Mas, MD

Surgeon, horse-lover. Support women leaders. Love Science. Posts are my own.

[Seth Abramson @SethAbramson]

Here's how I know Dems still don't appreciate the situation America is in and what MAGAs are capable of: the Governor of Kentucky should weeks ago have marched to the place Mitch McConnell's staff says he's in and then—if he didn't find him there—appointed a Democrat to his seat.

[Mas, MD @DrMSpring]

@maverickecom fable

[Eric Topol @EricTopol]

On our 250th birthday, celebrating the contribution of immigrants and international collaboration
—46% of people with doctoral-level degrees working in US science and engineering fields are foreign-born
—41% of the science and engineering research published by US authors in 2024 included international collaborators
—20% of physicians working the the USA were born and educated abroad
@ACarnegieFdn and @TheLancet
https://t.co/0e8pYHjvR5

[Royally Sage @sage1411]

My brother posts this every year in the family chat on the 4th. Still hilarious.

[Anthony Scaramucci @Scaramucci]

Trump is personally responsible for 28% of the national deficit of a 250 year old country.

Let that sink in.

We should all be embarrassed.

[Mas, MD @DrMSpring]

@DrNeilStone Same. I was so happy and proud to be one of the first. It felt like a celebration with all the docs/RNs. Now years and many covid vaccinations later, I never had more than a sniffle and my 80 yo mom and kids never tested positive (and we tested a LOT in those early days)

[Afshine Emrani MD FACC @afshineemrani]

On July 23rd, an FDA advisory committee will sit down and take up a question that touches everything I believe about medicine:
Who gets to decide how you heal?

The peptide market is a $1-3 billion underground economy. BPC-157, TB-500, KPV, MOTS-c — molecules that whisper to your cells: grow, repair, proliferate. Millions of people are injecting them right now. Most bought raw powder from anonymous Chinese manufacturers, shipped in vials labeled "for research use only," reconstituted into injections at the kitchen table.

I need to give you both halves of this story. Because the people selling you liberation aren't telling you the whole truth. And the people warning you away aren't either.
First — the hunger driving this is real, and I respect it.
The GLP-1 revolution showed millions of people that genuine transformation can come from a syringe. Once you've felt a legitimate, prescribed drug change your life, the leap to the next promised molecule feels small. I understand the pull completely. These are signaling molecules — fragments of the same language your body uses to talk to itself. They flip switches. They turn healing on.

The biology is elegant. The preclinical data on several of these compounds is genuinely fascinating. And the medical establishment's refusal to take patient interest seriously pushed this entire market underground — where it became far more dangerous than it ever needed to be.
Now the half that the promoters won't say out loud.

A molecule potent enough to accelerate tissue repair is, almost by definition, potent enough to accelerate things you don't want growing. The same signal that heals a tendon does not politely stop at the tendon. When you inject a compound whose entire job is to whisper "grow" to your cells, you had better be certain there's nothing in your body you don't want growing.
I order the scans. I see what hides. Most people injecting these have no idea what's quietly present in them.

BPC-157 — the crown jewel of peptide enthusiasm — has zero completed human randomized controlled trials for the recovery uses people actually want it for. The FDA application before the committee is for ulcerative colitis. The glamorous uses? Essentially no rigorous human evidence.

TB-500: zero completed human RCTs.
KPV, MOTS-c, DSIP, Semax, Epitalon: intriguing biology. Compelling stories. Clinical evidence ranging from thin to nearly empty.

Promising is not proven. "Mechanistically plausible" has harmed people before. The history of medicine is a graveyard of plausible.

And the supply chain should terrify you. Patients pool orders in group chats. Raw powder ships from China. Buyers reconstitute it at home — measuring doses with syringes that read in different units, using sterile water they're sourcing bootleg. We have created a country of amateur pharmacists performing sterile compounding next to the toaster.

Over 40% of tested samples from gray-market vendors fail basic purity or dose standards. Wrong content. Bacterial contamination. Endotoxins. Heavy metals. The only way to truly know what's in a vial is to send it to a lab — or take it yourself and find out.
Now what July 23rd actually is — and isn't.

