You are a good person -- thanks for the long post. I think RFK jr is the WRONG person for this job for so many reasons. However, not everything he says is horrible or wrong. Even a stopped clock is right twice a day, blah blah! I fear the upcoming destruction of the federal government is going to hurt so many people. Bird flu? We are in trouble.
Thanks Donna, I feel the same way about you :) Would be nice to harness RFK's energy and redirect it toward environmental stewardship. I do think we are in trouble as well. Another stress test of the rule of law, democracy, etc coming. If I were president I would nominate Atul Gawande MD for HHS.
Excellent idea (Atul Gawande MD for HHS). My spouse is a NOAA scientist and NOAA is a target for this incoming administration (why??) All that institutional memory will be gone. Spouse is 11 months from retirement age so I hope he makes it (plus: he loves his job and is so good at it. Sigh.
Unreal. I love NOAA weather forecasts, hurricane tracking, and of course all the amazing science they do that we all take for granted. Should these institutions lose people like him we will all suffer the consequences of thousands (millions?) of brain-years in expertise. Here's to holding on.
Thank you, again. Thanks for taking the time and having the patience and respect to respond to the "what do you think" query thoughtfully and intelligently. You are a trusted voice in my world.
That's a great honor Gemma. Please feel free to redirect me if I lose some of that patience and respect over the next 4 years +. It takes effort not to react with anger and rage when you feel something is injurious and unjust, and that hurts everyone I guess. I'll keep trying!
You're a better doctor than me Ryan, that's for sure! I can barely hide my disdain, and I'm sure it shows! Small comment about safety of water soluble vitamins: B6 excess can cause sensory neuropathy. Also zinc (not a vitamin, but popular in the woo-world) can cause malabsorption of copper and all the attendant issues with that (spinal cord issues, peripheral neuropathy etc.) And fish oil seems associated with increased risk of AF if >1g omega 3 in people with heart conditions. Anyway, thanks again for your levels headedness and advocacy. Take care and hope you have a nice weekend!
Hi Dr. Zhong - this is really important to recall and tell folks about. I feel like I should do a separate post on these heads up. I think I will, many thanks. And I'm sure you are a great doctor from your commentary here, and certainly I learn from it often. Have a great weekend, too!
Wow, lots to unpack here. I find the hypocrisy astounding. He using testosterone replacement therapy (TRT) and a 'anti-aging' supplement routine. https://honehealth.com/edge/rfk-jr-trt-steroids/
Just promoting a ~$41.2 billion supplement business and attacking 'big pharma'. Sure there are issues with big pharma but an unregulated supplement market with contents are not guaranteed. Diet and exercise has been promoted since I can remember, so nothing new there. Then there is the 'brain eating' worm (misnomer) and eating McD....(he'll love to have fries again that are cooked in tallow not that bad seed oil. https://www.rollingstone.com/politics/politics-news/trump-rfk-jr-mcdonalds-meal-seed-oil-1235169870/
Agreed KB, this comment is a good outline for a follow up post "if only we had more time." The unregulated supplement market makes plenty of money that could be redeployed towards stuff with better evidence. The hypocrisy causes whiplash, be careful out there!
Yes, they have flooded the zone. I try not to talk politics but some of my patients bring it up anyway so I listen and speak up only when necessary. A staunch Republican voter yesterday told me he was very disappointed with the cabinet picks.
This is terrific, Ryan. Thank you so much yet once again for laying all of this great information out so clearly, and with helpful links. One thing I learned over the last year or so was that there is off-label use of FDA-approved drugs by health care professionals, unclear the extent, but I found it concerning to discover that this happens. I don’t know enough about how all this works to know what monitoring or enforcement mechanisms exist to address this, but it raised the issue for me that it is very likely these agencies need MORE funding and support, not less, so as to beef up those mechanisms. RFK Jr, of course, will go exactly the wrong direction on this, as on so much else. It is horrifying to contemplate.
Thanks Susan :) I would have to think about this as I'm sure I could provide some good examples of how this might be acceptable and safe.... but in the spirit of this post I will quote the FDA:
Wow! You are beyond remarkable. The FDA link is so, so good. Truly, it is hard to have the appreciation we ought and need to have for the work agencies like this do AND, of course, the thought and care that goes into the best of the practice of medicine, which you exemplify—with a terrific example at your second link.
