MD, PhD, MAE, FMedSci, FRCP, FRCPEd.

neglect

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Tolerance is widely regarded as a moral virtue, a cornerstone of pluralistic societies and a safeguard against dogmatism. Yet, tolerance can sometimes be misplaced. Thomas Mann suggested that “tolerance becomes a crime when applied to evil”. In a similar vein, I propose that tolerance can become unethical when applied to homeopathy.

Homeopathy presents itself as a benign and natural alternative to or complement of conventional medicine. Its appeal lies partly in its historical pedigree and partly in its promise of gentle healing without side effects. However, beneath this veneer lies a system of belief that is fundamentally incompatible with science and ethics. Its core principles –  the notions that like cures like and that substances become more potent through extreme dilution – contradict basic laws of physics, chemistry and pharmacology. After more than two centuries of use and more that 500 clinical studies, there is no credible evidence that homeopathic remedies perform better than placebos.

In many areas of life, tolerance for differing beliefs is both appropriate and necessary. However, medicine is different. It is not merely a matter of opinion; it is a field grounded in empirical evidence, where opinions can have direct and drastic consequences for health and survival. To tolerate ineffective and therefore potentially harmful treatments within this domain risks legitimizing misinformation and undermining public trust in evidence-based care.

The ethical problem intensifies when homeopathy is integrated into healthcare systems or endorsed by public institutions. Such endorsement conveys an implicit message of efficacy and legitimacy, misleading patients who may lack the expertise to critically evaluate medical claims. This is particularly concerning in cases where patients choose homeopathic remedies as an alternative therapy, i.e.in place of effective treatments, potentially resulting in preventable harm. Here, tolerance can easily degenerate into complicity.

Defenders of homeopathy often invoke patient choice and patient autonomy. While these are important principles, they do not justify the abdication of professional responsibility. True respect for patients involves providing accurate information and protecting them from ineffective or deceptive practices. Allowing patients to choose homeopathy without clear, despite all the evidence that speaks against it is not an expression of respect but a failure of duty.

Moreover, the commercial dimension of homeopathy raises additional ethical concerns. The marketing of homeopathic products often exploits the language of science and medicine while evading the standards that govern them. Consumers are led to believe they are purchasing effective treatments. In reality, they are buying fake medicines that contain no active ingredients. This practice tolerance has degenerated into exploitation.

A society that prides itself on scientific progress and rational inquiry cannot afford to suspend its critical faculties in the name of tolerance. While civility and openness are essential virtues, they must not be confused with randomness or indiscriminate acceptance. Tolerance has limits, particularly when it intersects with matters of public health and scientific integrity.

Thus, the tolerance extended to homeopathy is not merely misplaced; it is ethically problematic. By granting homeopathy a status it does not merit, we risk eroding the very standards that protect patients and uphold the credibility of medicine. In this context, I feel that intolerance is not a vice but a necessary stance, one that affirms the primacy of evidence, reason, and the ethical obligation to do no harm.

A recent paper entitled “Research Ethics and Integrity and the Different Forms of Misconduct: Applications and Challenges in Traditional, Complementary, and Integrative Medicine Research” caught my eye. As the subject is close to my heart and often covered on this blog, I studied it carefully. Here is the abstract:

Research ethics and integrity are foundational to the credibility, safety, and societal trust of scientific inquiry. As the use of traditional, complementary, and integrative medicine (TCIM) grows globally, concerns about research misconduct (including fabrication, falsification, and plagiarism) have become increasingly salient. With up to 80% of populations in certain countries utilizing TCIM, the field’s expansion underscores the need for rigorous, ethically grounded evidence to guide practice and policy. However, around 470 TCIM-related articles have been retracted to date, as indicated on the Retraction Watch database, which may be due to ethical or non-ethical concerns. This educational article critically examines the state of ethics and integrity in TCIM research, drawing on case studies of misconduct and highlighting the broader consequences for patient safety, scientific credibility, and healthcare integration. In addition, the educational article explores emerging ethical dilemmas posed by artificial intelligence (AI), including risks of automated fabrication, falsification, plagiarism, and opacity in research reporting. To strengthen ethical conduct, we propose strategies spanning four domains: 1) improving education and fostering interdisciplinary collaboration to enhance research literacy, 2) embedding open science practices to promote transparency and reproducibility, 3) leveraging meta-research to monitor and advance research quality, and 4) developing policies and safeguards for responsible AI use. Upholding high ethical standards in TCIM research is essential not only to ensure reliable evidence but also to protect patients, sustain public trust, and enable meaningful integration of TCIM within evidence-based healthcare systems.

