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Aaron Kesselheim

@akesselheim.bsky.social
665 followers 68 following 81 posts

Professor of Medicine, Brigham and Women's Hospital/Harvard Medical School; Director, Program On Regulation, Therapeutics, And Law (PORTAL)

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Aaron Kesselheim @akesselheim.bsky.social · 14/09/2026
New in @thelancet.com let by T Hwang and K Vokinger, MFN drug pricing in the US would lower prices, with reductions in spending greater than net sales in some countries (but implementation is far away, legally tenuous, and subject to back-room deals/exclusions). www.thelancet.com/journals/lan...
thelancet.com
Most-favoured-nation pricing for prescription drugs in US Medicare: a cohort study
Most-favoured-nation pricing for brand-name medicines in Medicare was projected to decrease net spending. Potential reductions in net Medicare spending would be substantially greater than sales in the...
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Aaron Kesselheim @akesselheim.bsky.social · 11/08/2026
New from Sean Tu and I in @bmj.com -- the ethical and legal problems with the FDA's practice over the last 18 months of 'policy by publication': www.bmj.com/content/394/...
bmj.com
Pitfalls of announcing regulatory policy in medical journals
Sean Tu and Aaron Kesselheim argue that sidestepping established administrative processes to announce major regulatory policies undermines transparency, public participation and trust, and regulatory ...
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Aaron Kesselheim @akesselheim.bsky.social · 10/06/2026
New in Pediatrics led by @benro.me and John Kim showing increase in leucovorin use after FDA statements/publicity: publications.aap.org/pediatrics/a...
publications.aap.org
Use of Leucovorin After the FDA Announcement of Its Use for Autism Spectrum Disorders
BACKGROUND AND OBJECTIVES. Leucovorin, or folinic acid (vitamin B9), is approved by the Food and Drug Administration (FDA) to reduce adverse effects from antifolate cancer treatments including methotr...
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Aaron Kesselheim @akesselheim.bsky.social · 23/05/2026
From FactCheck.org -- do RFK's claims of record-breaking new FDA review speeds hold up? Uh, no. www.factcheck.org/2026/05/rfk-...
factcheck.org
RFK Jr.’s Muddled Claims on Drug Approval Speed - FactCheck.org
The Food and Drug Administration in recent months has approved a small number of drugs quite quickly under a new expedited review program. But Health and Human Services Secretary Robert F. Kennedy Jr....
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Aaron Kesselheim @akesselheim.bsky.social · 19/05/2026
New from Jerry Avorn and myself in @healthaffairs.bsky.social Forefront: Healing Our De-Commissioned FDA. Marty Makary's legacy will be that he undercut key principles that had made the FDA one of the most important public health institutions in the world. www.healthaffairs.org/content/fore...
healthaffairs.org
Healing Our De-Commissioned FDA | Health Affairs Forefront
Marty Makary's legacy will be that he undercut many of the key principles that had made the agency one of the most important public health institutions in the world.
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Aaron Kesselheim @akesselheim.bsky.social · 16/03/2026
PORTAL made it to the STAT Madness Sweet Sixteen for best innovation in science/medicine of 2025! Now we're up against the formidable UC-Irvine Blind Mice. Vote here to ensure PORTAL gets to the next round: www.statnews.com/feature/stat...
statnews.com
2026 STAT Madness
2026 bracket Welcome to STAT Madness, a bracket-style contest to find the best innovation in science and medicine. Explore groundbreaking innovations from
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Aaron Kesselheim @akesselheim.bsky.social · 10/03/2026
Still dancing! By fewer than 2 (percentage) points, made it to the Round of 32 and now we're facing off against the Scripps Rhinos. Once again, vote early and vote often for PORTAL in STAT Madness here: www.statnews.com/feature/stat...
statnews.com
2026 STAT Madness
2026 bracket Welcome to STAT Madness, a bracket-style contest to find the best innovation in science and medicine. Explore groundbreaking innovations from
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Aaron Kesselheim @akesselheim.bsky.social · 02/03/2026
Vote for PORTAL in the STAT Madness contest for best scientific "innovation" of 2025: discovering improper drug patents listed w/ FDA that FTC later forced mfrs to delist, helping timely generic availability (under MGB logo on the lower right bracket at the bottom): www.statnews.com/feature/stat...
