Connect with us

Brownstone Institute

My Golden Retriever Confronts the Medical Juggernaut

Published

10 minute read

From the Brownstone Institute

BY Clayton J. Baker, MDCLAYTON J. BAKER, MD 

Recently, our golden retriever, Bailey, got kennel cough. She hasn’t been in a kennel in years, but that’s what they called it: kennel cough.

Please forgive my ignorance in the matter. You see, I’m just a people-doctor. I’m not a veterinarian like, say, Pfizer CEO Albert Bourla. I can’t claim to be an expert on kennel cough.

But as far as I can tell, “kennel cough” appears to be vet-speak for a nonspecific respiratory tract infection in dogs. It seems to be a term veterinarians use much as I would “bronchitis.”

Do you know what a golden retriever with kennel cough sounds like? After all, people-doctors have historically described kids diagnosed with croup as having a “barking” cough.

Well, based on my limited experience, a golden retriever with kennel cough sounds like a Canada goose. Bailey was repeatedly emitting a medium-pitched grunt/honk, lower in register than a duck’s quack but higher than one of those old-fashioned ah-oo-ga automobile horns.

It’s kind of a Honk! Honk! Honk! with the H’s partially dropped. It’s actually quite alarming. Trust me, you don’t want to hear your golden retriever sounding like something it retrieved.

Now, Bailey is a good girl, and I love her dearly. But my wife loves that dog more than life itself. Sometimes I wonder if she’d donate her own liver if it were necessary to save her.

So my wife calls Bailey’s veterinarian, and she tells them about her symptoms.

I should mention that my wife is a doctor, too. Just a people-doctor like me, mind you, not an expert on kennel cough like Albert Bourla. But a medical case presentation is a medical case presentation, and she knows how to present a case.

So what did Bailey’s Primary Care Provider tell my wife after hearing the medical history from a fellow medical professional? Well, they told her that it sounds like kennel cough, and that they can see Bailey in 2 or 3 weeks.

Incidentally, this veterinary practice – I am not making this up – had recently been bought out by some kind of veterinary investment firm which, over the past couple of years, also bought multiple other practices in the area, including the only veterinary emergency room in town. Soon after those acquisitions, they closed down the emergency room.

My wife says to them, “2 or 3 weeks? Bailey will either be fully recovered or dead by then.”

“Well, we’ve been chronically short-staffed,” they replied. “We’re blocked up for urgent appointments…etc., etc.”

A brief, polite back-and-forth ensued, but ultimately Bailey’s “provider” didn’t offer an urgent appointment.

In their defense, this veterinary group knows what really is important. A couple of months earlier, at Bailey’s routine checkup, her doctor noted concerning “plaque buildup” on her teeth.

Do you know what Bailey’s doctor recommended? Doggie dental cleaning. Under general anesthesia. Seven hundred dollars, cash on the barrelhead.

They also have never delayed care when it comes to Bailey’s vaccines.

You see, according to the American Animal Hospital Association Guidelines (generously supported by Boehringer Ingelheim Animal Health, Elanco Animal Health, Merck Animal Health and Zoetis Petcare), all dogs should be vaccinated for:

  • Distemper
  • Adenovirus
  • Parvovirus
  • Parainfluenza
  • Rabies

while many or most dogs, depending on “lifestyle and risk”, should be vaccinated for

  • Leptospirosis
  • Lyme disease
  • Bordetella 
  • Canine influenza

and some should even be inoculated with Rattlesnake Toxoid.

I will add, these vaccines are not one-and-done shots. Most of them are recommended to be boosted annually, or at minimum every 3 years.

But again, the experts know what is really important. For example, while Bailey has fortunately avoided any major orthopedic problems to date, we know at least one golden retriever who has had both ACLs reconstructed, and other dogs who have had total hip replacements. Advanced orthopedic surgeries, while admittedly costly, are an essential component of the golden retriever’s healthcare armamentarium.