The full conclusions of the authors are as follows: “With the increasing global use of TCIM therapies, it is crucial for TCIM researchers to uphold high ethical standards to ensure the feasibility, validity, efficacy and safety of TCIM interventions. TCIM research challenges such as heterogeneity, complexity, and lack of standardization practices, alongside issues with research training and funding, create both transformative opportunities and ethical dilemmas that require reflection. Addressing these challenges requires a firm commitment to enhancing research ethics and integrity in TCIM. This commitment must be translated into action through multifaceted strategies: improving research and ethics literacy, fostering open science practices, and ensuring the transparency, integrity, and reproducibility of TCIM research. Strengthening ethical and research practices will not only support its continued development as a discipline but also maximize its potential to contribute to global health.”

I find it most commendable that this subject has finally been addressed by a group of researchers, most of who are known advocates of so-called alternative medicine (SCAM). I hope that this is proves to be a step in the right direction for the fileld of SCAM.

Yet, I fear that it is a small or even tiny step. The reason for my fear is that several important issues related to research ethics and integrity in SCAM are let untouched by the authors. In my view, the one of the most important amongst them is the SCAM researcher him/herself. As often discussed on this blog, SCAM research is unique amongst all areas of medical research for being populated by individuals who have a strong ideological bias in favour of SCAM.

These (pseudo)scientists tend to abuse science by trying to prove that their beliefs are correct. Rather than trying to falsify their hypotheses, they would bend over backwards to show that their favourite SCAM is effective. I tried to demontrate this clearly by establishing my ALTERNATIVE MEDICINE HALL OF FAME on this blog.

As to the many other omissions of important ethical concerns from the above paper, I recommend having a look at our book “More Harm than Good?: The Moral Maze of Complementary and Alternative Medicine“. It offers a much more complete review of the ethical issues involved in SCAM research (amusingly, it was not cited in the paper above).

A position paper of the Associazione Pazienti Malattie Oculari (APMO) evaluated IRIDOLOGY. Here is its abstract:

Iridology is an alternative diagnostic practice that claims to identify systemic diseases and organ dysfunction through visual inspection of iris features, including pigmentation patterns, crypts, furrows, and discolorations. Despite its continued presence within complementary and alternative medicine, iridology has not been incorporated into mainstream medical practice. This review critically examines iridology from an ophthalmologic perspective, addressing its historical origins and epistemological foundations, proposed mechanisms, biological plausibility, and clinical evidence. A systematic appraisal of the available literature, including the most recent government-commissioned evidence evaluation, demonstrates a consistent lack of diagnostic accuracy, reproducibility, and pathophysiological rationale. The ethical and clinical implications of iridology use are discussed, with particular attention to the risk of delayed diagnosis and patient misinformation. Based on the totality of evidence, iridology cannot be supported as a diagnostic or screening tool in ophthalmology or general medicine.

In the article itself, the authors drew the following, detailed conclusion: Iridology is a diagnostic practice whose foundational maps were constructed through uncontrolled post hoc observation, without anatomical, physiological, or embryological basis. Decades of controlled investigation – including the most recent government-commissioned systematic review applying GRADE methodology [16] – have failed to demonstrate diagnostic accuracy beyond chance, and no credible mechanism links iris features to systemic organ pathology.

A scientifically rigorous appraisal must acknowledge several nuances: the evidence base itself is limited in volume and methodological quality; a single study using automated photodensitometry produced one marginally significant finding; and one recent unblinded study reported high sensitivity at the cost of unacceptably low specificity. These exceptions do not alter the overall conclusion but illustrate that further high-quality prospective blinded trials would strengthen the evidentiary record.

