Hi, hello—did you miss me? I’ve missed you. I didn’t write a March letter because I was averaging 5hr of sleep a night (I’m working on two pre-launch drugs). This month, I

• celebrated (belated) Women’s History Month at Delmonico’s with —I spritzed TRM’s D.S. & Durga GOLFJAZZ for the occasion

• went to the Lebanese church for Palm Sunday with NRZ and the hip UES Christian church for Easter with KIU

• got new headshots by my childhood friend (thank you, Nigel!)

• celebrated birthdays at Jean’s, Zombie Hut, and Only the Wild Ones

• viewed the Schjerfbeck, Bassman, and Raphael exhibits at The Met

• drank a Korean Michelada at Orion Bar and a Verde Michelada at Yellow Rose

• got a random photo airdrop of my girls and me huddling in a giggly hug at Dimes (we hadn’t seen each other for two weeks)

• watched the Charli XCX indie film at Angelika—loved it!

• danced at Nightmoves + ate hot dogs at Rocco’s in celebration of SIB’s imminent baby

• tried my first Publix carrot cake slice in Hilton Head

• ate cardamom buns + chatted about the State of The Union with at La Cabra (catch me in a future letter!)

• averaged 6 hours of sleep a night (progress!!!!)

I’ll be in LA this week. If you’re curious about what I did in March, DM me.

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Now that we’ve covered that, here is your quick hit of what’s going on in healthcare + pharma:

GLP-1s users may be at slightly higher risk for gout, osteoporosis, and bone/tendon injuries, based on an analysis of 145,000 patients living with Type II diabetes and obesity. When you’re curbing your appetite with GLP-1s or other peptides, every meal counts. Of course, this study doesn’t prove causation, and I don’t think this is a reason to skip GLP-1s (if you’re a candidate), but it is a reminder that nutrient density matters. Calcium, Omega-3s, Vitamin D…go ahead and throw in some weight-lifting for good measure.

Speaking of GLP1s, genes may play a role in how much weight people using these drugs will lose. Maybe this will bring us closer to accepting that genes play a role in weight gain?

How we write about science can be political. In honor of (Belated) Women’s History Month and friends with babies, consider reading this 1991 piece titled “The Egg and the Sperm: How Science a Romance Based on Stereotypical Male-Female Roles.” We’re taught that sperm penetrates the egg (aggressor), and the egg is a passive recipient. This isn’t quite right. Language based on gendered stereotypes leaves little room for the reality that the egg is an active player. It is choosy about which sperm gets in. After enveloping the sperm, the egg’s coating hardens and is impermeable to whatever else is swimming around there. Sometimes, our eggs think our partners have bad vibes and don’t respect our choices. The body knows!!!

Our brains know, too. According to McGill researchers, one partner’s cognitive health can affect the other’s—if you’re together long enough. An analysis of Health and Retirement Study data from 9,000 hetero couples 50+ years old in the US found no major differences in short-term partnerships. In longer relationships, however, if your partner’s memory and mental acuity improve, yours may improve too. But your cognitive function may decline if theirs is. At the individual level, your life partner could be your ultimate longevity hack…choose your partner wisely! From a public health lens, the gap is that we focus most dementia and cognitive decline care on treating the individual. This approach leaves potential spillover benefits on the table, as couple-based treatments could have compounding benefits for both people.

Health systems are a major casualty of war economies. Globally, every 1% increase in military spending diverts 0.62% from public health spending. For lower-income nations, this is nearly a 1-to-1 loss in healthcare funding when military spending rises, severely limiting their ability to handle disease outbreaks or provide basic healthcare.

Trump’s tariffs/Most Favored Nations deals did not lower overall US prescription drug prices. A Senate Health, Education, Labor and Pensions Committee report found that despite Trump’s promise that his MFN order would bring our drug list prices closer to peer OECD countries, the average US list price is rising. They also flagged that drug companies that entered MFN deals with Trump had a combined 2025 revenue of $177 billion in profits (vs. $107 billion in 2024). My overall critique of this report is:

• no one pays the list price—especially not the government

• most companies raise drug list prices every year to account for things like inflation

• new oncology drug/gene therapy launch prices are set against country-specific value frameworks

• it’s unlikely that MFN would have restructured a company’s entire portfolio/approach to market access (I’ve said this before).

WHOOP is partnering with the Centers for Medicare and Medicaid (CMS) on the Medicare ACCESS program. ICYMI: the Advancing Chronic Care with Effective Scalable Solutions model (AKA ACCESS) is a new Medicare initiative enabling technology as a tool for managing chronic diseases. Will Ahmed’s LinkedIn announcement was met by much LLM-generated enthusiasm. Other companies like Noom, Headspace, and Weight Watchers were also selected as ACCESS model partners. The direct-to-consumer-ization of healthcare is here to stay.

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xxsem

Newsletter highlights include: new Lykke Li, Balanchine-era NYCB, an illuminating piece on what the heck is going on in SF to discuss over a tiny tini this weekend, and my qualms with using LLMs as your doctor. I also share a scene report from the “conservative Cosmo” NYFW event. This is what I wore:

If you’re here for the drug-dealing takes: Novo is on the FDA’s naughty list, the US government is limiting access to care in Minnesota, and our new pricing policies have EU governments scrambling.

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WHAT I’M INTO

Press Play: “Lucky Again” by Lykke Li

This song feels like a nostalgic track for a spring stroll, even though it’s new and there’s a blizzard outside. Perhaps it’s her mixing disco with Vivaldi. Or the relatability of wanting to strike luck over and over and over again. Welcome back, Lykke. We’ve missed you.

Build Literacy: Winter Season by Toni Bentley

I sort my “Books To Read” list by seasons. Some titles are snowy and blustery; others demand longer days and sandy bare feet. Because Winter Season is an intimate look at Toni Bentley’s inner life as she prepares for NYCB’s 1980 Winter Season, I’d categorized it under Winter (duh). My only regret is waiting until January to read it, because it would have been fun to start it around the time I saw George Balanchine’s The Nutcracker® last year. Through her journal-style writing, she lets us peer into her world in a Degas-like manner. It’s fascinating that George Balanchine was a God to early NYCB dancers. I’d wager that devotion hasn’t cooled in NYCB generations since. What I loved most, though, was how she frames ballet dancers as performers twice over: once for the house, and once for the audience living inside their own heads. Bentley balances the beauty and joy of her highs with a dash of the unglamorous ballet lows—eating disorders, identity crises, and low pay. Her musings range from what money is good for (to buy a fur coat and ballet clothes), feeling exposed (what you eat shows, how you slept shows, your love and care show…and how we love it, that exposure), and the perfect GRWM cocktail (coke and coffee, cigarettes, and rock and roll on the radio at three hundred decibels).

Let me curate ur news: “Child’s Play” by (Harper’s Magazine)

“Child’s Play” is to the agentic Gen Z SF world as Winter Season is to the secret lives of NYCB ballerinas. This was a curious and endearing look at the boys who are trying to make things happen before AI permanently blocks social mobility, leaving some of us in the “permanent underclass.” I’m most impressed by the Sperm Race guy and have tracked his work since we interviewed The Sperm King last year. I felt compassion for Roy and want him to hang out with his friends forevermore. But and his antics were the most charming to me, particularly his perfect read of Silicon Valley Broligarchs: “They have too much money and nothing going on. They have no swag, no smoke, no motion, no hoes. That’s all you need to know.”

PULSE CHECK!

“Pulse Check” is your quick hit of what’s going on in healthcare + pharma, complementing the longer, more in-depth “On Health” letters.

• Trump is pausing Medicaid payments to Minnesota under the premise of improper payment and fraud, but realheads know that’s smoke and mirrors.

  • KFF showed most improper payments come from documentation and human error (not fraud!)

  • But let’s play ball! If we accepted the premise that payment errors were All Fraud All The Time, Minnesota's error rate of 1.5% falls below the national average of 5%. So why are we targeting Minnesota when other states like South Carolina (8.7%) and Alaska (9.5%) have higher error numbers? I’m not saying we should halt payment for those states either, but Vance warned California might be next…

    

• Get ready for more MFN deals.

  • 2025 closed many Big Pharma MFN deals, but 2026 will be the year for small and mid-sized pharma to get on Trump’s good side.

    • Big Pharma can ride the MFN wave—they generally have more assets, a deeper pipeline, and fully control their launch strategies.

    • Smaller companies don’t have that luxury. They also often partner with international companies for licensing deals, and those partners DGAF about US pricing. I don’t know which smaller pharma companies will take the voluntary deal bait, but I’m sure it will happen.

  • Last year, I questioned the possibility that MFN would reduce US drug prices—citing confidential NET prices and potential Europe drug launch delays. [Please note this previously had a typo and I said “list” prices when I meant “net!”] We’re starting to see this play out:

    • 50+ conservative US organizations petitioned against codifying Trump’s MFN policy

    • A hot new bombshell has entered the villa: 10 US biotechs launched the Midsized Biotech Alliance of America, a coalition to ensure MFN doesn’t decimate US biotech innovation

    • The European Federation of Pharmaceutical Industries and Associations (EFPIA) published a call to action for Europe to up its game and incentivize biopharma innovation or risk trailing behind US and China ~4ever~.

    • We also have a new Danish government task force keeping an eye on US pricing policy and monitoring MFN threats to the Danish pharma sector

    • My former CEO doesn’t think MFN/tariffs will affect Novartis business in the near-term, but flagged they may delay future launches ex US.

    • Amgen withdrew Repatha (a PCSK9 inhibitor) from the Danish market likely due to MFN concerns. Repatha is one of Amgen’s primary growth assets, they’re likely trying to protect this revenue. Pharma will protect their US revenue.

• Did you think this year’s Super Bowl ads on crypto, AI, gambling, and weight-loss were scaring the hoes? The FDA probably did!

  • The FDA said Novo’s “Live Lighter” ad (premiered during this year’s Golden Globes) was misleading in an untitled letter dated February 5th. They flagged statements like “weight loss has never looked like this” and allusions to mental/emotional benefits beyond weight-loss imply the pill form is better than other GLP-1 formulations and can solve other life challenges, when they don’t have the data to back this up. My guess is Novo’s FDA submission package also doesn’t include evidence that the Wegovy pill can help you parallel park and rescue kittens.

    

• Neither ChatGPT nor Claude is HIPAA compliant, yet 40 million people a day ask ChatGPT healthcare questions and volunteer their own health data. A 2024 KFF survey found one in six people use LLMs for health. Why? Our healthcare system is complex, expenive, and inaccessible to some, particularly to those in rural hospital deserts (30+ minutes from the nearest hospital). Earlier this year, OpenAI published a healthcare report on how Americans use ChatGPT and introduced ChatGPT Health—making it clear they’re using your healthcare questions to train their models. Anthropic followed one week later, unveiling Claude for Healthcare and yassifying Claude for Life Sciences. Everybody wants this (a piece of the healthcare pie).

  

  • Elon Musk keeps asking Twitter users to upload their precious medical data to Grok, but Grok is like, ”Please…do not do that.”

  • AI and digital tools can help address some healthcare access gaps, with the right guardrails and privacy protections for patients. But the current state of AI healthcare apps is ripe for data breaches IMO, since they’re not subject to the same rigorous regulatory/legal oversight hospitals and clinics must follow to protect our personal data.

  • I’m all for reducing information asymmetry in healthcare. But don’t use a blackbox LLM as your doctor. Please don’t upload your medical data to basic consumer-facing LLMs. Or do! But recognize the risks. The internet is forever, and so is that LLM input. You’re your own person, and I value your agency. Maybe use it as a TA? Ask probing questions! But even former intelligence officers are telling us to avoid it.

  • I am hopeful about Claude for Life Sciences, as drug discovery is one of the AI use cases that excites me most. Sanofi and Novo Nordisk are already using Claude for Life Sciences to support admin tasks. Anthropic has now linked to Owkin (shoutout Thomas!), ClinicalTrials.gov, and an arsenal of tools to support R&D. This may help smaller biotechs, who may lack the right strategic capabilities in regulatory, commercial, and market access, optimize clinical trial design. I’m cautiously optimistic that this could help lower the barrier to entry and the eye-watering cost of drug R&D.

    • Claude’s premium tier subscription (i.e., not the free version) allows US Pro and Max subscribers to sync medical records from ecosystems like Function Health, Apple, and Android without archiving this sensitive information in Claude’s memory banks or funneling it into model training pipelines. We’ll see how that holds!

    • But I do hope they’re training these models to ask the right follow-up questions rather than relying on genpop to know what’s relevant/key/differentiating for diagnosis—a key skill doctors learn in medical school/training.

