New energy for 2026…

Imagine if every passenger on an airplane had a direct line to the pilot. That’s what medicine has become. We have embraced frictionless communication and that not a good thing. With things like Epic Chat, every member of the healthcare team has immediate access to the physician. Now there’s a constant stream of minor questions. It’s discouraged people from thinking critically. “Just ask the doctor,” has replaced any sort of clinical reasoning. When I was a resident, we had an answering service. Anyone who wanted to reach the doctor needed to go through a third party. This provided triage and accountability. If we were getting called in the middle of the night for stool softener orders, there was a record of that. A little friction in communication is a good thing.

As everyone watches the SpaceX IPO today, its worth remembering this advice from Buffett "The idea that a newly issued security (IPO)—brought to market at a time of the seller's choosing and surrounded by massive hype—is the single best bargain among thousands of global businesses is absolute nonsense. When an offering carries a ridiculous 7% commission just to incentivize salespeople, it simply cannot be the most attractive investment available. While people easily get caught up in the excitement of a new launch, look at the reality: you have thousands of existing public companies whose prices are set by a natural auction market, free from aggressive promotion or hidden fees. It makes no sense to buy a security precisely when an insider decides the timing is perfect to sell. Frankly, it isn't worth spending five seconds thinking about IPOs." - Warren Buffett

Lots of misunderstandings here. First, this isn’t peer reviewed science. This is a press release. The level of evidence is essentially “trust me bro” Second, sepsis early warning systems have been around for decades. This isn’t new. Most hospitals have systems like this. Third, and most importantly, the way this intervention reduces the mortality *rate* probably isn’t actually saving any lives. What it’s doing is generating a ton of false positives. These people don’t need antibiotics but get them anyway, leading to side effects and resistance. But if you double the number of people with “suspected sepsis” in the denominator you make the mortality *rate* appear to drop. This is why in an actual published scientific paper we’d look at the number of deaths per year not just a rate. That’s also probably why this is press release and not an actual scientific publication…

This is the EBM equivalent of this meme: Maybe it’s true. Maybe it isn’t. Maybe they should publish actual data.

All doctors are underpaid.

Anyone try to schedule an @AppleSupport Genius Bar appointment lately? It is an endless loop of pain. First AI chat, then support video/suggestions, then they give you a live agent - who starts all over again??? 😡

Respectfully, Dr. Oz…

Hot take: Every hospital that says they "can't afford to pay physicians more" has an EVP of Patient Experience making $400K. The budget isn't a constraint. It's a series of choices about who gets paid first.

get the fuck out of here Head/Ears/Nose/Throat: Examination was normal, except for scarring of the right ear consistent with prior gunshot injury. Dermatologic: Examination of the dorsal hands revealed ecchymosis (bruising), consistent with minor soft tissue irritation related to frequent handshaking in the setting of aspirin use for cardiovascular prevention.

When a President’s physicians start citing “AI cardiac age” metrics and explaining bilateral bruising from “frequent handshaking,” the line between medical documentation and political messaging disappears.

American soldiers die in Trump's war, not a word from Donald. Gas and food prices skyrocket, not a word from Donald. People demand the Epstein files, not a word from Donald. But the minute you take his fat name off a building, Donald writes Mein Kampf for Morons.

That national Republicans are all spending so much time and energy trying to tear Talarico down is actually just a sign that they’re pretty worried about holding on to a Senate seat in…Texas.

And, by their actions, it is clear to *everyone* that the GOP couldn’t be more afraid of him. #TeamTalarico

So yesterday Donald Trump posted a video of him crashing Stephen Colbert's final show, and literally throwing him in the garbage, and of course, I had to FIX it.

This is an official government account in a democracy. This is what Orbanism looks like. The president bragging, via AI video, that he forced a comedian who mocked him off the air and ‘into the trash’.

COMMENTARY: Let’s say it plainly: There has never been a president as corrupt as Donald Trump. There is no close second in our history. rollingstone.com/politics/po…

Admiral Cooper is unfit for command. This is a fair question. A necessary question. Utterly shameful.

CBS, CNN, Fox News, Politico and Business Insider are all controlled by Trump's billionaire allies. The reason they aren't reporting on Trump's corruption is because they see more value in protecting Trump than reporting news.

A court has to block this or it throws the legitimacy of our entire system of laws into question like never before.