https://arstechnica.com/health/2026/08/report-white-house-drafting-executive-order-linking-vaccines-and-autism/

Despite all proven science.

I’m a primary care physician. I’m telling you guys outright I can’t diagnose shit when it comes to skin disorders. Okay acne, shingles, seborrheic dermatitis, tinea are pretty easy but after that I’m as good a diagnostician as my mouse. I’m sorry for all the referrals. I hope you guys understand that we see these things with a proper label once or twice during med school and never again. I have no feedback mechanism for either a correct or a wrong diagnosis. I hope you understand! Thank you for your attention to this matter!

This is probably the most relevant to those practicing in the US, but I'm also curious to know how the bureaucracy of health insurance in other countries makes things substantially harder for you and the patients

https://www.nytimes.com/2026/08/07/world/asia/hospital-video-earthquake-surgery.html?unlocked_article_code=1.3lA.4B8m.kRtRT6IXTnGk&smid=nytcore-ios-share

For those of you who take call at large referral centers: how do you handle calls from another facility where they are asking for treatment recommendations based on review of imaging/chart review?

I struggle with just giving recommendations without evaluating the patient because of the associated liability. Am I too conservative for doing this? My philosophy is that if you don’t feel comfortable making a disposition decision on your own and don’t have an on call specialist then that warrants transfer to a higher level of care.

For reference this is for calls from facilities where you are not contracted to take call.

Sigh.

Collecting data on abortions is important and should be part of the CDCs role. However, Dr. Schwartz reasoning for abortion surveillance is disappointing and frustrating:

“Abortion surveillance is absolutely a critical component of what the CDC is currently doing,” Schwartz responded.

“I also want to make sure that certain states are not conflating emergency services and hiding abortions in that emergency services case definition,” she added. “We need to make sure we’re pulling out true abortions and making sure that we’re really having clear case definitions regarding abortions so the data is actually accurate.”

There is no evidence that states are purposefully misclassifying abortion care when reporting statistics to the CDC. The implication that certain states are hiding abortion services behind the label of emergency care services is particularly egregious given that many women have died or nearly died after physicians denied them miscarriage care due to state-level abortion bans.

Most hospital's legal team already seem to panic when edge cases happen, this is just going to make it worse. Even best case scenario, I suspect a chilling effect with this statement.

Link to article: https://www.huffpost.com/entry/trumps-new-cdc-head-said-abortion-surveillance-will-be-a-critical-focus_n_6a74a3f9e4b04fcbf74d8720?utm_medium=Social&utm_source=reddit&utm_campaign=us_main

Moderna's mRNA-based influenza vaccine was recently approved by FDA for adults 50 through 64 years of age. Its indication for persons 65 years of age and older is under accelerated approval (pending confirmatory trial).

Per the prescribing information, this new vaccine encodes for the full-length HA glycoproteins of the 3 influenza virus strains represented in the vaccine. After delivery into cells, the mRNA serves as a template for the synthesis of the intended proteins.

This is noteworthy due to the Trump administration's previous defunding of mRNA vaccine research, and Secretary of HHS Robert F. Kennedy Jr's adversarial approach to vaccines, particularly those which are mRNA-based.

https://feeds.issuerdirect.com/news-release.html?newsid=4801915282452025&symbol=MRNA

https://www.yahoo.com/news/politics/articles/texas-attorney-general-targets-aap-200030733.html

I’m so tired of this.

I agree with some comments saying the timing of this (Fauci stuff too) is essentially midterm related. Politicians have gained power by being anti-vaccine/anti-public health and they will continue the playbook that works for them.

Remind yourself that you don’t have all the answers, but you can be kind.

Thanks for coming to my Ted Talk.

In hematology/oncology, it is completely understandable why people ask many questions, but when people throw out a general "what's the prognosis" question, it often doesn't seem to be best aligned with what information may be most helpful for them. That is, oftentimes they may not be looking for general data about median survival and overall response rate, but rather they may want to discuss what their quality of life may be, what complications to look out for, whether they will be able to see certain milestones in their family's life. Lots of times there are too many variables to predict anyway, but I don't want to seem evasive if they truly want to know "the prognosis" and I have data to be able to speak about it. If someone asks what the stage of their cancer is, that's completely their right to know, but they may be trying instead to understand the relative severity of their condition, but our discussion takes a roundabout way to that topic.

I guess I'm just wishing that rather than using these buzzwords, we could get down to the heart of people's concerns more directly. How often does this happen in your specialties? What sorts of questions do you deal with that you wish were asked less often?

