R to @anish_koka: To clarify - Deaths from heart attack (CHD) not significantly different in VESALIUS , no difference in CV mortality for Fourier, ODYSSEY.
x.com/i/article/203587650580…
Even worse, is that the expanded budget isn't going to the patients.
A Medi-Cal patient is forced to wait 2 years for an ortho procedure, nearly 5 years for cataract surgery.
The money is ALL going to fraud.
If these surrogates were this clinically relevant with just 26 weeks of therapy.. the three large RCTs that had tens of thousands of patients with 4-5 years of follow up would show a really large benefit with regards to hard events.
You could actually run much smaller trials with much shorter follow up and still see a huge difference between control and treatment arm.
And yet VESALIUS, FOURIER, ODYSSEY show no clinically or statistically significant benefit in heart attack rate.
Which means I would commit zero dollars to any study attempting to use these surrogates as some proxy of clinical outcomes.
This is a junk study. But it is good for Instagram cred.
They buried a 19-year-old wrestler here, an athlete hanged by Iran's regime for protesting.
Saleh Mohammadi was one of Iran's valuable assets, part of the human infrastructure of its future but Islamic Republic destroyed that future.
It is painful and powerful to see people gathering to stand with his family, clapping for their hero.
Guarantee @WSJ @statnews would have zero problems with this cardiologist as FDA head. Because the only thing that matters to them is the truth, Science and the rare disease community.
Apparently someone from Sinai took folks with cad and did IVUS before and after psck9 inhibitors and showed plaque melting away.
And yet a 12,000 strong RCT (VESALIUS) of pcsk9 inhibitors in high risk 1º prevention patients had a 13% adverse event rate at 4 years.
🤔
Single arm ? Given issues with CIMT would have to see a control arm.
And if the mechanism for plaque regression is blood thinning? Why should that regress plaque ?
This is the best Healthcare trend I have seen in a long time!
Optumserve, one of United HC's subsidiaries (they have 2000+ of them) has a history of getting hundreds of millions in government contracts, including some to to reduce fraud waste and abuse.
The @TheJusticeDept has an ongoing criminal investigation open on United HC for
1. fraud in Medicare Advantage,
2.billing practices at United's PBM Optum Rx and
3. How UnitedHC pays the 10% of USA🇺🇸 physicians they employ
It looks like they are getting less of our tax 💵 nowadays.
UnitedHealthcare now gets more than 77% of its revenue from taxpayer-funded programs like Medicare Advantage and Medicaid. I wonder🤔 what kind of 'connections' made that possible
From: https://govtribe.com/vendors/quality-software-services-inc-dot-optum-inc-dot-1tpv6
Here in Hagia Sophia, on May 29th 1453, after 900 years of being a Christian cathedral, in the final hours of the Fall of Constantinople, a large number of Christian men, women, children, nuns, monks, priests, and others sought refuge from the Muslim invaders.
The Ottomans surged inside and massacred them.
On its holy altars they enacted “perversions with our women, virgins and children” including “the Grand Duke’s daughter who was quite beautiful” and forced to “lie on the great altar of Hagia Sophia with a crucifix under her head and then raped”
Those who were not murdered were enslaved.
Hagia Sophia resembled a “public brothel” before it was turned into a “stable for their horses”, with toppled altars used as troughs.
The Hagia Sophia’s main Crucifix was then paraded “in mocking procession” with “spitting and blasphemies and curses”.
“Behold the god of the Christians!” They jeered
its a terrible disease. I've cared for patients with it
It's also why we need better evidence
They deserve it
a 12 person propensity score matched analysis is very worrisome when randomized control at 1 year showed no benefit and heterogeneity of disease progression and symptoms is high
if truly beneficial, 12-24 extra months of the concurrent control group will tell you
How the Office of the Texas Attorney General @KenPaxtonTX is violating federal law.
I was kicked out of medical school ostensibly for "professionalism" issues. But I knew this wasn't true. For months, I fought for access to my educational records.
Two months ago, I finally got a glimpse.
Then, last week, under the order of an attorney from the TX AG's office, my access was blocked again -- a violation of federal law.
The Office of the Attorney General under Ken Paxton is helping Texas Tech to violate federal law.
Given how terrible the record is, it's not hard to understand why Texas Tech -- and now the Texas Attorney General -- wants to cover it up and make it go away.
