DJ Smithers
@djsmithers.bsky.social
Medicine resident and incoming research fellow in health policy at Harvard/Brigham & Women’s. Probably out running.
Reposted by DJ Smithers
A little announcement on the show today: It's our 29th birthday! 🎂
February 19, 2025 at 1:19 PM
A little announcement on the show today: It's our 29th birthday! 🎂
Reposted by DJ Smithers
I recommend this podcast, which includes interviews with fired federal workers. It does a good job capturing the personal cost of handing the government over to power-hungry sociopaths who don’t believe in competent governance.
podcasts.apple.com/us/podcast/t...
podcasts.apple.com/us/podcast/t...
Inside the Trump Purge: Federal Workers Tell Their Stories
Podcast Episode · The Daily · 02/19/2025 · 28m
podcasts.apple.com
February 19, 2025 at 11:34 AM
I recommend this podcast, which includes interviews with fired federal workers. It does a good job capturing the personal cost of handing the government over to power-hungry sociopaths who don’t believe in competent governance.
podcasts.apple.com/us/podcast/t...
podcasts.apple.com/us/podcast/t...
Yeah, these takes give away just how little someone understands about healthcare.
Nursing is a fundamentally human-centric role. Eg, inpatient they’re the most familiar with who patients are, what they typically look like, etc. They’re the eyes and ears for entire teams. That can’t be AI-ed.
Nursing is a fundamentally human-centric role. Eg, inpatient they’re the most familiar with who patients are, what they typically look like, etc. They’re the eyes and ears for entire teams. That can’t be AI-ed.
When someone brings up AI nurses in a positive way I am generally very concerned about what kinds of interactions they have had with the health system. Most of my memorable positive interactions were with nurses who very much needed to be human.
February 18, 2025 at 9:05 PM
Yeah, these takes give away just how little someone understands about healthcare.
Nursing is a fundamentally human-centric role. Eg, inpatient they’re the most familiar with who patients are, what they typically look like, etc. They’re the eyes and ears for entire teams. That can’t be AI-ed.
Nursing is a fundamentally human-centric role. Eg, inpatient they’re the most familiar with who patients are, what they typically look like, etc. They’re the eyes and ears for entire teams. That can’t be AI-ed.
Reposted by DJ Smithers
“There are currently four people remaining over there to do the work of 15 people. The danger to the national airspace can’t be understated."
"This is a very real threat to the American flying public.”
EXCLUSIVE ⤵️
"This is a very real threat to the American flying public.”
EXCLUSIVE ⤵️
FAA Employees Say Trump and Musk's Purge Is a 'Threat' to Air Safety
Donald Trump and Elon Musk fired hundreds of Federal Aviation Administration employees. The administration argues it won’t affect air safety.
www.rollingstone.com
February 18, 2025 at 5:08 PM
“There are currently four people remaining over there to do the work of 15 people. The danger to the national airspace can’t be understated."
"This is a very real threat to the American flying public.”
EXCLUSIVE ⤵️
"This is a very real threat to the American flying public.”
EXCLUSIVE ⤵️
Reading @chrislhayes.bsky.social’s The Sirens’ Call and @superwuster.bsky.social’s The Attention Merchants not to help me quit social media, but instead to have a higher brow inner monologue about why I should feel bad for being perpetually online
February 18, 2025 at 8:48 PM
Reading @chrislhayes.bsky.social’s The Sirens’ Call and @superwuster.bsky.social’s The Attention Merchants not to help me quit social media, but instead to have a higher brow inner monologue about why I should feel bad for being perpetually online
Reposted by DJ Smithers
You should go sub to Ellie’s newsletter; my longstanding issue w the epidemiologic transition concept is it’s a bit of scientific ideology that has made it impossible for several generations of epidemiologists to think about infectious diseases in anything but the barest of biomedical terms
RFK Jr wants the US to focus on chronic, not infectious, diseases. But we already did. 50 years ago.
It's called the "epidemiologic transition" and spolier alert:
It's not going so well!
Read more here: open.substack.com/pub/epiellie...
It's called the "epidemiologic transition" and spolier alert:
It's not going so well!
Read more here: open.substack.com/pub/epiellie...
RFK Jr wants the US to focus on chronic, not infectious, diseases. But we already did. 50 years ago.