  • What’s the policy play? There’s always one. OpenAI used its “AI as a Healthcare Ally” report to lobby for:

    • Breaking down silos and strengthening the healthcare system by linking patient genomics, medical imaging, and other Real World Evidence

    • Enabling infrastructure for AI-assisted drug discovery

    • Building a clearer AI medical device FDA regulatory pathway to expedite AI device access across disease areas (current FDA medical device approval requires assessment by disease area)

    • Updating FDA guidance to allow physicians to use AI medical devices in their practice

WHAT I’M UP TO

NYFW has felt progressively uncool to me for a few years, but I went to the “Conservative Cosmo” women’s magazine event anyway.

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Because you all were so nice, and the 2025 audit reception was overwhelmingly positive, I’m publishing twice in a week to bring you predictions for 2026. It pays to be a curious cat—satisfaction brought it back.

In case you missed the 2025 audit, you may read it here:

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Anyway, without further ado.

2026 IN/OUT

going grey; balayage / bottle blonde (6-week touch-ups in this economy??)

table tennis / pickleball

corporate america / self-employment

midtown (murray hill, specifically) / bushwick

cashmere and/or wool under-layers / uniqlo heattech

slopaganda / knowing how to read

active hobbies (e.g., ballet, horseback riding)/ working out; gyms

health misinformation / herd immunity

warm foods / cold plunge

GLP-1 pills, next-gen peptides (e.g., triple G retatrutide) / GLP-1 subq formulations

monitoring the situation / reacting

traditional chinese medicine (TCM) / chinese peptides

fiber + psychobiotics / protein-maxxing

mini skirts / midi skirts

oil, fossil fuels / electric cars

libs having kids / MAGA

colorectal cancer / charcuterie

fat grafting, transfer / breast implants

being uninsured / rural hospitals

What do you think about these predictions—do you agree or disagree? What do you think will happen in 2026? When I asked friends and lovers for their 2026 thoughts, TRM petitioned for golf to be out. Someone is betting on lower country club initiation fees if golf becomes passé.

xxsem

Stay tuned: My next letter will include a 2026 IN/OUT list—even if these lists are very much now on cool people’s “out” camp. If you’re nice, I’ll publish it this week.

I’ve broken these out into what I predicted and 1) nailed, 2) missed, and 3) what is still percolating. You can pick and choose what you care to audit. I welcome your thoughts on my assessment—it is biased, after all.

Called it!

IN: Health savings accounts (HSA)
OUT: Pre-existing condition protections

HSAs were the MVP talking point for anyone trying to kill the Affordable Care Act and curb healthcare costs. I’ll spend more time on this in a future letter, but here’s a summary: if you have a high-deductible (i.e., you have to spend $$$$ before your insurance picks up the tab), you can open an HSA. They not only reduce your taxable income, but this rolls over year after year, and you can invest the money and let your savings account grow tax-free. The caveat is that you can only use this account for approved healthcare expenses. Trump broadened the HSA eligibility criteria in 2025, extending the HSA benefit to more Americans. I anticipate that HSAs will stay hot in 2026, given our health insurance premiums will skyrocket now that the ACA marketplace enhanced subsidies have expired. I also think the gen pop is just now realizing HSAs are a thing. We still have pre-existing condition protections, but I’m not yet convinced this will hold.

IN: Streaming drug ads
OUT: TV drug ads

In 2025, Trump signed an executive order on pharma ads that empowered the FDA to send hate mail to top pharma companies and prompted me to write an op-ed in defense of drug advertising. Despite pouring 16% more into traditional TV spots last year, drugmakers saw impressions climb just 7% year-over-year, per Fierce Pharma. You might be thinking that’s not the most efficient use of advertising + promotional budgets, given most of our media diet now consists of streaming and scrolling. Pharma gets that—projected 2025 digital ad spend jumped 13% from 2024 digital ad spend. Expect more traditional TV ad divestment in 2026: experts forecast pharma companies will down-titrate traditional TV ad budgets and up-titrate digital spend.

IN: GenAI research
OUT: Traditional search bar

Even DuckDuckGo pulls up GenAI summaries when you try traditional search. Is nothing sacred?

IN: DTC drugs
OUT:Retail pharmacy

People told me this was one of my hottest takes, but I was unfazed. It’s true that retail pharmacy is still kicking, but DTC pharm-to-table drugs were a big win for 2025. First came LillyDirect, Pfizer4All, and NovoCare. Then came TrumpRX + MFN deals with DTC components. I’m a fan because we can now bypass traditional distro models + middlemen for some drugs and ensure patients (read: not PBMs) benefit from discounts/rebates.

IN: Sleep hygiene
OUT: Doom scrolling

Everyone I know is obsessed with sleep. Only a few of us are getting enough of it.

IN: Maximalism
OUT: Millennial greige

Called it, with more to come in 2026. Fashion-wise, we saw a clear shift towards maximalism in 2025’s runway shows. The New York Times claimed “quiet luxury is a thing of the past.” In terms of design, AD, Elle Decor, and others published on the resurgence of maximalism in interior design. I’m not sure I’m fully sold on the maximalist aesthetic, but I am glad for less millennial greige.

IN: Secondhand Leather
OUT: Veg leather

Until someone convinces me otherwise, I vow never to buy vegan leather again.

IN: Homesteading! hunting + foraging! grass-fed beef from happy cows!
OUT: Vegan diet

Is anyone vegan anymore? All I know is that homesteading, foraging, moon ceremonies, and bartering are all alive and well in the town of Rensselaerville.

IN: Saying it w your whole chest
OUT: Dog whistle

Sometimes the devil you know is easier to manage than the angel who actually hates you or whatever. "The Cruel Kids Table" was the perfect representation of this to me, where interviewees divulged they voted for Trump because they craved the freedom to say words the woke police will cancel you for. The pendulum swung as far in that direction as it could; for the time being, it’s swinging back to pro-social behavior.

IN: Light eugenics
OUT: Social Security

This was the one I left out of the write-up, but shared privately when people asked. Eugenics was definitely trending for a while there in 2025, starting when a Designer Baby scientist did fake skull science on me, escalating with a series of Designer Baby NYT Op-Eds, and reaching a crescendo with the chaotic Nucleus Genomics subway ads. This tempered following a takedown titled, “Concerns about the legitimacy and integrity of Nucleus Genomics.” My position is that polygenic risk scores are a good tool for disease management and personalized patient care. Our environment plays too big a role to be ignored by those building “designer babies.”

IN: Links aggregator newsletters
OUT: Trad media

Long live !

Missed!

IN: Beef tallow
OUT: Vegan skincare

Miss, kind of. I tried beef tallow for my skin, but it started clogging my pores, so I went back to my trusted petrolatum-based products for sealing in my skincare at night. It would have been nice if beef tallow worked for me, as my dog licks my face to sleep most nights and employs the same methods to wake me up in the mornings. Alas.

IN: Environmentalism
OUT: Mars

I have no words.

Mixed!

IN: Mexican coke
OUT: Diet Coke/coke zero etc

Mixed. Mexican Coke was prevalent in the NYC and LA dining scene, and Coca-Cola introduced a new SKU sweetened with cane sugar instead of high-fructose corn syrup to the US market; however, the cult of fridge cigarettes held strong.

IN: Caucasus mineral mining
OUT: Gold standard

The South Caucasus is open for business. Trump’s got his eye on those minerals! But I missed the ball on gold—it’s going up UP UP! Odd Lots covered this better than I could.

IN: Candlelight
OUT: Pina pro LED

The best meals I enjoyed this year were candlelit—whether in New York, The Bay, LA, Hawai’i, Helsinki, Glasgow, Edinburgh, or London. Even those in my friends’ and my homes. Even at friends’ weddings. But the cursed pina pro LED light still has a chokehold on the dining scene. Prayers for its downfall will continue in 2026.

IN: Mini cocktails
OUT: Beer

Both of these things proved to be in for me in 2025 (I imbibed in both mini cocktails and beers). But the NYC Restaurant mini cocktail trend changed my life. Before mini cocktails entered the zeitgeist, I’d order a single drink to split with a friend when I didn’t want to commit to 3oz of gin. It always backfired. Our lovely bartenders would still pour two drinks and charge us for one with a wink and a nod. My liver is happier now.

Let her cook!

IN: Fee for service
OUT: Value-based payment

Sidenote: In the US, many doctors are paid for each service they provide: every visit, test, test result readout, phone call, and care event has a fee. The more you do, the more you get paid, so we call this “fee-for-service.” On the other hand, value-based care generally aims to reward doctors for patient outcomes. Keeping people healthy, managing conditions well, and preventing ER visits = more money. The incentive is to deliver efficient, effective care. To illustrate the difference: If you hired a calculus tutor to help you study, you’d pay her by the hour (fee-for-service). However, if you worked out a deal where she only gets paid if you pass your calculus final, that would be a value-based payment arrangement.

No major shifts in fee-for-service or value-based payment models last year, but hospitals are reporting plans to scale up value-based care in 2026, while CMS doubled down on value-based care with its ACCESS model, intending to shift away from fee-for-service. Some might say I was wrong, but I’m still sus. It’s not that I don’t like value-based care; it is one of my favorite care-delivery models. It’s more of an execution/implementation issue. We’ve been hyping up value-based care as the answer to all of healthcare’s problems for like a decade now, but actual implementation has been painfully slow. It’s giving:

“this year is our year”
“we can never forget this tiger.”
“i know, i am focused on it.”
“we will execute this year.”

when the track record says otherwise.

IN: Natural dyes
Out: Red 40 dye

I’m not so sure that I’m seeing a massive natural dye takeover, but we’re bidding farewell to Red 40 dye. By the start of Q2 2025, the FDA announced plans to cancel Red 40 + other petroleum-based synthetic dyes by end of 2026. Perhaps 2027 will be the year of natural dyes.

IN: Scalp care
OUT: Olaplaex

Korean scalp salons were hot in NYC in 2025, and the NYT wrote about the scalp as the new “it” body part, but I think people are still catching up on this one. The best thing I did for my hair in 2025 was drop $$$ on this Sisley scalp serum (NOT AN AD).

IN: Ancestral farm olive oil
OUT: Burning ur olive oil by cooking above its smoke point

This was something I wanted to apply to my life, and I succeeded. Idk what the rest of y’all are doing with your olive oil, and I don’t think I want to know. It’s better this way.

IN: Interest group politics
OUT: MicroPlastic panic (lost cause??)

Interest group politics is always in, if you’re doing it right.

IN: Recession (for real this time)
OUT: Small plates restaurants (you can’t afford to spend $200 on sardines!)

So we didn’t formally recess last year in part due to the conspicuous consumption of the few. Are we out of the woods? That would be nice. Nevertheless, the vibecession continued in 2025. What I don’t love is that Small Plate Girliepop Restaurants still have a chokehold on the bicoastal elite. Come over for dinner, I’ll pop the tab of a sardine can for us for free.

IN: Cooking at home
OUT: Dining out (see above)

This was more of a personal goal, but I did not cook at home as much as I should have. Better luck next year!

IN: Shakers (furniture, design)
OUT: Silicon Valley furniture brands

Miss? I toured a beautiful Shaker drawings exhibit at the American Folk Art Museum at the beginning of 2025, and I know the Vitra Museum also held a Shaker exhibit this summer, so they’re at least trending up. Despite the furniture industry downturn, Wayfair prevailed per Barron’s.

IN: Digital cameras
OUT: Buying new iPhone

Miss? Wait and see? Anecdotally, I see more young people with digital cameras walking around NYC. And manufacturers are re-releasing old digital camera models and bringing new ones to market (albeit at eye-watering prices). The New York Times wrote about the Gen-Z digital camera adoption in 2023, but I don’t really see other generations slinking around with them. Maybe in 2026? On the iPhone front, do any of you remember this Back Market ad in the NYC subway targeting the polyamorous last year? Why does it feel like years ago? A handful of friends have expressed curiosity about “dumb phones.” Many others have purchased new old iPhones, then shared woes about the iOS. If Twitter dies in 2026, I might opt to buy a dumb phone as my main (I can’t get rid of my work iPhone, or they’ll take me out back and shoot me.)

IN: Word of mouth
OUT: Influencers

Despite the algorithm’s best efforts, the influencer persisted in 2025.

xxsem

Read below for a book that makes a good gift for Divorced Dads and all who love them, my thoughts on TrumpRX and the MFN deals, plus a few LA favorites on rotation this trip—including the iconic case study home on the market for the first time.

