Intervening Interventionalist

@amar_4inc @MarcoFoster_ Says the bit from India

@MarcoFoster_ Jennifer Welch said what many are afraid to say , when hate is being packaged and fed to the next generation, silence becomes complicity. This needed to be called out.

Jennifer Welch to Erika Kirk: “You are the racist fascist about whom I am talking to. The work your husband’s company and that you are doing to America’s youth to make them racist, narrow-minded, hateful and batshit crazy is an absolute disgrace”

Congressman Jamie Raskin has been ordered to repay the federal government $304,000 he took from the illegal student loan debt relief program for his daughter's tuition to Stanford. "Mr. Raskin knew the program would be shot down," wrote 14th District Judge Joseph A Barron, "so he pushed his application through using his position." Raskin's defense was that the program was perfectly legal when he took the money. "That defense is summarily rejected." The judge also noted that the Raskins are worth more than $14 million and shouldn't have qualified in the first place. "There's grounds for a criminal case here if ever this court saw one."

@DrDadBuilder In academia, those “community service hours” are mandatory for promotion

Hospitals pitch today where with dire need for urology. “10 call days a month. Unpaid. Think of it as community service.” I immediately thought about how many hours of the 240 hours of ‘community service’ the C-suite logs. Hard pass. There’s a better way to practice. What’s call culture like where you are? #MedTwitter #PhysicianBurnout

If it was a fax machine, no one would care. It’s because it resembles a human, even worse a child. That is on purpose. So humans don’t destroy them. Personally I would prefer all of my robots to look nothing like humans so I could treat them as they should be treated.

@iAnonPatriot This is not masculine

@MurrayHillGuy1 Now do women

Being attractive is basically life’s biggest cheat code. Same guy: 5/10 → “creepy, try harder bro” 9/10 → “omg he’s so confident 😍” Late to work: ugly → “unprofessional” hot → “he’s just busy like that” Says nothing at dinner: ugly → “awkward & weird” hot → “mysterious” We all pretend it’s personality but let’s be real… attraction rules over mostly everything in life

@DrDeepMD Surgeon making more than a million???? Hahah. neurosurgeon or ortho spine maybe (private too). People have no idea

lol on the surgeon/specialist Only ~1% of docs make $1m +/yr (including these groups) It is exceptionally rare to meet docs raking in millions Sure, you can be a burger flipper and make $1m too…if you own 12 franchises But. If you’re trying to get rich, I’d avoid medicine

@DrDeepMD I lost weight in fellowship. Was under 100 lbs. I time to eat. Best education that almost killed me

Residency training is brutal 80 hour weeks, months at a time just on nights, totally wrecking circadian biology No sunlight, inside all day every day getting blasted by LEDs and blue light and incessant alarms Slop trash food and snacks at every turn No wonder I gained 50lbs, lost all my hair, was totally inflamed, prediabetic, and on track to lose a decade+ off my life All while training how to save others Irony at its finest Thankfully, I’ve seen the light and turned it all around (except the hair part 😅)

As a rehab resident, terminal cancer patients were sent to acute rehab and told if they try hard and get stronger they can do more chemo to live. I can’t tell you how many people I sent directly to hospice. It was tragic. Making terminally ill patients in horrible pain try to exercise and get out of bed. This is where I learned end of life care. Unfortunately. Educational for me. Terrible for patients.

It was kind of started as a slow week in the ICU. Busier the last two days. 7 out of the 10 patients I’ve admitted since Wednesday had stage 4 cancer. Two are now dead. One of them was 79 getting platinum based chemo therapy. Gone now. Probably one more tomorrow. The rest I’ll get tuned up and out for more. Look. I know I have some oncologist followers. And I’m not trying to get personal with you . But what the f*ck is this bullshit? I can’t help but feel bitter as a MFer when I’m the one bedside with the crying wife and son today after some hare brained Hail Mary bullsh*t. Hasn’t been an oncologist in sight all weekend. Do these patients even know what the end is going to look like in the hospital? Maybe there is a better way to approach these cases? Hang your chemo. Bill your weekly clinic full of multiple level 5 bills because it’s all toxic effects of the Hope. Get paid the big salary. And leave someone like me to shovel all the dogshit at the end. It’s a moral f*cking hazard. Seems like the decent thing would be to come in and see your patients as they die. And I couldn’t figure out what was eating me this week until tonight. And this just crashed on me. Over me. It pisses me off. I’m venting. Yes. I’m. Venting. And I’ll get over it. But f*ck guys. And that’s it. I get up at 5am on a Sunday. To do it again. For one last day this stretch of 7. You’re welcome.

