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

Medicine is becoming more corrupt

184 implied HN points • 04 Nov 24
🏥 Health Politics Corruption Pharma University Research Ethics Healthcare access
  1. Medicine is being influenced by money from pharmaceutical companies, which can lead to biased practices. This means that decisions in healthcare might prioritize profit over patient care.
  2. Big donations to universities can result in naming rights and influence, creating a potential conflict of interest. This raises questions about the integrity and independence of academic institutions.
  3. There's a concern that this trend towards corruption could compromise the quality of medical research and education. Without accountability, the focus might shift away from ethical standards and patient welfare.

Will RFK Jr make it all the way to HHS secretary?

149 implied HN points • 14 Nov 24
🇺🇸 U.S. Politics Elections Policy Government Healthcare Political appointments
  1. RFK Jr. is Trump's nominee for HHS secretary, but getting confirmed may be difficult. He needs support from Republicans and could face pushback from powerful corporate interests.
  2. While RFK Jr. has some popular views, like being against pollution and the influence of big pharma, he also has a mixed history that could be used against him during confirmation.
  3. Even if RFK Jr. makes it to HHS, he might struggle to implement major changes due to strong opposition from the system and media, which could slow down his agenda significantly.

What does 'equity' mean?

140 implied HN points • 14 Nov 24
🚌 Education Equity Learning Teaching Curriculum Access
  1. Schools may prevent advanced students from excelling in their subjects because it is deemed unfair to those who are struggling. This can limit the potential of talented students.
  2. The concept of 'equity' can sometimes be used to excuse practices that are not truly fair or effective. Instead, it can lead to a situation where everyone is held back instead of finding ways to help those who need support.
  3. In professional settings, like medical interviews, virtual options are defended as equitable, but this can make the process less serious and impersonal. The focus should be on genuine fairness instead of just using equity as an excuse.

How to judge federal nominees: Stories about bears, sex scandals, conflict of Interest... And what about their *actual views*? what is relevant?

92 implied HN points • 04 Dec 24
🇺🇸 U.S. Politics Political Analysis Media influence Public Opinion
  1. When judging federal nominees, think about them compared to the likely next choice, not some ideal candidate. It’s about who is realistically in line for the job.
  2. Consider if the issues raised are criminal or if they relate to hypocrisy in their professional responsibilities. People should be held accountable for their job duties, not just personal lives.
  3. Look at their actual work and views. Those who are flexible in their opinions and bring ideas are often better than those sticking strictly to a party line.

Walensky wins the IDSAs Fauci Award

175 implied HN points • 24 Oct 24
🏥 Health Politics Public Health Policy decisions Trust Issues Covid response Communication
  1. Public health needs to be honest about its mistakes to regain people's trust. If it keeps celebrating errors, trust will stay low.
  2. Both Walensky and Fauci have made many mistakes in their public health decisions, like masking and vaccine guidelines. Their actions confused people and didn't always follow the science.
  3. For public health to improve, it should focus on open discussions and the truth instead of promoting those who were wrong. Otherwise, trust in health organizations will keep declining.
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Suggestions for a Practical Way of Responding to RFK, Jr: Reflections from an Infectious Disease Doctor

115 implied HN points • 19 Nov 24
🏥 Health Politics Public Health Vaccines Infectious Diseases Health Policy
  1. Don't assume bad intentions of people like RFK Jr. Even if you disagree with them, it's important to recognize that they may genuinely care about public health.
  2. Instead of labeling individuals as 'quacks,' it's smarter to engage with their arguments and acknowledge when they make valid points. This can earn more respect.
  3. Being honest about past mistakes in public health can help rebuild trust with the community. Acknowledging errors makes it easier to improve in the future.

Public health should be distrusted

176 implied HN points • 17 Oct 24
🏥 Health Politics Public Health Policy Analysis Vaccine debate Trust Issues
  1. Public health policies, like mask mandates, may not have strong evidence supporting their effectiveness. It's important to question if these rules actually help reduce virus spread.
  2. There seems to be no clear reason for timing these mandates, like starting in November. This raises doubts about their real necessity.
  3. Distrust in public health may be justified if they impose rules without credible data or consideration of their impact on people. It's okay to ask for better evidence and accountability.