Agree with the post. After RFK disparaged the quality of food on Trump's plane he was treated to a MacDonald's meal. These two actually seem like strange bedfellows. Just heard Gaetz withdrew his nomination. Wonder if we will again see a revolving door cabinet.
Wow. What a disgraceful power play by Trump if that's who gave him the meal. A real public humiliation it would seem. Will have to read more about this. And I heard the Gaetz news first here from you. That's so good for this country, I'm guessing a large majority would agree. I'm hoping a large majority would agree.
First, I'm not sure Gaetz was meant to be confirmed. Instead maybe it was a litmus test for Trump (who is 'loyal'), gave Gaetz an excuse to resign from this Congress before it issued its sex abuse report. Meanwhile Gaetz is newly elected for the incoming House in a couple weeks which has no ethics inquiry. Curiously, Trump has a new AG nominee instantly.
Finally, I find a bit 'rich' that a guy who was a IV Heroin addict, buying injecting Heroin obtained from random people in the street, has the gall to proclaim at a government hearing "the (Covid) vaccine to be the 'deadliest vaccine ever made.'”
Second, heading a huge government agency demands one be 'right' or 'correct' the vast majority of the time. Its steering the 'ship of state', not a game where we throw out our lowest or wrong attempts. The problem with the clown is not that he occasionally gets something 'right' but that the vast majority of time he is a total anti-science clown. WaPo article here on RFK, Jr.'s many bizarre positions. https://wapo.st/40Ymg3h
Thanks for your thoughtful response. I have a somewhat angrier response: I took Hydroxychloroquine for lupus back during first Trump administration. Trump’s promotion of it for Covid caused those of us who needed it to navigate supply challenges & price increases. Not what we needed. Glad the science has established that it doesn’t work against Covid. Many thousands of us already taking it & getting Covid seemed pretty clear to me. And there’s a dangerous side effect to Hydroxychloroquine: retinal toxicity. After nine years, I had to stop because I was getting deposits affecting my retina. Generally it takes some years to build up the deposits but not always. I also use ivermectin, for Rosacea. I don’t eat it, I use it on my skin. There for a while, also hard to find. What I’ve just written is pretty easy to discover, these drugs are not new. I take pharmaceutical advice from my doctor & pharmacist, period. As for RFK jr., the less said, the better. I’m hoping there are a few Republican Senators who care more about the public good & health than they do fealty to Trump.
Hi Sally, and I totally recall several of my patients who were without hydroxychloroquine for their autoimmune conditions because of the run on this medication after certain people and presidents touted it as a Covid treatment when we had none. The retinal toxicity is good to be reminded of, sorry to hear about that for you personally. I could look this up, but is it potentially reversible with time?
And yes, I'm done talking about RFK for a while... hopefully. Unless there is something newly, highly egregious that affects us in primary care. Tried to keep this mostly useful, topic-based instead of a personal profile of the man. Many thanks for stopping by and for sharing your story, it is so important to remember the collateral effects.
I can only speak to my experience with retinal toxicity. I was lucky enough to get baseline tests of my retinas prior to starting use. My ophthalmologist monitored me closely & at first sign of retinal deposits, I stopped using Hydroxychoroquine. From what we can tell, my situation “stabilized, no further deposits & very minimal damage.” I have not heard that retinal toxicity is reversible. I kind of doubt it; once the Hydroxychoroquine deposits get into retinas, I don’t know of a way to get it out.
I came here to make a similar comment about the very real effects on autoimmune patients who use hydroxychloroquine and were unable to fill their needed prescriptions when supplies dried up.
I really like the tone here. I've read plenty about this, but appreciate the framework around his actual tweet, and the pattern of pseudoscience and for-profit (just not FDA-regulated) treatments emerges as more of the same, just cloaked in righteousness.
I'll stick with the boring scientist and consensus panels, not the ideologues and cults of personality. Thank you for your writing as usual.
You are a good person -- thanks for the long post. I think RFK jr is the WRONG person for this job for so many reasons. However, not everything he says is horrible or wrong. Even a stopped clock is right twice a day, blah blah! I fear the upcoming destruction of the federal government is going to hurt so many people. Bird flu? We are in trouble.
Thanks Donna, I feel the same way about you :) Would be nice to harness RFK's energy and redirect it toward environmental stewardship. I do think we are in trouble as well. Another stress test of the rule of law, democracy, etc coming. If I were president I would nominate Atul Gawande MD for HHS.