This is why I love @ThomasSowell's point about tradeoffs. Paying $245 for an MRI forces someone to decide whether the MRI is worth more than the other things they could spend $245 on. That is how people reveal relative value. Yes, it's not fair. But neither are any of the financial decisions we make in life. The resources we consume are limited, and the prices we are willing to pay reflect the relative value we place on those limited resources. If the cost of the MRI socialized through insurance or government, we are not eliminating the tradeoff. We are saying the patient does not get to decide the relative value. Someone else does: taxpayers, premium payers, employers, or the insurer through prior authorization and rationing. For people truly living paycheck to paycheck on necessities, the more efficient answer is not “insurance” for a $245 service. It is a means-tested cash-equivalent subsidy, voucher, or HSA-style support that lets them buy the MRI directly at the transparent price. Insurance should protect against financial catastrophe. It should not be a convoluted prepayment system for low-cost, shoppable services.

I have two stacks on my desk. The left stack is financial disclosure forms from members of Congress. The right stack is waivers for members who filed their financial disclosures late. The right stack is always taller. On Wednesday morning, I watched a soldier get arrested on CNN. I am a Disclosure Analyst for the House Ethics Committee. I have held this position for eleven years. My job is to receive the forms, verify their completeness, and file them. I do not investigate. I do not flag. I do not refer. I file. I have a lanyard. The lanyard says ETHICS. The soldier's name is Gannon Ken Van Dyke. He is thirty-eight years old. He was stationed at Fort Bragg. He was Special Forces. In December, he created an account on a prediction market called Polymarket. On January 2nd, he bet $32,500 that the president of Venezuela would be removed from power. On January 3rd, he helped remove the president of Venezuela from power. He collected $409,881. He has been charged with five federal crimes. Commodities fraud. Wire fraud. Unlawful use of confidential government information. Theft of nonpublic government information. Unlawful monetary transaction. The Department of Justice called it "the first-ever insider trading prosecution on event contracts." I watched this on the television in our break room. Then I walked back to my desk and processed a late financial disclosure from a member of the House Financial Services Committee who purchased $250,000 in bank stocks eleven days before his subcommittee held a closed-door hearing on proposed capital reserve changes. The filing was forty-seven days late. The STOCK Act requires disclosure within forty-five days. The penalty for late filing is $200. I waived it. I waive most of them. In 2021, fifty-four members of Congress and senior staff violated the reporting rules. The fines were minimal. Most were waived. I have a form for the waiver. The form has a box that says "Reason." I write "administrative delay." In ethics, "administrative delay" means the member's office forgot and then remembered when a reporter called. My approval rate is one hundred percent. In any other field, that number would trigger an audit. In mine, it is called thoroughness. Let me show you what I processed this year. January. A senator on the Armed Services Committee sold defense contractor shares worth $1.2 million. Three days later, his committee received a classified briefing that the Iran campaign had exceeded its projected cost by 340%. The stock dropped 8%. He filed the disclosure sixty-one days late. I calculated the fine. $200. His chief of staff asked if it could be waived. He did not ask what the senator traded on. Nobody asks that. The form does not have a field for it. I waived the fine. The senator's portfolio returned 23.4% in 2025. The S&P 500 returned 16.8%. February. A representative on the Energy and Commerce Committee bought pharmaceutical stocks worth $400,000. Two weeks later, her committee advanced a bill that would extend patent exclusivity for the exact drug class she purchased. The stocks rose 14%. She filed on time. There was no fine. There was no investigation. There was nothing to investigate because buying stocks in companies regulated by your own committee is not illegal. It is legal. The STOCK Act made it legal by making it disclosed. In Congress, disclosed means legal. In my office, legal means filed. March. A member whose spouse manages a portfolio worth $9.2 million reported forty-three separate transactions in a single quarter. Twelve of them were in sectors directly affected by legislation the member co-sponsored. The timing on eight of those twelve was within a two-week window of committee action. I logged all forty-three. None were flagged. We do not flag. We file. I asked my supervisor once what would happen if I flagged a filing. She said we do not have a form for that. I never asked again. In 2020, I processed 847 disclosures. In 2023, 1,211. In 2025, 1,614. The number of enforcement actions in each of those years was zero. The numerator changes. The denominator does not. I want to tell you about the soldier again. He made $409,881. He tried to delete his Polymarket account by calling customer service and saying he lost access to his email. He moved his profits into a foreign cryptocurrency vault and then into a new brokerage