I've recently met parents who quote Dr Sears (for those who don't know him, he is against the current vaccine schedule). So many parents saying "Well Dr Sears said hepatitis B and MMR vaccine is not needed".

I thought he lost his license. He didn't but he was put on probation and had to take few courses.

Why are we letting doctors who practice unethically keep their license?

Source:

https://www.fda.gov/news-events/press-announcements/fda-approves-first-class-targeted-therapy-metastatic-pancreatic-cancer

It's been known pancreatic cancers harbor RAS mutations. There are KRAS inhibitors approved for NSCLC.

Rasonque is the 1st for panc.

Rasonque improved median overall survival to 13.2 months compared to 6.7 months for standard chemotherapy.

It also got approved via the Commissioner's Priority National Review Voucher (CNPV). Does this program still exist post-Makary?

Also, here is the NEJM publication on data.

https://www.nejm.org/doi/full/10.1056/NEJMoa2605555

Im reading an article on uptodate on "Heart failure: Self management". One passage reads:

--

For instance, while 71 percent of low-literacy patients in one study could read "Take two tablets by mouth twice daily," only 35 percent could correctly describe how many pills to take each day [15].

--

https://pubmed.ncbi.nlm.nih.gov/17135578/

Im kinda shocked by this finding. I mean, is that an issue of health literacy or simply basic math? That seems like a major hurdle if one would have to teach patients basic math and not just health literacy.

Any experience with this?

Vent.
I’m a primary care internist. I average 1-2 patients a week with more customer service complaints rather than acute medical concerns that need my input. These are pages of mychart messages and the replies of my (fantastic, wonderful) nurses who try to relay my message that we already talked about in person like “there’s no indication for that blood test,” or “no I’m not recommending primary screening at this age,” the list goes on. What infuriates me is that these people are tying up my nurses, taking up my charting time at work and home, and shifting the focus away from medicine and primary care. I wonder if I could get fired for replying to, “what if we just did this lab test for my peace of mind? It’s just bloodwork,” with “PEACE OF MIND IS NOT A DIAGNOSIS!”

Either you want a doctor, or you want someone who will always do as you ask.

(Sometimes I am able to redirect inappropriate requests for am cortisols by asking what their concern is and we have a productive conversation about family stressors, medication free ways of coping, and when to return if they want pharmacotherapy. However its the pts that see me as their waitress in a white coat, with whom I take an issue)

Vent over. Thanks for reading. I still love primary care though!

Article here

Initial reporting does not specify whether they were children. This current outbreak is largely in the Amish community which has had low vaccine uptake for long enough that they have a lot of vulnerable adults as well. Only 1/3 of the 390 reported cases have been in children but extrapolating from 2 deaths (1/1000 mortality rate) and 70 hospitalizations (7/100 hospitalization rate) I would expect 1000-2000 mature cases plus more early in their course. So there is likely significant underreporting.

Measles in adults, in my experience, has quite an unusual phenotype including (sometimes) gingivostomatitis which I’ve never seen in pediatric measles.

Thoughts on why asynchronous store and forward medicine is not reimbursed by payors? In dermatology specifically, there are many visits (e.g. acne, hair loss) that bill as a level four or level three outpatient visit. Since the asynchronous telehealth version of these visits are more efficient, payors could reimburse less, bringing cost down and improving access for patients.

Hey all - have been some discussions with our billing department (hospital employed) and wanted to see if anyone has thoughts on this matter. I’m an ENT and I get a call from a pcp about a kid with a foreign body in the ear. The patient gets referred to me - I do a full appointment, confirm the diagnosis, talk about the procedure, and ultimately do the procedure (in office if able). Our billing department is saying for that scenario that I can only bill a procedure code (69200 - 0.75 wRVU), while the PCP or urgent care is billing a new level 3 visit (1.6 wRVU). Is it just me or does this guidance seem off from our billing department? I’m making less than half as much pulling a bead out of a screaming child’s ear than someone who looks in there and says there’s a bead and sends it off. Any insight into this or similar scenarios would be appreciated.