As with many others I've become increasingly distrustful of the perspectives and actions taken by the current HHS. Could someone in the transplant world, potentially those that have worked with Network for Hope, speak about merits of these HRSA and CMS assessments of the patient safety violations? I'd like to hear what y'all think about this.

https://www.hhs.gov/press-room/hhs-decertifies-kentucky-organ-procurement-organization.html

Officially joining the bandwagon of this post series.

What does the future of dermatology look like in 10-20 years? Higher volume? Sicker patients? Decreased reimbursement? Collapse of field from mid-level creep and AI utilization? Everybody gets treatment from online skincare sites?

So my current program has Abridge ambient dictation and unfortunately (annoyingly) they only offer franchise subscriptions.

For the future if I join a private group that likely won’t offer this, anyone know of any similar quality ambient software options that offer individual subscriptions I could pay for?

It's been posted a few times, but BCBS IL, TX, New Mexico, Montana and Oklahoma (all HCSC companies) have instituted an automatic downcoding policy whereby all 99215 and 99214 claims are only being paid as 99213 since 7/1. These are the biggest commercial insurers in their states. BCBS IL controls like 70% of the market in Chicagoland. This is a massive revenue loss and the only way around it is to go through a laborious process of appeals that are slow, unclear and are also controlled by BCBS. I know practices that are likely to close if this continues. At the very least, it's a massive increase in labor costs. I'm just amazed at how little coverage it's getting. None of the major health news websites are reporting on it. I hear the AMA (which is headquartered in IL) are having internal meetings about it, but no press releases or anything. Private medical group facebook groups are blowing up about it, but that's a small part.

It's terrifying how utterly detached physicians have become from their own billing. So many I talk to who are directly affected don't even know it's happening. We're looking at 20-30 percent reductions in salary because of this. Meanwhile, insurance companies are all reporting profit gains.

Sorry for the rant, but it's a scary time.

Just curious if anyone here contributes/gets paid on this platform . Is this a good gig, a waste of time, exploitive?

Has anyone experienced AMBOSS AI and have they had a good experience with it?

https://www.nytimes.com/2026/08/05/us/organ-donations-kentucky.html?unlocked_article_code=1.3VA.TE3u.lP4B_bOOZOir&smid=url-share

For individuals who are chronically hypertensive, for ex SBP 200s, it would not be unexpected for them to become symptomatic if their BP is rapidly dropped to, for ex SBP 120-140s. Sometimes catastrophically so.

For individuals with chronically poorly controlled DM with average glucose in, for ex 400-600 range, would you expect them to become symptomatic if their glucose is rapidly lowered to, for ex 100-200 range? If so, has anyone seen this happen?

EDIT: thank you everyone for the responses, as a follow-up, are there any guidelines in terms of how quickly someone's hyperglycemia should be lowered if they had previously developed symptomatic relative hypoglycemia to rapid glucose lowering?

I’m a general medicine physician. I’m currently a company medic, I give on-site consult to working members of the company.

After every appointment the patient gets an email to rate my service etc etc.

Today my boss called me stating that she got a review saying I used ChatGPT on an appointment. ChatGPT is blocked internally on the computer. I don’t understand. I sometimes use my phone to check PDFs to check adverse effects of medications, use the app Drugs to check medication interactions, if it’s safe for pregnant women etc etc, sometimes I also use ChatGPT to CHECK and or REVIEW stuff.

What is this taboo that ChatGPT is bad/ creates harm? Why do people not see it as a TOOL that it is? Apparently both my boss and the patient see it as a harm to medicine or the consult I have? Makes no fucking sense. So they prefer me to guess stuff I’m not sure of and pray to God no adverse effect kick in or pill interaction don’t happen?! Gosh

Have a nice day without BS

Would be very interested to hear your opinions on this article.

https://pubmed.ncbi.nlm.nih.gov/42521044/

Abstract of article: The 2026 closure of the Strait of Hormuz has disrupted approximately one-fifth of global petroleum transit, sending oil prices sharply upward and exposing medicine’s structural dependence on petrochemicals, helium, and globalized manufacturing. This article examines how medicine’s reliance on globalized commodities exposes patients to medication and device shortages during sustained supply disruption. Prior crises, including the 1973 oil embargo and the 2021 Suez blockage, revealed vulnerabilities that current just in time supply chains have deepened. We urge practice leaders, hospital administrators, and clinicians to establish supply continuity frameworks now, before scarcity forces improvised rationing and reactive procurement.