This is what my "professionalism coach" at Texas Tech med school wrote.
Cheryl Erwin, Director of the Center for Ethics, Humanities & Spirituality.
Her notes:
> She compared my case to the Trump indictment.
> She suggested that questioning the unscientific COVID pandemic response -- lockdowns, mask mandates -- was like Trump questioning the 2020 election.
> She said that I "imbibed the cultural atmosphere of conspiracy theories."
> She characterized my position on the pandemic response as believing in a "conspiracy."
> She wrote that my exercising my First Amendment rights was me "making an idiot of himself."
> When I insisted I shouldn't be punished for speaking freely about how the medical profession abused its power, she called me "combative."
To my face, she told me none of these things. She signed off her emails, "Your friend." She promised confidentiality. And just weeks before she gave devastating testimony against me in a rigged hearing, she told me: "I will not abandon you."
She never once talked about what I wrote about on social media to my face. But it's almost all she could write about behind my back.
This is just one part of what's in my records. I got access in January after months of delays. First, one hour to review 2,000 records. Then, after I filed a complaint with the Department of Education, I was able to review them, escorted into a building, university-controlled laptop.
No copies. Even though all records were electronic.
I found things like the above. And so much more.
I filed an amended complaint in federal court using what I'd found in Texas Tech's own records.
Their response?
@KenPaxtonTX's litigation counsel sent me a letter telling me to stop contacting the university requesting FERPA access, that TTUHSC would provide no further access, and that my pending transcript amendment request would be paused indefinitely "until the litigation is resolved."
They said that I have seen the records enough. 1600 documents. Longer than Tolstoy's War and Peace.
They could just send the PDFs. Instead they insist on breaking the law.
They didn't cut off access because I was abusing it. They cut off access because their own records contain their own admissions -- and they would rather shut down a federal statutory right than let me keep viewing.
And here's the thing: what I have seen is only the tip of the iceberg. They have withheld many records. If this is what I have seen, what are they hiding?
I have filed a complaint, and now 5 supplements, with the Department of Education's Student Privacy Policy Office.
I will never, ever quit. Not this year. Not next. Not in 5. Not in 10. Not in 20 years. Not ever.
There will be justice.
@KenPaxtonTX -- Your office is breaking federal law; it is defending an agency that violated the United States constitution; you can withdraw your support any time if that agency's interests diverge with those of the state of Texas; that time is now.
@GregAbbott_TX -- Your university is punishing students for their speech for holding positions you agree with.
@CreightonForTX -- You are the new Texas Tech Chancellor. You are the "conservative". Prove it.
@EDSecMcMahon -- There is no litigation exception to FERPA. I was given 40 hours to review 1,600 documents. Now Texas Tech refuses any further access -- in writing. Your department has my complaint and 5 supplements. Enforce the law.
@EDUnderSecKent -- Texas Tech is breaking federal law, 20 U.S.C. § 1232g(a)(1)(A), 34 C.F.R. § 99.10(b), § 99.32. My complaint has been submitted months ago with supplements. When will the Department of Education do its job?
@TexasTech -- The truth will come out. And everyone will know.
Tomorrow.
The first of the secret recordings, published here. A senior Texas Tech official admitted to me that they didn't believe what they wrote about me in the official documents.
But that it was written in retaliation to my constitutionally protected speech.
His own words. On audio.
This is the hell that is Evin Prison in Iran, where political prisoners are held. This is actual CCTV footage from a hack showing what goes on there.
Important perspective.
Everyone has COI of one kind or another.
They destroyed his clan and the existence of Kashmiri Hindus from their state and thought they had won.
A Kashmiri Pundit destroyed their ecosystem and brainwashing of 70 years, in just six months and is smiling all the way to the Bank.
How it felt guarding your older cousin playing in grandma’s driveway
With utmost respect to all the authors, dear friends and respected clinicians, I agree with @venkmurthy and @anish_koka. It is important for clinicians to advocate for a better process for patient care guidelines.
Love the central message “lower LDL earlier” and much of the guideline. I would consider a follow-up step to advocate for over the counter statin - safe, effective, low cost, patients empowered and can discuss with clinicians when desired.
