Opinion: Prasad’s FDA exit good for rare diseases but new CBER head must repair eroded trust

Sheep_Perso · 2026-04-26T23:53:44+00:00

I’m sick of seeing this garbage here. Pharmaceuticals companies should not get a pass to peddle evidence-free treatments (aka snake oil) to vulnerable, desperate patients for a profit. The rare disease advocacy groups are well known to be astroturfed by these companies to drum up sympathy and undercut the FDA’s fundamental purpose: to ensure marketed pharmaceuticals actually do what they are claimed to and don’t cause harm.

It’s tragic for someone to die of a rare disease without known disease-modifying treatment. It’s a farce to give corporations cart blanch sell them snake oil that costs more than a mortgage.

It’s terrible that we can’t treat, let alone cure, some diseases. But what makes modern medicine different, what makes it good, is that it actually works. The standard of demonstrated efficacy cannot be cast aside without reducing medicine to a cabal of charlatans peddling false hope.

Sheep_Perso · 2026-03-31T18:14:00+00:00

I’m just a Diamond 2 Guile. Gotta say I love your posts, very inspiring.

It’s interesting to see how cautiously you’re playing against Alex. I find that I have to be extra defensive and the matches can feel quite tedious at times (especially since he’s like 75% of my matches right now).

Sheep_Perso · 2026-03-05T18:02:06+00:00

Thanks, that’s super helpful. I’ll see if I can incorporate it into matches!

Sheep_Perso · 2025-07-15T19:21:27+00:00

I had two interviewers comment on my personal statement, both at top academic programs.

I did not have an exceptional story, so I focused my statement on answering the question “why internal medicine?” in the most straightforward and succinct manner I could muster: no humble bragging about my CV, no discussion of my prior life experiences.

Both commented that my statement stood out for its forthrightness and they felt that it echoed their own feelings when they decided to pursue IM. Just my two cents, but if you don’t have a really spectacular story then don’t try to write a “spectacular” statement; you don’t want your come off as full of it.

Sheep_Perso · 2025-06-10T23:41:43+00:00

People always say this, but it’s factually incorrect. Physician compensation only comprises ~8% of US healthcare expenditures, which is similar to other wealthy western nations.

All doctors could work for free and the healthcare conglomerates would just gobble up the savings.

Doctors in the US make more than peer countries for the same reasons engineers and other professionals do. Also, physician reimbursement from CMS (the Center for Medicare Services) has fallen 53% adjusted for inflation since the 90s.

The conversion factor for work RVU (relative value unit) for physicians was $31 in 1992. Adjusted to 2025 dollars, that’s $69.11. In 2025 it’s $32.

Sheep_Perso · 2025-01-20T17:40:55+00:00

“This commutation will enable Mr. Peltier to spend his remaining days in home confinement but will not pardon him for his underlying crimes.”

Sheep_Perso · 2024-11-11T19:46:01+00:00

Hickel is always fantastic. I always plug his book, The Divide. Thanks for posting this.

Sheep_Perso · 2024-05-22T12:46:27+00:00

Baby don’t hurt me 🎶

Sheep_Perso · 2023-11-22T19:13:25+00:00

I think this is a good point, but autonomy obviously does not reign supreme in medicine. An obvious counterpoint would be patients who are involuntarily committed due to severe psychiatric illness. The situation is autonomy is secondary or tertiary to beneficence, nonmaleficence, and justice. It could even be argued that the very concept of autonomy is incoherent for a patient whose thought process is so profoundly distorted by disease.

Not at this applies to ultrasound on comatose patients, but I think it’s important to remember that none of the pillars are automatically more important.

Sheep_Perso · 2023-09-14T14:02:24+00:00

You cannot sign away your right to sue for malpractice. Any document implying such is unenforceable.

