Vinay Prasad's Observations and Thoughts

Vinay Prasad's Observations and Thoughts is a Substack that critically examines issues within medicine, healthcare policy, and related societal impacts, with a focus on evidence-based medicine, the politics of healthcare, public health recommendations, and academic freedom. It challenges mainstream narratives and calls for transparency, ethics, and rigorous scientific scrutiny in health policy and practice.

Health Policy Public Health Recommendations Evidence-Based Medicine Academic Freedom Political Influence in Medicine COVID-19 Policies and Measures Vaccine Safety and Efficacy Research Integrity and Academic Misconduct

The hottest Substack posts of Vinay Prasad's Observations and Thoughts

And their main takeaways

Anti-depressants: The trials last 8 weeks; People take them for 8+ years

85 implied HN points • 04 Mar 25

People often take anti-depressants for many years, even decades, but they were only studied for about 8 weeks in trials.
There isn't clear evidence that taking these medications long-term is better than not starting them at all, which raises concerns about their effectiveness.
We need longer and better studies to truly understand the benefits and downsides of anti-depressants, including how they impact things like sexual health.

Francis Collins retires from the NIH

128 implied HN points • 03 Mar 25

🏥 Health Politics Public Health Biotechnology Policy Analysis Epidemiology Research Ethics

Francis Collins helped find the cystic fibrosis gene, which saved many lives. However, his support for gain of function research and certain policies during the pandemic raised concerns.
Many believe that the impact of Collins' leadership during the pandemic was negative, leading to loss of trust in science and vaccination. His actions may have contributed to millions of deaths and economic losses.
Collins did not explore if the way the NIH gives out grant money was effective. Despite advancements in genetics, many common health issues remain largely unresolved.

The media is getting Trump's biomedical policy decisions wrong b/c it refuses to discuss the big picture

118 implied HN points • 01 Mar 25

🇺🇸 U.S. Politics Media Critique Public Health Government funding

The media often overlooks the larger issues in biomedical policy and fails to connect the dots in their reporting. They focus too much on individual actions instead of discussing significant systemic problems.
There is a need for reform in the current biomedical system, particularly regarding how funding and resources are allocated. Many aspects of this system are outdated and not effectively serving public health needs.
It's important to have honest discussions about proposed changes in biomedical policies, rather than framing them as attacks on science. Constructive debate can lead to better solutions and improvements in healthcare.

Federal workers fired to improve efficiency - media outraged; Federal workers fired for not complying with an unethical vaccine mandate - media silent

221 implied HN points • 27 Feb 25

🇺🇸 U.S. Politics Media Vaccine Mandates Employment Public Policy Government Ethics

The media shows a double standard when covering different types of worker firings. They react strongly to layoffs for efficiency but often ignore firings for not taking vaccines.
Vaccine mandates raised ethical concerns because they did not significantly protect others and forced individuals to lose their jobs. Many people who were fired have not been given a voice in media discussions.
The way the media reports on firings affects public trust in vaccines. Layoffs from companies like Elon Musk's may feel random, but firings due to vaccine mandates can lead to specific anger and distrust.

FDA approves Pfizer drugs with inadequate safety and efficacy data, and then regulators work for Pfizer

180 implied HN points • 24 Feb 25

🏥 Health Politics Regulation Public Health Corruption Pharmaceuticals

FDA approvals for Pfizer drugs may not have enough safety and effectiveness data. This raises concerns about the reliability of the drugs available to the public.
There is a pattern of FDA regulators moving to jobs at pharmaceutical companies after approving their products. This can create a conflict of interest and lead to questions about transparency.
The system seems designed to favor big pharmaceutical companies rather than prioritize patient safety and well-being. This indicates a troubling relationship between regulators and the companies they oversee.

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Universities are falling short again

150 implied HN points • 23 Feb 25

🇺🇸 U.S. Politics Public Policy Higher education Health Policy Government funding Social Issues

Universities didn't hold important debates during the COVID-19 pandemic. Topics like school closures and mask mandates were never discussed, leading to a loss of trust from the public.
There's a call for universities to address issues around NIH funding reform. Instead of promoting fear about funding cuts, they should engage in constructive discussions to improve the system.
The general public feels disconnected from universities, especially regarding how taxpayer money is spent. Universities need to listen to these concerns and actively involve diverse opinions to regain public support.