statnews.com
2026 STAT Madness
2026 bracket Welcome to STAT Madness, a bracket-style contest to find the best innovation in science and medicine. Explore groundbreaking innovations from
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Aaron Kesselheim @akesselheim.bsky.social · 21/02/2026
This is just needless, self-destructive, and problematic as regulatory policy. Also there never was and isn’t a two trial “dogma.” Bad headline, NEJM. www.nejm.org/doi/full/10....
nejm.org
One Pivotal Trial, the New Default Option for FDA Approval — Ending the Two-Trial Dogma | NEJM
This Sounding Board announces a new FDA policy that the default requirement for FDA approvals will be one robust pivotal trial plus confirmatory evidence, rather than two trials.
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Aaron Kesselheim @akesselheim.bsky.social · 19/02/2026
Great coverage of Joseph Daval and my article in JAMA on the highly problematic new FDA use of “expert panels”: www.raps.org/news-and-art...
raps.org
Experts argue recent FDA expert panels may violate FACA requirements
The US Food and Drug Administration@s (FDA) increasing reliance on holding expert panels, rather than advisory committees, for external expert advice may violate the Federal Advisory Committee Act (FA...
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Reposted by Aaron Kesselheim
Marita Hennessy @maritahennessy.bsky.social · 08/01/2026
Stigma, Scarcity & the Price of Legitimacy: Chronic Pain Advocacy & the Politics of Pharmaceutical Partnerships in Canada Daniel Eisenkraft Klein, Benjamin Hawkins, Quinn Grundy, Robert Schwartz onlinelibrary.wiley.com/doi/full/10.... I think findings here potentially transferable to obesity...
onlinelibrary.wiley.com
Stigma, Scarcity and the Price of Legitimacy: Chronic Pain Advocacy and the Politics of Pharmaceutical Partnerships in Canada
This study examines how chronic pain advocates in Canada navigated fraught relationships with pharmaceutical companies amid escalating concerns about the adverse public health impacts of opioids. Dra...
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Aaron Kesselheim @akesselheim.bsky.social · 21/11/2025
With the problematic national priority review voucher in the news again today (FDA staff not involved in decisionmaking? Really?), here’s our overview of how it opens the FDA up to corruption and moves us further and further away from “gold standard” reviews: www.statnews.com/2025/11/21/f...
statnews.com
The Trump administration is turning drug review into make-a-deal
“FDA decision-making may be reduced to a sequence of ‘make-a-deals’ with Trump, his FDA, or even political allies,” experts warn.
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Aaron Kesselheim @akesselheim.bsky.social · 31/10/2025
What he said
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Mark Lemley @marklemley.bsky.social · 22/09/2025
I filed an amicus brief on behalf of 24 professors challenging the interim PTO director's illegal policy of blocking IPRs for any patent that is more than a few years old. drive.google.com/file/d/1NhrG...
drive.google.com
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Aaron Kesselheim @akesselheim.bsky.social · 13/09/2025
Reprint of my Substack with @ylepidemiologist.bsky.social today in @statnews.com. Check it out if you’re interested in recent “moves” the FDA is making on drug ads. As with most claims this admin makes … IBIWISI: www.statnews.com/2025/09/13/p...
statnews.com
9 answers to burning questions about pharmaceutical ads
Got questions about the FDA’s new plans around pharmaceutical ads? We’ve got answers.
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Aaron Kesselheim @akesselheim.bsky.social · 10/09/2025
Another fun collaboration with @ylepidemiologist.bsky.social in Substack with a post on DTC drug ads and the new administration announcement claiming to seek greater enforcement: yourlocalepidemiologist.substack.com/p/pharmaceut...
yourlocalepidemiologist.substack.com
Pharmaceutical ads in the U.S.: Top questions answered
The Administration's order and what can actually be done
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Aaron Kesselheim @akesselheim.bsky.social · 09/08/2025
CBER bein’ like
media.tenor.com
homer simpson says that 's bad in front of a bookshelf
ALT: homer simpson says that 's bad in front of a bookshelf
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Yale CRRIT @yalecrrit.bsky.social · 21/07/2025
High brand-name drug prices fall once a generic enters the market. In a new @journalgim.bsky.social article, Ravi Gupta, CRRIT Co-Director @jsross119.bsky.social, and colleagues from @portalresearch.org assess associations between patents, revenue, and generic competition.
