Dave deBronkart

@ePatientDave.bsky.social
Participatory Med. Past: OpenNotes adv bd, HL7 #PatientsOnFHIR co-chair, Mayo visiting prof. #HeForShe, #AntiRacist

[Dave deBronkart @ePatientDave]

@rohanpaul_ai LOLOLOL I'm an avid LLM user but anyone who falls for THIS line deserves what they'll get. "Super-billionaire tells ordinary folks there's nothin' to worry about" as companies are already laying off thousands 🤪

[Dave deBronkart @ePatientDave]

@rohanpaul_ai Nice retort to this May 9 article! Coincidence? (No I don't have a gift link but you can check the buzz about it)
https://t.co/AaaZfH0eNj

[Kevin Pho, M.D. @kevinmd]

A practicing psychiatrist Googled her own name and was the 452nd result. The first seven clinics that came up were not hers. The clinic ranked first had no clinical staff she had ever met.

This is vertical integration in U.S. health care, observed at the consumer-facing search bar.

Three structural notes.

One. Vertical integration in U.S. health care now stacks payor, pharmacy benefit manager, bulk-purchase group, drug distributor, mail-order pharmacy, retail pharmacy, and clinic ownership inside single corporate structures. One parent company owns every step of the chain that connects a patient to a medication. When a market is vertically integrated end to end, the price-setting power and the patient-routing power both consolidate at the top of the stack.

Two. The consumer-facing consequence is search-result routing. Owned-and-operated clinics rank first not because their clinical reputation is stronger but because the search architecture is shaped by the parent company's commercial relationships, paid placements, and directory contracts. The patient typing a doctor's name into a search engine in 2026 is not finding the best clinical match. The patient is finding the result the largest parent company wants found.

Three. The independent practicing physician, the one with the two-location practice, the established patient panel, the clinical track record built over ten years, is now ranked 452. Not because the clinical care is worse. Because the ownership structure is smaller.

The historical antitrust frame applies cleanly. A "trust" was a group holding assets across an industry, and that asset-holding became illegal when it began to harm consumers on price and access. The vertically integrated structures now operating in U.S. health care satisfy that test. The unresolved question is whether existing authority will be applied to them.

The car-industry version of this structure would be one company that owns the factory, the dealership, the bank that finances the loan, the auto body shop, and the parts supplier. That structure was made illegal in cars a century ago. The same structure is currently legal in U.S. health care because corporate ownership is layered behind shell companies, and tracing who owns which clinic, which pharmacy benefit manager, and which clinic-chain back to a single parent is genuinely hard.

If you are searching for a physician right now, the doctor you find first is the doctor the corporate parent wants you to find first. The doctor with the best clinical match for your condition may be 451 results down the page.

Stephanie Waggel, MD, psychiatrist in Northern Virginia, explains how the search result became an ownership question on The Podcast by KevinMD. Link in the replies.

What is the single antitrust action that would most directly disrupt vertical integration in U.S. health care today?

#VerticalIntegration #ThePodcastbyKevinMD

[Ole Lehmann @itsolelehmann]

the pope and anthropic's co-founder just stood together at the vatican to release "magnifica humanitas," the first ever catholic teaching on AI

yes, you read that right. the full ceremony was 2 hours.

here's the most interesting things for you to know:

1. this is the biggest religious response to AI in history. popes only put out a handful of these huge official letters in their entire time as pope. the fact that one of them is about AI tells you how seriously the church is taking what's coming.

2. small detail with massive meaning: this pope picked the name "leo XIV" on purpose. the last pope named leo was leo XIII back in 1891, and his most famous act was writing the church's response to the industrial revolution. picking the same name is a deliberate signal. this pope sees AI as the new industrial revolution.

3. the catholic church does this every time a major technology reshapes humanity. they wrote "rerum novarum" in 1891 to respond to the industrial revolution. when nuclear weapons threatened the world in the 1960s, they wrote "pacem in terris." climate change and runaway tech got "laudato si" in 2015. now AI gets "magnifica humanitas." they don't issue these often.

4. the pope's main line: "AI needs to be disarmed." he literally compared AI to nuclear weapons. he said the church spent decades pushing for nuclear disarmament because the technology was too dangerous to leave in the hands of a few. he says AI is now in that same category.

