The Red Door

@DrDeepMD Yep. I’ve audited over 200 hospitals and the infection control is abysmal in all of them. Don’t get me started on their labs and onsite pharmacies.

For those who haven’t ever worked in a hospital Coming from someone who worked at some the top hospitals in the world They are some of the most dangerous places you can set foot in 1/5 people come back within 30 days due to complications Nosocomial infections are often MUCH worse than community acquired One thing leads to another and the whole thing spirals out of control We have some of the best acute care in the world. But. Do everything possible to avoid becoming a patient inside of one if you can help it

@mcuban The bigger question is why aren’t auditors doing their job in calling out the behavior? Instead they enable it with advice. So much for independence. SOX is meaningless.

If a healthcare company has 2700 subsidiaries and does 160 billion dollars annually in inter-company transfers, do they care if the government is involved or not ? If another company, same industry thinks they are so powerful they won’t show senators the pricing of a government contract with TriCare, even in a SCIF Do they really care if the government is involved or not ?

@kpharmd12 Well done Ohio. They led the way with the AG lawsuits. This is what it should look like…

Gainwell Technologies. Also mandatory dispensing fee ($10-$13) attached to every prescription dispensed no matter what pharmacy the Rx is filled. Even with that “extra” money paid out to pharmacies, the state is still saving more money vs. how it was before. Also, there is almost 100% in-network participation among Ohio pharmacies. I would bet no other PBM out there can boast those kind of numbers.

Ohio has already done it. Single PBM for Managed Medicaid plans. Same PBM for traditional Medicaid as well. There is no reason whatsoever why every State in the U.S. shouldn’t be doing it this way. In just the first two years, Ohio saved $140 million compared to the way it was before we got rid of the biggest PBM leeches.

@mcuban @PalmerLuckey He’s right. The consolidation reeks of conflicts of interest. The behemoths must be broken up by the FTC and the DOJ. Collusion, price fixing and RICO violations abound. All it takes is an honest investigation.

Yeah. That won’t work. The biggest players are vertically integrated and too big to give a shit. They keep competitors out (like my companies ) , set pricing and the rules and could not give a shit about outcomes. Sounds great as a concept. But ideology is not a healthcare strategy. You break them up. Then you may be able to start to pull gov out at some levels.

No chance it would. When there is regulatory capture, huge conglomerates effectively define the prices and rules. Not government. They would love to have government out of the way. They are so big, with so many subsidiaries, they could whatever they want. And it wouldn’t be to the benefit of patients.

@ScottPresler I hear you are raising funds for a primary. Please let us know where to contribute to your cause.

Senate Majority Leader Thune REFUSES to pass the SAVE America Act. If Thune won’t give us what we want. then we will take away his allies — peacefully. 👉I’m asking Texans to ELECT Ken Paxton & DEFEAT Senator John Cornyn👈 🗓️ Tuesday, May 26th, 2026 Game on!

@HomerPavlos @PastPaulitics I’m a Greek woman who also reads and speaks both current and Ancient Greek. Studied it for almost a decade and you are correct. She has no idea what she is talking about. We need to just ignore her. Shame because some women are brilliant. Just like some men.

