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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 06/02/2026

2024 Lancet Commission: "limited evidence" and "ongoing uncertainty." HRT not among 14 modifiable dementia risk factors. Observational studies ≠ RCTs. The gap should give us pause. #medsky ref: 2024 Lancet Commission on Dementia: buff.ly/Qibzfbr

thelancet.com

Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission

The 2024 update of the Lancet Commission on dementia provides new hopeful evidence about dementia prevention, intervention, and care. As people live longer, the number of people who live with…

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 06/02/2026

ELITE: 2×2 design, early (<6y post-menopause) vs late (≥10y) initiators. "ELITE-Cog findings fail to confirm an early critical window for the cognitive effects of estradiol."

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 06/02/2026

After 4 years treatment + 10 years follow-up: "mHT does not prevent cognitive decline when initiated around the time of menopause."

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 06/02/2026

The HRT "window of opportunity" for brain health: what the trials actually showed. KEEPS: 727 women, ages 42-58, within 36 months of final period. The exact population proponents said would benefit.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 06/02/2026

The seed oil discourse asks the wrong question. Ultra-processed food accounts for 55% of Americans' calories. That is the conversation we should be having, not whether your salad dressing is slowly killing you. #medsky

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 06/02/2026

The investigation has been done. Meta-analysis of 310,000 people: higher LA intake associated with 15% lower heart disease events, 21% lower CHD deaths. 30 RCTs found no effect on inflammatory markers.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 06/02/2026

Linoleic acid consumption increased from 3% to 7% of calories over the last century. Soybean oil up 1,000-fold. This is a real dietary shift worth investigating.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 05/02/2026

The seed oil discourse gets one thing right: linoleic acid consumption increased 1,000-fold last century. It gets more wrong: RCTs show no increase in inflammation. Large cohorts show lower heart disease with higher intake. What it misses: the real issue is ultra-processed food. #medsky

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 03/02/2026

The observational data looked promising. Registry studies showed 40-70% reduced AD diagnoses with GLP-1s. "Influencers" were buzzing. But healthier patients get GLP-1s. Confounding by indication. Immortal time bias. When you run the RCT: nothing. #medsky Ref: buff.ly/ZlZzHtS

globenewswire.com

Novo Nordisk A/S: Evoke phase 3 trials did not demonstrate a statistically significant reduction in Alzheimer's disease progression

Bagsværd, Denmark, 24 November 2025 – Novo Nordisk today announced the top-line results from the 2-year primary analysis of evoke and evoke+ phase 3 trials...

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 03/02/2026

Secondary endpoints: ADAS-Cog, MMSE, activities of daily living. No benefit on any measure. Some nominal tau biomarker reductions. Did not translate to clinical benefit. Novo discontinued the extension trial.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 03/02/2026

EVOKE Phase 3 trial results: Semaglutide for Alzheimer's disease: 3,808 patients with MCI or mild dementia. 104 weeks. Primary endpoint: no difference from placebo

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 02/02/2026

Why do red light therapy studies contradict each other? Biphasic dose-response. Too little does nothing. Too much backfires. The sweet spot is narrow. Most consumer devices are not independently verified to hit it. The honest answer: we do not know if yours works. #medsky

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 02/02/2026

Red light therapy has better evidence than most optimization interventions. The mitochondrial mechanism is plausible. Systematic reviews show modest benefits for muscle recovery and knee pain. Still not strongly recommended by major societies. But not dismissible either. #medsky

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 01/02/2026

Peptide evidence: essentially zero adequate human trials. Red light therapy evidence: multiple systematic reviews, plausible mechanism, moderate effects for some conditions. This is what engaging seriously with the evidence looks like. Not all optimization is equal. #medsky

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 20/01/2026

"Can I reverse my plaque?" Less important than you think. Plaque regression is a surrogate endpoint. A smaller unstable plaque is worse than a larger stable one. Statins regress plaque AND reduce mortality. Focus on outcomes, not imaging.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 15/01/2026

"I want the PCSK9 inhibitor, it is newer." You would not fund a startup with one Phase 2 trial when the competitor has 22 RCTs and mortality data. Why would the bar be lower for your coronary arteries?

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 14/01/2026

When your kid brings home flu, Xofluza is one dose for contacts vs 10 days of Tamiflu. Sounds better. But households aren't single-exposure events. Ongoing exposure may need ongoing coverage.

