Wounded Healer @ResearchChamp

@DrJMarine @LocasaleLab @brownstoneinst Don’t you think the academic medical culture felt the risk of losing grant and research money if they criticized Fauci?

I trained in a residency program without fellows, and we consulted subspecialists when something was truly beyond the scope of general internal medicine. Our attendings expected us to build a strong foundation and make decisions grounded in that knowledge. That foundation has served me throughout my career, and I sometimes find it surprising how often we now consult for problems that most internists should be comfortable managing. Atrial fibrillation in sepsis. Community-acquired meningitis. Many of these situations benefit more from thoughtful generalist care than an automatic specialty consult. I remember one of my first ICU admissions as a fellow in Seattle. The diagnosis was classic Pneumocystis pneumonia in a patient with advanced HIV. We discussed why he needed TMP-SMX, when steroids were indicated, and what to expect clinically. The immediate question from the residents was, “When do we consult ID?” My response was, “For what?” If the consult is to help with ART planning and longitudinal HIV care, absolutely. If it’s because we’re uncomfortable treating a textbook presentation ourselves, that’s a different issue. I worry we’ve gradually trained generations of physicians to seek subspecialty input before they’re comfortable applying their own knowledge. Some of that is appropriate because medicine is more complex than ever. Some is driven by fear, culture, or medicolegal concerns. But there is a cost. The best subspecialists are built on a strong foundation in general internal medicine. If trainees never develop the confidence to manage common problems independently, we risk weakening the very foundation that makes excellent specialists possible.

CoffeeBlackMD @CoffeeBlackMD

7 days ago

I know everyone is very busy. But it is simply normal to do zero work up while waiting for the specialist? It can be a minute to get into see me. Use a fucking AI to help you and order some basic shit in the mean time. Fuck. If I’m sending to cards for instance and I think it

64 5 256 129K 22

Nurse shortage persists in Kentucky hospitals, new report finds x.com/courierjournal…

Courier Journal @courierjournal

5 days ago

A new report has found that Kentucky hospitals face persistent staffing shortages, especially among nurses, with urban areas hit the hardest. courier-journal.com/story/life/wel…

1 1 1 928 0

Rick Pitino’s first conversation with Scott Davenport changed his life. When Pitino arrived at Louisville in 2001, he made a rare decision to keep Scott Davenport on his staff. During a meeting, Pitino challenged Davenport to lose weight, not for basketball, but so he’d be around to watch his kids grow up. Scott Davenport took that message to heart and went on to lose 79 pounds. In this episode of The Player’s Perspective Uncensored, Scotty D shares the unforgettable conversation that changed his life forever. 🎥 Watch the full episode now on YouTube or listen wherever you get your podcasts.

What has cardiology gotten spectacularly right, and spectacularly wrong, over the past 30 years? via @drjohnm The CAST trial should be taught in all medical schools. It’s the most important trial not just in cardiology but all of medicine. johnmandrola.substack.com/p/good-questio…

I work with a mid levels in both the ICU and my pulmonary clinic. And I generally think they are fantastic. I get so much pressure to move my new patients immediately into the mid levels clinic. But I think until diagnosis is established and patient stabilized, they should see the doc. They’ve tried to head me off at the pass by giving yearly bonus for percentage of new patients seen. And I won’t take the bait. When asked why I won’t change. It was pretty simple. $5000 isn’t worth it to me to trade for worse patient management.

The Asymmetry of Decline: Losing ten percent of your strength, your VO2 max, or your bone density in your forties is barely noticed by most people. You're a little slower on the hills, a little out of breath, your jump height diminishes... but again, most barely notice it. Far fewer react to it...

After coaching a lot of very successful people, here's an unsexy truth: A lot of success is learning to grind when it's boring. Doing the work that is uninteresting, and you really don't want to do. If you expect all building to be exciting, you'll never make it.

The U.S. Department of Veterans Affairs will test semaglutide, a GLP-1 receptor agonist, as a treatment for alcohol use disorder (#AUD). usnews.com/news/health-ne…

This misreporting by @politico gets to the heart of the covid response disaster. If governments had not suspended free speech, and the media not abetted devastating takedowns of scientists for the crime of contradicting government scientists, so much harm could have been avoided.

POLITICO @politico

a week ago

RFK Jr. tells CNN host that constitutional rights take priority over public health dlvr.it/TTqDhV

3K 471 5K 2.3M 271

Interesting.

Kevin Bass @kevinnbass

a week ago

They refuse to require ID to vote. But they will require ID to use the government grocery store.

654 3K 19K 478K 710

While I prescribe exercise as a heart pill, its value transcends CV events After this strava.app.link/bKM3uKP9f5b I’m impervious to work aggravations

Gregg Fonarow MD @gcfmd

2 weeks ago

🫀 Why do observational studies say exercise markedly slashes CV events and death, but RCTs often don't? 🤔 Reverse causation + confounding inflate cohorts? or Shorter, poor adherence RCTs miss real effects? The truth: Real and large, real just smaller, or not real? 🏃📊

3 11 39 26K 22

@DrJMarine Yes, the house of cards would start to fall if the truth was admitted

@MichaelAlbertMD “Clinical societies and expert physicians— so called “Key Opinion Leaders”— often lack expertise in critically evaluating these research efforts. At times, there may be financial incentives to look the other way” - @VPrasadMDMPH x.com/pash22/status/…

Ash Paul @pash22

2 weeks ago

How Not To Get Fooled by the Medical Literature: A 19 part series coming on @Sensible__Med via @VPrasadMDMPH sensible-med.com/p/how-not-to-g…