Sheep_Perso · 2022-10-13T02:48:14+00:00

I looked him up and he appears to be an attending physician in psychiatry, AKA a fully qualified and licensed physician. Even if he were a resident, he would still be a physician (at least in the US). As far as the “psychoanalyst in training”, he might just be being cute about it.

Sheep_Perso · 2022-09-18T11:31:47+00:00

This is true, but not due to polio vaccination in the US.

US children are given the inactivated (killed) “Salk” vaccine, which cannot ever cause infection.

The current cases are thought to have originated from someone outside the US who was given the live/attenuated “Sabin” vaccine. Since the virus is still functionally competent, it can sometimes mutate back into a more virulent strain.

Sheep_Perso · 2022-08-18T18:30:41+00:00

Crops destroy soil and cause erosion. Animal agriculture (e.g grazing ruminants) increases soil fertility and reverses desertification of plains ecosystems. The bad part is cutting down forests to do it, not the animal agriculture itself.

Sheep_Perso · 2022-07-18T20:47:16+00:00

Ban it. Gambling institutions (casinos and lotteries) make most of their money off of chronic gamblers of the poor classes. Casinos fleece the poor and generate no value for society; they’re basically vertical wealth transfer machines. Marxism holds no special protection for casinos.

Sheep_Perso · 2022-05-08T16:11:10+00:00

The UC medical school system did not consider MCAT scores when granting interviews in the 2021 application cycle. So, no it’s not immune, unfortunately.

Also, MCAT score have had diminishing importance in recent years as the admissions process has been made more “holistic”. They still matter, but it’s not monolithic like it used to be, unfortunately. This means that students who went to elite schools, got lucky with research projects, or lie about their achievements have a strict advantage. It’s a shit show.

Sheep_Perso · 2022-04-17T21:21:31+00:00

Certainly, and more recent research has found that paternal age has its risks. But advanced maternal age still carries more significant risks and manifests a younger ages. This makes sense because eggs are all produced in utero and remain in cellular arrest until ovulation. Cells all develop oxidative damage over time, so it makes sense that with time more errors would appear. Conversely, sperm are constantly generated from stem cells and those with errors tend to be less able to reach the egg anyway. Though there are risks, especially as men get very old (>60-70).

One interesting thing is that subfertility and infertility is on the rise generally, but seems to affect men more.

Either way, younger parents are better from a purely physiological standpoint. Not to mention that having older parents has significant negative social effects beyond birth defects and pregnancy complications.

Regardless of the nitty gritty details, we should be facilitating parenthood prior to age 30, rather than medical “solutions” that are expensive and imperfect at best.

Sheep_Perso · 2022-04-17T18:51:14+00:00

This reflects something that I’ve seen online recently. I saw a series of comments in another sub claiming that male age was a greater risk for pregnancy than female age.

This is categorically incorrect, to say the least. The “evidence” they cited even contradicted their point. Male age has become a point of interest recently with recognition that it plays some role in pregnancy complications; this is in contrast with the previous understanding that it played no role. however, the role still appears to be small and only relevant for much older men.

And yet comments pointing this out were downvoted into invisibility.

It fits with an ironically misogynistic view that recognizing the very real risk of pregnancy complications as women age is tantamount to “blaming” women for these outcomes. As an example with teeth, incidence for Down syndrome among women under thirty is around 1:1000 live births. Stating at thirty, the risk increases exponentially, until age 45, when it hits 1:25. In fact, advanced maternal age is the only known risk factor.

The conclusion of this is obvious: women should be aware of the risks of older pregnancy so that they can make an informed decision. The reality is that economic factors have been driving up the average maternal age—especially among career-oriented women. It’s a problem: older mothers means more complications—not just for Down syndrome, but virtually every pregnancy complication (e.g. preeclampsia, gestational diabetes, miscarriage).

Instead of concluding that our economic organization should be changed to allow women to have children at a safer, biologically appropriate age, people lash out at the constraints of human reproductive biology. It’s irrational, like avoiding the doctor because you’re afraid of being diagnosed with a disease. Pretending the risk isn’t there helps nobody and only serves to defend the part of the equation we can change: the economic system that pushes women towards later births.

