Because the story had not been erased. Anyone with an internet connection could read it. Subscribers already were. The information still moved—freely, globally, and irreversibly.

As a journalist, I thought that moment captured a turning point.

For most of modern history, censorship was about controlling distribution. Governments did not need to persuade—they only needed to block access. Control the printing presses, the broadcast licenses, the physi…

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A terror attack at Old Dominion University this week has revived a familiar and uncomfortable question about terrorism cases in the United States: how someone previously convicted of supporting a foreign terrorist organization can receive a relatively short sentence, serve even less time, and return to the daily life in the United States without difficulty.

Federal prosecutors had asked for more than twenty years in the Old Dominion case. The judge imposed eleven. The defendant ultimately served about eight years before being released in December 2024.

That outcome has prompted outrage in some national security circles. But there is another case, largely forgotten outside terrorism law specialists and a handful of national security reporters, that illustrates how unpredictable the U.S. sentencing system can be—even when …

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Last summer, as the world focused on Israeli and American air strikes against Iran’s nuclear facilities, Washington quietly sent a warning to North Korea: any transfer of nuclear technology—or an actual nuclear weapon—to Tehran would be treated as an act of aggression against the United States.

The message was delivered through diplomatic back channels and reinforced through Chinese intermediaries, according to U.S. sources familiar with the discussions. Their account of the warning has not previously been reported.

The warning reflected a concern inside Washington that the June 2025 strikes, while damaging Iran’s nuclear infrastructure, had not eliminated Tehran’s ability—or potential desire—to acquire nuclear weapons.

Inside Iran’s security establishment, the air strikes initially had the opposite effect Washington hoped for. Rather than ending the internal debate over pursuing nuclear weapons, the bombings strengthened the argument of hard-liners that Iran more than ever needed a nuc…

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