account. He used his real identity. He placed thirteen bets. Every single one was connected to an operation he personally participated in. In my eleven years, I have processed disclosures from members of Congress who traded on: Pending FDA approvals they learned about in committee. Defense appropriations they voted on. Trade policy they negotiated. Pandemic response measures they drafted. Interest rate decisions they were briefed on before the public. None of them have been charged. None of them have been investigated by the Department of Justice. None of them have been referred to the SEC. The STOCK Act has produced zero prosecutions since it was signed on April 4th, 2012. Fourteen years. Five hundred and thirty-five members. $635 million in trades last year alone. Zero cases. My daughter asked me once what happens when someone breaks the rules. I told her we write it down. She asked what happens after that. I said it depends. She was nine. She is twenty now. It does not depend. Nothing happens after that. The soldier made $409,881 and faces decades in prison. Nancy Pelosi entered Congress in 1987 with a portfolio worth approximately $785,000. It is now worth $133.7 million. That is a return of 16,930%. The Dow Jones returned 2,300% over the same period. Professional fund managers who beat the market for three consecutive years are considered exceptional. She has beaten it for thirty-seven. If a hedge fund produced those returns, the SEC would subpoena the records on a Thursday. She produced them from a building with a chapel and a gift shop. She announced her retirement last year. No investigation was opened. No disclosure was flagged. Her filings were on time. In my office, on time means compliant. Compliant means closed. I want to tell you about the fine. $200. That is the maximum penalty for violating the STOCK Act's disclosure requirements. $200 for a member of Congress whose portfolio gained $4.7 million in a single quarter. I calculated what $200 represents as a percentage of $4.7 million. It is 0.004%. I could not find a comparison that made it meaningful. It is less than the price of the parking pass in the Rayburn garage. It is less than lunch at the members' dining room if you order the crab cakes, which I am told are excellent though I eat at my desk. Since 2012, thirty-one bills have been introduced to restrict congressional trading. I keep a list. The list is longer than the STOCK Act itself. On March 5th, 2026, a representative from Michigan introduced the thirty-second. He called it the "No Getting Rich in Congress Act." The bill would prohibit the President, Vice President, members of Congress, and their spouses from trading individual stocks, cryptocurrency, futures, and commodities while in office. The bill was referred to committee. The committee has not scheduled a hearing. The committee is chaired by a member whose spouse executed $2.1 million in trades last year. The bill will be reviewed. In my office, reviewed means read. Read means acknowledged. Acknowledged means a status has been assigned. A status is the absence of an action that has been given a name so it looks like one. The soldier used classified information to make $409,881 on a prediction market. He has been charged with five federal crimes. The Department of Justice announced the case on the same day I processed three disclosures from members who traded on committee knowledge worth a combined $3.8 million. The difference between the soldier and the members is not what they did. It is the building they did it in. He did it from Fort Bragg. They did it from the Capitol. He used a prediction market. They used the New York Stock Exchange. He bet on a military operation. They bet on the legislation they write. He did not write the law. They did. They wrote the STOCK Act. Then they funded its enforcement at zero dollars. Then they set its maximum penalty at $200. Then they gave my office the authority to waive it. Then they traded $635 million. The soldier flew to Caracas. He breached a compound. He put his body between a mission and a bullet. The people who ordered the operation were in a building with a credenza and sparkling water. They did not go to Caracas. They went to their brokerage accounts. The soldier made $409,881 and is now in federal custody. The people who knew what he was going to do before he did it made more and filed less. His prosecution is not a failure of the system. It is the system. One conviction per decade, at the lowest level, so the briefing slides can say enforcement exists. The $409,881 is not the crime. It is the cost of making $635 million look supervised. In my field, we call this self-regulation. The soldier's Polymarket account has been frozen. His military career is over. He will spend years in federal prison. My office will process every congressional disclosure filed this year. Every trade logged. Every $200 fine calculated and waived. The system is immaculate. Fourteen years. Zero prosecutions. $635 million a year. A 16,930% return. I have not leaked a document. I have not filed a complaint. I have not deviated from the process one single time. The process was written by the people whose forms I process. As long as the disclosures go up and the cases don't, my performance review says I am meeting expectations. My lanyard still says ETHICS. In eleven years, nobody has asked me to define the word.

@BenSasse Ha! Ps praying for you

what kind of cocaine is good for cancer?

