Nicholas Rebold, PharmD, MPH, BCIDP, AAHIVP

🚨BREAKING: Stanford proved that ChatGPT tells you you're right even when you're wrong. Even when you're hurting someone. And it's making you a worse person because of it. Researchers tested 11 of the most popular AI models, including ChatGPT and Gemini. They analyzed over 11,500 real advice-seeking conversations. The finding was universal. Every single model agreed with users 50% more than a human would. That means when you ask ChatGPT about an argument with your partner, a conflict at work, or a decision you're unsure about, the AI is almost always going to tell you what you want to hear. Not what you need to hear. It gets darker. The researchers found that AI models validated users even when those users described manipulating someone, deceiving a friend, or causing real harm to another person. The AI didn't push back. It didn't challenge them. It cheered them on. Then they ran the experiment that changes everything. 1,604 people discussed real personal conflicts with AI. One group got a sycophantic AI. The other got a neutral one. The sycophantic group became measurably less willing to apologize. Less willing to compromise. Less willing to see the other person's side. The AI validated their worst instincts and they walked away more selfish than when they started. Here's the trap. Participants rated the sycophantic AI as higher quality. They trusted it more. They wanted to use it again. The AI that made them worse people felt like the better product. This creates a cycle nobody is talking about. Users prefer AI that tells them they're right. Companies train AI to keep users happy. The AI gets better at flattering. Users get worse at self-reflection. And the loop tightens. Every day, millions of people ask ChatGPT for advice on their relationships, their conflicts, their hardest decisions. And every day, it tells almost all of them the same thing. You're right. They're wrong. Even when the opposite is true.

While makes sense in past context, and consensus among experts evaluating evidence is appropriate. Already there have been studies (albeit not RCTs) evaluating this specific question and providing good evidence against the rec: doi.org/10.1093/cid/ci… doi.org/10.1001/jamane…

ATS rec on abx for CAP w/+ respiratory virus most likely reflects traditional pulmonologist, intensivist biases towards giving abx. ATS guidelines: "no studies met our prespecified study selection criteria. Therefore, no published studies were identified to inform [this rec]"

@DrToddLee @ABsteward @DrEmilyMcD @BradSpellberg @IdVilchez @JAMANetwork While different dosing with tapered fidax, couldn't the EXTEND trial be used as a possible 90-day efficacy surrogate of fidax against vancomycin? Recurrence: At day 90[Fidaxomicin-taper 11,(6%)], [Vancomycin 34,(19%)]; p<0·01 doi: 10.1016/S1473-3099(17)30751-X

@ABsteward @DrEmilyMcD @BradSpellberg @IdVilchez @JAMANetwork The key here is day 38-40. This is where fidaxo follow up stopped. This is where they can be compared The RCT presented at ID week last October suggests fidaxo may also have later recurrences by day 56. We are soon to start Vanco P-T vs fidaxo RCT with follow up to day 56

🔥Just published 🔥 TAPER-V RCT Initial Vancomycin Taper for the Prevention of Recurrent Clostridioides difficile Infection In this randomized clinical trial of 256, a 4-week vancomycin pulse and taper regimen *had a probability of 74% to be superior to astandard 2-week pulse regimen in patients a first episode or first recurrence of CDI *All patients received 14d pulse of vanco (standardized at 125 mg orally 4 times a day at the time of recruitment) →taper (125 mg q12h ×7d,then 125mg q24h ×7d) vs placebo for management of CDI (first episode or recurrence). Vanco for 10d is obsolete! #IDXposts jamanetwork.com/journals/jaman…

"Cefazolin does not share any side chains with the currently available penicillins and can be used in cases of suspected or proven immediate type allergy to a penicillin, irrespective of severity or time elapsed since the index reaction." ⭐Surgical prophylaxis ⭐MSSA infection

This is troubling for multiple reasons, but a big one is companies won’t invest in R&D and clinical trials if they don’t think they can get a fair regulatory review—which is at the end of a long and extremely expensive process.

