Thomas Bottiglieri, D.O.

Since concussions are typically diagnosed through self-reported symptoms, subtle symptoms can often be missed. So, doctors at NewYork-Presbyterian and Columbia Orthopedics have designed an AI- powered headset that can detect eye and neck movements that might otherwise be missed.

Precision exercise prescription for substance use disorders 🍺 💊 A sports medicine framework for tailoring therapeutic protocols to substance type and psychological phenotype 🏃‍♂️ 💪 #Editorial ➡️ bit.ly/4zZK9pB

1/The math tells the story on healthcare affordability—and spoiler alert—it’s not physicians, hospitals, ASCs, the NSA, or the “dog ate my term paper” type excuses. @AnthemBCBS or whatever they are called this week (Elevance) Q3 ‘26 net profit is reported below. Elevance is the largest BCBS owner in the US—14 plans—and @AnthemBCBS Q1-3 ‘26 profit was $4.592B. Add that net profit from Little Brother (Elevance) to Big Brother @UHC’s Q1-3 ‘26 net profit ($15.874B) and only 2 health plan’s net profits so far total $20,464,000,000. And this $20+B total is X of @Humana, @Aetna @Cigna & smaller commercial for-profit health plans. Note that the other ~36 @BCBSAssociation plans are “non-profit” (read non-tax paying), so we don’t receive quarterly reports on their “profits” which they call a “surplus.” So, let’s not listen for one second to the health plans and their associations point the finger of “un-affordability” to physicians and hospitals when the plans’ net profits so far are well into 11 figures—w/ another quarter of profits yet to be reported. Elevance reports $1.4B in Q3 profit, names Carelon president beckerspayer.com/financial/e…

Another way to explain why AI won’t be curing all disease soon is that it doesn’t remove the bottleneck. No, it’s not that it won’t be smart enough. Hell, it’s smart enough now, let alone in a year or 5 years. But no matter how smart it is, it just moves the bottleneck downstream. The perfect virtual cell and virtual tissue and virtual human will generate hypotheses, insanely good hypotheses that we’d never come up with on our own. Then AI will design the experiments to validate the hypotheses and run them in parallel and that’ll get us incredible drugs. But once we have the drugs we won’t know if they’re cures until we give them to real, live humans and watch them for the rest of their lives. So amazing treatments, which we already have, are going to start dropping faster than Millennium Prize problems. (I actually heard Anthropic is dropping 816 drug candidates the weekend before their IPO, BTW. You heard it here first.) But the point is that you can check a math proof by reading it. To check a cure you have to observe lots of humans for their entire lives. So how long does it take to find out if a treatment is a cure? An entire human lifespan. That’s the bottleneck. @AlexanderKalian

This kind of preening, holier-than-thou piece is a major reason the public doesn't trust doctors. Dr. Avorn suggests that clinicians begin discussions with patients regarding the federal budget reductions being made in coverage, describe the impending harm, and encourage them to vote to correct what has been done. But would Avorn extend the same ethical permission to a physician whose politics ran in the opposite direction? “Mrs. Jones, I apologize that your insurance premium is so high. The Affordable Care Act mandates a wider array of benefits and prohibits insurers from charging prices based on medical risk. You may wish to consider the politicians who authored those decisions prior to voting. I would be remiss not to address such an important aspect of your care.” Or consider a patient facing a long wait for an appointment. Surely a conservative physician could regard that as the ideal moment to explain California’s decision to spend state money expanding coverage to undocumented immigrants. A coverage dispute could prompt an equally earnest lecture about Medi-Cal paying for adult gender-transition procedures. Resources are finite; elections have consequences; how fortunate that the doctor is available to explain both. Will Avorn embrace that conversation as an example of fulfilling the physician’s ethical obligations? Or would he characterize the tone as manipulative and reduce the conversation to an abuse of the patient’s vulnerability? Once the physician’s preferred politics are defined as the patient’s health interests, then opposing viewpoints are likely going to be seen as ignorance. It appears Avron can’t even fathom a world where intelligent, well-meaning people disagree with the downstream consequences of policies. Read my full piece below

What happens when you get rid of brokers, PPO networks, percentage-of-savings fees and all the other nonsense — and actually PAY ATTENTION to the health plan? THIS HAPPENS. Nine years of real data. Using KFF national averages for each year as the benchmark, this employer’s actual health plan costs came in $3.89 MILLION below the national-average benchmark over nine years. That's for a group of less than 80 employees. Do the math. Not projected savings. Not modeled savings. Not “discounts” off inflated hospital charges. Actual costs. I have the receipts: • Actual stop-loss contracts • Actual claims reports • Actual administration fees • Actual enrollment • Actual plan expenses Your renewal is coming. Ask your broker to show you what your plan has actually cost over the last nine years — and then ask them to benchmark it. Ask them for stop loss premiums, admin fees and claims data. And while you’re at it, ask them whether self-funding works for employers with fewer than 100 employees. Most will tell you it doesn’t. Every group I manage has fewer than 100 employees. The slide below is what one of them looks like. No smoke. No mirrors. No made-up “savings.” Just receipts. IYKYK and you desperately need to know.