Experiment: Surface Best COVID19 threads from @ThreadReaderApp
Most people haven’t heard of this test, which is available in the US. It accurately predicts Alzheimer’s (not just if there’s a risk, but when). It is favorably affected by exercise and likely many other lifestyle factors.
Here’s (almost) everything we know about it. In Ground Truths (link in my profile d/t X-suppression)
Here’s (almost) everything we know about it. In Ground Truths (link in my profile d/t X-suppression)
Here's the response to exercise
The most sensitive and accurate biomarker to date
1/ The CMS final 2026 rate notice for Medicare Advantage just dropped, on the "no later than" date of April 7
The final rate is up- by a lot more than industry consensus of 75-100 bps!
I think a lot of plans are going to feel a little relief about their preliminary bids tonight
The final rate is up- by a lot more than industry consensus of 75-100 bps!
I think a lot of plans are going to feel a little relief about their preliminary bids tonight
2/ One sell side analyst said "the most bullish expectation we heard [before] was a +125bps improvement"
ahem... my expectation was better than that, but even I didn't think it would be 310 bps better.
So why?
Because Dr Oz likes Medicare Advantage?
ahem... my expectation was better than that, but even I didn't think it would be 310 bps better.
So why?
Because Dr Oz likes Medicare Advantage?
3/ If you missed, go back ands read my January tweetorial on the Advance Rate Notice (which was already "better than expected")
The short answer is that each year's "FFS growth rate" includes a true up of CMS actuaries' past and future cost estimates
The short answer is that each year's "FFS growth rate" includes a true up of CMS actuaries' past and future cost estimates
A major @Nature paper this week found a significant decline in dementia after an outdated Shingles vaccine.
I've reviewed the study and many other relevant ones in a new Ground Truths (link in profile)
I've reviewed the study and many other relevant ones in a new Ground Truths (link in profile)
A Table from the post
The effect in the 2 natural experiments differed substantially by sex with the benefit predominant in women
We’re still learning about the steep cuts to CDC, but I want to focus on the particularly dangerous and misguided elimination of CDC’s tobacco control program. If it’s not reversed, this would have devastating consequences and put American lives at risk.
Although FDA regulates tobacco products, setting rules on manufacturing, requiring warning labels, and overseeing how tobacco products are advertised and marketed, FDA alone can’t prevent tobacco addiction.
CDC plays a distinct and essential role—tracking tobacco use, analyzing the burden of tobacco-related disease, and sharing vital data with communities, researchers, and policymakers.
Aid leaders have been warning for 2 months that the gutting of @USAID would leave US unable to respond to major global disasters.
We are now seeing that play out in real time with the Myanmar quake - reality is calling bullshit on the Trump admin's narrative.
🧵
We are now seeing that play out in real time with the Myanmar quake - reality is calling bullshit on the Trump admin's narrative.
🧵
In today's press briefing @statedeptspox bizarrely "rejected the premise" that a meaningful US response requires USAID staff "to be physically there."
As the guy who used to deploy those teams - this is total nonsense.
You can't conduct search-and-rescue virtually. Come on.
As the guy who used to deploy those teams - this is total nonsense.
You can't conduct search-and-rescue virtually. Come on.
The reality is that other countries began deploying their teams immediately - and the US would have too, under any prior administration (including Trump 1).
But Elon, Pete Marocco, and Rubio have wrecked the USG's ability to do this.
But Elon, Pete Marocco, and Rubio have wrecked the USG's ability to do this.
OK, @elonmusk, challenge accepted.
Here's my own wall of receipts.
🧵
Here's my own wall of receipts.
🧵
I posted this over a month ago on some specific line items on DOGE's wall of receipts, explaining how these violated the Rubio guidance on protecting lifesaving activities.
Among the first cancellations were fundamental humanitarian relief supplies.