The DOJ is investigating how many crimes are committed with masks on

149 implied HN points • 22 Feb 25

🇺🇸 U.S. Politics Public Policy Criminal Justice Public Health Government Accountability

Wearing masks in public hasn't shown to help stop the spread of viruses and was even advised against by health experts before the pandemic. Many believe mask mandates are not useful.
There is a concern that masks provide anonymity, which some criminals may exploit. This has prompted the DOJ to look into how many crimes are committed by people wearing masks.
As more people stopped masking, some places started banning public masking altogether. This shift highlights a growing belief that masks can hinder law enforcement and harm social interactions.

PhD students in biology are cheap, exploited labor & sold a false promise

82 implied HN points • 25 Feb 25

🚌 Education Higher education

PhD students in biology often face long, uncertain timelines for completing their degrees, which can lead to a lot of stress and anxiety.
The pay for these students is very low, making it feel like they are doing tough work for little reward, often working long hours without fair compensation.
Many people who get biology PhDs end up in jobs outside of academia, and the system is criticized for producing too many graduates with too few opportunities.

RFK jr is confirmed!

273 implied HN points • 13 Feb 25

🇺🇸 U.S. Politics Health Policy Government oversight Regulatory Affairs Public Health Political Advocacy

We need a better system to watch vaccine safety. The current ones are not good enough to catch all problems.
The US should ban harmful dyes and pesticides that are already banned in other countries like the EU and Australia.
People working at the FDA should not also work for big drug companies for a set time to avoid conflicts of interest.

What should the control arm be in a vaccine trial? Is it a placebo if it contains aluminum?

106 implied HN points • 19 Feb 25

🏥 Health Politics Vaccines Clinical Trials Public Health Policy Ethics

In vaccine trials, using a control arm that contains something like aluminum may not be truly a placebo, which can make it hard to determine side effects.
If the control group feels side effects from a placebo, like aluminum, they may think they received the vaccine and change their behavior, affecting the trial results.
Sometimes, trials need more than one control group to get a clearer picture of both safety and effectiveness, like comparing a true placebo to a placebo that causes some discomfort.

The NIH must make these 8 reforms right now

123 implied HN points • 11 Feb 25

🏥 Health Politics Scientific Integrity Research Ethics Public Trust

The NIH should reduce indirect costs because a lot of the money is not spent effectively. Instead of letting universities keep so much, more money could go directly to help research.
We need to be careful with which studies get funding. Some research doesn't tell us anything useful, and it's a waste of taxpayer money.
It's important to make sure that scientific research can be repeated and verified. If a lab can't replicate results, they should lose funding.

The reproducibility crisis and what it means for the NIH

111 implied HN points • 12 Feb 25

🔬 Science Research Ethics Scientific Method Data Integrity

Many scientific experiments don't give the same results when repeated. It's like trying to bake a cake and it flops even though the recipe seemed good.
Scientists often face pressure to produce results, which can lead to mistakes or even dishonesty in their work. They tend to focus more on getting results than on finding the truth.
There's a big need for change in how science operates. Even if some discoveries are useful, there's a concern about whether research is really delivering reliable results.

NIH reduced indirects from 60+% to 15%: 10 things you should know

148 implied HN points • 08 Feb 25

🏥 Health Politics Public Health Research Funding Higher education Academic Integrity

The NIH has lowered the amount of money it gives to universities from over 60% to 15%. This means more money can go to actual researchers instead of administrative costs.
This change will make universities operate differently, encouraging them to reduce unnecessary costs and possibly hold faculty more accountable for their behavior.
Lowering these indirect costs could lead to more funding for research projects. Researchers might actually benefit from this change, as it could increase the number of grants available.

