INTRODUCTION: Things Fall Apart; the Center Cannot Hold Prelude Before the time of COVID, my wife and I had built a quiet life on a Virginia horse farm. Both of our homeschooled sons were healthy and happy, had graduated from college, and were married. We had one grandchild. The farm and tractor were mostly paid off. We had homesteaded the place, starting with unimproved rolling hay fields purchased directly from the prior owner--no bank loans necessary. Beginning with an old office trailer, we had built up fences, power, well, septic, barn, and both a main and a guest house over five years. Run-down historic outbuildings were being renovated. Years of experience in rebuilding and landscaping small farms had allowed us to cre­ate a working operation, our own park and garden.

Our refuge is located in a sleepy Virginia county with about as many residents as before World War II, an hour and a half south of the traf­fic and bustle of the nation''s capital. Using American political slang, a red county in a purple state, stretching along the western side of the Shenan­doah National Park. Internet access is a problem, and television requires a satellite dish. The historic farms of USA founding fathers Thomas Jefferson (Monticello) and James Madison (Montpelier) are only a short drive away. The first Lutheran church built in North America is two miles over the hill as the crow flies. Old established farming families control local politics. Trees pop up if no one mows the grass. Amish and Mennonite communi­ties work nearby farms.

Our Portuguese senior stallion was coming along nicely in his dressage training, we had a great string of brood mares, and homebred Australian shepherd dogs were our daily companions. My wife and I planned trips to the Golega Lusitano horse fair in Portugal and a horse competition in Texas. Price and availability of hay was a constant topic. Far from the madding crowd. Together with Dr. Jill Glasspool, my wife and partner in all things for over forty years, I was maintaining a boutique medical research consulting practice that paid the bills. When we started our lives together, I was work­ing as a short-order cook, farmer, and carpenter; she was a waitress, and we managed to work and pay our way through years and years of university training. This was our fifth small farm rebuild.

Our primary challenges at the time consisted of business development, writing, reviewing, and execut­ing contracts, and juggling the very different demands of the consulting business, the farm and gardens, and the horse-breeding operation. Occa­sionally I was asked to lead an NIH contract study section or review a man­uscript for some journal, but that was just about all the contact I still had with the world of academia that I had chosen to leave almost twenty years prior. I had recently picked up a promising new Rockville, Maryland-based client that supported clinical research and regulatory affairs for Chinese pharmaceutical and biotechnology companies seeking to bring their prod­ucts to the US market. Jill and I were trying to build a more international consulting practice and reduce our dependence on what often seemed like arbitrary and capricious US Government contracts, and we had planned and executed a series of actions toward that goal. It was a quiet and fulfilling life. The Twin Towers, Pentagon, and anthrax-powder letter attacks had changed both the face of infectious disease research and my professional life as profoundly as had the advent of AIDS at the very beginning of my career. Shortly after the terror attacks, the Norwegian investors in the genetic vac­cine company we had helped launch (Inovio) pulled back out of fear of US instability. We were left high and dry with neither clients nor academic appointment, so by necessity I joined a Department of Defense contract management firm called Dynport Vaccine Company (DVC) as assistant director of clinical research.

At the time, DVC had recently received the "prime systems contract" for managing all advanced development (clinical and regulatory steps for licensure) for all Department of Defense biode­fense-related drugs and vaccines. Little did I know when I took the job that Dynport''s majority owner, Dyncorp, ran one of the two main US-based mercenary armies; that the field of "biodefense" was about to explode; that my career path would be transformed forever; and that I would be cata­pulted into the shadowy realm that exists between academic biotechnology research and US government-funded infectious disease intelligence, surveil­lance, and threat mitigation. While employed at DVC, I had the epiphany that if I really wanted to help people, I needed to leave the cloistered, backbiting, and self-aggran­dizing reality of academic discovery research and embrace the world of advanced medical product development. The professional culture around me neither wanted nor needed more "academic thought leaders," and the true unmet need was for people who understood both the wild west of discovery research as well as the highly regulated world of advanced development-- clinical research, regulatory affairs, project management, and all that goes into making licensed medical products. If I really wanted to help people by enabling development and licensing of lifesaving treatments, I had to forget about the ivory tower world of academics and learn the skills necessary to help companies navigate the world of the Food and Drug Administration and the European Medicines Agency. So that became my new career path, and I threw myself into learning all that was required to meet this need. In the ensuing years I exceeded my goals by winning or managing billions of dollars in US federal contracts doing precisely that. Over the years before COVID, Jill and I had developed a modest net­work of friends and professional colleagues scattered across the globe.

This network was built from our consulting practice, from when I was working on US Government-funded biodefense and influenza vaccine contracts, as well as my prior days as an academic teaching pathology and molecular biol­ogy to medical students while doing bench research, writing papers, filing patents, and getting involved in various biotechnology start-up companies. And we had our horse friends of course. LinkedIn, Facebook, occasionally Twitter, and email correspondence allowed us to stay in touch with all of our friends and colleagues. Social media censorship and shadow banning was something that happened to people who lived in China--I could not imagine that it could happen to me. Jill and I simultaneously lived in two very different worlds that rarely touched each other; one in cutting-edge biotechnology and infectious disease medical countermeasure research, and the other immersed in horses, hay, orchards, farm equipment, construction, and the local feed store. Somewhere between September and December 2019, a novel coronavi­rus entered the human population and began spreading like wildfire across the globe, turning my world upside down. Maybe it also transformed your life, too? If someone had written a letter describing my life today to the person I was before this outbreak, the old me would have concluded that the author specialized in (improbable) dystopic fiction and should probably be looking for another line of work. Looking back, I am struck by how sheltered and naive I was (pre-COVID), and how much my worldview and my role in it have been radically shifted by subsequent events.

Will you take a memory walk with me for a moment? Until COVID, I thought that free speech was a protected fundamental right guaranteed to all citizens of the United States of America by the Bill of Rights. Having been assigned core texts like 1984, Brave New World, Animal Farm, Lord of the Flies, and The Trial and Death of Socrates in fourth and fifth grade as a "gifted and talented" student in the California school system of the time, I believed there was no way anything like what was written in those books could happen here in the USA during the 21st century. Internet censorship and government-controlled propaganda were unfortunate things that happened to those who lived in the People''s Republic of China under totalitarian Communist Party control, but I had been born into a modern Western free society and had the luxury of watching this play out from afar. Social media was a tool that we used to chat with friends, sell horses (Facebook), write about the scientific issues of the day, and look for new biotech clients (LinkedIn). Trained at one of the top clinically focused medical schools in the United States, Northwestern Feinberg School of Medicine, I believed that physicians were deeply committed to upholding the Hippocratic oath (principle of nonmaleficence), had freedom and responsibility to diagnose and treat patients as individuals, and were guided by a shared core of bioethical principles codified after the Second World War and incorporated into US federal law as the "common rule." At the center of this training was the practice of taking a detailed history and physical exam, beginning with the "chief complaint"--uncovering the real problem that brought the patient to the physician. Patients had medical autonomy; and "informed consent" for any medical procedure was ethically critical. I knew that corporatized (and computer algorithm-driven) medicine was placing ever-heavier burdens on the daily grind required to maintain a clinical practice--an unfortunate reality that practicing physicians and medical care providers had to endure if they elected to work under those systems.

But for my colleagues, there was always the option to leave for private practice. One edgy new frontier for clinical practice was direct payment to phy.