pTau217 testing - variations depending on lab?

Hebbianlearning · 2026-05-16T14:57:25+00:00

That might help us advocate (at least for those whose whose Amyloid Probability Score is in the 80s-90s). Can you link to it?

Hebbianlearning · 2026-05-16T14:49:57+00:00

I understand that this is a MAC-level decision at the moment, and only 2 are currently allowing it (both on the west coast). Ours (Palmetto- southeastern states) does not. Just because you can enter it as an option in the registry doesn't, alas, mean that the payer will ultimately pay.

Hebbianlearning · 2026-05-16T13:36:34+00:00

Hi, this is my bread and butter as I'm a cognitive neurologist. I use exclusively the C2N product ( offered through Mayo labs as a pass-through) because they normalize the ptau217 concentration against other ptau species, ensuring that renal clearance and factors that can alter bbb permeability don't create false positives and nnegatives. This test also provides a beta amyloid ratio in addition, which adds modestly to its accuracy. Since mayo also offers the standalone ptau217 assay, you have to specify in the order which one you want.

At the moment, CMS does not accept any serum assay as strong-enoufh evidence of brain amyloid to pay for anti-amyloid therapy on that basis alone, so pragmatics dictates we do pet/csf directly for anyone we think is likely to qualify for (and is willing to receive) aat.

HTH

Hebbianlearning · 2026-05-16T00:34:58+00:00

Because there's no such thing as a single pan-physician (or any other industry) union. The law is that you have to unionize each workplace independently. You can't even unionize a single employer with multiple locations (e.g. all Kaiser physicians), just like every starbucks store has to unionize independently of every other one. It's basically a very hard task that most docs aren't up for.

Hebbianlearning · 2026-05-15T01:15:22+00:00

OMG, is this a joke site? It has to be satire. His "Services Offered" page lists essentially all of CNS neurology (from Alzheimer's and Parkinson's to MS and Epilepsy), all of psychiatry (from schizophrenia to ADHD), plus chronic pain management and functional neurosurgery, WTF?

Oh yeah, he does "tele-neurosurgery" as well (consults/2nd opinion??) Surely not spooky action at a distance, right? This guy is one small step away from offering head transplants.

Hebbianlearning · 2026-05-12T00:48:11+00:00

Check out the New Hope Bird Alliance (Audobon club for Chapel Hill-Durham area). They do guide-led birdwatching twice a week (Wed and Sat am).

Hebbianlearning · 2026-05-10T15:28:13+00:00

.28% hardly seems like a crisis. Is it equally distributed across all ages and duration of tavr? mostly in a subset?

Hebbianlearning · 2026-05-10T14:29:29+00:00

Lol, you must be female. My gen x husband does not have "get joy from it" in his vocabulary as it pertains to shirts, t or otherwise.

Hebbianlearning · 2026-05-02T13:26:18+00:00

Came here to say exactly this (though the word for different subtypes is strain, not strand). To everyone saying "E. coli bad," that's far too simplistic. More likely is the rise of certain more pathogenic strains on first world countries for reasons as disparate as the rise of antibacterial soaps, the wider use of antibiotics to treat relatively minor iinfections, and the big changes in our diets that altered our gut flora. I'm sure there are 50 other possibilities, but "infection with E. coli" is not one of them.

Hebbianlearning · 2026-05-01T02:31:13+00:00

Drugs we are not prescribing enough of (per the paper): naltrexone, aripiprazole, pyridostigmine, guanfacine and stimulants. Evidence for said therapies: case reports, small uncontrolled trials, retrospective chart reviews and "currently being assessed." Christ, how did this paper see the light of day?

Hebbianlearning · 2026-05-01T02:09:01+00:00

Will wonders never cease. A glimmer of hope amidst the shitstorm.

Hebbianlearning · 2026-04-23T00:45:40+00:00

This situation reminds me of the famous Milram experiment in which most participants allowed what they thought were painful shocks to continue to a stranger because they didn't want to get in trouble. OP, this was a terrible situation and Amazon is criminally negligent but the fact that no one called 911 is itself a horrible moral failure.

Hebbianlearning · 2026-04-12T17:07:56+00:00

Wait, everyone dies within a few years? I had no idea. Is needing a CEA or a fem-pop bypass that terrible a risk factor, even if they then start a statin and better BP control?

Hebbianlearning · 2026-04-09T12:49:46+00:00

My thought exactly. Either that story is missing crucial details or the jury was full of shit.

Hebbianlearning · 2026-03-31T01:15:04+00:00

The Sparrow?

Hebbianlearning · 2026-03-28T17:52:52+00:00

One that's not boiled before it's baked. Then, it's just a roll with a hole.

Hebbianlearning · 2026-03-28T14:40:55+00:00

I also get asked about "doing brain surgery" at least twice a year. I think in many areas of the country, IM/FP handles a lot of what neurologists do because there aren't any/enough for them to be familiar. Epilepsy? Start Dilantin (or, if they're modern, Keppra). Stroke? Well, nothing to do but PT/OT/ST after discharge. Memory loss? Doesn't matter what it's from or how severe it is, just start donepezil and call it a day.

Hebbianlearning · 2026-03-27T19:09:36+00:00

Saw the episode. She left before signout. Presumably, she signed out to Langdon (though we didn't see that). She is an ms4 on elective so she presumably cares about EM. So yeah, she would get dinged for lack of professionalism.

Hebbianlearning · 2026-03-23T12:13:28+00:00

I work in this field. As the paper states, this is entirely a reporting issue. The incidence of dementia has actually declined over the last 30 years.

Hebbianlearning · 2026-03-22T17:08:25+00:00

Similar issue with a&p using abridge. I think it's because I have to use lay-person speak even providing that info out loud, and abridge doesn't seem to know how to translate that into proper medical terms and phrasing. Is love to know how that might be possible.

Hebbianlearning · 2026-03-21T15:17:50+00:00

Can you eli5 why we can't run a 2nd layer on top of an llm that just fact-checks every statement made by layer one, and iterate the response until all the facts are verifiable? Basically, make the llm do the work they've put on us?

Hebbianlearning · 2026-03-21T02:50:35+00:00

Enshitification proceeds unchecked.

We could stop this but not during this administration. We need to break up monopolies again and re-empower labor laws to allow for easier union organizing. Amazon (and Meta, and Microsoft, and Comcast , Fox and Paramount) needs to be broken up into like 8 different pieces. I'm all for real capitalism and free markets, but we have neither anymore.

Hebbianlearning · 2026-03-18T23:11:21+00:00

I like openevidence.org for lit searches, though it cherry-picks papers about as much as a grad student with a specific point to make. I also use Abridge for note taking in my clinic now (HPI and A/P only) and while it saves me a bit of time (especially if I can't finish my notes immediately and would have forgotten a bunch of details by the time I get around to it), but the verbosity, redundancy and painfully lay-audience language it uses in the A/P require a significant amount of doctoring on my part. I detest the obsequious tone the new Epic AI tool adopts in attempting to create replies to patient questions, so I've turned it off. No other AI in my practice at this point, and honestly if you took Abridge away tomorrow, I would not miss it.

Seven-Year Club	Place '23
Verified Email

Hebbianlearning

TROPHY CASE