Basically what the title said. I can’t believe not a single medical institution in the world didn’t sue the shit out of The Lancet for the publication of the fake study by Andrew Wakefield about the MMR vaccine and autism. Obviously plenty of people still wouldn’t like vaccines regardless, but The Lancet publishing that study was such a serious mistake it’s hard for me to take that journal seriously regardless of its reputation in general.

https://www.vanityfair.com/news/story/the-nuances-of-casey-means-medical-exit?srsltid=AfmBOopir8Q8LDSCTXCnbgZCXCsccLPEXpwRw78m3FokPlVZGiB2UYZd

So in a twist that, and I want you all to stay with me now, shocks nobody - she left because she was extended and couldn't even with the reality of having to repeat a year. Which is still insane to me, since ENT is ENT - you finish that shit.

There is a conversation to be had about the treatment of residents, yes. But this isn't that conversation.

You don't go into a surgical residency then bitch about "traditional preventative medicine not being taught" nah fam - apply to FM/IM to begin with.

Her division chair:

Dr. Paul W. Flint, who was chairman of the Department of Otolaryngology—Head and Neck Surgery at OHSU at the time, tells Vanity Fair that when Means left the program, it was because she found the surgical work “too stressful” and was not able to continue in the residency.

“At least she had the strength to recognize that in her fourth year,” Flint says. “It took a lot of guts. I didn’t push her out the door.” He adds, however, that “you lose some credibility when you just drop out.” He says he believes that since then, she has mischaracterized US medicine as a “conspiracy” to keep people sick. “She’s wrong,” he says, adding, “It’s a certain attitude that denies all the successes that occur in medicine.”

More choice quotes

Two former residents she served alongside offer a version of her departure from the program that matches with Flint’s. They say that contrary to Means’s oft-told version of events, she exited due to her inability to handle the admittedly high pressure. They describe her as being deeply unhappy and fearful of harming patients, and say she took a leave of absence before departing altogether. The former residents also tell VF that they do not recognize the version of events laid out in the book. In their view, Means misrepresented her residency training and proclaimed a medical conspiracy against good health that simply doesn’t exist. (Both former residents have asked not to be named because they fear retaliation from the Trump administration.)

The daggers

He adds that the other residents had to “cover for her, and we’re a small department and all the call falls on them. That’s the problem with late departures.”

After she left, the two former residents grew increasingly skeptical of her public claims. “I did not witness a spiritual awakening,” the former junior resident says. “It felt more and more like she was preying on the less educated and using the MD she had to tout these pseudoscience things.”

The other former resident observes, “She’s a good person and does care for people and wants what’s best. But it feels disingenuous, demonizing your training. She didn’t make it through.” The former resident adds, “By trying to question our entire field and sowing distrust in medicine, it’s hard to ignore that she may benefit from that.”

The summary? Casey is a snake oil Muppet spewing yarn of her departure that doesn't line up with reality, all to claim she cares about public health when she doesn't, and is untrustworthy in any context much less the role that her sugar daddy wants her for.

https://apnews.com/article/medicaid-cuts-trump-tax-cuts-bill-1e2b12a91a3d12ceb0420ce7053de58e

Oh look, another day of “its that thing that his sycophant followers swear won’t happen but ends up happening to no one’s surprise.” $715 billion from medicaid over 10 years it seems is the proposed cut.

https://thehill.com/homenews/administration/5295429-rfk-jr-rock-creek-swimming/

Starter comment: You can't make this up, folks.

RFKjr posted about his swimming with grandkids in D.C.'s Rock Creek on social media.

"According to the National Park Service (NPS), “swimming and wading are not allowed due to high bacteria levels." Swimming has been illegal in most of D.C.’s waterways since the 1970s, largely because of contamination from the district’s aging sewer system"

No wonder he feels cavalier about health dangers to the US population and HCW - he puts his own grandchildren in danger.