1 8 25 5K 9

You do not need a doctorate to compare Fauci's private record with what he said publicly or to notice that the evidence did not support his certainty. Fauci majored in classics before going to medical school when medical education provided little training in scientific research and academic physicians were handed laboratories very early in their careers. His MD was a clinical credential, not scientific training. He conducted laboratory research at a time when molecular immunology was not yet a developed science, akin to studying chemistry before the periodic table or planetary motion before calculus. He then became an NIH administrator at a relatively young age. By the time the pandemic arrived, he had spent decades as a bureaucrat, far removed from conducting frontline science himself. Fauci’s diaries clearly show how little interest he had in carefully examining the urgent scientific questions of the pandemic. He made definitive pronouncements about masking, whether vaccines prevented transmission, and the virus’s origin without seriously engaging with the underlying evidence. His power came from projecting the image of a scientist and knowing how to grease the wheels inside a bureaucracy, not from possessing deep expertise in the fields on which he pronounced.

Michael Albert, MD @MichaelAlbertMD

2 weeks ago

I'll be honest. If Dr. Fauci is the scientific foundation of your argument, congratulations. You've demonstrated you can name a scientist. You haven't demonstrated that you understand the science. Understanding Fauci's work requires years of training in immunology, infectious

2K 56 495 215K 57

A man spends 50 years teaching at MIT. He knows his time is running out. So he records one last lecture — everything he knows, distilled into a single hour. He died 5 months later. This is that lecture. The most important hour you'll watch this week. Bookmark it for later!

Fauci’s behavior is only the tip of the iceberg as to what pervades our biomedical institutions. Fauci reaches out to friends at Duke for award nominations. Duke receives hundreds of millions of dollars from the NIH. That funding elevates Duke in rankings, those rankings are presented as proof of excellence, and Duke administrators are then considered for the highest positions at the NIH. Funding, prestige, awards, and appointments circulate through the same small network, with each favor presented as an independent recognition of merit. Meanwhile, anyone who questions the arrangement risks being blacklisted and cast aside.

Sanat Dixit MD FACS @sdixitmd

2 weeks ago

Dr Fauci personally sought nominations for major awards during the pandemic, and participated with NIH staff in preparing materials for a $1 million Dan David Prize nomination that emphasized his COVID-19 work that essentially amounted to a “best guess.”

0 1 21 8K 2

One of the most infuriating things about the entire Covid debate is that there are still people who, for whatever reason, continue to insist that we do not know where Covid came from. I am not talking about Fauci and his associates, who actively pushed the cover up. I mean all the people here who still repeat this line as though the evidence is evenly balanced. It is not. We may not know in which specific Wuhan Institute of Virology laboratory the experiment was conducted, the exact date on which it occurred, or precisely who carried the virus out of the lab and into the community. But there is no doubt whatsoever that Covid came out of a lab and anyone with a functioning cerebral cortex knows it. Continuing to pretend otherwise only serves the people who created Covid and covered it up. I have written extensively about this for the past six years, but here is a quick reminder of some of the most obvious and incontrovertible reasons we know that Covid was in a lab. First, the virus appeared on the doorstep of the only lab in the world conducting precisely the kinds of experiments capable of producing a virus like the Covid virus. The Proximal Origin crew tried to obscure this by claiming that such research was being conducted everywhere. It was not. The work was being at the Wuhan Institute of Virology and only there. Second, that same lab mysteriously removed its entire database of virus sequences in September 2019. The database has never reappeared. Third, Covid emerged ready to infect human beings like wildfire. Natural animal viruses do not do that. They require time to adapt to human cells. Covid, by contrast, was extraordinarily well adapted for human transmission from the moment it appeared, precisely because it had been engineered for that purpose. Fourth, Covid is the only known SARS-related coronavirus with a furin cleavage site. No natural SARS-like virus has ever been found with one. That feature also happens to enhance the virus’s ability to infect human cells. Fifth, the fraudulent Proximal Origin paper argued that Covid could not be manmade because Covid’s receptor binding domain, the part of the virus that docks onto human cells, was not designed for the tightest possible binding. That was a misdirection. The relevant question is not whether it had the strongest bind, but whether it had the optimal bind for human transmission. Covid did. Even more damningly, Fauci grantee Ralph Baric had explained this to Chinese researchers (and later lied about it), i.e. how to design a human-optimized receptor binding domain, exactly like the one found in Covid. Sixth, Fauci’s other big coronavirus grantee, Peter Daszak, working with the Wuhan lab, submitted a proposal in 2018 that was a blueprint for creating Covid-like viruses, including the above mentioned furin cleavage site. American authorities refused to fund it because they considered the work far too dangerous. But the Chinese participants already had the blueprint in their possession. The existence of the blueprint was concealed from the public until a whistleblower leaked it in 2021. At that point, for all practical purposes, the question of Covid’s origin was settled. I could go on and on. But if this were a jury trial, the evidence would already be far beyond a reasonable doubt. Anyone who continues pretending otherwise is doing an enormous disservice to the truth and helping the people responsible.

How Not To Get Fooled by the Medical Literature: A 19 part series coming on @Sensible__Med via @VPrasadMDMPH sensible-med.com/p/how-not-to-g…

An ER resident once called me at 2am about a patient with ear lobe pain. I was a cardiology fellow, juggling a million things, and I did not want that call. Then he said one more sentence: "Just look at the EKG." It was a heart attack.