It is a meeting. The PCAC will review seven peptides and vote on a recommendation. The vote is advisory. The FDA is not bound by it. Even a unanimous "yes" only begins a rulemaking process that typically takes six to twelve months before a single legal vial reaches a pharmacy shelf.

The part almost no one will tell you: this same committee reviewed these peptides in 2024 — and voted against them. Less than two years later, the political winds reversed. After the Health Secretary signaled support on a podcast, the companies that had nominated these peptides for the restricted list withdrew their nominations.

We are being asked to celebrate that a scientific panel is revisiting a decision it made on the evidence — not because the evidence changed, but because the politics did.

You don't have to be a cynic to find that uncomfortable. You only have to believe that evidence should outrank enthusiasm.
Here's what I'd actually tell you.

If you're a patient: wait for the regulated path. If these peptides clear the process honestly — through a full panel, on real evidence — a tested, properly dosed version prescribed by a physician who knows your history is worlds safer than powder from a group chat. The absence of a clinical trial is not a conspiracy against you. Sometimes it's just the truth not being in yet.

Do not self-inject research-grade chemicals. And if you're on a GLP-1 that's working and legally prescribed, that's a real win — don't let it become the on-ramp to riskier experiments.

If you're a clinician: the legal status hasn't changed yet. "The patient signed a waiver" does not move the medico-legal risk. When legitimate compounding arrives, the value isn't access to the molecule — it's honest informed consent, pharmaceutical-grade sourcing, third-party testing, and real follow-up.

One more thing the breathless coverage won't mention.
We didn't escape Big Pharma by going underground. We traded a regulated American company we could sue for an anonymous Chinese manufacturer we cannot even name. We traded known impurities for unknown impurities. We traded FDA oversight for group-chat consensus.

The consumerization of medicine reached its logical extreme — and the result isn't liberation. It's a different kind of dependency, with less transparency and zero legal recourse.

The relief people feel from these compounds is real. The hunger to heal is real. I will never shame anyone for wanting their body back.

But your body is not a portfolio to optimize before a regulatory catalyst. It is the one irreplaceable vessel you were given. Treat it as sacred — because it is.
The fuse, they keep telling us, is lit.
Maybe. But you are not a firework. You're allowed to take your time.

I wrote the full deep dive — the supply chain, the mechanism, the regulatory timeline, the evidence for each compound, and what I'd actually recommend — on my Substack.

[Afshine Emrani MD FACC @afshineemrani]

A Japanese immunologist just made me rethink one of the most basic prescriptions I give my patients.

Dr. Qing Li has spent over 20 years at Nippon Medical School in Tokyo proving something that sounds too simple to be real: the chemicals that trees release into the air walk straight into your bloodstream, lower your stress hormones, and supercharge your immune system in ways no pill has ever replicated.

Here's the study that stopped me. He took 12 healthy middle-aged men on a three-day forest trip. No intense hiking. No meditation program. Just slow walking — about two hours a day — breathing the air among the trees.

Blood and urine samples before, during, seven days after, and thirty days after.

The results: Natural Killer cell activity — your immune system's frontline defense against cancer cells and viral infections — jumped approximately 50%. The number of NK cells rose. Three critical anti-cancer proteins they release — perforin, granulysin, and granzymes — increased sharply.

The boost didn't vanish when they went home. It was still measurable at day seven. Still partially present at day thirty. Two hours a day among trees upgraded their immune defense for a full month.

He repeated the study with women. Nearly identical results. Then he ran the decisive control: same three-day trip, same walking duration, same hotels, same food — but in an urban environment.

Zero measurable change in NK cell activity. Zero.

It wasn't rest. It wasn't "getting away." It was the forest.

The mechanism is what fascinates me as a physician. Trees release aromatic compounds called phytoncides — particularly α-pinene and β-pinene — to defend themselves against insects, bacteria, and fungi. These compounds are most concentrated among pine, cedar, cypress, and oak, especially after rain or in warmth.

When you walk among trees, you inhale phytoncides into your lungs and absorb them through your skin. Once inside your body, they directly stimulate NK cell production and activity. Dr. Li estimates approximately 50% of the immune benefit comes from the chemistry of the forest air itself.

Then he proved something even more remarkable. He put subjects in an urban hotel room and vaporized hinoki cypress essential oil through a humidifier overnight. No forest. No nature walk. Just the phytoncides in the air while they slept.