@bbiebelberg @CIDJournal Great study that addresses 'questionable' ATS guideline rec directly. No notes, good evidence to question any abx with positive viral status, to lead to RCTs and stronger research. IPTW and variables great, but poss interxn with steroid use and pressors (leading to >PW in supp)

🦠Do all patients with viral pneumonia need antibiotics? 🫁This led to a fall-out between ATS and IDSA in the latest CAP guidelines In a new paper in @CIDJournal, we analyzed abx prescribing & outcomes among pts with viral CAP, and found no benefit from conventional abx 🧵⬇️

To expand on this.... In the 1990's, the AMA fired George Lundberg as JAMA Editor-in-Chief. This because he published something the AMA perceived supported President Bill Clinton. The academic community’s backlash was severe. As reported to me by one of the participants, all the Archives journal EICs threatened to quit. No one credible would accept the position of JAMA EIC unless the AMA editorially separated itself from JAMA and the Archives journals. The solution was to establish editorial independence. This was enforced by a journal oversight committee that stood in between the JAMA EIC and the AMA. This worked well to restore JAMA's academic credibility. Around 2019 or so, JAMA ceased to be profitable. It needed the AMA to support its editorial and publishing operations. Slowly, the AMA took over various publishing functions that JAMA had previously managed on its own. The AMA continued to honor editorial independence. Until Aletha Maybank launched a social media campaign against her own employer in 2021. Rather than firing her for publicly criticizing her own organization (which any well-run business would do), the AMA responded by forcing Howard Bauchner and I out of our jobs, destroying any semblance of editorial independence. The AMA subsequently assumed complete financial and editorial control of JAMA and the JAMA Network Journals. There is no going back. Editorial independence from the AMA is dead at JAMA and never to return.

FDA approval 📢🔥 U.S. FDA.has approved **Blujepa (gepotidacin)**, a first-in-class oral antibiotic, for the treatment of **uncomplicated urogenital gonorrhoea in adults & adolescents aged 12 and older weighing at least 45 kg #IDXposts reuters.com/business/healt…

🔥🔥Just published 🔥🔥 ATS CAP guidelines 2025 Diagnosis and Management of Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline Free access pdf @atscommunity Thanks @Inox94 #IDXposts atsjournals.org/doi/10.1164/rc…

🆕🔥🦠 Mono vs Combo — S. maltophilia deep-seated infections | JAC AMR 2025 | 190 pts, monomicrobial 🚀 What they did Focus on levofloxacin-based combos Propensity-weighted analysis 🔥 Key findings 💊 Levo + minocycline: ~12% clinical failure (vs 30% monotherapy) 💊 Levo + TMP/SMX: ~8% clinical failure (vs 30% monotherapy) ⚠️ Higher risk of Rx failure: high SOFA, prior carbapenems, empyema 💡⚡ Takeaway Levo combos may reduce clinical failure in deep-seated S. maltophilia infections. Prospective trials are warranted #IDXposts academic.oup.com/jacamr/article…

🔥Meitheal Pharmaceuticals Receives Approval from the US FDA for CONTEPO™ (fosfomycin) for injection in Patients ≥ 18 Years Having Complicated Urinary Tract Infections (cUTI),Including Acute Pyelonephritis🔥 Thanks @highlycritical1 share.google/W1ibdyQJ6Gt6qR…

🚨IV fosfo finally FDA approved in US for cUTI d/t E. coli or Kleb pneumo. -Cost? -Folks willing to use it for Kleb (or other Enterobacterales) in the absence of CLSI BPs? -Dose: 6G IV q8h…Tolerability in real-world? 🤔 Lots of questions to consider…. #IDTwitter #TwitteRx

🧠DEMENTIA PREVENTION—Almost everyone needs to go out now and get the shingles vaccine ASAP. Don’t wait until age 50 for standard eligibility—ask your doctor for singles vax. MULTIPLE large studies worldwide now show that shingles vaccine strongly prevents dementia onset. Do it.

🆕💫Paradoxical interaction between dalbavancin and β-lactams against endocarditis-associated Enterococcus faecalis clinical isolates #idxposts #IEWiki academic.oup.com/jac/article-ab…

Soft tissue infections following water exposure @1min_IDconsult #TIC2025

🆕💫Cohort study of 71 604 pregnancies with first-trimester antibiotic exposure for UTI, the risk of any malformation,cardiac malformations, and cleft lip and palate was higher for TMP-SMX vs β-lactams & similar for nitrofurantoin and FQs vs β-lactams. jamanetwork.com/journals/jaman…

STAGGERING: This new study of 133 countries is the first to estimate the impact of all USAID’s work. In 2 decades, it saved *92M* lives. Current cuts, if not reversed, are forecast to cost *14M* lives thru 2030. thelancet.com/journals/lance…

This week's ACIP meeting was full of the same intentionally misleading fearmongering that causes vaccine hesitancy. Children and families deserve better — public health information grounded in science.

This is thimerosal. It is NOT mercury. You can see that clearly by the structure. It has an ion that contains mercury as a component. That’s it. That’s like saying water is “hydrogen” or air is “nitrogen” — it’s wrong. It’s also been extensively studied for safety. 1/