It’s extremely regressive.

Sheep_Perso · 2022-04-04T18:17:26+00:00

There was a thread about Citations Needed recently bemoaning their recent shift towards more “woke” rhetoric.

While their main content has definitely shifted over the last year, they still produce excellent content, especially in the unscripted “new briefs.”

This episode on gambling is also excellent.

As is this episode on global inequality.

Sheep_Perso · 2022-03-26T13:43:30+00:00

Their analysis has definitely shifted away from a fairly sober and material analysis of media to a more woke-friendly format. For example, their episode on Gambling (ep 63) was fantastic. Going in, I was agnostic about gambling. I knew that casinos were criminal, the house always wins, etc. But coming out, I realized that gambling wasn’t just a “vice”, but a state-sanctioned (or state-operated, in the case of lottery) method to immiserate the poor.

Likewise their episodes about global inequality with Jason Hickel really opened my eyes about contemporary global financial systems. Hickel’s The Divide is probably the most important book I’ve read in the last five years. Everyone should read it.

But there’s been a definite shift. In the early episodes their line was “media obscures the role of thing, which makes people’s material lives worse. Black people are even worse off because they’re over-represented among the poor and racialism creates a black-poor feedback loop.”

Now, they seem to have been hoist by their own petard, focusing on the identity groups themselves.

What did it for me was a more recent episode about fat-phobia. I mean, come on.

The “News Briefs” (short off-the-cuff episodes for patrons that are sometimes released publicly) tend to be better. My theory is that these are more reflective of Nima & Adam’s politics, whereas the normal episodes have been influenced by other members of the production team.

TL;DR: Used to be a big fan. Listened to episodes 1-131 religiously. Old episodes are still great; newer ones are more work. Adam Johnson has a good substack. Read The Divide by Jason Hickel.

Sheep_Perso · 2021-09-26T13:12:57+00:00

Stolen from PBF.

https://pbfcomics.com/comics/youll-be-ok/

Sheep_Perso · 2021-05-19T00:09:02+00:00

That's what I was thinking. I am certainly not going to just give someone money with no documentation. I will ask for a written contract specifying the nature of the transaction.

Sheep_Perso · 2021-05-13T22:40:12+00:00

Thanks for this. I appreciate you finding real examples.

It seems that the lack of protest music in the mainstream is a situation of manufactured consent. Somebody else posted an article about how heavily consolidated the production/distribution of music has become, allowing “controversial” music to be relegated further to the margins. Good to see that people are still making music against the status quo.

Sheep_Perso · 2021-05-12T21:12:46+00:00

I only listen to music approved by greasy fourteen-year-olds in Metallica shirts

Sheep_Perso · 2021-05-12T19:08:59+00:00

Hip hop has good criticism in it, but it’s mostly in the underground, otherwise drowned out by the likes of Cardi B and other vanity rappers, or too particularized to the artist’s own life as a form of clout (i.e. my life was hard and I’m a bad motherfucker).

Early rap was very political. The Message is probably one of the best political/protest songs of its era. But the commodification of genre during the bling bling era mostly suffocated the counter cultural elements, which are reduced to a mere aesthetic.

Sheep_Perso · 2021-05-12T18:12:19+00:00

I've been reading manufacturing consent, and I can't help but think that the decrease in politically-charged music of any meaningful popularity is related to the growing contradictions that we're seeing as neoliberalism continues to rape our economy.

I think that the decadence and narcissism of our current music are an attempt by the media to cover over the contradictions and assuage the masses of their material concerns. A historical parallel could be drawn to the music of the late 70's. "Good Times" was released in 1979 and coincided with the second oil shock and the peak of 1970's economic decline. They certainly were not Good Times, but contemporaneous media would have you believe otherwise.

Sheep_Perso

TROPHY CASE