1/ I love reading the annual March MedPAC report to Congress on Medicare Payment Policy
such good, clear data and policy thinking.
kudos to @medicarepayment staff and chair @Michael_Chernew
I'll post some thoughts/highlights as I read through this morning
such good, clear data and policy thinking.
kudos to @medicarepayment staff and chair @Michael_Chernew
I'll post some thoughts/highlights as I read through this morning
2/ My focus will be on the areas I know best
-Primary care
-Alternative payment models
-Medicare Advantage
-Competition and consolidation
The report is here for those following at home.
medpac.gov/document/march…
-Primary care
-Alternative payment models
-Medicare Advantage
-Competition and consolidation
The report is here for those following at home.
medpac.gov/document/march…
3/ Here's the first nugget from their core responsibility - recommending payment rates to congress that ensure beneficiary access to care
Clinicians are paid 140% of Medicare by commercial plans... but you wouldn't know that by working with independent practices (as I do)
Clinicians are paid 140% of Medicare by commercial plans... but you wouldn't know that by working with independent practices (as I do)
Seattle’s only national park honors the grit of the Klondike gold rush, where Donald Trump's grandfather built the family's early wealth.
But the DOGE cuts have placed the park’s future at risk.
A 🧵 about the park and Frederick Trump...
But the DOGE cuts have placed the park’s future at risk.
A 🧵 about the park and Frederick Trump...
There are some fascinating twists of history in this story.
Frederick Trump had his first foray into the world of hospitality as a 22-year-old in Seattle, when he opened a restaurant very close to the site of the current national park.
nytimes.com/2025/03/14/us/…
Frederick Trump had his first foray into the world of hospitality as a 22-year-old in Seattle, when he opened a restaurant very close to the site of the current national park.
nytimes.com/2025/03/14/us/…
In 1896, Frederick Trump made the family's first foray into U.S. politics in the mining town of Monte Cristo. In a local campaign, he apparently allied himself with William Jennings Bryan, the populist Democrat who railed against tariffs.
nytimes.com/2025/03/14/us/…
nytimes.com/2025/03/14/us/…
In study led by Cassie Simonich & T McMahon, we quantify antigenic evolution of RSV F. Important because:
1⃣ RSV top cause of infant hospitalization in USA
2⃣ New antibodies & vax can prevent hospitalizations
3⃣ But will virus evolution erode efficacy?
biorxiv.org/content/10.110…
1⃣ RSV top cause of infant hospitalization in USA
2⃣ New antibodies & vax can prevent hospitalizations
3⃣ But will virus evolution erode efficacy?
biorxiv.org/content/10.110…
RSV has high burden in infants: top cause of infant hospitalization in USA, 2nd-leading cause of infant mortality globally
A monoclonal antibody (nirsevimab) recently recommended for infants born in USA in RSV season. It prevents hospitalizations
pubmed.ncbi.nlm.nih.gov/38457312/
A monoclonal antibody (nirsevimab) recently recommended for infants born in USA in RSV season. It prevents hospitalizations
pubmed.ncbi.nlm.nih.gov/38457312/
RSV vaccines also now approved to protect infants (via maternal vaccination) & elderly
But some viruses evolve to erode antibodies and vaccines
Will RSV do same? Worryingly, a Regeneron antibody failed phase 3 trials due to resistance in some RSV strains
pubmed.ncbi.nlm.nih.gov/32897368/
But some viruses evolve to erode antibodies and vaccines
Will RSV do same? Worryingly, a Regeneron antibody failed phase 3 trials due to resistance in some RSV strains
pubmed.ncbi.nlm.nih.gov/32897368/
On claim after claim about @USAID / foreign aid, Elon is just making shit up as he goes along. No truth to any of it.
This claim is demonstrably false. Deaths have already been documented from the aid freeze. And the so called "sanity check" is a clown show of incompetence.
This claim is demonstrably false. Deaths have already been documented from the aid freeze. And the so called "sanity check" is a clown show of incompetence.
This is not a "brief pause." Aid orgs doing critical lifesaving work are being denied reimbursement for work already completed, and can't access USG payments to continue operations.
Many had their programs waived from the freeze, then terminated, then un-terminated.
A farce.
Many had their programs waived from the freeze, then terminated, then un-terminated.
A farce.
This is all hugely disruptive and the practical effect is global drawdown of lifesaving humanitarian and health activities.
Our @RefugeesIntl teams in the field over the past two weeks have documented widespread breakdowns of lifesaving relief operations in Syria & Bangladesh.
Our @RefugeesIntl teams in the field over the past two weeks have documented widespread breakdowns of lifesaving relief operations in Syria & Bangladesh.
Yesterday, Rubio terminated 5800 USAID contracts – more than 90% of its foreign aid programs – in defiance of the courts.