Excellent idea (Atul Gawande MD for HHS). My spouse is a NOAA scientist and NOAA is a target for this incoming administration (why??) All that institutional memory will be gone. Spouse is 11 months from retirement age so I hope he makes it (plus: he loves his job and is so good at it. Sigh.
Unreal. I love NOAA weather forecasts, hurricane tracking, and of course all the amazing science they do that we all take for granted. Should these institutions lose people like him we will all suffer the consequences of thousands (millions?) of brain-years in expertise. Here's to holding on.
Thank you, again. Thanks for taking the time and having the patience and respect to respond to the "what do you think" query thoughtfully and intelligently. You are a trusted voice in my world.
That's a great honor Gemma. Please feel free to redirect me if I lose some of that patience and respect over the next 4 years +. It takes effort not to react with anger and rage when you feel something is injurious and unjust, and that hurts everyone I guess. I'll keep trying!
You're a better doctor than me Ryan, that's for sure! I can barely hide my disdain, and I'm sure it shows! Small comment about safety of water soluble vitamins: B6 excess can cause sensory neuropathy. Also zinc (not a vitamin, but popular in the woo-world) can cause malabsorption of copper and all the attendant issues with that (spinal cord issues, peripheral neuropathy etc.) And fish oil seems associated with increased risk of AF if >1g omega 3 in people with heart conditions. Anyway, thanks again for your levels headedness and advocacy. Take care and hope you have a nice weekend!
Hi Dr. Zhong - this is really important to recall and tell folks about. I feel like I should do a separate post on these heads up. I think I will, many thanks. And I'm sure you are a great doctor from your commentary here, and certainly I learn from it often. Have a great weekend, too!
Wow, lots to unpack here. I find the hypocrisy astounding. He using testosterone replacement therapy (TRT) and a 'anti-aging' supplement routine. https://honehealth.com/edge/rfk-jr-trt-steroids/
Just promoting a ~$41.2 billion supplement business and attacking 'big pharma'. Sure there are issues with big pharma but an unregulated supplement market with contents are not guaranteed. Diet and exercise has been promoted since I can remember, so nothing new there. Then there is the 'brain eating' worm (misnomer) and eating McD....(he'll love to have fries again that are cooked in tallow not that bad seed oil. https://www.rollingstone.com/politics/politics-news/trump-rfk-jr-mcdonalds-meal-seed-oil-1235169870/
PS Have you seen this? What to Know About Jay Bhattacharya, Trump's Potential NIH Pick
— Stanford professor is most closely associated with the Great Barrington Declaration
https://www.medpagetoday.com/special-reports/features/113018?xid=nl_mpt_DHE_2024-11-20&mh=4fd234bd649d6b29ed250e95f839c2ea&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%20-%20Randomized%202024-11-20&utm_term=NL_Daily_DHE_dual-gmail-definition
It's turtles all the way down.....
Agreed KB, this comment is a good outline for a follow up post "if only we had more time." The unregulated supplement market makes plenty of money that could be redeployed towards stuff with better evidence. The hypocrisy causes whiplash, be careful out there!
Thank you! My possibly false hope is that he is not able to be confirmed. Then we have Dr. Oz at CMS.
Excellent fact based post. And sometimes Halloween candy is necessary.
Yes, they have flooded the zone. I try not to talk politics but some of my patients bring it up anyway so I listen and speak up only when necessary. A staunch Republican voter yesterday told me he was very disappointed with the cabinet picks.
This is terrific, Ryan. Thank you so much yet once again for laying all of this great information out so clearly, and with helpful links. One thing I learned over the last year or so was that there is off-label use of FDA-approved drugs by health care professionals, unclear the extent, but I found it concerning to discover that this happens. I don’t know enough about how all this works to know what monitoring or enforcement mechanisms exist to address this, but it raised the issue for me that it is very likely these agencies need MORE funding and support, not less, so as to beef up those mechanisms. RFK Jr, of course, will go exactly the wrong direction on this, as on so much else. It is horrifying to contemplate.
Thanks Susan :) I would have to think about this as I'm sure I could provide some good examples of how this might be acceptable and safe.... but in the spirit of this post I will quote the FDA:
https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
When in doubt, stay in the lanes, right?
Hey, I just thought of one. Propranolol for situational anxiety. Has definitely saved some careers and best man speeches!
https://mccormickmd.substack.com/p/propranolol-for-situational-panic
Wow! You are beyond remarkable. The FDA link is so, so good. Truly, it is hard to have the appreciation we ought and need to have for the work agencies like this do AND, of course, the thought and care that goes into the best of the practice of medicine, which you exemplify—with a terrific example at your second link.
