This is amazingly clear and complete review of CT-FFR. Wow. Sobering when described like this 👇🏻
When you send a CT scan to HeartFlow and receive an FFRCT value, you are receiving output from a system you cannot audit, based on models you cannot inspect, run on servers you cannot access. The clinician is expected to trust the number. This is a significant departure from the usual epistemic standards of medical evidence.
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THE DONALD TRUMP FILES
What about Donald Trump? Isn't he in the Epstein files?
Well, we have now read 1.39 million DOJ documents in the Epstein case. Every one. We have built investigation dossiers on eight people: Bill Gates (2,265 documents), Woody Allen (2,613), Reid Hoffman (1,976), Bill Clinton (1,586), Larry Summers (739), Leon Black (667), Elon Musk (55), and Donald Trump.
For Donald Trump, across the entire corpus, we found 40 documents.
Not 40 damning documents. 40 documents total -- every sworn deposition, every FBI interview, every civil complaint, every flight log entry, every media reference of any kind linking Trump to Epstein in the largest document production in DOJ history.
As with Elon, the number is the story. And as with Elon, the documents themselves tell that story even better.
Every quote below is verbatim. Every citation is a DOJ document number you can verify. Click the links. This post comes from those links. There are just 40. You can read them yourself.
THE FRIENDSHIP
It must be made clear:
Trump and Epstein were friends. This must be stated plainly, because everything that follows only makes sense if you understand that.
They were Palm Beach neighbors in the 1990s. Both owned waterfront estates. Both moved in the same Manhattan social circles -- the dinner-party circuit that included Mort Zuckerman, Leon Black, Ronald Perelman, and a dozen other New York billionaires. In March 2003, Vanity Fair profiled Epstein as "The Talented Mr. Epstein" and named Trump as one of seven businessmen who dined at his 71st Street townhouse [187-11]. Juan Alessi, Epstein's house manager, named Trump among many prominent visitors to the Palm Beach property [055-12]. A 1993 photograph shows Trump and Marla Maples with Epstein and Maxwell at a New York party [EFTA00787056].
This was before Epstein's convictions.
In 2002, reached by phone for a New York Magazine profile, Trump gave the currently most weaponized quote in the entire archive:
"I've known Jeff for fifteen years. Terrific guy. He's a lot of fun to be with. It is even said that he likes beautiful women as much as I do, and many of them are on the younger side. No doubt about it -- Jeffrey enjoys his social life." [EFTA00013640]
That quote has been cited thousands of times. It was given on speakerphone, before any public allegations, before any investigation, before any reason to be cautious. "It is even said that" is hearsay framing -- Trump reporting what others say. "On the younger side" is ambiguous. But the quote exists, and it reflects a social warmth that post-Epstein scandal Trump would prefer to erase.
In 2003, Ghislaine Maxwell assembled a leather-bound album for Epstein's 50th birthday. Trump's contribution: a card with "several lines of typewritten text framed by the outline of a naked woman, which appears to be hand-drawn with a heavy marker," signed below the waist [senate_judiciary_to_bondi].
These are the facts, and the facts must be stated openly.
The friendship was real. But what happened next matters more.
THE FALLING OUT
Around 2004, that friendship ended.
Trump outbid Epstein at auction for the Maison de L'Amitie estate in Palm Beach. In Michael Wolff's 2017 recordings, Epstein himself confirmed the real estate dispute as the breaking point [wolff_tapes_transcript_exhibit].
But the real estate dispute was simply the excuse that Epstein made for something darker. Brad Edwards, the attorney who represented Epstein's victims, established under oath that Trump banned Epstein from Mar-a-Lago after Epstein sexually assaulted an underage girl at the club [773-04].
There is no documented contact between Trump and Epstein after the falling out in 2004. Not one email. Not one phone call. Not one schedule entry. Not one reference of any kind in 1.39 million documents.
After 2004, the relationship was over. Trump had drawn a hard line.