We are going to get pro-DEI backlash

170 implied HN points • 03 Feb 25

🇺🇸 U.S. Politics Policy Debate Social Issues Diversity Initiatives Education reform

DEI, or Diversity, Equity, and Inclusion, has faced criticism for not being fully inclusive of all viewpoints. It's seen as favoring certain groups over others, creating a backlash.
Many people feel overwhelmed by mandatory DEI training that can feel shaming or pointless. There's a desire for more meaningful conversations about inclusivity that actually lead to change.
There's concern that, after a political pushback against DEI, it could come back even stronger. The future might bring more strongly enforced DEI measures in workplaces and schools.

Fauci is pardoned

311 implied HN points • 20 Jan 25

🇺🇸 U.S. Politics Elections Legislation Government Public Policy Health Policy

Biden's last pardons included Anthony Fauci, which raises questions about his past actions related to pandemic research.
Fauci might face consequences for his alleged past actions, especially if questioned again about funding controversial research.
His handling of the pandemic was criticized, as he oversimplified responses and made many incorrect recommendations that impacted public health and schools.

Will RFK Jr get confirmed?

113 implied HN points • 31 Jan 25

🇺🇸 U.S. Politics Elections Policy Legislation Public Opinion Political parties

People have strong opinions about RFK Jr.'s hearing, often based on their own beliefs. It's hard to say who came out on top because opinions are so divided.
For RFK Jr. to get confirmed, he has to win over a few Republican senators without losing Democratic votes. It's a tricky balance, and some senators are unsure about their support.
RFK Jr. claims he isn't against vaccines but wants more studies to ensure their safety. However, the arguments about vaccine safety are complicated and not fully addressed during the hearing.

What is the truth about alcohol consumption

235 implied HN points • 13 Jan 25

🏥 Health & Wellness Nutrition Mental health Public Health Lifestyle Substance Use

Moderate alcohol consumption might not be as harmful as some studies suggest, but it's essential to consider various health impacts when deciding how much to drink.
Understanding what and how much we drink can help manage health risks better. It's important to enjoy alcohol responsibly without overthinking it.
More research is needed to understand the true effects of alcohol on health, and personal experiences and preferences should also play a role in drinking habits.

Pausing NIH study sections is going to be fine

157 implied HN points • 23 Jan 25

🏥 Health Politics Public Health Medical Research Policy Reform Government oversight

Pausing NIH study sections can help bring necessary changes. It's a good opportunity to rethink how research funding is distributed.
Current funding processes tend to support more conventional ideas rather than groundbreaking ones. There needs to be a push for more innovative and transformative research.
If cuts happen in research funding, especially for less impactful areas, it could lead to better use of public dollars. We need to focus on research that truly makes a difference.

Artificial intelligence and mRNA vaccines are not going to cure cancer

156 implied HN points • 22 Jan 25

🏥 Health Politics Healthcare Medical Research Public Health Vaccines Technology

Artificial intelligence and mRNA vaccines are not expected to cure cancer. Both technologies have limitations that make them less effective in treating this complex disease.
Cancer therapeutic vaccines have been studied extensively, but only one has received FDA approval, and it shows only a slight benefit in survival. Overall, these vaccines often do not work as hoped.
AI struggles to diagnose cancer accurately and often lacks the needed data to improve this. Simply detecting cancer is not enough; finding the right treatment for each specific case is much more complicated.

NIH study sections are broken

106 implied HN points • 29 Jan 25

🏥 Health Politics Research Funding Public Health Scientific Integrity Policy Debate Health Disparities

NIH study sections often fund unambitious science instead of groundbreaking research. This is a problem because many mediocre scientists are in charge, which doesn't help advance science.
There's a heavy focus on diversity and inclusion in NIH grants, but much of it just repeats what we already know. Instead, we need better treatments for everyone, regardless of race or status.
The review process for grants can discourage scientists from speaking out on important issues. This silence can lead to a lack of innovative ideas and solutions in research.

