Jonathan Alessi, PhD

Dutch late night TV has its take

ABC yanks Jimmy Kimmel’s show ‘indefinitely’ after remarks about Charlie Kirk | CNN Business Disney’s ABC is taking Jimmy Kimmel’s late night talk show off the air indefinitely amid a controversy over his recent comments about Charlie Kirk’s suspected killer.

Our democracy is getting replaced with fascism right before our eyes, and most of the country is sleeping through it because it doesn't yet seem like it's directly affecting them.

www.cnn.com/2025/09/17/m...

18 year old me would never have imagined I would be raising my kids in a world in which our country would disappear people into concentration camps, actively assist in genocide, and be led by a man bending over backwards to protect child sex traffickers.

Extremely well said! Looking forward to the series!

“1 out of every 5 dollars in Medicaid is improper”

1 out of every 5 Americans uses Medicaid and it still costs the federal government half of what our defense budget does. The actual data shows <2% of Medicaid spending is considered improper, and the majority of that is not on the beneficiary side.

"If the proposal is enacted, Americans today and tomorrow will be sicker, poorer, and die younger”
an $18 Billion cut
Only 3 NIH Institutes will remain in place, and even they will have their funds markedly reduced
www.statnews.com/2025/05/30/n...

Wish this were just satire

Atul Gawande on Instagram: "“No children are dying on my watch,” said Rubio. It's blatantly false. So far, 190,000 children and 90,000 adults have died due to the dismantling of USAID (even assuming... 9 likes, 0 comments - atul.gawande on May 24, 2025: "“No children are dying on my watch,” said Rubio. It's blatantly false. So far, 190,000 children and 90,000 adults have died due to the dismantlin...

“No children are dying on my watch,” said Rubio. It's blatantly false. Credible estimates count 190K deaths so far.

In Kenya, I am seeing devastating impact, incl this child's starvation & many deaths directly caused by Rubio’s actions. More in my @msnbc.com clip. www.instagram.com/atul.gawande...

I’d love to see their data! Cause this has been studied by actual scientists & the decline in American life expectancy has ACTUALLY been driven largely by:

-guns
-illicit drugs
-COVID
-lack of healthcare access

And our horrible maternal mortality rates are driven by abortion restrictions & racism.

More broadly, I now wonder if the advent of the new weight loss medications will force the ADA to make its diagnostic algorithm for adult onset type 1 more strict- leaning a tad more toward more false type 2s

We’ll see! 🤷🏻‍♂️

#medsky #diabetes #endo #DM2 #DM1 #obesity

In an ideal world, he would be treated for his obesity regardless of diabetes type, but in the real world, insurances often do not pay for anti-obesity treatment unless the patient has type 2.

So, the likelihood he has type 1 is pretty high, but I don’t feel it’s certain without more information.

On top of that, he has obesity, sleep apnea, diabetes, low t, and high blood pressure- all diseases that would improve with weight loss.

I will admit, being a medical student, I neglected to ask this patient about all of these type 1 risk factors (I plan to).

I do know that his GAD titers were high, though- in the 200s.

Further, evidence of increased risk for type 1 reduce the false positive risk (see left of pic).

This evidence may include young age at diagnosis, family history of autoimmunity, rapid progression to insulin dependence, and lack of obesity/overweight.

These antibodies are also measured in titers and that plays a role in our diagnostic confidence as well. While we break the test into positive and negative categories, this is a continuous number.

Regardless of the category definition, higher titers make us more confident in a type 1 diagnosis.

However, this test can be positive in 2.5% of people without diabetes at all! And a diagnosis based on this test in a population this age with obesity leaves a high risk of a false positive (~60%)

(Picture from Jones et al. 2021)

The guidelines suggest the GAD antibody positivity alone confirms the diagnosis when the doctor is suspicious of type 1 before the test.

So how do we tell who’s who?

For example, bariatric surgery reduced A1c from 8.7% to 7.1% or 1.6% in one study of type 2 (courcoulas et al. 2024). In type 1, this value is substantially less ~0.5% (Kirwan et al. 2016).

I expect weight loss medicines to demonstrate a similar pattern.

The diagnosis of Type 1 vs type 2 diabetes is actually quite important as a diagnosis of type 2 substantially expands our treatment options/ expectations.

Medical thought problem:

Patient came in for chronic foot wound previously diagnosed with type 1 diabetes via GAD +ve, islet A2 -ve as a 50 year old.

He now also has class 1, stage 3 obesity, high blood pressure, obstructive sleep apnea, and low T.

Works, not faith

Hannibal green

Or

Hank lecter ?

A Chicago Pope implies the existence of an MLA Pope and APA Pope

El Faro English @elfaroenglish 🚨“We have received reliable information that the Salvadoran Attorney General’s Office is preparing arrest warrants for El Faro journalists,” announces El Faro director @CarlosDada Quote El Faro @_elfaro_ May 3 “Hemos recibido información confiable de que la Fiscalía General está preparando órdenes de captura contra periodistas de El Faro”, informó hoy @CarlosDada, director de El Faro. 🧵 Mira esta conversación:

El Faro English @elfaroenglish · May 4 El Faro just published a three-part video interview with two former leaders of the 18th Street Revolucionarios gang, shedding new light on Bukele’s years-long relationship to, and negotiations with, Salvadoran gangs. From elfaro.net El Faro English @elfaroenglish May 4 “We understand that the alleged crimes for which these warrants are being built are apology for crimes and illicit association. Any capture or raid on our homes will be for having done journalism,” states editor-in-chief @CronistaOscar Quote El Faro @_elfaro_ May 3 Replying to @_elfaro_ “Comprendemos que los delitos por los que construyen estas órdenes es por apología de delitos y agrupaciones ilícitas. Cualquier captura o allanamiento a nuestras casas va a ser por haber hecho periodismo”, señaló @CronistaOscar, jefe de redacción de El Faro.

El Salvador's President Bukele is reportedly preparing to arrest the journalists who have reported on the secret deals Bukele struck with Salvadoran gangs that have enabled his consolidation of power.

Hay evidencia alguna que diga que usar la postura “correcta” para ir al baño ayuda a prevenir las enfermedades uroginecologicas?

Hay evidencia que los ejercicios de control del periné las prevenga?

I don’t know. I think such a system would be more aligned with reality, less constraining, and could potentially be similarly valid/reliable.

What do others think?

One would then include descriptions of what that would look like or what to focus on at that stage.

“Your job and focus this year is mastering the elicitation and communication of relevant info” or “you should be focused on learning to scrutinize research.”

I get the impression that most people use the system as a proxy for “are you performing as expected for someone in this stage of training?”

And if that’s the case, why not just use the same scale, but say “you’re performing at MS3 level” or MS4 level, etc…

It is also highly dependent on the job we are given as a member of the team.

It is very difficult to demonstrate manager skills when you are not given that ability.

Many of my rotations implicitly discouraged me from doing anything more than basic reporting.