Based on the available evidence, the Associazione Pazienti Malattie Oculari endorses the following key messages:

  • Iridology should not be used or endorsed as a diagnostic or screening tool in ophthalmology or general medicine.
  • The epistemological foundations of iridology (chart construction through uncontrolled post hoc correlation) are incompatible with scientific validation regardless of clinical trial results.
  • Computer-aided iridology represents a technological advance that has not yet addressed the underlying validity problem and should not be regarded as validated.
  • Patient inquiries should be addressed with empathy, scientific clarity, and a clear distinction between genuine ocular signs of systemic disease and unsupported claims.
  • Ophthalmologists have a professional responsibility to safeguard the scientific integrity of ocular diagnostics and to protect patients from practices with potential for harm.

All of this confirms what I have been saying and writing for several decades. My recent book BIZARRE MEDICAL IDEAS has a chapter on iridology and his inventor. Here is its abstract:

Ignaz von Peczely (1826-1911) was born into a noble Hungarian family. He became a lay homeopath but later decided to study medicine in Vienna where he graduated aged 36. He then had a thriving medical practice in Vienna. Peczely’s discovery of iridology allegedly goes back to his childhood when he noted discolourings in the eye of an injured owl. Throughout his professional life, Peczely promoted iridology with some success. Other practitioners took over the mantle and made sure iridology is popular to the present day.

What needs stressing, I feel, is the fact that iridology is not just a mere folly, it is dangerous! False negative and false positive diagnoses – iridology is unable to deliver anything else – carry serious, sometimes life-threatening risks.

Ten years after Brexit, it seems reasonable to ask what effects Brexit has caused on health-related matters for the UK and beyond. Here is my attenpt to provide an answer; these are the 8 issues that come to my mind:

  1. Workforce Disruption and Recruitment Shift: The ending of free movement led to a sharp drop in EU-trained doctors, nurses, and social care staff. To plug these vacancy gaps, the UK was forced into recruiting heavily from non-EU nations. This created a fragile reliance on international recruitment from countries facing their own healthcare worker shortages. In turn, this further supported the xenophobic sentiments of some UK citizens.
  2. Medicine Supply Problems: Leaving the EU single market introduced significant customs and regulatory friction. This friction directly contributed to the frequency and severity of local pharmaceutical shortages in the UK.
  3. Loss of Regulatory Leverage: By exiting the European Medicines Agency (EMA), the UK became a standalone market. Pharmaceutical companies now regularly prioritize the much larger EU and US markets for rolling out cutting-edge new treatments, leaving the UK Medicines and Healthcare products Regulatory Agency (MHRA) to act as a “rule-taker” by fast-tracking approvals already granted elsewhere.
  4. Cross-Border Friction: Reciprocal healthcare arrangements became more complex under the new Global Health Insurance Card (GHIC) system. While basic travel is covered, specialized cross-border medical networks face ongoing administrative and legal hurdles. Many British ex-pats’ found themselves without health cover.
  5. Regulatory Divergence in Training and Innovation: The UK has increasingly diverged from EU rules, such as lowering the mandatory clinical training hours required for a nursing degree to get staff into hospitals faster. Additionally, medical technology and AI developers now face double-compliance costs (clearing separate UK and EU hurdles). This makes the UK a more expensive market to launch new health technologies.
  6. The Macro-economic Squeeze: The overall economic downturn resulting from Brexit reduced UK GDP, shrinking the available tax revenues. This has directly limited the government’s financial capacity to fund the NHS, to clear post-pandemic backlogs, and to invest in long-term social care reform.
  7. Exacerbating Health Inequalities: As inflation, food costs, and supply chain disruptions damaged the UK, vulnerable socioeconomic groups have been hit the hardest. These economic pressures, combined with a chronically strained social care sector, significantly widen UK health inequalities.
  8. Compounding Pressure on Patient Outcomes: While ultimate health metrics, such as mortality rates and overall life expectancy, are influenced by dozens of complex variables, an underfunded NHS, chronic staffing vulnerabilities, and restricted access to new drugs create a persistent, negative headwind against public health which, in the long run, can only negatively affect patient outcomes.

All of these effects are clearly negative.

Can anyone think of a positive effect?

I can’t!

