Paul Abramson MD
@paulabramsonmd.mydoctorsf.com
Private physician in SF @mydoctorsf.com, MedEd at UCSF, concierge medicine, #addictionmed, infectious diseases, hospital med, gerontology, fmr EE, armchair ethicist. Bunny dad. #medsky
Pinned
"Can I reverse my plaque?" Less important than you think. Plaque regression is a surrogate endpoint. A smaller unstable plaque is worse than a larger stable one. Statins regress plaque AND reduce mortality. Focus on outcomes, not imaging.
January 20, 2026 at 3:10 PM
"Can I reverse my plaque?" Less important than you think. Plaque regression is a surrogate endpoint. A smaller unstable plaque is worse than a larger stable one. Statins regress plaque AND reduce mortality. Focus on outcomes, not imaging.
"I want the PCSK9 inhibitor, it is newer."
You would not fund a startup with one Phase 2 trial when the competitor has 22 RCTs and mortality data. Why would the bar be lower for your coronary arteries?
You would not fund a startup with one Phase 2 trial when the competitor has 22 RCTs and mortality data. Why would the bar be lower for your coronary arteries?
January 15, 2026 at 3:20 PM
"I want the PCSK9 inhibitor, it is newer."
You would not fund a startup with one Phase 2 trial when the competitor has 22 RCTs and mortality data. Why would the bar be lower for your coronary arteries?
You would not fund a startup with one Phase 2 trial when the competitor has 22 RCTs and mortality data. Why would the bar be lower for your coronary arteries?
When your kid brings home flu, Xofluza is one dose for contacts vs 10 days of Tamiflu. Sounds better. But households aren't single-exposure events. Ongoing exposure may need ongoing coverage.
January 14, 2026 at 3:30 PM
When your kid brings home flu, Xofluza is one dose for contacts vs 10 days of Tamiflu. Sounds better. But households aren't single-exposure events. Ongoing exposure may need ongoing coverage.
Reposted by Paul Abramson MD
In this flu season, we are reviewing cases of rhabdomyolysis with super high CK levels in the context of influenza A infection
Here's a case report, but surprised there's not more in the literature: pmc.ncbi.nlm.nih.gov/articles/PMC...
Here's a case report, but surprised there's not more in the literature: pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov
January 14, 2026 at 2:37 PM
In this flu season, we are reviewing cases of rhabdomyolysis with super high CK levels in the context of influenza A infection
Here's a case report, but surprised there's not more in the literature: pmc.ncbi.nlm.nih.gov/articles/PMC...
Here's a case report, but surprised there's not more in the literature: pmc.ncbi.nlm.nih.gov/articles/PMC...
Each day you delay flu treatment increases death risk by 14-40%. Both antivirals shorten illness by about one day if started within 24 hours. After 48 hours, Xofluza has no data at all.
January 14, 2026 at 4:10 AM
Each day you delay flu treatment increases death risk by 14-40%. Both antivirals shorten illness by about one day if started within 24 hours. After 48 hours, Xofluza has no data at all.
If you care about healthspan, you have to care about blood pressure.
Uncontrolled BP claims 10 million lives yearly. Intensive control cuts cardiovascular events by 30%.
Taking a peptide feels sophisticated. Checking your BP feels ordinary.
The evidence base isn't close.
Uncontrolled BP claims 10 million lives yearly. Intensive control cuts cardiovascular events by 30%.
Taking a peptide feels sophisticated. Checking your BP feels ordinary.
The evidence base isn't close.
January 13, 2026 at 3:10 PM
If you care about healthspan, you have to care about blood pressure.
Uncontrolled BP claims 10 million lives yearly. Intensive control cuts cardiovascular events by 30%.
Taking a peptide feels sophisticated. Checking your BP feels ordinary.
The evidence base isn't close.
Uncontrolled BP claims 10 million lives yearly. Intensive control cuts cardiovascular events by 30%.
Taking a peptide feels sophisticated. Checking your BP feels ordinary.
The evidence base isn't close.
The choice that matters isn't Tamiflu vs Xofluza. It's today vs tomorrow. Same-day flu treatment was associated with 64% lower mortality. Drug selection? Similar outcomes.
January 11, 2026 at 5:30 PM
The choice that matters isn't Tamiflu vs Xofluza. It's today vs tomorrow. Same-day flu treatment was associated with 64% lower mortality. Drug selection? Similar outcomes.
