iiinova — where your digital self keeps evolving

Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 29/11/2025

I just saw Nuremberg and it reminded me that we used to be a nation of ardent Nazi killers. Let’s make America great again.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 15/12/2024

You can’t make this shit up. 🎁 www.nytimes.com/2024/12/13/u...

This is an image of an article featuring Mitch McConnell, identified as a Republican leader and a polio survivor. The headline reads, “McConnell Defends Polio Vaccine, an Apparent Warning to Kennedy.” The article quotes him as saying, “Efforts to undermine public confidence in proven cures are not just uninformed — they’re dangerous.” The photo accompanying the article shows Mitch McConnell with a serious expression, wearing glasses and a suit.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 13/12/2024

Voters who supported Trump don’t understand —and won’t for years— that they voted against their economic self-interest. David Welch’s “Politics and Propaganda in the Third Reich” explains how the Nazi’s did the same. I wrote about it here.

open.substack.com

Propaganda’s Power: Nazi Germany and the Trump MAGA Movement

Reinforcing Beliefs, Silencing Dissent, and Justifying Retaliation

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Doctor David @doctordavid.bsky.social · 13/12/2024

That's their playbook. It's disgusting, self-serving, and harmful to us all.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 12/12/2024

I published this editorial November 2017. Title: In the U.S. “Healthcare” Is Now Strictly a Business Term 1/

pmc.ncbi.nlm.nih.gov

In the U.S. “Healthcare” Is Now Strictly a Business Term

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Alice Han @dralicehan.bsky.social · 11/12/2024

It’s so frustrating! Honestly, I try to find any other way than to deal with the insurance company. Often times, it’s @costplusdrugs.com if they have it. These companies bank on us not having the time to do this. This creates more physician burnout than anything else I think

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Gabriel Bosslet @gbosslet.bsky.social · 11/12/2024

Want a specific example of the death by a thousand cuts that is #PriorAuthorization? Here is an example from yesterday in clinic A short 🧵 I get a note in my inbox that a patient of mine was denied inhaled budesonide for their asthma 1/

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 11/12/2024

Good read by @walkerbragman.bsky.social. Nobody likes their health insurance company. Health insurers have a fiduciary responsibility to their shareholders, not policyholders, aka Americans. That's antithetical to any healthcare system.

sunshine.optout.news

Murder in the First World

The murder of a healthcare executive has many…cheering?

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Paul Offit @pauloffit.bsky.social · 07/12/2024

Do we really want a liar and conspiracy theorist as our next head of HHS? Great 30-minute video. Please repost far and wide.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 02/12/2024

seems like they are not aware of, or think $2 trillion in budget cuts — historically known as economic “shock therapy” — will not affect their social security and Medicare (and maybe Medicaid) benefits? Elon told them it’s going to lead to some “hardship.”

At a virtual town hall event Friday held on Musk's social media platform, X, the multibillionaire Tesla and SpaceX executive said he was "praying for a victory" for Trump, so he could begin working in a high-level Cabinet role to axe federal spending.
"We have to reduce spending to live within our means," Musk said. "And, you know, that necessarily involves some temporary hardship, but it will ensure long-term prosperity."

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 07/12/2024

“Let it burn. That’s what people wanted.” This common explanation is untrue and requires us to step back and see the bigger picture. You can’t fight what you don’t understand. I’ll use an example to prove my point. Watch this short video then come back to this 🧵. x.com/HeartlandSig... 1/

x.com

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🦋Dr. Natalia🕊🌻🪬 @solnatamd.medsky.social · 07/12/2024

There is time to be silent & there is time to speak up. Sucking up to dictators will quickly turn the practice of medicine into Nazi-type medicine. Do academics recommend we stay silent, follow the orders & experiment on people just like German Medical Association did?

