The number of these alarmist climate predictions from the 90’s is incredible. Almost all of them have proven wrong, but the people behind them continue to be cited as supposed experts.
This is compelling from Dr. Franklin an ICU physician on the Measles outbreak :
"Here are the agreed-upon facts. Nearly 2,300 US cases of measles were reported in 2025… Last year, Canada had 25 times as many cases per capita as the US and will likely surpass the US per capita numbers in 2026…In both countries, unvaccinated patients account for 90-95 percent of the cases.
But why are these people are unvaccinated?
The accepted and widely reported narrative is that the measles spread is a result of Robert F. Kennedy Jr.’s rhetoric and the antivax movement. The main “proof” is the gradual downward trend in kindergarten vaccination in the US, from 95 percent to roughly 92 percent in the last decade…
While Kennedy’s remarks on vaccination are intemperate and may interfere with vaccine campaigns other than measles, the actual data suggest the measles outbreak has little to do with Kennedy and the antivaxxers, despite press and public health assertions.
If vaccine skepticism is not the main driver of the higher caseload, then what is?
The first clue is the ages of infected patients. Unlike the pre-vaccine era, when nearly all cases were children under 13 and cases of adult measles were rare, the current cohort in both the US and Canada is significantly older…
The most logical explanation is that most of these older patients did not originally come from the US or Canada, but from countries with lower vaccination rates. This does not mean the influx of unvaccinated into North America was responsible for actually importing measles, but it may have contributed substantially to the pool of high-risk patients in susceptible communities.
There is circumstantial evidence to support this.
The largest measles outbreak in the US in the last two years was in Spartanburg, South Carolina, which has the largest percentage population of Ukrainian immigrants of any American metropolitan area. Measles vaccination rates in Ukraine were among the lowest in Europe for the first two decades of the 20th century. A 2024 measles outbreak in Chicago involved primarily migrants from Venezuela, which saw a decline—from 96% in 2017 to 68% in 2021—in routine childhood vaccinations, including measles vaccine.
Canada has seen an even greater increase in immigration, with a 33 percent rise in population since 2000. Currently, the worst outbreak is in Southern Manitoba, a key hub in Canadian immigration. Even a highly publicized outbreak in the Canadian Mennonite community may be partly immigration driven, as Canada’s Mennonite community includes immigrants from Mexico. "
Read the whole post on Berenson's stack!
New Unreported Truths, about measles, lies, and open borders
So much in this episode —
1. Quantifying the rural health care access gap in America
2. Analyzing @mcuban Mark Cuban’s health plan
3. How CMS reimbursement basically created the field of neurocritical care
4. Next week : Neurosurgeon Elad Levy on his pioneering work !
Pinned: Rural Health Myths, Mark Cuban's HSA Gambit, and How Neurocritical Care Was Born
Back from hiatus, Anish and Dr. DiGiorgio swap travel notes on Japan and San Diego before diving into Anish's recent Substack piece mapping emergency cardiac care access across the United States — where 98% of Americans live within 90 minutes of a PCI-capable hospital, a level of coverage no peer country (including Canada) comes close to matching. They extend the analysis to thrombectomy-capable stroke centers, trauma coverage, and what it really means when the Commonwealth Fund ranks the US last. The conversation turns to whether the "rural healthcare crisis" narrative justifies continued subsidies (critical access designation, 340B, DISH payments, the new OBBA rural fund) or simply props up a monopoly structure that blocks physician-owned hospitals and ASCs. They unpack Mark Cuban's HSA-plus-catastrophic-coverage proposal, its blind spots on chronic illness and supply-side cost, the two-midnight rule lawsuit between Jefferson and Aetna, cost-plus reimbursement grandfathering, and how CMS's new "efficiency adjustment" has made it financially rational for neurosurgeons to hand off post-op critical care — inadvertently telling the origin story of neurocritical care as a specialty. They close with the new CDC director announcement and a look ahead to next week's guest, Dr. Elad Levy.
00:00 Back from hiatus — Japan, San Diego, and American public transit
03:45 Happy tax day and the Bay Area commute problem
04:45 Anish's Substack piece: mapping PCI access across America
07:50 Why PCI capability is the right proxy for emergency care infrastructure
10:00 Building the map — counties, census tracts, and the 90-minute door-to-balloon window
14:30 98% coverage: the US vs Canada, Russia, China
18:24 Thrombectomy-capable stroke centers and the 60-minute brain window
22:07 What do you actually want from a healthcare system?
