My pick for surgeon general.
@MartyMakary is correct. FDA has the right personnel at @FDACBER
Dr. Bowden (@MaryBowdenMD) on her fight with Houston Methodist and the Texas Medical Board.
https://x.com/anish_koka/status/2027203529543180427?s=20
Pinned: Talking to the amazing @MaryBowdenMD on @DRsLoungePod : the origin story..
The Doctors Lounge - Jason Locasale (Duke,Harvard,MIT alum) on problems in academia. https://x.com/i/broadcasts/1MJgNgNERDwGL
The more I learn about this soldier, more I love him. It’s because of men like him, we are free and can sleep easy at night. The way his wife looks at him tells you a lot about the man he is. The way he looks at her, tells you how much he loves her and that she’s a big reason for his success. What a special couple and example for us all.
Vivek Murthy : the former surgeon general.
Today on @DRsLoungePod 9pm EST live we have superstar doctor @MaryBowdenMD
Apparently you actually can fight a multibillion dollar health system and come out on top. Much respect.
🔥
we're making @blocks smaller today. here's my note to the company.
####
today we're making one of the hardest decisions in the history of our company: we're reducing our organization by nearly half, from over 10,000 people to just under 6,000. that means over 4,000 of you are being asked to leave or entering into consultation. i'll be straight about what's happening, why, and what it means for everyone.
first off, if you're one of the people affected, you'll receive your salary for 20 weeks + 1 week per year of tenure, equity vested through the end of may, 6 months of health care, your corporate devices, and $5,000 to put toward whatever you need to help you in this transition (if you’re outside the U.S. you’ll receive similar support but exact details are going to vary based on local requirements). i want you to know that before anything else. everyone will be notified today, whether you're being asked to leave, entering consultation, or asked to stay.
we're not making this decision because we're in trouble. our business is strong. gross profit continues to grow, we continue to serve more and more customers, and profitability is improving. but something has changed. we're already seeing that the intelligence tools we’re creating and using, paired with smaller and flatter teams, are enabling a new way of working which fundamentally changes what it means to build and run a company. and that's accelerating rapidly.
i had two options: cut gradually over months or years as this shift plays out, or be honest about where we are and act on it now. i chose the latter. repeated rounds of cuts are destructive to morale, to focus, and to the trust that customers and shareholders place in our ability to lead. i'd rather take a hard, clear action now and build from a position we believe in than manage a slow reduction of people toward the same outcome. a smaller company also gives us the space to grow our business the right way, on our own terms, instead of constantly reacting to market pressures.
a decision at this scale carries risk. but so does standing still. we've done a full review to determine the roles and people we require to reliably grow the business from here, and we've pressure-tested those decisions from multiple angles. i accept that we may have gotten some of them wrong, and we've built in flexibility to account for that, and do the right thing for our customers.
we're not going to just disappear people from slack and email and pretend they were never here. communication channels will stay open through thursday evening (pacific) so everyone can say goodbye properly, and share whatever you wish. i'll also be hosting a live video session to thank everyone at 3:35pm pacific. i know doing it this way might feel awkward. i'd rather it feel awkward and human than efficient and cold.
to those of you leaving…i’m grateful for you, and i’m sorry to put you through this. you built what this company is today. that's a fact that i'll honor forever. this decision is not a reflection of what you contributed. you will be a great contributor to any organization going forward.
to those staying…i made this decision, and i'll own it. what i'm asking of you is to build with me. we're going to build this company with intelligence at the core of everything we do. how we work, how we create, how we serve our customers. our customers will feel this shift too, and we're going to help them navigate it: towards a future where they can build their own features directly, composed of our capabilities and served through our interfaces. that's what i'm focused on now. expect a note from me tomorrow.
jack
I’ve seen more movement in this year alone compared to the last 4 years👌🏽
I was honored to share the stage with Mises heavy hitters! GKS @FreeMarketMed
Epic will roll out this unusable tool and all hospital systems will say "we don't need to buy a separate AI summary tool, Epic has one!"
The woman screaming at @JeffFlake in this viral video from 2018 during the Kavanaugh hearings is Ana María Archila
Zohran Mamdani just named her commissioner of the Mayor's Office of International Affairs for New York City
On cardiac calcium scores that are recommended ubiquitously:
I have sent dozens of FOIAs to Texas Tech to get records about my medical school dismissal since October. Instead of providing the records, Texas tech has filed hundreds of pages of briefs to the Texas Attorney General requesting to withhold the documents.
If I was dismissed from medical school for the reasons they claim, why won't they just provide the records? The records should confirm the official story, and we'd be done. I'd just be embarrassed and slink away in shame, and that'd be it.
One thing I know from the records I have been able to obtain is that they are explosive. So I want more. And as a resident in the state of Texas, I have that right. Texas taxpayers, at a taxpayer-funded institution, also have the right to know what is happening at Texas Tech, how the school is run, and whether it retaliated against a student for their (true) speech about how the COVID response was mishandled.
Something I haven't talked about is that I was open to working with the administration when all of this was going on. That is shown in many documents and recordings. The only conclusion that I can draw is that it was not enough that I should be silenced: Texas Tech decided to make an example out of me.
But I say: the facts should speak for themselves. They should be public. Not the official documents. The internal ones. The Texas taxpayer has the right to see how the sausage is really made. That's Texas law.
Child, 4, arrived alone for heart surgery. His doctor became his mom. https://wapo.st/4aRWBwO
R to @anish_koka: open.substack.com/pub/benrya…
Ben Ryan @benryanwriter actually obtained @CaseyMeansMD evaluations from her surgical residency.
