Hey Has anyone had a Walgreens pharmacist require your last visit note to “evaluate” prescriptions for opioids, when you are writing a script for a patient who has been on a stable regimen? I just had a pharmacist give me the most difficult time and saying it’s bc it’s dilaudid.

This is the values debate right here. I have said “Contrarianism without strong values always leads to the right.” That’s true for pundits generally. What this interview shows is Coates‘ values. And Klein’s lack of strong values.

- there is almost no circumstance where MTHFR genotyping needs to be done because it doesn't change management, and most of the claimed disease associations for it are not supported. - Folate receptor autoantibodies (FRAAs) ≠ cerebral folate deficiency (5/7)

- Glutathione is not an FDA-approved medication and IV glutathione infusions, though they can be obtained via compounding pharmacies, there have been cases where these infusions were contaminated with endotoxin, which causes distributive shock and can be fatal. (4/7)

In which a top US Border Patrol official, incredibly, tells my tall and Anglo colleague @chipmitchell1.bsky.social that he's not the type they're looking for as they go about downtown Chicago arresting people based on "how they look" chicago.suntimes.com/immigration/...

I didn’t travel for most of trump’s first term, I was afraid of waking up one day locked up abroad by an executive order. Many US workers felt that way last week bc of the new H-1B rules. I wrote about it + implications for healthcare, especially rural healthcare. open.substack.com/pub/adverser...

The way this lady flips her hair aside as she blithely insists there was an "overemphasis on slavery" at the Smithsonian is a perfect little touch. But more important -- museums aren't there to make you feel good. You're thinking of an "amusement park." The words look a little alike, I guess.

This may be the most important paper ever published about NIH funded research. www.science.org/doi/10.1126/...

As a physician-scientist who was recently on an H-1B, studying many things including the physician workforce, last week’s executive order hit home. I wrote about it, and what it could mean for healthcare in the US, especially in Rural America. On Adverse Reaction! open.substack.com/pub/adverser...

Has anyone modeled childhood hep B predictions with this likely change based on current vaccination uptake trends, hep b community levels and past patterns? Or are there comparator countries we can look at?

The TSA +Clear line is longer than regular TSA. What does Bourdieu say about that?

Fuck

What a day

Bill Cassidy wasn’t just a hepatologist, he was also a vaccinologist. He authored large studies on the hep B vaccine in adolescents, and others seeking to improve vaccine uptake, including the flu shot. It is truly a shame that with all this expertise, he let RFK Jr move forward.

I feel like ppl who are strict wrt IV benadryl haven’t experienced the worst of pruritus. It’s worse than pain. I had intractable, treatment resistant pruritus many times as a child. I’ve had opioid-induced pruritus & IV benadryl worked so fast & so well it made me wish I had such relief as a child.

Listening to “thinking like an economist: how efficiency replaced equality in US public policy” and I get the sense that @epopppp.bsky.social probably has a lot to say wrt the conflict between “abundance” democratic neolibs and the left.

scoffing at DOGE ripping out the basic architecture of global food and medical aid because "Europe can fill this void if it wants." sneering ignorance that approaches a war crime

Achieved my goal of getting “means testing” into a JAMA family title. We discuss the impact of Ontario’s once-universal no-cost drug coverage program for young ppl & the subsequent exclusion of privately insured ppl on contraceptive uptake. @jamapediatrics.com jamanetwork.com/journals/jam...

Jesus after coming back to Earth:

I would take this very seriously if contacted. Rabies can have a very long incubation time before symptoms develop. Post exposure prophylaxis administered in a timely manner is very effective.

In this study,two popular, commercially available USMLE preparation question banks looked at how diseases like HIV, TB, substance use disorders as well as cardiovascular disease and cancer were represented in people experiencing homelessness. What do you think they found? Full text 👉 rdcu.be/ewSuC

I cannot emphasize enough that the playbook being used against mRNA vaccines (and vaccines in general) is IDENTICAL to the playbook used to restrict voting rights after the 2020 election: actively sow public distrust, then cite the distrust you sowed as an independent reason for your desired policy

The *cities* conversation is a proxy for racism. I think people should stop pretending they don't know this. YEARS ago, I said that "woke" conversations were a REACTIONARY TRAP and to look with suspicion especially on the white people who used the term. I was 1000% vindicated in this.