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 07/12/2024

The other night in the emergency department, I saw a woman in her 30s who came in complaining of ongoing coughing. She explained that she had been diagnosed with pertussis (whooping cough) back in August and now wanted help managing her symptoms.

open.substack.com

The Erosion of Empathy in the ER

Reflections on Preventable Illness in a Broken System

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 05/12/2024

Trump’s return to the White House w Republican control of Congress may end Affordable Care Act’s Medicaid expansion. Nine states—Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia—have trigger laws to end their expansion if federal funding decreases.

kffhealthnews.org

9 States Poised To End Coverage for Millions if Trump Cuts Medicaid Funding - KFF Health News

About 3.7 million people are at immediate risk of losing health coverage should the federal government cut funding for Medicaid expansions, as some allies of President-elect Donald Trump have proposed...

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 22/10/2024

Medical Science Under Dictatorship A warning by Dr. Leo Alexander chief medical advisor to the Chief of Counsel for War Crimes, Nuremberg, United States Zone of Germany, 1946-1947. restoringourheritage.com/articles/nej...

open.substack.com

Medical Science Under Dictatorship

A Stark Warning Against the Perils of Politicizing Medicine and the Erosion of Ethics

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 03/11/2024

Our system fails patients regularly. I believe it’s due to corporations and private equity firms buying the majority of physician groups, especially recently. Their policies strip physicians of our autonomy, violate the AMA Code of Medical Ethics and Corporate Practice of Medicine state laws.

The graph titled “Physician Employment Trends (1980-2023)” illustrates the percentage of employed physicians (as opposed to those who are self-employed) in the United States from 1980 to 2023. The x-axis represents the years from 1980 to 2023, while the y-axis represents the percentage of employed physicians, ranging from 0% to 80%.

Key features highlighted in the graph include:

1. Sharp Increase Post-2000: After the year 2000, there is a notable upward shift in the percentage of employed physicians, marking a steeper growth rate in employment trends.
2. Fastest Growth Period: Between approximately 2015 and 2023, there is an even sharper increase, indicating the fastest growth period for physician employment during this time.

Overall, the trend line is consistently upward, starting from around 20% employed physicians in 1980 and reaching just over 70% by 2023. This shift reflects a significant change in physician employment patterns over the past four decades, with an accelerating trend towards employment rather than self-employment among physicians.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 02/12/2024

“…according to the message sent by Catherine Su, a radiation oncologist married to Jay Bhattacharya, the Stanford professor of medicine leading the study. the study came under fire… it was based on a heavily flawed data analysis that ignored questions about the antibody test’s false positive rate”

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CalMatters @calmatters.org · 25/11/2024

RFK Jr. was a key figure in protests over California vaccine laws. He could set U.S. health policy in the Trump administration. cal.news/3Va2DSd 📝 Ana B. Ibarra

cal.news

RFK Jr. was on the losing side of California vaccine fights. Now, Trump wants him in his cabinet

Robert F. Kennedy Jr. was a key figure in protests over California vaccine laws. He could set U.S. health policy in the Trump administration.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 02/12/2024

The Third Reich Politics and Propaganda by David Welch

Such indifference proved fatal.
Interest in the fate of Jews had in fact rapidly evaporated after the Reichskristallnacht. Ian Kershaw has written that the road to Auschwitz was built by hate, but paved with indifference' 56 It was no longer necessary after 1941 to 'publicise' the threats posed by Jews, and as a result the Jewish Question became of no more than marginal importance in the formation of popular opinion within the Third Reich. Propaganda had helped to create such apathy and indifference by persuading people that they could retreat into the safety of their depoliticised private lives and leave the 'solutions' to such 'problems' to others. Tragically, the 'moral ambiguity' that characterised the public's response to the well-publicised plans to exterminate Jews and other 'inferior' races encouraged the regime to 'realise the unthinkable'.

