David Harker, MD, FAAD

Everyone else in medicine: it’s a maculopapular rash Dermatologists:

I hate to give airplay to misinformation, but the following post is still online - hasn’t been deleted - and it’s from the person who is currently nominated to be Surgeon General of the United States- who btw doesn’t have an active medical license. This post alone should be disqualifying for the job. Here are the dangerous factual errors in the post: 1) Hep B is not transmitted exclusively through needles and sex; it can also spread perinatally from mother to child, through household contacts sharing items, or other blood exposures. 2) Even if parents test negative, testing isn't perfect - late infections, errors, or incomplete records can and do occur, risking newborns who have a 90% chance of chronic infection if exposed 3) Her claim of zero documented cases from infected playground needles: While rare, there are cases of Hep B transmission from community needlesticks in children. 4) The virus CAN survive on surfaces/needles - up to 7 days or more. 5) Far from "insanity" or "no benefit," the birth dose has reduced U.S. childhood Hep B infections by >95%, preventing cirrhosis and liver cancer. America can’t afford a Surgeon General who so boldly states clear and harmful misinformation, much less someone who doesn’t even feel the need to remove such online falsehoods WHILE AWAITING A CONFIRMATION VOTE. 🤦🏽‍♂️

Takeaways from Hegseth’s press conference this morning: 1. There is no strategic goal. He said this isn’t about “regime change” despite the President saying otherwise, repeatedly. That means they can't explain how all of this makes Americans safer in the end. 2. He said “this will end on the President’s choosing,” and provided no real timeline. That reinforces that there is no plan and no strategic goal, just a 79 year old man who spends too much time in a ballroom in Florida deciding when to stop this. 3. Hegseth suggested the Commander-in-Chief is setting the operational tempo — which is really high right now, putting a lot of stress on our troops and systems. Donald Trump, despite what he may believe, doesn’t have the capacity to make these types of operational decisions that have real consequences for commanders and servicemembers. 4. And finally, going into a conflict of this scale with no strategy and a wishy-washy end state often leads to a less than optimal outcome, starting with the potential for continued escalation and a long, bloody conflict. Americans want leaders who focus on improving their lives, not starting more wars. It’s clear to me and everyone else who is paying attention that this President needs to be reined in, but that’s not going to come from this Secretary of Defense, who has tough sounding talking points but little else to offer the American people or our servicemembers.

Hey @ICEgov maybe you should try this very standard and rational approach when your agents shoot someone. Props to our local PD.

Remember the MAHA movement is a system of pseudoscience/grifting to finance wellness influencers. To push their various snake oils: supplements, unnecessary vitamins, ivermectin, or whatever they can buy in bulk to jack up the price, it’s essential to denigrate actual experts

Troops from European countries are arriving in Greenland to defend the territory from us. Let that sink in. And now Trump is setting tariffs on our allies, making you pay more to try to get territory we don’t need. The damage this President is doing to our reputation and our relationships is growing, making us less safe. If something doesn’t change we will be on our own with adversaries and enemies in every direction. Republicans in Congress need to stand up to Trump.

A leader who truly cared about justice, law, and order would say, “Today a federal officer killed a woman while on duty. We take this very seriously and a full investigation is underway. While the investigation is ongoing, the officer in question has been placed on leave.”

ARE YOU KIDDING ME!? 🤯 📺 peacock

I have a story to share about Neisseria meningitidis, the bacteria the meningitis vaccine protects us against. Not for the faint of heart. But PLEASE listen up and protect your children, despite what RFK Jr. and his brain worm tell you.

If you ever wanted to know about the risks of measles vaccines compared to the risk of measles, here it is. Citation: Peter Hotez Artist: New York Times

The United States is likely to lose its measles “elimination status” as early as January 2026 if ongoing measles transmission continues.

RFK Jr. claims vaccines given in the first six months of life have “never been tested for autism” and that the only study on DTP found a link that the CDC “threw out.” None of this is true. Infant vaccines have been studied for autism across massive populations. A Danish cohort followed over 650,000 children. Studies of cumulative antigen exposure in the first two years found identical levels between children with and without autism. Thimerosal-containing vaccines were compared head-to-head with thimerosal-free formulations. No difference. A 2025 WHO systematic review of over 30 studies across multiple countries reaffirmed no causal relationship. The study claiming a link that he’s likely referencing relied on VAERS data, a passive reporting system incapable of establishing causation, and lacked a valid comparison group. The Institute of Medicine reviewed it and found it “seriously flawed” and “uninterpretable.” It wasn’t discarded arbitrarily. It failed basic methodological standards. The framing of “the CDC threw it out” implies a cover-up. But the rejection of a vaccine-autism link isn’t a CDC position alone. It’s the consensus of independent researchers worldwide, the National Academy of Medicine, the American Academy of Pediatrics, and the WHO. Notice the rhetorical narrowing: by specifying “first six months,” RFK Jr. sidesteps the enormous body of MMR research (given at 12-15 months) while implying earlier vaccines are an unstudied blind spot. They aren’t. The evidence base is enormous and consistent. Over 30 studies, millions of children, multiple countries, different methodologies, all pointing the same direction. Continuing to re-examine a question answered this thoroughly isn’t scientific rigor. It’s manufactured doubt. Resources spent relitigating resolved questions are resources not spent understanding what actually causes autism or improving the lives of autistic people. The CDC, under RFK Jr.‘s influence, has called for re-examination of this question. The WHO, the AAP, and researchers worldwide have not followed suit. There’s a reason for that.