@realdocspeaks Haven’t reviews the literature referenced but the new castle and other quality measures for chosen studies are still subjective. It’s better than nothing, but to pretend that SR with MAs are completely objective is foolish

This is exactly what we don't need! Let's attack the male doctors based on the meta-analysis done on 35 studies. Meta analysis are a joke, you look at 35 studies done over varying time periods, with different patient populations, and then you massage the stats to get a "statistically significant" and clinically irrelevant finding. Males work longer hours and for a longer time period and are constantly criticized. There are numerous organizations that promote women, but none for men and a few are: • American Medical Women's Association • AAMC Group on Women in Medicine and Science • Association of Women Surgeons In stead of dividing physicians, you should support all physicians. Other physicians aren't the problem!

@MaryBowdenMD But who are the members who voted for him ?

The country’s largest state medical society, Texas Medical Association, just elected John Carlo as Chairman of the Board. Carlo is CEO of Prism Health, which focuses on HIV and transgender care. As former leader of TMA’s COVID task force, Carlo supported mandates and lockdowns.

@hjluks @CynicalPublius This

@CynicalPublius You sure the pain is due to the meniscus tear? Not a rhetorical question. Having that surgery will increase your risk of OA. Not saying you don’t need it. Just saying that this decision making isn’t as straightforward as most would assume.

I'm getting my knee scoped on Tuesday. I have a bad meniscus tear. It went from being a minor annoyance to crippling almost overnight, without any single instance of injury. There is some arthritis in there too, I'm hoping to avoid an eventual knee replacement (too many bad PLFs and 12 mile ruck marches, IYKYK😉). I already have an icing machine from my shoulder replacement, but does anybody have any helpful tips/ideas? Thanks in advance.

@newstart_2024 Mitochondria is still from the mom so definitely a fetus with 3 parents

Three-parent babies are already happening. Andrew Huberman explained a controversial new fertility technique called three-party IVF (legal in Mexico, the UK, and parts of Europe, but still illegal in the US). The method: Take the nuclear DNA from the intended mom and dad, then insert it into a younger donor egg that keeps its healthy mitochondria (the cell’s energy factories). This can dramatically boost success rates for older women or those with mitochondrial problems. It started in mice, moved to primates, and is now being used in humans. Would you support three-party IVF becoming legal in the US, or does the idea of a child having genetic material from three people cross an ethical line?

I love this form of meditation. My daughter has spent every night before bed easy sewing a bunch of different animals. So precious but she does it in silence or with music. No iPad. She said it’s a form of relaxation. I showed her your post. Beautiful soul. She said I get it.

Should finish this hat before sleeping tonight!

Interesting

@hjluks @Brady_H Train in Texas like I do and you’ll be okay in 95 degree weather while doing a 7 mile….. well not okay but you do it anyway because you don’t have a choice.

Hahaha. Last week was 35-40 degrees. Could keep a 10 min pace at 120 hr. So… today is 85 and humid 🤣🤣 HR was 135 at 12 min/mi Heat sucks. Except if you’re @Brady_H

@kevinmd Don’t care created by AI. It’s truth.

Hospitals are putting hard caps on physician compensation, sometimes as low as the 75th percentile, and calling it fraud and abuse protection. Think about what that means. If earning above the 90th percentile is inherently suspicious, then 10 percent of every physician in every specialty must be breaking the law. At the 75th percentile, 25 percent of all physicians are apparently committing fraud. That logic falls apart the moment you say it out loud. Health law attorney Dennis Hursh has been reviewing these clauses for years, and he says they are showing up in the majority of physician employment contracts now. Some contracts say compensation "may be reviewed" if it exceeds the threshold. Others are blunt: under no circumstances will your total compensation exceed this number. So if you are the most productive physician in your specialty in the entire country, your pay is frozen. Every dollar you produce above that cap flows to the institution. And as Hursh puts it, the CEO's bonus is not capped. It gets worse. Most hospitals are not giving physicians clear, timely productivity data. You might be told you produced 9,500 WRVUs, but without access to the actual benchmarks, you have no idea whether you are approaching the cap. You are flying blind while working at a pace that funds someone else's compensation growth. There is also a downstream effect that hurts the entire profession. Compensation surveys from MGMA and SullivanCotter use reported salary and productivity data. When the highest producers have their pay artificially suppressed, it pulls benchmark numbers down for every physician in that specialty the following year. The cap does not just limit one doctor. It compresses pay across the board. Hursh says physicians need to review contracts for this language, demand regular and transparent productivity reports, and push for independent third-party compensation reviews when they are producing at the top of their field. The hospital should not be the one deciding whether the cap is justified. The physicians most hurt by this are exactly the ones hospitals cannot afford to lose. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Have you seen this cap in your own contract? #ThePodcastbyKevinMD