Category: Health Policy

Dyslexia Comes Back To Bite President Trump

Apr 3, 2026

By MIKE MAGEE

This past week, Donald Trump decided to get into a war of words with a person with dyslexia. His target was the Governor of California, Gavin Newsom, who has struggled with the learning disability since the age of 5.

The President’s action was premeditated and intended to take the potential Democratic 2028 Presidential contender down a peg. It got pretty personal pretty fast. Trump was direct as is his way. He said simply, “Everything about him is dumb.”

In response, the governor broadened the conversation to include young Americans with the condition with these targeted words of encouragement, “To every kid with a learning disability: don’t let anyone — not even the President of the United States — bully you. Dyslexia isn’t a weakness. It’s your strength.”

Trump seemed surprised by the blowback from his “dumb” remark. It drew a stern rebuke from the Yale Center for Dyslexia and Creativity which reminded the President that approximately 20% of the US population is challenged by some form of this condition.

Fellow dyslectic, author and political commentator, Molly Jong-Fast, quickly connected the political dots to current events: “Mr. Trump is a bully, but beyond that he tries to flatten things. Sometimes voters respond to this flattening, this simplification of complicated issues, but ultimately his refusal to see nuance in things, his inability to plan ahead, to see second- or third-order effects is his undoing (see: this war he has gotten us into).”

As the Yale experts put it, “Reading is complex. It requires our brains to connect letters to sounds, put those sounds in the right order, and pull the words together into sentences and paragraphs we can read and comprehend. People with dyslexia have trouble matching the letters they see on the page with the sounds those letters and combinations of letters make. And when they have trouble with that step, all the other steps are harder.”

Neuroscientists couldn’t agree more. Language is indeed complicated. At least five areas have been identified as role players in coordinating human capacity for language and speech.

There Are Three Kinds of Primary Care, Not to Be Confused With Each Other

Apr 2, 2026

By HANS DUVEFELT

(Note: Hans is rerunning some of his greatest hits. This one is from 2014 and leans right into my current and future obsession with fixing primary care-Matthew Holt)

Primary care doctors, the way things are organized in this country, perform three kinds of services. If we don’t recognize very clearly just how fundamentally different they are, we risk becoming overwhelmed, burned out, inefficient and ineffective. And, if we think about it, should we really be the ones doing all three?

SICK CARE

Historically, people called the doctor when they were sick. That service has, at least in this country, become more or less viewed as a nuisance in primary care offices. We keep a few slots open for sick people, in part because the Patient Centered Medical Home recognition process requires us to. But our clinics may worry that those slots go unfilled and lead to lost revenue.

Instead, sick people scatter toward emergency rooms with crowding, high overhead and liability driven testing excesses or to freestanding walk-in clinics that only sometimes are integrated with the primary care office but universally staffed by providers who don’t know the patient. These providers, due to staffing cost strategies, are sometimes the least experienced clinicians within their organizations, doing what I feel is the most challenging work in health care – sorting the very sick from the only moderately ill or even completely healthy but worried patients.

In the worst case scenarios, the walk-in clinic is freestanding, operating without any access to primary care or hospital records, starting from absolute scratch with every patient. Some of these clinics are well equipped, with laboratory and x-ray facilities and highly skilled staff. But some are set up in a room in the back of a drug store and staffed by a lone nurse practitioner with minimal equipment and no backup.

Because health care in this country has no master plan, this is what has emerged. If we had a national strategy for health care services, does anybody think it would look like this?

CHRONIC DISEASE MANAGEMENT

More and more people suffer from chronic diseases like diabetes, hypertension and autoimmune conditions. This is where the bulk of primary care work is done. Much of it is straightforward and predictable: Diabetics get their glycosylated hemoglobin checked every three months, hypertensives get their blood pressure logs and blood tests reviewed at certain intervals. And, sadly, much of it is ineffective. Few people lose weight, improve their blood sugars or change their lifestyles. Our visits follow the same tired routine from one time to the next – “I’ll do better this time, Doc”.