Here’s a list of just some of the lifesaving awards that were terminated. Nearly all were Congressional mandated. They've saved millions of lives. 🧵
Here’s a list of just some of the lifesaving awards that were terminated. Nearly all were Congressional mandated. They've saved millions of lives. 🧵
1. All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated.
2. All tuberculosis programs, including the Global TB Drug Facility – terminated.
So - I've actually led Ebola outbreak response at @USAID.
This is bunk from Elon. They have laid off most of the experts, they're bankrupting most of the partner orgs, have withdrawn from WHO, and muzzled CDC.
What's left is a fig-leaf effort to cover their asses politically.
This is bunk from Elon. They have laid off most of the experts, they're bankrupting most of the partner orgs, have withdrawn from WHO, and muzzled CDC.
What's left is a fig-leaf effort to cover their asses politically.
I led USAID's response to the 2014-15 outbreak in West Africa.
Also went to Congo with WHO to assess response at peak of the 2019 outbreak (under Trump 1).
Those were both robust USG ops.
That capacity has now been wrecked.
cgdev.org/publication/st…
Also went to Congo with WHO to assess response at peak of the 2019 outbreak (under Trump 1).
Those were both robust USG ops.
That capacity has now been wrecked.
cgdev.org/publication/st…
Normally there would be:
- resources rapidly pushed to partners & host govt
- robust interagency (USAID/CDC/DOD) teams deployed to field, backstopped by Ops Centers in DC and Atlanta
- real-time operational cooperation and info-sharing with WHO
But not this time.
- resources rapidly pushed to partners & host govt
- robust interagency (USAID/CDC/DOD) teams deployed to field, backstopped by Ops Centers in DC and Atlanta
- real-time operational cooperation and info-sharing with WHO
But not this time.
Train wreck coming.
A federal judge has ordered the USG to lift the aid freeze, pay what it owes, and show evidence that it has not been defying the court.
Which the USG can't do, because Pete Marocco has been defying the court and has purged the staff who move those payments.
A federal judge has ordered the USG to lift the aid freeze, pay what it owes, and show evidence that it has not been defying the court.
Which the USG can't do, because Pete Marocco has been defying the court and has purged the staff who move those payments.
It is clear as day that Marocco has made no effort to comply with multiple orders from the court to lift the arbitrary & capricious aid freeze.
He is likewise defying @SecRubio's order to waive lifesaving assistance.
Virtually no money has been unlocked by either order.
He is likewise defying @SecRubio's order to waive lifesaving assistance.
Virtually no money has been unlocked by either order.
And Marocco's ongoing purge of @USAID personnel means it's functionally impossible to comply with these orders.
He and DOGE have pushed out nearly the entire workforce that would normally process these payments, knowing full well this makes compliance with the orders impossible.
He and DOGE have pushed out nearly the entire workforce that would normally process these payments, knowing full well this makes compliance with the orders impossible.
Our preprint on post-vaccination syndrome is out. We studied immune signatures and examined spike protein in the blood of people who have developed chronic illnesses after COVID-19 vaccination. (1/) medrxiv.org/content/10.110…
Vaccines have saved countless lives and inspired me to become an immunologist. While generally safe, some people experience adverse effects, including Post-Vaccination Syndrome (PVS). Studying PVS is crucial for improving patient care and enhancing vaccine safety & acceptance. (2/) pubmed.ncbi.nlm.nih.gov/37986769/
To explain the study and results, @MalloryLocklear wrote this excellent summary. (3/)
news.yale.edu/2025/02/19/imm…
news.yale.edu/2025/02/19/imm…
Measles cases may likely grow into the 1000’s
The TX measles outbreak continues
With “bubbles” of undervaccination getting bigger, we can expect outbreaks in one to catch on to the next
Igniting transmission that may catch and spread across the U.S.
cnn.com/2025/02/18/hea…
The TX measles outbreak continues
With “bubbles” of undervaccination getting bigger, we can expect outbreaks in one to catch on to the next
Igniting transmission that may catch and spread across the U.S.
cnn.com/2025/02/18/hea…
One of the most common tropes is that measles is fine & doesn’t cause damage…
This is highly inaccurate
Measles literally grows by infecting and killing memory immune cells. It causes loss to existing immunity creating vulnerabilities & acute damage that is often severe
2/
This is highly inaccurate
Measles literally grows by infecting and killing memory immune cells. It causes loss to existing immunity creating vulnerabilities & acute damage that is often severe
2/
To discover the massive-stealth-impact measles has on immune protection against infections not associated w measles, we looked at what happened in populations after measles outbreaks swept through, decade after decade across nations…
What we found was astonishing…
3/
What we found was astonishing…
3/
1/ After residency at Mass General Hospital, I reported to Atlanta to meet my fellow CDC Epidemic Intelligence Service Officers.