Book cover: THE THIRD REICH POLITICS AND PROPAGANDA
SECOND EDITION
David Welch

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 01/12/2024

My tweets from 2017 are currently being ported from Twitter to BlueSky. This is a great way to uncover buried gold from years past. Too bad nothing’s changed. No wait, it’s changed. It’s worse now.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 30/11/2024

People think emergency doctors can successfully intubate their unvaccinated, let’s say, 4 year-old, with vaccine preventable Hib induced epiglottis/critical airway. They’re wrong. That’s on the parent, not the doctor. Vaccinate your kids or face the consequences of harming your own child.

Haemophilus influenzae type b (Hib)
infection
Naturally acquired disease caused by H. influenzae seems to occur in humans only. In healthy children under the age of 5, H. influenzae type b was responsible for more than 80% of aggressive infections, before the introduction of the [Hib] vaccine. 501 In infants and young children, H. influenzae type b (Hib) causes bacteremia, pneumonia, epiglottitis and acute bacterial meningitis. (511 On occasion, it causes cellulitis, osteomyelitis, and infectious arthritis. It is one cause of neonatal infection. 152]

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 30/11/2024

Have the American Medical Association and the American College of Emergency Physicians devised plans to safeguard doctors from parents who opt not to vaccinate their children? What are the psychological consequences for doctors when children die preventably under their care? What about legal?

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 29/11/2024

“You, Elon, appear to believe you can act with impunity and are attempting to silence your critics. I’m not intimidated,” he added. Alexander Vindman is a true American hero. 🇺🇸

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David Gorski, MD, PhD @gorskon.bsky.social · 28/11/2024

Thinking about this, it’s hard to believe that it’s been almost three years since I wrote this post on how far right the antivax movement has become. www.respectfulinsolence.com/2022/01/28/w...

respectfulinsolence.com

Why is there now such an affinity between antivaxxers and fascism?

Increasingly, the antivaccine movement has become allied with fascism, including openly fascist groups marching in their rallies. Why?

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 28/11/2024

I wrote this in April 2020, during the first wave of the COVID pandemic in NYC. Weeks later, I volunteered at Elmhurst Hospital in Queens, NY, in a COVID ICU. I’m now certain that America’s healthcare system is on the brink of collapse. You should see what I see at work in the ER everyday.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 22/06/2020

Pulled this out of a patient. This is what a taser barb looks like.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 27/11/2024

This service is legit. It won’t migrate every post from Twitter to BlueSky, but it’s better than losing them all when you delete your Twitter account. 5 ⭐️ | would recommend

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Jeffrey B. Benyacar @drjeffreyb.bsky.social · 26/11/2024

My friend @nicksawyermd.com has shared horror stories on this topic. Not okay. Healthcare workers are not punching bags. #medsky

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 26/11/2024

Trump/Musk’s proposed $2 trillion domestic spending reduction, coupled with additional tax cuts for the wealthy, resembles economic “shock therapy” used during neoliberal reforms in Chile under Augusto Pinochet. It certainly caused “temporary hardship” for ordinary citizens.

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Jonathan Howard @joho.bsky.social · 25/11/2024

They were and still are the medical establishment.

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Jonathan Howard @joho.bsky.social · 25/11/2024

He started the the pandemic saying it was “dangerous” to call someone an idiot for minimizing Covid. Now he panders to his paying customers. More here: sciencebasedmedicine.org/lying/

sciencebasedmedicine.org

Dr. Vinay Prasad: “I Don’t Believe in Forgiveness Because in My Opinion These Pieces of Shit Are Still Lying.” | Science-Based Medicine

Mass purges and prosecutions of scientists have happened before. We shouldn't pretend they can't happen here.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 25/11/2024

It doesn’t even have to be a real life issue that actually happened. They only need enough people to believe it’s true. That’s what Sen. Ron Johnson told a lawyer arguing for criminal prosecutions based on the ridiculous idea that COVID vaccines cause AIDS. Watch the video: x.com/HeartlandSig...

x.com

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 25/11/2024

I’m taking bets on the issue that will trigger Trump’s Kristallnacht 2025.