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Aaron Kesselheim @akesselheim.bsky.social · 13/07/2025
Superman. See it.
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Aaron Kesselheim @akesselheim.bsky.social · 04/07/2025
New @healthaffairs.bsky.social Forefront covering the recent EOs on drug prices and tariffs -- little good news for prices or access -- www.healthaffairs.org/content/fore...
healthaffairs.org
Trump’s Ongoing Tariff Chaos Will Make Medications Less Affordable And Harder To Find | Health Affairs Forefront
In his first term, Trump made a lot of noise about lowering drug prices but accomplished little of consequence. The noise continues, but it is now accompanied by new ill-conceived initiatives, includi...
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Aaron Kesselheim @akesselheim.bsky.social · 04/07/2025
New PORTAL Post from @portalresearch.org for June. Sign up to receive these directly to your inbox! mailchi.mp/eb7d1808132b...
mailchi.mp
PORTAL Post | July 2025
New faculty members, the ORPHAN Cures Act, “hyaluronidase hopping,” and more from PORTAL
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Aaron Kesselheim @akesselheim.bsky.social · 04/07/2025
Unrecorded manipulation of large datasets has been common in the US government since Trump's election -- bad for science, trust, and transparency -- in @thelancet.com from Janet Freilich and myself: www.thelancet.com/journals/lan...
thelancet.com
Data manipulation within the US Federal Government
A US Department of Veterans Affairs dataset compiling veteran health-care use in 2021 was quietly amended on March 5, 2025. A column titled gender was renamed sex, and the words were also switched in ...
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Aaron Kesselheim @akesselheim.bsky.social · 28/06/2025
Language is now back in the Senate version of the OBBA that would undermine Medicare price negotiation for drugs with Orphan Drug Act designation. Here's our HA Forefront published yesterday (!) from Helen Mooney and @benro.me on why it is a very bad idea: www.healthaffairs.org/do/10.1377/f...
healthaffairs.org
Congress Should Remove The Rare Disease Carve-Out From Medicare Drug Price Negotiation, Not Expand It | Health Affairs Forefront
Expansion of the Medicare drug price negotiation rare disease drug carve-out would unnecessarily limit the number of drugs eligible for negotiation, allow for continued high drug prices for products that earn billions of dollars in Medicare, and introduce a new set of misaligned incentives.
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Aaron Kesselheim @akesselheim.bsky.social · 26/06/2025
New in @jama.com, Joseph Daval and I discuss legal issues surrounding ACIP including its role in setting government policy and dealing with politically-motivated agendas arising from its new membership: jamanetwork.com/journals/jam...
jamanetwork.com
Legal Challenges for the Advisory Committee on Immunization Practices
This Perspective offers an analysis of the legal foundations in the context of these and other challenges to the role of the Advisory Committee on Immunization Practices.
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Aaron Kesselheim @akesselheim.bsky.social · 11/06/2025
Thanks to the 2024 peer reviewers for @jlme-journal.bsky.social, with a list here: www.cambridge.org/core/journal...
cambridge.org
Thank You to Our 2024 Peer Reviewers | Journal of Law, Medicine & Ethics | Cambridge Core
Thank You to Our 2024 Peer Reviewers
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Aaron Kesselheim @akesselheim.bsky.social · 15/05/2025
I helped Your Local Epidemiologist answer some of her pressing Substack subscriber questions on drug prices. yourlocalepidemiologist.substack.com/p/your-top-1...
yourlocalepidemiologist.substack.com
Your top 10 FAQ on drug prices
Some clarity for this wildly confusing topic.
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Aaron Kesselheim @akesselheim.bsky.social · 08/05/2025
New Health Affairs Forefront post on the Medicare negotiation "biologic bonus" and the massive financial hit to patients and the health care system of delaying small molecule negotiation from 9 to 13 years, led by Chris Cai and @benro.me: www.healthaffairs.org/content/fore...
healthaffairs.org
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Aaron Kesselheim @akesselheim.bsky.social · 24/04/2025
New op-ed with @drjoshs.bsky.social and Peter Lurie about the agenda-driven reality of 'radical transparency' -- www.washingtonpost.com/opinions/202...
washingtonpost.com
Opinion | It’s not hard to see through RFK Jr.’s ‘radical transparency’ pledge
So far, what’s been released is little more than tactics in pursuit of Kennedy’s own agenda.
