America’s Got Governance

  • Scranton’s Crime Reality Check as Mayor Cognetti Eyes a House Seat

    Scranton’s Crime Reality Check as Mayor Cognetti Eyes a House Seat

    I can smell political panic like a burger left too long on the grill. Scranton, Pennsylvania, Joe Biden’s hometown, is staring down ugly crime headlines while Mayor Paige Gebhardt Cognetti tries to swap City Hall for Congress, challenging freshman Rep. Rob Bresnahan Jr. in Pennsylvania’s 8th District.

    Fox News framed it plain on February 17, 2026: a “crime crisis” narrative dogging a Democrat mayor as she eyes a House seat. In a district this tight, narratives turn into ballots fast.

    What Scranton has lived through

    This is not just vibes and yard signs. In 2024, Scranton endured an ambush-style shooting where Detective Kyle Gilmartin was hit twice in the head on January 11, 2024. Aiden Gabriel Deininger, 20, was charged with multiple counts including attempted homicide of law enforcement officers. Gilmartin survived.

    Local reporting also pointed to five homicides in the first five months of 2024, compared with three in all of 2023. People do not need a consultant to explain what that feels like on a front porch at night.

    Cognetti has argued the “crime spike” narrative is overcooked. In a 2025 mayoral debate, she swatted away New York Post numbers, saying the Post is not a crime database and telling people to use official databases. Fine. But you cannot data-talk your way out of the sound of gunfire.

    Why this race matters beyond Scranton

    PA-08 is tight enough to make a man’s jeans feel tight. Bresnahan flipped the seat in 2024 with 50.8% to 49.2%, a margin of 6,252 votes. Cognetti is a declared candidate for 2026, and the FEC lists her as a Democratic House candidate for PA-08.

    Governance is cops, cameras, and consequences

    Fox reported Cognetti’s camp says she expanded the police force, added 51 new police vehicles with smart tech, and deployed hundreds of cameras, including more than 230 CCTV cameras around the city. Local reporting has also highlighted major public-safety investments, including dozens of new police vehicles since 2023, upgraded body cameras, equipment, and funding tied to a federal grant.

    Fox also referenced a 2020 interview with the Black Scranton Project where Cognetti discussed an aspiration for a future where officers would not need firearms. I cannot locate the full original interview video or transcript in public archives right now, but Fox using it tells you what the opposition plans to hit.

    In the Fox piece, Bresnahan’s campaign manager, Peter Brath, accused Cognetti of downplaying gang violence, wanting to disarm police, and claimed she was “caught partying” in New York City days after the December 2025 machete killings. That New York City detail is presented as a campaign allegation in the Fox story, and I have not seen a public document in the reporting that pins it down beyond that claim.

    But the December 2025 horror is real. On December 9, 2025, Scranton police say two women were killed and another woman critically injured in a machete attack at the Hotel Jermyn Apartments. WVIA reported the suspect, Michael Willie Marquis Woods, 38, was charged with two counts of criminal homicide, attempted criminal homicide, aggravated assault, and aggravated cruelty to animals.

    My bar-stool sermon is simple: stop treating public safety like a campaign prop. Run the city. Measure what works. Tell the truth about what people are living through. Live free, grill hard, and demand grown-up governance.

  • Mike Evans, Free Agency, and the Only Budget System Anybody Respects

    I like my news the way I like my steak: hot, simple, and not explained to me by a pastel infographic made by somebody who thinks a brisket is a personality type.

    So here comes the headline with real American clarity: Tampa Bay Buccaneers wide receiver Mike Evans is coming back for 2026, but he is also going to test free agency. That is not drama. That is the marketplace. Everybody claims they are “just looking” until the bidding starts.

    What we actually know

    • Fox News reported on February 17, 2026 that Evans will play in 2026 and plans to explore the free agency market, based on his agents telling ESPN.
    • This would be the first time in his career he hits free agency, and he will turn 33 in August.
    • Retirement speculation floated around because his 1,000-yard streak ended in 2025 after 11 straight seasons, with hamstring and collarbone injuries in the mix.
    • Fox News reported he missed nine games and finished with 30 catches for 368 yards and three touchdowns in eight games.
    • Tampa Bay missed the playoffs in 2025 for the first time since 2019.

