David Brennan, MD

@StuartBlitz Create a clinician-centric user friendly EHR. Make no mistakes.

Claude, build and implement a functional US healthcare system. Make no mistakes.

@MichaelAlbertMD Good

Widely criticized keto diet study retracted retractionwatch.com/2026/05/22/wid…

@agingroy Any major physiologic or emotional event can cause telogen effluvium. Thankfully hair comes back normally once the the follicle resets.

If you’re on Ozempic or Mounjaro and your hair started thinning around month 3, you’re not alone. Researchers tracked over half a million people on these drugs. At 12 months, they were 76% more likely to start losing hair compared to similar patients who weren’t taking them. A separate review of 24 studies across the entire drug class found the risk was about 3 times higher than placebo. The weight loss is probably the trigger. Your body reads rapid calorie restriction as a stress signal. Hair follicles go dormant, then fall out 2 to 4 months later. Bariatric surgery patients get the same pattern. It usually reverses. Once your weight stabilizes, most people see regrowth within 3 to 6 months. These drugs have significant metabolic benefits. Nobody serious is saying don’t take them. But temporary hair shedding is a real side effect, and patients deserve to know about it before it shows up in the shower drain. In the largest Mounjaro trial (2,539 patients, NEJM), hair loss climbed with the dose. At 5 mg, 2.8% of patients lost hair. At 15 mg, 5.7%. On placebo, 1%. Women seem to be affected more than men. One early analysis found roughly double the risk for women on semaglutide, though that data hasn’t been peer-reviewed yet. If your doctor prescribes one of these drugs, ask about hair loss. It probably won’t change the decision, but you’ll be ready for month 3.

@EricTopol @tberzin @NatureMedicine @nliulab Could de-skilling threaten the differentiation between physicians and other “provider” roles, and fuel the shift toward cheaper, scalable staffing models? Why hire physicians if they don’t retain key clinical advantages?

We've written about AI-induced physician deskilling that has already surfaced thelancet.com/journals/lance… @tberzin AI-induced never-skilling among newly trained doctors, while not yet proven, is a serious concern that needs to be addressed @NatureMedicine @nliulab nature.com/articles/s4159…

@elonmusk 1.21 jiggawatts

This trend will continue for many years

@JCanNuSH Thank you. I didn’t realize how restrictive gag laws were. It looks like many of those practices were outlawed around 2018 but there is still pressure from PBMs. I appreciate you spreading the word about this.

That is wonderful, and I know pharmacists work hard for their patients, but if you follow accounts from pharmacists, they are full of complaints about how PBM gag clauses prevent them from disclosing to patients that cheaper cash pay options exist. If they violate these clauses, they risk network exclusion.

🙋‍♀️Just so you know: you don’t have to blindly accept the price the pharmacy quotes you for a med based on your insurance. ▪️If the medication is a generic, check to see if you can get a better price just paying out of pocket (instead of using insurance) or thru a discount program like GoodRx/SingleCare. ▪️If it’s a brand name, check to see if a manufacturer savings card exists or a GoodRx/SingleCare discount is available. ▪️For long term meds, check the pricing at CostPlusDrugs. If you bypass insurance, it likely won’t count toward your deductible, but you may still be better off. Going with GoodRx saved me $100 today on one of my fills. (I would’ve been even better off with CostPlusDrugs, but they were out of my med this time.)

@elitecmc $10

@DavidNBrennan What’s his co-pay?

My buddy just started atorvastatin, and told me his EOB listed the price at $1000. I didn’t believe him so I looked up my telmisartan ($500). These are $5-15 medications that the pharmacy is “charging” 100X. Are these just legacy prices, or is this part of the racket?

@DavidNBrennan I believe the PBMs (through their contracts) have ways to punish the pharmacies for allowing OOP payment instead, which the PBM wants to dissuade because they profit off of the differences.

How bad were the enhanced games at enhancing? They somehow took near world-class sprinters, doped them, and made them slower... Not just from their PRs, but from last season...and in most cases, slower than a good HS runner... Here's the details:

@TexasPharmD @mcuban from your perspective are there other reasons the “list price” is kept so high when nobody is paying anything close to it? See below (my Rx)

@DavidNBrennan Yes

@TexasPharmD Thanks. I get that, too. I’m assuming the list price is just a legacy figure then—meaningless for all intents and purposes?

@DavidNBrennan We're not "charging" them $500, these are already agreed to by contract. It would be like if I agreed to mow your lawn for $50 a week and I send you a bill for $50,000. What's your response? Cut me a check for $50 like we agreed upon.

@Brady_H Like the beer mile, but all the events

“De-hanced” games Same premise but athletes use marijuana, shrooms, beta-blockers, alcohol, etc.

@Mark_o1t My buddy didn’t either. $10 I think. But what happens between the $1000 and the $10 is the mystery to me.

@DavidNBrennan That's insane, I've never paid more than $12 for any statin. Note: It doesn't work for everyone. I took these for 3 years, no change in results. Changed my diet, lost 30lb, no statin, 40% improvement in my results.

@mcuban For the most part we are paying close to those prices, but the math from list price to OOP is staggering and not at all intuitive.

@DavidNBrennan They are getting ripped of.

@cremieuxrecueil Let’s also see the opposite trend happen with movement, exercise and overall fitness!

We're going to win

@mcuban IMO, once the study is published in a prominent journal, it’s just a matter of manufacturing capacity because physicians will incorporate into management if affordable. Make it available through all Rx channels.

Drug startup creates an amazing drug. It's groundbreaking. They want to sell that drug for just enough to cover their expenses and to make a 10 pct return. Where and how can they sell it so it reaches as many patients as possible ?