The more our country’s chronic disease burden increases, the more clinician time and effort this kind of work will consume. And the more we need to question whether there isn’t a better way to deliver chronic disease management.

Oh. Another Moonshot

Apr 1, 2026

By KIM BELLARD

If all goes well, in the next couple of days NASA will be sending astronauts on their way to the moon, for the first time since – gulp – 1972. They’re not landing, mind you, they’re just doing a fly around, something Apollo 8 first did way back in 1968. Given the advances in microchips, computing power, AI, a robust private space industry, and Elon’s grand plans to inhabit Mars, it doesn’t really sound all that ambitious, hardly a “moonshot” in the sense that we’ve come to use that term, but I guess we should be glad that NASA hasn’t entirely conceded space to the billionaires.

The Artemis II mission will send four astronauts – including, if you are counting (and many are), the first person of color, the first woman, and the first Canadian to reach the moon — on a ten day, 230,000 mile trip that won’t actually orbit the moon but just loop around it, not getting closer than a few thousand miles. “Things are certainly starting to feel real,” Christina Koch, one of the four, said during a news conference Sunday morning.

Last week NASA unveiled its “Ignition” strategy that Artemis II is part of. It includes not just the fly-by, but also a follow-up mission in 2027, a manned landing in 2028, and a permanent moon base in the 2030’s, committing $20b over the next seven years to accomplish the latter. “NASA is committed to achieving the near‑impossible once again, to return to the Moon before the end of President Trump’s term, build a Moon base, establish an enduring presence, and do the other things needed to ensure American leadership in space,” said NASA Administrator Jared Isaacman.

He added: “Today, we are providing a demand for frequent crewed missions well beyond (previously announced moon landings in 2028). We intend to work with no fewer than two launch providers with the aim of crewed landings every six months, with additional opportunities for new entrants in the years ahead. America will never again give up the moon.”

I knew Elon and Jeff were going to get something from all this.

Today’s April Fool is me in 2011

Apr 1, 2026

I randomly found this interview I had completely forgotten about on Youtube from 2011. I was younger and thinner then, even though I didn’t have much hair. And I was very optimistic that tech was going to change health care in 10 years……and that it was going to take a long time. Guess we are still waiting!

Healthcare’s Quiet Dependence on the “Possimpible”

Mar 31, 2026

By GANESH ASAITHAMBI

In an episode of the sitcom How I Met Your Mother (HIMYM), Barney Stinson introduces a fictional word: possimpible. The possimpible combines “possible” and “impossible” and describes the extraordinary achievements by people who refuse to accept conventional limits. In modern healthcare, the possimpible is no longer a joke; it has quietly become an expectation.

Clinicians are expected to provide care that is safer, faster, and more compassionate despite rising administrative burdens, workforce shortages, and an increasingly complex patient population. These expectations often extend beyond what existing systems were designed to accommodate. The distance between what the system can provide and what patients need is increasingly filled by clinicians.

Picture this example at the end of a clinician’s day. A physician takes a seat to call a patient’s family. The phone conversation takes longer than expected with questions about their loved one’s prognosis and hesitancy about what to do next with fear about what is to come. The physician provides reassurance and guidance. The physician hangs up, only to find that note dictations are not complete and messages are still unread. None of this shows up as productivity, but it is needed to provide quality care. There are thousands of scenarios like this that take place every day in American health care.

These moments appear routine. However, they reflect something more consequential: healthcare has become quietly dependent on clinicians to stretch beyond the boundaries of the systems they work within.

Adventures in health care billing. My $51.96 zit co-insurance

Mar 30, 2026

By MATTHEW HOLT

I know my many fans love me delving into the world of why we get seemingly incorrect trivial bills in health care, and what they all mean. The long telenovella of the $39.94 bill from Labcorp is as yet stalled with One Medical apparently resubmitting the original claim with the new preventative codes on it. But even though I am continuing and expanding my role as a difficult patient this year, there are still some blasts from the past that won’t quite leave.