Emily Wilson is a kind of a feminist that is truly a bad person that wants to hurt you. Not directly, but in depth, through her profession as a classicist. She is attacking my culture and the Greeks because she hates virtues. She is blatantly lying because most of you don't know to read Greek. But I am Greek and I can read both modern and ancient Greek. So let me tell you why she is purposely lying. The references with insulting epithets toward the servant/slave women who betrayed Odysseus’s house and slept with the suitors are numerous. The most common ones, however, are "bitches" and "shameless" that were serious insults. Most foreigners translated the word "bitch" as "slut" which is correct to say that this is wrong because it's not what the text writes but in a sense of "non-literal translation" it's not out of context because those women who slept with the suitors and betrayed Penelope were "shameless bitches". Especially the word "shameless" is a strong insult in Greek. It implies sexual shamelessness lack of decency, and moral boldness and this is why foreign translators are using the word "sluts" in English. But Homer doesn't use the Greek word directly to call them "whores". The following translations I will use are made directly from the ancient Greek text into modern Greek. We Greeks do not read foreign translations. What we call an adaptation (απόδοση) from ancient to modern Greek is not considered a "translation" for us, since it is the same language. In other words an adaptation of a Greek text bridges the gap between ancient or dialectic Greek and the modern target audience. 1. Odysseus to a servant woman (Book 18, line 340): "Bitch, if I go and immediately repeat your wretched words to Telemachus, he will tear you to pieces, you’ll be smashed into bits." [ἦ τάχα Τηλεμάχῳ ἐρέω, κύον (=Bitch), οἷ᾽ ἀγορεύεις, κεῖσ᾽ ἐλθών, ἵνα σ᾽ αὖθι διὰ μελεϊστὶ τάμῃσιν] 2. Penelope to Melantho (the servant who slept with Eurymachus and betrayed them), when Melantho spoke rudely to Odysseus (who was still disguised) (Book 19, line 91): "Nevertheless, you bold, shameless bitch, you do not escape my notice at all, doing a great deed which you will wipe off on your own head." [πάντως, θαρσαλέη, κύον ἀδεές (=fearless bitch), οὔ τί με λήθεις ἔρδουσα μέγα ἔργον, ὃ σῇ κεφαλῇ ἀναμάξεις] 3. "Perhaps in foreign lands too, some servant women insult him, every time he enters a famous lord’s house, just like these bitches here who all together insult you, stranger. I imagine that to avoid their reproach, their shamelessness…" (Book 19, around line 370) 4. "Servant women shamelessly dragging themselves here and there." (Book 20, line 318) 5. "Twelve of them appeared completely shameless, who had no regard for me and showed no respect to Penelope." (Book 22, line 422) Emily Wilson cannot tolerate any criticism of the women who betrayed the man Odysseus and slept like shameless bitches with the enemy, betraying Penelope. In her worldview, men are always the bad guys, and only women are the heroines. She herself calls the academic translators misogynists. It is inconceivable that there are today "eunuch" academics who defend this malicious and worthless woman. This woman is in Classical Studies in order to destroy them, so that you, who will read her books, will form a false image of the epics that built Western civilization. How Odysseus is not a hero, Achilles is not a hero, men are not great and brave but evil, and how the patriarchy must be fought so that women can win. They are trying to convince you that there is no heroism in Homer. Yet the epics were written precisely for this reason: so that you understand what it means to be a hero, what sacrifices are required, what difficulties you will face, and how you will achieve eternal fame. How you will conquer your passions, how anger destroys you, and how moral virtues lead you toward godlike status. She hates all of this. She wants you spiritually dead. She hates you. Therefore, it is completely justified for you to hate them too.

@megbasham @GeorgiaMaeHowe He is. When he was at John’s Hopkins he and Ge Bai would post about the grift they discovered in their research around healthcare. He knows the system. He called it out. He’s a good man.

I don’t know what was behind Makary’s resignation, but if I can piggyback on this essay, when I found out I had cancer, my coworker @GeorgiaMaeHowe urged me to reach out to Marty Makary to see if he might offer some advice. We had interviewed him on Morning Wire, so I had his contact information. But I thought, my goodness, the man has just taken over the FDA! I can’t imagine how busy he is—I can’t bother him with my garden variety cancer diagnosis! But, I also had some decisions to make. And it can be hard to know what treatment path to choose as an ordinary person with no medical expertise. So I bit the bullet and called him, a little nervous that he might find me presumptuous. Not only did he give no hint that it was an imposition that I called him, he stayed on the phone with me for about 45 minutes, walking me through all the variables. Then he asked me who I was considering for my surgical oncologist. I mentioned a couple of names and he said, “Let me look into them and get back to you.” This was far more than I was expecting from someone in his position with the kinds of demands he has on his time. But he called back a few days later and had vetted my surgical options and highly recommended one in particular. He had made calls to other oncologists he knew in Charlotte to ensure that it wasn’t just someone well trained surgically who looked good on paper, but also someone who had a great reputation for being ethical. (and let me just say, I took Makary’s advice on which surgeon to choose, and it turned out to be a massive blessing because that guy wasn’t only an amazing physician, he also turned out to be a strong Christian, who goes to Kevin DeYoung’s church, so he was really encouraging spiritually through the process as well!) Then Makary encouraged me to call him anytime if I needed further advice. Which I did, and on those occasions, he once again stayed on the phone with me for a long time, providing counsel and walking me through my options. So all that to say, I’ve personally experienced Marty Makary’s character and I have to agree with this assessment. He’s a good man.

@DrDeepMD @ManOnThePen Pancreatic insufficiency that goes with those two is also severely underreported. The flip side is that the benefits really do outweigh the cons when this treatment is done correctly. The key is “correctly.” Most patients don’t follow instructions.

Nice chart by @ManOnThePen showing various side effect profiles across Reta and Tirz Very interesting to note the %s of *placebo* as well (nearly double for Reta placebo) The mind and suggestion are very powerful In my experience, gallstones/pancreatitis being underreported

@HEALTHCOSTtruth They already passed the hospital price transparency act. The problem is THEY ARE NOT HOLDING HOSPITALS ACCOUNTABLE TO IT!!!

How about patients deserve to know how much a hospital bill will be before they go?

@dr_huffer There was research on this where the names were also excluded and candidates were interviewed “blind” with disguised voices. Then they revealed the candidates information and scored them again. I can’t find it but the results were very revealing.

If we did medical school admissions completely race blind: application without a photo or racial demographics, interview via zoom with camera off… Who would object, and why?