RFK Sr is rolling in his grave
Yes, intergenerational trauma strikes again.
I think about that often. Makes me sad actually.
his family has disowned him
Agree with the post. After RFK disparaged the quality of food on Trump's plane he was treated to a MacDonald's meal. These two actually seem like strange bedfellows. Just heard Gaetz withdrew his nomination. Wonder if we will again see a revolving door cabinet.
You are my new best friend since this is the first place I saw this! (Matt G).
Wow. What a disgraceful power play by Trump if that's who gave him the meal. A real public humiliation it would seem. Will have to read more about this. And I heard the Gaetz news first here from you. That's so good for this country, I'm guessing a large majority would agree. I'm hoping a large majority would agree.
The chess match continues...
First, I'm not sure Gaetz was meant to be confirmed. Instead maybe it was a litmus test for Trump (who is 'loyal'), gave Gaetz an excuse to resign from this Congress before it issued its sex abuse report. Meanwhile Gaetz is newly elected for the incoming House in a couple weeks which has no ethics inquiry. Curiously, Trump has a new AG nominee instantly.
Finally, I find a bit 'rich' that a guy who was a IV Heroin addict, buying injecting Heroin obtained from random people in the street, has the gall to proclaim at a government hearing "the (Covid) vaccine to be the 'deadliest vaccine ever made.'”
Galling is a good choice of words. Can you imagine Xavier Becerra, or Donna Shalala with such insanity? Neither can I.
Second, heading a huge government agency demands one be 'right' or 'correct' the vast majority of the time. Its steering the 'ship of state', not a game where we throw out our lowest or wrong attempts. The problem with the clown is not that he occasionally gets something 'right' but that the vast majority of time he is a total anti-science clown. WaPo article here on RFK, Jr.'s many bizarre positions. https://wapo.st/40Ymg3h
Revolving door cabinet? Count on it...
He complained about the meal, see the Rolling Stone link in my original reply.
Thanks for your thoughtful response. I have a somewhat angrier response: I took Hydroxychloroquine for lupus back during first Trump administration. Trump’s promotion of it for Covid caused those of us who needed it to navigate supply challenges & price increases. Not what we needed. Glad the science has established that it doesn’t work against Covid. Many thousands of us already taking it & getting Covid seemed pretty clear to me. And there’s a dangerous side effect to Hydroxychloroquine: retinal toxicity. After nine years, I had to stop because I was getting deposits affecting my retina. Generally it takes some years to build up the deposits but not always. I also use ivermectin, for Rosacea. I don’t eat it, I use it on my skin. There for a while, also hard to find. What I’ve just written is pretty easy to discover, these drugs are not new. I take pharmaceutical advice from my doctor & pharmacist, period. As for RFK jr., the less said, the better. I’m hoping there are a few Republican Senators who care more about the public good & health than they do fealty to Trump.
Hi Sally, and I totally recall several of my patients who were without hydroxychloroquine for their autoimmune conditions because of the run on this medication after certain people and presidents touted it as a Covid treatment when we had none. The retinal toxicity is good to be reminded of, sorry to hear about that for you personally. I could look this up, but is it potentially reversible with time?
And yes, I'm done talking about RFK for a while... hopefully. Unless there is something newly, highly egregious that affects us in primary care. Tried to keep this mostly useful, topic-based instead of a personal profile of the man. Many thanks for stopping by and for sharing your story, it is so important to remember the collateral effects.
I can only speak to my experience with retinal toxicity. I was lucky enough to get baseline tests of my retinas prior to starting use. My ophthalmologist monitored me closely & at first sign of retinal deposits, I stopped using Hydroxychoroquine. From what we can tell, my situation “stabilized, no further deposits & very minimal damage.” I have not heard that retinal toxicity is reversible. I kind of doubt it; once the Hydroxychoroquine deposits get into retinas, I don’t know of a way to get it out.
I came here to make a similar comment about the very real effects on autoimmune patients who use hydroxychloroquine and were unable to fill their needed prescriptions when supplies dried up.
I really like the tone here. I've read plenty about this, but appreciate the framework around his actual tweet, and the pattern of pseudoscience and for-profit (just not FDA-regulated) treatments emerges as more of the same, just cloaked in righteousness.
I'll stick with the boring scientist and consensus panels, not the ideologues and cults of personality. Thank you for your writing as usual.