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Gregg Gonsalves @gregggonsalves.bsky.social · 23/11/2024

Now imagine the alternative universe where this man ran HHS. We'd be in such a better place. Peter Hotez is a national treasure.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 24/11/2024

As I wrote in this @medpagetoday.bsky.social perspective, doctors spreading medical disinformation want you to believe their assertions are matters of reasonable scientific debate. Some are, but many are not. That’s the entire point. www.medpagetoday.com/opinion/seco...

This legislation is vital as it empowers the Medical Board of California to discipline physicians who mislead patients with pseudoscience or conspiracy theories. For instance, extensive research has shown that hydroxychloroquine and ivermectin are ineffective against COVID. Additionally, no credible evidence supports claims that COVID mRNA vaccines cause vaccine-induced AIDS, magnetization, infertility, microchips, mRNA spike protein shedding, DNA alteration, mRNA spike protein-induced diseases, cancer, or sudden cardiac death.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 23/11/2024

These doctors advocate for violent retribution against vaccine advocates and those favoring COVID public health measures, particularly actual frontline physicians and nurses, based on a false reality they’ve created. @gorskon.bsky.social

sciencebasedmedicine.org

COVID-19 vaccines and the Nuremberg Code | Science-Based Medicine

Antivaxxers love to claim that vaccine mandates (especially COVID-19 vaccine mandates) violate the Nuremberg Code. They have no idea what they're talking about.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 23/11/2024

“Dr. Vinay Prasad Says No Amnesty for the COVID Tyrants” “I mean, like if you want forgiveness, the first thing you have to say is what you actually did wrong, and they're still f***ing lying." Prasad is faculty at the prestigious medical school UCSF. What the f**k is he talking about?

 Dr. Vinay Prasad Says No Amnesty for the COVID Tyrants
Dr. Vinay Prasad says to "I don't believe in forgiveness because in my opinion, these pieces of sh*t are still lying. I mean, like if you want forgiveness, the first thing you have to say is what you actually did wrong, and they're still f***ing lying."
Dr. Zubin Damania aka "Zdogg" has to be feeling a little uncomfortable in this conversation because he was one of the loudest and boldest voices pushing the Covid narratives that grated on the nerves of many.
x.com/thechiefnerd/s...
youtube.com/watch?v=sEznoT...
NO AMNESTY!

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 22/11/2024

This deserves our attention. There’s real discussion about removing the American Medical Association’s control over doctor payments, which would make incomes more equitable and encourage more future doctors to enter primary care. This is way past due. @ddiamond.bsky.social wapo.st/3Zix1fK

wapo.st

RFK Jr. weighs major changes to how Medicare pays physicians

Kennedy and advisers say the system drives doctors to perform costly surgeries rather than combating chronic disease.

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Jeffrey B. Benyacar @drjeffreyb.bsky.social · 22/11/2024

This is an important Op Ed and worth your time. (Minor nit: I wish the headline writer would have eschewed the word 'punish' to 'hold doctors accountable.' My hindsight is of course 20/20). #medsky #misinformation

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 31/05/2024

where do the parents of unvaccinated kids take them when they’re really sick? Not to RFK Jr’s house. They take them to see me. For me it’s personal.

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 21/11/2024

Corporate and private equity executives, who promote healthcare as a profession of ethical values, exploit doctors and nurses’ compassion to maximize profit. Nurse Tristin Kate Smith, who committed suicide months before her death, named the healthcare system as her “abuser.” is.gd/2CiXIa