WHAT I’M INTO

Press Play: “4 Raws Remix” by EsDeeKid ft. Timothée Chalamet

Everyone knows I love a Scouse. Which is why I joined the cult of EsDeeKid (thanks, Olivia!) after my Lad Work Trip in Scotland. She said Scousers (Liverpudlians if you’re posh) are “the closest to Scottish that a British person can get.” He’s really good at selling street debauchery. Later, I learned of the niche internet theory that EsDeeKid is actually just Timothee Chalamet in a balaklava. This music video is their response to that conspiracy theory. Now that we’ve heard both of them rap, we know better than to confuse the Scouse accent with that of a French-American. It’s Himothée Chalamet chillin’.

Side Note: A friend in the table tennis community told me he was skeptical of Timmy’s Marty Supreme press tour antics. I haven’t watched Marty Supreme yet (will watch it Jan 1 with MKS!), so I can’t speak to that. But my understanding is this is who he was before the French art heau arc. Unclear? Anyway, table tennis is IN for 2026. Pickleball is OUT. You heard it here first.

Build Literacy: I Regret Almost Everything by Keith McNally

I’m late to the game, but the British restaurateur who invented the Vaguely European Vintage-Looking New Bistro in New York published a memoir this year. He has a lot to say, and his life is kind of a mess, but he’s honest about his shortcomings. I Regret Almost Everything reads like an extended cut of his Instagram captions, which makes it an easy read. He’s politically incorrect, but writes with a bluntness and honesty that feels refreshing. Reading about the many lives he lived before his restaurant era reminds me of my high school AP World History teacher, who somehow evaded the War by serving as an army dishwasher or something, then owned a textile company before hard pivoting to teaching ambitious children. These stories interest me, because my peers in the Ivy League to Corporate Heau “career funnel” don’t seem to have as many fun and flirty side quests, especially among the lower-income set. And who can blame us? Life’s expen$$$$ive.

Let me curate ur news: “The World Has Laws About Land and Sea, But Not About Ice” by Brett Simpson (The Atlantic)

The Arctic is melting. You probably already knew that. But did you know that ships are taking shortcuts through it? A cargo ship sailing from Asia to Europe through the Arctic has cut its travel time by half (20 days vs. the usual 40), unlocking a route only made possible by melting ice. Climate scientists predict come 2025, most of the Arctic Ocean will be ice-free in summer. Partially exacerbated by human intervention like ice-breaking ships and environmental pollution, but also the inherent impermanence of sea ice. The challenge is ice is lawless! And we don’t know who owns the ice. To me, ice belongs to itself. Legal scholars propose giving Ice personhood to protect it from exploitation, but this isn’t as black and white as it sounds.

PULSE CHECK!

“Pulse Check” is your curated healthcare + pharma quick hit, complementing the longer, more in-depth “On Health” letters.

• In response to Trump’s Most-Favored Nation (MFN) executive order and tariff threats, three companies struck deals with the Trump Administration:

  • Side Note: MFN is Trump’s strategy to anchor US drug prices to what peer OECD countries pay. Mostly by setting price targets and imposing tariffs, but some policy positions also suggest raising ex-US drug prices closer to US levels. I don’t think this is the best way to achieve his goal (and not only because I’m pharma-pilled). It’s just that we always have a list price and a net price. No one pays the list price, not even the US. Outside of the US, it’s common practice for pharma companies to secure access through confidential rebates/discounts. I imagine this pricing strategy will continue, regardless of EU4 + UK prices reaching US parity. It could also further delay access to drugs ex-US as drug companies either delay launches or choose not to launch to protect US prices. We also tend to value innovation higher than other countries, which is why we get drugs faster and have access to more of them in the US (I can get into this in a later letter, if you’d like!). There are better ways to optimize access to drugs. For starters, let pharma have a seat at the table instead of being served for lunch.

    • Pfizer was the first mover. Committing to Medicaid MFN pricing and discounts of up to 85% on primary care drugs via TrumpRX (online government platform) with price parity for new products. This grants them a 3-year exemption from Section 232 (tariffs!)

    • AstraZeneca followed, using the Pfizer deal as a model, and committing to MFN pricing for Medicaid and new products. They also vowed to equalize US prices with those of other OECD markets and pledged $50 billion in US manufacturing and R&D investment by 2030 and “repatriate” increased foreign revenue on existing products. They also secured a 3-year exemption from Section 232 tariffs.

    • Merck (the other one…Merck KGaA, Darmstadt, Germany) EMD Serono offered lower pricing on fertility products at list prices discounted up to 84% when the three standard IVF protocol drugs were used in tandem. This also secured them tariff relief (details unclear), but their biggest win was gaining an FDA National Priority Review voucher for a new infertility drug and securing concessions from specialty pharmacy distributors.

• Then we got more deals:

  • Lilly offered its Zepbound multi-dose pen at the lowest dose for $299 with additional doses up to $499. Novo offered Ozempic and Wegovy at $350 cash monthly when purchased through the government online portal. Both of these negotiated prices will reportedly enable Medicare and Medicaid beneficiaries to gain Zepbound, Mounjaro, Ozempic, and Wegovy at $245, with a $50 co-pay for those on Medicare). Lilly included other migraine and diabetes drugs in the deal, and made future promises on Orforglipron, their oral GLP-1 pill, if approved by the FDA. Novo also committed to lower prices for their insulin products.

  • Additional drug pricing deals include: Bristol Myers Squibb, Boehringer Ingelheim, Genentech, Gilead, GSK, Merck (the American one), Novartis, and Sanofi. These reflect the earlier deals—offering products at MFN prices through Medicaid and discounted rates for direct to patient sales while promising lower prices on new drugs and U.S. investment on manufacturing and R&D.

• I’m not convinced these MFN deals will move the needle much.

  • First, they’re confidential and vague, so we can’t predict real savings in the health system.

  • Second, we have different healthcare priorities! Tying ourselves to the healthcare agendas and willingness to pay of other OECD countries is a losing game. The US is unique for many reasons, including the speed and breadth of access to drugs that other countries don’t have. Naturally, our treatment patterns differ. We value a quality-adjusted life year improvements more than other countries. For example, the National Institute for Health and Care Excellence in the UK historically valued a standard QALY at £20-30k, where as our most conservative QALY values range from $100-150k. Recognizing they were losing out on innovation, the UK updated its standard threshold this year, but at £25-35k it’s still significantly lower than the US. Our health system is also a mix of government and commercial payers—sometimes doctors are the payers. Letting other countries decide if a new drug is worth paying for feels antithetic to American philosophy.

  • Third, and most vexing for public health: MFN could delay drug launches in ex-US countries to maintain US prices.

  • Last, it’s fascinating that the small government party is centralizing Direct to Patient (AKA direct-to-consumer) sales via an online platform named TrumpRX. But I do think DTC drugs options can support better access to quality drugs and reduce middle-men (i.e., PBM) waste in the system.

• Now, do I think Trump is a drug dealer? No. TrumpRX is just a site that links out to each pharmaceutical company’s site to buy the drugs cash. TrumpRX is NOT a point of sale. That makes him more of an an influencer with an affiliate link than a drug dealer.

WHAT I’M UP TO

Working East Coast Hours on the Pacific Coast frees up your late afternoons for things like touring real estate for an LA pied-à-terre to cement your bicoastal lifestyle. I learned finding good-boned midcentury homes butchered with grey acrylic floors and other anachronisms is easy. But finding a midcentury gem in pristine condition, restored to its original midcentury charm? That’s a tall order. When you uncover one, sellers often credit the same woman for their door, window, furniture hardware, lighting and accessories worthy of an art museum:

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Before we dive in, I need y’all to know my best friend (PKH) and acupuncturist’s husband produced a really cool show: Dinner Party. It sold out, or I would’ve urged you to buy tickets. All I can say is it was unlike anything I’ve seen, and you should stay tuned in case it makes it back to the stage.

Trump signed an executive order for HHS/RFK Jr. to crackdown on direct-to-consumer pharma advertising. As you may recall, RFK Jr. pledged to ban pharmaceutical ads in his campaign trail—a position that unites the Left/Right/Extremist on the spectrum. The earnest public health types think they’re manipulative, Europeans think we’re insane for advertising prescription drugs, and others think wanting to live is cringe. Since 1997, the FDA has allowed drug ads that represent both the benefits and drawbacks from the promotional drug. The Trump administration does not have legal standing to ban pharma ads, because current interpretations of the First Amendment protect freedom of speech for pharmaceutical firms (among other corporations), but they can regulate these ads. Regulating US pharmaceutical ads isn’t new; it’s why people laugh at the 1.5x speed side-effect voice-over to soothing visuals.

So. While Trump’s order did not ban drug ads, it empowered the FDA to send hate mail/warning letters to hundreds of companies like Novartis, Eli Lilly, and Hims and Hers. Tbh I’d probably write to that last one, too, and I think there’s value in regulating prescription drug ads within reason. Dr. Makary AKA FDA chief and Liverpool native (go reds!) also published an anti-drug ad op ed on JAMA and released this clunky scripted video. (Seriously, who wrote this copy? Let me help you!) They also proposed broader oversight of social media marketing. I wrote about this before, but TV viewership is at an all-time low. Sharing information is about finding people where they are, and they are scrolling social media and pressing play on their favorite podcasts. Who’s pitching the Vyvanse x Spotify lo-fi beats study playlist?

It is important for my sanity to accept that RFK Jr. and his team think they’re doing what’s best—even when they’re missing the mark or promoting “natural” remedies that are snake oil (at best) or do more harm than good (at worst). We tell ourselves stories in order to live, as Joan Didion says in The White Album. Mine is that people are inherently good and want to do good. Thus, it makes sense to want to ban DTC pharma ads if you’re operating from a belief that pharma ads are inherently evil. But I disagree with that premise. Here’s why:

DTC drug ads raise awareness + reduce information asymmetry

This is my top reason because health literacy is my passion (hence…Of Note… The Worried Well).

Searching, “Crohn’s disease” after watching a Skyrizi ad instead of subscribing to the chronically online adage “hot girls have stomach problems” is a public health gain. Pharma marketing both gets people to visit their doctor and seek treatment for (sometimes underdiagnosed) conditions and democratizes healthcare intel. Seeing your doctor because an ad resonated with you is the first step for many who could benefit from a diagnosis and discussing treatment options with their doctor. Other times, we learn some treatments aren’t right for us.

After watching a TikTok on migraines that talked about potential stroke risk, I asked my doctor about switching from a combination birth control pill to a progesterone-only pill. I had my first migraine with ocular aura in 2020, and a couple more through 2024. In that time, I’d gotten regular check-ups with my primary care provider/gynecologist, dermatologist, and ophthalmologist—all of whom knew my medical history and current prescriptions yet missed my risk factors. My doctors caught the risk implications before I even finished my question and swiftly changed my prescription. Just like us, our doctors are subject to human error. Pharma marketing can be another tool in the toolbox to improving health outcomes.

It’s an options game

Given we have more treatment options for some disease areas in the US than other countries, decisions about the most appropriate treatment are best left to the patient and their doctor to balance trade-offs and individual needs.

Banning drug ads may also risk monopoly by prioritizing bigger and more entrenched pharmaceutical companies who can capture market share without DTC prescription drug ads. This is because branded DTC drug ads don’t only increase name drug prescriptions, they have positive spillover effects on generics for the branded drug.

Some drugs are so good for population health gains that broader access has direct social value. Statins are the classic example of a highly effective and affordable drug with many low-cost generic options that benefit from branded ads. With statins, Alpert, Lakdawalla, and Sood (2023) found the “benefits of advertising exceed the costs for this class of drugs” and “advertising bans could be harmful to consumers.”

Pharmaceutical companies do their due diligence

The redditor pushing colloidal silver is not bound to stringent regulation. By design, DTC prescription drug ads present science-backed information. The FDA lays out what pharma companies can and cannot say in their drug ads, and pharmaceutical companies work with agencies they trust to deliver ads within these guardrails. Further, now that insurance companies, tech health start-ups, and compounding pharmacies have entered the Prescription Drug Marketing Chat, I admit that there’s room to uphold these new players to the same standards. Too many of you are on peptides of questionable origin for my liking.

Prescription medicines are not cigarettes

People who want to ban pharmaceutical marketing often point to early days of cigarette ads as an analogue for banning prescription drug ads. However, those ads promoted dangerous products (i.e., cigarettes) whereas pharmaceutical drugs support health gains.

That’s all from me for now! I open up the floor/comments/emails/DMs for your thoughts. Thank you for sticking with me, I hope we can find nuance to complex public health issues.

xxsem

Today on the letter: A Latina banger of an anthem, a book that’ll make you think about the health and depth of your friendships, and a nightmare surrogacy experience. On the healthcare front, we also have findings on heat exposure + biological age, American Health Politics, and GLP-1s (always). Behind the paywall, I share my recommendations from a long weekend in Helsinki, Finland.