I have never felt so intimidated by my peers
The best and the brightest, they were star clinicians, had served in disaster zones; MD/PhDs and MSF.
I have never felt so intimidated by my peers
The best and the brightest, they were star clinicians, had served in disaster zones; MD/PhDs and MSF.
2/ We were placed at various centers throughout CDC, learning from the world's experts- in tuberculosis, mosquito-borne diseases, food-borne diseases, ...
and some of us were placed with state & local Health departments to be on the front lines of outbreak response
and some of us were placed with state & local Health departments to be on the front lines of outbreak response
3/ In my first day on the job, I got into a city sanitation car to investigate an outbreak of bloody diarrhea at a state psychiatric facility.
My boss has served in the EIS. Her boss, the legendary head of the NYC Bureau of Communicable Disease had also.
Our commissioner too.
My boss has served in the EIS. Her boss, the legendary head of the NYC Bureau of Communicable Disease had also.
Our commissioner too.
So...Max Primorac was the lead anti-USAID witness in the House hearing this morning and is one of the architects of the assault on the agency.
He made a few odd claims about his credentials at USAID in today's hearing.
He made a few odd claims about his credentials at USAID in today's hearing.
He claimed that he "oversaw containment of two Ebola outbreaks and led the Bureau for Humanitarian Assistance."
Neither of these claims are accurate.
Neither of these claims are accurate.
On Ebola - there were two outbreaks in Congo in 2018-19 - a small one in Equateur and a huge one in Eastern DRC.
Tim Ziemer, a well-respected health leader, was overseeing Ebola response for USAID.
Max was working on religious freedom programs.
foreign.senate.gov/hearings/confr…
Tim Ziemer, a well-respected health leader, was overseeing Ebola response for USAID.
Max was working on religious freedom programs.
foreign.senate.gov/hearings/confr…
As I told CNN earlier, most of the disinformation about @USAID falls into one of three categories:
▶️ Outright fabrications
▶️ Real programs, but not USAID-funded
▶️ Programs that make sense if you take 2 minutes to understand them
▶️ Outright fabrications
▶️ Real programs, but not USAID-funded
▶️ Programs that make sense if you take 2 minutes to understand them
▶️Fabrications:
"Gaza condoms" is the classic here.
Absurd on its face, but still Elon and Trump spent a week repeating it as the pretext for destroying USAID.
Until Elon just glibly admitted it was bullshit and we shouldn't trust what he says.
"Gaza condoms" is the classic here.
Absurd on its face, but still Elon and Trump spent a week repeating it as the pretext for destroying USAID.
Until Elon just glibly admitted it was bullshit and we shouldn't trust what he says.
▶️Real, but not USAID:
@RepBrianMast repeated a bunch of these today (a musical in Ireland, an opera in Colombia, a "drag show" in Ecuador).
One problem: all were State Dept funded - not USAID (as even Mast's own website admits).
foreignaffairs.house.gov/press-release/…
washingtonpost.com/politics/2025/…
@RepBrianMast repeated a bunch of these today (a musical in Ireland, an opera in Colombia, a "drag show" in Ecuador).
One problem: all were State Dept funded - not USAID (as even Mast's own website admits).
foreignaffairs.house.gov/press-release/…
washingtonpost.com/politics/2025/…
Musk is continuing his wildly distorted claims attacking USAID. The last round is debunked below.
And I'll unpack the reality in this 🧵, too. 1/13 wapo.st/3ErHBZM
And I'll unpack the reality in this 🧵, too. 1/13 wapo.st/3ErHBZM
Conservative Andrew Natsios led USAID under the GOP and he masterfully unpacks the lies and slander in this interview. 2/13
politico.com/news/magazine/…
politico.com/news/magazine/…
Meanwhile, as a test case for illegally hijacking the entire US government, the world’s richest man is destroying health and humanitarian efforts with gleeful indifference to the horrific damage to the US and people’s lives. 10 Examples:
OK, time to bust another @USAID myth.
Stephen Miller said on Fox today that USAID is a rogue slush fund. Trump & Elon have made the same accusation.