The claim that Elon Musk might be “killing millions” sounds like hyperbolic rhetoric, but it is an entirely predictable mathematical projection of his policy choices. Peer-reviewed global health modeling showed that the systematic dismantling of USAID—spearheaded by Musk’s Department of Government Efficiency (DOGE)—will result in over 14 million preventable deaths by 2030, millions of whom are children. By freeze-framing and terminating programs that provide life-saving vaccines, malaria bed nets, and HIV therapeutics, these actions have directly triggered the resurgence of entirely controllable diseases.

Hard to believe?

See for yourself; here is the abstract of the paper published in the Lancet:

Background: Official development assistance (ODA) accounts for the majority of humanitarian and development assistance in the world’s most vulnerable countries and has played a pivotal role in advancing global health. We aimed to comprehensively evaluate the impact of ODA funding on mortality across the past two decades, and to project the potential consequences of current defunding trends.

Methods: We conducted an integrated retrospective evaluation and forecasting analysis using longitudinal panel data from 93 low-income and middle-income countries (LMICs). First, we estimated the association between ODA per-capita funding and mortality outcomes from 2002 to 2021 using a two-ways fixed-effects multivariable Poisson regression model with robust standard errors, adjusted for all relevant demographic, socioeconomic, and health-system covariates. We then assessed age-specific and cause-specific effects, performing extensive sensitivity and triangulation analyses to test the robustness and causal interpretation of results. Finally, we integrated the retrospective impact estimates into validated country-level microsimulation models to forecast mortality under three defunding scenarios up to 2030: a business-as-usual trajectory, a severe defunding scenario, and a mild defunding scenario.

Findings: Higher ODA funding levels were associated with a 23% reduction in age-standardised all-cause mortality (rate ratio [RR] 0·77; 95% CI 0·70-0·85) and a 39% reduction in under-5 mortality (0·61; 0·49-0·75). ODA funding was associated with large mortality declines in major communicable diseases: 70% for HIV/AIDS (RR 0·30; 95% CI 0·24-0·39), 56% for malaria (0·44; 0·35-0·56), 56% for nutritional deficiencies (0·44; 0·30-0·65), and 54% for neglected tropical diseases (0·46; 0·36-0·59). Significant reductions were also observed in mortality from tuberculosis, diarrhoeal diseases, lower respiratory infections, and maternal and perinatal causes. Forecasting analyses projected that ongoing reductions in ODA funding could, under a severe defunding scenario, result in 22·6 million (95% uncertainty interval [UI] 16·3-29·3) additional deaths across all ages by 2030, including 5·4 million (4·1-6·8) among children younger than 5 years. Under a mild defunding scenario-defined as a continuation of current downward trends-the projected excess deaths would be 9·4 million (95% UI 6·2-12·6) overall and 2·5 million (1·8-3·2) among children younger than 5 years.

Interpretation: ODA funding has played a decisive role in reducing preventable mortality across LMICs over the past two decades, and the abrupt withdrawal of this support threatens to cause millions of avoidable deaths, reversing decades of progress in global health.

Funding: RF Catalytic Capital and the Spanish Ministry of Science and Innovation.

Attempting to shield Musk from the moral indictment of these deaths by hiding behind bureaucratic complexity is a cop-out. Musk is not a passive advisor suggesting minor budgetary trims; he has aggressively engineered and celebrated the destruction of these aid mechanisms on his public platform, explicitly branding the defunding of life-saving infrastructure as “clipping waste.” When an individual wields unchecked power to eliminate interventions with legally and medically proven survival rates, the line between “efficiency” and institutional negligence disappears. He is fully aware of the survival benefits of these programs, making the choice to dismantle them a calculated acceptance of mass mortality.

While defenders argue that epidemiological models deal in macro-statistics rather than localized causality, this defense elides the nature of modern accountability. Musk cannot hand-select which specific child dies of malaria, but he did hand-select the budget line that funded their treatment. Pretending this is just a structural or collective government failure sanitizes the reality: a single billionaire used his leverage to treat global survival infrastructure like an unprofitable corporate acquisition, making him materially and morally responsible for the human body count that follows.

In March 2025, a federal judge ruled that DOGE’s effort to dismantle USAID likely violated the Constitution and ordered restoration of access to key systems, saying USAID had been effectively eliminated. That matters because it weakens any claim that the dismantling was merely speculative or rhetorical: courts have already treated the shutdown effort as legally serious.