Biden gives a Medal to Moderna and Pfizer - 10 reasons that was a bad idea

190 implied HN points • 04 Jan 25

🇺🇸 U.S. Politics Pharmaceutical industry Health Policy Government Accountability Public Health

Awarding a medal to Moderna and Pfizer seems unfair because it ignores the dangers of other vaccines, and many people felt misled about vaccine risks.
These companies have already made a lot of money from their products, so giving them a medal feels unnecessary and insulting.
Some people suffered due to vaccine mandates and the actions of former officials. Recognizing these companies with a medal might send the wrong message.

Covid shots don't need to be 'pulled' from the market, we just need to stop giving EUA to boosters without data

199 implied HN points • 31 Dec 24

🏥 Health Politics Vaccination policy Public Health Regulatory Affairs Healthcare Ethics

Most people who want COVID shots are getting them, while those who don't want them simply aren't taking them. There's no need to remove the vaccines from the market.
The FDA should require proper clinical trials for COVID boosters to gather real data on their effectiveness. This would help clarify the true benefits and risks of the vaccines.
Calling for all COVID shots to be pulled from the market is unhelpful and distracts from the need for transparency and accuracy in vaccine data. Better studies will provide clearer answers.

Red Dye #3 is out, and boosters may get RCTs: Why is the evidence to remove a chemical from food LESS THAN the evidence to recommend a medical interventions?

119 implied HN points • 15 Jan 25

🏥 Health Politics Medical Ethics Public Health Food Safety

The FDA is banning Red Dye #3 because it could be harmful, but there's a higher standard for proving medical products effective before they're recommended. We should be careful about both but have different rules for food and medicine.
Medical treatments often come with costs and potential side effects, so it's important to run proper studies before suggesting them to healthy people. When making decisions about interventions, we should prioritize safety and benefit.
There's a real difference in how we treat food additives versus medical products. While we question the safety of new medicine, we should also question adding unnecessary chemicals to our food.

An open letter to Harvard President, Alan Garber

268 implied HN points • 14 Dec 24

🏥 Health Politics Vaccine Mandates Academic Freedom Public Health Political Influence Medical Ethics

Harvard should show a commitment to academic freedom by reinstating fired professors like Martin Kulldorff. This would help represent a wider range of ideas on campus.
The COVID-19 vaccine mandate by the Biden administration had issues, particularly with not considering natural immunity. This raised questions about individual rights versus public health.
The treatment of some faculty members during the pandemic raises concerns about political bias in academic settings. Harvard needs to correct its mistakes to ensure a true diversity of thought.

Marty Makary: Is the First Good Pick for FDA commissioner in a long time

380 implied HN points • 23 Nov 24

🇺🇸 U.S. Politics Health Policy Media bias FDA Regulations Public Health COVID-19

Marty Makary is seen as a strong candidate for FDA commissioner with a history of standing up against corporate interests in healthcare. He's known for questioning common government policies during COVID, advocating for decisions based on evidence.
Media coverage tends to portray Marty negatively, often ignoring his valid criticisms of lockdowns and vaccine mandates. His positions centered on protecting the vulnerable and ensuring informed consent are highlighted.
Marty has a reputation for being open-minded and thoughtful in his approach to medicine. He aims to improve healthcare systems and make them more accessible, which is appreciated by some of his colleagues.

Duke health's 2025 policy would ban an 11 year old kid from visiting his sick or dying father

141 implied HN points • 05 Jan 25

🏥 Health Politics Public Health Health Policy Medical Ethics Healthcare access Infectious Diseases

Duke's new visitor policy can stop an 11-year-old from seeing a sick parent, which seems unfair. It's strange to think an age difference of just one year can change something so serious.
The rules made by Duke don't seem to be based on solid evidence, making them feel illogical and hard to understand. A 13-year-old can visit, but not an 11-year-old, which doesn't make sense.
There's a concern that this policy will cause emotional pain for families who can't visit their sick loved ones. Many believe hospitals should have better, data-driven policies to prevent such situations.