NK cell activity increased significantly. Stress hormones dropped. The trees weren't even there — just their chemical signature — and the immune system responded.

The other half of the effect is your nervous system. Multiple Japanese field studies showed that forest walks significantly lower cortisol, heart rate, and blood pressure compared to matched urban walks. Parasympathetic activity — your "rest and recover" system — rises. Sympathetic activity — your "fight or flight" system — falls.

University of Michigan researcher MaryCarol Hunter quantified the minimum effective dose. Just 20 minutes in a natural setting — no phone, no conversation, no aerobic exercise — produced a 21.3% drop in cortisol beyond normal daily decline. The sweet spot was 20 to 30 minutes. Benefits continued after that, just more slowly.

As a cardiologist, this data is directly relevant to what I treat every day.

Chronic cortisol elevation drives hypertension, insulin resistance, visceral fat accumulation, systemic inflammation, and endothelial dysfunction — the exact metabolic storm that causes heart disease. Parasympathetic activation improves heart rate variability — one of the strongest predictors of cardiac resilience and long-term survival.

I just wrote about how your immune system hunts and kills cancer cells every single day without you ever knowing it. NK cells are the soldiers doing that work. And Dr. Li proved that two hours among trees supercharges those soldiers for a month.

I've prescribed statins, PCSK9 inhibitors, GLP-1 drugs, blood pressure medications, and every advanced therapy modern cardiology has to offer. I believe in all of them.

But I can't write a prescription for anything that simultaneously boosts cancer-killing immune cells by 50%, drops cortisol, lowers blood pressure, improves heart rate variability, activates the parasympathetic nervous system, and lasts a month — for free.

Except walking into a forest.

The average person now spends over 90% of their life indoors. Cortisol stays chronically elevated. NK cells stay sluggish. The parasympathetic system rarely gets to run. Your biology was shaped over millions of years under a canopy of trees. Modern life put it in a box of drywall and screens.

Your body hasn't forgotten. It's waiting.

What I now tell my patients:

Find any trees. A city park with decent canopy works. Go slow. Breathe deeply. Leave the phone behind. Minimum effective dose: 20 minutes. For the full immune effect: aim for two hours when possible. Once a month maintains the NK cell boost.

The Japanese government has funded forest medicine since 2004. They have certified forest therapy trails and physician-prescribed shinrin-yoku programs. They treat it as evidence-based preventive medicine.

We should too.

This weekend — before the world takes you back — walk into the trees. Feel what your body has been missing.

Nature isn't a luxury. It's medicine your ancestors took for free every single day. And the science now proves what they always knew.

[Afshine Emrani MD FACC @afshineemrani]

I'm a cardiologist. I take seven supplements every day and I've told you about each one on this platform.
Now I need to tell you about the ones that can hurt you — because some of the most popular supplements in the world have been proven in large clinical trials to cause the exact diseases they were marketed to prevent.

This isn't anti-supplement. This is pro-truth. And the data is devastating.

I'll start with the one published two weeks ago — because 40 million Americans are taking it right now.

Glucosamine. The joint supplement your parents probably have in their medicine cabinet. A study published June 9 in Nature Metabolism — not a wellness blog, Nature Metabolism — found that glucosamine users with mild cognitive impairment were 25% more likely to progress to full Alzheimer's disease. Among patients with established dementia, glucosamine users had a 25% higher mortality rate.
The mechanism: glucosamine enhances a metabolic process called hyperglycosylation that is already overactive in Alzheimer's brains — essentially feeding the exact pathology that's destroying neurons. University of Florida researchers confirmed this in both human health records and mouse models.
40 million Americans take this supplement annually. It never worked for joint pain in rigorous trials — it performed no better than placebo. And it may be accelerating cognitive decline in the people most vulnerable to it.

Beta-carotene. Sold for decades as antioxidant protection. Two massive trials in smokers — the Finnish ATBC trial and the American CARET trial — found up to 28% more lung cancer in people taking beta-carotene supplements. The American trial was halted early because the harm became too clear to continue ethically.
The supplement marketed to prevent cancer caused cancer. And it kept selling after the results were published.