THE GIRL IN THE SPA
Virginia Roberts was sixteen years old, earning nine dollars an hour as a locker room attendant at Mar-a-Lago [1218-11]. In her memoir, she described the club in awestruck terms -- "sheer awe at the gold arches."
Ghislaine Maxwell approached her while she was reading a book about massage [EFTA01689026].
"I was working at Donald Trump's spa in Mar-a-Lago and I was prompted by Ghislaine to come to Jeffrey's mansion in Palm Beach that afternoon after work." [1090-16]
Roberts names many powerful men in her testimony. Clinton. Prince Andrew. Dershowitz. Wexner. She does not name Trump. He was the property owner. But Maxwell did the recruiting.
An FBI interview of a different victim's mother captures how this worked: she "heard that a prince and DONALD TRUMP visited EPSTEIN's house and this made [her] think that if they are there then how could EPSTEIN be a criminal" [EFTA00089603].
That is what Epstein did with famous names. He wore used them as bait. As camouflage. If Epstein was associated with so-and-so, then how could he be a predator? Trump, unlike others, immediately put a stop to that.
THE ACCUSATIONS
Three allegations against Trump exist in the corpus.
A Jane Doe civil lawsuit against Epstein's estate alleges that Epstein introduced her to Trump when she was fourteen, "allegedly elbowing Trump and saying, 'This is a good one, right?' Trump smiled and nodded in agreement" [1078-5].
At the Maxwell trial, a victim testified under oath that Epstein introduced her to Trump and took her to Mar-a-Lago when she was fourteen [120-cr-00330/745]. That testimony confirmed the social introduction. It contained no allegation of misconduct by Trump. Defense counsel used Trump's name to establish Epstein's social reach, not to implicate Trump.
In 2016, during the presidential campaign, a civil complaint alleged the rape of a thirteen-year-old at Epstein's 71st Street house in the summer of 1994 -- Katie Johnson v. Trump & Epstein [EFTA01386393]. It was filed pro se, dismissed for improper filing, refiled with an attorney, and dropped before trial. It was never proven, never tested under cross-examination, never corroborated by any other witness in the criminal investigation.
In August 2017, Epstein told Michael Wolff on tape: "I was Donald's closest friend for 10 years" [wolff_tapes_transcript_exhibit]. He claimed Trump liked to "f--- the wives of his best friends" and that Melania first slept with Trump on Epstein's plane. These recordings were released days before the 2024 election. They are unsworn claims by a convicted pedophile and serial liar to an author -- a man who told the same journalist his week included "woody allen, elon musk, frank gehri... bill gates" [EFTA02561193].
And that pedophile and liar had an axe to grind. A big one.
Those are the allegations. What follows is what happened when they were investigated.
THE INVESTIGATION
The FBI investigated Donald Trump in connection with the Epstein case.
The master case index lists him as a "positive case hit" with "salacious information": "Donald Trump (one identified victim claimed abuse by Trump but ultimately refused to cooperate)" [EFTA00161528]. One allegation. One victim who refused to cooperate. No prosecution.
The FBI's National Threat Operations Center received four separate complaints naming Trump [EFTA01660679]. A hearsay oral sex claim via a friend-of-friend chain. An anonymous party guest list. A claim about "big orgy parties" from a sixteen-year-old model. A Trump Golf Course allegation "deemed not credible." All anonymous. None corroborated.
The Senate Judiciary Committee -- bipartisan, Grassley and Durbin -- reported that FBI personnel were specifically instructed to "flag" any records in which President Trump was mentioned across all 1.39 million documents. The result: no incriminating "client list." No evidence of criminal conduct [senate_judiciary_to_bondi].
The Southern District of New York, which prosecuted the Epstein case, had Trump's phone records in their evidence. Their grand jury presentation includes a message slip showing Trump called Epstein on November 1, 2000 -- a routine call, no message content [EFTA00008599]. The same presentation, same pages, includes message slips reading "She has females for Mr. J.E." Prosecutors had Trump's innocuous call alongside explicit trafficking procurement. They found nothing to charge.