@drterrysimpson So how would you do that? The healthcare industry is required to develop scoring models for hiring. What criteria would you add and how would you rank candidates to achieve a balance on any uncontrollable metric? What weight should each criteria have? What gets removed?

I absolutely want more minority physicians serving their own communities because representation, trust, cultural understanding, and continuity of care matter. We see measurable benefits from that in many underserved populations. But that does not require abandoning competence standards or assuming selected candidates are less capable. Minority students admitted to medical schools are overwhelmingly competent, complete training, pass boards, and become successful physicians. The caricature that diversity means “unqualified hires” is unsupported and frankly insulting. My concern is different: selection systems should still rely on transparent, rigorous, auditable criteria tied to success in medicine rather than crude demographic box-checking. The goal should be expanding opportunity and representation while maintaining confidence that every physician earned their place through merit and ability. Those ideas are not contradictory unless people insist on turning every discussion into a political tribal war.

If politicians can redraw voting maps to dilute representation, now they want to redraw medical school admissions the same way. America doesn’t need fewer minority physicians. It needs more qualified physicians from every background serving every community.

@drterrysimpson We need to demand stricter selection rules that prioritize competencies not uncontrollable variables. And documented. And auditable. I prefer correction be done by eliminating bias not force ranking on it.

And I think that feeling matters more than people on either side sometimes admit. Nobody wants to wonder, quietly and forever, whether they were selected because they were excellent or because they checked a demographic box. That uncertainty can feel corrosive to dignity and professional respect, especially for people who fought through real barriers and discrimination to get there. The irony is that many diversity efforts were created because prior systems were never truly blind in the first place. But once institutions begin visibly weighting immutable characteristics, they risk undermining confidence in everyone they select — including highly accomplished candidates who absolutely earned their place. That is why transparent, rigorous, auditable standards matter so much. At the same time, “blind” systems are difficult in medicine because medicine is not purely a technical profession. Communication, trust, cultural understanding, persistence, leadership, and service all matter to patient outcomes, and those are harder to quantify cleanly than an exam score. So the challenge is not simply removing bias. It is building systems where candidates believe they were respected as individuals of merit while communities also feel represented and cared for. That balance is extraordinarily difficult — and pretending otherwise is where most of these debates become dishonest.

@drterrysimpson Blind to anything that I cannot control. I want criteria to be based on clinical competence. It’s a slippery slope to use race, gender, or other uncontrollable criteria. Instead of asking for criteria inclusion, we should be demanding exclusions of the uncontrollable criteria.

And that experience is real. Women in medicine absolutely faced barriers that were overt, humiliating, and systemic. Many had to outperform mediocre men simply to be considered “acceptable.” That history should not be minimized. But there is a tension here worth acknowledging: If we say history, bias, networks, and exclusion shaped opportunity for generations, then institutions will inevitably try to account for that somehow. The disagreement is not whether unfairness existed. It plainly did. The disagreement is how to correct for it without creating new unfairness. Most people agree on the goal:fair, rigorous, competence-based selection. The hard part is deciding what “best criteria” actually means. Pure test scores? Interviews? Resilience? Leadership? Communication? Socioeconomic adversity? Clinical exposure? Research? Geographic need? First-generation status? Medicine is full of extraordinarily intelligent people who are terrible physicians. It is also full of physicians who were not statistical superstars on paper but became remarkable clinicians because they connected with patients, adapted under pressure, and understood the communities they served. So yes — criteria matter enormously. They should be transparent, defensible, and auditable. But humans are not machine parts, and selecting future physicians has never been reducible to a single spreadsheet column.

@drterrysimpson I say this as a woman in my 60’s who faced massive discrimination in a hugely male dominated part of healthcare. When we use criteria like age, gender, race, religion (ahem Catholic health systems), we do a disservice. We need to score candidates on better criteria.

@drterrysimpson Five criteria for employment selection: school, major, grades, internal proficiency assessments and race. How would you rank candidates for hire? Race comes first. Very problematic, even with good intentions. Competence should outrank race criteria don’t you think?

@drterrysimpson But that’s not how they score candidates for hire. I audited HR departments and they have to document the selection criteria, candidate scores and selection scoring. It does happen that way. Sorry.

@DrDiGiorgio The lab companies are missing massive direct to consumer opportunities. Cash pay is the future. They need professionals to help them develop a strategy. They already hate insurance companies so half the battle is won.

There are nearly a billion elective clinic visits in the US every year. Hundreds of millions of lab tests, x-rays, physical therapy visits, and generic medication prescriptions. Explain why we need to route any of those through “insurance.”

@DrDeepMD I’ve seen sharp pain without gallbladder. Are you seeing bile duct blockages?

Seeing more and more cholelithiasis and cholecystitis (gall stones/gallbladder inflammation) in those on GLPs Side effects still single digit incidence But if you are feeling sharp ab pain after a fatty meal while on GLP Consider gallstones as a cause