Rania Nasis, MD, MBA

@benryanwriter this is probably due to better blood sugar regulation. there’s a link between impaired insulin sensitivity in brain and migraines. even in those that seem to have normal standard metabolic labs.

Multiple studies have suggested that GLP-1s like Ozempic (semaglutide) are associated with improvement in migraines. I can attest this frankly miraculous phenomenon in my own life. During the months preceding my starting Zepbound for sleep apnea in May 2025, I was wrestling with a ghastly relapse of chronic migraine; this following several years of fairly good control over them. Within weeks of starting the GLP-1, my headaches all but vanished. I've had one short period of bad headaches since then—a relapse I attribute to my since-eliminated habit of routinely searching my own name on Bluesky—but have otherwise enjoyed very good control over migraines for the past year on Zepbound. (I've also shed 14% of my body weight.)

central jersey, south jersey, north jersey

“why have we left it all to fools?” a haunting question from this week’s reading

kudos to those like @BradStanfieldMD for actually doing the work in the longevity space. it takes integrity to publish results when they aren’t positive. we have so many unanswered questions around rapamycin and this helps point the way to better future studies.

dear @SevenRooms there is no reason I should have to enter my birthday in order to make a brunch reservation. your job is make rsvps easier, not more intrusive.

an unforgettable party. frenemies circling. implied threats. building against impossible timelines. tension everywhere. triumph and achievement breaking through decay. a glimmer of hope. guilt. shame. pride. an awe-inspiring discovery. a man pushed too far. the world set on fire. and that’s just wrapping up part 1! all building towards a shocking reveal. there’s still room left to join the discussion.

@anothercohen i got a marketing email from a company pretending to be medvi after that article came out. fraud is everywhere 🤣

Friend got a marketing email from Medvi this morning. Email copy aside, the provider they are using in the screenshot is an actual doctor, not an NP, whose real name is Alec Wier, and he is COMPLETELY UNAFFILIATED with Medvi. This entire company is run on fraud and deception and I hope the founder ends up in prison

@JesseTinsley @BillAckman @X please tell me you did not settle. that’s jus insane.

@BillAckman @X We had a similar situation demanding extended severance. This employee joined through an acquisition and was only with us a few months. They worked remote. Their claim? We didn’t put bathroom breaks on their calendar so they had to hold it all day. Absolutely ridiculous.