5. anthropic co-founder christopher olah told the pope, on stage at the vatican, that anthropic's own research team keeps finding things inside their AI models that "mirror joy, satisfaction, fear, grief, and unease."

6. olah's reframe of what AI actually is: these things are grown. they're trained on a structure roughly modeled after the human brain and fed everything humans have ever written. in his own words: "they are made from us, from our words." he said even the people building them don't fully understand what's happening inside.

7. olah publicly admitted that every AI lab, including his own, faces pressure that can conflict with doing the right thing. commercial pressure to keep shipping, competitive pressure from other labs, plus the older pressures of pride and ambition. his solution: we desperately need outside critics with no skin in the game who will tell the labs when they're failing.

8. olah says there are 3 giant questions the AI labs cannot answer alone and the world needs religion and philosophy to step in on:

> how do we make sure poor countries actually benefit from AI?
> what does human flourishing even look like in this new world?
> and what are these things we're actually building?

9. one of the sharpest lines in the whole encyclical: "the promise of automatic general prosperity often proves illusory." translation: the idea that AI will just make everyone rich on its own is a fantasy. someone has to actually design the system so the benefits get shared.

10. the pope also pulled out a 100-year-old quote: "contemporary man has not been trained to use power well." said by a theologian back in the 1920s. the whole encyclical is basically a long argument that we need to learn how to use this kind of power before it uses us.

11. the pope kept stressing that he doesn't have the technical answers. but he says the church has thousands of years of wisdom on what it means to be human, and that wisdom is exactly what's missing from how we're building AI right now. his closing line: this technology should serve "human flourishing and human dignity, not control consciences."

[Dave deBronkart @ePatientDave]

@MattZirwas @EricTopol @NEJM I think I understand, because I've experienced a similar sense that people are bending meanings. FWIW, I found that no matter how provably right I was, in some cases very few people remained we still see things my way.

Anyway, enough - I'm not one to chew on such things.

[Dave deBronkart @ePatientDave]

@MattZirwas @EricTopol @NEJM I don't see why you'd say that. I love AI, but it's WELL documented (not just one company) to blithely parrot planted falsehoods. What's your skepticism? I think it's super valid.

[Richard Lehman @RichardLehman1]

This is absolutely the vital test for LLMs

[Dave deBronkart @ePatientDave]

Browsing history, I just ran across this observation. VERY true, and it's why if you want change, a big consulting firm is not the one to ask. AmIRight?

[Alexandra Drane @adrane]

Love @ePatientDave 'When things are crap, activists get angry, analysts write more reports.' Get angry PRODUCTIVELY, get active #health2con

[Dave deBronkart @ePatientDave]

@ImmunoFever @threadreaderapp And is there any way to convince us all whether that's what I have going on? I'm keenly aware that endothelial cells are also what make the glomeruli work (I have only one kidney, and primary aldosteronism) and that they make up the blood brain barrier, so leaking is NOT good

[Dave deBronkart @ePatientDave]

@ImmunoFever @threadreaderapp That's what I thought. So now my big question (which none of my docs can help with, yet) is: what can humble ol' me do about this??

[Dave deBronkart @ePatientDave]

@Resolut46967 I only noticed this now. I followed.

[Dave deBronkart @ePatientDave]

@SAS For my first trip with you today, I've had multiple major problems with online tech. Still cannot get app to register me - keeps saying "Sorry, we couldn't fetch the terms & conditions." So, no mobile BP. Website offers "download BP" but sends a non-working PDF. Help!!

[Dave deBronkart @ePatientDave]

@ImmunoFever @threadreaderapp Yes, I'm a subscriber and rolled it up myself!

So tell me - I've long suspected I have post-COVID endothelial dysfunction, with many ramifications, from VO2max to brain fog. Am I correct in thinking that's essentially what your magic lining cells are? https://t.co/rPNlkiH5gG

[Ron Filipkowski @RonFilipkowski]

Cook Political moved Trump from Lean Antichrist to Solid Antichrist.

[Dave deBronkart @ePatientDave]

@Edsterko @krassenstein I'm thinking out loud so don't yell at me.

Max exempt tip amount is $25,000.
If she gains $3k in takehome that's the 12% marginal bracket.

$25k of tips would be $125k of checks at 20%, $10k/month, $2400/day.