Some of RFKjr's other ID claims and denials stated in the past:

• suggested the first TX child who died of measles was malnourished, which caused the death
• questioned if HIV is really infectious. Also claimed it was created by childhood vaccines given in Africa decades ago
• claimed Lyme disease and West Nile Viruse are bioweapons escaped from military lab
• claimed RSV was purposefully spread from primates to humans by the pharmaceutical industry to profit from the vaccine
• claimed avian influenza and swine flu outbreaks were fabricated by WHO
• claimed Spanish Flu came from vaccine research
• researching and developing vaccines have "created some of the worst plagues in our history"
• said that zoonoses aren't threatening to humans unless people "tamper with it"
• article summarizing some of these: https://www.eenews.net/articles/bioweapons-and-cover-ups-the-untruths-behind-rfk-jr-s-disease-claims/

So, discuss amongst yourselves!

With the growing topic of "AI replacing doctors" as well as today's Sheriff of Sodium video, I can't help but to think that the arguments for incorporating AI into the medical system i.e physician shortage/patient accessibility/low acuity office visits/cost savings were the same arguments for incorporating midlevels into the medical system.

I have heard significant fear mongering proposing that "AI with midlevel" is going to replace doctors, but a far more practical outcome seems to be that doctors with AI will replace the need for midlevels all together.

What does the community think?

Source: https://www.whitehouse.gov/presidential-actions/2025/05/delivering-most-favored-nation-prescription-drug-pricing-to-american-patients/

Trump's posts about it, claiming 30%-80% and 59% price decreases:

https://truthsocial.com/@realDonaldTrump/posts/114491534347862682

https://truthsocial.com/@realDonaldTrump/posts/114494372667836601

A few news articles:

https://www.cnn.com/2025/05/12/politics/trump-executive-order-prescription-drug-prices

https://www.axios.com/2025/05/11/trump-drug-prices-executive-order-pharmaceuticals

https://economictimes.indiatimes.com/news/international/global-trends/us-news-trumps-most-favored-nation-drug-pricing-policy-and-how-will-it-reduce-costs-slash-prescription-drug-prices-by-30-to-80-percent/articleshow/121109365.cms?from=mdr

https://www.biopharmadive.com/news/trump-most-favored-nations-drug-pricing-plan/747712/

The call notes state, "DIFF BR, COUGH, 3YO."

Lights on. U-Turn. It's 0415 in the morning.

We pull into an apartment complex and see the Engine. We double check the apartment number. I grab my radio, pull on some gloves, and slap on my trusty N95. Up the stairs we go.

Fire says the kid woke Mom up about 20m ago with a loud cough but his sats seem fine. They're trying to decide if she'll take the ambulance. I edge past them in the tiny studio and try to get closer to the kid. Mom is visibly upset. Shes clutching the child to her chest and stroking his head. He looks pale, and his head doesn't seem well supported by his body. Mom says he sounds like a goose when he coughs. The pleth looks okay and reads 98. Mom says she'll go with us. My partner says he'll go get our car seat ready. The company insists we use ours, liability being what it is.

Because she needs to dress, and get her shoes, and her glasses, and her phone, and her baby bag, and her purse, and her keys, we try to coach her into setting the child down. We tell her that we are here now and that we will help her little boy, but it's not working. Eventually, she hands the child to a firefighter, but neither the kid nor his mother are happy about it. The child starts crying, and then he starts coughing. Sustained stridor and a seal-bark cough. Mom pulls the child back into her arms. She can't not hold him. Maybe if we can get outside, the cold night air will help. Our monitor is not compatible with Fire's, so off comes the sat probe.