I am reaching out to the @X community for advice with the likely risk of sharing TMI. I have been sufficiently upset about the whole matter that I have lost sleep thinking about it and I am hoping that this post will enable me to get this matter off my chest. By way of background, I started a family office called TABLE about 15 years ago and hired a friend who had previously managed a family office, and years earlier, had been my personal accountant. She is someone that I trusted implicitly and consider to be a good person. The office started small, but over the last decade, the number of personnel and the cost of the office grew massively. The growth was entirely on the operational side as the investment team has remained tiny. While my investment portfolio grew substantially, the investments I had made were almost entirely passive and TABLE simply needed to account for them and meet capital calls as they came in. While TABLE purchased additional software and other systems that were supposed to improve productivity, the team kept increasing in size at a rapid rate, and the expenses continued to grow even faster. While I would periodically question the growing expenses and high staff turnover, I stayed uninvolved with the office other than a once-a-year meeting when I briefly reviewed the operations and the financials and determined bonus compensation for the President and the CFO. I spent no time with any of the other employees or the operations. The whole idea behind TABLE was that it would handle everything other than my day job so that I would have more time for my job and my family. Over the last six years, expenses ballooned even further, employee turnover accelerated, and I became concerned that all was not well at TABLE. It was time for me to take a look at what was going on. Nearly four years ago, I recruited my nephew who had recently graduated from Harvard and put him to work at Bremont, a British watchmaker, one of my only active personal investments to figure out the issues at the company and ultimately assist in executing a turnaround. He did a superb job. When he returned from the UK late last year after a few years at Bremont, I asked him to help me figure out what was going on with TABLE. When I explained to TABLE’s president what he would be doing, she became incredibly defensive, which naturally made me more concerned. My nephew went to work by first meeting with each employee to understand their roles at the company and to learn from them what ideas they had on how things could be improved. He got an earful. Our first step in helping to turn around TABLE was a reduction in force including the president and about a third of the team, retaining excellent talent that had been desperate for new leadership. Now here is where I need your advice. All but one of the employees who were terminated acted professionally and were gracious on the way out (excluding the president who had a notice period in her contract, is currently still being paid, and with whom I have not yet had a discussion). The highest compensated terminated employee other than the president, an in-house lawyer (let’s call her Ronda), told us that three months of severance was not enough and demanded two years’ severance despite having worked at the company for only two and one half years. When I learned of Ronda's request for severance, I offered to speak with her to understand what she was thinking, but she refused to do so. A few days ago, we received a threatening letter from a Silicon Valley law firm. In the letter, Ronda’s counsel suggests that her termination is part of longstanding issues of ‘harassment and gender discrimination’ – an interesting claim in light of the fact that Ronda was in charge of workplace compliance – and that her termination was due to: “unlawful, retaliatory, and harmful conduct directed towards her. Both [Ronda] and I [Ronda’s lawyer] have spoken with you about [Ronda’s] view of what a reasonable resolution would include given the circumstances. Thus far, TABLE has refused to provide any substantive response. This letter provides the last opportunity to reach a satisfactory agreement. If we cannot do so, [Ronda] will seek all appropriate relief in a court of competent jurisdiction.” The letter goes on to explain the basis for the “unsafe work environment” claim at TABLE: “In early 2026, Pershing Square’s founder Bill Ackman installed his nephew in an unidentified role at TABLE, Ackman’s family office. [His nephew]—whose only work experience had been for TABLE where he was seconded abroad for the last four years to a UK watch company held by Ackman—began appearing at TABLE’s offices and conducting interviews of employees without a clear explanation of his role or the purposes of these interviews. During this period, he made a series of inappropriate and genderbased [sic] comments to multiple employees that created an unsafe work environment. Among other things, [his nephew] made remarks about female employees’ ages (“Tell me you are nowhere near 40”), physical appearance (“Your body does not look like you have kids”), as well as intrusive questions about family planning and sexual orientation (“Who carried your son? Who will carry your next child?”). These incidents were reported to senior leadership at TABLE and Pershing Square. Rather than being addressed appropriately, the response from senior management reflected, at best, willful blindness to the inappropriateness of [his nephew]’s remarks and, at worst, tacit endorsement.” The above allegations about my nephew had previously been brought to my attention by TABLE’s president when they occurred. When I learned of them, I told the president that I would speak to him directly and encouraged her to arrange for him to get workplace sensitivity training. The president assured me that she would do so. When I spoke to my nephew, he explained what he actually had said and how his actual remarks had been received, not at all as alleged in the legal letter from Ronda’s counsel. I have also spoken to others at the lunch table who confirmed his description of the facts. In any case, he meant no harm, was simply trying to build rapport with other employees, and no one, as far as I understand, was offended. Ironically, Ronda claims in her legal letter that TABLE didn’t take HR compliance seriously, yet Ronda was in charge of HR compliance at TABLE and the person who gave my nephew his workplace sensitivity training after the alleged incidents. In any case, Ronda, as head of compliance, should have kept a record or raised an alarm if indeed there was pervasive harassment or other such problems at the company, and there is no evidence whatsoever that this is true. So why does Ronda believe she can get me to pay her nearly $2 million, i.e., two years of severance, nearly one year of severance for each of her years at the company? Well, here is where some more background would be helpful. Over the last two months, I have been consumed with a major family medical