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Reposted by Paul Abramson MD

Rheum Cat @rheumcat.bsky.social · 14/01/2026

In this flu season, we are reviewing cases of rhabdomyolysis with super high CK levels in the context of influenza A infection Here's a case report, but surprised there's not more in the literature: pmc.ncbi.nlm.nih.gov/articles/PMC...

pmc.ncbi.nlm.nih.gov

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 14/01/2026

Each day you delay flu treatment increases death risk by 14-40%. Both antivirals shorten illness by about one day if started within 24 hours. After 48 hours, Xofluza has no data at all.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 13/01/2026

If you care about healthspan, you have to care about blood pressure. Uncontrolled BP claims 10 million lives yearly. Intensive control cuts cardiovascular events by 30%. Taking a peptide feels sophisticated. Checking your BP feels ordinary. The evidence base isn't close.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 11/01/2026

The choice that matters isn't Tamiflu vs Xofluza. It's today vs tomorrow. Same-day flu treatment was associated with 64% lower mortality. Drug selection? Similar outcomes.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 09/01/2026

Software can be patched. Markets recover from failed experiments. The body's irreplaceable systems cannot. "Move fast and break things" doesn't work here.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 09/01/2026

Patients overestimate statin side effects by an order of magnitude. True attributable muscle symptoms: less than 1%. Severe myopathy: less than 0.1%. The perception gap drives people toward less-proven alternatives.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 08/01/2026

How smart people fool themselves about health interventions: Subtle adjustments to probability estimates. Shifts in confidence levels. Quiet downgrades of source reliability for inconvenient findings. Small biases that accumulate into confident but unfounded conclusions.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 07/01/2026

The same traits that drive innovation—systematic thinking, high openness, confidence in analysis—become vulnerabilities when applied to human biology. The mindset that builds companies requires different guardrails when applied to health.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 07/01/2026

Statins reduce all-cause mortality in high-risk primary prevention (RR 0.92). PCSK9 inhibitors do not demonstrate that benefit in this population. The boring generic pill has the outcome data the fancy injectable lacks.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 06/01/2026

Dunning himself clarified his research: "You can be incredibly intelligent in one area and completely not have expertise in another." Tech founders approaching human biology with the confidence they bring to software development is a textbook case.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 05/01/2026

"Unintelligent people are more easily misled by others. Intelligent people are more easily misled by themselves." They construct more sophisticated rationalizations. Find creative ways to dismiss contrary evidence.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 04/01/2026

Aging muscle isn’t just smaller. It's different. Soendenbroe et al. 2024 (J Cachexia Sarcopenia Muscle): heavy resistance training reverses irregular myofiber shape, a marker of aging. Net: strength work improves muscle quality, not just size. For healthy aging, resistance training is non‑negotiable

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 04/01/2026

Just as long as they know there are a different set of counfounding variables that can make cystatin C estimates inaccurate as well (hence their being predictors of badness beyond just kidney failure). Not a panacea but having both is great if you're willing to think through it.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 03/01/2026

My approach: I don't "fire" patients who do this. That just forces them underground. We engage. We monitor. We talk about how "dosing protocols" on Reddit are made up. My job isn't to be a parent; it's to be a lead engineer checking your math.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 03/01/2026

I was an engineer before I was a doctor. In engineering, we don't scale systems that haven't passed integration testing. These compounds are unvalidated, unlicensed, and often impure. Running this code in production (your body) violates basic risk management principles.

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 03/01/2026

The "risk" isn't abstract. It’s not just "it might not work." A 2024 report in the Journal of Emergency Medicine documented compartment syndrome from peptide injections. That is a high price for "optimization."

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 03/01/2026

The "Pitch Deck" is full of bugs. I checked the specs (Am. J. Sports Med, 2025) on the most popular SF stacks: BPC-157: Validated in rats. No rigorous human trials. TB-500: Preclinical only. Banned in sports. CJC-1295: Mouse data. You are biohacking based on a murine spec sheet. 🐭

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 03/01/2026

I’m quoted in today’s @nytimes.com on the "Chinese peptides" trend in SF. She asked about the "founder mindset" applied to biology. My take: "The entrepreneurial parallel isn't funding a scrappy start-up. It's wiring money to an unregistered offshore entity based on a pitch deck." buff.ly/n5nEob

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 02/01/2026

Creatinine-based eGFR estimation is the default, cheap, fast, and often wrong. Cystatin C is more accurate, must be ordered separately, and in many settings takes days to return. Why? #medsky

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 14/01/2025

The simple pleasure of chewing on a stick in the morning.

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Reposted by Paul Abramson MD

BK. Titanji @boghuma.bsky.social · 29/12/2024

I know it's been an eventful year but let's not forget that AI served up this monstrosity of a figure in a paper that was published and then retracted by one of the frontiers journals this year. The rat with giant balls lives in AI infamy for all time scienceintegritydigest.com/2024/02/15/t...

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Paul Abramson MD @paulabramsonmd.mydoctorsf.com · 29/12/2024

T-SPOT.TB performs much better in many immunocompromised populations IMO, but historically was logistically more difficult from CA due to time-sensitive FedEx of samples to Memphis which failed a lot with winter storms. Less an issue now that Quest bought T-SPOT.

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