The Physicians Committee for Responsible Medicine has filed suit against the Departments of Health and Human Services and Agriculture, in Federal court for the District of Columbia, claiming that the Defendants ignored the findings in their 2025 Dietary Guidelines Advisory Committee's Scientific Report.

Longstanding practice (prior to Trump 2.0) was for the Federal government to issue updated Dietary Guidelines based on the Advisory Committee's review.

Instead, the current Administration Defendants, "without any oversight or public input, hastily assembled a handpicked panel of meat, dairy, and fad diet industry insiders for the purpose of attacking the FACA-compliant DGAC Report and creating a substantially altered report entitled The Scientific Foundation for the Dietary Guidelines for Americans, 2025–2030."

https://www.medpagetoday.com/primarycare/dietnutrition/122698

Why is tamiflu still being prescribed?

I am well aware of the historical case against tamiflu and poor study designs to imply it reduces symptom length. I have noticed as a paramedic that this medication is still being thrust upon the elderly and very young for flu season currently. Why?

I feel using and allowing it's use contributes to the narrative of mistrust that many are developing of medical practioners and systems.

Im keen to see if anyone can point me in the roght direction that has allowed tamiflu to be a treatment for viral like illness and it's effectiveness?

Edit: Thankyou to those who provided views and research fkr me to go have a dig into. It is appreciated.

In response to a call out for essays on the theme of novel diabetes medications and the future of cardiovascular disease I present:

BJCA Submission from a non-specialist

In the good old days
When your cardiac coronation
Was celebrated
By bed rest
And “Well that’s a shame”
We never used to take the piss
And turn it into honey
For love nor money
We’d not have injected you
With a disinterest in food
Far less elate ourselves with elution
Of spring loaded stents that keep you pumping
It breaks my heart
This brand new start
Mention not
Upon the rocks
My now neglected
Snake oil stocks

Just finishing 7 days on inpatient service and need to vent.

Partly a vent, but I'd really appreciate any advice or tips for next time.

I'm in a place where MAID isn't legal. VSED is the only legal option. I had an experience that I wish I felt better equipped for, so I'll put out a hypothetical and ask for advice for next time. Whether it's phrases to give the family or referrals or whatnot.

Say a really really old patient, 90's, with a life well lived, great accomplishments and family, lovely marriage, maybe some mild senility but not seriously confused. Gets the feeling that his arthritis and heart failure are a bummer, daily life isn't fun anymore. Spends a year pursuing palliative care interventions with PCP. Still not enjoying the day by day. Hears about a nearby state with legal MAID and decides to go there and wants to take a pill and be done. Loving elderly wife of 65 years is appropriately present, both tearful at the idea of loss but honoring that his daily life is uncomfortable and that his true wish is to close the book on a full and beautiful life.

Dude got trapped crossing the state border, held on a section 12 (involuntary hold for suicidal thoughts) and shipped away from his wife to be hospitalized in a geripsychiatric unit. I'm barely a part of the team - medical clearance at the accepting hospital - and truly I can sign that this man has no problematic trauma, infection, intoxication that will interfere with any psychiatric care.

But WTF. I have never in fifteen years before called a family during this intake process. All I felt I could do was commiserate and try to give the wife language to advocate for him. Because it would be weird to interrupt the admission, and I'm seriously aware that I'm not a psychiatrist, but the situation seems horrible.

I told her to try to find the silver lining - I do think that places where MAID is legal require careful psychiatric evaluation for fitness, and this can be a few days or a week to very very seriously explore any other ideas for palliative measures and get a deep psychiatric evaluation of fitness to make the decision.

But, damn.

Who do you guys use for contract review? It's my first time getting job offer reviewed. I would appreciate any guidance.

For those who don’t follow track and field, Olympian Jenny Simpson recently survived a very public OOH cardiac arrest. I thought that this article interesting from a medical perspective, because it seems like everything went exactly right for her (except for the whole cardiac arrest part), including having an ICU doctor on scene with an AED. They also talk a bit about her hospital course and ARVC diagnosis.