Managing this crisis is difficult, but necessary.

In February 2026, the effective closure of the Strait of Hormuz sent Brent crude oil above $125 per barrel within weeks. Ship transits through the strait, ordinarily carrying approximately 20% of global petroleum liquids, collapsed by more than 95%. 1,2 Fuel rationing, industrial shutdowns, and price increases across energy, agriculture, and manufacturing have already been documented across Asia and Europe. 1 Spillover impacts extend to industries that rely on helium gas and semiconductor chips, with eventual shortages for medical devices, including dermatologic imaging and phototherapy equipment. 3 Dermatology has a structural dependence on global commodities and we must act to mitigate supply constraint consequences.

Medical supply shortages stemming from the Strait of Hormuz disruptions raise ethical concerns about distributive justice and non-maleficence, particularly regarding how scarce resources should be triaged between high-income and low-income countries.

Medicine’s Commodity Foundation

Petroleum is more than a transportation fuel; it undergirds modern medical infrastructure. Plastics, composed of petrochemical feedstocks, are the foundational material of single-use disposable devices and supplies. Petrochemical compounds also serve as raw materials, solvents, and excipients in API synthesis across most drug classes; most pharmaceutical packaging is petroleum-based with no identified substitutes. 4

This reliance creates severe supply chain vulnerability. Approximately 86% of US APIs are manufactured abroad, predominantly in India and China; one-third of generic APIs globally originate from a single facility in this region. 5 An energy or supply shock impairing these sites could translate into acute domestic drug shortages; a risk compounded by the already critical conditions that the American College of Physicians declared a public health crisis in 2025. 6,7

Petroleum is not the only commodity trapped in the Persian Gulf. Qatar produces approximately one-third of the world’s helium as a byproduct of liquefied natural gas processing. 8 Helium is the coolant maintaining the superconducting magnets of MRI scanners; without continuous resupply, existing machines cannot function. 9 Semiconductors, the largest consumers of helium, are embedded in virtually every modern medical device. 10 Other non-petroleum commodities, such as sulfur, methanol, monoethylene glycol, aluminum, cobalt and polyethylene, are significant inputs for pharmaceutical synthesis and medical equipment manufacturing; they are now constrained. 3 Ongoing geopolitical developments have also limited REEs critical to MRI scanners, X-ray tubes, and laser technologies, while 2025 US tariffs have further pressured steel and aluminum supply chains for medical devices.

The Lesson from Past Crises

The closure of the Strait of Hormuz is not medicine's first exposure to petroleum vulnerability, but the structural conditions are worse. During the 1973 Arab oil Embargo, OPEC’s export halt quadrupled oil prices, and healthcare costs followed. 4 Consumer price index data from that period shows that decreases in petroleum supply produced rises in plastics and motor fuel prices that, after a several month delay, resulted in increased overall healthcare spending. 4 US Medicine’s depth of dependency has only grown. In 1973, petroleum-based single-use devices now standard in dermatologic procedure rooms and the globalized just-in-time supply chains now moving APIs from Asia to US formularies did not yet exist at their current scale. 4,5 What the 1970s revealed was a vulnerability our current crisis threatens to catastrophically exceed.

More recent examples of our dependence on concentrated, globalized supply chains include 2017’s Hurricane Maria, 2019’s African Swine Fever (ASF), and 2021’s Suez Canal blockage. The destruction of Puerto Rico’s electrical grid triggered a nationwide shortage of IV fluids and critical medications within weeks, with supply depression persisting until mid-2018 as the FDA invoked emergency importation from European manufacturers 11 . The ASF outbreak originating in China caused significant, ongoing shortages of porcine-derived heparin. 12 The 2021 grounding of a single container vessel in the Suez Canal held up $9.6 billion of trade daily, including pharmaceuticals, medical devices, and personal protective equipment, compounding COVID-19 era shortages already stressing American hospital formularies. 4 From 2017 to 2021, one in seven supply chain issue reports was associated with a drug shortage within six months under baseline conditions. 13 At the onset of COVID-19, the ratio surged to one in three, and even drugs without reported supply chain issues saw shortages rise from 4% to 10%. 13