(This probably sounds selfish, but I just hope and pray Bailey doesn’t develop gender dysphoria. I don’t think we can afford to take her down to Cornell to have them surgically construct a neophallus for her.)

Whew. Let’s step back and review. As I said, I’m no expert on these matters, like Albert Bourla. I want to make sure I’ve got all this correct.

Our golden retriever must navigate a healthcare system that cares so much for her health and well-being that it’s willing to intubate and anesthetize her for a tooth cleaning. Cha-ching!

In the name of vaccination, it will repeatedly inject her with numerous inoculations, up to and potentially including rattlesnake toxoid. Cha-ching!

It offers any number of extensive and expensive Orthopedic surgeries – as long as Bailey’s owner pays. Cha-ching!

And yet, when she gets sick with an acute respiratory infection, it tells her to stay home and wait, offers no treatment, and refuses to see her. Even though, should she become severely ill, her emergency health care system has been decimated by corporate profiteers.

Do I paint an accurate picture, or do I exaggerate?

Fortunately, Bailey’s story has a happy ending.

As so many other concerned patients and family members do, we consulted Dr. Internet. I know, I know, patients are supposed to trust the experts, and refrain from doing their own research – but you’ll have to forgive us. After all, it’s the family dog we’re talking about here. And we did discover some interesting information.

According to our research, the most common first-line treatment for kennel cough is doxycycline, an inexpensive, generic, people-antibiotic that’s been around since the 1960’s. The primary purpose of prescribing it here is to treat against Bordetella, the most common bacterial cause of the disease.

Incidentally, Bailey is up to date on all her recommended vaccines, so the fact that she got kennel cough in the first place raises its own set of questions. I won’t head down that rabbit hole here, except to ask:

If a disease doesn’t merit the patient being seen, assessed, and treated when they contract it, why is obsessive vaccination against it so necessary?

My wife called back, and in her very polite but insistent way, explained that if they weren’t going to see Bailey, we were ‘requesting’ a prescription, which in the end they wrote. I half expected them to say, “Doxycycline, but that’s human paste!” To their credit, they didn’t.

You’ll be glad to hear that after commencing empirical, early treatment with a cheap, decades-old, repurposed drug, Bailey improved almost immediately. Whether this was due to the doxycycline, her own immune system (God gave her one too, we must not forget), or both, we cannot be certain. Anyway, the goose honk is gone, her appetite is back, and she’s got the frequent zoomies again.

But the whole episode left me with a lingering, uneasy, even unhealthy feeling. It’s not exactly déjà vu, but rather the sensation that I’d been through something very similar – and similarly unpleasant – before.

Whatever could that be?

Author

  • Clayton J. Baker, MD

    C.J. Baker, M.D. is an internal medicine physician with a quarter century in clinical practice. He has held numerous academic medical appointments, and his work has appeared in many journals, including the Journal of the American Medical Association and the New England Journal of Medicine. From 2012 to 2018 he was Clinical Associate Professor of Medical Humanities and Bioethics at the University of Rochester.

Todayville is a digital media and technology company. We profile unique stories and events in our community. Register and promote your community event for free.

Follow Author

Brownstone Institute

Bizarre Decisions about Nicotine Pouches Lead to the Wrong Products on Shelves

Published on

From the Brownstone Institute

  Roger Bate  

A walk through a dozen convenience stores in Montgomery County, Pennsylvania, says a lot about how US nicotine policy actually works. Only about one in eight nicotine-pouch products for sale is legal. The rest are unauthorized—but they’re not all the same. Some are brightly branded, with uncertain ingredients, not approved by any Western regulator, and clearly aimed at impulse buyers. Others—like Sweden’s NOAT—are the opposite: muted, well-made, adult-oriented, and already approved for sale in Europe.

Yet in the United States, NOAT has been told to stop selling. In September 2025, the Food and Drug Administration (FDA) issued the company a warning letter for offering nicotine pouches without marketing authorization. That might make sense if the products were dangerous, but they appear to be among the safest on the market: mild flavors, low nicotine levels, and recyclable paper packaging. In Europe, regulators consider them acceptable. In America, they’re banned. The decision looks, at best, strange—and possibly arbitrary.