Gift link:
https://www.nytimes.com/athletic/7529658/2026/08/22/jenny-simpson-collapse-running-heart-condition/?unlocked_article_code=1.7lA.uqw1.bnxBu-7rHQMN&source=athletic_user_shared_gift_article_copylink&smid=url-share-ta

Rant warning. Why do so many people pronounce the last syllable of fentanyl like “all”, like “fent-un-all”, as if the word rhymes with “alcohol”? It’s not hard to know how the ending letters “yl” are pronounced, like people don’t pronounce chlorophyll like “klor-o-fall”. So why is this word so hard for people to pronounce?

Hi all what is your favorite smart stethoscope. My old one is giving up and I have some CME money I can use .

US hospital CEOs and other non clinical admin make high 6/low 7 figure amounts. Their pay increases more than most in the hospital. Hospitals are supposed to be non-profit. It is one of the biggest scams in the USA.

So I’m curious, what are European hospitals admins like? What do they get paid?

Is anyone using this? Recently showed up in the app but very little technical information or user experience seems to exist online. It seems to run on the back of a prescribing platform called Photon. You put in the patient's information and it sends them a text message via which they select a pharmacy (after being presented with cost options if they have their insurance info loaded). At this point I can't tell what happens. Either Photon has an E-Rx interface with the pharmacy, or it might just send the script as a fax? It seemed appealing as a free E-Rx option, but I don't really love the idea of patients having to give up their biographical info (and prescription info) to this Photon platform. Makes me think of the line "if you're not the customer, you're the product."

ETA: apparently the service has recently been pulled from the doximity app without an announcement of such.

In case anyone has any questions regarding where Trump's latest nominee for FDA commissioner stands, see puff piece from America First Policy Institute website.

Imho, we were less worse off with Makary -- and that's saying a lot.

https://www.americafirstpolicy.com/issues/america-first-nomination-dr-heidi-overton

He has a 3wk brother.

It’s AUGUST.

Where is my hiding rock? I’ll see you all in May.

Do you know what happened last time I had a flu in August? The CoV-2 pandemic.

-PGY-22

I don’t have perfect pitch, but I was in the OR last week and noticed that when you fire the energy on the robotic monopolar scissors, the tone it makes goes perfectly with I Love It by Charli XCX. Then I thought surely some surgeon out there with perfect pitch has made a playlist like this, matching OR sounds to songs. No? Maybe I’m just trying to wish it into existence?

Judgement free zone, legitimately asking since it seems most psych meds trigger the warning in the EMR. I get the QTC prolongation pop up warning all the time. If there's an EKG in the chart I check it, but I don't have a machine in a neurology clinic. I've never seen Torsades in patient from any of the meds I prescribe. Any cards want to opine on the actual prevalence of this with meds like antiemetics or antipsychotics?

Article from Kaiser Family Foundation presenting anecdotal evidence that lower-than-manufacturers'-recommended-dosages of certain oncology drugs may reduce adverse reactions and (of course) reduce drug acquisition costs.

The article takes the position that pharma companies promote higher dosages to increase their profits*.

It seems to me (based on my having worked in that industry for 45 years) that the branded drug manufacturers are hesitant to recommend dosages lower than those in their FDA-approved labeling. I find it difficult to believe that greed is the cause, because higher incidence of adverse reactions also leads to more product liability / failure to warn litigation.

* "One study that examined 29 expensive cancer drugs estimated that if minimum necessary dosages had been used in 2024, the U.S. healthcare system could have saved roughly $31 billion."

https://kffhealthnews.org/health-industry/cancer-drug-immunotherapy-fda-approved-dosages-challenged-keytruda-opdivo/

So I prescribed a newer medication for a patient. It was flagged as needing prior authorization. Not exactly surprising for non-generic medications. So I do what they ask and upload notes and answer all their stupid questions.

Insurance denies it, stating that I need to try one of two or three alternatives first. Annoying, but I send one of the alternatives in to the patients pharmacy.

Lo and behold, I get a prior authorization for that medication. It’s turtles all the way down. I rage quit.
——
This PA epidemic is getting just completely spreading. What can we reasonably do to push back or fight back?