WHAT I’M INTO

Press Play: “222" by Tei Shi ft. Loyal Lobos

Two is my favorite number, for no reason other than I like even numbers, and it appealed to my 6-year-old eye when I decided 2 was aesthetically pleasing enough to claim as my favorite. At ’s Burger Diva Birthday, I learned it might also be hers. Is this fake news? LMK. I’ve had the refrain, “Caótica/ Frenética/ Re-crazy, yea/ Magnética” stuck in my head since last month when I watched this “conjoined twin” music video. This song is coy + flirty, oscillating between Spanish + English. The video opens with a split-screen shot of Tei Shi dialing Loyal Lobos, but they’re next to each other in matching black body suits. It transported me to one 4AM January morning in my Chinatown tenement apartment after a night at Skin Contact. If you’re asking, “Don’t they close at midnight?” Yes, next question. Thinking I’d lost my phone, I called myself from SDM’s cell, found it in a different room, and answered, “Hi, SEM? It’s me, SEM!” Anyway, I think it’s fun when my friends and I wear similar outfits to the function—birds of a feather, great minds, or whatever.

Build Literacy: Lonely Crowds: A Novel by Stephanie Wambugu

This is a story about many things, but at its core, it’s about complicated friendships between women. Two young confidants and co-conspirators grow into imperfect women; it’s a familiar tale, given that my friendships with complex women are my most rewarding. Ruth, our narrator, is a precocious Catholic Girl. She befriends Maria, an orphan who knows how to play the shitty cards she was dealt. Maria is to Ruth in Lonely Crowds as Mila Kunis’ Lily is to Natalie Portman’s Nina in Black Swan. Where Ruth is shy and obedient, Maria is charming and free. Maria’s cavalier and inconsiderate tendencies bring out Ruth’s nurturing side. Maria finds more success in her art than Ruth. Ruth holds Maria on a pedestal and idealizes her. Naturally, these dynamics breed resentment and tension despite deep love and care. In the Los Angeles Review of Books, Wambugu caveats, “I think if you have a friendship without those things, you’re probably not that close.” Ain’t that the truth.

Anti-algorithm news: “The Baby Died. Whose Fault is it?” (Wired)

This one is a doozy. Cindy Bi, a Chinese Venture Capitalist preoccupied with mothering a white son, hired a surrogate to carry her only male embryo. In the worst possible scenario (something you wouldn’t even wish on your worst enemy), the baby was stillborn. Bi has since decided to make her surrogate’s life miserable. I understand that she was grief-stricken, and we shouldn’t judge people by their worst moment, but she crossed wayyyy over the line of impropriety. I have an ongoing agreement with my VC friend that I will alert her if she ever turns into a tone-deaf VC caricature. Which begs the question: Does Cindy Bi have any friends? From a health policy lens, Bi’s rhetoric and attempts to charge her surrogate for murder are concerning. Down the line, this could implicate women who lose a pregnancy or choose to have an abortion. Surrogacy can be a beautiful thing, but we need stronger surrogate protections.

PULSE CHECK!

“Pulse Check” is your curated healthcare + pharma quick hit, complementing the longer, more in-depth “On Health” letters.

• Heatwaves age us as much as smoking + drinking. Comparing people’s chronological age to their biological age, scientists found that people aged faster when exposed to extreme heat. This matters because last year was the hottest on record, adding 41 more extreme heat days globally than expected. Beyond aesthetics (i.e., looking hot + young), heat kills more people than other extreme weather-related events in the US. I raised this with BotticelliBimbo (MPH of Stripper Economic Index fame), and she wants you all to know that heatwaves also make us dumber and more aggressive because “heat literally cooks people’s brains.” I’m looking up real estate in Helsinki, Finland, as we speak.

• FDA has started publishing redacted Complete Response Letters (CRLs) for drugs under review. This isn’t common practice. Previously, the pharmaceutical company chose when to release these letters. A CLR is when a drugmaker submits their drug for approval, and the FDA says, “Nah fam, we’re not ready to approve this.” It’s not a “No,” they usually need more info or want the company to address concerns. Sometimes the FDA thinks your data is mid and/or sus and wants more evidence, other times it’s a quality assurance concern if your lab fails the vibe check. These letters include a roadmap to help drug makers fix and resubmit. Speaking for myself, I’d worry this move could reveal too much of my drug development strategy to my competitors. I’m not sure how others in the field are receiving this.

• The World Health Organization has added GLP-1s to the essential medicines list. This is a list of necessary drugs to promote population health, and helps enable access in lower- and middle-income countries.

• RFK Jr. got flamed in a Senate hearing on CDC troubles and vaccine misinformation this week. Where the FDA oversees the development of vaccines + drugs, the CDC studies real-world population-level use outside of the controlled clinical trial setting. The issue is that RFK Jr. and his team updated the COVID-19 vaccine guidelines, which then require CDC approval/endorsement to become official recommendations. Now, why does this matter? Insurance Coverage! If FDA guidance conflicts with CDC vaccine policy, insurers tend to follow the cheaper option: denying coverage for those vaccines. This has major affordability and access implications for most Americans who can’t afford out-of-pocket vaccines. When the COVID-19 vaccine guidelines updates reached the CDC, Dr. Susan Monarez (MAHA CDC Director) resisted. In turn, HHS tweeted that she was resigning. Dr. Monarez was like, “Bet. No, I’m not,” so they fired her. Members of the Senate are now calling for RFK Jr.’s resignation or firing. For now, I’d look at professional societies such as the American Academy of Obstetrics + Gynecology and the American Academy of Pediatrics for evidence-based vaccine guidelines.

WHAT I’M INTO

I went to Helsinki! And I think you should too! Everyone’s skin looked great. (Did you think I was joking about Finnish real estate?).

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People go to Shelter Island to escape both the bustle of the city and West Village clones in the Hamptons. On this particular Thursday afternoon, the island stretched like a cat awakening from a nap—the hottest news was Stars Cafe’s new location. Shelter Island’s the distant, self-assured cousin to the Hamptons, in part because you can only reach it by private boat or ferry. My preferred approach? Nestle yourself between two SUVs for a short $3 ferry ride from Greenport, NY, and feel the bay wind on your face. If you’re packing light, surrender to the island’s rhythm and choose the 20-minute walk over a 5-minute drive from the North Ferry Port to Sunset Beach Hotel. Or ride your bike! (I prefer my two feet over two wheels unless I’m in the back of a motorcycle, but this is definitely a bike island.)

I strolled through a lush, green, unmarked park, past The Chequit, and noted the “SODA - DRUGS” sign for the Shelter Island Heights Pharmacy (real ones know this pharmacy serves the best sandwiches in town). A fork on the road points you left for Sunset Beach Hotel, but Google Maps promised me a shorter and more relaxed route through Shelter Island Country Club. This was where I FaceTimed NRZ, who was working East Coast Hours from Greece, and flipped the camera to show her Sunset Beach Hotel’s iconic yellow and white awning.

Where Shelter Island whispers, Sunset Beach Hotel flashes a coy smile and a wink. It’s welcoming but not desperate—uninterested in fanfare. Like its sister hotels (e.g., Chateau Marmont, Chiltern Fire House), Sunset Beach Hotel draws people in whether they book a room or a table. It’s also the kind of place where hospitality is an art form rather than a transaction. If Alessandro from Duke’s Bar (RIP) has ever made you an ice-cold, bone-dry martini, you know what I mean.

Something to know about me: I don’t love cocktails with dinner, but I cherish an apéro/digestif moment. So I walked down before dinner to stimulate the appetite, as they say. The maître d' tells me she’s saved her favorite table for me at check-in. I’m influenced, perhaps from the water, heat, or chatter of revelers, to stray from my usual City order (martini/negroni) in favor of a spicy tequila Campari drink with blood orange juice + a spicy salt rim.

I quickly learn that I do in fact have the best seat in the house. My table is in the middle, on the side overlooking the water and sunset—not because I asked for it, but because TRM called to tell them it’s my birthday. They thought I’d like the view, and they were right.

Sometimes I wonder if isolation and technology have forever changed the hospitality landscape. Restaurants and hotels evolved to meet clientele’s sterile and frictionless preferences with offerings like mobile check-in/out and QR codes. If I’m being real, these days I cherish the days of cringe, turning beet red as my dad joked with a server. The way I feel about reading physical menus is the way Scout Finch (we’re throwing it back!) felt about reading and breathing in general: “Until I feared I would lose it, I never loved to read. One does not love breathing." No, thank you. I don’t want to scan your Quick Response code! So, I sigh with relief when the server brings me a menu depicting a cheeky acro-yoga couple superimposed on a California poppy.

My evening plays out like a series of vignettes with a choreographed Front of House ensemble cast; each table has its story but there’s harmony to the space. The restaurant manager takes it all in from the corner, directing the servers while letting them improvise. At one table, a group practices their French with the new French server. He indulges them while they share laughs. I later learn he’s from a ski town near Nice, which is apropos since the hotel evokes riviera vibes. At another table, a couple bargains with their towheaded child who’s lost interest in his food. He’s enchanted by the well-behaved dog at table next to mine. It’s not until he succeeds in petting the dog, that he returns to his meal. Someone brings the dog a fresh bowl of water. When dessert comes, I’ve befriended the women at the table with the dog, so I share some of my whipped cream with him. These casual interactions and expert anticipation of needs can make you feel both singular and seamlessly part of the scene. Sunset Beach Hotel doesn’t care who you are, they’re just happy to see you. And if you’re there on a weekend, they’ll invite you to let your hair down and live a little.

The hotel GM (shoutout Manolo) visits my table to introduce himself at some point. We talk about his move to the US from Europe and he assures me that Sunset Beach Hotel practices the same level of discretion as the Chateau Marmont (IYKYK). Something that stood out to me is that he works a core staff group at all his hotels, deploying them where the season is the hottest. So, you may be served by some of the same people in the winter in one part of the country that serve you at Sunset Beach Hotel in the summer. I decide that if I ever want to pivot to the hospitality industry, I’ll save the $$$$$ needed for Cornell’s Nolan Hospitality Management program and instead ask Manolo to train me on the job.

I ended the night with an ocean dip. It was the perfect digestif.

xxsem

The pharma finesse to investing, innovating, and implementing health technology is why I joined the field. It’s a necessary (albeit not sufficient) player for collective health gains. To me, the pharmaceutical industry is a net social good, but 61% of Americans disagree: they trust lawyers, oil and gas, and even The Feds more than they trust pharma. I can tell you that over my ~10-year career in the industry, I’ve worked with reliable, rigorous, and compassionate people who care a lot about improving people’s quality of life ASAP, while pursuing future cures. This is true, but I doubt anecdotes alone are enough to convince you. Instead, I’ll guide you to the facts and welcome an open dialogue.

Drugs save lives

Forgive me for starting with the obvious. Pharmaceutical innovation can help us live longer by turning deadly illnesses into chronic, manageable conditions, curing diseases, or preventing them altogether.

Pure cost-effectiveness health technology assessment countries only pay for drugs that show quality-of-life improvements and meet quality-adjusted life year thresholds. You already know about the health benefits of GLP1 inhibitors, because I, and everyone else on here, have written about them. They’re disrupting the obesity treatment landscape and are directly responsible for cardiometabolic improvements (think: heart disease, kidney disease, diabetes) and impulse control/desire. Heart disease is the leading cause of death in the US + worldwide, responsible for 41% of US deaths in 1970, down to 22% of US deaths by 2022. A Health Affairs analysis attributed about half of that heart disease mortality decline to pharmaceuticals (Thank baby Jesus for statins!). That same analysis linked pharmaceutical innovation with 76% of mortality improvements for patients living with HIV. Drugs like iptacopan may delay kidney failure, improving quality of life with a pill as an alternative to dialysis/ kidney transplant.

Also consider cancer, the second leading cause of death in the US + globally. Chronic Myeloid Leukemia (CML) is no longer a death sentence thanks to imatinib. This drug was so iconic that it made the cover of Time. Imatinib was a massive W for CML care, illustrated by a major glow-up in US long-term survival from the 90s (before imatinib approval) vs early aughts, after imatinib FDA approval (2001).

Overall, the US observed a decline of 34% of cancer deaths from 1991 to 2022, avoiding about 4.5 million expected deaths due to earlier detection and improved treatment options (both areas where pharma contributes) and lower smoking rates. A 2020 study published in the Journal of Medical Economics found a correlation between cancer medicines approved in the US between 2000 and 2016 and the prevention of 1.3 million cancer deaths for the top 15 most common cancers. In the UK, half of the people diagnosed with cancers in 2018 were expected to live 10 years or more vs only 24% in the 1970s.

One more for good measure: a World Health Organization analysis found vaccines yielded a 40% reduction in global infant mortality.