27:12 The original sin of Medicare and the employer tax exemption
30:13 Rural hospital subsidies: critical access, 340B, DISH, and the OBBA rural fund
37:02 Physician-owned hospitals, Stark Law, and ASCs as an alternative model
40:30 Mark Cuban's HSA plan: stop-loss, direct primary care, and the $2,100 family premium
44:13 Extending the idea to Medicaid — wealth accrual and the 100% benefit cliff
46:31 The chronic illness problem and federal reinsurance as a backstop
47:57 The missing piece: supply-side deregulation and lowering cost of care
50:19 Jefferson sues Aetna: the two-midnight rule and who the real villain is
53:04 UCR, cost-plus reimbursement, and the hospitals still grandfathered in
55:37 The CMS efficiency adjustment and the neurosurgeon's 8-day break-even
58:45 The origin story of neurocritical care as a specialty
01:02:16 New CDC director Erica Schwartz and next week's guest Dr. Elad Levy
@anish_koka and @drdigiorgio
@drsloungepod
Resources:
Quantifying the Rural Access Problem: Emergency Cardiac Care as a Window into American Healthcare — https://anishkokamd.substack.com/p/quantifying-the-rural-access-problem
America Has Solved the Hardest Healthcare Access Problem Better Than Anyone Else — Here's the Data — https://anishkokamd.substack.com/p/the-us-healthcare-system-has-basically
Interactive PCI Access Maps (US & Canada) — https://anishkoka.github.io/pci-access-maps/
Spotify: https://open.spotify.com/show/7vE4aCMpVHnSGwuOHiGVLp
Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1489323962
YouTube: https://www.youtube.com/@TheDoctorsLounge
Didn’t realize how badly Bird was blocked before the last second heroics
“He’s difficult to work with or not a team player” works every time.
Important to investigate this.
Some good points here, but about that punch line — statins have been around since the 1980s.. and are still believed to be effective at lowering bad cardiovascular events with very rare serious side effects by most cardiologists.
Recent guidelines may over reach with regards to LDL targets, but the LDL hypothesis hasn’t been “reversed” the way geocentrism was going on 40 years now.
As a side note, what is the NNT for whatever diet strategy you’d like to embark on with yearly plaque volume CT scans ? How well do “AI assisted” plaque volume CT scans replicate ? Are there any potential downsides to annual or x frequency CT scans ?
Its an absolute health policy myth that Canadians have better access to medical care than Americans because everyone in Canada gets a Medicare card.
An uninsured illegal immigrant living in rural Nevada has better access to emergency cardiac care than many "insured" Canadians
There are trade-offs to living in rural parts of the country. From the latest @DRsLoungePod
Last night, Shamim Mafi, 44, of Woodland Hills, was arrested at Los Angeles International Airport for trafficking arms on behalf of the government of Iran. She is charged with a violation of 50 U.S.C. § 1705 for brokering the sale of drones, bombs, bomb fuses, and millions of rounds of ammunition manufactured by Iran and sold to Sudan.
If convicted, she faces a statutory maximum sentence of 20 years in federal prison.
Mafi is an Iranian national who became a lawful permanent resident of the United States in 2016.
She is expected to make her initial appearance on Monday afternoon in U.S. District Court in downtown L.A. She is presumed innocent until proven guilty in court.
Nurses aren’t neurosurgeons, and this one is wrong.
A patient with a traumatic brain injury does not blow a pupil BEFORE losing consciousness.
That fighter might have an optic nerve injury, but he doesn’t have a traumatic intracranial hemorrhage.
Lewis Terman can't defend himself against this travesty from Malcom Gladwell, but we can do it for him.
Here's the real study results from Terman's own volumes (Genetic Studies of Genius) and later analyses.
Terman identified ~1,528 California schoolchildren with Stanford-Binet IQs of 135+ (average around 150).
He followed them studiously for decades with follow-ups continuing after his death.
His goal was to replace myths about "geniuses" with data on their development. People thought IQ might cause lower health, physical weakness, susceptibility to disorder. Terman tracked not only IQ but personality, health, family background, and life outcomes.
The result? The group as a whole crushed general population benchmarks.
By their mid-30s (and this is close to the Great Depression) ~70% of the men and ~67% of women had bachelor's degrees vs. ~8% nationally at the time
Close to a 10x out performance !!
At a time when few entered let alone stayed on at University, many "Termites" pursued and achieved graduate degrees (97 PhDs, 57 MDs, etc.).