What the Market Shows

My October 2025 audit was straightforward. I visited twelve stores and recorded every distinct pouch product visible for sale at the counter. If the item matched one of the twenty ZYN products that the FDA authorized in January, it was counted as legal. Everything else was counted as illegal.

Two of the stores told me they had recently received FDA letters and had already removed most illegal stock. The other ten stores were still dominated by unauthorized products—more than 93 percent of what was on display. Across all twelve locations, about 12 percent of products were legal ZYN, and about 88 percent were not.

The illegal share wasn’t uniform. Many of the unauthorized products were clearly high-nicotine imports with flashy names like Loop, Velo, and Zimo. These products may be fine, but some are probably high in contaminants, and a few often with very high nicotine levels. Others were subdued, plainly meant for adult users. NOAT was a good example of that second group: simple packaging, oat-based filler, restrained flavoring, and branding that makes no effort to look “cool.” It’s the kind of product any regulator serious about harm reduction would welcome.

Enforcement Works

To the FDA’s credit, enforcement does make a difference. The two stores that received official letters quickly pulled their illegal stock. That mirrors the agency’s broader efforts this year: new import alerts to detain unauthorized tobacco products at the border (see also Import Alert 98-06), and hundreds of warning letters to retailers, importers, and distributors.

But effective enforcement can’t solve a supply problem. The list of legal nicotine-pouch products is still extremely short—only a narrow range of ZYN items. Adults who want more variety, or stores that want to meet that demand, inevitably turn to gray-market suppliers. The more limited the legal catalog, the more the illegal market thrives.

Why the NOAT Decision Appears Bizarre

The FDA’s own actions make the situation hard to explain. In January 2025, it authorized twenty ZYN products after finding that they contained far fewer harmful chemicals than cigarettes and could help adult smokers switch. That was progress. But nine months later, the FDA has approved nothing else—while sending a warning letter to NOAT, arguably the least youth-oriented pouch line in the world.

The outcome is bad for legal sellers and public health. ZYN is legal; a handful of clearly risky, high-nicotine imports continue to circulate; and a mild, adult-market brand that meets European safety and labeling rules is banned. Officially, NOAT’s problem is procedural—it lacks a marketing order. But in practical terms, the FDA is punishing the very design choices it claims to value: simplicity, low appeal to minors, and clean ingredients.

This approach also ignores the differences in actual risk. Studies consistently show that nicotine pouches have far fewer toxins than cigarettes and far less variability than many vapes. The biggest pouch concerns are uneven nicotine levels and occasional traces of tobacco-specific nitrosamines, depending on manufacturing quality. The serious contamination issues—heavy metals and inconsistent dosage—belong mostly to disposable vapes, particularly the flood of unregulated imports from China. Treating all “unauthorized” products as equally bad blurs those distinctions and undermines proportional enforcement.

My small Montgomery County survey suggests a simple formula for improvement.

First, keep enforcement targeted and focused on suppliers, not just clerks. Warning letters clearly change behavior at the store level, but the biggest impact will come from auditing distributors and importers, and stopping bad shipments before they reach retail shelves.

Second, make compliance easy. A single-page list of authorized nicotine-pouch products—currently the twenty approved ZYN items—should be posted in every store and attached to distributor invoices. Point-of-sale systems can block barcodes for anything not on the list, and retailers could affirm, once a year, that they stock only approved items.

Third, widen the legal lane. The FDA launched a pilot program in September 2025 to speed review of new pouch applications. That program should spell out exactly what evidence is needed—chemical data, toxicology, nicotine release rates, and behavioral studies—and make timely decisions. If products like NOAT meet those standards, they should be authorized quickly. Legal competition among adult-oriented brands will crowd out the sketchy imports far faster than enforcement alone.