Attorney General William Barr, under oath before the House Oversight Committee:
"I was never informed of the evidence, and I'm skeptical there is any... if they had evidence, this would've been low-hanging fruit." [oversight_republican_staff_memo]
THE ATTORNEY WHO WOULD KNOW
Brad Edwards represented Epstein's victims for years. He investigated every lead. He subpoenaed records, deposed witnesses, and built the case that led to federal prosecution. He was the attorney most motivated to find evidence against anyone connected to Epstein.
In April 2010, Edwards filed a sworn affidavit:
"While research by other plaintiffs' attorneys and myself has uncovered other persons that were acquaintances of Mr. Epstein, specifically Donald Trump, Alan Dershowitz, Bill Clinton, Tommy Mottola, and David Copperfield, we have no information that any of those people (other than Mr. Dershowitz) have spoken to Mr. Epstein about Jane Doe or any of the other specific victims of Mr. Epstein's molestation." [560-03]
Edwards' attorney Jack Scarola: "There is no evidence the President was involved in Epstein's schemes" [773-04].
Edwards filed a notice to depose Trump in September 2009 [701]. As a witness. Not as a suspect. He sought Trump's testimony to help the victim's case.
And there is this: when Edwards was investigating Epstein, reaching out to the powerful men in Epstein's orbit for cooperation, Trump was the only person who picked up the phone and returned his call [50-2009-CA-040800/549].
The attorney who spent years investigating on behalf of Epstein's victims -- who had every reason to find evidence, every incentive to implicate the powerful -- swore under oath that his investigation found nothing linking Trump to the abuse.
When he called, Trump answered. Readily. Trump knew what Epstein was and wanted to talk about it.
WHAT THE DOCUMENTS DON'T SHOW
Pilot David Rodgers flew Epstein's planes for twenty-eight years. He sat for a seventeen-page FBI interview and reviewed his flight logs covering 1991 through 2007 [EFTA00159180]. Trump appears once: Flight 934, January 5, 1997. Passengers: Epstein, Maxwell, Donald Trump, Mark Epstein, and Didier, a chef. Route: Palm Beach to Newark.
No flight in the corpus shows Trump traveling to Little Saint James, to Zorro Ranch, or to any international destination on Epstein's aircraft.
Epstein's famous ninety-two-page personal contact book does not contain a "Donald Trump" entry [black-book-redacted]. It lists Robert and Blaine Trump, Ivana Trump, Ivanka Trump, and Trump Management Inc. -- the socialite channel, not Donald.
There are zero financial transactions between Trump and Epstein in any direction. No donations. No investments. No advisory fees. No foundation grants.
Even Epstein's own defense lawyers, in a motion to pare down a 169-person witness list, argued that Trump had "no connection at all" to the case [1338]. And Epstein himself, in a draft letter, grouped Trump among "friends and other innocent bystanders" whose names had been dragged in by "abusive discovery" [EFTA01128737].
THE COMPARISON
The Epstein documents reveal concentric circles of association. At the center: people who were financially entangled, who visited the island repeatedly, who maintained the relationship through and after Epstein's conviction.
Trump was not in any of these circles.
Woody Allen: 2,613 documents. Nine years of regular contact. Dinner companion. Epstein attended his film shoots.
Bill Gates: 2,265 documents. Multiple confirmed meetings. Donations routed through Epstein. Boris Nikolic named in Epstein's will.
Reid Hoffman: 1,976 documents. 36 documented gift exchanges. Slept at Epstein's 71st Street mansion.
Bill Clinton: 1,586 documents. 147 sexually explicit messages with Maxwell. Multiple confirmed island visits. Flights on Epstein's plane confirmed by his pilot ("ten or twenty times"). Active participation in the post-arrest denial campaign.
Larry Summers: 739 documents. Regular dinner companion. Island visits with family. Harvard Program for Evolutionary Dynamics funded through Epstein.
Leon Black: 667 documents. $158 million paid to Epstein across a decades-long financial relationship.
Elon Musk: 55 documents. Zero financial transactions. Twenty-two months of sporadic, taciturn emails with Epstein chasing Musk, but leaving Epstein little to grab onto.