By their mid-40s, 96%+ of men were professionals or semi-professionals (doctors, lawyers, engineers, academics, etc.).
Incomes were roughly double the national white-collar median. Imagine: A single level to pull and you double national incomes!
They produced thousands of scientific articles, books, and patents. This was then replicated in wonderfully detailed and prodigious Vanderbilt studies.
Their health, far from poorly, was better and they had lower rates of divorce and fewer psychiatric problems.
The sample, which based on Gladwell's presentation we should expect from regression to the mean to be downwardly socially mobile , was massively upwardly mobile.
Even relative to their (already fine) childhood homes. High IQ predicted climbing the socioeconomic ladder, not coasting on family money.
Hoping to obfuscate all this success, Gladwell spins a yarn for y'all.
His claim that "rich smarts" had a silver spoon in their mouths while poor smarts were "utter failures" (imagine saying THAT in 2026…) is nonsense and betrays Terman's own words and findings.
Terman did examine differences in adult achievement (A: highest ~top third or so; B: middle/moderate professionals; C: lowest ~bottom 20–30%).
There was a correlation with childhood family socioeconomic status (SES): A's had more parental education/support/resources on average; C's had less.
But the "C" group ("failures" according to Gladwell) far from "produced nothing" Most won college degrees. Most won professional or semi-professional jobs. Most had incomes and achievements well above the general population. Framing these people as underachievers is a disgrace, TBH.
Terman was one of those leading the emphasis on both the need for opportunity and a society which encouraged education, had capital to allocate, enforced the rule of law etc.. And to emphasize the role of "non-cognitive" traits of conscientiousness (persistence, drive, goal setting and ambition). He also emphasised the need for good health.
He didn't pretend that we do not stand on the shoulders's of giants (those who gifted us our current SES) but he did show in staggering detail, the amazing accomplishments of all of these children, identified at a young age as having already college-level knowledge and ability.
Puff like poverty "reduces a one-in-a-billion brain to a lifetime of worse than mediocrity" is debunked in the American context by the whole cohort outperforming expectations massively. Not just the tippy top, but the cohort as a whole . Resoundingly.
Terman, and no scientist you will find, ever claimed IQ alone guarantees universal leadership or output - the idea of "just one thing", here as everywhere is a distracting red herring.
What Terman did was revolutionize what we know about just how strong a predictor of life success high IQ is. And how precious those point-1 percent are.
It is curious that Terman missed William Shockley and Luis Alvarez (future Nobel physicists). Shockley was co-inventor of the transistor and father of Silicon Valley (along with Frederick Terman, the son of Lewis Terman, who in turn created the "Stanford Binet" IQ-test and did much to promote Stanford and IQ).
As the late Danny Kahneman would have point out, calling out this miss of two people in a sample of 250,000 is to commit the fallacy of low base-rates: Sampling ~1,500 out of ~ 250,000 kids makes missing a 2 people in the extreme tails a likelihood, not a fatal flaw.
This is classic Gladwell: Storytelling with punchy examples, but under scrutiny, the specifics on Terman all fall apart.
Unlike Gladwell, Terman's results stand the test of time far better than any pop-psych retellings.
h/t @charlesmurray
Today in SF, a smart articulate young person knocked on our door canvassing for Saikat = she said if I wasn't into that then I should consider Connie Chan = we had a very nice chat where I explained if I wanted socialism, I'd have stayed in India + the damage to SF last decade...
This is Nancy Lefrançois and her 11-year-old son Loïc. They are dead now.
They are dead because Baljeet Singh, who was driving a semi, was so engrossed in playing an online game on his cell phone that he didn't notice that the traffic ahead of him was stopped for road work.
Singh mowed down 7 vehicles with his truck. 10 victims other than Nancy and Loïc miraculously survived, but were badly injured.
After Singh was treated for shock, he fled the country and went on the lam. For years.
Nancy's husband Benoit was unable to attend her funeral because he was in a coma for 3 weeks with serious injuries.
The other child in their vehicle suffered injuries to his spine, internal bleeding, a broken nose, and facial injuries requiring plastic surgery.
Singh was eventually caught by US authorities and returned to Canada.
Singh is now expressing deep regret. Which seems self-serving and convenient because he had a plethora of violations prior to this catastrophic event, suggesting a pattern of reckless disregard for the lives and safety of others.
According to CTV News reporter, Joe Lofaro, "A review of the truck’s dash camera showed that he committed more than 40 traffic violations during his last three trips and repeatedly used his cellphone while driving, weaved between lanes, and failed to take his mandatory rest periods, leading him to exceed the number of permitted driving hours."