Pharma firms invest heavily in R&D

Developing new drugs is a team effort between private, academic, and public institutions. Pharma carries the team, investing the most in drug development. But you don’t have to take my word for it. Harvard health economist Amitabh Chandra is one of my favorites in the game. Are you allowed to have favorites? There’s room in my brain for them all. My 2016 MPH health econ professor at Columbia often cited Chandra’s work, even joking about how his health economist hot takes on Twitter made him unfit for political office. Anyway, Chandra led the most comprehensive global biopharma R&D investment assessment to date, finding that it totaled over $276 billion in 2021. US companies lead the pack, making up 50% of global R&D investment. These investments create life-altering medications and advance scientific and medical progress. Considering we get about 40-50 successful drugs approved a year, Chandra extrapolates that it takes more than $5B to bring a (1) drug to market. We need incentives like IP and patent protections because pharma isn’t as profitable as people think. Most drugs fail. We exhibit Health Innovation Fan Behavior.

Science is an iterative art form

Pharma investment refines and calibrates scientific learnings to improve the patient experience. Each novel drug builds on earlier research in baby steps, big leaps, or pivots. Advances in companion diagnostics that support targeted, personalized medicine raise all boats, not just the drug they’re intended for. In health economics, these are seen as valuable scientific spillover effects. Even when drugs fail, we learn, share findings, and propel the field forward. Sometimes drugs get repurposed. Minoxidil was originally developed for high blood pressure, but was discontinued due to excess hair growth. Now, men and women use it for hair growth. Pfizer developed sildenafil to treat angina (chest pain from reduced blood flow to the heart). It wasn’t as effective as they’d hoped, but men reported a remarkable side effect: significant and extended erections. We now know this drug as Viagra. In other cases, pharmaceuticals offer real options value (ROV)by keeping patients alive long enough to benefit from future innovations/potential cures. The bigger a drug’s survival benefit, the higher its ROV.

It’s good for the economy!

If social welfare as a basic concept doesn’t sway you, perhaps economic benefit will. Globally, the pharmaceutical industry directly contributed $2.3 billion to the GDP in 2022. Pharma is also a job creator, supporting 75 million jobs worldwide in 2022, 7.8 million were employed by the industry directly, and 1.1 million were involved in R&D.

Quantifying the social burden of disease is hard, but I like WifOR’s method. They consider paid and unpaid work as well as caregiver/family burden, and calculate the social benefits of pharmaceutical innovations. Their research has found that MS drugs added $6 billion in economic value for Brazil, Canada, China, France, Germany, Italy, Japan, Spain, the UK, and the US from 2017-2023, with a projection of $27 billion by 2032.

As cancer incidence rises, so will the economic burden as health budgets shrink, but pharma is invested in long-term social health gains. Estimates show cancer is on track to cut $25.2 trillion from the GDP between 2020 and 2050. Improving cancer care and patient outcomes benefits our economy and social welfare. Research from the RAND Corp showed that investing $40 million in women’s lung cancer research could yield a 1200% return. From a study of 11 cancers, we learned that every dollar invested in cancer diagnosis and treatment has a $8 ROI. A healthy workforce benefits us all!

Okay, wrap it up SEM…

The pharmaceutical industry is a necessary and eager partner in solving health system challenges. Consider them in your future public-private partnerships. That’s all for me on this at the moment, but I look forward to reading your thoughts in comments, DMs, emails or texts.

Love you, mean it.

xxsem

Press Play: “RIP KP” by King Princess

A few weeks ago, I played this slutty anthem after a (1) LAX martini served on the rocks (??) on my way to SFO for a friend’s wedding. The perfect cocktail presentation when “If you want it on the floor, you can have it like that” loops in your head, in my opinion. I knew I was in for a treat when Daisy (of Dirt Megaverse fame) asked if I had watched the music video. I swiftly tapped on the Safari app to find this treasure before toggling to airplane mode and sent it out to three friends. It’s still stuck in my head, so I’m making it your problem.

Borrow from your local public library: Didion & Babitz by Lili Anolik

Lili Anolik is a bit kooky, which I learned from a 2022 How Long Gone episode where she’s featured discussing her hatred for hydrating and how she always orders the thing at The Odeon (salmon + greens, I think?) even though she doesn’t like it that much. She locks onto certain topics and people like a pitbull. Some of her obsessions include Brett Easton Ellis and Eve Babitz. I love a curious girl, so I listened to her Bennington College podcast, skipped her first Babitz book, and made note of this Didion x Babitz crossover release. I like letting the universe choose my books for me, so I took it as my sign that it was time to indulge when the Agoura Hills Calabasas Barnes & Noble advertised it at a $3 discount. In many ways, this cotton candy read shines a light on the highs and lows of intimate female friendships. Perhaps because she’s a Vanity Fair/AirMail editor/writer, Anolik’s pen brings you along for the ride like she’s dishing gossip. I don’t mind her style, except I hate when a writer calls me “Reader” in prose. At the end of the book, I felt like I broke into someone’s home and pored over their personal belongings—a little dirty and ashamed, but informed. I’ve long considered Babitz an LA writer, but she also lived and worked in NYC. Babitz felt she couldn’t become an adult in LA, something only possible in “a place that demanded exertion, endurance, defiance” like New York. I was born + bred in LA, but also feel that New York raised me. Cheers to that!

Anti-algorithm news: “Peter Thiel and the Antichrist” (New York Times)

I’m giving you a break this time by assigning required “listening” rather than “required reading,” as I usually do. Ross Douthat interviewed Peter Thiel last week and created a safe space for Peter to yap and unravel. Because Ross is who he is, I anticipated religion to come up in their conversation. But Peter spoke so candidly that some of the things he said would qualify him for a 5150 hold in California. Has someone checked on him recently? Anyway, I can’t decide if he’s being so public because we’re at the point of no return or because he thinks he’s God. When asked if the human race should survive, he hesitated before answering yes, as transhumans (but not that kind of trans).

In case you’d still like some on-theme accelerationist assigned reading, here’s Sam Altman’s blog promoting an optimistic AI and humanoid robot future (Altman doesn’t want you to be scared!). Should I be investing in Uranium? How can I buy some? If you read that, you also have to skim this coverage on an Apple paper showing current AI isn’t smarter than a child/can’t handle complexity, nor solve children’s puzzles. Balance! My takeaway, for now, is that we should all get familiar with AI and AI-generated content while strengthening our media literacy. Just don’t use it to outsource critical thinking (more on this below!). I also wouldn’t trust that the information you feed your LLM of choice is private; imagine you’re talking to Altman, Thiel, etc..

PULSE CHECK!

“Pulse Check” curates healthcare updates to complement the longer, more researched “On Health” pieces. See the latest On Health edition below, and the pulse check behind the paywall.

• People who rely on ChatGPT may be losing their ability to think critically, per MIT researchers. It’s funny to me that they built in an LLM trap, assuming people would run the study through an LLM to make sense of it. They asked 54 people aged 18-29 to draft SAT essays and split them into three groups using OpenAI's ChatGPT-4o model, Google, or brains only. Based on electroencephalogram (EEG) brain wave measures (electrical activity/neurons firing), they found LLM users “consistently underperformed at neural, linguistic, and behavioral levels.” Their essays were also unoriginal. So you’re slower, cringe, AND cheesy. Nightmare. This is still under peer review, but the results make sense. Our brains are muscles. They’re also a little lazy. We build neural pathways that can be reinforced and strengthened or weakened and pruned away, but they’ll take the path of least resistance whenever possible. The cool thing about this is that they showed LLMs to be helpful tools when people used their brains to draft early versions, then refined them using LLMs. LLMs are a useful tool, but outsourcing critical thought is LAME.

  

• Biotech startup Bexorg is restarting dead human brains. It’s less Matrix-y than it sounds, I promise. Yale scientists restored brain cell activity in dead pigs, and they’re now trying it on human brains. The brains arrive in their labs with no electrical activity, and they use proprietary BrainEx technology to restore blood flow with fake blood and reboot cellular activity. The goal? Accelerate drug development for central nervous system conditions (think: neuro, psych) by testing directly on human brain cells instead of animal brain cells to get a clearer picture of drug dosing, safety, and efficacy. Neuroscience is still a baby science (<100 years old). Most neuroscience drug trials fail. There’s so much unmet need, but we’ve barely scratched the surface of what we know about our brains. I hope this helps us crack the code.

• Khosla Ventures is betting on therapeutic plasma exchange for longevity. Circulate Health showed its technology lowered biological age, then raised $12 million in seed funding to scale its tech to 24+ additional longevity clinics by end of year. Each session runs patients a smooth $10k. I’d still like to add myself to the waitlist for ’s mom’s plasma should she ever be interested in monetizing.

• Remember when I said we couldn’t get psychedelics approved because the FDA didn’t think we’d behave? RIP (temporarily) Lykos. This administration (i.e., RFK Jr.) is paving the way for a more favorable regulatory and political environment for psychedelics, starting an arms race to be first-to-market AKA the HBIC of psychedelics. Beckley and Atai Life Sciences announced a merger last month; today, Beckley released Phase 2b clinical trial data showing their inhaled mebufotenin (reformulated from DMT) was better at reducing depression in people living with treatment-resistant depression vs an active comparator. That they saw these results within the month is awesome, because most psych drugs take weeks/months of calibration. In February, GH Research published data on its version of inhaled 5-MeO-DMT, but their trial was smaller and compared against a placebo.

• In my 2025 oracle newsletter, I predicted retail pharmacies are out and DTC drugs are in for 2025. Bloomberg reported that HHS officials met with big retailers like Amazon + Walmart to find ways for Americans to buy their drugs directly from pharma companies. I gather this was more of an exploratory conversation, but I am bullish on this as a way to trim the fat in the distribution chain (yes, I’m talking about PBMs).

• In that same vein, how did I miss that Walgreens is going private?

WHAT I’M UP TO

Pacific fish is my favorite fish. I’ll choose Pacific Fish from a strip mall in Los Angeles or Honolulu over a $200 omakase in NYC. So when SNP proposed a drive out to her favorite sushi restaurant in the Bay, I assumed it would be in San Francisco. It was not! Curious, I googled the place and was immediately sold. The best sushi in San Francisco is

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Last month, in another blow to vaccine confidence, HHS/RFK Jr. announced that they want new vaccines tested against placebos. That pissed off some medical professionals. In response, Calley Means asked: "Can someone please explain to me why ‘health experts’ would be alarmed at conducting science on new drugs?” The administration defended it as a win for vaccine safety, claiming none of the vaccines recommended for children were ever tested against placebos. This is false. To prove their point, infectious disease doctors pulled out the receipts: a crowdsourced list of placebo-controlled vaccine trials. Later, a smart, curious friend of mine (who may be a little skeptical about vaccines) texted me about this. And it made me realize that what feels like basic science to me can be totally esoteric to others.

So this was a lesson in grace. No one can know it all, which makes life fun. So, let’s spend some time on the placebo question. When are they appropriate? When are they not? By the end of this letter, you can all make an INFORMED decision on whether or not this is good policy. I love teaching men to fish.

Let’s back it up, what’s a placebo?

A placebo is an inactive treatment meant to mimic the real deal (active treatment), but it’s cap. In clinical studies, researchers can compare how trial participants respond to active treatment vs placebo to measure effectiveness AKA how well the drug achieves its intended effect. For example, sugar pills for trials assessing oral treatments or saline for studies where active treatment is injected/delivered intravenously. Using a placebo that looks/smells/tastes like the active treatment limits bias in trial results by reducing the risk that participants figure out whether they got an active treatment or an inert placebo.

When are placebos appropriate?

Randomized, placebo-controlled trials are widely considered the GOAT of evidence-based medicine. In the simplest terms, participants are randomly sorted into equal groups (treatment arms) where one group gets an active treatment and the other, a placebo. If it’s double-blinded, neither the participant nor the researchers know who’s getting what. If it’s single-blinded, the researchers know, but participants don’t.

Let’s take a look at vaccines. Placebos are good when testing new vaccines for new pathogens (e.g., RSV, COVID-19). The COVID-19 vaccines, for instance, were tested against placebos. We had nothing else to compare them to. Once scientists establish a foundation of vaccines that work, they test new iterations against existing vaccines.

When NOT to use placebos?

We can’t give someone a fake drug when a real one could save their life. This is especially the case for cancer, infectious diseases, and rare diseases.