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Aaron Kesselheim @akesselheim.bsky.social · 07/03/2025
Interesting new op-ed! Very proud of Max: thehill.com/opinion/5180...
thehill.com
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Aaron Kesselheim @akesselheim.bsky.social · 16/02/2025
Analysis from former @portalresearch.org fellow Catherine Hwang and @benro.me showing the extent of out-of-pocket costs associated with starting brand-name Entresto over ACEI/ARB for heart failure and implications for overall spending: jamanetwork.com/journals/jam...
jamanetwork.com
Spending After Sacubitril-Valsartan vs Renin-Angiotensin System Blockers for Heart Failure
This cohort study assesses health care costs after initiating sacubitril-valsartan compared to an angiotensin-converting enzyme inhibitor or an angiotensin II receptor-blocker in Medicare patients bei...
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Aaron Kesselheim @akesselheim.bsky.social · 16/02/2025
New in @nejm.org from Peter Ubel, Astrid Grouls and myself on "financial toxicity" and how to consider it in the context of new drugs @portalresearch.org: www.nejm.org/doi/abs/10.1...
nejm.org
Out of Pocket Getting Out of Hand — Reducing the Financial Toxicity of Rapidly Approved Drugs | NEJM
The FDA often exercises flexibility in deciding whether to approve highly promising drugs for patients in desperate need of treatment options. But it doesn’t consider a drug’s likely financial toxi...
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Aaron Kesselheim @akesselheim.bsky.social · 14/02/2025
Survey of clozapine prescribers shows satisfaction with the REMS but desire for more educational info, led by @asarpatwari.bsky.social & team at @portalresearch.org in collab with FDA, where world class scientists are sadly being censored and forced out of their jobs: jamanetwork.com/journals/jam...
jamanetwork.com
Physician Experiences With and Perspectives on Clozapine Prescribing
This survey study examines physician-prescriber experiences with and perspectives on the clozapine risk evaluation and mitigation strategy.
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Aaron Kesselheim @akesselheim.bsky.social · 14/02/2025
Interesting use of modeling to predict the timing of patent challenges seeking generic drug entry in PLoS Medicine, led by Ally Memedovich and @portalresearch.org faculty affiliate Reed Beall at Univ Calgary - journals.plos.org/plosmedicine...
journals.plos.org
Predicting patent challenges for small-molecule drugs: A cross-sectional study
Ally Memedovich and colleagues report on patent challenges within the first year of eligibility among small-molecule drugs approved by the FDA from 2007-2018 and investigate the extent to which market...
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Aaron Kesselheim @akesselheim.bsky.social · 10/02/2025
media.tenor.com
a philadelphia eagles logo with the words " it 's a win " below it
ALT: a philadelphia eagles logo with the words " it 's a win " below it
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Melissa Barber @mbarber.bsky.social · 07/02/2025
Feels v strange to post a paper this week, but @akapczynski.bsky.social, Trudel Pare, Sahil Agrawal, and I wrote a legal roadmap to help states win (and defend) public pharma initiatives. We've sent it out, so law review folks- check your inboxes! #lawsky papers.ssrn.com/sol3/papers....
Abstract: The U.S. market for prescription drugs is failing many Americans. Drug prices in the U.S. are nearly three times higher than in comparable countries, and evidence shows that patients regularly forego essential medicines because they cannot afford them. Additionally, shortages of important medicines are common. In partial response, California recently passed a law to enable public manufacture and distribution of medicines, starting with insulin, a drug needed by millions of diabetics in the state. Many other states, as well as the federal government, are considering similar action to drive down prices of older drugs and to help resolve shortages.  Public production could yield important benefits, but there are legal obstacles to overcome at every step, from developing the product at the bench to getting it to the patient. This Article maps the primary legal and logistical issues these programs will face and describes how they can be overcome. We focus most of our attention on a major challenge that has not yet been properly described: even if states succeed in manufacturing affordable, high-quality drugs, how can they ensure that the drugs will actually reach the millions of patients who need them? After all, private, generic manufacturers already struggle to enter the market and distribute cheaper alternatives. We propose that states can succeed in ways that private entities cannot because they have unique legislative and regulatory mechanisms to counteract the concentrated power of market intermediaries. Using tools like mandatory contracts and regulatory requirements that require middlemen to carry publicly produced medicines, states can facilitate market entry and ensure that the maximum number of patients can access low-cost public products. This bottleneck, therefore, provides a further justification for public pharma—it can not only mitigate drug pricing and access issues, but possibly improve market access for private firms too.