This shouldn’t be a philosophical debate. It’s a misunderstanding of how infectious disease works. Vaccines aren’t perfect. The measles vaccine is 97% effective with two doses, not 100%, so some vaccinated people remain vulnerable. More importantly, some people can’t be vaccinated at all: infants under 12 months, immunocompromised patients, people with anaphylactic reactions to vaccine components. They depend on the rest of us not spreading a highly contagious virus to them. Measles has an R0 of 12-18, meaning each infected person spreads it to 12-18 others in an unvaccinated population. The virus can linger in the air for two hours after an infected person leaves a room. At that level of contagion, you need 92-95% vaccine coverage to stop community transmission. When coverage drops, outbreaks happen, and the people who pay the price are often those who had no choice in the matter. “My body, my choice” makes sense for decisions that affect only your body. Transmissible disease isn’t that. Your choice not to vaccinate can put a 6-month-old in the hospital or kill an immunocompromised kid who couldn’t get the shot. The question isn’t “why does it matter if I take it.” The question is whether your comfort with risk should override someone else’s right not to get infected by you.

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Art not made with AI

Thirty Years of Ortho: What I’d Tell the Next Generation I’ve been an orthopedic surgeon for three decades. Long enough to see techniques come and go, implants rise and fall, and the pendulum of “standard practice” swing back and forth more times than I can count. What hasn’t changed are the pressures that come with the job… and the quiet lessons you don’t fully understand until you’ve liv,ed them. If I were talking to the next generation—residents, fellows, the young attendings just getting their legs under them… this is what I’d tell them. You can’t build a meaningful career on RVUs. You can meet every target and still feel empty. A career that lasts is built on trust, judgment, and relationships. You don’t measure that in productivity metrics. A good surgeon listens more than they talk. People think surgery is a technical field, but the real work is in understanding what someone is actually asking of you. Most patients are just scared. They don’t need your scalpel, no matter what the MRI shows. Half the mistakes in this profession start with bad listening. Master the anatomy. Master the craft. But learn the limits too. Early in your career, you’re focused on what you can do. With experience, you start to appreciate what you shouldn’t do. Judgment is a superpower. Protect your time, or the system will take every minute you allow it to. Learn to say no!!! There’s no shortage of demands. Notes. Inboxes. Meetings. Every one of them feels urgent. Some of you might actually feel important when you go to meetings... But... None of them is worth sacrificing your sanity or the people waiting for you at home. Seek colleagues, not titles. Promotions and committee seats feel important for a season, but it’s just fluff, and nothing gets accomplished in those meetings anyway. Your strength matters more than you realize. Not your technical strength—your physical and emotional strength. You can’t take care of people if your own health fades. Move, lift, sleep, and protect your energy. A worn-out surgeon becomes brittle. Be the doctor you’d want for your family. You need a life outside the operating room if you want a long life inside it. The surgeons who last aren’t the ones who work the most—they’re the ones who stay grounded. They have people they care about, interests that pull them away from medicine, and enough perspective to know that identity and work are not the same thing. Thirty years in, the operations are only part of the story. What keeps you going is the purpose behind the work—helping people move, reassuring them when they’re scared, giving them back pieces of their life. That’s the part that never gets old.

Never count out @BYUMBB

@DrAkhilX Xerosis

Tell me a medical term starting with the letter 'X'.

In a remarkable perspective piece just published in the New England Journal of Medicine, nearly every living FDA Commissioner or Acting Commissioner blast Vinay Prasad's recent memo to CBER staff outlining changes to vaccine policy. *Extremely* uncommon nejm.org/doi/full/10.10…

The CDC just rewrote its vaccine and autism page to claim that saying "vaccines do not cause autism" is not evidence-based. This is false. The evidence is overwhelming & consistent. 🧵 cdc.gov/vaccine-safety…

@BarstoolBig12 Why is the best one way in the back?

Who has the best mascot in the Big 12??