monkburger

1930 all over again.

There’s an important caveat to keep in mind when it comes to food databases, especially those relying on branded or restaurant items:

U.S. law does not require food manufacturers to disclose everything that goes into their products. Under the Code of Federal Regulations (21 CFR § 101.100), there are exemptions to ingredient labeling... An example: flavorings, spices, and incidental additives (like processing aids or anti-caking agents) are not always listed explicitly. Also: proprietary blends and "natural flavors" can legally conceal dozens of chemicals (some synthetic), which consumers have no way of identifying.

Micronutrient data is often estimated or missing from labels and restaurant menus, which limits the accuracy of even the best-intentioned databases. Studies show that the nutritional information provided by restaurants and brands is frequently incomplete or inaccurate, especially when it comes to sodium, sugar, and actual serving sizes. (Urban et al. "The Energy Content of Restaurant Foods Without Stated Calorie Information" ; Labuza et al., 2008 and others)

IMO Food databases are only as accurate as the source data allows. Until food labeling laws mandate full disclosure and third-party verification, apps like this can support health awareness. Still, they shouldn't be treated as precise medical or dietary guidance—particularly for people with allergies, sensitivities, or chronic health conditions that require strict tracking.

What? The AMA is not what it was. What are you, a PGY3?

It’s easy to paint with broad strokes, but sweeping generalizations rarely capture the full picture. Not all of us “gatekeep” or overprescribe, we follow evidence-based guidelines and clinical judgment. When a patient presents with nonspecific fatigue and unintended weight loss, for instance, ordering a CBC, CMP, TSH, and A1C isn’t "unnecessary" it’s standard of care to rule out anemia, metabolic derangements, thyroid dysfunction, or early diabetes. That’s not about revenue.. it’s about ruling out high-risk pathology before it escalates.

As for the AMA, it’s far from perfect, but it doesn’t define the ethos of every practicing clinician. Many of us—regardless of where we trained—are here because we care deeply about patient outcomes, not profit. I don’t dismiss international medical graduates; I’ve worked alongside phenomenal ones. What matters to me isn’t where someone studied, but how they think, how they treat, and whether they practice medicine with integrity.

Healthcare needs reform, no doubt—but assuming every U.S. physician is complicit in systemic issues is reductive. Most of us are doing the best we can within a deeply flawed system.

Profits over patients.

Pharmacies have to have crazy high prices though because PBMs reimburse at such shit rates, based on some percentage of the price given to them. Because if they buy the bottle at $30 and list the price at $60, the PBM contract will only reimburse at the adjusted wholesale price (another made up number), eg: 17% plus a $1.99 dispensing fee. This disgusting math results in getting a loss on the drug.

Even all this leaves out some of the most absurd abuses of PBMs. They set minimum drug copays, have the pharmacy collect a $15 copay for a $5 drug, and have the pharmacy pay the PMB the $10 difference. They make it a breach of contract for the pharmacy to inform the patient this is happening or to charge the $5 and bypass the insurance. The total lack of anything even approaching ethnics is absurd...

The blinding? Functionally useless UNLESS the researchers genuinely believe subjects couldn't tell whether they were in a psychedelic fugue state or on a placebo. The ketanserin condition? A self-congratulatory exercise in proving that a known 5-HT2A antagonist blocks 5-HT2A-mediated effects. Stunning. rolls eyes

Then there’s the pharmacokinetics section, breathlessly confirming that LSD is absorbed, peaks, and is metabolized..just like every other small-molecule drug with hepatic clearance. The BDNF findings? A biochemical footnote with no functional correlation (tossed in for faux mechanistic depth)

The most egregious limitation is the absurdly small sample size (n=16), which utterly cripples its statistical power. The authors throw around p-values without any serious correction for multiple comparisons.. Their confidence intervals (CIs) are embarrassingly wide in several places, making many of their so called significant findings borderline meaningless. For example, their pharmacokinetic (PK) values show ranges so broad (eg: Tmax varying from 0.25–5.0h, CL/F spanning 1.6–22 L/h) that any attempt at a reliable dose-response relationship collapses under basic scrutiny; their p-values dance precariously around the threshold of significance. (There are many more)

If this is what’s guiding psychedelic research, we’re in serious trouble.

I don't care to dissuade you from anything - you are flat-out wrong on things.

In my opinion, hEDS is a real condition, but sick-tok is causing patients to demand from physicians a dx - regardless if they meet the clinical criteria for it or not.

Stick to your lane.