I am tired of writing about the avoidable slaughter of Canadians on our roads.
Accidents are an unavoidable reality of driving. Well-meaning people sometimes make unintentional and catastrophic errors that end in tragedy. We all know and accept this.
But these events aren't accidents. These are deaths caused by wanton recklessness. The drivers in these cases consciously disregard known risks and as a consequence, people die who would otherwise not.
11-year-old boys die. Little girls die. Moms and Dads die. Grandparents die. Lives are shattered. Innocents have catastrophic injuries that forever change their futures.
None of it needs to happen. It's all a choice.
Canadians will keep getting slaughtered on our roads if we don't stop mass-importing third worlders to drive semis.
Only about 18% of Indians have a driver's license. India has over 150,000 road deaths per year.
It is fantastical to believe that people born and raised in places where driving is unusual and recklessness on the roads is the norm will all be cultural outliers.
It is pure ignorance to deny that, even for the outliers who do value safety and competence, skills like driving in snow and ice are easily acquired.
Canadian driving skills are first learned through observation and experience in a small vehicle. They are not easily acquired by adult foreigners behind the wheel of a semi.
It is akin to organised crime to allow companies to bring these drivers in, and it is suicidal not to shut the companies down and deport the offenders when they slaughter Canadians on the road.
Elbows Up policies get Canadians killed. The willful blindness of Canadians who refuse to tell the truth and the clinging to bromides about diversity being a strength are destroying Canada.
Please bro just one more tax will fix it trust me bro
Dr Oz confirms that after stopping payments to 450 hospices in California, still NOT ONE has called and asked to have their payments reinstated
450 hospices out of 450 hospices in California were fraud
He says collectively they stole $750 million in just on year
I encourage everyone to watch this incredible documentary about one of the best to ever play the game, someone near and dear to my heart, and my former General Manager for the Lakers - the legendary Jerry West! Watch now on Amazon!
This is the 2nd Best Basketball Documentary I’ve ever seen.
Appearances by Michael Jordan, Stephen Curry, Magic Johnson, Shaquille O’Neal, Kareem Abdul Jabbar and more.
Ultimate respects paid to The Logo. What a story, from start to finish. Incredible.
MUST WATCH! 2 hour education.
Horrific footage shows the moment 15-year-old Jaden Pierre was attacked and fatally shot at a NYC park in Queens.
Great work by Carlos Cardenas, MD, a @texmed past president.
WANTED FOR HOMICIDE OF A 15-YEAR-OLD: On 4/16/2026 at 6:15 pm, a teen was shot and killed near Merrick Blvd and Baisley Blvd in Queens. The NYPD is looking for this individual in connection with the shooting. If you have any information, call @NYPDTips at 1-800-577-TIPS (8477).
Mamdani’s city-owned grocery store:
- Won’t open until 2029
- Will cost taxpayers $30 million (triple what is costs to open a normal store)
- Will only have discounted prices for a very basic selection of food.
All of that is best case currently.
Good luck, NYC.
A 15-year-old kid was beaten and shot to death at a Southeast Queens playground yesterday. And somehow this isn’t the top story. Credit to AG Letitia James & BP Richards for speaking up.
Where is everyone else, including @NYCMayor Mamdani?
Outrage shouldn’t depend on zip code. Every child deserves protection.
Call NYPD at 800-577-TIPS if you know anything.
I visited Meharry Medical College last week—an institution with a powerful legacy of advancing medical breakthroughs and training leaders who serve communities across the country.
I am grateful for the opportunity to connect with students, faculty, and researchers who are driving innovation and helping us better understand and address chronic disease.
At NIH, we’re committed to strengthening partnerships like this and supporting gold-standard research that improves health for all.
TL/DR:
The Philadelphia Annual School budget is massively inflated because of ~$1billion one time emergency Covid subsidy that the politicians/school district now want to make permanent.
And so they want to raise your taxes to make up for the lost Covid dollars.
Discussing Jefferson Health suing Aetna over Medicare Advantage payments
Talking about the @mcuban bank account to solve America's unaffordable healthcare problem.
What do you want out of your healthcare system? Do you want an insurance card, or a system that can get an occluded coronary artery open in time to save your life ?
Discussing remarkable breadth of care available to all Americans regardless of insurance that has no peer comparator in the world.