The Bottom Line

Enforcement matters, and the data show it works—where it happens. But the legal market is too narrow to protect consumers or encourage innovation. The current regime leaves a few ZYN products as lonely legal islands in a sea of gray-market pouches that range from sensible to reckless.

The FDA’s treatment of NOAT stands out as a case study in inconsistency: a quiet, adult-focused brand approved in Europe yet effectively banned in the US, while flashier and riskier options continue to slip through. That’s not a public-health victory; it’s a missed opportunity.

If the goal is to help adult smokers move to lower-risk products while keeping youth use low, the path forward is clear: enforce smartly, make compliance easy, and give good products a fair shot. Right now, we’re doing the first part well—but failing at the second and third. It’s time to fix that.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).

Continue Reading

Addictions

The War on Commonsense Nicotine Regulation

Published on

From the Brownstone Institute

Roger Bate  Roger Bate 

Cigarettes kill nearly half a million Americans each year. Everyone knows it, including the Food and Drug Administration. Yet while the most lethal nicotine product remains on sale in every gas station, the FDA continues to block or delay far safer alternatives.

Nicotine pouches—small, smokeless packets tucked under the lip—deliver nicotine without burning tobacco. They eliminate the tar, carbon monoxide, and carcinogens that make cigarettes so deadly. The logic of harm reduction couldn’t be clearer: if smokers can get nicotine without smoke, millions of lives could be saved.

Sweden has already proven the point. Through widespread use of snus and nicotine pouches, the country has cut daily smoking to about 5 percent, the lowest rate in Europe. Lung-cancer deaths are less than half the continental average. This “Swedish Experience” shows that when adults are given safer options, they switch voluntarily—no prohibition required.

In the United States, however, the FDA’s tobacco division has turned this logic on its head. Since Congress gave it sweeping authority in 2009, the agency has demanded that every new product undergo a Premarket Tobacco Product Application, or PMTA, proving it is “appropriate for the protection of public health.” That sounds reasonable until you see how the process works.

Manufacturers must spend millions on speculative modeling about how their products might affect every segment of society—smokers, nonsmokers, youth, and future generations—before they can even reach the market. Unsurprisingly, almost all PMTAs have been denied or shelved. Reduced-risk products sit in limbo while Marlboros and Newports remain untouched.

Only this January did the agency relent slightly, authorizing 20 ZYN nicotine-pouch products made by Swedish Match, now owned by Philip Morris. The FDA admitted the obvious: “The data show that these specific products are appropriate for the protection of public health.” The toxic-chemical levels were far lower than in cigarettes, and adult smokers were more likely to switch than teens were to start.

The decision should have been a turning point. Instead, it exposed the double standard. Other pouch makers—especially smaller firms from Sweden and the US, such as NOAT—remain locked out of the legal market even when their products meet the same technical standards.

The FDA’s inaction has created a black market dominated by unregulated imports, many from China. According to my own research, roughly 85 percent of pouches now sold in convenience stores are technically illegal.

The agency claims that this heavy-handed approach protects kids. But youth pouch use in the US remains very low—about 1.5 percent of high-school students according to the latest National Youth Tobacco Survey—while nearly 30 million American adults still smoke. Denying safer products to millions of addicted adults because a tiny fraction of teens might experiment is the opposite of public-health logic.

There’s a better path. The FDA should base its decisions on science, not fear. If a product dramatically reduces exposure to harmful chemicals, meets strict packaging and marketing standards, and enforces Tobacco 21 age verification, it should be allowed on the market. Population-level effects can be monitored afterward through real-world data on switching and youth use. That’s how drug and vaccine regulation already works.

Sweden’s evidence shows the results of a pragmatic approach: a near-smoke-free society achieved through consumer choice, not coercion. The FDA’s own approval of ZYN proves that such products can meet its legal standard for protecting public health. The next step is consistency—apply the same rules to everyone.

Combustion, not nicotine, is the killer. Until the FDA acts on that simple truth, it will keep protecting the cigarette industry it was supposed to regulate.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).

Continue Reading

Trending

X