Vitamin E. Marketed for prostate health and longevity. The SELECT trial — 35,000 men, one of the largest supplement trials in history — found 17% more prostate cancer in men taking vitamin E. The trial was designed to prove the supplement protected against prostate cancer. It proved the opposite.

High-dose fish oil. I recommend moderate omega-3 supplementation — I take it myself. But the high-dose formulations marketed for cardiac protection carry a documented, dose-dependent risk of atrial fibrillation — the most common serious heart rhythm disorder I treat. Meta-analyses of randomized trials confirm it: the higher the dose, the higher the risk of developing the very arrhythmia you're trying to prevent.

Niacin. Doctors stacked this on statins for decades to raise HDL — "good" cholesterol. Two large trials totaling nearly 30,000 patients found no reduction in heart attacks. The larger trial — HPS2-THRIVE — also found more diabetes and more serious infections in the niacin group. We raised the number on the lab report without improving the outcome that mattered. The number moved. The patients didn't benefit.

Concentrated green tea extract. Found in weight-loss pills and "fat burner" supplements. Multiple documented cases of severe liver injury and acute liver failure. The risk is highest with high-dose EGCG taken on an empty stomach. Health authorities in multiple countries have issued warnings. The supplement aisle version of green tea bears no resemblance to the cup of tea that's been safely consumed for centuries.

Turmeric capsules — particularly the "enhanced absorption" formulations. A growing series of hospital reports ties high-bioavailability curcumin supplements to liver injury, including at least one death and evidence of genetic susceptibility. The irony is bitter: these products are marketed as anti-inflammatory liver protectors.

Here's what connects all seven of these.

Every one was marketed as safe, natural, and beneficial. Every one was sold on the premise that "natural" means "harmless." And every one was proven — in large trials or rigorous case series — to cause the exact harm it was supposed to prevent.
Beta-carotene: marketed to prevent cancer. Caused cancer.
Vitamin E: marketed for prostate health. Caused prostate cancer.
Fish oil megadoses: marketed to protect the heart. Caused arrhythmias.
Niacin: marketed to prevent heart attacks. Didn't prevent a single one.
Glucosamine: marketed for joint health. May accelerate brain death.
Green tea extract: marketed for metabolic health. Destroyed livers.
Turmeric capsules: marketed to protect the liver. Damaged livers.

The supplement industry generates over $60 billion annually in the United States alone. It is not regulated like pharmaceuticals. No supplement needs to prove it works before it goes on sale. No supplement needs to prove it's safe at the doses being sold. The marketing runs years ahead of the science — and when the science catches up with bad news, the product stays on the shelf.

I'm not telling you to stop all supplements. I take creatine, glycine, magnesium, CoQ10, vitamin D3 with K2, psyllium husk, and omega-3 fish oil every day. I've written about each one because the evidence supports them at the doses I recommend.

But the difference between a helpful supplement and a harmful one is the quality of the evidence behind it — and the honesty of the person recommending it.

The supplements that work have rigorous data, appropriate dosing, and honest acknowledgment of limitations. The supplements that hurt have marketing departments, celebrity endorsements, and a $60 billion industry that profits whether the science supports them or not.

Your body is not a dumping ground for everything labeled "natural." Arsenic is natural. Cyanide is natural. The word means nothing without evidence.

Before you take any supplement — especially high-dose or "enhanced absorption" versions — ask one question: what does the largest clinical trial show?
If your supplement company can't answer that, your supplement company is selling you hope in a capsule. And hope without evidence is how people get hurt.

[Neil Stone @DrNeilStone]

Oh

[Dr. Vin Gupta @VinGuptaMD]

Watching a flu outbreak sweep through a major military training installation after @PeteHegseth pointlessly politicized the vaccine requirement is a reminder that viruses are unimpressed by amateur political theater.

https://t.co/Aj4qfsUbUZ

[Jerome Adams @JeromeAdamsMD]

I’m actually a chronic disease epidemiologist by training. Never did I imagine I’d spend this much of 2026 debating vaccines. Yet our federal health leaders are enthusiastically ushering back vaccine-preventable diseases like measles and pertussis.

Many of us want to fully embrace MAHA’s prevention and wellness agenda - but that’s impossible when the basic foundation of our health and life expectancy is being dismantled brick by brick.