• Placebos are uncommon in cancer clinical trials. Most studies compare a new treatment to an approved one because keeping sick people from cancer care is unacceptable. Why give patients fake drugs when the risk is death? In a double-arm trial, one group gets the investigational drug (new treatment), and the other group receives the next best thing (existing standard of care). If the new drug performs significantly better, it may usurp the existing drugs to become the new standard of care. In the rare cases where placebos are used, it’s usually one of two reasons:

  • First, when the new drug is added to an existing drug, and you want to vibe check the contribution of each drug in the combination. If the active treatment arm tests the new therapy plus standard of care chemo, a comparator arm would use placebo plus standard of care chemo.

  • Second, when researchers are studying a cancer without approved treatments. In these cases, physicians may take a “watch and wait” approach, so placebos are fair game.

• New vaccines for diseases with existing vaccines are usually tested against those vaccines in “bridge” studies. I’m not a vaccine expert, but my understanding of bridge studies is that they assess whether a vaccine candidate (new vaccine) and an approved vaccine trigger your immune system in the same way. We want enough of an immune response to build antibodies for future pathogen exposure. Bridge studies build on historical studies where older vaccine generations were tested against placebos to determine whether they’re worth bringing to market. As with cancer, it’s unethical and irresponsible to knowingly expose trial participants to the risk of debilitating illness/death when we can avoid it.

How can we account for situations where placebos aren’t appropriate?

I love this topic because I love novel trial designs and Real-World Data. When it’s unethical or impractical to run randomized placebo-controlled trials, researchers have the option of using single-arm trials. They’re pretty self-explanatory: there’s one group and they all get the investigational product. We see these a lot in areas of unmet need (think: cancer, rare diseases). If you’re thinking this isn’t enough evidence, congratulations…you’re already thinking like a scientist. We address this evidence gap by building artificial control arms using Real World Data (claims data, electronic health records, registry data) and comparing them against trial results. Some countries are more accepting of innovative trial designs than others. Both the FDA and EMA accept single-arm trials for regulatory approval. Sometimes, with the promise to collect more data once the drug is on the market. But it can be more challenging when asking insurance companies and payers to reimburse the drug (we can get into this in a future letter).

Knowledge is the antidote to paranoia

The fun thing about science is it’s always evolving. You don’t need a fancy degree to understand this stuff, just a dash of curiosity and a healthy dose of context. Placebos are powerful tools, but they’re not always the right ones. What do you think?

xxsem

Today, in the letter, I argue for exposing ourselves to pseudoscience to practice critical thought, and ask if Spotify is feeding me industry plants. Behind the paywall, we chat GMO babies, where real BOTOX® comes from, and how the guy who let snakes bite him for sport might be our next public health hero. You can also find a sign-up link to my ballet studio’s Summer Intensive, if sweating in an old building without AC while kind people teach you ballet and modern dance sounds good to you. I will be there! Onward.

WHAT I’M INTO

Press Play: roll the dice by smerz

Are they industry plants? Maybe. The first time I listened to Smerz, it felt like a gift from the Spotify algorithm, so I looked Smerz up. They’re a Norwegian bestie duo based in Copenhagen + Oslo who have been on the scene for about a decade and are reminiscent of Coco + Clair Clair. You know I love all things Scandinavian, but it’s interesting how Smerz fraternizes classic American aesthetics with Scandi effortlessly cool. Frenzied electronics accompany the gals as they strut and pout through Las Vegas casinos and pawn shops. The swimmy POV music video looks like it was filmed through a potato, strumming that nostalgic chord that people crave in uncertain times. I imagine this is how hip-hop video vixens spent their days off in the ‘90s.

Borrow from your local public library: Breath by James Nestor

I borrowed this book from as a beach read. It served its purpose, but I also yelled at Nestor many times while reading this. He makes some wild claims with the certainty and confidence rivaling LeBron James. For instance, ADHD is “directly attributed to difficulties during sleep.” To which I needed to remind him that correlation does not mean causation. Some of his claims are science-backed, others are vibes-based or anecdotal pseudoscience. Still, it’s worth reading if only to test your critical thinking skills.

Anti-algorithm news: Trump’s sovereign-wealth fund won’t make America richer (The Economist)

I’d read Trump’s Feb 3rd executive order calling the Secretaries of Commerce and Treasury to form a sovereign wealth fund, but I didn’t know much more about that. Having read this piece, I’ve decided he wants a sovereign wealth fund because it sounds cool, not because it’s a strategic choice for our country. Countries like Norway and Singapore with sovereign wealth funds have them because they have more money than they know what to do with. So they choose to invest it. Us? We are $29T in debt. The Cato Institute (famously conservative/ libertarian thot tank) also thinks it’s a bad idea. Some think tariffs would inject capital into this fund. I imagine people willing to give Trump’s admin more control over their money would only consider it if it were fiscally strategic. The Economist states, “A state that taxes citizens or does not pay down debt in order to invest in risky assets should expect its borrowing costs to increase. Why should investors be happy with a 4% return on Treasuries if the government is chasing a 7% return in stocks?”

I like my investments where I can see them: Simmering in retirement accounts and CDs I never think about, or hard at work in mutual funds, ETFs, and sexy stocks I only look at when my financial advisor asks me what’s up. My money, my choice. But I can get behind it at the local level, for states like Alaska which has a wealth fund because they have MINERAL$sss. Even then, the ROI isn’t higher than that of private citizen investments. Did I miss the part where we found more natty resources on our land? No?

PULSE CHECK!

“Pulse Check” curates healthcare updates to complement the longer, more researched “On Health” pieces.

• The new baby boom is polygenic embryo screening, and the new arms race is embryo gene editing.

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Was Adam (of Adam and Eve fame) patient zero in the male loneliness epidemic? In this episode, the ladies chat about social isolation and welcome their first guest, Producer Paul, to introduce some y-chromies and testosterone into the mix. We focus on the medicalization of loneliness, friend tech, and other budding business solutions to commodify connection. Your loss is their [capital] gain.

SOURCES

https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf

https://www.belonginstitute.com/courses/2025-in-person-community-building-intensive-2

https://www.statista.com/topics/11644/loneliness-in-the-us/

https://www.scienceofpeople.com/loneliness-statistics/

https://abcnews.go.com/Health/500-cases-measles-reported-nationwide-19-states-cdc/story?id=120251851

https://fortune.com/2025/03/28/23andme-bankruptcy-chapter-11-genetic-data-medical-ancestry-dna-silicon-valley-delete/

https://www.cbsnews.com/news/colorado-psychedelic-mushrooms-healing-centers/

https://www.jnj.com/media-center/press-releases/u-s-fda-approves-tremfya-guselkumab-the-first-and-only-il-23-inhibitor-offering-both-subcutaneous-and-intravenous-induction-options-for-adult-patients-with-moderately-to-severely-active-crohns-disease

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Some drugs are not like other drugs, they’re special

Most oral pills and self-injected medications like Ozempic are simple to store and use. You pop a pill with or without food (read that label, girl!), chug some water, and move on. In the US, your pharmacy will either bill you or the insurer paying for your Pharmacy Benefits. Let’s call this the bill-and-dispense model. Often, these are pharmacy benefit managers like CVS Caremark or Cigna Express Scripts that want you to get their preferred formulary drugs from their preferred pharmacies. If you’re 65+, this is Medicare Part D. The D is for drugs.

Other medicines call for expertise from specialists like oncologists, rheumatologists, neurologists, dermatologists AKA cancer doctors, inflammatory disease doctors, brain doctors, and skin doctors. I’m spelling it out because this tweet went viral this week and I want us to be on the same page:

This matters because we’ve seen a shift from small-molecule drugs to oncology and rare disease biologics, a trend likely to grow with the Inflation Reduction Act. Complex drugs like Monoclonal Antibodies (mAbs) and their younger, more toxic, cousins Antibody Drug Conjugates (ADCs) need special handling. Healthcare providers personally administer specialty drugs to ensure quality control! Safety! Efficacy! This is because most oncology and other specialty drugs have precise storage requirements and must be given at exact doses and intervals with real-time patient monitoring to catch any bad reactions. Examples include: chemotherapy drugs, IV infusion therapies like Keytruda (Merck), and specialty injections like Ilumya (Sun Pharma of plaque psoriasis fame).

When your doctor or their clinical staff gives you a drug in their office, she/her practice has already paid pharma wholesalers/manufacturers for that drug up-front (buy). Then, she bills your medical benefits payer for both her service (administration) and the drug (bill). That’s why it’s called “buy-and-bill.” Billing this way helps clinicians offset the cost of administration, storage, and inventory control. If you’re 65+, this is charged to Medicare Part B and is exempt from typical formulary IN/OUT lists. With the “ASP + 6%” rule, Medicare pays the clinician back for the Average Sales Price of the drug, then adds 6% to cover overhead costs.

To put this into perspective, consider your local Bushwick Art Boy at La Cantine who still uses his parents’ credit card as a a buy-and-bill analogy. La Cantine buys coffee beans from La Colombe, sources seasonal ingredients from local farms, and keeps them stocked. He walks in, grabs a table, and orders his usual: a cortado and Poblano egg and cheese to stay. Once he’s done, the cafe bills his parents (insurance), who cover the cost, for the ingredients + service charge. This is like buy-and-bill: the cafe buys the beans and food upfront, then charges his parents’ credit card. If we wanted to look at pharmacy dispensing, it would be akin to pre-ordering/pre-paying coffee on the Starbucks Mobile App and picking it up when it’s ready.

Drug delivery for control freaks

So we know buy-and-bill allows for better drug quality control/integrity and administration. What are the other benefits?

• Drug Selection: Healthcare providers can recommend the best course of care/treatment based on patient needs, clinical presentation, and insurance coverage.

• Cost control: Providers get better control over the prices of drugs they give you. Buy-and-bill drugs may have lower patient cost-sharing since they’re not subject to typical formulary restrictions.

• Better access to quality care: Patients in rural areas may have better access to high-quality medicines when their clinicians stock these medicines vs relying on specialty pharmacies.

• Physician profit margins: Because they’re paid for both the drug and administration, clinicians earn more with this model.

Why does buy-and-bill have haters?

No drug distribution model is perfect—what are some concerns?

• Misguided incentives: Critics say buy-and-bill encourages clinicians to prescribe more expensive medications.

• Risky Business: Providers pay upfront for costly drugs, then wait for insurers to reimburse them. This is a higher financial risk as clinicians eat the cost if insurance denies payment.

• Inflated costs:

  • Site of administration: Where you get your drug matters. Hospital-affiliated outpatient clinics sometimes bill up to 100% more versus office-based practices. Legislators are hoping to address this through site-neutral policies.

  • Exploiting the 340B Program: The 340B drug discount program is a 90s girl, introduced so patients could access affordable drugs. The idea is that nonprofit hospitals and clinics that treat low-income patients for free (or at low costs) are community safety nets. 340b clinics/hospitals get deep discounts from pharmaceutical companies. Things get messy because 340b sites will still charge insurers/Medicare the full list price under buy-and-bill and pocket the difference.

It’s a mixed bag

Buy-and-bill is the most common drug distribution model for provider-delivered treatments. But payers + politicians increasingly prefer cheaper drug distribution and reimbursement models. Ultimately, it’s still about who gets control and who gets paid.

The most common alternatives shift payment away from healthcare providers to specialty pharmacies:

• White bagging: A specialty pharmacy (often selected by the payer/in-network) ships the prescription to your healthcare provider, who stores it until it’s time to treat you with the drug in their office or clinic. Insurers love this option, especially when they also own specialty pharmacies ;)

• Brown bagging: Mimics the traditional pharmacy model, where you can either pick up your drugs at the pharmacy or get them mailed to your home, then “brown-bag” them à la school lunch to your healthcare provider for administration.

  • I don’t think anyone actually likes this option. There’s no way to know how we (the patients) handle drugs before taking them to our doctors. What if I left it in my car in San Fernando Valley 100F heat? Even over-the-counter drugs face this issue. Look no further than benzoyl peroxide acne medications that can degrade into benzene (a known carcinogen) in extreme heat.

• Clear bagging: A fun third thing, where your provider’s in-house specialty pharmacy prepares and dispenses your drugs and walks them over to your physician for administration

Buy-and-bill faces headwinds

What can we expect in the drug distribution space?

Legislation: Many states have introduced legislation to address some of these concerns. Some, like Delaware and Ohio, block brown and white bagging practices. Other states, like Rhode Island, are trying to protect patients by limiting and regulating “white bagging.” Further, Congress and the FTC are exploring PBM regulation and the Inflation Reduction Act of 2022 includes updates to how Medicare pays for these drugs.

Market Consolidation: I’m a big fan of fellow healthcare blogger Adam J. Fein, PhD of Drug Channels Institute. He’s the only person I know flagging this upcoming trend: all signs point to wholesalers paying to play in the oncology buy-and-bill profits sandbox. Anticipating patent expiration for biologics, major wholesalers like McKesson, Cardinal Health, and Cencora bought up generics/biosimilars (generics for biologics) organizations, oncology group purchasing organizations, and provider groups. They’ve built this brick-by-brick with a little help from private equity.

