David B. Stewart, MD, MHA, FACS, FASCRS

We deserve better.

@HEALTHCOSTtruth You're awesome.

"Your surgery has been cancelled." That is the exact message UPMC sent directly to a patient via email because his employer runs a self-funded plan that refused to play their PPO pricing games. They demanded $33,873.40 upfront instead. They thought they could hold his health hostage to force a payout. They picked the wrong plan. What we did: 1️⃣ Caught them in writing violating IRS 501(r) Extraordinary Collection Action rules 2️⃣ Copied the IRS Tax-Exempt Division and the State AG directly on the thread. 3️⃣ Handed the patient the legal scripts to protect themselves. UPMC's team never bothered to answer our compliance questions after we copied the PA AG and IRS. Meanwhile, in the background, the patient was quietly routed to another facility. His surgery was successfully completed yesterday. The employer's capital is protected. The patient is safe and will not face financial ruin. The healthcare cartel loses. It's just execution. Posted in full with patient's permission.

The IDEAL Macro Breakdown to overhaul body composition: Protein g = .75 x Bodyweight (in lbs)…yes, this is enough Fat g = .25 x Bodyweight (in lbs)…yes, your hormones will be fine with this much fat per day Carb g = Fill in the rest As alluded to in the header, this is how you want to distribute Macros IF your objective is achieving the best possible outcome as far as body composition enhancement is concerned

Cats aren’t worms. You don’t casually double the lifespan of a mammal. What we have is evidence of a large 1-year survival benefit in a tiny group of cats already suffering from advanced kidney disease. The 30-year claim is based on nothing. It's still exciting but for a different reason. The comparative biology angle is more interesting: cats may have a species-specific AIM vulnerability that makes kidney failure a major lifespan bottleneck and fixing that could matter a lot. But “doubling lifespan” is doing far more work than the data support.

This is the problem with socialism. The answer is always more money. Never a number. Never a limit. Never a point where voters are allowed to ask, after we spent all this, why are the results still mediocre? NYC Public Schools is already running a roughly $44.6 billion budget. Depending on how you count the all in costs, that puts spending in the neighborhood of $40,000 plus per student. That's more than most private schools charge. So what's the amount of money per pupil that will make New York public schools adequate? How much wealth should be redistributed to those Queens teachers to make the system "fair?" We see this in healthcare, too. Any potential cut to Medicaid is dooming poor people to die. @SenSchumer claimed over 50,000 people were going to die if we made even the slightest cut to Medicaid. Fine. Then say the quiet part out loud. What is the target spend per Medicaid enrollee? What happens when spending rises and patients still cannot get care? Let's get those numbers out there, find a way to fairly tax the wealthy to fund the safety-net, and then be done with it. $50k per student per year? $10,000 per Medicaid beneficiary with some age-adjustment? $200,000 per mile of high speed rail track? They can never tell you. One, because they have never run a business before, so they have no idea how to actually look at a balance sheet. But, two, they don't want the money to go to the teachers, students, patients, or choo choo train. They want wealth redistributed from class enemies like Bezos to their political allies. They want to fund things that sound nice. "Free childcare" "Free diapers" "Free Faith Healers" so they can take money from people they don't like and give it to people they do like. But, again because they have never run an actual business and because their only motiviation is to just not fail badly enough to prevent their re-election, the services come in way over budget and under-quality. They're spending other people's money on other people, and as Milton Friedman points out, that's when you stop caring about both price and quality. So the people to whom they promised free stuff look at their free stuff and are disappointed. "I was supposed to get healthcare but now I need to wait a year for my knee replacement." So they blame their class enemies and say "well it would work if we could just take MORE of their money and redistribute it." So they take more money, but the quality doesn't improve. Their political allies, the union bosses and NGO CEOs get big paychecks they then funnel back into their campaigns. And again, and again. Until all the people who actually produce wealth have been taxed into oblivion. You have no more Amazon. No more abundance. Just bread lines and poverty. And that teacher in Queens still isn't getting paid what they are worth.