So bothered by inflated class 1 recs for baseless metrics like #CAC. 2 negative RCT, one with signal for harm. Cohort data showing prognosis but no data to demonstrate outcome benefit. This is not a class 1 level of evidence for benefit. Predominantly inappropriate testing causes harm and wastes limited resources in a nation $39 trillion in debt.
Institute of Medicine “Guidelines We Can Trust” urge class 1 recs to have strong RCT data for this very problem.
2/3 of replies to @gbiondizoccai ‘s brief poll agree that #CAC is used more inappropriately than appropriately.
Cardiologists should re-evaluate the guidelines process:
- need more diverse perspectives
- balance vocal proponents for testing or intervention with other perspectives and science
- uphold IOM standard for class 1 recs
We could really use a revitalized and objective USPSTF, which has always recommended these novel biomarkers have interesting potential but no evidence to routinely endorse.
Next we can expect a lobby for CMS to fund all these “class 1 tests, highest level of rec” with our taxpayer dollars.
Basically do the opposite of what advertising tells you to do, and you will live longer and healthier.
Expert opinion. Not based on RCT.
But it is a Class 1 Recommendation.
Doctors in large centers don't realize what a life-changer fast operating room turnover times are.
For those that don't know, the turnover time in OR's varies widely between hospitals. That's the time it takes to clean the room and set up for the next case.
In efficient hospitals, especially those that are physician owned, it can be as quick as 20 minutes. In large academic hospitals, it can push 4 or even 5 hours.
Think of the difference that makes for quality of life, patient care, and revenue.
A doctor who has a large waitlist of patients might be at the hospital until 8pm and still only get two surgeries done because the turnover time is so long. That same doctor could get 3 or 4 surgeries done in a more efficient hospital, getting home in time to have dinner with his family.
A physician owned hospital would never tolerate a 4 hour turnover time. That's money being lit on fire. Yet hospitals tolerate this all the time because they don't face competition. There's no incentive to run efficient.
So the patients have to wait longer for their surgery, the doctors get frustrated, and everybody loses.
Yep. @drdanchoi just had a great conversation on this and it’s covered in a chapter in my new book coming in next 4 weeks. Why we are educating the public on importance of seeing private practice doctors. Check us out at http://ThePrivateDocs.com and sign up your practice today 😃
Right but just doing something because there’s nothing else to do is pretty problematic as well.
Speaking as a loved one of a rare disease patient.
Patient today came to see me to discuss possible tonsillectomy. @TexasChildrens quoted her $15,000 as a "discounted cash price." My price is $3760.
Every physician and hospital in the country could list their prices on their website. It's not hard.
I've never heard a better description of modern healthcare:
I needed Chat for this
7. Critique of current research direction
The author is criticizing the field for:
Studying lower-risk patients
Making incremental tweaks
Using expensive versions of the same mechanism (more LDL lowering)
Translation:
“We’re squeezing tiny gains out of the same idea instead of finding new ones.”
. . .
Bottom line in plain English
Lowering LDL works—but we’re hitting diminishing returns
Even with very low cholesterol, many patients still have events
That remaining risk comes from other mechanisms
The field needs new ideas, not just better cholesterol drugs
Excerpt:
The bigger message to the cardiology research community is one worth taking to heart. Even taking the 4-point MACE outcome in VESALIUS at face value — the most favorable composite, the softest endpoint — the treatment arm still had a 13% event rate despite achieving a median LDL of 45 mg/dL. Thirteen percent of patients on evolocumab, with LDL driven to levels that would have seemed impossibly low to the trialists of the 1990s, still had a major cardiovascular event within five years. The LDL hypothesis has yielded remarkable results — it is one of the genuine success stories of modern preventive cardiology — but the curve is flattening. We may be approaching the limit of what cholesterol lowering alone can accomplish. The residual risk that persists despite aggressive lipid lowering is driven by inflammation, by plaque biology, by factors that circulating LDL levels do not fully capture. That is where the next generation of trials needs to go — not into ever more granular risk stratification of ever lower-risk populations to justify ever more expensive versions of the same mechanism, but toward genuinely new targets. Vesalius did not refine Galenic anatomy. He replaced it. The field may need a similar reckoning.
x.com/i/article/203458975322…
R to @anish_koka: open.substack.com/pub/anishk…
AI churning more patient $ and ☢️ with no data on clinically meaningful outcomes.