A Letter to My Abuser
On Monday, August 7, 2023, our
held mine as I moved forward in
beautiful girl,
Tristan
Kate Smith,
my nursing career. My patients and
ended her life.
their families have been there for me,
Tristin was 28 years old, and the supported me, and reminded me why
youngest of two brothers and three
sisters. She was a daughter. She was an aunt. She was a friend. She was a nurse. Tristin was brave and beautiful and smart. She fought depression for a long time. With regret-filled hindsight, we can now see the signs for what they were. She never sought professional help, but her home was filled with evidence that she'd been trying to help to carry me through my career. I told you I would be there through the good and the bad, but you have taken my heart and slowly crushed the goodness it had. You love-bombed me with
affection, and you told me I was going into a career that matters. I could make a difference.
herself. Her beloved dog, Calypso, and cat, Sphinx, wanted for nothing;
Tristin spent her time and energy with them. We found more dog enrichment toys and contraptions than a single pet store sells. She had written and posted
affirmations and mantras
throughout her house. She displayed photos of herself with her friends, family, and pets. She had
out to friends. She had reached out to family.
She tried so hard to stay alive, but none of it was enough to stop the darkness.
You're reading this now because
Tristin's story needs to be told.
We need to take action. Our nation's healthcare system is broken, and it broke our girl. Her passion for nursing had turned into a nightmare. Tristin was in trouble. Nurses are in trouble.
Female nurses commit suicide at more than twice the rate of females in the
Tristin Kate Smith
Feb. 21, 1995 - Aug. 7, 2023
general population. We must do better.
Call or email your congresspeople. Tell them we can do better. Reach out to your friends in nursing and offer to listen. Help them get the help they need.
The following is a …

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 21/11/2024

Baby Boomer physicians sold private practices to corporations and private equity firms rather than passing them down to younger doctors, as is customary. Then they called us lazy. They sold the professional practice of medicine when it was never theirs to sell. Even lawyers didn’t do this.

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Andy Kaczynski @kfile.bsky.social · 21/11/2024

NEW on RFK Jr: In audio we uncovered from his radio show he read and praised a description of Trump and his supporters as "belligerent idiots," "outright Nazis," and "cowards" and "bootlickers." He also compared Trump to Adolf Hitler. www.cnn.com/2024/11/21/p...

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 13/11/2024

This is not good. Read the entire paper, “Medical Science Under Dictatorship” by Dr Leo Alexander, chief medical advisor to the lead American prosecutor during the Nazi doctors trial in 1946-47. Alexander’s full article linked in the post below and here: restoringourheritage.com/articles/nej...

restoringourheritage.com

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Nick Sawyer, MD, MBA, FACEP @nicksawyermd.bsky.social · 21/11/2024

Here are some key insights gained from studying this issue for 4 years: 1) This problem is timeless. 2) Numerous attempts have been made to address the “self-regulating” professional practice of medicine (state medical boards), including 6 FEDERAL INVESTIGATIONS. 3) It’s a failure of leadership.

State Medical Boards and the Politics of Public Protection
State medical boards have been investigated by the federal government at least six times. Here is a summary of those investigations:
1. 1984 - GAO Report on the Need for Federal Authority
- Investigated the need for federal oversight to protect Medicare and Medicaid patients from practitioners who lose their licenses.
2. 1986 - HHS OIG Report on Medical Licensure and Discipline
- Focused on the state of medical licensure and discipline, particularly concerning foreign medical graduates and the effectiveness of state medical boards.
3. 1987 - GAO Report on Medical Malpractice
- Investigated the systemic issues related to medical malpractice, which indirectly involves state medical boards' role in discipline.
4. 1990 - HHS OIG Report on State Medical Boards and Medical Discipline
- A follow-up report that examined the performance and challenges of state medical boards in disciplining physicians.
5. 1993 - HHS OIG Report on State Medical Boards and Quality-of-Care Cases
- Investigated how state medical boards handle quality-of-care issues, identifying promising approaches.
6. 2006 - HHS Investigation on State Discipline of Physicians
- Provided an in-depth analysis of the performance and challenges faced by state medical boards through case studies.
The persistence of the problem with state medical boards' failure to adequately discipline dangerous physicians, despite decades of investigations and overwhelming evidence, can be attributed to several interconnected factors:

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