issue – one of my older daughters had a massive brain hemorrhage on February 5th and has since been making progress on her recovery – and I am in the midst of a major transaction for my company which I am executing from a hospital room office next to her . While the latter business matter is publicly known, the details of my daughter’s situation are only known to Ronda because of her role at our family office. Now, let’s get back to the subject at hand. Unfortunately, while New York and many other states have employment-at-will, there has emerged an industry of lawyers who make a living from bringing fake gender, race, LGBTQ and other discrimination employment claims in order to extract larger severance payments for terminated employees, and it needs to stop. The fake claim system succeeds because it costs little to have a lawyer send a threatening letter and nearly all of the lawyers in this field work on contingency so there is no or minimal cash cost to bring a claim. And inevitably, nearly 100% of these claims are settled because the public relations and legal costs of defending them exceed the dollar cost of the settlement. The claims are nearly always settled with a confidentiality agreement where the employee who asserts the fake claims remains anonymous and as a result, there is no reputational cost to bringing false claims. The consequences of this sleazy system (let’s call it ‘the System’) are the increased costs of doing business which is a tax on the economy and society. There are other more serious problems due to the System. Unfortunately, the existence of an industry of plaintiff firms and terminated employees willing to make these claims makes it riskier for companies to hire employees from a protected class, i.e., LGBTQ, seniors, women, people of color etc. because it is that much more reputationally damaging and expensive to be accused of racism, sexism, and/or intolerance for sexual diversity than for firing a white male as juries generally have less sympathy for white males. The System therefore increases the risk of discrimination rather than reducing it, and the people bringing these fake claims are thereby causing enormous harm to the other members of these protected classes. So what happened here? Ronda was vastly overpaid and overqualified for the job that she did at TABLE. She was paid $1.05 million plus benefits last year for her work which was largely comprised of filling out subscription agreements and overseeing an outside law firm on closing passive investments in funds and in private and venture stage companies, some compliance work, and managing the office move from one office to another. She had a very good gig as she was highly paid, only had to go into the office three days a week, and could work from anywhere during the summer. Once my nephew showed up and started to investigate what was going on, she likely concluded that there was a reasonable possibility she would be terminated, as her job was in the too-easy-and-to-good-to-be-true category. The problem was that she was not in a protected class due to her race, age or sexual identity so she had to construct the basis for a claim. While she is female and could in theory bring a gender-based discrimination claim, she reported to the president who is female and to whom she is very close, which makes it difficult for her to bring a harassment claim against her former boss. When my nephew complimented a TABLE employee at lunch about how young she looked – in response to saying she was going to her 40-year-old sister’s birthday party, he said ‘she must be your older sister’ – Ronda immediately reported it to our external HR lawyer. She thereby began building her case. The other problem for Ronda bringing a claim is that she was terminated alongside 30% of other TABLE employees as part of a restructuring so it is very difficult for her to say that she was targeted in her termination or was retaliated against. TABLE is now hiring an external fractional general counsel as that is all the company needs to process the relatively limited amount of legal work we do internally. In short, Ronda was eminently qualified and capable and did her job. She was just too much horsepower for what is largely an administrative legal role so she had to come up with something else to bring a claim. Now Ronda knew I was a good target and it was a good time to bring a claim against me. She also knew that I was under a lot of pressure because on March 4th when Ronda was terminated, my daughter had not yet emerged from consciousness, she was not yet breathing on her own, and my daughter and we were fighting for her life. I was and remain deeply engaged in her recovery while at the same time I was working on finishing the closing for the private placement round for my upcoming IPO. Ronda also knew that publicity about supposed gender discrimination and a “hostile and unsafe work environment” are not things that a CEO of a company about to go public wants to have released into the media. And she may have thought that the nearly $2 million she was asking for would be considered small in the context of the reputational damage a lawsuit could cause, regardless of the fact that two years of severance was an absurd amount for an employee who had only worked at TABLE for 30 months. She also likely considered that I wouldn’t want to embarrass my nephew by dragging him into the klieg lights when her claims emerged publicly. So, in summary, game theory would say that I would certainly settle this case, for why would I risk negative publicity at a time when I was preparing our company to go public and also risk embarrassing my nephew. Notably, she hired a Silicon Valley law firm, rather than a typical NY employment firm. This struck me as interesting as her husband works for one of the most prominent Silicon Valley venture firms whose CEO, I am sure, has no tolerance for these kinds of fake claims that sadly many venture-backed companies also have to deal with. I mention this as I suspect her husband likely has been working with her on the strategy for squeezing me as, in addition to being a computer scientist, he is a game theorist. My only advice for him is to understand more about your opponent before you launch your first move. All of the above said, gender, race, LGBTQ and other such discrimination is a real thing. Many people have been harmed and deserve compensation for this discrimination, and these companies and individuals should be punished for engaging in such behavior. Which brings me to the advice I am seeking from the X community. I am not planning to follow the typical path and settle this ‘claim.’ Rather, I am going to fight this nonsense to the end of the earth in the hope that it inspires other CEOs to do the same so we shut down this despicable behavior that is a large tax on society, employment, and the economy and contributes to workplace discrimination rather than reducing it. Do you agree or disagree that this is the right approach?