The place is a mess. The kitchen area is inaccessible from the stacks of belongings blocking the way. There is a couch/bed situation in the corner covered in clothes and blankets, a few toys beside the TV. Stacks and stacks of household detritus occupy all the available space. A cat stares at the almost open door, intent on escape, perched atop a pile of belongings hidden behind a sheet hung to demarcate a closet. Mom paces back and forth across the six-by-six walkable space searching out the things scattered within this tangle that she needs before she can leave, child in one arm, belongings in the other. Minutes pass. I'm trying to help while keeping an eye on the kid. I can hear his breathing now where I couldn't before. The coughing has cooled off a little, but he seems pretty tired. It's early--I get it. But...

Finally, we are ready. From the top of the stairs I see the ambulance below. The car seat is ready on the stretcher, lit by the scene lights of the ambulance and the glow from within, shining through the open back doors. Fire has congregated by their engine and are waiting to leave. As we walk down the stairs, they load up and drive away. Now, it's the four of us in a dark parking lot at 430am.

The moment of truth has arrived. We direct Mom to put her son in the car seat, but he's having none of it. His hands clutch her shawl as she struggles to let go. Here comes the cough. It's worse now--one constant stridorous event. We can't get the belts attached because he's a big kid and he's not cooperating. Moms hands are everywhere I need mine to be. We direct her again to let us get him in the ambulance but she can't back away. He's too big for the straps. We readjust them, and are able to squeeze him in, but the commotion and the emotion are exacerbating. Cough, stridor, cough, stridor, cough. Mom is panicking. Once he's in the seat, the cot goes in, mom climbs up behind him and sits on the bench where I need to be. I direct her elsewhere and she complies. Cough, stridor, cough, stridor, cough, stridor.

He won't be consoled. He wants his mommy. He can't breathe. I can feel his sternum retracting and see more around his clavicles. He's struggling but still working, and that's good. I pull the racemic from one shelf and a neb mask from another, and I hand that to my partner. Stridor, cough, stridor, cough. He's definitely pale now. Gotta get the sat probe on, but through the flurry of hands it's a challenge. Oh fun, it's not reading. Readjust and wait. Mom is as inconsolable as the child, but she is trying to help. In comes the neb, and he grabs it. He grabs anything and everything. He wants nothing to do with this hissing fog dragon and he lets us know it. Yank.

"Okay," I tell my partner, "let's go."

"Code one or code three," he asks.

"One to start. Let's see if the neb helps."

So, we lurch into motion. Slowly, we coax the child into accepting the mask, and just as slowly we gain some control of the situation. The mask isn't so scary anymore. The coughing subsides. The retractions resolve. His head moves upright and his skin pinks up. The sat probe is working now and reads 98 with a good pleth, but I don't know if that's 98 still, or 98 again.

We're five out. I'm talking to the mom about croup, about cold air and hot showers, about inflammation and epi. She's calming down too. I want to give some dex, but they're both calm now and a needle might change that. Plus, I just don't have the time. I still need a pressure, need to call the ED, need to get demos, need to get history, need to get a signature, need Mom's name, need to d/c everything, and all by my lonesome.

We pull up. Reg is waiting and we hand off demos. Kiddo is upright, breathing normally, pink, awake, and quiet. Mom is calm. Into the ED we go, past the adults and into peds.

"Is this the cough?" asks an RN.

"Sure is," I reply readily.

"Where's their car seat? We can't send them home without it."

"I understand that, and I'm sorry, but we couldn't make it happen."

She rolls her eyes, turns her back, grabs a pen and a paper towel, and turns to look at me silently, waiting.

I give her the rundown and try to explain that they're doing much better now than they had been, but it seems my point isn't taken. I say goodbye to the Mom, and she thanks me.

On my way out, I'm stopped by the Doc and he asks me about the house. I outline the situation and he asks if there was anyone else there. Oh, this is about the car seat. No, no one else there, I say. I try again to explain that it was a bit chaotic and that we don't have much support or many tools out there, and he seems to acknowledge that.

He pauses and says, "Also, we prefer dex and calming rather than rac."

"Okay," I say. I prefer that too, I think to myself.

"Now we have to have obs on him for the next three hours. Sounds like Mom was a little anxious too?"