    Why he is not “just another free agent”

    Evans is not a novelty bobblehead. Fox News notes he was a six-time Pro Bowler in the 11 seasons before the injury-heavy 2025, helped Tampa win the Super Bowl in 2020, and led the NFL in receiving touchdowns in 2023. That is a franchise landmark wearing shoulder pads.

    The salary cap: the last honest budget in America

    Here is the part that makes me want to stand up on a bar stool and preach. The NFL has something most politicians only cosplay with: a cap. A real ceiling. Real consequences.

    Fox News points out Tampa may need to open cap space to keep him, citing Over The Cap putting the Buccaneers at nearly $24 million in cap room this offseason. And OverTheCap’s contract page for Evans shows 2026 as a void year with a $13,074,000 2026 salary cap charge. Dead cap is like burnt propane: money already spent, still stinking up the place.

    Rules are rules, not vibes

    NFL.com reported Evans’ agent, Deryk Gilmore, said Evans is opening it up, and that he will definitely play a 13th season, possibly in Tampa, possibly elsewhere. That is the whole sermon right there: adults make choices, the rules stay put, and math does not care how emotional anybody gets.

    Mike Evans is going to test the market. Fine. Let the rest of the country try testing something radical too: accountability. Live free, grill hard, and make budgets mean something again.

  • Zillow’s Forever-Open-House Problem Is a National Security Leak in a Polo Shirt

    I’m parked on a bar stool with hickory smoke in my beard, listening to the fryer crackle like AM radio, and I’ve got a question: why do we treat America’s front doors like they’re part of a public museum?

    The story Fox News flagged

    On February 17, 2026, Fox News tech columnist Kim Komando warned that criminals can use old real estate photos on Zillow to plan break-ins, because listing photos can stay online long after a home sells. That means someone can look up an address and study doors, windows, layouts, and even where cameras are mounted, like they’re cramming for a final exam in Being a Dirtbag.

    Komando also noted Zillow says its database covers more than 160 million homes. That is not a “cute app.” That is a gigantic cabinet of residential intel sitting out in the open.

    She tied the speed of online exposure to a grim reminder: the ongoing disappearance of Nancy Guthrie, the mother of Today host Savannah Guthrie, and how quickly an address and home photos can be pulled up. Information moves faster than wisdom. Always has.

    Why criminals love the internet’s “open house forever” feature

    Yes, criminals are responsible for their crimes. Full stop. But leaving high-resolution interior photos online forever is the digital version of taping your home’s scouting report to a telephone pole.

    Komando’s point was broader than one website, too. It’s a whole pipeline:

    • People-search sites can surface addresses fast.
    • Real estate sites can surface interior photos.
    • Mapping tools can show the outside view.

    You don’t need a movie mastermind. You need Wi‑Fi and bad intentions.

    The data-broker business model (and the opt-out maze)

    This is what happens when privacy gets chopped up like brisket and sold as “engagement.” Komando named people-search outfits like Spokeo and WhitePages and warned that opting out takes time.

    Data broker practices have been controversial for years. The FTC, for example, announced a 2012 settlement with Spokeo tied to allegations about marketing consumer profile information to employers and recruiters in a way that raised Fair Credit Reporting Act issues. Meanwhile, states have tried their own privacy rules, creating a patchwork of forms and fine print. Reporting has also shown opt-out pages can be made hard to find, even when companies claim compliance.

    What homeowners can do right now

    Komando’s core advice was simple: if you’re not selling, stop donating your home blueprint to the internet.

    • Zillow: Sign in, claim your home’s property page, then use owner tools to hide or remove photos. For some off-market homes, you may need support.
    • Redfin: An owner dashboard can hide listing photos.
    • Realtor.com: A claiming process can allow photo removal.
    • Google Street View: You can request blurring via “report a problem,” and once blurred, it’s permanent.

    The Founding Fathers did not pitch tea into Boston Harbor so your 2016 kitchen photos could live online until the sun burns out. Claim your listings, hide what you can, and demand sane standards. Live free, grill hard, and make privacy American again.

  • Repo Gunfire in Manor, Texas and the Consequences People Keep Misplacing

    I have seen a lot of things in this great republic, but nothing says “we are raising adults on a steady diet of entitlement and energy drinks” like somebody treating a repossession like it is a call to open fire.

