Just an old doc trying to make a difference

Joined July 2015
Jon Bignault retweeted
When will we learn? End vertical integration Hospital spending keeps growing, yet the answer is always more funding. We need to question how we fund care and where the money goes. We reward consolidation and hospital ownership while making it harder for independent physicians and smaller facilities to compete. Then we wonder why local care disappears. The idea that bigger automatically means better is bullshit. When a few systems control the market and cut services that don’t generate enough revenue, what alternatives remain? That is how consolidation can help create healthcare deserts. We need to decentralize care by restoring competition. Support independent practices, allow physician-owned hospitals to compete, and reform Stark and ownership restrictions. Give local alternatives a fair chance instead of continuing to concentrate money and control in large systems.
The U.S. has lost more than 24,000 hospital beds over the past 15 years. At the same time, the population has grown by more than 30 million people. And it’s not just a rural problem: rural and urban hospitals closed at the same rate, per Bloomerg.
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Jon Bignault retweeted
Premise: Incentives drive all human behavior. The corollary: How to destroy a country: A vast social security and support system that serves as a magnet for those who would rather not work. An open immigration policy that does not screen immigrants to determine their ability and willingness to provide for themselves and their families. An open immigration policy that does not screen for political and/or religious ideologies that are a threat to the country. Economic incentives large enough to incentivize immigrants on the state dole to have large numbers of children, but insufficient for educated and economically productive mothers to be able to quit to raise a family. The declining fertility of the most educated and productive women due to their delay to begin a family as a result of their desire and/or need to advance their careers, among other reasons, to live a life they deem consistent with their educational achievements and/or to repay their student debts. Amnesty programs that give citizenship and voting power to illegal immigrants without consideration of their economic productivity or their threat to the country due to their religious or political ideologies. The changing demographics and increased population due to the above factors. The state responding to protests by increasing social support. The continued failure to punish and hold accountable violent and looting rioters. Government managed by a massive and growing unelected bureaucracy. Government fraud, waste, and abuse contributed to ballooning budgets. Anti-business legislation that makes it difficult for businesses to compete in a global marketplace being disrupted by AI, including restrictions on firing even poorly performing employees. Overly burdensome, globally uncompetitive, corporate taxation. Continuous increases in personal taxes to raise funds to provide for the rapidly growing welfare state. The substantial majority of the tax burden levied on a small percentage of the population. A growing percentage of the electorate paying no taxes and receiving welfare. The introduction or threat of a wealth tax including the taxation of unrealized gains, i.e., taxes on paper wealth. The flight of the most productive business builders and highest taxpayers to lower tax countries with lesser security concerns. A growing percentage of the electorate voting for candidates that support increased welfare and laws favorable to, and/or that match the cultural and ideological needs and desires of a growing unproductive immigrant population. The rapid rise in anti-semitism and inadequate efforts to address this hatred. Increased borrowing by the state to fund the growing social burden. Higher sovereign interest rates due to all of the above. The resulting need to reduce expenditures to make the math work. Increasingly violent protests that make life less livable for the productive and law abiding citizens leading to their accelerated departure. And so on…
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Jon Bignault retweeted
Replying to @BuzzPatterson
Dr. Oz found 'waste' and it happens to be the independent doctor treating you in one visit. Not facility fees. Not hospitals ignoring price transparency. Not MA upcoding. The doctor. Savings: about 0.1% of Medicare. That tells you who has lobbyists and who doesn't.
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Jon Bignault retweeted
Replying to @ItsStella_4
Zelensky blew up a dozen oil refineries and because it’s a GLOBAL COMMODITY that causes the prices to skyrocket
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Really is. If the median American can own a car then they can afford to pay cash to have a baby. If they really can’t, just give “food stamps for healthcare” in an HSA and be done with it.
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Jon Bignault retweeted
Inflation Facts Most people think inflation is higher today than under the Biden years and in fact the Fed did raise interest rates over fears of renewed inflation. But the facts are something else. Under the President’s first term inflation was under 2 per cent a year and ended at 1.2 per cent in 2020. Then during the Biden years inflation soared to 8 per cent in 2022. A total of 21.4 per cent of price increases. Then in the second term inflation has averaged about 2.7 or total increases so far even with the tariffs and Iran conflict at 5.4 per cent. So inflation has come down from 8 per cent to around 3 per cent. Gas was most expensive in 2022 at 3.95 a gallon, more expensive than today. Those are the facts plain and simple.
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Jon Bignault retweeted
The presumption that the Fed raising short-term rates reduces inflation is predicated on the belief that higher rates reduce demand and investment. But what if higher rates don’t reduce demand and investment because the demand for intelligence and energy is unaffected by higher rates because winning the race for super intelligence has a near infinite ROI and the demand for compute will remain incalculable. Why won’t higher rates at this unique moment in history therefore lead to more inflation as interest costs are embedded in everything? And the problem is compounded as the more the Fed raises rates, the more inflation we will have and the more the Fed will need to raise rates further and so on. But what if the old models don’t apply to the current paradigm and the Fed is wrong? I think the Fed might have just made a mistake. Am I right or am I wrong?