$4k would require being in 16% bracket (there is none)

[Dave deBronkart @ePatientDave]

@ImmunoFever @threadreaderapp unroll

[Berci Meskó, MD, PhD @Berci]

Generative AI (in the form or large language models) will act as the ultimate interface between healthcare professionals and a range of AI-based and other digital tools. Here is another proof of my prediction.

Cleveland Clinic is the first health system to pilot "Chart Chat for Nursing", the first EHR-integrated AI conversational tool for inpatient nurses.

"𝑇ℎ𝑒 𝑡𝑜𝑜𝑙 𝑝𝑢𝑙𝑙𝑠 𝑓𝑟𝑜𝑚 𝑡ℎ𝑒 𝐸𝐻𝑅 𝑡𝑜 𝑎𝑙𝑙𝑜𝑤 𝑛𝑢𝑟𝑠𝑒𝑠 𝑡𝑜 𝑎𝑠𝑘 𝑞𝑢𝑒𝑠𝑡𝑖𝑜𝑛𝑠 𝑜𝑛 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠’ 𝑐ℎ𝑎𝑟𝑡𝑠, 𝑤𝑖𝑡ℎ 𝑒𝑎𝑐ℎ 𝑟𝑒𝑠𝑝𝑜𝑛𝑠𝑒 𝑝𝑎𝑖𝑟𝑒𝑑 𝑤𝑖𝑡ℎ 𝑓𝑢𝑙𝑙 𝑐𝑖𝑡𝑎𝑡𝑖𝑜𝑛𝑠, 𝑡ℎ𝑒 𝑐𝑜𝑚𝑝𝑎𝑛𝑦 𝑠𝑎𝑖𝑑 𝑖𝑛 𝑎 𝑝𝑟𝑒𝑠𝑠 𝑟𝑒𝑙𝑒𝑎𝑠𝑒.

𝑁𝑢𝑟𝑠𝑒𝑠 𝑐𝑎𝑛 𝑎𝑠𝑘 𝑝𝑙𝑎𝑖𝑛-𝑙𝑎𝑛𝑔𝑢𝑎𝑔𝑒 𝑞𝑢𝑒𝑠𝑡𝑖𝑜𝑛𝑠, 𝑝𝑢𝑙𝑙𝑖𝑛𝑔 𝑓𝑟𝑜𝑚 𝑝ℎ𝑦𝑠𝑖𝑐𝑖𝑎𝑛 𝑝𝑟𝑜𝑔𝑟𝑒𝑠𝑠 𝑛𝑜𝑡𝑒𝑠, ℎ𝑜𝑠𝑝𝑖𝑡𝑎𝑙 𝑝𝑜𝑙𝑖𝑐𝑦, 𝑑𝑜𝑐𝑢𝑚𝑒𝑛𝑡𝑎𝑡𝑖𝑜𝑛, 𝑜𝑟𝑑𝑒𝑟𝑠 𝑎𝑛𝑑 𝑟𝑒𝑐𝑒𝑛𝑡 𝑙𝑎𝑏𝑠 𝑖𝑛 𝑠𝑒𝑐𝑜𝑛𝑑𝑠."

It seems healthcare professionals are about to "chat" with the EHR systems across specialties and disciplines, just like what patients do at home.

Source: https://t.co/JFpK9lobp3

[Dave deBronkart @ePatientDave]

@heygurisingh PLEASE! No sloppy wording!! Study did NOT prove that; did not test thoughtful use by thinking people. PLEASE!

It showed that LAZILY RELYING on a tool makes you lose your edge. That's very different. Correct? Fix it please?

We energetic thoughtful users resent YOUR sloppy work.

[Dave deBronkart @ePatientDave]

@StateDept Golly, perhaps in the way that DJT doesn't believe in staying away from war crimes? Like genocidally ending a whole civilization?

[Dave deBronkart @ePatientDave]

@atrupar I believe this is called genocide, a war crime. I don't understand why you're not calling it that. Or maybe I do - but I thought Rupert was gettin' religion about TACO Prez, like most of humanity has

[Dave deBronkart @ePatientDave]

@FoxNews I believe this is called genocide, a war crime. I don't understand why you're not calling it that. Or maybe I do - but I thought Rupert was gettin' religion about TACO Prez, like most of humanity has