On @DRsLoungePod - we are opening by talking about the non working US major city infrastructure (San Francisco / Philadelphia)
Welcome to our live show! https://x.com/i/broadcasts/1qxvvkMXXozxB
Medical boards were designed to protect patients, not to police a doctor’s free speech. Between license suspensions and retaliation for court testimony, the overreach has gone too far.
We’re taking a stand for every physician and patient in America.
Its just a never ending need for revenue in these cities. Take Philadelphia.
The Philadelphia school district annual budget is now $4.6 billion.
It faces a $300million structural budget deficit for the '26-'27 school year almost entirely because of expiring federal pandemic relief.
As a result, a new revenue source has been proposed - a $1 rideshare tax that Philadelphia Politicians say ride share companies should absorb.
Take 15 minutes to peel back the layers on this -- 2016 budget was ~$2.9billion , so in 10 years the budget has ballooned by 60%.
In the same time period total enrollment for public schools is essentially flat to slightly down. This means the purported per student spending has gone from ~$14,000 to $23,000. If you look a little closely, you see a jump a big jump in the budget from 2021->2022. What happened ?
This is because of ARPA, which stands for the American Rescue Plan Act — it was the $1.9 trillion federal stimulus bill signed by President Biden in March 2021 in response to COVID-19. For school districts specifically, it included a dedicated fund called ESSER (Elementary and Secondary School Emergency Relief) that sent massive one-time grants to districts based on their share of low-income students.
Philadelphia, as one of the poorest large cities in America, received an outsized share, ~$1.1 billion total over the pandemic relief period. You can see it clearly in the chart: FY2022 and FY2023 are the two years where the federal grant recovery funds ($861M and $459M respectively) inflated the total budget well above the underlying trend. Without ARPA, the FY2022 budget would have been around $3.2B, not $4.1B.
The catch is that ARPA was supposed to be one-time stimulus with an expiration date. Districts used it to hire staff, expand programs. When the funds expired at the end of 2024, all of those ongoing commitments remained but the revenue disappeared, creating the structural $300M deficit the district is now trying to close with additional taxes on the populace.
So the Philadelphia School District has effectively used the COVID pandemic crisis to set a new baseline for what it "needs" to function. You will be completely unsurprised to hear that Philadelphia, despite the funding, continues to rank near the bottom in terms of outcomes one would typically care about like reading and math.
Despite the absolute torrent of funding that has been applied here, 50-60% of Philadelphia public school students are unable to read or do a math at a basic level. This is multiple times worse than the national average of 30-40%, which is already a pretty terrible indictment of the education system. Philadelphia is still uniquely bad.
Its pretty clear the Philadelphia school district is a gigantic welfare program that employs a lot of people, and generates a lot of contracts under the pretense of educating students. The catch — and this is the core of the district's current fiscal crisis — is that ARPA was explicitly one-time money with an expiration date. Districts used it to hire staff, expand programs, and sustain services. When the funds expired at the end of 2024, all of those ongoing commitments remained but the revenue disappeared, creating the structural $300M deficit the district is now trying to close through cuts.
The only thing worse than what's happening is the news coverage on the topic in Philadelphia. Local media presents this as a budget shortfall with no context, which naturally leads many of the good people in Philadelphia with the impression that we're doing a good thing by raising some additional revenue for our local schools. Seems the compassionate thing to do.... except they are just being duped by the politician-policy world that would gladly redistribute the entirety of your income, and it still wouldn't be enough.
Wake up folks!
We had a random walk in today and even though not fully open, we saw our first patient and got to battle test our flow and tech stack.
Worked like a charm!
@kaufcare opening in Denver 4/20!
Thomas Sowell spent 60 years studying group-based policy worldwide.
He couldn't find a single case where a group became prosperous through it. 🧵
You could buy a grocery store for 2 million
You could build a grocery store for 3 million
And yet somehow, when the socialist government does it, it won’t open until 2029 and cost 30 million.
Thank you for the perfect example why socialism is always an object failure
In 2008, beloved actor Paul Newman made a medical decision that revealed wisdom ahead of its time.
He had been diagnosed with lung cancer, underwent chemotherapy, only to later discover his condition was terminal.
Newman faced a defining choice:
• He could undergo aggressive hospital-based interventions that might extend his life by a few months.
• Or he could walk away from the hospital, spend his final days at home, and die on his own terms, surrounded by those he loved.
Newman chose the latter, choosing quality over quantity, spending his final days with his wife, Joanne, and his daughters.
Newman had always been known for his humility and grounded perspective.
But perhaps one of his greatest gifts was the wisdom he left behind on how to view death. 🧵