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Samuel Borer, MD @samuelmborer.bsky.social · 15/07/2026

There are so many epistemic errors here (reductionism, biomarker fetishism, substituting lab values for clinical judgment) but the deepest is changing the telos of medicine. What is medicine for? Physicians are not optimisation engineers whose measure of effectiveness is institutional performance.

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Samuel Borer, MD @samuelmborer.bsky.social · 07/07/2026

Consider me one of your early supporters! We would be lucky to have you Eric.

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Reposted by Samuel Borer, MD

Kevin M. Kruse @kevinmkruse.bsky.social · 25/06/2026

"Why should Pennsylvania, founded by the English, become a Colony of Aliens, who will shortly be so numerous as to Germanize us instead of our Anglifying them, and will never adopt our Language or Customs, any more than they can acquire our Complexion." - Ben Franklin on Emmers' German ancestors

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Samuel Borer, MD @samuelmborer.bsky.social · 24/06/2026

The tell is that “personalised” here means more data, not more person. An indicator is only meaningful when a causal pathway links it to the outcome, and most of these markers never clear that bar. They moved the numbers from the population to the molecule and called it precision.

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Samuel Borer, MD @samuelmborer.bsky.social · 24/06/2026

With equally absent animosity: a party’s resources are not property. They are delegated power held in trust for a constituency. A party that treats its own constituency as an outside threat has already conceded it no longer represents them.

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Reposted by Samuel Borer, MD

Dr. Sandra Steingraber 🏳️‍🌈 @ssteingraber1.bsky.social · 14/06/2026

Your reminder that fairy tales are full of stepmothers because women once routinely died in childbirth, from postpartum sepsis, or from other infectious diseases and left behind housefuls of motherless children. Stable nuclear families are made possible by vaccines, antibiotics, and safe abortions.

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Reposted by Samuel Borer, MD

Sharon 🪳🌹 @sharonk.bsky.social · 18/06/2026

one thing i genuinely wish both Labour and Dems would do is stop over-relying on electoral gurus like Morgan McSweeney and actually hire political scientists and sociologists to investigate "okay, how does class formation happen now, and how does it shape political votes? how do we win?"

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Samuel Borer, MD @samuelmborer.bsky.social · 10/06/2026

The bit I cannot get past is the breeze. Imagine carrying this much fear of a light wind and concluding the problem is everyone else’s masculinity. The men most scared of looking soft will tell on themselves every single time.

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Samuel Borer, MD @samuelmborer.bsky.social · 05/06/2026

Yentl syndrome at its worst. Though it is a great example of value-dependent realism. Diseases are real, but which states get carved out as diagnostic entities depends on values. The diagnostic categories themselves carry the residue of whose bodies were studied in their construction.

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Samuel Borer, MD @samuelmborer.bsky.social · 04/06/2026

Lately, I’ve been having an academic affair with Mario Bunge’s concept of systemism and emergence. Clinical reality is stratified into levels; each with its own vocabulary because each has emergent properties irreducible to those below. Ontologically hierarchical, but epistemologically autonomous.

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Samuel Borer, MD @samuelmborer.bsky.social · 03/06/2026

Medicine has no coherent account of what the patient is. Genomicist's molecular system; epidemiologist's statistical class; pathophysiologist's malfunctioning mechanism; phenomenologist's experiencing subject; narrative physician's self-narrator; ethicist's autonomous chooser. Not equivalent.

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Samuel Borer, MD @samuelmborer.bsky.social · 26/05/2026

I’m tempted to frame it as capacity vs subjecthood. AI can do some things we associate with intelligence: abstraction, synthesis, inference, problem-solving. But it still seems to lack the thicker features of minded life: understanding, agency, responsibility, and a lived world.

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Samuel Borer, MD @samuelmborer.bsky.social · 26/05/2026

Criteria represents aspects of the disease, while construct refers to a whole. Reliability is a property of the rule and whether it applies consistently. Validity is a property of the relation between the rule and what it’s trying to reach. Whether the aspects captured genuinely belong to the whole.

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Samuel Borer, MD @samuelmborer.bsky.social · 26/05/2026

It is how thresholds get revised (140/90 → 130/80 in 2017) without the cuff changing what it measures. Or how cuff, ambulatory, and home readings can disagree. Or the existence of white-coat and masked hypertension. It is only possible because the operational rule and the referent are not the same.

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Samuel Borer, MD @samuelmborer.bsky.social · 26/05/2026

So true! Even BP can be tricky. It both names what the cuff measures (a force on a vessel wall at one moment) and what the clinician diagnoses (a cardiovascular state of the patient extended across time). Can a momentary force accurately translate to a temporal state?

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Samuel Borer, MD @samuelmborer.bsky.social · 24/05/2026

So our criteria are answerable to something beyond themselves. The important question is: when a clinical construct is operationalised, what has actually been clarified? And what has only been made easier to apply? [4/4]

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Samuel Borer, MD @samuelmborer.bsky.social · 24/05/2026

Take depression. DSM criteria help identify cases. But if “depression” simply meant “whatever satisfies DSM criteria,” the criteria could not fail. They would succeed by definition. Yet medicine still asks whether criteria track suffering, prognosis, and treatment response. [3/4]

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Samuel Borer, MD @samuelmborer.bsky.social · 24/05/2026

A diagnostic criterion is a rule for applying a term. A referent is what the term is about. These blur together because criteria make medicine workable: communication, research, billing, teaching. But a rule for using a word is not the same as the reality the word is trying to reach. [2/4]

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Samuel Borer, MD @samuelmborer.bsky.social · 24/05/2026

A question I keep returning to: When we use a diagnostic term, what are we trying to name? Not just: which criteria must be satisfied? But: what, in the person’s clinical reality, is this term trying to reach? That distinction seems small. I think it matters. [1/4]

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Samuel Borer, MD @samuelmborer.bsky.social · 23/05/2026

Medical language sounds precise until you ask what the words mean. Take “normal”: does it mean average, healthy, ideal, age-expected, or just close enough? A lab value can be abnormal but harmless; a common condition can still be pathological. So what is medicine really saying when it says normal?

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