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Jon Bignault retweeted
This week in medicine 1. Dana-Farber/23andMe show that a rare inherited EGFR mutation increases lung-cancer risk 25-fold - and 62-fold in never-smokers. 2. City of Hope researchers develop a new blood test that detects early stage (I–II) pancreatic cancers with ~87% sensitivity - by combining a 10-miRNA signature with the existing test, CA19-9. Bigger trials up next. 3. Novo’s CagriSema delivers 19% placebo-adjusted weight loss in a phase 3 obesity trial - and, in a separate phase 3 trial in type 2 diabetes, beats low-dose tirzepatide for weight loss (12.4% vs 9.1%). 4. Mayo Clinic/n-Lorem researchers develop a personalized antisense oligonucleotide for a single patient with CHCHD10-mutant ALS. After a year, markers of neuronal damage dropped, and clinical/lung function stabilized or even improved. 5. GenFleet’s oral KRAS G12D ON/OFF inhibitor produces responses against both pancreatic and lung cancer in a phase 1 trial - and moves straight to phase 3. Its differentiation is that it targets both active and inactive KRAS. 6. Brigham researchers find evidence that Epstein–Barr virus reactivation precedes multiple sclerosis relapses by weeks to months. 7. Stanford researchers build a Virtual Biotech, with >37,000 AI agents - finding that drugs targeting cell-type-specific genes were 48% more likely to get approved, with 32% fewer adverse events. 8. Bayer’s finerenone gets FDA-approved for chronic kidney disease in type 1 diabetes - the first new treatment for this population in more than 30 years. 9. Stanford researchers find that the anti-seizure drug, levetiracetam, may directly inhibit diffuse midline glioma. Children taking it had longer survival (in retrospective cohorts) - prospective trials up next. 10. A European trial finds that, after removal of high-risk colorectal adenomas, waiting 5 years for the first surveillance colonoscopy is just as good as doing one after 3 years - potentially almost halving the number of follow-up colonoscopies needed.
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Over 80% of doctors now work for corporations because ACA made independent medicine financially impossible for small practices. Now, politicians want a new law to ban corp. ownership. Washington creates a regulatory monster, then acts shocked when Wall Street steps in to fund it.
Patients want to know that decisions about their health care are being made by doctors, not by Wall Street investors. If we’re going to lower costs and un-rig the health care system, we need to stop the corporate takeover of medicine. I’ve got a bill to get the job done.
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Those who blame the Docs for the No Surprises Act issues are sadly misinformed. There are bad apples, and they need to be addressed, but when the IDR process rules for the Docs 80-90% of the time and the Insurance companies still don’t pay, ask Willie Sutton where the problem is.
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Jon Bignault retweeted
There is a short distance between endorsing the killing of a political opponent and carrying out the actual killing. Don’t forget: the very first killing of Mao’s Cultural Revolution was the brutal murder of a principal by a group of young high school girls.
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Replying to @DutchRojas
Bureaucracy focuses on policing the process rather than holding people accountable for the outcome. When you punish the collective with rules instead of punishing the specific wrongdoer, you protect the corrupt and handcuff the productive.
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Universities & hospitals suffer from the exact same disease: massive administrative bloat funded by predatory billing. Both systems stopped investing in the actual frontlines (professors & doctors) & instead built a giant corporate class of vice presidents & managers.
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Jon Bignault retweeted
Medical training is far too long, and access to the profession is too dependent on dog-and-pony, performative exercises such as community-benefit activities and superficial research experiences. As a result, the system selects for people skilled at impression management who talk and present themselves well but are less interested in developing actual competence. Scientists could also be relieved of the burden of supervising aspiring doctors who have no real interest in research but need to pad their resume. This consumes resources and wastes everyone’s time. The problem with research rankings goes even deeper. These rankings are heavily weighted toward how much NIH money a university brings in, regardless of whether that money produces anything meaningful. In practice, universities rise in the rankings by hiring grant-writing, soft-money mercenaries whom they care little about beyond their ability to bring in grant revenue.
Dr. Glaucomaflecken continues his fight against med student research (see link). I don't think we necessarily have to ban research, although that would be an improvement. We just need program directors to recognize that ranking by research pubs is bad for our profession. It causes early burnout among trainees and cheapens the value of research. Spread the word about the downsides of research rankings. There are lots of excellent program directors who will respond to this message the more it gets out. facebook.com/share/r/1EcmykH…
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Jon Bignault retweeted
7 clicks on the computer + 2 confirmation clicks on phone app + password entry for every single narcotic refill in Epic. Just in case you were wondering why you can’t get an appointment with your PCP today.
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We need to feature more stories like this.
Emma Schols ran back into a burning house burning 93 % of her body to rescue all six of her kids. She was on a ventilator for weeks. Doctors said people rarely survive burns that extensive. When she woke up, the first thing she asked was whether her children were alive.
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If Obama had built a ballroom because it is unsafe in this era of drones and other madness to host state dinners in tents on the White House lawn, no one on the Left or the Right would have batted an eye. It's the right thing to do. This was never about the White House itself. It was ONLY about hating anything Trump does. No other reason. And two lower courts agreed.
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It took them 60 years to figure out that if you give a bunch of free stuff to poor people, you create more dependent poor people.
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If you ever want to feel poor, read the Friday Wall Street Journal real estate section.
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Forgive me Christina but this is laughable considering the AMA doesn't represent physicians but is like a billing cartel that btw has provided billing framework (CMAA) for hospitals to submit insurance bills for ai analysis with no physician involvement at point of care.
Guess who’s joining me on Lifers to debate whether autonomous AI will outpace human physicians? My friends it is AMA CEO John Whyte and one of the JAMA paper’s authors Zeke Emanuel. They are ready to duke it out over ice cream. If you are not subscribed, links below. 👇
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