You can’t die of cancer or heart disease at age 60… If you’ve already died from pertussis or polio or measles or flu when you were six. 🤷🏽‍♂️

[Jerome Adams @JeromeAdamsMD]

Most U.S. adults have at least one risk factor for cardiovascular disease, America's leading cause of death. Given the clear evidence linking COVID vaccination to better CV outcomes, discouraging or limiting access to vaccination seems difficult to reconcile with a goal of making America healthier.🤔

[Hunter Biden @HunterBiden]

To everyone so eager to cancel someone for a tattoo they got at age 22, a drunk text, a selfie they took in the middle of a mental health crisis:

Show us your laptop.
Show us your iCloud.
Open your entire digital life to your worst enemy. No context. No filter. No explanation.

You won’t.

You won’t because you know what I know. Any one of us, frozen at our worst moment, photographed in our lowest hour, looks like a monster. Looks like a stranger. Looks like someone who deserves to be cast out.

That is not who we are.

My mom and baby sister were killed in a car accident when I was just a kid. Cancer took my brother Beau, my best friend and my rock. I battled alcoholism. I battled addiction. I chose the coward’s way out more times than I can count.

For years I believed the defining chapters of my life were written by tragedy, loss, and shame.

I no longer believe that.

Pain can shape us. Loss can humble us. Failures can leave scars that never fully fade. But none of them have the authority to define us.

And it sure as hell ain’t the critic that counts.

That authority belongs to us alone-the person in the arena.

Every setback presents a choice. Play the victim, or cut the bullshit and take ownership for who we become next.

Life does not determine our character. It reveals it.

Again and again we are asked the same question. When shit happens, what next?

We are not defined by what happened to us. We are not defined by the worst photo, the worst text, the worst tattoo, the worst night. We are defined by the person we choose to become. And by the courage to choose that person, every single day.

So before you reach for the gavel - show us your laptop.

You won’t.

The whole world saw mine. And I am still here. Still becoming. Still choosing. Still standing.

That is the only definition that matters.

[Marco Foster @MarcoFoster_]

“It’s time to wake the fuck up”

Neil deGrasse Tyson: “Half of my fellow graduate students when I was getting my PhD were foreign nationals. Do you realize one third of all the Nobel Prizes in sciences won by Americans were won by immigrants to America? If you’re gonna trail the world in practically everything, including your economy, it’s time to wake the fuck up”

[Neil Stone @DrNeilStone]

After 8 billion doses (yes 8 BILLION, not a typo) Covid vaccines are at this point one of the most tested medical interventions in history and one of the safest ever

[Jerome Adams @JeromeAdamsMD]

I’m always happy to have respectful conversations about vaccines. But it is difficult when people don’t know or won’t acknowledge the facts. The countries with the highest life expectancies – far higher than the United States – have more recommended vaccines and higher uptake.👇🏽

[Hunter Biden @HunterBiden]

Things most Americans agree on:

Groceries cost too much.

Tariffs suck and make no sense.

Congress and Presidents shouldn’t trade stocks.

The debt is a mess.

The border should be secure, but legal immigration is good.

Endless wars are stupid, especially ones that nobody wants and have never been explained.

Americans are exhausted.

AI is like my new best friend that also might be trying to take my job, my ability to think for myself, and my humanity in the process. Yo like I love you, but WTF, but I still love you.

Diversity is actually awesome! The opposite is boring AF.

Canadians are super fucking cool.

Mexicans are chill.

Putin isn’t a good guy looking out for America’s best interest. Rocky IV and Miracle are great movies.

Good neighbors are a blessing.

Freedom of religion and coexistence without having to blow each other up is probably a good idea.

We all question, are we alone in the universe?

We all fuck up along the way.

Epstein didn’t hang himself.

The Trumps and Epstein were best friends for decades. It’s like Bert trying to tell us Ernie was just an acquaintance in the same social scene on Sesame Street back in the day.

The Cowboys suck. Go Birds!

Things we’re told to fight about:

Me.
Laptop.
Vaccines.
Transgenders in sports.
Pronouns.

That’s the joke.

[Hunter Biden @HunterBiden]

Wait…Did he just say checkered past ? I’m 28 felonies, 6 bankruptcies, and an Epstein bromance short of his checkered past.