Does RFK Jr have a guiding philosophy or is he just spitballing?

112 implied HN points • 17 Nov 24
🏥 Health Politics Health care Regulation Philosophy Public Health Medical Ethics
  1. RFK Jr. has a distinct philosophy focused on skepticism towards corporations and promoting body autonomy. He is against vaccine mandates and supports personal choice in health decisions.
  2. Vivek Ramaswamy believes in reducing FDA regulations to make it easier for drug companies to operate, but he emphasizes the need for safety studies without enforcing unrealistic efficacy requirements.
  3. The current FDA leaders, like Scott Gottlieb and Bob Califf, prioritize corporate interests and maintain high drug prices. Many feel they don't push for the best evidence and often end up working for pharmaceutical companies after leaving government.

Vaccines are like drugs: Some are safe, some are effective, and some have benefits > harms, but not all

135 implied HN points • 31 Oct 24
🏥 Health Politics Vaccines Public Health Medical Ethics Drug Safety Clinical Trials
  1. Vaccines, like drugs, can vary in safety and effectiveness. Some work well for certain people but not for others.
  2. It's important to measure how well vaccines work, not just for virus-related issues but for overall health.
  3. We need better monitoring and data sharing after vaccines are given, along with the ability to hold manufacturers accountable if something goes wrong.

Lessons from Emory-- Masking Mistakes

164 implied HN points • 13 Oct 24
🏥 Health Politics Public Health COVID-19 Vaccine Policy Health Equity
  1. Closing schools for long periods during COVID-19 was a mistake. Some countries didn't close schools and found that kids were not at high risk, which should have guided decisions.
  2. Vaccinating children and healthy adults who have had COVID-19 may not be the best idea. There's concern that this might lead to more vaccine hesitancy, especially when the urgency is communicated incorrectly.
  3. The COVID-19 pandemic impacted poorer communities much more than wealthier ones. There needs to be more open discussions and debates to improve understanding about pandemic responses and their effects.

More suggestions for FDA reform for a Trump presidency

98 implied HN points • 07 Nov 24
🏥 Health Politics Public Health Regulatory Affairs Healthcare policy Scientific Integrity
  1. The FDA should stop allowing pharmaceutical companies to advertise directly to consumers. This could help reduce biased promotion of drugs.
  2. It's important to improve transparency in the FDA's decision-making process and ensure that medical advice is based on solid evidence.
  3. We need better oversight of the fees the FDA charges for reviews so that smaller businesses aren't unfairly priced out, and more funding should go into tracking the safety of drugs after they are approved.

The National Academy of Medicine is only inducting COVID commenters who were incorrect

103 implied HN points • 01 Nov 24
🏥 Health Politics Public Health COVID-19 Policy Analysis Trust Issues
  1. The National Academy of Medicine is mostly recognizing people who gave wrong advice about COVID-19. It's surprising that many who commented about COVID-19 and were inducted were incorrect.
  2. There seems to be a focus on honoring those who were strongly in favor of measures like masking and lockdowns. This suggests a loyalty to a specific viewpoint rather than evaluating based on facts or merit.
  3. This trend can hurt public trust in health institutions. If organizations are driven by ideology instead of balanced evidence, it makes people skeptical about their recommendations.

5 Lessons from Stanford's COVID Conference

129 implied HN points • 06 Oct 24
🏥 Health Politics Pandemic response Public Health Education & Policy Mental health Data Analysis
  1. Closing elementary schools during the pandemic may have been a bad idea because kids were not significant spreaders of COVID-19. Some experts, like Anders Tegnell from Sweden, believed this from the start.
  2. Many people now agree that long school closures were harmful, but some didn't speak up about it at the time. It shows the importance of questioning popular opinions instead of just following the crowd.
  3. Countries that had less income inequality tended to handle the pandemic better than those with more inequality. Access to basic healthcare might have played a bigger role than strict lockdowns or border closures.