Beyond the headline: cystatin C discordance with creatinine eGFR is about more than just kidney function; it predicts outcomes, may suggest systemic problems, and the directionality is critical (GFRcr > eGFRcys is a good sign). buff.ly/CscgFAJ #medsky
Discordance in Creatinine- and Cystatin C-Based eGFR and Clinical Outcomes: A Meta-Analysis - PubMed
In the CKD-PC, 11% of outpatient participants and 35% of hospitalized patients had an eGFRcys that was at least 30% lower than their eGFRcr. In the outpatient setting, presence of eGFRcys at least 30%...
buff.ly
January 10, 2026 at 5:38 PM
Beyond the headline: cystatin C discordance with creatinine eGFR is about more than just kidney function; it predicts outcomes, may suggest systemic problems, and the directionality is critical (GFRcr > eGFRcys is a good sign). buff.ly/CscgFAJ #medsky
Software can be patched. Markets recover from failed experiments.
The body's irreplaceable systems cannot.
"Move fast and break things" doesn't work here.
The body's irreplaceable systems cannot.
"Move fast and break things" doesn't work here.
January 9, 2026 at 6:02 PM
Software can be patched. Markets recover from failed experiments.
The body's irreplaceable systems cannot.
"Move fast and break things" doesn't work here.
The body's irreplaceable systems cannot.
"Move fast and break things" doesn't work here.
Patients overestimate statin side effects by an order of magnitude. True attributable muscle symptoms: less than 1%. Severe myopathy: less than 0.1%. The perception gap drives people toward less-proven alternatives.
January 9, 2026 at 4:15 AM
Patients overestimate statin side effects by an order of magnitude. True attributable muscle symptoms: less than 1%. Severe myopathy: less than 0.1%. The perception gap drives people toward less-proven alternatives.
How smart people fool themselves about health interventions:
Subtle adjustments to probability estimates. Shifts in confidence levels. Quiet downgrades of source reliability for inconvenient findings.
Small biases that accumulate into confident but unfounded conclusions.
Subtle adjustments to probability estimates. Shifts in confidence levels. Quiet downgrades of source reliability for inconvenient findings.
Small biases that accumulate into confident but unfounded conclusions.
January 8, 2026 at 6:02 PM
How smart people fool themselves about health interventions:
Subtle adjustments to probability estimates. Shifts in confidence levels. Quiet downgrades of source reliability for inconvenient findings.
Small biases that accumulate into confident but unfounded conclusions.
Subtle adjustments to probability estimates. Shifts in confidence levels. Quiet downgrades of source reliability for inconvenient findings.
Small biases that accumulate into confident but unfounded conclusions.
The same traits that drive innovation—systematic thinking, high openness, confidence in analysis—become vulnerabilities when applied to human biology.
The mindset that builds companies requires different guardrails when applied to health.
The mindset that builds companies requires different guardrails when applied to health.
January 7, 2026 at 7:02 PM
The same traits that drive innovation—systematic thinking, high openness, confidence in analysis—become vulnerabilities when applied to human biology.
The mindset that builds companies requires different guardrails when applied to health.
The mindset that builds companies requires different guardrails when applied to health.
Statins reduce all-cause mortality in high-risk primary prevention (RR 0.92). PCSK9 inhibitors do not demonstrate that benefit in this population. The boring generic pill has the outcome data the fancy injectable lacks.
January 7, 2026 at 4:10 AM
Statins reduce all-cause mortality in high-risk primary prevention (RR 0.92). PCSK9 inhibitors do not demonstrate that benefit in this population. The boring generic pill has the outcome data the fancy injectable lacks.
Dunning himself clarified his research: "You can be incredibly intelligent in one area and completely not have expertise in another."
Tech founders approaching human biology with the confidence they bring to software development is a textbook case.
Tech founders approaching human biology with the confidence they bring to software development is a textbook case.
January 6, 2026 at 6:02 PM
Dunning himself clarified his research: "You can be incredibly intelligent in one area and completely not have expertise in another."
Tech founders approaching human biology with the confidence they bring to software development is a textbook case.
Tech founders approaching human biology with the confidence they bring to software development is a textbook case.
"Unintelligent people are more easily misled by others. Intelligent people are more easily misled by themselves."
They construct more sophisticated rationalizations. Find creative ways to dismiss contrary evidence.
They construct more sophisticated rationalizations. Find creative ways to dismiss contrary evidence.
January 5, 2026 at 7:01 PM
"Unintelligent people are more easily misled by others. Intelligent people are more easily misled by themselves."
They construct more sophisticated rationalizations. Find creative ways to dismiss contrary evidence.
They construct more sophisticated rationalizations. Find creative ways to dismiss contrary evidence.
Aging muscle isn’t just smaller. It's different.
Soendenbroe et al. 2024 (J Cachexia Sarcopenia Muscle): heavy resistance training reverses irregular myofiber shape, a marker of aging.
