Rishikesh Behere

Never buy freshly made juice from a vendor whose eyes look yellowish.

Private equity firms bought 500 hospitals. Death rates in their emergency rooms went up 13%. They fired 12% of the staff. Then they paid themselves billions in dividends. A Harvard study just confirmed what doctors already knew: people are dying so investors can hit quarterly targets. Exactly what happens. A PE firm buys a hospital using debt. The debt gets placed on the hospital's balance sheet, not the firm's. Now the hospital owes hundreds of millions it never borrowed. To service that debt, the hospital cuts costs. Costs mean nurses. The numbers from the Harvard/University of Chicago study are horrifying. After PE acquisition, emergency department salary spending dropped 18.2%. ICU salary spending dropped 15.9%. Hospital-wide employees were cut 11.6%. Emergency department deaths rose 13%, seven additional deaths per 10,000 visits. A separate study found patients undergoing surgery at PE-acquired hospitals had 17% higher odds of dying within 90 days. Steward Health Care, owned by Cerberus Capital, filed bankruptcy with $9 billion in debt after closing hospitals across Massachusetts. The CEO lived on a $40 million yacht while emergency rooms went dark. Eight hospitals serving 2 million people nearly disappeared because a PE fund extracted more cash than the system could survive. The private equity industry has poured over $1 trillion into healthcare. They operate a quarter of ERs nationwide. This isn't going away. The investing angle nobody talks about. Non-PE hospital operators like HCA Healthcare (HCA) and Tenet (THC) are the direct beneficiaries. Every time a PE hospital closes or deteriorates, patients flow to the nearest competitor. HCA has returned 1,200% since 2011. Patient volume from PE closures is a structural tailwind nobody's pricing in. Medical staffing firms (AMN Healthcare, Cross Country) charge premium rates specifically because PE hospitals cut staff. The staffing shortage IS the business model for these companies. The disruption play: outpatient surgical centers (SCA Health, now part of UnitedHealth) are pulling profitable procedures out of hospitals entirely. PE-owned hospitals lose their highest-margin surgeries to outpatient, and the death spiral accelerates. Pull up tradevision and monitor healthcare M&A alerts, hospital closure filings, and patient volume migration data. When a PE-owned hospital announces "restructuring," the patient volume shift to competitors like HCA starts within 30 days. That 30-day window is when the competitor's earnings revisions haven't updated yet. Free to try. (a private equity firm bought your local hospital. borrowed $500 million in the hospital's name. fired 12% of the nurses. emergency room deaths rose 13%. then they paid themselves dividends. nobody went to prison. they're currently buying another hospital.)

Daytime napping is associated with a larger total brain volume.

Scientists from NCRA Pune have made a discovery with the potential to shake up science's understanding of how early galaxies were formed after the Big Bang They have discovered a galaxy which they've named Alaknanda. It is a fairly basic galaxy, so why is it such a big deal? 🧵

Just came up with a more visual explanation of how gravity could interact with human aging across the gravitational spectrum. (Again, this is part of the hypothesis, not proven yet).

We manage very high volumes, up to 1,000 radiographs a day, and AI helps manage this load efficiently. The algorithm is tuned for a high negative predictive value (NPV), which reduces the chance of missing abnormalities while maintaining patient safety.

To understand why medicine is so complex, let's make a crude simplifying assumption that there are only 100 biomarkers that are important (in reality there are vastly more). Let's also crudely assume each market is allowed only two values. That gives us 2^100 possibilities, which is about 10^30. That is vastly more than humans that ever lived. And this is with the extremely over-simplified model. We face a practical infinity of possibilities. In reality, no two patients are ever really alike. No statistical model can give you very high confidence on how to treat. That is why AI can never treat patients, because human doctors exercise something called "clinical judgment". That judgment is what enables a doctor to tell us "this is not a serious issue, get good sleep" vs "this definitely needs deeper investigation". That judgment is hard. Often they cannot even explain why they arrived at this but great doctors have that intuition. The entire Big Medicine is about systematically dismantling clinical judgment and convert doctors to mere "protocol pushers". Great doctors resist this. Now on top of the measurable biomarkers, there is the unmeasurable factor called "mental state". Every good doctor knows a positive mental state in a patient leads to far better clinical outcomes. That is why good doctors practise compassionate medicine, not just numbers based medicine. I know an outstanding skin doctor in Chennai who prescribed me medicine for my very-itchy Eczema that I had endured for months, and he also told me "try to avoid stress and it may go away, and you may not even need the medicines I prescribed". I consciously reduced my stress level and the problem went away without medicine. That is a truly great doctor. What does it have to do with autism-vaccine connection? As my crude numerical analysis showed, we have the problem of N=1 way too often in medicine and that is even more true for autism where each kid is truly unique, and that is why statistics are mostly useless and clinical judgment is mostly all we have. We cannot have broad sweeping mandates, definitely not broad vaccine mandates. Each doctor has to exercise their judgment with their patient. And they have to listen to the patient concerns first. What Big Medicine is about is to try to reduce medicine to be a pure statistical science and it is not. Conditions like autism do not fit that paradigm at all. That is the battle here. At its core it is not just an autism battle, it is a philosophy of medicine battle. I pledge to keep fighting this fight because I nearly wanted to commit suicide at one one point in my life. Just this morning, a depressed parent approached me for advice and that started my X thread today. I urge intelligent doctors to debate this philosophy of medicine issue. I will not respond to the arrogant "stay in your lane" types.

Parents should take this analysis seriously. I believe there is increasing evidence that we are giving way too many vaccines to very young children. This is spreading in India too and we are seeing a rapid increase in autism in India.