Donald Trump: 40 documents. Zero financial transactions. Zero island visits. One commuter flight. A friendship that ended in 2004, eleven years before the first federal prosecution, after Trump drew the line and Epstein was banned from Mar-a-Lago for his behavior. The only person in Epstein's orbit who returned the victim's attorney's call.
Trump's entire file is 1.8% the size of Gates's.
WHAT REMAINS
These documents show a man who was part of an early social world he did not yet completely understand, who called a predator "terrific" before anyone knew what that predator was, who sent a crude birthday card before there was any reason not to, whose property was used as a hunting ground without his knowledge or permission -- and who, when the investigation came, banned the predator from his club, picked up the phone for the victim's attorney, and was cleared by every investigative body that looked.
40 documents. Every quote verbatim. Every citation verifiable.
Full compendium (40 docs): https://drive.google.com/file/d/1HhFLNr0AUlKcdDZS-OOKlKJaLMms8lGj/view?usp=sharing
AI-optimized compendium (upload to any LLM and ask it anything): https://drive.google.com/file/d/1Sl1Su1Jm0N73NrIt3DDQxSSSU3AlOaZb/view?usp=sharing
New Hand Carved Wood Sign
Accepting New Patients 😄😎
FDA is moving with unprecedented agility.
Today we approved a multiple myeloma drug just 55 days after the application was filed. And last week’s approval (a major leap forward) was approved in 44 days.
If a trial result shows immediate promise for many Americans, why wait?
Stat news article uses ARM to comment— why?
Worth mentioning that CEO of Uniqure is an ARM board member.
More info the public may find interesting on how Science is reported.
"ARM’s board reads like a who’s who of the cell and gene therapy sector. Current and recent board members include executives from uniQure, Pfizer, Bristol Myers Squibb, Thermo Fisher, Amicus Therapeutics, and dozens of other companies with direct financial stakes in FDA regulatory decisions. uniQure’s CEO Matt Kapusta has sat on the ARM board since 2024. Previously, uniQure’s Chief Business Officer sat on the board as well."
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Saw one of my best friends from elementary school on the news discussing Iran.
Great job Mehdi!
(WATCH) Dr. Bhattacharya
We begin today with one of the most striking turnabouts in modern public health. Dr. Jay Bhattacharya, was a respected medical doctor and professor at Stanford University when Covid struck. He stuck out his neck early, calling out public health mistakes on Covid, the shutdowns, and more. For that, he was targeted and smeared by Dr. Anthony Fauci and others at the National Institutes of Health. But today, he leads the very agency that once worked to silence him. And he’s working to restore public trust after fallout from the wave of government misinformation.
The 2019 trial sham surgery for Uniqure was superficial skin nicks and specifically did not require drilling into the skull, or a brain injection.
The only person who says the FDA asked for partial burr holes etc. is the CEO of Uniqure.
No, @US_FDA is not stopping a silver bullet for Huntington's disease!
Huntington's is awful. But the proposed treatment made patients WORSE during the 12-month blinded control period compared to people who didn't get it. And several patients suffered severe illnesses from it...
“The Enemy of My Enemy is My Friend”
Why don’t private practice doctors collaborate for the good of patients and protection. Are CINs and MSOs the answer? Have you called and met with your private practice competitors and discussed working together?
It’s up to us doctors
@DutchRojas @HeathVeuleman
Things we won’t know unless we did a proper trial. Right ?
This requires you to trust CSF nfl levels as a reasonable surrogate for outcomes.
What is that based on? Critically , if it’s so good, why was the 2019 RCT -ve.
The default assumption has to be this is a non-working product from a company in Amsterdam , and they want to use matched historical controls to get FDA approval.
R to @anish_koka: 15/ In this context multiple outlets are reporting the FDA is asking for an impossible comparator arm (10 hour sham brain surgery) based on comments from the CEO of UniQure after their Type A FDA meeting. I can't find any evidence that anyone at the FDA actually said this. @HHSGov spokesperson noted the CEO comments to be a "distortion"
R to @anish_koka: 13/ Bottom line: UniQure ran a trial years ago. It failed. Rather than go back to the science to come up with something that works, they found a comparison (an external control group) that looks favorable and want the FDA to approve based on that.