    What happened in Manor, Texas

    Police say this blew up just before 11 a.m. on Tuesday, February 17, 2026, at the View at Manor Crossings Apartments on FM 973, just north of U.S. 290. Officers responded to reports of shots fired and found shell casings in the parking lot.

    And yes, the whole ugly spectacle was caught on surveillance video.

    • Police say the repo driver had a spare key and was driving the SUV out.
    • The video shows the vehicle clearing the gate while a suspect chased after it and fired.
    • Fox News notes the suspect in the video is wearing a red shirt.

    Who police say did it, and what they say he used

    Manor police identified the suspect as Derion Lyles, 18, who police say lives at the complex. Police say Lyles fired three rounds from an AR pistol:

    • Two rounds went into the ground.
    • One round hit the SUV’s rear driver-side tire.

    The repo driver was not injured. Lyles was taken into custody and booked into the Travis County Jail. FOX 7 reported charges of deadly conduct, unlawful carrying of a weapon, and theft of a firearm.

    Then comes the part that ought to make every taxpayer grip their steering wheel a little tighter: police said the gun used was tied, via its serial number, to a home burglary in Alabama.

    What is still unclear

    Fox News says it is unclear whether the suspect was the owner of the repossessed SUV, and unclear whether there was contact between the suspect and the repo driver before the shooting.

    My bar-stool sermon

    A repo is not a personal insult. It is a contract coming home to roost. If you answer that reality with gunfire in broad daylight, you are not “standing up for yourself.” You are lighting a roman candle inside the idea of a civilized society.

    Live free, grill hard, and act like consequences are still a thing.

  • Hollywood Offered Gordon Gekko to Beatty and Gere, and Washington Still Cannot Cast a Grown-Up

    The other night I had hickory smoke in my beard, a cheap AM radio crackling like a campfire sermon, and that familiar sound of America arguing about money while pretending it is about morality. The grill was hot. The country is hotter. And right on cue, Fox News served up a little Hollywood trivia that reads like a governance tutorial with a side of grease.

    Douglas says Beatty and Gere passed, and he got the part

    Here is the clean fact pattern, cooked medium rare. Michael Douglas, now 81, said at a TCM Classic Film Festival panel on Sunday, February 15, 2026, that he recently learned director Oliver Stone first offered the Gordon Gekko role in Wall Street to Warren Beatty, then to Richard Gere, and both passed. Fox News reported it on February 17, 2026.

    • Douglas said he had not watched the movie fully in about 40 years.
    • He said it surprised him because, as an actor, you want to believe you were the first choice.

    We all know how it turned out: Douglas played the ruthless Wall Street investor Gordon Gekko opposite Charlie Sheen as Bud Fox. Douglas won the Academy Award for Actor in a Leading Role for Wall Street at the 60th Academy Awards, held April 11, 1988. That is not a rumor. That is the Oscars record book.

    Fox also notes Douglas returned as Gekko in 2010 for Wall Street: Money Never Sleeps, with the character newly released from prison and looking to rebuild what he lost. Douglas has also teased a coming memoir, saying it will cover his decades-long career, his marriage to Catherine Zeta-Jones, and his past battle with stage four cancer.

    America has a casting problem, and it is called governance

    Now pull your bar stool closer, patriot, because this is not just an entertainment story. It is an American civics lesson wearing a power suit.

    Hollywood offered a villain role to two A-listers. They said no. Fine. Then the role found the one guy who made it iconic. That is the free market of talent. That is selection pressure. That is a brisket cook-off where the judge is time.

    Washington is different. It is a film set where the same extras keep getting promoted because they know where the catering table is. The permanent bureaucracy plays casting director, the lobbyists play talent agents, and the taxpayer plays the exhausted studio executive who never asked for this sequel.

    And what do they keep casting? People who can deliver lines, not results. People who can sound serious, not be serious. Meanwhile the Constitution gets treated like a prop Bible made of foam, held up for the camera and dropped the second the lights go off.

    Beatty and Gere passed on Gekko. Fox did not get into the why, so neither will I. The verified point is simple: they passed, Douglas took it, and the part became history. In politics, too many folks with actual backbone keep passing on the job of running things, and the stage fills up with careerists who never pass on anything except accountability.

    So here is my advice, delivered like a hot rack of ribs: stop letting the same casting director pick the same flops. Demand competence. Demand clarity. Demand a government that fears the voter the way a man fears overcooking a brisket in front of his father-in-law. Live free, grill hard, and make governance earn its paycheck.

