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
Oh yeah - thats rough. $1800 woudl get you 36 months of unlimited office visits, free telemedicine and no copays at DirectCare ofifces. And any office procedures are free and meds are pennies a pill and labs are dollars a test.
Looking back at old legacy media coverage of COVID and I’m struck by how quickly the tone of what The Science said shifted as soon as Trump weighed in…particularly when the two agreed.
These headlines — both news stories — aren’t even two months apart from @washingtonpost
The media covering this are not impartial observers, they are holy warriors on a crusade.
They are 100% head hunting, and they won’t stop until their targets are eliminated.
A detailed and brutal look at the tactics of buzzy AI compliance startup Delve
"Delve built a machine designed to make clients complicit without their knowledge, to manufacture plausible deniability while producing exactly the opposite."
https://substack.com/home/post/p-191342187
Hot take: HIPAA hinders patient care
AHA in 2010: " We can't make money just taking care of sick patients. We need elective, commercially insured patients. Shut down these damn doctor owned hospitals."
AHA in 2021:"We had record revenues in spite of the pandemic throttling high margin elective cases. Looks like we figured out how to make money caring for sick patients."
AHA in 2023:"Yeah so even though we had record revenues post pandemic, and our C suites got crazy production bonuses; we lost money on our balance sheets because our investment arms took a bath in the market. Can you guys at CMS maybe give us a pay bump to offset our losses?"
AHA in 2026:"We can't make money taking care of sick patients. We need elective, commercially insured patients. Don't repeal the ban on physician owned hospitals. Doctors are just greedy interlopers anyway.
Hey can I show you my new Maybach?????"
@GeBaiDC @DrDiGiorgio @DrBruggeman @DutchRojas @anish_koka @nickshirleyy @DrOz
If you want to know exactly how it lies about real journalists when they threaten it with too much truth (by "it" I mean "the science") here is a vivid case study.
Dear Kashmiri Hindus, I want to wish you happy Navreh but every time I think of you, I think of the hollowness of my wishes, I think of how we failed you, I think of how 700,000 of you still cannot return to your homes, and so please accept not my wishes but my apologies.
Sorry.
R to @anish_koka: VESALIUS was carefully designed with the 3, 4 point composite outcome and hierarchichal testing precisely because trial designers knew a lower risk population than 4S, FOURIER, ODYSSEY would have far fewer cardiovascular events. Fewer cardiovascular events means a trial has to be much larger to show a statistically significant benefit.
The size of clinical benefit is inversely proportional to the size of the trial needed to demonstrate statistical benefit. If an RCT has 100,000 patients in it, the size of the effect you are looking for is extremely small OR the trial designer was drunk/high.
The 4S trial which had patients that had survived a heart attack with high LDLs ? - the control arm had a 11.5% CV mortality. VESALIUS control arm had a 3.6% CV mortality.
Consequently the VESALIUS trial had 12,257 patients , the 4S trial had 4,444 patients.
Bottom line: VESALIUS is designed to be a positive trial.. and its hard to blame companies that are spending billions of dollars to run these trial.
It was an honor to testify in front of the @HouseCommerce subcommittee on health regarding healthcare affordability.
We discussed consolidation and the demise of independent physician practice.
My solutions include:
Repeal section 6001 of the ACA which banned physician owned hospitals
Reform Stark law
Implement site neutral payments
Reform 340B
Use FMAP to encourage states to be pro-competition (repeal CON, eliminate non competes)
PSA: Not Noninferior = Inferior.
Great post. I walked away in '93 and never looked back. GKS
NOT NOINFERIOR and INFERIOR
R to @anish_koka: Some background --
Why do hierarchical testing ? (any statisticians / trialists reading are welcome to correct/clarify)
The two word answer : Multiple Comparisons.
Every time you run a statistical test at p<0.05, you're accepting a 5% chance of a false positive, otherwise known as finding an effect that isn't real. Otherwise known as a Type 1 Error.
Basically, if you test 10 endpoints in the same trial, each at p<0.05, your chance of getting at least one spurious significant result by chance alone rises to about 40%. Test 20 things and it approaches 64%. This is the multiple comparisons problem.
Without any correction, a trial could throw everything at the wall and call whatever sticks "significant." This is commonly referred to as a fishing expedition.
Hierarchical testing is one way to keep the overall false positive rate at 5% across all the tests you plan to run.
Pretty simple logic : you only get to test the next hypothesis if the previous one passed. Because each test is conditional on the prior one succeeding, you never spend more than 5% alpha total across the entire chain. No penalty needed for multiple testing as long as you follow the sequence.
Back to VESALIUS ..
R to @anish_koka: After both co-primaries passed, the secondary endpoints were tested in this fixed sequential order:
1. MI + ischemic stroke + ischemia-driven revascularization — HR 0.79 ✓
2. CHD death + MI + ischemia-driven revascularization — HR 0.79 ✓
3. CV death + MI + ischemic stroke — HR 0.73 ✓
4. CHD death + MI — HR 0.73 ✓
5. MI alone — HR 0.64 ✓
6. Ischemia-driven revascularization — HR 0.79 ✓
7. CHD death alone — HR 0.89, p=0.39 ✗ — chain breaks here
R to @anish_koka: The design of the trial was interesting
-Two co-primary endpoints were tested simultaneously.