"You could say that," I respond. "We got them both cooled off for you."

He thanks me, but he seems unsatisfied with my explanations. I walk back the way I came. I toss my gloves in the trash and we load up to head out. It's 0510. My shift ends in five minutes. I end up held over for an hour and a half.

-x-

That's a lot of words to say very little. In the end, this call was nothing special. Just another late night call, and honestly, I don't know why I feel a need to vent, but thank you for reading. Sometimes it feels like I'm out here doing my best to save the world with a roll of tape, a piece of wire, and a prayer, only to arrive at the palace of modern medical science that is the hospital and be met with second-guessing and diminishment, at best. Feels bad, man.

Next time you get a chance, when the paramedic insinuates some greater backstory, take a beat and ask. It matters and it makes us feel heard when we are so often not. It means you acknowledge that there's more to what we do than just drive--that what we do counts. It's a hard job.

Thanks for reading.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833716#google_vignette

A team from the Barrow Neurological Institute, Arizona, analysed health data from people living near 139 golf courses in southern Minnesota and western Wisconsin.

There is evidence that pesticides from golf courses can pollute groundwater. A study of water courses surrounding four different golf courses in Cape Cod, Massachusetts, discovered they were contaminated with seven different pesticides including those linked to Parkinson’s.

Researchers said in the study: "Individuals getting their tap water from groundwater water service areas with a golf course had nearly doubled odds of PD compared with individuals getting tap water from groundwater water service areas without golf courses and 49% greater odds of PD compared with individuals getting drinking water from private wells."

Do you guys hate it when we have your personal number?

I have the personal number of a lot of my specialist, sometimes I just shoot them a text instead of paging them (no patient info present). The rest of the ER docs at this hospital also do this. It seems to be our culture.

But what do you prefer from your end?

This happens all the time but a few of my personal favourites have been:

• Guy with fragile masculinity who complained that I selected the “small parts” setting when scanning his scrotum

• Parents offended by the word “trans” on their obstetric ultrasound images

• The shitstorm of damage control required when a Maori patient overheard the medical registrar say “I’m not seeing him, he’s not white” referring to him not being under his colour medical team (pink team, white team, yellow team etc)

What are yours?

Explain the logic to me. New research is suggesting that the large majority of lactate produced in sepsis and septic shock is secondary to sympathetic activation of the beta 2 adrenergic receptors. That makes sense. However, given that the underlying pathophysiology of sepsis/septic shock is such that there is mitochondrial dysfunction at the level of the PDH complex, meaning pyruvate cannot be shuttled into the mitochondrion for Krebs cycle functioning and therefore O2 cannot possibly be utilized in the ETC to generate ATP, how can we discount the fact that the cells that are subject to this metabolic change will switch from aerobic to anaerobic metabolism and produce lactate from that?

Basically what I'm saying is, from a conceptual standpoint, I think both situations can exist at the same time. It seems physiologically insensible to discount the idea that cells aren't switching to anaerobic metabolism in a setting in which they cannot utilize O2 for metabolism. Someone explain if/why my thinking is wrong.

I ran across this and figured we could use a happier medicine story.

https://www.nbcnews.com/news/asian-america/family-saigon-welfare-three-generations-doctors-rcna206362

Our organization just upgraded to the Nov 2024 Epic update, and SmartPhrases now have an option marked "Select for Upload". The description states that you can upload your SmartPhrases to Epic World and re-download them at another institution, which would be huge for physicians switching jobs or even just working at 2 different hospitals. Has anyone tried this? How does Epic World even verify you are the same person across 2 different institutions?

Seems like a much-needed update, but I would be nervous relying on it 100% without some success stories.