Until next time.

xxsem

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In this week’s episode, we bring you a dispatch from AHAIC 2025 (Africa Health Agenda International Conference), take control of the bro-centric longevity conversation, and look into what the girligarchs are up to in the femtech space. What are the market opportunities in this billion-dollar industry? Who’s funding it? Will it impact our well-being or is this just a pink-washed cash grab? And why did it take so long to realize women are not just small men?

LINKS + SOURCES

Investment in health: www.weforum.org/stories/2023/01/davos2023-womens-health-rethinking-the-cost-as-an-investment-for-societal-gain

Gender gap in medical research: https://time.com/7171341/gender-gap-medical-research/ 

Antidepressant gender differences: https://pmc.ncbi.nlm.nih.gov/articles/PMC5286730/#:~:text=Factors%20that%20may%20contribute%20to%20sex%20differences%20in%20antidepressant%20efficacy.&text=A%20number%20of%20studies%20suggest,these%20studies%20has%20been%20disputed.

Women Spending Power: https://nielseniq.com/global/en/insights/analysis/2024/shaping-success-a-deep-dive-into-womens-impact-on-the-cpg-landscape/ 

FemTech Market: https://www.grandviewresearch.com/industry-analysis/femtech-market-report

Menopause Market: https://www.managedhealthcareexecutive.com/view/international-menopause-market-expected-to-reach-27-63-billion-by-2033 

VO2 max + longevity: https://www.jacc.org/doi/10.1016/j.jacc.2018.06.045

The threat to HIV care

The public health response to HIV/AIDS will go down in history as one of the field’s greatest hits. Globally, HIV-related causes of death (mortality) and new infections (incidence) are down, thanks to community activists, international collaboration, care providers, and drug makers who changed the HIV landscape. Yet, Massachusetts flagged a cluster of more than 200 new cases since 2018 while West Virginia, Indiana, and Ohio also faced HIV outbreaks. While HIV hasn’t been a death sentence since Gen Z entered the stage, our current US health policy climate threatens access to HIV care.

Over shared plates at Girl Dinner™ restaurants (see: Bar Valentina), friends share their concerns over cuts to HIV services in the US and abroad. The overall sentiment is that many people will die. PEPFAR, a George W. Bush program with strong bipartisan support that has saved 25 million lives and reached 20.5 million people via HIV testing and care access (including PrEP) is in jeopardy. DOGE also attacked USAID, which is a top player in tuberculosis prevention. This matters because USAID’s role in preventing infectious diseases around the globe also protects the US and tuberculosis is one of the top killers of people living with HIV. Our role in global health protects American interests. Sometimes, I feel like I have whiplash because the last iteration of Trump’s administration prioritized HIV prevention in the US. He even launched the Ending the HIV Epidemic (EHE) initiative, aiming to reduce new HIV infections by 75% by 2025 and 90% by 2030 by targeting the highest-burden regions and populations in the US. We’re nowhere near meeting this target, and it seems like his new admin has abandoned the program. I visited their website and found this notice:

My read of the Trump 2.0 Administration: They’re betting big on our collective amnesia. I’m resisting this by patronizing the arts and giving my time and money to causes close to my heart. But the data is on their side. While 90% of Americans say they know a bit about HIV, only 37% of Gen Z report being knowledgeable. Art and visibility matters when it comes to breaking stigmas and saving lives. We lost a large part of our cultural heritage as HIV/AIDS wiped out an entire generation of queer artists, dancers, and musicians. What more could visionaries like Alvin Ailey, Robert Joffrey, Michael Bennett, and Keith Haring have done? We’ve missed out, let’s not let this happen again.

In dialogue with Julian Donahue

As my tiny act of resistance, I attended last night's premiere of Cornfield Dance’s The Endless Ladder. Julian Donahue, a choreographer who happens to be one of my ballet teachers, performed. I took the opportunity to ask him about his upcoming one-man show, With Violets in her Lap. Here is an excerpt from our chat.

I’ll be at his fundraiser at Singer’s Bar on March 18th. If you want to say hi and buy me a drink, RSVP here.

Can’t make it? Call your representatives! And contribute to Julian’s show’s production here.

What inspired you to create this show? Was there a particular moment that sparked With Violets in Her Lap?

I had the original idea for this show 6 years ago, when I was still in college: a requiem for all the queer people lost to AIDS. But at that tender age I don't think I had the personal or artistic gravtias to tackle a project with such depth. I always say that art for me is like a buildup and a purge. An idea lives in me until it has gestated and begs, kicking and screaming, to come out into the world. Last year, I experienced the first serious push that now was the time. Then the 2024 election happened and this project became even more relevant and timely.

You describe the loss of the AIDS generation as a “void” in queer lineage. How has embodying that absence through dance changed your personal connection to queer history?

The void and I have a complicated relationship. The concept comes from a quote from queer architect Aaron Betsky: "The queerest space of all is the void, and AIDS has made us live in that emptiness, that absence, that loss... it is not a queer space any of us would want to inhabit, but many have been forced to make it their own." Early on in this project I experienced the void as a kind of absence of queer ancestry. A whole generation lost to AIDS that means younger queer people don't have as many queer mentors. But this project has brought me closer to so many queer people of all generations in my life, and many new friends. I'm conscious now that the void can be an illusion, there is still community. I'm also conscious that it's important to look deep into the void, because it's not just a black hole, each individual lost to AIDS is a uniquely shaped, and irreplaceable void in the world and the queer cultural fabric.

Can you talk about your process for choosing the music for this piece?

The original idea I had in college was to use Mozart's requiem. As I read more about AIDS and queer resistance it became very evident to me that this period was not all loss and depression, it was also joy, celebration, anger, desperation, relief, community. Listening to the requiem there are movements that sound like relief, or joy, or anger, not just sadness. I've always been fascinated by disco music because of it's association with joy and celebration. But there is a melancholic quality to disco. Often the lyrics are gut wrenching while the beat is dancey and uplifting. Sylvester died of AIDS in 1988, and on his deathbed thanked his fans and the queer community for giving him his life. This idea of life and death being closely related, mourning and celebration being almost the same act, is a foundational idea to this work.

You’ve drawn from a diverse range of movement styles—from Cecchetti ballet to Baroque and Renaissance dance. How are you weaving these influences together to tell this story?

The study of historical dance has taught me that our bodies carry history. This show makes the point that AIDS has left the queer community with a generational trauma. Even though the folks who died of AIDS in the 80s and 90s are not my biological ancestors, they are my cultural ancestors. Weaving together different dance styles helps show the audience the way our bodies can be vessels of different histories. For a very informed dance audience, viewers may notice specific allusions. For someone who isn't a dancer, one may see the collage aspect of my choreography: a lot of different styles in one big melting pot.

What was the most challenging part of embodying this history? Have any moments in rehearsal surprised you?

The most challenging part is taking on a subject that is traumatic to so many. I am keenly aware that this moment in history has deeply hurt so many people. The last thing I want to do is make people relive something they've closed the door on. But that's why it's so important for people to understand that this project is not a history. This project is a reflection on the way the AIDS crisis lives on in the queer community of today. As someone born in 1997, thought to be the last year of the AIDS crisis in the US, when protease inhibitors became widely available, I experienced AIDS as a slur, a bullying tactic. Growing up bullies would say "You're a fag. You're gonna die from AIDS." When someone close to me received a false positive diagnosis, on top of the difficulty of dealing with a medical system that didn't know how to proceed with that diagnosis, all the trauma of being told for years as a kid that this would be your death sentence came back like a flood. At the Works in Process showing, I showed two sections from the show and engaged in conversation with the audience. A surprising moment was the way talking about this work seemed healing for me and for audience members. Conversation will continue to be an integral part of this project

The show features an entr’acte by Lavender Menace. How does drag fit into your exploration of queer ancestry and memory?

I am fascinated by drag for its ability to link chaotic ideas by being both entertaining and confrontational. Drag also inspires me because it's an art form in which one artist comes to represent their community. Drag artists are often the loudest and most visible supporters of our community, which they accomplish by standing firmly in their individuality. As a one man show, this project takes a deep inspiration from that history of queer performance art.

This show isn't aiming to represent the AIDS crisis, but is instead your personal search for queer ancestors. How do you see that personal storytelling as a form of activism?

The AIDS crisis was a genocide of government inaction. The ultimate goal of genocide is not just to kill people, but to erase memory. Genocide is a losing game, because they can never kill memory. Memory lives in our bodies and in space. My life has been touched by the crisis: whether it be the bullies who use AIDS to threaten me with early death, whether it be the void in the fabric of queer lineage, whether it be the spectre of losing access to Prep and HIV funding today that would thrust us back into a full blown HIV/AIDS crisis. In college I studied dance and political science. This project has shown me once again how those two disciplines are connected. Putting on a show is an exercise in community building and community engagement. Telling this story through dance has been a deeply communal experience, building queer power through queer art. I owe so much inspiration to ACT UP, Gran Fury, the Marys, and drag artists.

The AIDS crisis profoundly affected the dance world, with choreographers and performers lost before their time. How do you think that loss still echoes in the dance community today?

One aspect of the void is cultural. V (formerly known as Eve Ensler) talks about how the AIDS crisis took out so many folks who existed on the fringes, who had radical ideas, who thought, acted, dressed, danced, differently. Sarah Schulman calls this the gentrification of the mind. We will never know those dancemakers who never got to show their masterpiece, or those dancers who never got to perform the role that would make them famous. Alvin Ailey's legacy is immense and impressive despite his untimely death, but how many more dancers and young choreographers could have been touched by him personally if he hadn't been taken from us? These are questions that will never be answered, and that's the void. It is a loss of life, a loss of culture, a loss of community, a loss of lineage.

What do you hope young people—especially those who may not have engaged deeply with this history—take away from your performance?

I hope they look into their lives and investigate how the AIDS crisis has affected their young lives. Gen Z people grew up in the spectre of all this death. We did not live it, but we grew up in the aftermath. The body knows that and feels that, and so it is a trauma waiting in us. I hope young folks, old folks, and everyone in between come to the shows, or to events leading up to the shows, and turn to their neighbors to hear their stories. March 18th we will have a fundraiser and consciousness raising celebration in Brooklyn at Singers Bar. And stay tuned for an April event in the works: an intergenerational conversation about AIDS, loss, and being queer in today's world.

As a Gen Z artist, how do you see your work contributing to the ongoing lineage of queer storytelling through dance?

I am beyond inspired by the guts of so many queer artists. Inspired by the drag artists and trans folks of the 1960s and 1970s who wore the clothes they wanted risking arrest; inspired by the Marys who refused to let the deaths of their friends be a silent mourning but instead brought the bodies into parks, into the streets, and to the front steps of a fundraiser for President Bush Sr.; inspired by Sylvester who made gut-wrenching and booty bumping music that spoke to life and death; inspired by John Kelly who spoke to me about fairy dust; inspired by all the queer artists who took to the streets and took action. Some parts of this project are gutsy, and I hope, humbly, that it encourages other Gen Z artists to be gutsy, loud, brash, and confrontational, because they're coming for us whether we like it or not.

Society has moved past the bootstrap girlboss era. We’re obsessed with sleepmaxxing and the business world has noticed. This week’s episode is all about R&R—no, not that kind. Re$$$t & Revenue. We start with a brief weather report on tech CEO ketamine slumber parties, RFK Jr. confirmation, and pharma drama, then discuss all things sleep. Cozy up and press play.

RESOURCES & REFERENCES

Weather Report

• Don’t Die Summit: https://fortune.com/well/article/bryan-johnson-tech-millionaire-dont-die-summit/

• Ketamine Slumber Parties: https://www.wired.com/story/ketamine-psychedelic-slumber-parties-tech-executives/ 

• MAHA Exec Order: https://www.whitehouse.gov/presidential-actions/2025/02/establishing-the-presidents-make-america-healthy-again-commission/

• Jury still out on glyphosate: https://www.nytimes.com/2025/02/19/well/glyphosate-health-cancer.html

• Trump Admin Bird Flu Blunder: https://www.nbcnews.com/politics/white-house/trumps-drive-reshape-government-threaten-bird-flu-response-rcna192133 

• Treating ADHD Lifespan: https://www.cnn.com/2024/03/12/health/adhd-medication-lower-risk-of-death-study/index.html 

Sleep Deep-Dive

• Business of sleep: https://www.axios.com/2024/01/13/sleep-tech-supplements-bedding-healthy

• Defining Sleepmaxxing: https://dailyconcept.substack.com/p/what-is-sleepmaxxing?utm_source=%2Fsearch%2Fsleep%2520hygiene&utm_medium=reader2

• Getting good sleep could add years to your life: https://www.acc.org/About-ACC/Press-Releases/2023/02/22/21/35/Getting-Good-Sleep-Could-Add-Years-to-Your-Life 

• Quality of Melatonin and CBD Gummies in US: https://jamanetwork.com/journals/jama/fullarticle/2804077

• Gallup Americans sleep less: https://news.gallup.com/poll/642704/americans-sleeping-less-stressed.aspx

• 40% of employees in a 4-day workweek trial reported fewer sleep issues: https://www.businessinsider.com/4-day-work-week-employees-report-decrease-insomnia-sleep-problems-2023-2#:~:text=40%25%20of%20the%20around%202%2C900,an%20increase%20in%20sleep%20issues. 