Net: strength work improves muscle quality, not just size. For healthy aging, resistance training is non‑negotiable
Soendenbroe et al. 2024 (J Cachexia Sarcopenia Muscle): heavy resistance training reverses irregular myofiber shape, a marker of aging.
Net: strength work improves muscle quality, not just size. For healthy aging, resistance training is non‑negotiable
January 4, 2026 at 5:30 PM
Aging muscle isn’t just smaller. It's different.
Soendenbroe et al. 2024 (J Cachexia Sarcopenia Muscle): heavy resistance training reverses irregular myofiber shape, a marker of aging.
Net: strength work improves muscle quality, not just size. For healthy aging, resistance training is non‑negotiable
Soendenbroe et al. 2024 (J Cachexia Sarcopenia Muscle): heavy resistance training reverses irregular myofiber shape, a marker of aging.
Net: strength work improves muscle quality, not just size. For healthy aging, resistance training is non‑negotiable
I’m quoted in today’s @nytimes.com on the "Chinese peptides" trend in SF. She asked about the "founder mindset" applied to biology. My take: "The entrepreneurial parallel isn't funding a scrappy start-up. It's wiring money to an unregistered offshore entity based on a pitch deck." buff.ly/n5nEob
January 3, 2026 at 6:09 PM
I’m quoted in today’s @nytimes.com on the "Chinese peptides" trend in SF. She asked about the "founder mindset" applied to biology. My take: "The entrepreneurial parallel isn't funding a scrappy start-up. It's wiring money to an unregistered offshore entity based on a pitch deck." buff.ly/n5nEob
Creatinine-based eGFR estimation is the default, cheap, fast, and often wrong. Cystatin C is more accurate, must be ordered separately, and in many settings takes days to return. Why? #medsky
January 2, 2026 at 8:15 PM
Creatinine-based eGFR estimation is the default, cheap, fast, and often wrong. Cystatin C is more accurate, must be ordered separately, and in many settings takes days to return. Why? #medsky
The simple pleasure of chewing on a stick in the morning.
January 14, 2025 at 3:21 PM
The simple pleasure of chewing on a stick in the morning.
Reposted by Paul Abramson MD
I know it's been an eventful year but let's not forget that AI served up this monstrosity of a figure in a paper that was published and then retracted by one of the frontiers journals this year.
The rat with giant balls lives in AI infamy for all time
scienceintegritydigest.com/2024/02/15/t...
The rat with giant balls lives in AI infamy for all time
scienceintegritydigest.com/2024/02/15/t...
December 29, 2024 at 2:46 PM
I know it's been an eventful year but let's not forget that AI served up this monstrosity of a figure in a paper that was published and then retracted by one of the frontiers journals this year.
The rat with giant balls lives in AI infamy for all time
scienceintegritydigest.com/2024/02/15/t...
The rat with giant balls lives in AI infamy for all time
scienceintegritydigest.com/2024/02/15/t...
T-SPOT.TB performs much better in many immunocompromised populations IMO, but historically was logistically more difficult from CA due to time-sensitive FedEx of samples to Memphis which failed a lot with winter storms. Less an issue now that Quest bought T-SPOT.
Out now in @thetxidjournal.bsky.social!
T-SPOT.TB is more likely to produce actionable results than QFT-TB in patients with cancer being screened for latent TB.
#TxID #IDSky
onlinelibrary.wiley.com/doi/10.1111/...
T-SPOT.TB is more likely to produce actionable results than QFT-TB in patients with cancer being screened for latent TB.
#TxID #IDSky
onlinelibrary.wiley.com/doi/10.1111/...
December 29, 2024 at 5:52 PM
T-SPOT.TB performs much better in many immunocompromised populations IMO, but historically was logistically more difficult from CA due to time-sensitive FedEx of samples to Memphis which failed a lot with winter storms. Less an issue now that Quest bought T-SPOT.
Pet rocks are going to trend
Remember, a pet rock is for life, not just for Christmas
allpoetry.com/column/75833... #GeologistProblems
allpoetry.com/column/75833... #GeologistProblems
December 28, 2024 at 10:26 PM
Pet rocks are going to trend
Mabel is not a bad bunny
(Trending topic)
(Trending topic)
December 27, 2024 at 2:04 AM
Mabel is not a bad bunny
(Trending topic)
(Trending topic)
Mabel and Merlin exploring their new hidey house.
December 25, 2024 at 8:59 PM
Mabel and Merlin exploring their new hidey house.
Reposted by Paul Abramson MD
My BSKY policy is to block people who seem to be trolls on sight.
December 22, 2024 at 9:11 PM
My BSKY policy is to block people who seem to be trolls on sight.