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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

For now, I suspect we'll continue to see dollars drip drip dripping into these spas, unfiltered and largely unchecked.
But maybe this study will be a wake-up call.
Full piece here: buff.ly/3fU3lDG

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

Adults can make their own decisions about their bodies and money. But those decisions should be informed by transparent facts.
If a spa makes a health claim, they should back it up with data. And patients need to understand both benefits AND risks.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

There's something very 2025 about this whole industry. This idea that going outside the standard of care means you're getting better care. That you can just optimize your way to health with the right cocktail of vitamins.
That assumption is likely false.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

Look, I'm a nephrologist. Fluids are sort of my bag. ;)
The thing is, dripping fluids directly into your bloodstream has real risks. You need someone who knows your medical history, understands contraindications, and can handle complications.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

And when asked about risks, most just mentioned bruising. Only 6 of 87 clinics mentioned infection, despite documented cases of infections and at least one death linked to these treatments.
Oh, and zero clinics accepted health insurance.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

But here's where it gets really wild: the secret shopper calls.
When researchers called posing as sick customers:

86% got specific therapy recommendations from whoever answered the phone
Only 8% got connected to an actual doctor
Only 24% heard about ANY risks

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

Then there's what these spas are actually claiming.
100% of the websites made health claims about their products.
Only 0.8%—that's 2 out of 255 sites—provided ANY references to back up those claims.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

First, the regulation picture. NO state has specific legislation for IV hydration spas.
Only 6 states have rules about who runs these places.
Only 12 regulate who can prescribe.
Only 4 states—FOUR—address all aspects of oversight.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

Researchers (full disclosure: Yalies but I was not involved) examined state laws, reviewed 255 spa websites, and then called 87 spas posing as customers with headache and cold symptoms.
What they found was eye opening to say the least.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

Turns out there is a catch. A big one.
IV hydration spas are a $1.5 billion industry in the US, growing rapidly. And they're operating in a regulatory wild west with almost no oversight.
A new study in JAMA just exposed how bad it really is.
buff.ly/4iskboS

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

The ad promised to cure migraines, chronic fatigue, fibromyalgia, depression, anxiety—you name it. All I had to do was call a number and someone would come to my hotel room with a bag of "hydration fluid" and "electrolytes."
Surely there'd be no catch.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 3d

I woke up in Las Vegas last week with some mysterious symptoms: pounding headache, nausea, feeling like I hadn't slept at all. Who knows what could cause such a thing? As I searched for coffee, I saw a sign promising salvation: IV fluids. On demand. For $248. 🧵

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

More detail / nuance in my full writeup about this article on @medscape if you want to dive deeper: www.medscape.com/viewarticle/...

/🧵

Is the Rise in Cancer in Young People... Fake?

A study looking at the eight fastest-rising cancers in young adults concludes that the real problem is overdiagnosis. But not everyone agrees.

www.medscape.com

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

The cancer epidemiology world is getting spicy, and honestly? That's good. These debates push us toward better understanding.
But let's not throw out the baby with the bathwater. Young people + cancer = worth investigating, even if some cases are overdiagnosed. 12/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Bottom line: Overdiagnosis becomes more likely with age (more competing risks of death). So I'm very hesitant to write off cancer increases in YOUNG people as unimportant.
Yes, we need smarter screening. But we also need to figure out what's going on. 11/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

What worries me? Statements like "searching for biological causes is bound to be unproductive" and studying exposures "diverts funding from more important issues."
That's a false dichotomy! We can tackle overdiagnosis AND investigate why more young people are getting cancer. 10/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Good news for my colonoscopy anxiety: Even the authors agree colorectal cancer shows a REAL increase. Both mortality AND incidence are up. So yeah, still keeping that appointment. 😅 9/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

The authors lean heavily on thyroid and kidney cancers - the poster children for overdiagnosis. But these are notoriously slow-spreading. Not exactly representative of all cancers on the rise. 8/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Also: "Less deadly" ≠ "unimportant"
A 45-year-old with endometrial cancer probably shouldn't wait 40+ years to see if it matters. And there's a lot of "clinically relevant" between "totally fine" and "death." 7/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

The paper dismisses improved treatments, saying it's "implausible" that better care would perfectly balance rising rates.
But does it need to be perfect? Looking at those mortality graphs, there's plenty of wiggle room. We're not talking about laser precision here. 6/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Here's where it gets tricky. Maybe mortality is flat because:

We've gotten WAY better at treating cancer (immunotherapy?)
We're catching dangerous cancers earlier (which is... the point?)
The increase is in less-deadly but still important cancers 5/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

A new paper in JAMA Internal Medicine argues we're just getting better at finding cancers that don't matter. Their evidence: Cancer diagnoses ⬆️ dramatically, but mortality rates? Pretty flat.
Seems logical, right? Well... 4/
buff.ly/8nX2y5h

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Enter "overdiagnosis" - finding real cancers that would never have caused problems. Like how 60% of men over 79 who died from OTHER causes had prostate cancer at autopsy.
Real cancer? Yes.
Problem? Not for them. 3/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

The facts everyone agrees on: Early-onset cancer rates (before age 50) ARE rising. Some cancers like thyroid, kidney, endometrial, and colorectal are up >1% per year since 1992.
The debate? Whether these new cases actually matter. 2/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

🧵 New headlines say rising cancer rates in young people might be... fake? Before you panic (or un-panic), let's talk about why this is both more complicated AND more interesting than it sounds. Spoiler: I'm still getting my colonoscopy. 1/

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