Someone needs to explain the "epidemiologic transition" to him
open.substack.com
February 17, 2025 at 9:10 PM
You should go sub to Ellie’s newsletter; my longstanding issue w the epidemiologic transition concept is it’s a bit of scientific ideology that has made it impossible for several generations of epidemiologists to think about infectious diseases in anything but the barest of biomedical terms
Reposted by DJ Smithers
It's a horrendous flu season. It's killing kids, it's killing adults. It's killing people who were perfectly healthy before and people who, like most Americans, have chronic illness. It costs NOTHING to keep existing resources available. Our government is spending money to make Americans sicker.
On Friday night, HHS ordered CDC to take down all flu vaccine campaign materials from its website. Materials are starting to come down.
For example, a campaign explaining that flu shot can reduce flu severity from "wild to mild" is now offline. Left image is from Friday, right is now
Meanwhile...
For example, a campaign explaining that flu shot can reduce flu severity from "wild to mild" is now offline. Left image is from Friday, right is now
Meanwhile...
February 16, 2025 at 6:32 PM
It's a horrendous flu season. It's killing kids, it's killing adults. It's killing people who were perfectly healthy before and people who, like most Americans, have chronic illness. It costs NOTHING to keep existing resources available. Our government is spending money to make Americans sicker.
Reposted by DJ Smithers
In most people with cirrhosis, acetaminophen (up to 2g/day) is a safer analgesic than NSAIDs (kidneys, GI mucosa) or opioids (CNS function, gut motility)
Spreading the word from @shreyatrivedimd.bsky.social @ebtapper.bsky.social
Spreading the word from @shreyatrivedimd.bsky.social @ebtapper.bsky.social
February 18, 2025 at 5:29 PM
In most people with cirrhosis, acetaminophen (up to 2g/day) is a safer analgesic than NSAIDs (kidneys, GI mucosa) or opioids (CNS function, gut motility)
Spreading the word from @shreyatrivedimd.bsky.social @ebtapper.bsky.social
Spreading the word from @shreyatrivedimd.bsky.social @ebtapper.bsky.social
Reposted by DJ Smithers
1/ I am seeing a lot of comments on the slashing of NIH support along the lines of “universities should just spend their huge endowments.”
I’m the last person to cheer on the institutional stratification rising endowments have contributed to. But let me explain why this is not a solution.
I’m the last person to cheer on the institutional stratification rising endowments have contributed to. But let me explain why this is not a solution.
February 18, 2025 at 1:48 PM
1/ I am seeing a lot of comments on the slashing of NIH support along the lines of “universities should just spend their huge endowments.”
I’m the last person to cheer on the institutional stratification rising endowments have contributed to. But let me explain why this is not a solution.
I’m the last person to cheer on the institutional stratification rising endowments have contributed to. But let me explain why this is not a solution.
Reposted by DJ Smithers
Medicaid "work requirements" do not work. They are a form of administrative burden that reduces Medicaid's effectiveness at increasing the insured rate while increasing churn, which the knock-on effects of delayed and forgone care & medical debt www.ncbi.nlm.nih.gov/pubmed/32897...
Medicaid Work Requirements In Arkansas: Two-Year Impacts On Coverage, Employment, And Affordability Of Care - PubMed
In June 2018 Arkansas became the first US state to implement work requirements in Medicaid, requiring adults ages 30-49 to work twenty hours a week, participate in "community engagement" activities, o...
www.ncbi.nlm.nih.gov
February 14, 2025 at 10:41 PM
Medicaid "work requirements" do not work. They are a form of administrative burden that reduces Medicaid's effectiveness at increasing the insured rate while increasing churn, which the knock-on effects of delayed and forgone care & medical debt www.ncbi.nlm.nih.gov/pubmed/32897...
Reposted by DJ Smithers
Major news:
Entire first-year class of the Epidemic Intelligence Service must be out by 5pm, sources say.
Also: a major CDC contractor "just let go." Others may follow.
This is an attack on our ability to detect outbreaks.
More, with quotes from CDC officials:
open.substack.com/pub/insideme...
Entire first-year class of the Epidemic Intelligence Service must be out by 5pm, sources say.
Also: a major CDC contractor "just let go." Others may follow.
This is an attack on our ability to detect outbreaks.
More, with quotes from CDC officials:
open.substack.com/pub/insideme...
News: Half of CDC "disease detectives" terminated. DOGE takes aim at US disease surveillance.
Entire first-year class of the Epidemic Intelligence Service must be out by 5 p.m., sources say. Also: a major CDC contractor "just let go," and others may follow.
open.substack.com
February 14, 2025 at 7:13 PM
Major news:
Entire first-year class of the Epidemic Intelligence Service must be out by 5pm, sources say.