    Teaser: Michael Douglas says Beatty and Gere passed on Gordon Gekko. The bigger scandal is how often Washington passes on responsibility, then hands you the bill anyway.

  • America’s Got Governance: When Family Court Runs Like a DMV, Kids Pay the Price

    America’s Got Governance: When Family Court Runs Like a DMV, Kids Pay the Price

    I can smell the stale casino air from here. Cheap hotel carpet, overworked AC, and the kind of regret that clings to your boots. Now add a cheer competition that never got to hear one more routine. That is the gut-punch behind this story, and it is the kind of thing that makes a man grip his bar stool like it’s the last stable object left in America.

    And yes, I’m going to talk politics, because when the system touches a family for years and the ending is two bodies in a hotel room, that is governance. That is the state doing what the state does best: shuffling forms until the human beings fall out of the folder.

    What happened in Las Vegas

    • Las Vegas Metropolitan Police say a welfare check was requested on February 15, 2026, around 10:43 a.m., at a hotel in the 3700 block of West Flamingo Road.
    • Officers and hotel security knocked and called into the room, got no response, and cleared the call because, at that time, they did not believe anyone was in danger.
    • Later that afternoon, after additional requests came in, security entered the room around 2:27 p.m..
    • Police say a mother and daughter were found dead with apparent gunshot wounds, and preliminary findings indicate the mother shot her daughter and then herself.

    Fox News reports that while police did not publicly identify the victims, court documents and family members identified them as Tawnia McGeehan, 38, and Addi Smith, 11, found at the Rio Hotel & Casino. Fox also reports a note was left behind, but authorities have not disclosed what it said. Motive is not publicly established, and anybody pretending otherwise is just doing karaoke with other people’s grief.

    Fox further reports the coroner ruled McGeehan’s cause of death as a gunshot wound to the head and listed the manner of death as suicide, while Addi’s cause and manner of death were still pending as of February 17, 2026.

    The custody battlefield: years of choreography

    Fox News reports this tragedy sat on top of a years-long custody battle going back to a 2015 divorce. Judges imposed detailed exchange protocols: park five spaces apart, have the child walk between vehicles alone, do certain exchanges at a police department at a specific time, do not film, and communicate through a court-approved custody app.

    Fox also reports that in 2020, McGeehan temporarily lost custody after a judge found conduct that could alienate the child from her father. By 2024, Fox reports the parents had a joint legal and physical custody agreement, alternating weeks.

    Procedure is not protection

    I’m not here to quarterback cops from a bar stool. The police timeline is what it is. But the broader machine we’ve built loves one thing more than it loves families: liability management. If government were a pickup truck, it would be all bed liner and no engine. It looks tough, but it can’t haul what matters.

    I’m a Trump guy. I like law, order, and the plain old idea that a nation should protect its citizens first. Still, no administration can fix what the states refuse to admit is broken: a custody system that runs on autopilot until tragedy hits the windshield.

    Stop treating custody like a paperwork sport. Stop pretending a court-approved app is the same thing as real oversight. Put kids over procedure.

    Live free, grill hard, and do not apologize.

  • Intermittent Fasting Just Hit a Brick Wall, and the Hype Merchants Are Sweating

    I can smell it now: that January gym optimism, mixed with stale pre-workout and the quiet whimper of a bathroom scale. America loves a shortcut the way a kid loves the fireworks aisle. And right when intermittent fasting has been struttin around like it invented discipline, a big old stack of grown-up science shows up and flips on the fluorescent lights.

    What the major review found

    Fox News spotlighted a new Cochrane review examining intermittent fasting using evidence from 22 randomized clinical trials including 1,995 adults, with studies spanning regions such as North America, Europe, China, Australia, and South America.

    • Compared with regular dietary advice, intermittent fasting may make little to no difference in weight loss or quality of life.
    • Compared with no intervention or a waiting list, intermittent fasting likely makes little to no difference in weight loss.

    In plain English from a bar stool: all those magic hours and holy eating windows might land you about where a normal, boring plan does, and sometimes about where doing basically nothing structured does. Like bolting a lift kit on a truck just to drive to the grocery store.

    Limits the algorithm will not sell you

    This is not some influencer science-fair poster. It is a systematic review of randomized trials, and it comes with caveats the hype machine hates.