Absolutely disgraceful.
Analyzing the new lipid guidelines in the context of the recently completed VESALIUS trial
Honestly, as someone who has traveled a lot, India is the best country I have ever traveled to. It’s incredible. I will have been here for 9 days when I leave, and there is still so much to see and do. My experience has been amazing and India is portrayed negatively in the media as a place Amercians should avoid, but I realize a lot of that is completely made up.
The people, food, culture and hospitality culture are just incredible. I have felt safe and comfortable the entire time I have been here and India will truly be the next big super power. This country has incredible potential and you have to see it yourself to understand because the media only makes it out to be 3rd world.
That couldn’t be further from the truth.
Indian people are the nicest people I have ever met. I am very grateful for my time in India. I have enjoyed it so much and I hope I can come back every year.
Next time I want to visit South India. I have tried to do as much as possible these last 9 days but there is still so much to see and do.
All good things come to an end. I’ll be back (hopefully soon).
I love India. My misconceptions have been corrected. I have nothing but nice things to say. 🇮🇳
Why does a kid with Indian-American race need a 1600 on SAT to have the ~same odds of admission as a White kid with 1450?
I cannot think of a single credible, benign explanation for this!
If anyone appointed by the executive branch attempted to cut off all federal funding to Emory University to make them accountable for this decision, the system wouldn’t allow it.
As DOGE showed, the managerial class is all powerful.
Is there a conflict of interest when hospitals:
1) design policies to prevent pt “leakage”
2) incentivize intensity of care with RVU targets
3) use 340b arbitrage
There’s an honest convo to be had re: pros & cons of competition from MD-owned hospitals.
The below is propaganda.
U.S. immigration policy is .. interesting.
Delve, a YC-backed compliance startup that raised $32 million, has been accused of systematically faking SOC 2, ISO 27001, HIPAA, and GDPR compliance reports for hundreds of clients. According to a detailed Substack investigation by DeepDelver, a leaked Google spreadsheet containing links to hundreds of confidential draft audit reports revealed that Delve generates auditor conclusions before any auditor reviews evidence, uses the same template across 99.8% of reports, and relies on Indian certification mills operating through empty US shells instead of the "US-based CPA firms" they advertise. Here's the breakdown:
> 493 out of 494 leaked SOC 2 reports allegedly contain identical boilerplate text, including the same grammatical errors and nonsensical sentences, with only a company name, logo, org chart, and signature swapped in
> Auditor conclusions and test procedures are reportedly pre-written in draft reports before clients even provide their company description, which would violate AICPA independence rules requiring auditors to independently design tests and form conclusions
> All 259 Type II reports claim zero security incidents, zero personnel changes, zero customer terminations, and zero cyber incidents during the observation period, with identical "unable to test" conclusions across every client
> Delve's "US-based auditors" are actually Accorp and Gradient, described as Indian certification mills operating through US shell entities. 99%+ of clients reportedly went through one of these two firms over the past 6 months
> The platform allegedly publishes fully populated trust pages claiming vulnerability scanning, pentesting, and data recovery simulations before any compliance work has been done
> Delve pre-fabricates board meeting minutes, risk assessments, security incident simulations, and employee evidence that clients can adopt with a single click, according to the author
> Most "integrations" are just containers for manual screenshots with no actual API connections. The author describes the platform as a "SOC 2 template pack with a thin SaaS wrapper"
> When the leak was exposed, CEO Karun Kaushik emailed clients calling the allegations "falsified claims" from an "AI-generated email" and stated no sensitive data was accessed, while the reports themselves contained private signatures and confidential architecture diagrams
> Companies relying on these reports could face criminal liability under HIPAA and fines up to 4% of global revenue under GDPR for compliance violations they believed were resolved
> When clients threaten to leave, Delve reportedly pairs them with an external vCISO for manual off-platform work, which the author argues proves their own platform can't deliver real compliance
> Delve's sales price dropped from $15,000 to $6,000 with ISO 27001 and a penetration test thrown in when a client mentioned considering a competitor
Lots more of this please. Until a large number of people go to jail, they will keep doing this. They are stealing from all those who really need medical services.
from above this is a job posting for a producer for STAT.
Stat admits this in writing:
https://x.com/PawsQuiVive/status/1960068103057936705?s=20