Also: a major CDC contractor "just let go." Others may follow.
This is an attack on our ability to detect outbreaks.
More, with quotes from CDC officials:
open.substack.com/pub/insideme...
Entire first-year class of the Epidemic Intelligence Service must be out by 5pm, sources say.
Also: a major CDC contractor "just let go." Others may follow.
This is an attack on our ability to detect outbreaks.
More, with quotes from CDC officials:
open.substack.com/pub/insideme...
Reposted by DJ Smithers
If there’s a Disease X outbreak in the next four (or more?) years we literally will be flying blind, we just fired the people who would have tracked it
CDC source:
“We just had word that all our fellows and post doc staff are laid off effective immediately. The famous Epidemic Intelligence Service, aka the Disease Detectives, is no more. That’s 1260 staff.
They are calling this ‘Phase 1’.”
“We just had word that all our fellows and post doc staff are laid off effective immediately. The famous Epidemic Intelligence Service, aka the Disease Detectives, is no more. That’s 1260 staff.
They are calling this ‘Phase 1’.”
February 14, 2025 at 8:29 PM
If there’s a Disease X outbreak in the next four (or more?) years we literally will be flying blind, we just fired the people who would have tracked it
Reposted by DJ Smithers
They are going to ignore court orders.
If they ignore court orders, the social contract is dead and buried, the constitution is no longer in effect.
It's a rubicon that cannot be uncrossed.
If they ignore court orders, the social contract is dead and buried, the constitution is no longer in effect.
It's a rubicon that cannot be uncrossed.
February 9, 2025 at 6:39 PM
They are going to ignore court orders.
If they ignore court orders, the social contract is dead and buried, the constitution is no longer in effect.
It's a rubicon that cannot be uncrossed.
If they ignore court orders, the social contract is dead and buried, the constitution is no longer in effect.
It's a rubicon that cannot be uncrossed.
Reposted by DJ Smithers
Here are some facts about "facilities and administrative" (F&A) costs, what we in the business call "indirects" and what Musk is calling "overhead" as he tries to convince Americans with being ok with cutting billions on dollars from medical and public health research at universities & hospitals
1/
1/
February 9, 2025 at 6:55 PM
Here are some facts about "facilities and administrative" (F&A) costs, what we in the business call "indirects" and what Musk is calling "overhead" as he tries to convince Americans with being ok with cutting billions on dollars from medical and public health research at universities & hospitals
1/
1/
Reposted by DJ Smithers
1. Today the NIH director issued a new directive slashing overhead rates to 15%.
I want to provide some context on what that means and why it matters.
grants.nih.gov/grants/guide...
I want to provide some context on what that means and why it matters.
grants.nih.gov/grants/guide...
NOT-OD-25-068: Supplemental Guidance to the 2024 NIH Grants Policy Statement: Indirect Cost Rates
NIH Funding Opportunities and Notices in the NIH Guide for Grants and Contracts: Supplemental Guidance to the 2024 NIH Grants Policy Statement: Indirect Cost Rates NOT-OD-25-068. OD
grants.nih.gov
February 8, 2025 at 12:18 AM
1. Today the NIH director issued a new directive slashing overhead rates to 15%.
I want to provide some context on what that means and why it matters.
grants.nih.gov/grants/guide...
I want to provide some context on what that means and why it matters.
grants.nih.gov/grants/guide...
Reposted by DJ Smithers
I'm not sure how to explain how financially devastating this will be for universities. This is, literally, catastrophic for universities and for science in the United States.
⚠️ Effective Monday 2/10/25, NIH indirect rate capped at 15%. Applies to existing & future grants.
—> Deep budget cuts & program closures coming to a university near you.
Is this the break the glass moment for university administrators who have been silent so far about the attack on science?
—> Deep budget cuts & program closures coming to a university near you.
Is this the break the glass moment for university administrators who have been silent so far about the attack on science?
NOT-OD-25-068: Supplemental Guidance to the 2024 NIH Grants Policy Statement: Indirect Cost Rates
NIH Funding Opportunities and Notices in the NIH Guide for Grants and Contracts: Supplemental Guidance to the 2024 NIH Grants Policy Statement: Indirect Cost Rates NOT-OD-25-068. OD
grants.nih.gov
February 7, 2025 at 11:45 PM
I'm not sure how to explain how financially devastating this will be for universities. This is, literally, catastrophic for universities and for science in the United States.