    • Most studies followed people for 12 months or less.
    • None of the included studies reported participant satisfaction with intermittent fasting.
    • The trials did not report outcomes people argue about daily, including diabetes status or overall measures of other health problems.
    • Evidence on unwanted events was uncertain because reporting and methods were not strong enough for clean conclusions.

    Why this matters beyond diet drama

    Fox News also pointed to a bigger backdrop: the World Health Organization reported 2.5 billion adults were overweight in 2022, including 890 million living with obesity. That is not a vibe. That is a warning label the size of a continent.

    And when certainty gets sold without evidence, it stops being “wellness” and starts looking like a marketplace problem. I am not alleging a specific crime in this fasting story. I am saying the broader wellness bazaar gets real comfortable selling confidence like it is a product.

    So what do we do with this?

    If intermittent fasting helps you keep a routine you can live with, fine. The review does not crown it as clearly better for weight loss. Fox News also included outside experts making the un-sexy point that sustainability matters and diets are tools.

    Pick the tool that fits your life, not the one with the loudest marketing budget. Read the evidence like you would read a warranty on a smoker.

    Live free, grill hard, and do not let the internet sell you certainty with a side of nonsense.

  • Mark Kelly Sniffs 2028 While the Pentagon Tries to Play Campaign Referee

    I’m sitting here with the grill popping like AM radio static, watching Washington do that thing where it can’t just argue politics like adults. No, it has to drag the military, the courts, and everybody’s blood pressure into the same mud pit.

    Fox News reports Sen. Mark Kelly of Arizona, retired Navy captain and former astronaut, told the BBC on Feb. 16, 2026 he will “seriously consider” running for president in 2028. Convenient timing, because he’s also in a legal brawl over a Pentagon censure and a retirement-grade process that puts his retirement rank and pay on the table.

    The legal fight, laid out like a rack of ribs

    Kelly filed a federal lawsuit in Washington, D.C. on Jan. 12, 2026 against Defense Secretary Pete Hegseth, the Department of Defense, Navy Secretary John Phelan, and the Department of the Navy.

    The complaint says Hegseth issued a Secretarial Letter of Censure dated Jan. 5, 2026. It also says the Navy started Retirement Grade Determination Proceedings that same day, which could affect Kelly’s retirement rank and pay. Kelly argues the actions are retaliation for speech and cross constitutional lines, including First Amendment and separation-of-powers protections for legislators.

    The judge stepped in

    On Feb. 12, 2026, U.S. District Judge Richard J. Leon, in Kelly v. Hegseth (Civil Case No. 26-81 (RJL)), granted a preliminary injunction in part.

    The order blocks the government from enforcing the Jan. 5 censure letter and from enforcing the Jan. 5 retirement grade determination notification while the case plays out. Hegseth has indicated he plans to appeal.

    The performance is the point

    If Kelly wants to float a 2028 trial balloon, fine. But mixing that ambition with a fight over whether the executive branch can mess with a retired officer’s status in response to speech is the kind of governance that stinks like lighter fluid on a steak.

    This isn’t just symbolism. The lawsuit frames the sequence as censure, then reopen retirement grade, then potentially reduce rank and pay. If retirement pay can be treated like a political lever, every retiree who ever wore a uniform has a reason to pay attention.

    Meanwhile, the grand jury lane hit a wall

    On Feb. 10, 2026, reporting based on the Associated Press said a grand jury in Washington declined to indict Democratic lawmakers connected to a November 2025 video about resisting “illegal orders.” That reporting said it was not immediately clear what charges prosecutors tried to bring, or whether they sought indictments against all six lawmakers.

    Fox News framed it more specifically, reporting a grand jury declined seditious conspiracy charges. But however you slice it, the grand jury did not indict.

    America doesn’t need institutions turned into campaign stage props. We need competence, consistency, and a Constitution treated like law, not theater. Live free, grill hard, and demand grown-ups in charge.

  • Shia LaBeouf, Mardi Gras, and the One Job Government Still Has to Do

    I can smell it from here: Bourbon in the air, brass bands blaring, beads flying, and somebody’s common sense skidding down the street like a bald tire on a wet on-ramp.

    That’s Mardi Gras. It’s glorious. It’s dumb. It’s America in a party mask. And it’s also the kind of night where the only thing separating celebration from chaos is the unsexy miracle of law and order.