Toru Miyazaki gave 11 cats with advanced kidney disease an experimental injection. 15 others didn’t get it. A year later, 9 of the 11 treated cats were alive. Only 3 of the 15 untreated cats survived. He just filed for approval, and the drug fixes a defect only cats have. Most cats die from one thing: their kidneys fail. By age 10, 4 in 10 cats already have chronic kidney disease, and by age 15, the rate doubles to 8 in 10. Once diagnosed, a cat has about 2 years left. The reason kidney disease hits cats so hard is a broken protein in their blood. All mammals carry a protein that helps the kidneys clean out waste. In humans and dogs, the protein floats freely and goes to work when the kidneys are in trouble. In cats, it stays stuck to another protein and can’t get loose. So the waste piles up, and the kidneys eventually give out. Miyazaki originally found the protein in 1999, back when he was at the University of Tokyo. He figured out the cat-specific glitch in 2015. The paper he published in the Veterinary Journal in February laid out the trial. The injection is a working version of the missing protein. His company, the Institute for AIM Medicine, filed the approval paperwork with Japan’s Ministry of Agriculture on April 24, 2026. If the review clears, the drug goes on sale in spring 2027. The 30-year lifespan figure in the tweet is Miyazaki’s own projection of what cats could reach without kidney disease. The trial only ran a year, and the average cat today lives 15. Most die from the same disease this injection treats. The research almost died in 2020. After running out of funding during COVID, Miyazaki went public. Cat owners across Japan responded by sending in 300 million yen, around 2 million dollars total. He resigned from the University of Tokyo and worked on the drug full time. The treatment in front of regulators today exists because cat lovers refused to let the research die.

@MarkCoffin14 This was really smart of you, given the circumstances. You were forced to give a bogus grade and you emphasized that by giving the grade before the term paper, because the uni made all of it a farce. So you farced harder.

I gave the student their grade before the term paper (which was an alternative to the final exam). A "B". And then I told my department chair and the Dean of the School of Business I'd never pursue another cheating case EVER. You should have seen their faces.

The main reason I quit academia and gave up a tenured faculty position at @EastCarolina was because I caught a student red-handed plagiarism a term paper. Failed them. But administration forced me to change their grade and I was threatened with a lawsuit by the parents 1/2

I'm an obesity medicine physician. If I could change one thing about my patients' health, it wouldn't be their weight. It would be this. 🧵

Super Mario is named after real-life businessman Mario Segale, who was renting out a warehouse to Nintendo. After Nintendo fell far behind on rent, Segale did not evict them but gave them a second chance to come up with the money. Nintendo succeeded and named their main character after him.

"Harvard-trained" sounds really good, because of the prestige of the university. It is not an argument for or against anything. Here are a non-exhaustive list of retracted scientists who affiliated with Harvard: /1

the greatest harm of mandated quality improvement metrics is the crowding out of actual quality improvement instead of improving what matters, hospitals have legions of staff and resources directed to optimizing quality measures that have no evidentiary basis for improving health SEP-1 is a great example We should not be chasing and treating lactates in sepsis, especially for the many people with SIRS who get billed as sepsis but never had such physiology to begin with

@rorynotsorry Any thoughts on reconstituting with bacteriostatic 0.9% NaCl as opposed to BAC?

I interviewed a guy who has tested more Peptides than anybody in the world over a year ago. He even explains where the lie came from. From manufacturers who were trying to cover up for poor quality. They would blame it on shaking the vial. Janoshik states that all peptides that we would deal with are robust. youtu.be/shgk3-u51Ys?si…

This his great information. A good Retatrutide guide. Reconstitute properly. Start low (1mg), Protein + patience + workout hard = results. This is a great way to get lean, add mass and feel great. It may even curb other bad habits. Who is following along with low dose and seeing the results?

Blue Cross continues to want a 6 month renewal form to support anti-obesity drugs that require filling out a 13 page form with incessant details that take 30+ minutes to complete, have no evidence based credibility to many of them, a 3 week turn around at times for approval, and lead to numerous drug interruptions. It seems criminal?