Free lecture in San Diego - How to read trials

40 implied HN points • 24 Nov 24
🏥 Health Politics Public Health Medical Ethics Pharmaceuticals Healthcare policy Patient Advocacy
  1. There is a free lecture in San Diego about reading trials. It's a great opportunity for anyone wanting to learn how to understand trial results.
  2. The lecture is unique because it is not funded by pharmaceutical companies. This might give a more unbiased view on the information being discussed.
  3. Attending this lecture could help people become more knowledgeable about medical studies. It's a chance to ask questions and get clarity on trial data.

Questions graduating med students can ask on residency interviews, and some they shouldn't

41 implied HN points • 30 Oct 24
🏥 Health & Wellness Medical education Career development
  1. It's important to ask about successful graduates from the program to see what you can aspire to. Their stories can reveal what the program really values and how it helps its students.
  2. Asking about any past failures or who wasn't a good fit can give insights into the challenges of the program. This helps you understand what it takes to succeed there.
  3. Questions about unique strengths of the program and faculty engagement can show you how well the program supports its residents. Specific answers are more revealing than vague statements.

What is happening to medical students?

220 implied HN points • 22 Feb 24
🏥 Health Politics AMA Political Activism Medical education Leadership
  1. Students shouting down speakers at the University of Chicago raised concerns about their behavior and the medical school's leadership.
  2. Debating whether the AMA should issue a statement on the war highlighted the complexities of making impactful statements and maintaining professional standards.
  3. The lack of courage in inviting diverse speakers and fostering debate in medical schools may contribute to a culture of protest among students.

The New York Times still won't cover covid honestly

200 implied HN points • 04 Mar 24
🏥 Health Politics COVID-19 Healthcare Media Opinions
  1. Improving air quality did not stop COVID19 in Kindergartens. No evidence shows that upgrading air quality reduces seasonal respiratory viruses effectively.
  2. Masking may not be necessary in 2024. Few individuals are wearing masks as they are inexpensive and easily available online, suggesting a reduced need for them.
  3. The New York Times seems to be biased in covering COVID. It is important to accept life's risks, not wear masks unnecessarily, and focus on socialization and personal care.

Apoorva Mandavilli keeps making mistakes at the New York Times to exaggerate the risk of COVID to keep Americans scared

162 implied HN points • 18 Feb 24
🏥 Health & Wellness COVID-19 Journalism Medical Misinformation
  1. Apoorva Mandavilli is accused of making mistakes and exaggerating COVID risks to keep Americans scared
  2. Critics claim that Mandavilli's reporting lacks journalistic integrity and is more aligned with activism
  3. There are concerns about bias in Mandavilli's reporting, including inaccurate statistics and flawed analysis

UCSF has match day outdoors & plans on contact tracing... in 2024

132 implied HN points • 16 Mar 24
🏥 Health Politics Medical education Public Health Risk management
  1. Population immunity to COVID-19 is high, making large outdoor gatherings unnecessary. Holding events outdoors may not significantly impact transmission and could be inconvenient.
  2. There is little evidence to support the need for contact tracing in 2024. The effectiveness of contact tracing for the virus is questionable.
  3. Medical school policies may sometimes prioritize perceived safety over rational decision-making, potentially impacting student experiences and learning.

Robert Califf the FDA commissioner is making inappropriate and irresponsible claims about vaccines and boosters on twitter

176 implied HN points • 04 Jan 24
🏥 Health Politics FDA Vaccines Boosters Misinformation Twitter
  1. FDA commissioner Robert Califf is making inappropriate claims about vaccines and boosters on Twitter.
  2. Califf's claims are not supported by randomized trials, which go against FDA standards.
  3. Califf is spreading misinformation and using low quality evidence, acting more like a Pfizer spokesperson than a respected academic and scholar.