@JTLonsdale there’s also a cultural rot underpinning this. the haves pretending to care about the have-nots but really just resentful of the have-mores. and increasingly comfortable punishing them for existing. that’s what makes passing regulations in these areas so easy.

This is true! And education, healthcare, and housing would also be cheap, plentiful and better for all IF we had free markets in those areas. The government and special interests have conquered them with bad regulations, administrative unions, dumb permits & other commie rules.

@maxlugavere and salad dressings

Wait until you find out about most smoothies and coffee drinks.

@patrickc @conor64 agree with all these but the thing that did the most damage was ostracizing anyone that asked reasonable questions about the above and then refusing to acknowledge mistakes in the aftermath. many in charge would do the same thing again.

Offhand — * Vacillation on masks, with abundant motivated reasoning in every case. * Promulgation of made-up thresholds with no evidentiary basis (e.g. 6 feet). * Authoritarian delight in nanny state intrusiveness (policing the beach and such). * 180 on many issues around BLM. * Lack of effective response from science funding bodies. * Denial of aerosolized transmission. * Changing of trial readouts so that they’d occur after the election. (Confirmed to me by senior OWS officials.) * Crazy criteria for vaccine distribution. * Adamant insistence on vaccine efficacy beyond what was supported by data. * Almost complete lack of follow-through on OWS (on pan-variant vaccines). I’m sure there are more, but those are the ones that stick out.

A question for everyone: survey data suggests that by the end of the Covid-19 emergency trust in public health institutions had decreased significantly. If you are among the people who reacted that way, why specifically? I'm hoping for long, diverse, individualized answers.

part of the problem is lack of enforcement. you wouldn’t need so much regulation if fraud was called out and penalties were severe (jail time). but also most of the regulation in place is basically honor system. no one checks unless you really f-ed up or get so big that class action lawyers come looking for pay days.

@BillDA Same in supplements. FDA labeling rules added to protect consumers mostly just raise compliance costs for small brands. The big players absorb it. The small ones exit. Less competition, not more safety.

This, but for almost every single regulation Nobody ever considers second-order consequences

@josiezayner even if they did somehow work wonders, we don’t have much data on proper dosing and duration. dose makes the poison. not to mention impact of taking multiple peptides with potentially overlapping mechanisms.

Meathead science: Gray market peptides probably aren't going to kill you, wow, that means we should all inject them. The problem with peptides is that for what is most likely a placebo response, there are real chances of infection for people not being sterile or inflammation from impurities because people are ordering untested low quality peptides. So yeah chances aren't unreasonable that you could get tissue damage especially if you have no idea what you're doing but you're right you probably not going to end up in the emergency room and die. Good for you I've seen people buying and injecting 98.5% pure. At best thats 1.5% You have no idea what it is and are injecting it into your body. Is it TFA? Or maybe remnants of the previous peptide run on that purification column? But yeah totally worth it for maybe placebo

i don’t think he fully grasps what a clinical trial (or getting there) really entails. it’s like when you hear newbie biotech founders claim they’re only a couple years away from commercialization when all they have is academic preclinical studies. what agency would approve this to go into humans without longer safety studies in animals first?