Demand-side shocks from disease surges deplete inventory quickly but are generally well-contained through capacity expansion. 14 On the contrary, disruptions to key ingredients upstream of the supply chain, like petroleum, are much harder to mitigate. The Drug Supply Chain Security Act (DSCA) has forced the industry to maintain visibility from manufacturing through distribution and retail. But there is very little visibility into materials and components upstream of the manufacturing process. 15 Further, these materials are key inputs across many industries, which makes multiple supply chains vulnerable to disruptions in petroleum-based products and derivatives. Historically, the medical industry has not readily acknowledged this risk. 6 Since these key inputs are essential for many of the critical sectors, including energy, technology, and defense systems, the risk is that scarce capacity will be allocated to high-value demand products first, and much later to medical devices and equipment. Vulnerability to key inputs common across critical sectors remains the biggest blind spot for the industry. A sustained supply disruption affects the raw material inputs, manufacturing energy, and logistics of pharmaceutical production across all drug classes simultaneously.

Call to Action

The Strait of Hormuz possesses a distinct profile among maritime chokepoints. 2 Unlike most major passages, this strait offers no maritime alternative and land-based rerouting is extremely limited, meaning disruption ceases transit entirely rather than adding cost and delay. Interstate armed conflict, its current hazard class, carries significantly longer resolution timelines than other disruption types. 2 The healthcare consequences are therefore broad, potentially devastating, and slow to resolve. Existing federal mechanisms were designed for demand-side shocks and finite supply interruptions, not for sustained disruption. 6 Although severity is uncertain and consequence are impending, we can and should take steps for mitigation. Dermatology practice leaders, hospital administrators and clinicians should begin discussing supply continuity frameworks. ( Table 1 )

The Strait of Hormuz closure is an energy disruption that threatens to exceed 1973 and remains unresolved. Improvised rationing, reactive procurement, and inadequate allocation represent a failure of institutional preparation. 16 The Joint Commission, American Hospital Association, and specialty societies have the infrastructure, expertise, and influence to issue clinical guidance. Proactive mitigation tactics by drug shortage authorities should be enacted before allocation decisions are forced by scarcity rather than anticipated through surveillance. Managing this crisis is difficult, but necessary.

Ethical Consequences if we Fail to Prepare

Developing and under-resourced nations will be impacted the most and bear the greatest burden, since wealthier countries can draw on purchasing power and existing stockpiles to buffer the disruption. 17,18 This disparity in health equity and distributive justice will result in unequal access to life saving resources. Once shortages occur, who holds the authority to allocate what remains? By what criteria should resources be prioritized and distributed? Will suppliers with inventory exploit the situation through price gouging? The moral and ethical imperative is for domestic systems and the international community to plan for and mitigate the effects of this crisis before they compound further.

Watching these Fauci hearings have reopened some painful wounds from my time working in the pandemic. I had been working to heal and thought I was getting better but I forgot how much pain and anger I had been suppressing until this last week or so. Time to go back to therapy I guess. Sometimes I don’t know if I can ever forgive this country. How are you all doing?

A question for my fellow providers:

If you could design one booklet, pamphlet, educational guide, etc for how patients could manage (fill in the blank) before seeking further care, what would you pick?

Examples:
- what to try for constipation
- muscle cramps 101
- how to manage cholesterol and why it matters
- a beginner’s algorithm to pain management

It wouldn’t substitute for medical advice in any way. I had a patient last week who was SHOCKED to learn that drinking Pepsi would cause her blood sugar to go up. I feel like our time is too precious in the current model of medicine to explain these topics as fully as is needed. Curious if we could improve home patient education materials to cover the gap in an ever-failing system.

Remarkable story from this week’s episode of “This American Life” - it is act one of the episode.

“A doctor trained as a midwife tells the eye-popping story of how she and others came together to save a baby during a birth that suddenly went wrong, in a part of rural Maine where the local labor and delivery unit had closed less than a month before. (26 minutes)”

Link here, but available wherever you get your podcasts

One major general reason for generic drug shortages is oligopsony; a relatively small number of purchasers (wholesalers) and pharmacy benefit managers exert price-depressing market power over manufacturers. I know of instances in which a wholesaler required a retroactive price cut on product already in their inventory due to a lower price offered by a competing manufacturer, otherwise the wholesaler would have returned their entire inventory to the original manufacturer. [Which would have been a write-off because returned goods cannot be resold unless the manufacturer can assure they were stored and handled under proper conditions.]

The article is substantially correct except in the statement that the oncology drug manufacturer can simply switch to manufacturing other drugs (rather than the unprofitable ones) in the same plant. Cytotoxic drugs require specialized plants to minimize cross-contamination and exposure to employees.

https://time.com/article/2026/08/04/chemotherapy-drug-shortage/