For a deeper look into the systemic impact of these specific health program suspensions and the firsthand accounts of how these funding disruptions unfolded on the ground, you can watch this France 24 Interview with a USAID Whistleblower.

Critics of so-called alternative medicine (SCAM) often point out that much of it lacks plausibility. Proponents of SCAM tend to think that this is an irrelevance. So, what is plausibility, and why does it matter?

Think of scientific plausibility as a reality check. Before scientists spend time and money testing a new idea, they ask a basic question: Does it actually line up with what we already know about how the universe works? While an idea being plausible doesn’t automatically make it true, it acts as a crucial filter. It helps us separate ideas that are worth investigating from those that break the fundamental laws of logic, physics, chemistry, biology, etc.

This is exactly where many SCAMs fall apart. Their claims often contradict basic science before a study even begins. Take homeopathy, for example. It relies on the idea that a substance can cure an illness, even if it is diluted over and over again, often to the point where not a single molecule of the original ingredient is left. This directly defies molecular theory and the well-established “dose-response relationship,” which simply states that the amount of a substance matters. Similarly, practices like “energy healing” postulate mysterious vital energies that cannot be seen, felt, or measured by any instrument known to modern science.

This matters because it changes how we look at “proof.” In science, if an idea is highly unlikely from the start, a single positive study usually isn’t a breakthrough. Instead, it’s much more likely to be a fluke, a statistical error, the result of a flawed experiment or even fraud.

Instead of trying to fix these scientific contradictions, proponents of SCAM often change the subject or move the goalpost. They might, for instance, that claim the scientific method is closed-minded or simply ignore negative results. But you cannot bypass the rules of reality. If a treatment claims to do something that contradicts everything we know about nature, it requires extraordinary proof to be taken seriously.

I do understand why SCAM enthusiasts try to ignore the issue of plausibility. But ignoring it runs several risks. For instance, it risks doing research that is entirely wasteful. More importantly perhaps, it risks paying undue attention to false positive results which, in turn, can seriously harm vulnerable patients – just think of a cancer patient who has fallen victim to the claims of homeopaths – backed by multiple, implausible and fase-positive results – suggesting that homeopathy can cure cancer.

“Science and pseudoscience diverge particularly sharply in their ethical and moral foundations. While science is built upon principles of honesty, openness, and responsibility, pseudoscience undermines these values often by placing ideology and belief over evidence and truth. Science is not least an ethical enterprise, and the divide between science and pseudoscience is a matter of profound moral importance. The ethical stakes become especially acute when pseudoscience causes harm…”

These lines come from my recent book, THE LEOPARD LILY PROJECT, which is only marginally about so-called alternative medicine (SCAM). Yet they do apply well to SCAM which does not merely fail the test of scientific rigor but also fails the test of medical ethics. When a practice trades empirical validation for dogmatic ideology, it ceases to be an innocent alternative and becomes a profound moral transgression. SCAM regularly promises holistic salvation while actively undermining the principles of honesty, openness, and responsibility, effectively replacing rigorous scrutiny with profitable mystique.

The ethical stakes transition from academic to tragic whenever a vulnerable patient is guided away from effective treatments. SCAM cloaks itself in the gentle language of empathy and natural, holistic, individualised healing, yet its business model relies on exploiting the desperation of the sick. Informed consent is rendered impossible when patients are fed misleading or even fabricated data and disproven promises. By substituting anecdotes for evidence, SCAM weaponizes false hope, monetizing the fear of illness under the guise of medical autonomy. SCAM fosters a broader culture of conspiratorial thinking that systematically erodes public trust in collective public health infrastructure.

When conventional physicians prescribe a treatment, they are bound by evidence, medical ethics, regulatory oversight, and a legal duty of care. When SCAM practitioners prescribe an unproven therapy, they operate in an ethical void, often shielded from accountability by vague disclaimers.

Science remains an ethical enterprise acknowledging its own limitations and subjecting its claims to rigorous correction. Pseudoscience demands faith instead of evidence and leaves its patients to bear the physical consequences of its intellectual dishonesty. To pick up and rephrase the theme from my recent book: evidence-based medicine and SCAM diverge particularly sharply in their ethical and moral foundations.