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Reposted by Aaron Kesselheim
Program On Regulation, Therapeutics, And Law (PORTAL) @handle.invalid · 06/02/2025
Check out the February edition of the PORTAL Post, featuring analysis on: - the promise and risk of drug repurposing, - drug importation to address shortages, - use of subgroup analysis in cost-effectiveness studies - biosimilar patent litigation, - and much more! #medsky #healthpolicy
mailchi.mp
PORTAL Post | February 2025
Protecting health agency independence, drug repurposing, academic detailing, and more from the PORTAL team.
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Aaron Kesselheim @akesselheim.bsky.social · 04/02/2025
Criticism of the QALY includes the idea that it'll be used to limit drug access to patient subgroups, but @araymakers.bsky.social shows in J Cancer Policy that no evidence of QALYs in cancer drugs being used to do that -- from @portalresearch.org: www.sciencedirect.com/science/arti...
sciencedirect.com
An empirical investigation into concerns over quality-adjusted life-years: a review of cost-effectiveness analyses in oncology
Health care payers often use cost-effectiveness analyses (CEA) using the quality-adjusted life-year (QALY), as the measure of benefit, to inform reimb…
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Aaron Kesselheim @akesselheim.bsky.social · 04/02/2025
Use of Doxepin for insomnia -- example of potentially useful drug repurposing that seems to be under-prescribed among patients who could benefit because of a problematically high pricing point -- from Chris Cai and @benro.me at @portalresearch.org: jamanetwork.com/journals/jam...
jamanetwork.com
Trends in Fills, Spending, and Prices of Doxepin for Insomnia
This cross-sectional study explores US prescription fills, retail spending, and prices of low-dose doxepin for insomnia and the possible cost savings to patients had they used liquid doxepin, a less e...
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Aaron Kesselheim @akesselheim.bsky.social · 31/01/2025
New in @jlme-journal.bsky.social from co-first authors Liam Bendicksen and Mirre Scholte as well as others at @repo4eu.bsky.social, a review of results from research and roundtables on regulatory pathways for drug repurposing in the US & EU: www.cambridge.org/core/journal...
cambridge.org
A Regulatory Roadmap for Repurposing: Comparing Pathways for Making Repurposed Drugs Available In The EU, UK, And US | Journal of Law, Medicine & Ethics | Cambridge Core
A Regulatory Roadmap for Repurposing: Comparing Pathways for Making Repurposed Drugs Available In The EU, UK, And US - Volume 52 Issue 4
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Aaron Kesselheim @akesselheim.bsky.social · 31/01/2025
New piece led by Anushka Bhaskar @portalresearch.org in STAT First Opinion on protecting public health agencies from damaging political interference -- even the threat of which can greatly affect people's behavior: www.statnews.com/2025/01/31/p...
statnews.com
How to protect HHS, FDA, NIH, and other health agencies from political interference
When politicians subordinate scientific institutions to electoral interests, they undermine immediate public health efforts and inflict lasting damage on institutional credibility.
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Aaron Kesselheim @akesselheim.bsky.social · 29/01/2025
From Rosa Ahn-Horst @portalresearch.org -- psychiatric drug innovation over the last decade shows widespread use of clinical endpoints but few new mechanisms of action and 3/16 drugs for which < half the trials submitted to FDA were positive (in JAMA Network Open): jamanetwork.com/journals/jam...
jamanetwork.com
Trials Preceding FDA Approval of Novel Psychiatric Drugs
This cross-sectional study reports on the study design characteristics of clinical trials for novel psychiatric drugs approved by the US Food and Drug Administration.