R to @anish_koka: 14/ Huntington's patients deserve better than a therapy that only looks effective when you compare it against people who never had a procedure. The placebo bar exists to protect them — not to obstruct innovation.
R to @anish_koka: 11/ To be clear: FDA isn't being uniquely harsh here. Roche faced the same standard with its therapy that had a failed result in 2023 — see Roche study in NEJM (https://www.nejm.org/doi/full/10.1056/NEJMc2300400). UniQure is being treated like everyone else.
R to @anish_koka: 12/ Per FDA public comments: FDA does not require RCTs for everything : If you treat a severely ill Huntington's patient and they dramatically improve — full approval is possible without an RCT. But that would require a dramatic, unambiguous signal. UniQure doesn't have that.
R to @anish_koka: 9/ UniQure's explanation for failure of the 1 year randomized data: "the drug just takes longer than a year to work." Fine — but if that's true, why does the external controlled data show a benefit within that same year? You can't have it both ways.
R to @anish_koka: 10/ Did FDA ever promise to accept the external control data as sufficient? No documented promise exists. FDA routinely says "we need to see the data." That's not a broken deal — that's standard practice.
R to @anish_koka: 7/ Why doesn't that count? Because external controls don't experience a placebo effect. Patients who believe they received a life-changing brain therapy will report feeling better. Patients who never had any procedure won't. That gap is the placebo effect.
R to @anish_koka: 8/ UniQure's own data is internally inconsistent. Their 1-year randomized data shows no difference between treatment and control. But their historically controlled data shows a big benefit. How is that?
R to @anish_koka: 5/ UniQure has done this before. They ran a sham-controlled study in 2019. Their product failed to show benefit.
R to @anish_koka: 6/ So where does UniQure's claimed 60–75% benefit come from? Not from a randomized trial. From comparing their treated patients against an external cohort — people who never underwent any procedure at all.
R to @anish_koka: 3/ This isn't new policy. For 20+ years, FDA has required placebo-controlled trials for Huntington's treatments — including trials with fake intrathecal injections and even fake brain injections. You haven't heard of those drugs because they all failed.
R to @anish_koka: 4/ What did FDA ask UniQure to do? Compare their brain injection against a sham intervention — a small nick in the scalp under brief anesthesia. Not 10 hours of surgery. A few minutes. ( I can find no official confirmation from FDA they have asked for a 10 hour sham surgery comparator arm)
The UniQure/FDA Huntington's gene therapy controversy explained :
1/ UniQure is battling the FDA in the press over a placebo-controlled trial requirement for their Huntington's gene therapy. Here's a brief summary. 🧵
R to @anish_koka: 2/ Huntington's disease is notoriously heterogeneous — patients decline at very different rates. It's also a condition where the placebo effect is well-documented. This is exactly why FDA requires placebo controls.
Hospitals employ teams of coders to make patients seem sicker at baseline to adjust their expected mortality because it helps their bottom line/ improve margins.
Not fraud. But abuse?
Risk adjusting used frequently by the metric industrial complex is gameable - doesn't work and ultimately harms patients.
Performance metrics and the cost of reporting that's borne by independent physicians.. how it contributes to physicians dropping out of the Medicare program.
Now discussing Doctors and Performance Stats ..
https://x.com/DrDiGiorgio/status/2028573232903893058
Great discussion about the difficult decision surgeons have to make to take a patient back to the operating room because of a complication.
Discussing the great article by @lee_c_zhao on the death of the former Shah of Iran, potentially at the hands of famed surgeon Michael Debakey.
https://www.leezhaomd.org/post/the-second-cut-debakey-the-shah-and-the-hubris-of-the-comforting-explanation
Welcome to our live show! https://x.com/i/broadcasts/1YxNrZbVzlXxw