- 3-point MACE: Death from coronary heart disease + myocardial infarction + ischemic stroke
- 4-point MACE: 3-point MACE + ischemia-driven arterial revascularization
The choice to have two co-primaries rather than one is meaningful. 3-point MACE is the harder, more clinically meaningful endpoint — it excludes revascularization, which is partly operator and system-dependent. 4-point MACE is softer and easier to move because revascularization is more frequent and more influenced by physician decision-making than by hard events.
Having both as co-primaries gave the trial two shots at success and ensured that even if the harder 3-point endpoint had been borderline, the softer 4-point likely would have carried it through. (Both were positive)
R to @anish_koka: This tests PCSK9 inhibitors in a lower risk group of patients - No prior MI, but 50% had evidence of coronary disease or cerebrovascular disease (without a clinical hx of stroke or MI) .. so this is testing PCSK9inhibitors for primary prevention as opposed to FOURIER and ODYSSEY which were secondary prevention trials.
R to @anish_koka: The PCSK9 inhibitor class of medications have demonstrated benefit in the FOURIER and ODYSSEY trials that included patients who already had a heart attack or an ischemic stroke.
These were high risk patients, but they were already on statins with an LDL that was ~90mg/dl to start. The benefit with regards to mortality was pretty small - some of the lowest benefit seen of all of the trials done to date with lipid lowering despite the fact that the average LDL in the treated group was ~50.
On the heels of this comes the VESALIUS-CV trial
R to @anish_koka: As time progresses (see legend) the mortality reductions seen in the statin trials attenuates for a # of reasons
1. In an effort to broaden indications for use, lower risk populations are chosen
2. Subsequent trials have patients already on statins and consequently have much lower baseline LDLs to start with (FOURIER and IMPROVE-IT at bottom left) have starting LDL of ~90 and did not show a clinically significant decrease in mortality despite ~50% LDL lowering
R to @anish_koka: To date, lipid (LDL-targeted) RCTs have demonstrated reductions in cardiovascular events in a variety of settings. The great grandfather 4S trial in 1994 showed that simvastatin used in patients who had just had a heart attack, who on average had an LDL of 189, reduced cardiovascular mortality and overall mortality by 2.9% -- meaning you would need to treat ~35 people to prevent one fatal event.
I cannot speak more highly of @DrDiGiorgio's testimony before House E&C this morning: "The system effectively starves independent practices of revenue while burying them in paperwork, making selling to a hospital the only viable way out."
Full testimony: https://democrats-energycommerce.house.gov/sites/evo-subsites/democrats-energycommerce.house.gov/files/evo-media-document/digiorgio_testimony_he-hearing.2026.03.18.pdf
1) After I wrote a @bmj_latest investigation on virologists conspiring to label critics "conspiracy theorists" my reporting became a focus of NIH officials and researchers they funded.
"Really disappointed they gave space to this scheister," wrote Peter Daszak of my BMJ piece.
The inequality causes crime narrative is activist science. 43 studies. 1,341 estimates. Half the data never published.
Corrected effect: near zero.
Inequality doesn’t drive crime.
If this can happen, the presidency is not real. Neither is the quadrenial plebiscite, nor the idea that the people are in charge at all. It's all fake. https://www.cnn.com/2026/03/17/media/voice-of-america-staff-reinstated-trump?Date=20260317&Profile=CNN&utm_content=1773791351&utm_medium=social&utm_source=twitter
Berenson rarely misses.
The only good thing about all this is that the country is now aware a managerial elite who’s salary you pay controls all the major institutions and has run the country for some time.. you were simply never aware of it.
Yeah. To see former dean’s of public health now say consolidated health systems are the problem after writing tomes on the value of integrated clinical networks.. is really something.
This isn't rare. I have seen in academic centers, community centers, and everything in between!
Wish we could use CAC and reliably stop with medications. However, all to often we end up with further imaging and even invasive procedures, even among asymptomatic patients.
RT @txsportsdoc: With the new @nickshirleyy Medicare/Medical fraud video dropping in Los Angeles CA it’s even worse than MN. CA has highest…
Med Students yesterday:
"After 10 years, including a gap year and 2 years in a non ACGME accredited fellowship, I'm pleased to announce I've matched in Neurosurgery. Happy to serve."
Van Nuys Home Health Care operators:
"Lulz. Let me show you my new Maybach"
CMS UPIC Contractor Directory - Interactive Map | It would actually make a whole lot more sense if @DrOzCMS
was leaning on his fraud prevention contractors and Hospice falls right into UPIC territory, considered high risk http://cms.gov/data-research/…
Makes more sense versus trying to emulate juvenile Nick Shirely with X videos..besides Oz is there for the PE opportunites, his son was a PE investor, and they created ZorroRX..Oz is buddying up with PE Bill Frist - they post this stuff themselves as giant narcissists
ZorroRX is a health benefits company co-founded by Dr. Mehmet Oz and his son, Oliver Oz. The company, which connects patients to the federal 340B Drug Pricing Program, was established in 2024 to help hospitals and employers reduce costs. Oliver Oz serves as the Chief Operating Officer
And then there's the CMS antifraud contractor, UNH IDIQ contractor..Optumserve, hiding in plain sight for those who choose to read..and not be groomed into alternative perceptions..