We updated our essay on B12 - this diagnosis is too often missed for several reasons. Claude does a great job of giving you the opportunity to better understand Vitamin B12 Deficiency: The Diagnosis That Hides in Plain Sight — and in Plain-Normal Labs open.substack.com/pub/leadin…

If Platner's tattoo had been a Confederate flag, Democrats would have remembered what they claim to believe in. But it was just the symbol of a Nazi concentration camp guard, and it was mostly Jews who were upset, so he still gets to be the progressive hero this moment needs.

Agree - I'm using Perplexity and more recently really like like Claude AI

Our posts on nutritional deficiencies continues with Zinc - very tricky as you will see open.substack.com/pub/leadin…

Gastrointestinal Beriberi Secondary to Intermittent Hemodialysis With Rapid Improvement Following Thiamine Administration - Day - 2026 - Case Reports in Gastrointestinal Medicine - Wiley Online Library onlinelibrary.wiley.com/doi/… Fascinating case that taught us much

This is wonderful - we have a useful Annals On Call - Physicians Not Providers @AnnalsofIM acpjournals.org/doi/10.7326/…

Improving my current pharyngotonsillitis talk with Claude. Claude is like a colleague - asks questions, makes suggestions, but ever complains when I have a better suggestion. Claude designs slides much better than I can - is always ready when I am, never complains about time

Using several AI products and thinking about the strengths and weaknesses of AI. I had this case and a long "discussion" with Claude - and this is the product of why AI helps physicians but need physicians for diagnostic reasoning open.substack.com/pub/leadin…

WHAT WE GIVE ISRAEL The standard US military aid package is $3.8 billion per year $3.3 billion in Foreign Military Financing plus $500 million for joint missile defense programs. Israel must spend most of this on US-made products and services, and by 2028 essentially all of it must be spent in America. WHAT ISRAEL GIVES BACK 1. F-35 R&D Savings: 55 billion Israel resolved multiple technical issues during the F-35’s early development, reducing US R&D costs by an estimated $55 billion and accelerating deployment timelines.  The total F-35 program cost was $55 billion in R&D Israel’s combat testing effectively saved the US from having to discover and fix those problems on their own dime. 2. Intelligence Value: equivalent to 5 CIAs (75 billion/year) General George Keegan, former Chief of US Air Force Intelligence, stated that Israel’s intel value equals “5 CIAs” providing a 400% return on investment on the $3.8 billion aid package. One CIA budget runs approximately $15 billion.  Five times that equals roughly $75 billion worth of intelligence annually for $3.8 billion in aid. 3. Strategic Base Value: $15–20 billion/year As stated by Admiral Elmo Zumwalt and General Alexander Haig, Israel is the largest US aircraft carrier that does not require US military personnel on board, cannot be sunk, and is deployed in a critical region sparing the US the need to manufacture, deploy, and maintain real aircraft carriers with ground divisions, which would cost the US $15–20 billion annually.  4. F-35 Export Multiplier: $40 billion in sales, $173 billion backlog Israel’s battle-tested performance and upgrades to the F-35 contribute to $40 billion in US exports and a $173 billion backlog for US industry.  Israel essentially serves as the world’s most credible advertisement for American weapons. 5. Jobs and Economic Output: 255,000 jobs, $72 billion annually The F-35 economic engine alone supports 290,000 US employees and $72 billion in annual economic output.  Israeli stakeholders hold contracts with over 1,000 American companies across 48 states, DC, and Puerto Rico. Why do people need to lie about this? Because they have nefarious reasons. There’s no other reason to lie about this stuff.

I thought I understood conformation bias - it is even more important than I thought (thanks to Claude) leadingrounds.substack.com/p…

Special time of year in Birmingham. Great salad at FoodBar

A new episode of Annals On Call is available to listen to now. In this episode, Dr. Centor @medrants discusses the @ACPIMPhysicians' latest recommendations for #RSV vaccination with Dr. Rachael Lee @DoctorRachael. bit.ly/4uWa4fy

#UncleBob proudly presents: Annals On Call - Who Should Receive the RSV Vaccine? | @AnnalsofIM acpjournals.org/doi/10.7326/… featuring @DoctorRachael

This is the first of several substacks based on a chalk talk I regularly give: what all internists should understand about CKD. Would love your comments and questions. Measuring kidney function: what eGFR tells you, and when to doubt it open.substack.com/pub/leadin…

This is based on a "chalk talk" I've been giving for many years. More to come Hypophosphatemia: The Electrolyte That Can Stop the Heart open.substack.com/pub/leadin…

Interesting - but such a low percentage of invasive GAS. They make the correct point that this is not high enough to justify antibiotics. There are other reasons and I will still treat the 3s & 4s

You know them all… 1) Shorter Is Better 2) Oral Is the New IV 3) Static/Cidal: Not a Thing 4) Antibiotics are the most potent anxiolytics in the pharmacopeia 5) Resistance is inevitable 6) ESR/CRP: Stop the Zombie Tests 7) Todd’s quote: The urine is innocent until proven guilty

In the latest episode of Annals On Call, Dr. Centor @medrants discusses interventions to prevent recurrent kidney stones with Dr. Gary Asher. bit.ly/4fvmupY

BREAKING: A massive civil war has reportedly emerged within the New York Times, with many journalists questioning the credibility of Kristof’s piece. One NYT journalist stated: “I am sick of being embarrassed by the Opinion section.”

Scurvy in 2026: The Disease That Shouldn’t Exist — But Does open.substack.com/pub/leadin… Another AI written substack - I ask the questions and Claude provides the answers