Ian Blubaugh, MD

@awgaffney Primary care, FM. 1) No, not really, unless it's telling me something that feels a bit unconventional or off. 2) Since leaving residency, I rarely if ever had time to do broad reviews. That's not really feasible.

(1) Do you feel a need to double-check OpenEvidence against established sources before acting upon its recommendations? (2) Isn't there something lost by substituting reading of broad reviews or chapters, with the pursuit of specific answers to narrow questions?

Beyond some curious test queries I've essentially never used OpenEvidence, never in clinical care, but I know it's widely viewed as very useful including by people I very much respect. The questions I have for proponents is:

@LeorSapir what specialty is 'physician' (n=161k) and 'general doctor' (n=29k)? this is completely useless data with those two sets in there.

Interesting. See my comment to the original post.

I open this damn app and look at my timeline, and I feel my IQ dropping and my blood boiling, and yet I keep opening it again every day like some masochistic freak.

@DrSarahAxelrath also there's a FDA approved self swab now.

Right that most people handle Pap smears fine, but wrong to assume that they aren’t very painful, scary, and traumatic for some. If you’re very worried, talk to your doctor! We can prescribe meds to make it more comfortable. We don’t want you to die from preventable cancer.

@benryanwriter Journalist

What are some words the have been subjected to concept creep? (Meaning an egregiously broadening definition that has neutered the word’s impact.) The ones I’ve thought of include: Harm Trauma Pedophile Violence Eugenicist Nazi OCD

@Leo_Abstract @mnmcsofgp @tracewoodgrains You go through a lot of contortions to suck Israel's dick. Nicely done.

@mnmcsofgp @tracewoodgrains given how relentlessly fake Pallywood stuff in general is, it had never even occurred to me to imagine that the child was alive at the time of the scan. pick up a corpse, put a bullet in its head, take an x-ray, contact the all-errors-in-one-direction New York Times. done.

When these images circulated, I was asked, as a neutral party, to adjudicate a bet on whether they were real x-rays. My conclusion after close examination and consultation with independent specialists is that they were. See replies for the assessment. x.com/K_AminThaabet/…

When patients ask, “What disorder do I really ‘have’?” the honest answer is usually more interesting and messier than a single label. I wrote for the @nytimes on what I wish people understood about diagnoses and the nature of mental health problems. nytimes.com/2026/05/11/opi…

@HenryRunamucker @PSSDNetwork @BorisSpider14 Thanks

@ibluba @PSSDNetwork @BorisSpider14 I believe this was the analysis in question: karger.com/pps/article/88…

This is consumer medicine. The only way to tell if SSRIs are effective is through high quality clinical trials, ideally involving controlled studies. Neither Sen. Tina Smith, nor anyone else, has a "right" to treatments that are no more effective than a placebo. I have no idea whether SSRIs are safe and effective but the test is not your feelings, it's clinical evidence.

@SBlake2000 @benryanwriter That is a through discussion of the issues with screening as a metric measure. I'm a PCP. There's nothing in there about how that provides financial incentives to treat with SSRIs, which is what the article was about.

@ibluba @benryanwriter Yes. Here is an excellent discussion on the problem: pcplens.com/p/the-depressi…

The economics of antidepressant prescribing: “federal law created an incentive structure that makes psychiatric medication the default for tens of millions of Americans who might be better served by therapy, lifestyle intervention or no clinical intervention at all.” — @adamomaryphd Gift link: wsj.com/opinion/behind…

@SBlake2000 @benryanwriter Do any of the ACO shared savings metric involve SSRI therapy? cms.gov/medicare/medic…

@ibluba @benryanwriter This is all about "quality bonus payments" and "shared saving" when a person is put on a "treatment" and shows improvement at some point down the line. The incentives go in one direction.

@benryanwriter How is a visit for tapering not reimbursed but a visit for medications is? Do any of you understand how insurance billing works?

@benryanwriter "Each new prescription generates a billable visit, while tapering a patient off an ineffective drug takes time, monitoring and follow-up... which the system doesn’t reimburse." That's just flat out incorrect. There's no citations to support that clinicians are incentivized.

@PSSDNetwork @BorisSpider14 There's no link to the study in question. Do you have it?

@ibluba @BorisSpider14 Actually, there’s robust RCT evidence that supports the case against ever prescribing SSRIs. x.com/HengartnerMP/s…

@thepeacepoet99 @datadriven_tdoc If anything, testosterone seems to improve some of the chronic pain and mobility issues. That's purely anecdotal though.

@thepeacepoet99 @datadriven_tdoc hEDS is obviously a poorly understood, multifactorial condition, but I would consider myself a relative (reluctant) expert on it as it takes up a large portion of my panel. And it is predominantly cis women I see, though transmales are affected of course.

Autistic women seem to develop severe manifestations of connective tissues disorders like EDS when you put them in menopause in their 20’s

@benryanwriter @LeorSapir @TheFP @wpath Yes, peds gender care has a lot of issues, but it seems that this quote which is widely reproduced, really just speaks to the heterogeneity of the group and complexity of the presentations.

@benryanwriter @LeorSapir @TheFP @wpath strict guidelines, and approach a nuanced take to problems. I see this in hypertension, depression, obstetrics, gender care, etc.. nearly everything. Most patients don't fit neatly into guidelines or algorithms, and there's a need to improvise beyond where evidence is.

"We're all just winging it." This is a quote memorialized by @LeorSapir in a @TheFP article about a 2022 @WPATH conference session introducing the new nonbinary chapter in the organization's transgender-care guidelines. Here is the full clip of the woman who said this, about how doctors providing body-modification treatments to people identifying as nonbinary are operating in a scientific vacuum. For the full video of the conference session, see the quote tweet. Here is what the woman said, as I wrote in my Substack: Lastly, a care provider named Erica from Utah got up and put into plain language how much these medical providers are operating in the dark. She said that when she was treating within a binary framework, she felt confident. But there was a lack of data and expertise, she said, to guide her when treating nonbinary patients—a population she noted had surged in number in recent years. Erica made a plea for guidance from the people in the room on how to care for these patients properly. “I will fully just take your ideas,” she said. Such guidance, she said, could come from a forum as informal as a social media platform. She advised providers to “like make a Pinterest board or something.” She pled for others to “throw a tweet out there or something, saying, ‘This is kind of what I do, and it might be different for you, but this is a regimen that you might use.’” “I feel like we’re all just winging it,” she said. “But maybe we can just, like, wing it together—publicly in a space where we can share the ideas of how we’re winging it.” Until then, she said, “I still don’t know what to do.” She continued: “because I want to help these folks, and I haven’t yet been given the tools.” She closed with a final plea for social-media-driven directives from this treatment field: “You know, Pinterest tweet, whatever.”