    What Fox News reported: arrest and charges

    On Tuesday, February 17, 2026, Shia LaBeouf was arrested in New Orleans and charged with two counts of simple battery. Police were called to the 1400 block of Royal Street at about 12:45 a.m. after two adult male victims reported being assaulted.

    • Police said LaBeouf was causing a disturbance and becoming increasingly aggressive at a Royal Street business.
    • A staff member attempted to eject him.
    • Once outside, the allegation is he struck one victim multiple times with closed fists, left, returned more aggressive, and struck again.
    • He also allegedly punched another person in the nose.
    • Bystanders held him down until officers arrived.
    • He was taken to a hospital for treatment of unknown injuries, and upon release, he was arrested and booked on those charges.

    Fox News reported no further information was immediately available. That matters. Early reporting can be thin: the name of the specific business is not consistently presented as coming from police, and the extent of any injuries beyond police saying they were unknown is not clear in the initial reporting.

    Governance is not vibes

    Now let me preach from a bar stool like the Founding Fathers are hollering through an AM radio buried under grill smoke.

    Governance isn’t hashtags. It isn’t a celebrity redemption arc sponsored by feelings. It’s the plain rulebook showing up when somebody allegedly swings on people in public, and the system answers with plain words: charged with two counts of simple battery.

    One reminder for the internet attorneys

    A charge is not a conviction. The allegations still have to be tested. But the civic point is simple: the rules are supposed to apply in the street, not bend for fame, not wobble for applause, not get negotiated like a coupon.

    Because when the night gets stupid and fists start flying, regular citizens are not extras in somebody else’s spectacle. They’re the whole reason the system exists.

  • Jury Sides With Mayo in Joyner Case, and the COVID Messaging Muscle Memory Still Twitches

    I still remember the 2020 vibe: every powerful institution humming like an overheated laptop, and everybody suddenly talking like they had to clear a sentence with a compliance officer before they cleared it with their own brain.

    What the jury decided (and when)

    On Feb. 12, 2026, an Olmsted County District Court jury in Minnesota sided with Mayo Clinic across the board in Dr. Michael Joyner‘s civil case, following a nine-day trial. The jury deliberated for about five hours and answered “No” to every question on the verdict form.

    The core dispute, as summarized in Fox News: Joyner argued Mayo retaliated against him for criticizing the government’s COVID-19 response and for not sticking to what he described as “prescribed messaging” during the pandemic. He said leadership worried federal funding could be cut. Mayo denied retaliation and said discipline followed findings that he was rude and disrespectful toward coworkers and outside partners.

    The specific claims the jury rejected

    • That Mayo breached its anti-retaliation policy tied to a 2020 final written warning.
    • That Joyner proved he reported or disclosed a compliance concern or wrongdoing in good faith and reasonably before the 2020 warning.
    • That Joyner proved the same before the 2023 final written warning.
    • That the 2023 warning relied on the 2020 warning.
    • That Mayo’s appeal panel breached step 12 of its appeals procedure by not letting him submit additional information when he appealed the 2023 warning.

    Why this fight grew bigger than one doctor

    Post Bulletin reporting traced the roots back to June 2020, when Joyner led the nationwide Expanded Access Program for convalescent plasma. That program was funded by a $54 million grant from the Biomedical Advanced Research and Development Authority (BARDA).

    Post Bulletin also reported that outside partners including MITRE Corp. and Epic had interest and some involvement in the program, and that Mayo’s Institutional Review Board formally sanctioned MITRE in September 2020 for two MITRE employees attempting to intimidate researchers on Joyner’s team into providing access to private patient data.

    Discipline, conduct, and the courtroom scoreboard

    Joyner said Mayo “weaponized” discipline in retaliation. Mayo’s lawyers argued discipline was about unprofessional behavior, including what they described as bullying communications staff and a 2020 ultimatum demanding millions of dollars within 48 hours or he would stop work on COVID-19 treatments. Joyner’s side argued the money demand was tied to a separate for-profit initiative to develop a product derived from convalescent plasma, with stress and long hours as context.

    Mayo won. Joyner lost. And the larger argument still lingers: when federal dollars, reputations, and “messaging” all get fused together, who really gets to speak freely inside the institutions running American medicine?

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