She was in good standing , and her superiors spoke well of her.
Reminder that most of what you’re reading is just noise.
Read his Substack (link in reply)
Last week—after it became clear that Harvard was not serious about settling with the United States—@CivilRights went to court to enforce our right to review Harvard’s admissions data.
@TheJusticeDept will not let schools refuse to cooperate with our federal civil rights laws!
There is so much waste, fraud, and abuse in Medicaid-financed home health and personal care services everywhere, but in New York, it is off the charts.
https://paragoninstitute.org/paragon-pic/new-yorks-per-capita-home-health-aide-workforce-is-three-times-greater-than-other-states-average/
The ACA mandated that insurance cover more services, that people could not receive pricing discounts for being healthy or engaging in healthy behaviors, and that massively subsidized insurers selling the product.
So, unsurprisingly, premiums went through the roof..
What's amazing is some of these people are prominent academics, and yet they still behave like that.
Well as ortho surgeon who providers DME and had to go through this process, not sure how the fraud is occurring. We had to have Medicare come to our office and make sure we were a legitimate business. Is someone rubber stamping these in CMS for some reason?
Stopping new licenses doesn’t seem like the right answer as could harm access for seniors. Again, I bet a couple of us seasoned private practice docs could help solve this for the gov
The United States of America is a generous country and we take care of our own. It's disgraceful that fraudsters out there are taking advantage of programs like Medicaid. That stops today. @DrOzCMS
The Nurses Health Study is only partly funded by the NIH. Private philanthropic organizations partially fund the NHS.
Just so I have the rules right : If you are partially correct - you are a misinformation spreader, a liar or both ?
Asking for a friend.
This @TheJusticeDept just settled with an IT company that used AI-generated job advertisements to exclude U.S. workers from certain jobs.
Whether it is an employee, a recruiter, or an AI tool, @CivilRights will hold employers liable when they engage in illegal discrimination!
Do people realize that Medicare’s payment formula penalizes doctors for being efficient?
The amount doctors get paid for every office visit and procedure is calculated by “time, effort, judgement, skill, and stress” taken for the procedure.
So if innovation makes a procedure quicker, safer, easier, or simpler, the doctors will get paid less.
Yet another example of central planning killing innovation.
God knows there’s plenty of derangement on Twitter but I’ve never seen anything that comes close to the homicidal derangement of Bluesky responses to J Singal’s careful research into the horrifying scandal of pediatric gender medicine. It’s like it needs its own DSM category
AI is going to be great for small practices navigating the complexities of claims getting paid.
Third party payment for outpatient (non-procedural) care is still long term a losing proposition.
This. 1000x this.
@DrDiGiorgio
My colleague @molsjames - who has a spotless record - has been trying for over a year to get a Texas medical license.
Meanwhile, Texas Medical Board is recruiting doctors from other countries to apply for licensure.
The response to Jesse Singal’s NYT oped about the unreliability of US medical organizations regarding pediatric gender medicine is best characterized as a 24-hour tantrum, one with violent overtones.
Let me tell you what happened before I got to the OR this week.
My patient needed surgery. I recommended it. My training, my board certification, and my years of clinical experience all pointed to one answer. The insurance company had a different one: not yet.
That’s prior authorization and it is breaking American medicine.
Here’s the number that should stop you cold: in a prospective multicenter study of orthopedic subspecialty practices across 6 states, 98.5% of prior authorization requests were ultimately approved when recommended by a fellowship-trained, board-certified orthopedic surgeon.
98.5%.
The system isn’t catching bad medicine. It is a delay machine that consumes enormous resources, causes real patient harm, and exists primarily to make the economics of denial work in the insurer’s favor.
The 2024 AMA survey of 1,000 physicians put numbers to what every physician already knows:
- 39 prior authorizations per physician per week averaging 13 hours of physician and staff time
- 93% of physicians say PA delays patient care
- 82% say patients commonly abandon their recommended treatment because of PA
- 29% report PA caused a serious adverse event — hospitalization, permanent damage, or death
- 61% are concerned insurers are now using AI to systematically increase denial rates, with some tools producing denials up to 16 times higher
This is not utilization management. This is obstruction at scale. Surgery is precision and focused on minimizing collateral damage. Prior authorization is brute force with disregard for the collateral damage.
In my world, delay has a clinical cost. A patient waiting on PA for fracture repair, joint replacement, or spinal stabilization is losing function and sometimes losing the window for the best possible outcome. That cost never shows up on an insurer’s earnings call. Given that the average patient is on an insurer’s books go 3 years, delays can sometimes mean making someone else pay the bill for the necessary treatments.
The consensus statement insurers signed in 2018, promising PA reform? Seven years later, only 16% of physicians working with UnitedHealthcare say anything has actually changed. They made another promise to Secretary Kennedy and Administrator Oz recently but is there any real change coming?
Voluntary reform has failed. Legislative and regulatory action is the only path forward and physicians need to be loud enough for long enough that lawmakers act.
It is deeply problematic that federal funding flows to institutions that disproportionately hire H-1B visa workers over American workers.
@TheJusticeDept will continue to root out this problem and protect the employment @CivilRights of Americans!
Apparently Too much competition is bad!
6 is the magic number. (Take a listen)
I am still waiting to hear a single thing from Zeke that would actually work to reduce healthcare costs.
Great idea from Jermaine on a simple fix to healthcare : instead of giving money to private insurance companies, just give it to the government.
That will go great. lol.
Listening to Zeke Emmanuel - Using AI to reduce billing admin will not mean hospitals will pass savings to patients - they will just take those $$ and hire other useless compliance admins.