Internal HHS and CDC communications leaked by the US Senate HELP Committee expose a truly scary crisis of institutional integrity. Secretary Robert F. Kennedy Jr. systematically dismantled evidence-based public health infrastructure to implement his personal, ideological and dangerous agenda. This was not merely a shift in administrative policy; it was an aggressive, top-down politicisation of science that directly compromised public safety.

It is now clear that less than 24 hours after his confirmation on 29/30 January 2025 – in the midst of a severe flu season that had already claimed 16,000 lives, including 68 children – Kennedy issued a direct mandate to halt active flu vaccine public service advertisements. Internal communications from HHS Director of Communications Andrew Nixon explicitly confirm this “was a direct ask from Secretary Kennedy.”

The institutional damage caused by Kennedy’s actions extends far beyond suppressed messaging into structural purges. In fact, it seems likely that Kennedy committed perjury. During his confirmation hearings, Kennedy misled lawmakers regarding his intentions to restrict vaccine access and his past anti-vaccine interventions. Once in power, his chief of staff enforced an “absolute need for political review” over career scientists. Kennedy subsequently fired the entire 17-member Advisory Committee on Immunization Practices (ACIP), replacing them with people with strong anti-vaccine views. When career CDC Director Susan Monarez resisted rubber-stamping these politically motivated recommendations, Kennedy fired her, triggering a wave of high-level resignations among the agency’s top medical officers.

The leaked emails also confirm that Kennedy bypassed standard scientific clearance protocols to dispatch handpicked researchers into confidential CDC databases. This was a deliberate attempt to weaponize raw public health data to manufacture evidence for a spurious vaccine-autism link that has been thoroughly debunked by global longitudinal studies involving millions of children.

By substituting ideological loyalty for empirical evidence, the US administration has compromised the foundational mechanics of medicine. When a federal health agency is forced to prioritize dogma over data, the ultimate cost is inevitably paid in preventable human disease and death.

The conclusion: Kennedy has likely committed the serious crime of perjury, has shown to be a danger to our (the damage can quickly spread beyond the US) health, and in my view has to be removed from office asap.

Having narcissistic tendencies, e.g. bragging or making yourself the center of attention, are normal, if they occur only occasionally. However, Narcissistic Personality Disorder (NPD) is different. With NPD, symptoms are more severe, occur regularly and in different situations and environments, and make relationships with others challenging.

The 9 most common symptoms of NPD are the following:

  1. Grandiose sense of self-importance.
  2. Preoccupation with fantasies of success, power, brilliance, beauty, or ideal love.
  3. Belief that they are “special” and should associate only with high-status people or institutions.
  4. Need for excessive admiration.
  5. Strong sense of entitlement.
  6. Interpersonally exploitative behaviour, using others to achieve their own ends.
  7. Lack of empathy, with little recognition of others’ feelings or needs.
  8. Envy of others, or belief that others are envious of them.
  9. Arrogant or haughty attitudes and behaviours.

Now, let’s consider a person who is almost constantly in our minds, mainly because he makes the headline news practically every day:

DONALD J TRUMP.

Does he perhaps display any of the above-listed symptoms? Let’s find out by going through them one by one and citing concrete examples**:

  1. Trump displays grandiose sense of self-importance regularly and to an extreme degree. Example: in August 2019, he told reporters, “I am the chosen one”.
  2. Trump displays preoccupation with fantasies of success, power, brilliance, beauty, or ideal love regularly and to an extreme degree. Example: he said he was “always the best athlete” before his first presidential physical in January 2018.
  3. Trump displays his belief that he is “special” and should associate only with high-status people or institutions regularly and to an extreme degree. Example: in his 2018 rally line about the “elite,” he said, “We’re the elite… We’re the super-elite”.
  4. Trump displays a need for excessive admiration regularly and to an extreme degree. Example: according to a 2026 analysis, he has a “relentless demand for exaltation,” wants “praise, admiration, and accolades,” and even accepts honors that critics said were meant for others.
  5. Trump displays a strong sense of entitlement regularly and to an extreme degree. Example: he defended accepting a luxury Boeing 747 from Qatar by saying it would be “stupid” to turn down a “free plane,” and the aircraft was reported to be intended for his use as Air Force One.
  6. Trump displays interpersonally exploitative behaviour, using others to achieve their own ends regularly and to an extreme degree. Example: in the border detention context, he “exploits his power” and “leverages cruelty strategically,” especially in policies that harmed vulnerable migrants and children.
  7. Trump displays lack of empathy, with little recognition of others’ feelings or needs regularly and to an extreme degree. Example: the family-separation policy at the US border, which causes severe suffering, while Trump continues to treat it as a political instrument rather than a human tragedy.
  8. Trump displays envy of others, or belief that others are envious of them regularly and to an extreme degree. Example: he has repeatedly made unverified claims about his inauguration crowd size, television ratings, and rally attendance, frequently comparing them directly to Obama’s numbers in an attempt to prove he is more widely loved
  9. Trump displays arrogant or haughty attitudes and behaviours regularly and to an extreme degree. Example: While accepting the party’s nomination in Cleveland, Ohio, Trump delivered a dark assessment of the US, describing a nation plagued by rising crime, economic decay, and international humiliation. After spending a large portion of the speech detailing these systemic crises, he uttered (in grammatically wrong English): “Nobody knows the system better than me, which is why I alone can fix it.”

So is Trump suffering from NPD?

Judge for yourself.

I guess he is not suffering from but enjoying it!

___________________

 

And what is the solution? Treatment of NPD can be difficult because people with NPD may not feel therapy is necessary, so progress often depends on motivation and a good therapeutic fit. There is no effective drug treatment and talking therapies are usually recommended. In Trump’s case, removal from office would obviously be an acutely necessary measure.

__________________

 

**I am sure you know of much better examples (the coice is truly vast); feel free to cite them in the comments.

The US Defense Secretary Pete Hegseth’s decision to make the annual flu vaccine optional for US military service members in April 2026 was not an exercise in “medical autonomy,” as he called it at the time. It was a recklessly ideological act that has now already cost a life. By lifting a long-standing, evidence-based mandate Hegseth dismissed as “absurd” and “overreaching,” he prioritized ill-advised principles over the health, welfare, and readiness of US service members.

The consequences arrived swiftly and were confirmed in mid-June 2026. At Lackland Air Force Base in Texas, at least 159–160 recruits fell ill with flu within weeks, with two hospitalizations. One sixth-week trainee, Keon McDaniel, died on June 16 at Brooke Army Medical Center after a medical emergency on June 12. While the official cause of death remains under investigation, sources report McDaniel had not received the flu vaccine. Vaccination rates among Air Force trainees plummeted to roughly 40% after the mandate was lifted, compared to near 100% coverage while immunization was mandatory.

The outbreak was so severe that the Air Force received an emergency exception from the Pentagon and reinstated mandatory flu shots for all recruits at Lackland – an admission that Hegseth’s policy was dangerously wrong. The exception was granted by the Under Secretary of Defense for Personnel and Readiness, which can authorize mandatory vaccination when risk assessments warrant it.

Hegseth styled himself “Secretary of War” while declaring mandatory vaccination “not rational.” Yet the mathematics of infectious disease are clear: in communal settings like military bases, where close contact is unavoidable, voluntary vaccination leads almost inevitably to outbreaks. Yet Hegseth ignored decades of public health evidence that flu vaccines reduce morbidity, prevent complications, and maintain operational readiness. His decision was irresponsible and little more than political posturing aligned with anti-vaccination rhetoric that currently undermines public health across the US under Trump’s administration.

The death of a young trainee is a human cost Hegseth cannot dismiss. Texas Congressman Joaquin Castro is now calling for a full DoD accounting of the outbreak and an investigation into McDaniel’s death. Whenever military leaders make policy decisions, they must prioritize readiness and safety over ideology. Hegseth failed that duty in the most appalling fashion. His flu shot reversal was by no way a victory for autonomy; it was a failure of leadership that endangered service members and will likely cost more lives if not urgently corrected across the entire armed forces.

As of June 20, 2026, the mandatory flu vaccine has not been reinstated across all armed forces – only at Lackland. The broader policy remains voluntary, leaving the rest of the military exposed to Hegseth’s stupidity and similar outbreaks.

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