FALSE. They're either ignorant of how USAID spends money, or willfully lying about it. Or...
Anyway, caffeinate and read on.
🧵
Stephen Miller said on Fox today that USAID is a rogue slush fund. Trump & Elon have made the same accusation.
FALSE. They're either ignorant of how USAID spends money, or willfully lying about it. Or...
Anyway, caffeinate and read on.
🧵
Buckle in for a roller coaster ride through the USAID budget process. To keep you reading, I will use memes.
Step 1.
Every year, the White House (via OMB) puts together a federal budget proposal to Congress. Every federal agency (incl USAID) sends OMB their budget wishlist.
Step 1.
Every year, the White House (via OMB) puts together a federal budget proposal to Congress. Every federal agency (incl USAID) sends OMB their budget wishlist.
OMB goes over everything and begins cutting down Agency requests and reviewing them for alignment with the president's priorities.
So to be clear: every dollar that USAID requests from Congress goes through White House review.
Not very slush-y.
So to be clear: every dollar that USAID requests from Congress goes through White House review.
Not very slush-y.
1) Since there is a lot of confusion about the reduction of the overhead rate on NIH grants to 15% (see here: ) I'll do a little tweetorial (or X-torial?) about it.grants.nih.gov/grants/guide/n…
2) So, for every dollar that NIH pays for research through a grant (we call this direct cost), they usually add extra money (which we call indirect cost). While the direct cost pays for the actual research (salaries of scientists, reagents etc.), the indirect cost pays for....
3)....infrastructure and utilities. It pays for basic things like electricity, water, heat, even toilet paper but also things like maintenance of animal facilities, core facilities with special equipment, administrative services, building maintenance, security, mail, internet....
The state of play, a week into Elon's assault on USAID.
USAID is in a state of suspended animation - it has been powered down, but it's not *quite* to the point where it can't be powered back on.
What happens next comes down to the courts & Congress.
🧵
USAID is in a state of suspended animation - it has been powered down, but it's not *quite* to the point where it can't be powered back on.
What happens next comes down to the courts & Congress.
🧵
Ignore the wood-chipper tweets and here's where things actually stand:
- USAID's HQ is intact and could resume work
- USAID's staff are mostly furloughed - but could be recalled
- Overseas missions have been told they'll be drawn down - but for now remain intact and in place
- USAID's HQ is intact and could resume work
- USAID's staff are mostly furloughed - but could be recalled
- Overseas missions have been told they'll be drawn down - but for now remain intact and in place
- Much of USAID's partner base faces financial ruin - but is not yet *in* financial ruin. Orgs would survive if funding resumed.
- USAID's many grants & contracts are frozen - but only a few are yet cancelled. They could resume.
- USAID's many grants & contracts are frozen - but only a few are yet cancelled. They could resume.
Rubio claims that @USAID lifesaving assistance for health and humanitarian needs will continue. But his team just communicated that the entire agency will be imminently reduced from 14,000 to 294 people. Just 12 in Africa.
We already see the shutdown's cost. Kids with drug-resistant TB, turned away from clinics, are not just dying - they're spreading the disease. People around the world w HIV, denied their medicine, will soon start transmitting virus. The damage is global. wbur.org/onpoint/2025/0…
Communications in one mission overseas:
"I'm sorry to say that all of us will be on administrative leave -- perhaps even starting today/this evening. I don't have the adequate words. Please know that your work was good, and it mattered."
"I'm sorry to say that all of us will be on administrative leave -- perhaps even starting today/this evening. I don't have the adequate words. Please know that your work was good, and it mattered."
Might not feel this way on twitter - but back here on earth, DOGE did not have a great day yesterday on the @USAID front.
Elon's attempt to speedrun the destruction of USAID is starting to hit real legal and political bumps.
The pushback is starting - and must be sustained.
🧵
Elon's attempt to speedrun the destruction of USAID is starting to hit real legal and political bumps.
The pushback is starting - and must be sustained.
🧵
Congress is waking up to what is happening, on both sides of the aisle.
Big spontaneous rally outside of USAID HQ yesterday with a sizable contingent of Congressional Dems defending the agency.
Big spontaneous rally outside of USAID HQ yesterday with a sizable contingent of Congressional Dems defending the agency.
GOP is waking up as well. Multiple Republican senators weighed in yesterday criticizing the Rubio aid freeze. Notable that they're doing so publicly.