You do realize that physicians owning hospitals is simply re-capturing their production, right? It creates no new cost to the system. Today, parasites like health systems and payers use a host of predatory tactics to exploit physician labor and extract physician wealth. Physicians owning hospitals doesn’t cost one new dollar - in fact, it reduces the taxpayer burden because physician-owned hospitals cannot participate in the same subsidies and arbitrage as health systems. You’re being scammed by the dregs of society. Wake up!

A guy I know lost both parents to a drunk driver. He got custody of his 3 siblings and had to drop out of uni to work and take care of them. He used to joke a lot, always outside, always laughing. After it happened, he barely talked. Just always looked tired. If this law had been in place it would have eased his burden a bit.

ngl my mom worked at @SpiritAirlines for 25+ years and at the airport in general for 30+. She has accomplished many feats throughout her career and has done what some would say is the impossible as a General Manager keeping her station one of the Top 3 Stations afloat even during Spirits downfall. @Delta @AmericanAir @FlyFrontier @JetBlue My mom is now out of a job, but with her expertise and knowledge with everything that goes in and out for managing flights and any roadblocks being cleared, I think she'd be a great hire, even despite the fuel prices being so high right now.

@LocasaleLab Bingo.

Political hacks keep pushing this narrative, and legacy media keeps amplifying it. The reality is that NSF has been a major contributor to the decline of the American university system. These advisory boards have little to do with scientific expertise and far more to do with bureaucratic structures - people who climbed through a broken system to end up in these roles.

Spirit Airlines died tonight at the hands of the socialist crusader, Elizabeth Warren She must be so proud to add another casket to her achievements. Tonight at 3am, Spirit turns off the lights. 14,000 jobs gone. 30+ smaller airports lose service. JetBlue offered $3.8 BILLION in cash to buy Spirit in 2022. Shareholders, flight attendants union, literally everyone voted yes. The combined company would have held 9% of the US market against a Big 4 that already owned 80%. For anyone who understands numbers: 9% isn’t a monopoly against 80%. Warren said no. She wrote letters. She pressured Buttigieg. Biden’s DOJ sued. A federal judge killed the deal in January 2024. Her argument: the merger would cost consumers $1 billion a year. Now look at her collateral damage she dusts under the rug. 510 pilots gone in the months after. 1,800 flight attendants furloughed in December. 14,000 jobs in 2023. 7,500 last week. Zero tonight. And that’s just the people in Spirit uniforms. Catering goes. Fuel guys go. Baggage crews, gate agents, airport coffee shops, hotels and rental cars in 70 cities Spirit flew to. Every airline job carries 3 more on its back. 40,000 people out of work because of one woman’s moronic crusade against the market. And the math ain’t mathing. Spirit abandoned 90 routes during the death spiral. Fares on those routes are up 14% on average. Oakland to Newark: $135 to $288. Fort Myers to San Juan: $92 to $219. Kansas City to Newark up 66%. That’s reality. Not some BS number from a “study.” So @SenWarren tell me how this saves the consumer money? Cheap carriers in a market drop fares 21% across the board. Southwest did this in the 90s and saved Americans $68 BILLION over 20 years. Warren killed it. That’s what moronic politicians led by socialism do. Then with her own blind arrogance, she tweeted Spirit’s collapse is “a Biden win for flyers.” A win. 14,000 people are reading termination letters tonight. And she’s taking credit. This is socialism in 2026. A senator who’s never made payroll thinks she knows how to run a market better than the people who own and work in the company. She saved you a billion on imaginary paper. She cost you ten times that in real life. She didn’t protect consumers from anything. 14,000+ will go from working to welfare. She will make sure to blame billionaires, hardworking tax payers, AI, capitalism and whatever monster they will make up tomorrow hiding under your bed. Higher taxes. Fewer jobs. More expensive everything. She called it a win. I hope you enjoy winning.