This particular one concerns some rather unpleasant dermatology issues. For many years I had an nasty small sore/lesion on my leg that never quite healed. Then I started getting a few more that started as zits and never quite left. My wise PCP Andrew Diamond at One Medical told me to use some antibiotic wash and referred me to a dermatologist. Unfortunately the one I was referred to was out of network for the Blue Shield HMO I was in, but one request back to One Medical and I was both sent to a dermatologist in my network and got a pre-auth in the mail from Blue Shield to go see him!

Dr Cristian Gonzalez took a quick look at my leg, decided what the problem was, and proceeded to inject, freeze and attack my various lesions. He then prescribed a cheap topical steroid for me to use, and basically after 4 visits over the summer and Fall, my legs went back to resembling a baby’s bottom–well more or less.

For each specialty visit Blue Shield had a co-pay of $85 per visit, which I handed over using my HSA card. One time the front desk said I had a balance, but when I asked them what it was for they told me it was a mistake. Until this week.

Some 4 months after my last visit I got a bill in the mail for $51.96

Given that I had made a co-pay of $85 each time, this seemed a little odd. So I took a look at my Blue Shield EOBs. (BTW they are back online, you may recall they vanished when Blue Shield cancelled and then changed my plan but the Internet never forgets….)

There a curious anomaly began to play out. Each visit generated three identical claims and three more or less identical EOBs.

Calling BS

Mar 27, 2026

By KIM BELLARD

We are living, you’d have to say, in the age of bullshit. Our politicians can’t answer the simplest of questions without spouting word salad answers aimed at running out the clock until the next question. Our corporations spew endless platitudes about their lofty goals in an attempt to distract us from their mendacious profit-seeking. And now we have AI producing endless volumes of words, an unpredictable amount of which aren’t remotely true.

For better or worse (and, trust me, it has often been for worse), I’ve always been one to ask “why,” to probe vagueness — whether it was a teacher, a boss, or a politician. Call me cynical, call me skeptical, call me inquisitive, but I have a low tolerance for bullshit, in its many forms. So I was thrilled to see that a new study suggests that employees who don’t fall for corporate bullshit may be better employees.

The study is from Shane Littrell, a postdoctoral researcher and cognitive psychologist at Cornell University, whose research “focuses primarily on how people evaluate and share knowledge, particularly the ways that misleading information (e.g., bullshit, conspiracy theories, corporate messaging) influence people’s beliefs, attitudes, and decisions.”

One wonders what he was like as a child.

His new research introduces a new tool called the Corporate Bullshit Receptivity Scale (CBSR), which was “designed to measure susceptibility to impressive-but-empty organizational rhetoric.”

His paper defines “bullshit” as “a type of semantically, logically, or epistemically dubious information that is misleadingly impressive, important, informative, or otherwise engaging,” and distinguishes it from other types of speech (such as jargon) in that “it is both functionally misleading and epistemically irresponsible.”

Assault on Scientific Integrity Is “Fundamentally Problematic.”

Mar 24, 2026

By MIKE MAGEE

This past week, U.S. District Court Judge Judge Brian E. Murphy, dealt Trump and RFK Jr. a severe blow. Not mincing word, he voided HHS vaccine schedule changes and labeled the action an assault on scientific integrity that was “fundamentally problematic.”

In early December, 2025, President Trump directed HHS Secretary Robert Kennedy to review the standing childhood immunization schedule. That schedule has historically guided the state school-entry requirements for vaccines as well as mandating no out-of-pocket costs to parents from vaccine insurers.

The order had followed Kennedy’s summary dismissal of all members of the CDC’s Advisory Committee on Immunization Practices replacing them with a suspect group of vaccine skeptics without any peer review.

Professional organizations, including the American Academy of Pediatrics and the American Medical Association quickly challenged the action in court.

Judge Murphy suspended the appointment of 13 of the 15 new vaccine panel members, and stated that only 6 of the 125 “even under the most generous reading, have any meaningful experience in vaccines.” The swift rebuke followed the evaluation of the new RFK Jr. appointed group’s work output by an independent coalition of scientific researchers which documented 60 misleading or false segments and vaccine claims in their inaugural December meeting.