A San Francisco professor is glad to get Covid and wrote about it

181 implied HN points • 27 Dec 24

🏥 Health Politics Public Health Vaccines Disease Management Policy Debate Healthcare Ethics

The professor felt grateful to get Covid, believing it confirmed that avoiding the virus for so long didn't guarantee safety. She took many precautions, but still got infected, showing that complete avoidance is nearly impossible.
The article suggests that the number of vaccine doses given now may not be effective, especially since the virus has changed. The biggest protection was seen with the first dose, and there isn't much evidence for needing many more.
Masking practices by some families seem to be more about social pressure than actual effectiveness. There's little evidence that selectively wearing masks helps prevent respiratory viruses in casual settings.

Will some Democrat Senators vote for RFK Jr?

107 implied HN points • 10 Jan 25

🇺🇸 U.S. Politics Elections Policy Health Senate Political Reform

Some Democrat Senators might support RFK Jr. because they believe he can bring about important changes, especially in food policies and health regulations.
Concerns about infectious diseases like measles and polio are overshadowed by the more pressing issues of chronic diseases caused by poor diet and exposure to harmful substances.
Partisan politics and groupthink may prevent more Democrats from supporting RFK Jr., even when they see the benefits he could provide in health and wellness.

The true story of the Samoa measles outbreak

152 implied HN points • 24 Dec 24

🏥 Health Politics Public Health Vaccination Health Policy Global Health Medical Ethics

Measles was introduced to Samoa in the 1880s and a significant outbreak occurred due to a combination of poor health systems and low vaccination rates. The outbreak was worsened by significant events, including the deaths of two children after a vaccination mistake.
After the vaccine-related deaths, the Samoan government paused the vaccination program, leading to a sharp decline in vaccination rates. Many people turned to traditional medicine instead of seeking proper medical care when measles spread.
The story of the Samoa measles outbreak highlights that the responsibility for the crisis is complex, involving multiple factors like poor health literacy and governance. Blaming any single person for the outbreak, like RFK Jr., oversimplifies the true situation.

Do other countries do it? A simple litmus test for RFK Jr's ideas

323 implied HN points • 16 Nov 24

🇺🇸 U.S. Politics Public Policy Health Policy Vaccination Political Debate Media Analysis

When discussing RFK Jr's ideas, it's helpful to ask if other countries do things the same way. If yes, it opens up a conversation instead of labeling him as crazy.
Some of RFK Jr's views, like raw milk and fluoride in water, have examples in other countries. This doesn’t mean they are right, but it shows there’s room for debate.
Vaccination policies vary globally, and questioning them shouldn't be dismissed. It’s okay to discuss which vaccines may or may not be necessary.

The difference between the US childhood vaccination schedule and Denmark's

195 implied HN points • 09 Dec 24

🏥 Health Politics Vaccination Public Health Research Methods Child Health

There are big differences between the childhood vaccination schedules in the US and Denmark. Studying these differences could help us understand which method works better for kids.
A cluster randomized trial could test the effectiveness of the US vaccination schedule compared to Denmark's. This means grouping areas to follow one schedule or the other and then measuring health outcomes.
There's a lot of uncertainty about which vaccination approach is best. By collecting better data, we can start to settle these important questions instead of just accepting existing beliefs.

What a Trump presidency can mean for health care

342 implied HN points • 06 Nov 24

🏥 Health Politics Health Reform Public Health Policy advocacy Nutrition Regulation

We need to eliminate conflicts of interest in healthcare. This means doctors shouldn’t take money from companies that could influence their decisions.
The CDC and NIH are failing in their roles and need restructuring. They should focus better on data and improve how they operate.
Children's nutrition is important. Schools should serve healthier food, and we need to cut down on processed foods to promote better eating habits.

Jay Bhattacharya is a superb pick for NIH director

209 implied HN points • 30 Nov 24

🏥 Health Politics Public Health Policy Analysis Epidemiology Healthcare systems Health Equity

Jay Bhattacharya wants to study the effects of lockdowns and other COVID-19 measures. He believes this research will help prevent similar harsh actions in the future.
He plans to improve how scientific research is done, focusing on making findings repeatable and clear. This could really help how science is understood and applied.
Jay aims to change leadership rules at NIH and make grant processes better through trials. He believes changes in these areas could lead to more effective research.