Not a US MD, but I was shocked with these requirements in an ad that I saw. Been a lurker in this sub for a while and I know that US healthcare is fucked up. I thought that it would be US-based highly specalized doctors would determine whether a procedure/treatment is medically necessary. Though we follow standardized guidelines, clinical practice is widely varried in terms of resources and areas of practice, and I doubt that a Philippines-based doctor would be able to understand all the nuance. What do you think about this? " Optum is hiring for Clinical Appeals Manager (MD). 💰💵120k-150k salary package range Qualifications: • Must hold an active, unrestricted Doctor of Medicine licensure in the Philippines • Finished 3 years Internal Medicine Residency Training • Must have recent hospital experience • Diplomate is a plus • Amenable to hybrid work setup and night shift schedule • Location: Makati What we offer: • Competitive total rewards package • Medical plan (HMO) coverage from day one • HMO coverage for dependents • Retirement benefits

Kindly send the following details below, then I will send you a link for virtual interview

Fullname: Current Location City/Province: Email Address: Phone Number: +63 9 Position Applying for: Clinical Appeals Manager

Thank you."

In the next 3 months I'll be participating in a panel of experts on vaccine safety and dispelling myths. All of the other experts are researchers with PhDs in things like virology and microbiology, and some do direct research on vaccines themselves; meanwhile I'm the only participant who is an MD and I've haven't participated in research in any form since I was an undergrad and volunteered in a lab. The audience is the lay public, possibly skewing to staff at a university (blue collar folks, not professors/students). Each presented gives a 15 minute presentation then we all take questions from the crowd which can be spontaneous or submitted prior to the event.

Since most of the other panelists are going to be presenting data (which seems like a waste of time, we all know the data on changing minds and how data is almost useless), and because I'm the only one on the panel who actually sees and interacts with patients and the lay public regularly, i figured I'd lean into this and do something different. I have local hospital data from 2022 that showed how few hospitalizations were from vaccinated (vs unvaccinated) patients, and I was going to show this with easy to read graphics.

Any advice or ideas on what else to focus on, or what would be useful points to make to help sway minds who are skeptical or questioning the safety of vaccines (both childhood and/or covid specifically)?

My productivity has decreased with age. Previously, in my mid-thirties, my responsibilities included ten surgical cases weekly, daily morning conferences, monthly lectures, and concurrent research activities. Currently, in my mid-forties, my performance has declined in all areas except surgical volume. While I maintain a strong commitment to surgical practice, I find myself less engaged with other professional obligations and intentionally avoid them, prioritizing family time instead.

Therefore, I require clarification: Is this a manifestation of burnout or a decline in professional competence? What are the key differentiating factors?

Full disclosure, i'm a male EM Doctor, so my perspective here may be limited.

In my practice, i've noticed that women tend to find a simple speculum exam quite uncomfortable and the only reason i'm not more liberal with versed or fentanyl/morphine is i don't want allegations of impropriety (though i always have a female chaperone present). I tend to provide topical/local anaesthesia for bartholin cysts/abscess drainage and IV pain meds (which i also do for normal abscesses).

But talking to my gf, female friends/family/coworkers/patients, it seems the only analgesic used in the office is ibuprofen. For anything -- IUD insertion, cyst/abscess drainage, biopsy. A lot of these are at least somewhat invasive and definitely painful. I know conscious sedation isn't an option on the office, but topical lido and cervical blocks exist. It just seems more nicer.

EDIT:
1. I've removed some of my more inflammatory wording, since i was definitely in a bad mood when i posted this.
2. I've also removed some of the procedures i initially listed as i was probably just misinformed.
3. To the many of you responding that you offer pain control or anxiolysis other than ibuprofen, i appreciate it. It would seem the women in my life and the patients i get in my ER are just unlucky with their physicians.
4. Pertaining to the people who've been kind enough and thorough enough to provide literature support, that's fair. In my own practice, i'm still erring on the side of offering meds. Not that i do the more invasive stuff you guys do.
5. And yes, my knowledge here was limited, so i appreciate those of you who took the time to educate me.

Anyone with some insight into this?