AAP President Andrew Racine M.D. was quick to applaud the court’s decision, stating ““This decision effectively means that a science-based process for developing immunization recommendations is not to be trifled with and represents a critical step to restoring scientific decision-making to federal vaccine policy that has kept children healthy for years.”

The action couldn’t come soon enough according to state Public Health officials across the country who have been struggling to turn around a Measles epidemic tied to lax vaccination rates.

How Digital Narratives Shape Mental Health Outcomes

Mar 19, 2026

By SUHANA MISHRA

When discussing treatment outcomes, we usually talk about dosage, adherence, and access. Rarely do we speak about algorithms.

Yet as I began working on a scoping review examining misinformation and disinformation in mental health with a team at the Royal College of Psychiatrists led by Dr. Subodh Dave, I realized that some of the most powerful determinants of patient outcomes are not confined to clinics. They live in comment sections, short-form videos, and anonymous threads that shape people’s view on what is the “truth”. In fact, the NY Post says, “over half of top TikTok mental health videos contained misleading information”.

I chose to do this research because I’ve seen how a single online post or video can change the way someone thinks about their own mental health. I’ve witnessed my very own family members be discouraged to follow a treatment plan based on an inaccurate post sent in a WhatsApp group chat. By examining misinformation in collaboration with experts, I hope to identify practical strategies to help clinicians and public health professionals address their hidden determinants of mental health outcomes.

One of the most striking lessons that I’ve learned is that misinformation in psychiatry doesn’t always seem like a conspiracy. It can often seem like comfort. According to an ArXiv study from Cornell University, people adopt misinformation because it satisfies psychological and social needs rather than accuracy goals.

A viral post on a Reddit thread r/antipsychiatry which claimed antidepressants “numb your personality” may be rooted in one person’s difficult experience. A video on tiktok circulating discouraging medication in favor of “natural rewiring” may promise autonomy in a system that feels impersonal. These narratives spread not because they are outrageous conspiracy theories, but because they really resonate with people.

That resonance has consequences.

Oscar-Nominated Film Highlights Shared American, Iranian Health System Concerns

Mar 18, 2026

By MICHAEL MILLENSON

At the recent Academy Awards broadcast, a brief film clip from the Oscar-nominated Iranian film “It Was Just An Accident” showed a man pushing an unconscious, very pregnant woman on a gurney into a hospital emergency room. Without intending to do so, the excerpt pointed to one of the many common concerns shared by Iranians and Americans when dealing with their respective health care systems.

In the Iranian movie, a hospital desk clerk turns away the woman for lack of a payment up front with cash or a credit card. Although that kind of rejection is supposed to be illegal in America, indigent patients can be turned away if the hospital simply tells them their problem isn’t urgent. Even if accepted as self-pay, they might find themselves being billed up to 13 times what the hospital accepts from the government.

Yet it’s not just high costs and unfeeling bureaucrats that worry both Americans and Iranians – although Oscars host Conan O’Brien did joke that in the movie “Hamnet,” Shakespeare’s wife giving birth alone in the woods was “what we call in America ‘affordable health care.’” Iran is an urbanized nation of 93 million people. While the radical hostility to Western values of its clerical rulers is an important contributor to the current war with America, the society as a whole struggles with many of the same health-system problems as other developed countries, including the United States, and often approaches them in a similar way. Still, there are some exceptions unique to the Iranian context.

Consider Iranian researchers articles about diabetics’ experiences at the doctor’s office; ensuring a future supply of nurses; and health insurance utilization and expenditures for a particularly vulnerable population. Though all are topics which might equally appear in a U.S. journal, what sets them apart here is the authorship. At least one co-author of each is affiliated with an institution whose origins would seem as far away from health services research as imaginable. That’s Teheran’s Baqiyattalah University of Medical Sciences, (pictured below) which was founded by the Islamic Revolutionary Guard Corps.

*By غلامرضا باقری – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18235725*

Affiliation aside, Iranian researchers are typically trained much like their U.S. counterparts, and that’s reflected in both their work and the international journals where it’s published.