Remember when Biden won in 2020 Charlotte Clymer said the victory made her so excited she might reenlist.

What exactly happens if you continue doing the research after NIH says the grant is frozen

"But what universities are learning, that authoritarian scholars already know and have been saying, is that complying with illegitimate attacks does not make them stop—it makes them continue" Super useful timeline of the attacks on GMU

“The only people I know” is an important qualifier here.

There’s an MD-PhD (sociology?) Hospitalist who does work on contested illnesses. Based out of NYC I think. I’m blanking on his name. Help!!

There’s an MD-PhD (sociology?) Hospitalist who does work on contested illnesses. Based out of NYC I think. I’m blanking on his name. Help!!

Thank you, everyone who came out to hear the brilliant @maxjordan.bsky.social, @morgangodvin.bsky.social @chelsealshover.bsky.social, and me chat about #LiberateMethadone. It shouldn't be easier to get the poison than the cure. www.penguinrandomhouse.com/books/781015...

Did anyone download the medicare part D spending by drug from the CMS website for years before 2019

Pretty sure I’m developing some kind of intolerance to beef which is really tragic bc I love a good steak. And oxtail 😩

Is there a reconstructive surgery job shortage

Who is submitting 40 NIH proposals this is crazy greedy (or desperate?). Chat GPT ruining science 😠

Important new article led by @maxjordan.bsky.social - shows that USMLE QBanks often present patients experiencing homelessness in ways that are stereotypical & stigmatizing. This is how med students learn —> important implications for care. We need to do a lot of work / retraining here.

Police reports in small Central Louisiana towns described a rash of armed robberies. The crimes had targeted people with no ties to the region, all of them immigrants struggling to find a toehold in the country. But according to federal investigators, the reports were full of lies.

Homelessness is rising among older adults, driven by lack of affordable housing paired with a late Baby Boom cohort effect (entire generation coming of age amidst recession and poor job opportunities). Good deep dive in @nytimes.com www.nytimes.com/2025/05/27/u...

Los Angeles people: Come see me speaking at a book talk with @maxjordan.bsky.social and “Mother of Methadone” author @melodyglenn.bsky.social. I’m on methadone, it’s gonna be a lively chat! Thursday July 24, register here: www.eventbrite.com/e/opioid-cri...

How did snapchat come back

Saturday was my friend Euzahn’s bday & memorial. She passed on may 5th after a rather brief hospitalization. The closest friend loss I’ve experienced yet. We went to Howard, she was admired by all. We became close friends after college. We were planning to see each other soon. Life is short, man.

Today is my friend, the late Shekinah Elmore’s birthday. Sharing her ted talk with you all, on how to live with radical uncertainty (www.ted.com/talks/shekin...) as well as her @nejm.org “P53 and me” article. Li-Fraumeni Syndrome is really something. I miss her dearly. ♥️ www.nejm.org/doi/full/10....

My latest, with @kellydoran.bsky.social: In 2 major USMLE Step 1 & 2 Qbanks, vignettes with patients experiencing homelessness overrepresented HIV, TB, & substance use, underrepresented top causes of death like CV disease & cancer, & often used stigmatizing language link.springer.com/article/10.1...

Ask yourself why Rolling Stone is the only outlet performing this obvious public service.

Speaker Johnson should just take the L on this vote. Most of America doesn’t want this bill to pass anyways. It’s it both the worst and most unpopular piece of legislation in modern history.

My first first-author paper on faculty got a nice @uclahealth.org press release. It’s one of the first studies (the first tbh) to link racial disparities in pain treatment, patient satisfaction & risk of opioid misuse in a single framework using longitudinal data. www.uclahealth.org/news/release...

Abundance of caution is not indication for hospitalization, if I were the resident getting this “new admit” page from the ED I would be calling down to push back. 😅

Anyway greetings, morning Zohran Hive!

🚨New paper! In a cohort of ED patients randomized to personalized opioid risk communication interventions, satisfaction with pain treatment was protective against opioid misuse risk 3 months later, esp for Black participants whose preference for opioids was unmet. link.springer.com/article/10.1...