This is a good summary of everything HHS Secretary RFK Jr. is doing both publicly and behind the scenes to destroy the US vaccination program. He even wanted to end requirements for the polio vaccine. He will not stop, and Republicans in Congress will continue to do nothing about it.

In recent years, FDA inspectors have uncovered disturbing lapses in facilities producing food bound for American supermarkets. Under the second Trump administration, inspections became their lowest since 2011, excluding the pandemic. (Published Nov. 2025)

So frustrating having to pick up the pieces for a patient who just spent 6 months seeing an "alternative" cancer doctor. Finally got an accurate, pathology-confirmed diagnosis and am getting him set up to see a board-certified hem/onc doc.

So much fun working with @hyponaqueen this year at @wser with the research program. More ultrarunning research has come out of @WSER than any other race in the world, and it's great to be a small part of the program this year. Thank you, WSER, and thank you, researchers!

Jibboom Street Marching Band wins 1st place in the open category at the Truckee 4th of July Parade! Thank you to all the musicians who came out and celebrated America's 250th in Truckee style

#ultrarunning dog-owning friends. What's the farthest or toughest run you've ever done with your dog?

Second to last @wser post. Smart runners & cooler temps helped keep things relatively calm this year, but a HUGE thanks to the entire medical team!!! There is no other trail race in the world that has this amount of experience and talent. You are the top!

Whoever could have predicted? 🧐

Loved my last patient & his wife- he's a 69 yo cowboy from rural NV who was just in the hospital after getting bucked off his horse. His wife's comment regarding the hospital "I wish they'd spend less money on artwork and decor and more on staff". That's healthcare today

Series of multiple stories - but worth resharing as a whole: "... @cidrap.bsky.social News is examining what we've learned in the 20 years since the first human papillomavirus (HPV) vaccine was approved...." www.cidrap.umn.edu/20-years-hpv...

Imagine taking a job at a homeless shelter. One job pays $20/hr to cook/serve food. The other job pays $30 to write down what people are eating. Sadly, this analogy is what insurance companies are doing to family medicine and primary care. We get paid more for data than care

Primary care docs out there- what do you do when the specialists insist on getting particular imaging/tests before they even see the patient? Just had an ENT doc insist on a sinus CT for a patient who I'm sending over for globus sensation

RIP to an incredible artist. Got to see an exhibition of his at the Portland Art Museum recently. Thanks for making my brain a happier and smarter place

Just read this article- absolutely fascinating. A tip of the cap to Sparty www.scientificamerican.com/article/how-...

I spoke with @bloomberg.com about the “America First Global Health Strategy” I’ve written about it for @nejm.org & @bmj.com; what I discuss here is the VERY short time frame that Trump gives its partner countries to self-finance all the programs the US funds www.bloomberg.com/news/feature...

RFK Jr. has little interest, inclination or aptitude for leading HHS. He’s a dangerous dilettante. He’s a hot mess. www.nytimes.com/2026/06/07/u...

95% of CDC workers say Americans will die because of federal cuts to the agency. Virtually all staffers (99%) say reductions in staff and lack of leadership have left the agency unprepared to respond to a pandemic or other public health emergency. ow.ly/UTK550ZaH3c

Has any patient's life been saved because their doctor included CPT II code? Added a CPT 10 code? If not, why are doctors focused on this? @aafp.org

I just sent someone this emoji 👃. Instead of this emoji 🙏

Yesterday I met with the new "quality" medical director for a local MA plan. Nice guy, but he's 10+ years younger than me and has never worked in a physician-owned practice. I had to bite my tongue a number of times when he was lecturing me on the importance of RAF/HCC codes:

I went to Utah to see what life is like in America's new reality, where vaccine-preventable diseases are common again. Utah's measles outbreak has lasted 10 months. Pediatricians teared up in interviews. Mothers were stressed. 🧵My latest @wired.com @kffhealthnews.org www.wired.com/story/anguis...

NEW: Regulators have linked Mark McAfee’s raw dairy farm to more than a dozen recalls and outbreaks that left hundreds of people ill. “I’ve put a couple kids in the hospital,” McAfee said. “But here’s the thing: I’m a pioneer.”

Having seen Otzi a couple of times, this is kind of fascinating

The American diabetes Association now threatens its physicians with police action if they criticize the government. This should not be a thing in any country.

Researchers at Stanford University modeled how many people could die or be disabled in 25 years if vaccines for polio, measles, rubella or diphtheria were no longer available. We illustrated their findings.

Just came across this Substack- really, really well done by Dr. Nguemeni

As a family doc in private practice who is getting more and more burned out by P4P, hopefully, CMS and the big insurance companies will start to realize how these programs can result in worse outcomes jamanetwork.com/journals/jam...

Bruno can't tell the difference between sticks and small trees.

😢

Misery loves company. Are there any countries/healthcare systems that are reducing administrative workload? And if so, how do I move there?

Here’s where I would note that Jay Battacharya isn’t qualified (let alone credentialed) to provide any sort of care unsupervised care to a general patient let alone one with Ebola or Hantavirus infection

Why did I never know that Sonny Rollins played the sax solo on the Rolling Stones' "Waiting on a Friend"

In normal times, the fact that government officials at HHS blatantly lied to the public and got caught would be a scandal of unusual size. Everyone involved in this disinformation scheme against the people of the United States should be held accountable.

Kilian is getting ready for WSER. marathonhandbook.com/kilian-jorne...

It’s time! The Western States Medical Conference is on!

Enemy of freedom? Explain your nuanced approach

Yup. And it’s bad. 👇🏻👇🏻👇🏻 “Because of layoffs, terminations and high-profile departures, key confirmed positions at US health agencies are vacant. Currently, the CDC has no director; there’s no US surgeon general; there’s no commissioner at the FDA” www.theguardian.com/world/2026/m...

Arrived in London today. Had a pint at the John Snow pub in London and saw the site of the Broad Street pump to honor Public Health!

After a fantastic (but cold and rainy) week in Paris with friends, we're now headed to London for three days with no plans. What should we see given we are going to have more cold and rainy weather? @gavinyamey.bsky.social any recommendations for vinyl stores?

As someone who has cared for children with cancer in their last days, surrounded by those they love, relishing final moments together, I cannot even put into words the terribleness that those responsible for this deserve.

“He will not be missed by a single career person,” said an FDA staffer granted anonymity to discuss Makary’s tenure prior to the news of his pending departure. “And we will only regret it when they manage to find someone worse.” www.politico.com/news/2026/05...

Democratic lawmakers sent a letter to the HHS Secretary Robert F. Kennedy Jr. demanding answers on why a study on COVID-19 vaccine effectiveness was blocked from appearing in the CDC’s flagship publication. Read more: ow.ly/JvY650YWi8P.

Unearthed reports reveal that RFK Jr. fired every full-time CDC cruise ship sanitation inspector ahead of the Hantavirus cruise ship outbreak. www.cbsnews.com/news/cdc-cru...

Outside my office

Let's see if any of these physician influencers and so-called medical thought leaders can keep a small family medicine office going when the transformer to the office blows, and you don't have any electricity.

Winter 3.2 in the Sierra

That’s terrible…and unusual 😳 apple.news/A76A7gzrYQb6... #IDSky

My mom was telling me she can't watch the game!. Insane

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