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Aaron Kesselheim @akesselheim.bsky.social · 27/01/2025
Dark times for science. Proud of my colleagues at JLME for speaking up: www.statnews.com/pharmalot/20...
statnews.com
'This is censorship': Trump freeze on communications forces medical journal to pull HHS authors' article
The article had to be pulled even though HHS Office of Research Integrity officials gave a public talk on the topic last fall
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Reposted by Aaron Kesselheim
The Journal of Law, Medicine and Ethics @jlme-journal.bsky.social · 26/01/2025
Due to the Trump administration freeze on communication from government agencies, an article JLME planned to publish this spring on research misconduct has been placed on hold. Read more: www.statnews.com/pharmalot/20...
statnews.com
'This is censorship': Trump freeze on communications forces medical journal to pull HHS authors' article
The article had to be pulled even though HHS Office of Research Integrity officials gave a public talk on the topic last fall
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Aaron Kesselheim @akesselheim.bsky.social · 09/01/2025
Also out this week a review of new EU pharma policies and their potential impact on repurposed drugs with the excellent Mirre Scholte and Manuela Joore who are collaborating with @portalresearch.org on the REPO4EU project: pubmed.ncbi.nlm.nih.gov/39756647/
pubmed.ncbi.nlm.nih.gov
Revising EU pharmaceutical legislation: will it foster drug repurposing? - PubMed
Repurposing off-patent drugs can be a potential source of low-cost treatments for patients with unmet medical needs. Here, we review the proposed new European Union (EU) pharmaceutical legislation in ...
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Aaron Kesselheim @akesselheim.bsky.social · 09/01/2025
In @nejm.org this week led by @tombollyky.bsky.social with Sarosh Nagar of @portalresearch.org and Chloe Searchinger - how a rational regulatory approach to supporting importation of generic drugs can be used to respond to essential medicine shortages: www.nejm.org/doi/full/10....
nejm.org
The Role of Importation in Remediating U.S. Generic Drug Shortages | NEJM
U.S. shortages of critical drugs are a worsening problem, and the FDA has been too slow to authorize temporary importation of drugs from other well-regulated markets to meet pressing U.S. needs.
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Aaron Kesselheim @akesselheim.bsky.social · 09/01/2025
Congrats to former @portalresearch.org fellow Hussain Lalani for having one of the most-read articles in JAMA Health Forum in 2024: read.alerts.jamanetwork.com/csb/Public/s...
read.alerts.jamanetwork.com
Most Viewed Articles 2024
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Aaron Kesselheim @akesselheim.bsky.social · 30/12/2024
Dry powder inhaler shows similar effectiveness and safety to metered-dose inhaler, w numerous implications including that environmentally-friendly prescribing in this case is also clinically equivalent -- led by @wbfeldman.bsky.social of @portalresearch.org in BMJ: www.bmj.com/content/387/...
bmj.com
Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: new user cohort study
Objective To compare the effectiveness and safety of budesonide-glycopyrrolate-formoterol, a twice daily metered dose inhaler, and fluticasone-umeclidinium-vilanterol, a once daily dry powder inhaler,...
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Reposted by Aaron Kesselheim
OncoDaily @oncodaily.bsky.social · 24/12/2024
The case of cancer drug Xtandi - Bishal Gyawali @akesselheim.bsky.social @jama.com oncodaily.com/science/bish... #Cancer #CancerPolicy #JAMAOncology #OncoDaily #Oncology #Xtandi
oncodaily.com
Bishal Gyawali: The case of cancer drug Xtandi - OncoDaily
Bishal Gyawali: The case of cancer drug Xtandi / Aaron S. Kesselheim, Bishal Gyawali, cancer, Cancer Policy, Emily H. Jung, Helen Mooney, JAMA Oncology, Jerry
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Aaron Kesselheim @akesselheim.bsky.social · 24/12/2024
Comments for great CNN health reporter Meg Tirrell on new independent generic liraglutide @portalresearch.org: www.cnn.com/2024/12/23/h...
cnn.com
FDA approves generic GLP-1 drug, a daily injection, for people with type 2 diabetes | CNN
The US Food and Drug Administration on Monday approved a generic version of the daily injectable GLP-1 medicine liraglutide for people with type 2 diabetes, opening the door for lower-priced options t...
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Aaron Kesselheim @akesselheim.bsky.social · 23/12/2024
Let's get it passed (next yr)!: @portalresearch.org led by Alex Egilman, @benro.me, and Bryan Walsh cited as basis for bipartisan Skinny Labels, Big Savings Act (www.hickenlooper.senate.gov/wp-content/u...) from Sens Hickenlooper, Cotton, Welch, Collins: www.hickenlooper.senate.gov/wp-content/u...
hickenlooper.senate.gov
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