Take RFK Jr seriously: what RFK Jr. gets right and wrong

288 implied HN points • 18 Jun 23
🏥 Health Politics Health Policy Vaccine Safety Public Health Medical Ethics Media Coverage
  1. RFK Jr. has valid points about corporate influence in politics and government corruption.
  2. RFK Jr. highlights failures in Covid-19 policies such as lockdowns and vaccine mandates.
  3. RFK Jr. advocates for stricter oversight on vaccine safety and criticizes the close relationship between FDA and pharmaceutical companies.

Book 4: The Story of the Lost Child

16 implied HN points • 29 Oct 24
📚 Literature Fiction Literary Analysis Book Reviews Author studies Cultural Commentary
  1. The climax of 'The Story of the Lost Child' centers around the heartbreaking loss of a child named Tina, highlighting the intense pain of not knowing what happens to a loved one.
  2. Elena Ferrante's writing captures complex relationships and deep emotions, with characters that represent different sides of the author's own experience, making the story feel personal and relatable.
  3. There are intriguing theories about Ferrante's identity, suggesting she might be a collaboration between a husband and wife, which adds a layer of mystery to her powerful storytelling.

Did Republicans die more during the pandemic bc they didn't get the vax?

209 implied HN points • 29 Jul 23
🇺🇸 U.S. Politics Pandemic response Political Bias Vaccine distribution Health Disparities Public Health
  1. A recent paper suggests that Republicans were more likely to die during the pandemic due to not getting vaccinated.
  2. The paper had flaws in its methodology and did not consider factors like age, BMI, and vaccination status.
  3. Criticism of Republicans for not getting vaccinated highlights a double standard in how different groups are treated in research and society.

Mayo Clinic Suspends A Doctor Who Commented in NYTimes About Testosterone's impact when Trans-athletes compete in Women's sports

230 implied HN points • 08 Jun 23
🏥 Health Politics Academic Freedom Censorship COVID Public Health
  1. Mayo Clinic suspended a doctor for comments on transgender athletes in women's sports, violating academic freedom.
  2. Academics should have the freedom to express their views in media without censorship.
  3. Universities should prioritize the free exchange of ideas over financial gain.

Forest fires and n95 masking

225 implied HN points • 10 Jun 23
🏥 Health Politics Public Health Policy Epidemiology
  1. Public health recommendations should be evidence-based and consider the best use of resources.
  2. When it comes to community N95 masking for forest fires, there is a lack of studies showing its effectiveness.
  3. Randomized trials measuring endpoints in response to N95 masking during forest fires could provide valuable data.

The only real solution to vaccine skepticism: We need more randomized trials and a new phase IV safety system

206 implied HN points • 29 Jun 23
🏥 Health Politics Vaccines Public Health
  1. Experts need to rely on randomized trials for authorizing medical products to ensure effectiveness and safety.
  2. Implement a new safety system to detect rare vaccine adverse events, using observational and real-world randomization.
  3. Re-examine older vaccines for safety to address growing public distrust, regardless of expert opinions.

If results are too good to be true, you can't exclude harms

71 implied HN points • 07 Mar 24
🏥 Health & Wellness Research Vaccination Pregnancy Study Side Effects
  1. Results that seem too good to be true may not be accurate and can hide potential harms or biases.
  2. Confounded studies, where data is influenced by other factors, can be misleading and unhelpful in drawing conclusions.
  3. It's important to consider the full data and potential biases in research studies, especially when interpreting studies involving vaccinations during pregnancy.

A flawed paper claims COVID19 vaccines prevent cardiovascular complications for a YEAR after the shot

67 implied HN points • 18 Mar 24
🏥 Health Politics Medical Literature
  1. When reading medical papers, it's important to consider the methodology used by researchers and look beyond just the main data presented.
  2. It's crucial to be aware of negative control outcomes, which are endpoints that cannot possibly be linked to the exposure being studied.
  3. The flawed paper in question claims that COVID-19 vaccines prevent cardiovascular complications for up to a year after vaccination, but upon closer examination, the study's methodology and conclusions are highly questionable.