Reposted by DJ Smithers
It's hard to keep track of all the awfulness, but Idaho has introduced a massive attack on Medicaid, proposing the elimination of Medicaid expansion if they don't impose a work requirement, cap enrollment to 50k, and restrict benefits to being for only up to 3 years open.substack.com/pub/miranday...
Draconian Medicaid Cuts Proposed in Idaho
In one of many recent attacks on health care access, in Idaho’s House Bill 138, Rep.
open.substack.com
February 5, 2025 at 6:00 PM
It's hard to keep track of all the awfulness, but Idaho has introduced a massive attack on Medicaid, proposing the elimination of Medicaid expansion if they don't impose a work requirement, cap enrollment to 50k, and restrict benefits to being for only up to 3 years open.substack.com/pub/miranday...
Reposted by DJ Smithers
And let's be clear that Medicare 'fraud' is largely done by health insurance companies (e.g. Medicare Advantage plans) and health care executives (e.g. Rick Scott). www.nytimes.com/2022/10/08/u...
February 5, 2025 at 5:54 PM
And let's be clear that Medicare 'fraud' is largely done by health insurance companies (e.g. Medicare Advantage plans) and health care executives (e.g. Rick Scott). www.nytimes.com/2022/10/08/u...
Reposted by DJ Smithers
CDC's Youth Risk Behavior Survey (YRBS) -- which, since 1990, has tracked high school students' behaviors that can influence health and social outcomes (like smoking, drug use, and dietary habits) -- is now offline
January 31, 2025 at 5:45 PM
CDC's Youth Risk Behavior Survey (YRBS) -- which, since 1990, has tracked high school students' behaviors that can influence health and social outcomes (like smoking, drug use, and dietary habits) -- is now offline
Reposted by DJ Smithers
This is a big deal, y'all. Federal health websites are being stripped of content or removed in their entirety. Stick with this thread for a look at what's disappeared so far! 1/x
January 31, 2025 at 7:28 PM
This is a big deal, y'all. Federal health websites are being stripped of content or removed in their entirety. Stick with this thread for a look at what's disappeared so far! 1/x
Reposted by DJ Smithers
It’s true that there are health policy tradeoffs in many arenas. But one thing that is not a tradeoff is our decision, in the US, to punish the sick: Deductibles, copays, coinsurance, “medical debt”, medical bankruptcy are socially useless, socially harmful, policy decisions.
January 13, 2025 at 3:24 AM
It’s true that there are health policy tradeoffs in many arenas. But one thing that is not a tradeoff is our decision, in the US, to punish the sick: Deductibles, copays, coinsurance, “medical debt”, medical bankruptcy are socially useless, socially harmful, policy decisions.
"commissioners in climate disaster–prone states...have favored overly lenient regulation of insurers in terms of the adequacy of their loss reserves, in order to encourage them to keep providing insurance at all" prospect.org/blogs-and-ne...
The Next Financial Crisis: Insurance
Today on TAP: Increasing damage from fires, hurricanes, and floods will destabilize a lightly regulated industry—and spill over into broader financial markets.
prospect.org
January 13, 2025 at 8:24 PM
"commissioners in climate disaster–prone states...have favored overly lenient regulation of insurers in terms of the adequacy of their loss reserves, in order to encourage them to keep providing insurance at all" prospect.org/blogs-and-ne...
Reposted by DJ Smithers
$2.3 trillion in Medicaid spending cuts reportedly being considered by Republicans represents 31% of projected federal Medicaid spending over the next decade.
@robinr.bsky.social
www.kff.org/quick-take/h...
@robinr.bsky.social
www.kff.org/quick-take/h...
House GOP Eyeing Cuts of Nearly One-Third in Projected Medicaid Spending
House Republicans are considering deficit reductions of $5.5 trillion, which includes $2.3 trillion cuts in Medicaid… Cuts of this magnitude would put states at financial risk, forcing them to raise n...
www.kff.org
January 13, 2025 at 7:36 PM
$2.3 trillion in Medicaid spending cuts reportedly being considered by Republicans represents 31% of projected federal Medicaid spending over the next decade.
@robinr.bsky.social
www.kff.org/quick-take/h...
@robinr.bsky.social
www.kff.org/quick-take/h...
Reposted by DJ Smithers
There are and will be many public health issues to defend in the coming years. We can all have an impact individually, and we can have a greater impact working together.
January 11, 2025 at 2:51 PM
There are and will be many public health issues to defend in the coming years. We can all have an impact individually, and we can have a greater impact working together.