The healthcare system will be different from this point forward *and* BPC likely doesn’t work or is bad (invigorates cancer). If I had to do any clinical trials I’d use one that has been FDA approved previously like Sermorelin. I just want someone to collect this data!!!!! Please, thank you.

@StuartBlitz and they probably spent seven figures on that branding

I am *begging* pharma to get better at branding

@PatrickHeizer also, companies already exist that make (in weeks) personalized cancer vaccines for pets. see torigen. torigen.com

Sorry to be the downer because this is an impressive story in some senses. But it is ~trivially easy to make a single mRNA vaccine. It's not hard. I cure mice of various cancers with various therapeutics all the time. I've made mice lose more weight in a month than tirzepatide does in a year. What is hard and expensive is proving its BOTH safe AND effective **in a randomized and controlled study in humans** while ALSO manufacturing it at clinical scale and grade. I am happy for this man and his dog. It is impressive. But y'all are overhyping it.

it often comes down to people not knowing what they don’t know. there’s a general fear that pharma is bad and keep us from cures to make money. but most people can’t wrap their heads around how insanely complex human biology is and how a fix in one area can cause serious problems in another (maybe immediately, maybe months/years later). and everyone says it’s their body and therefore their choice when things look promising, until outcomes go bad and then it’s the regulators’ fault for not stepping in sooner. and what he did is awesome and love that it’s gotten people so excited about science. and if that inspires more talented people to pursue a career in this field, that’s a win.

not sure the fda can put the cat back in the bag. it’s slow & uneven in enforcement (rarely results in jail) and at times pressured by powerful/loud advocacy groups to look past thin evidence. it’ll be interesting to see if civil courts have an impact here eventually. only a matter of time before someone has a bad side effect and sues rich influence. civil has much lower bar than criminal.

if i were a regulator forced to clean up this mess, i think the obvious solution is to hit the enablers hard that pushed this stuff downmarket without evidence (jail them!) and then leave the drugs a choose your own adventure for patients that do the work to research

my observation is that the way we make decisions around acceptable risk in medicine are based around a "reasonableness" standard that may have been common a decade ago, but certainly isn't today. young people are hilariously risk on with experimental drugs. update accordingly

this isn’t about CICO. its mostly about regulatory nuance around calculating calories of novel ingredients. the lawsuit is a money grab — there will be a settlement with lawyers making millions and consumers get a ~$.75 refund. david’s approach to counting calories is generally permissible by fda when ingredients aren’t fully digested, but this is based mostly on company-generated data. so it could draw the attention of the fda to take a closer look. if that happens, i think worst case scenario is that they have to increase calories per g of epg on label but unlikely that it would be as much as fully digested fat. lawyers are exploiting differences between how people think about calories versus how they can be measured. so they can claim consumer harm even if it’s scientifically defensible. bad for brand because this nuance in calorie calculations is something the average consumer doesn’t understand and will lose trust in david as a result. but none of that gets to the bigger question in imo, is epg something we want to be eating in the first place?

not an expert here, but i know enough to have a more informed view than most. the lawsuit is a money grab — there will be a settlement with lawyers making millions and consumers get a ~$.75 refund. david’s approach to counting calories is generally permissible by fda when ingredients aren’t fully digested, but this is based mostly on company-generated data. so it could draw the attention of the fda to take a closer look. if that happens, i think worst case scenario is that they have to increase calories per g of epg on label but unlikely that it would be as much as fully digested fat. lawyers are exploiting differences between how people think about calories versus how they can be measured. so they can claim consumer harm even if it’s scientifically defensible. bad for brand because this nuance in calorie calculations is something the average consumer doesn’t understand and will lose trust in david as a result. but none of that gets to the bigger question in imo, is epg something we want to be eating in the first place?

@ranianasis As the most qualified person who replied to this, do you have an opinion on which party in the lawsuit is right?

Feels like the David lawsuit is effectively a referendum on CICO? Plaintiff: a calorie is a calorie Defendant: the body burns different food types differently