• Veteran Study: https://www.sciencedirect.com/science/article/abs/pii/S016503272101209X 

• Cost of Productivity, Obstructive Sleep Apnea: https://med.umn.edu/news/obstructive-sleep-apnea-hidden-health-crisis-america#:~:text=A%20recent%20study%20by%20the,%2C%20physical%2C%20and%20economic%20benefits 

• Zepbound FDA approved for sleep apnea: https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea 

• Sleep Trends: https://globalwellnessinstitute.org/global-wellness-institute-blog/2024/04/30/sleep-initiative-trends-for-2024/ 

• Big (Ultra-processed) Food’s response to Ozempic’s anti-hedonic effects

• Updates on women’s health: Halle Berry’s pivot into the area, DTC insurance for IVF guarantees a baby or your money back, and a surge in sepsis rates after Texas banned abortion

• Pharma Drama: Trump tries bullying Pharma to move drug development to the US (or else) and people are upset about Pfizer’s new Chief Medical Officer

• For the culture, I unpack my four-hour meal at NYC Gjelina and share thoughts (from the eyes of an untrained ballerina) on the many City Ballet performances I watched this month

WHAT I’M INTO

Press Play: “Spectrum” by Florence + The Machine

I thought about linking Kanye West’s Runaway music video with the Czech ballerinas dressed in black, but I’m having a one-sided beef with him right now. Instead, you get this beautiful David LaChapelle-directed video in which Florence commands a flock of ballerina swans. It’s a more fitting choice, given that I watched City Ballet’s Swan Lake this Friday.

Borrow from your local public library: Into the War by Italo Calvino

Here’s a short read to balance the long book I recommended last time. Three separate but linked stories set in Italy during the summer of 1940 depict life as an Italian teenager at the onset of WWII. If Into the War reads like journal entries, it’s probably because it’s autobiographical fiction. We know at the outset that Il Duce’s ideals don’t pass Calvino’s moral vibes test. Yet, while Calvino is too young for Mussolini’s fascist army, he is old enough to be recruited into a Fascist Youth Brigade (which he joins mostly because his friends are members). Instead of frontline war stories, we get the periphery of war from the lens of teenagers who were just young enough to avoid direct violence. They care more about flirting and having a good summer with their friends than winning or losing the war. But they feed the war machine regardless. On a Youth Brigade trip to the newly annexed Menton (that he tags along for the adventure), he’s disappointed to find “a France that was dead.” What affected me most about Into the War is how people behaved amidst the threat of Fascism. I regret to inform you that there are some foreboding parallels to today. Calvino perfectly captures how the public appeased proto-fascists, and complacency paved the way for horror when he writes about laying eyes on the baby-faced Il Duce for the first time:

“What struck me was how young he was; a boy, he seemed, just a boy, as fit as a fiddle…The war was here, the war he had declared, and he was in a car with his generals…And as though it were some sort of a game, he sought only the complicity of other people—not too much to ask—so much so that people were tempted to allow him it, in order not to spoil his party: in fact one almost felt a sting of remorse at knowing that we were more adult than he was, in not wanting to play his game.”

Anti-algorithm news: “Buy All This, Look Rich” by Chantal Fernandez

If you listened to the first episode of The Worried Well, you know I don’t buy into the illusion of affordable luxury. Goods are usually either accessible or luxurious. Chantal Fernandez’s deep dive into Quince’s shady practices is the most recent proof point in my favor. Despite competing with brands like Gap, Everlane, and Aritzia, Quince has never hired a fashion designer; it’s a soul-less dupes venture. Where does Quince come out ahead of brands like Shein? Their attempt to use natural fibers. But the poor workmanship and quality unravel the seams to expose Quince’s rotten core: data-scraping, green-washing, exploiting the de minimis tax exemption, and renegotiating contracts with factories “to a point where they say, ‘If I give you a cost that’s any lower than this, I will not be able to sell it to you.’”

PULSE CHECK!

“Pulse Check” curates healthcare updates to complement the longer, more researched “On Health” pieces.

Read more

Before I get to that, I have an update for you! In my mission to become God’s favorite Key Opinion Leader, I launched a podcast with two of my favorite healthcare business insiders: Emily C. + Ariana M. We called it The Worried Well, a term for those who are healthy but are preoccupied with fear of becoming ill. They’re well but suspicious about it. We all know them, and we all love them. Look no further than your friend who lives and dies by their Oura ring or attending the “Don’t Die Summit” at Javits Center today. Policymakers and insurance companies hate their healthcare resource utilization, but we can cover that later. You can listen to our first episode here if you’re on Spotify and here if you’re not. Onward!

So, why don’t we have national health insurance?

If your brain is fried or your attention span is short, the simple answer is that the American Medical Association (AMA) is to blame. But nothing happens in a vacuum. We don’t have universal healthcare because it’s not the American way. Our political system, economic priorities, cultural attitudes toward healthcare, and diverse population keep our ailing health system from flatlining. For decades, experts have warned that we spend far more on healthcare than other wealthy nations without seeing better health outcomes. While all rich countries invest more in healthcare per capita than low-income countries, we spend nearly 2x per person and have a lower life expectancy than other high-income countries. Many factors drive this: we are the richest (#1 by GDP, though we fall behind countries like Luxembourg + Switzerland when adjusted per person), have better, faster, stronger specialized health technologies, pay doctors more than other countries, and practice defensive medicine.

Is the American healthcare system just four cats under a trench coat?

Depends on who you ask! We have a mixed healthcare system of private and public (gov-funded) insurers and healthcare providers.

• We borrow from Germany’s Bismarck model for our employer-sponsored commercial insurance system and private care delivery. That’s when you get your insurance from your employer. They cover part of the cost and deduct a portion from your paycheck.

• We also have a tax-funded insurance that iterates on the British Beveridge model and covers the Veterans Health Administration, the Indian Health Service, and the Federal Bureau of Prisons.

• Some of us technically do have single-payer national health insurance, with the Centers for Medicare and Medicaid Services acting as the government payer for citizens 65 and older and/or disabled. Still, care is mostly delivered in private settings. Medicaid covers low-income earners and is jointly funded by states and the federal government. If you’re ever confused between the two, know that we care for the elderly—Medicare—and we aid the poor—Medicaid.

• Those not covered by the above fall under the out-of-pocket and/or uninsured model by default. When people who can’t afford health insurance but make too much money to qualify for Medicaid show up at Emergency Rooms and can’t cover their bills, they still receive tax-funded healthcare. As non-profit entities, hospitals don’t pay taxes, and our Federal taxes help hospitals offset their unpaid patient bills. However, continuity of care is expensive and harder to access (especially if they need referrals to specialists or higher-tech care). The Affordable Care Act (ACA) expanded Medicaid and subsidized Marketplace plans to lower the number of uninsured people, but we still had 25.3 million uninsured people in 2023. For reference, we had about 47 million uninsured people pre-ACA.

How did we get here?

Political priorities + interest group influence

Our sweet angel President Teddy Roosevelt (famously sympathetic to both business + labor) wanted health insurance for the working class. He failed to bring this dream to life, but he understood that investing in the health of American citizens was an economic investment in the country. After the Great Depression, President Franklin D. Roosevelt sought to expand social services through the Social Security Act. Although he wanted to include national health insurance, he deliberately omitted it to avoid jeopardizing the law’s passage.

World War II opened a national health insurance window of opportunity in the US. We elected the pro-national health insurance Harry Truman as President and equipped him with a Democratic-majority Congress at a time where public opinion on national health insurance was high. Truman, like others before him, understood that healthy human capital is priceless. Unlike his predecessors, he wanted single-payer, tax-funded health insurance for all. Truman’s plans failed due to a strong oppositional force that swayed public opinion by debasing nationalized healthcare as un-American and as socialism (Cold War America’s biggest fear).

The opposition in question? The American Medical Association. The AMA initially supported compulsory health insurance but quickly turned into its biggest hater. To counter Truman’s efforts, the AMA charged each member an extra $25 and used those funds to throw shade at national health insurance. This was an unprecedented political smear campaign designed to stop Congress from passing nationalized health insurance and steer Americans toward private, voluntary health insurance. The AMA framed nationalized healthcare as a threat to doctors’ profits and autonomy, which was ironic given that the AMA was founded to regulate medical labor and bring order to what was once the Chaotic Wild West of Medicine. Of course, the AMA’s efforts in licensing doctors and standardizing medical education have protected patients from harm, but physicians haven’t operated with complete autonomy since 1847. In a genius marketing ploy, the AMA framed private insurance as “freedom” (are you hearing the U-S-A chants, too, or is it just in my head?) and used mass advertising, physician outreach, and congressional lobbying to shift public opinion against national health insurance. We didn’t get Single-Payer For All, but we eventually got Medicare and Medicaid. One thing I like about this story is that when Lyndon B. Johnson signed Medicare into law, he honored Truman as “the real daddy of Medicare.”

Before we proceed, I’d like you to know that the AMA now has a more neutral stance on nationalized health insurance, as younger doctors are pushing back and gaining ground.

Population size + heterogeneity

In homogenous countries like Switzerland, where I (a mutt) can change the local race demographics by going on a work trip to Basel, achieving universal healthcare for their 8.8 million population is easier. In contrast, 340 million people of different races, ethnicities, and socioeconomic backgrounds live in the US. It may have been easier to convince people that nationalized healthcare fits within the American value system if we suspended racial and/or class bias.

Cultural attitudes toward healthcare

Culturally, Americans tend to value individualism and self-reliance. Most of you know that our European allies prioritized nationalized healthcare in post-war eras. While the UK was rolling out its National Health Service, the AMA was flipping public opinion—convincing middle-class Americans to buy privatized health insurance instead. This helped sew together the patchwork system we have today.

An old grad school professor of mine used to say that the “American medical-cultural nexus is ‘more is more.’” I think he was right. Americans demand the best care, the latest technology, and every available treatment. Is this possible in a nationalized system? Many Americans are skeptical that the government can run healthcare efficiently, which is obvious when I see celebratory tweets on the DOGE team weakening federal health agencies and freezing funds. This mindset makes health reform difficult and reinforces the status quo. When single-payer, tax-funded healthcare is painted as un-American, overhauling the system to help marginalized communities is a hard sell.

TL;DR:

We have a mixed healthcare system because of historical choices, public skepticism about government involvement, and corporate influence. I am hopeful that as more people start seeing population health as an investment, we will find ways to improve access to care for those who need it.

xxSEM

P.S., This is a letter to every one of you who ask me this question each month. I love your curiosity!

On the first episode, we dive into the booming world of longevity clinics.  What do they offer?  What’s the hype?  And why are Gen Z/millennials dropping serious cash on anti-aging?  We look into the rise (and fall!) of spots like Extension Health, Hooke, Modern Age, and Forward, the recent TikTok drama around Continuum, and what the broligarchs (think: Sam Altman, Jeff Bezos) are backing.  We also learn that Emily is bullish on hyperbaric oxygen tanks and that brain rot might be…fake news.  Is longevity the future?  Listen to find out. Resources and References:

• The Global Wellness Industry Is Now Worth $6.3 Trillion: https://archive.is/ydXjm

•  Article about Longevity Written in the Atlantic in 1928: https://www.theatlantic.com/magazine/archive/1928/05/the-secret-of-longevity/649408/

Defining what a longevity clinic actually is:

• The Longevity Clinic Will See You Now—for $100,000: https://www.wsj.com/health/longevity-clinics-aging-living-longer-2b98e773

• Modern Age has closed: https://beautymatter.com/articles/nyc-based-longevity-clinic-modern-age-to-close

F45 now also has GLP1s: https://insider.fitt.co/issue-no-282-gym-as-clinic/

Neko Health, the body-scanning AI health startup from Spotify’s Daniel Ek, opens in London: https://www.nekohealth.com/se/en/neko-health-raises-260m-series-b