Sabotaging RFK Jr's confirmation will increase vaccine hesitancy

197 implied HN points • 01 Dec 24

🏥 Health Politics Vaccination Public Health Policy Regulation

Blocking RFK Jr.'s confirmation could make more people anxious about getting vaccines. This is bad for public health.
Scott Gottlieb has made decisions that may hurt trust in the FDA. His past actions raise concerns about his true intentions.
To reduce vaccine hesitancy, it's better to approve RFK Jr. so he can help produce more research and answer important questions.

Why Did Trump Win?

272 implied HN points • 08 Nov 24

🇺🇸 U.S. Politics Elections Voter Behavior Political Analysis Public Policy Campaign Strategy

Trump won because different voters had different reasons for supporting him. Issues like immigration and inflation resonated with many.
His clear stances on controversial topics, like abortion and transgender issues, attracted some voters who felt more represented by him.
Trump's personality and media presence helped him gain a following, while perceptions about his opponent's weaknesses were also influential.

Will Biden Pardon Fauci?

153 implied HN points • 05 Dec 24

🇺🇸 U.S. Politics Justice Healthcare Public Policy Government Accountability Political Commentary

Biden might pardon Fauci, who is accused of perjury for his statements about gain of function research. This could set a worrying example for future public health leaders.
Fauci's handling of the pandemic included many controversial decisions, like his advice on masks and school closures. Many believe he didn't provide enough scientific backing for these decisions.
Justice isn't just about punishment; it serves to deter future wrong actions. Pardoning Fauci could lead to more reckless behavior in health leadership during crises.

Doctors migrating to bluesky is like Harris declining to speak with Joe Rogan

219 implied HN points • 15 Nov 24

🇺🇸 U.S. Politics Election Dynamics Political Ideology Public Discourse Media influence Social media

Some doctors are leaving social media platforms like X for newer sites like Bluesky, especially after the recent elections. This change seems more emotional than principled since they didn't leave when their views were challenged earlier.
Kamala Harris declined to speak with Joe Rogan because she was worried about upsetting her progressive supporters. This shows a reluctance to engage with differing opinions.
People with far left views often avoid conversations with those they disagree with, which can harm communication and understanding. This avoidance might damage academic and public discourse over time.

A simple suggestion for RFK Jr to end corruption in medicine

189 implied HN points • 23 Nov 24

🏥 Health Politics Medical Ethics Pharmaceuticals Public Health Government Policy Healthcare Reform

RFK Jr. wants to fight corruption in medicine, especially the money doctors take from pharmaceutical companies. It's important to have honest practices to benefit patients.
A proposed change is to limit the number of doctors in advisory groups who have received money from drug companies. This could start at no more than 60% in 2025 and end with 0% by 2028.
By having fewer conflicts of interest, doctors might focus more on what's best for patients rather than just following drug company interests. This could lead to better healthcare decisions.

What does RFK Jr mean for healthcare?

176 implied HN points • 13 Nov 24

🏥 Health Politics Healthcare policy Public Health Pharmaceuticals Vaccine Mandates Regulatory issues

RFK Jr. could be pushed out of the healthcare conversation because he is anti-corporation. Many pharmaceutical companies might not want him involved due to his stance.
He wants to change how vaccine makers are protected from lawsuits, suggesting they should face accountability like other drug companies. This could lead to better safety practices in vaccines.
The current healthcare system is seen as corrupt and ineffective. There's a need for deeper reforms and better studies to ensure drug and vaccine safety.

Doctors criticizing RFK Jr. paved the way for his ascendency

165 implied HN points • 15 Nov 24

🇺🇸 U.S. Politics Political critique Public Health Government Policy Vaccination Debate

Criticism from doctors has helped RFK Jr. gain popularity. When they speak out against him, it can draw more attention to his ideas.
Some health officials, like Ashish Jha, have made decisions that seem to prioritize corporate interests over scientific evidence. This has led to a loss of trust among the public.
RFK Jr. stands against big pharmaceutical companies and their influence on science. He points out the problems caused by these interests in the health sector.