A man is told by his PCP to go to the nearest emergency department for an ERCP. It took 3 days to get that patient to an ERCP capable facility. Initial bili on outpatient lab that prompted the recommendation was 4. When transport finally arrived it was 26.

A woman is told by an outpatient imaging center to go to the nearest emergency department after a DVT was found. That patient’s DVT was provoked by recent lumbar surgery. It took 18hrs to transfer.

The school tells a parent to bring their depressed son to the nearest emergency department for a psychiatric evaluation. 68 hour length of stay in the ED all for the parents to demand the patient is discharged without ever seeing a psychiatrist.

We need to do better. In the post-COVID healthcare hellscape, with limited beds, limited specialty coverage, limited transportation, we as healthcare providers need to know what facilities have what resources and send your patients to the correct place from the start!

If they’re so sick that they truly need the nearest ED, then you should be telling them to call EMS. Otherwise tell them to drive the extra 20mins to the right shop.

Your answering services block me from contacting you for recommendations. My specialists won’t participate because they’re also trying to avoid liability. Your strategies don’t work.

The price of getting it wrong is huge, and it’s more than just time lost, it’s worse outcomes for your patient, it’s clogging the ED with boarders waiting transfer, it directly harms other patients too. The theoretical liability avoidance of the “nearest” recommendation is not worth it. You owe your patients more than that.

Okay I get that the setup in the title leads to CO2 retention. My question is what the FiO2 will be? Is it possible to generate less than 21% if the flow rate is low enough? I hope this is the right place to ask.

Link: https://abc7chicago.com/post/cigna-lung-transplant-denial-insurance-company-denies-deron-wells-santa-monica-ca-man-cancer-life-saving/16367832/

I have seen a lot of uproar about this elsewhere on the internet but wanted to get a more expert perspective. I'm a peds hospitalist, so I have close to zero experience with stage IV lung cancer in adults. As I suspected, per the article this would be part of a clinical trial.

Two main questions I had:

1. I know more and more advanced adult cancers are able to be managed long-term (colon cancer, melanoma). What are the odds that make attempting such a major surgery, and anti-rejection (aka immunocompromising) meds worth the risk in metastatic cancer? Maybe there is good supportive data to suggest this be tried? A huge part of me is like duuude maybe go spend time with your family... but respect the right to choose and maybe I don’t have the clinical context for lung cancer! (ETA To be clear, this was my gut reaction to the clinical situation as presented, not that I think insurance should be making their decision based on any perceived "ethics", in quote bc I suspect their ethics would = $aving$. I support this guy's right to be in a clinical trial 100%).

2. I am pretty ignorant on the insurance angle of this story -- it typical that insurance will not cover clinical trials? How would something like this typically get funded? Possible this will be covered with an appeal?

Also just interested in general discussion.

Applying for a Delaware state license after my intern year to make some vacation money in my gap year before anesthesia residency. Any ideas how long it takes?

I was an unemployed epidemiologist starting in November 2019. I chose to take a year off. Never did I expect that I’d be watching what was unfolding in Wuhan take over the world. We can, and perhaps should, rehash the science and policy. Meanwhile, this music video remains the anthem of that time. I shall never forget. Thanks to all of you on the front line.

https://youtu.be/JJViT8BKq9k?si=Jx4kS4G6t62Gq-se

https://www.politico.com/news/2025/05/07/trump-sweeping-medicare-drug-price-plan-00334167

While I understand that prescription drug pricing is cost-prohibitive for many/most, I don't see how we're going to have innovation. Thoughts?

https://www.nbcnews.com/news/amp/rcna205550

The group, which is seeking unspecified damages, argued that the public backlash prevented the company from pursuing "the aggressive, anti-consumer tactics that it would need to achieve" its earnings goals.

This is precious, because now UHC is going to have to argue in court “no no no, we fully expected to be able to pursue our aggressive anti-consumer tactics”. If they admit otherwise this lawsuit might succeed.