(2026-03-17) ZviM Medical Roundup #7

Zvi Mowshowitz: Medical Roundup #7. It’s time to check in on some other things that have been going on, including various developments at the FDA.

Table of Contents

• FDA Reformandum Est.
• FDA Delenda Est.
• IN MICE.
• Doctor, Doctor.
• Trust The Process.
• Cancer Screening.
• Autism Everywhere All At Once.
• Other Mental Problems Everywhere All At Once.
• Source Data Verification.
• External Review Board.
• Walk It Off.
• An Unhealthy Weight Can Be Worse Than You Realize.
• Our GLP-1 Price Cheap.
• Right To Die Should Include Right To Try.

Walk It Off

A new large observational study claims that 45 minutes a day of walking gives you most of the all-cause mortality benefits of exercise, and running doesn’t do better than walking until you do rather a lot of it, whereas too much jogging can actively backfire and swimming and bicycling do little

It’s an observational and self-reported study, so you can’t assume causation and doubtless ‘willing and able’ correlations should be doing a lot of work.

I do buy that this is evidence for ‘if you do a lot of walking that largely counts being active and doing exercise.’

An Unhealthy Weight Can Be Worse Than You Realize

Not a Good Jewish Girl: My fiancée is extremely mad that losing 20 pounds with a GLP-1 has basically cured her sleep and back issues and made her PMS symptoms much more tolerable, improving her overall mood on a daily basis and making her job less stressful.
These drugs should be fully subsidized

Our GLP-1 Price Cheap

Arthur B.: The US government could buy the patent for some oral GLP agonist like orforglipron for under $30B, give it away with Medicaid and save about $200B a year in Medicaid / Medicare future spending on obesity-linked diseases.

Or the market can solve this on its own, if this crosses the threshold and becomes worthwhile enough that consumers pay cash

David Wainer: Two years ago, a GLP-1 prescription could cost an uninsured patient more than $1,000 a month. Today, Novo Nordisk’s Wegovy pill starts at just $149 through cash-pay programs

Then again, perhaps the market is solving this via patent infringement? Novo Nordisk says so in their lawsuit against Hims & Hers.

Right To Die Should Include Right To Try

In Canada and want to try an experimental treatment? We can’t allow that, would you instead like to have us help you commit suicide?

FDA Reformandum Est

Senator Bill Cassidy released a new report on modernizing the FDA. Alex Tabarrok approves, which means it’s probably good.

The FDA chief has an even better idea.
Matthew Herper: FDA chief Marty Makary says ‘everything should be over the counter’ unless drug is unsafe or addictive [or requires monitoring].

There’s also the bad news, which was the main event.

FDA Delenda Est

Settle in for the tale of Moderna, and its attempt to get approval for a flu vaccine.

Alex Tabarrok: I Regret to Inform You that the FDA is FDAing Again.
I had high hopes and low expectations that the FDA under the new administration would be less paternalistic and more open to medical freedom. Instead, what we are getting is paternalism with different preferences. In particular, the FDA now appears to have a bizarre anti-vaccine fixation, particularly of the mRNA variety

This is what happens when you burn the term supervillain on people who want lower prices on drugs. What do you then call people who outright destroy one of the most promising medical advances of our time for no benefit whatsoever, via torching a $750 million study for decisions the FDA had explicitly already approved.

Per STAT, Vinay Prasad overruled FDA scientists to reject the application outright, and we have confirmation that staff was ready to review

Matthew Herper: As you can see, volunteers who received Moderna’s flu shot, mRNA-1010, had about 26% less influenza-like illness in a 40,000 patient study

It is hard to overstate how destructive this is

At minimum, this forces ballooning costs as studies have to be designed defensively in case the wrong person at the FDA suddenly changes their mind.

*Mr. Kennedy (RFKjr) long raised concerns as a vaccine activist that the inactive ingredients in vaccines could cause harm and should not be used in human trials"

"They say Kennedy was not involved here, but he’s head of the agency and has been furiously acting to undercut Moderna and its mRNA research at every turn.*

IN MICE

We now have a single vaccine could protect against all coughs, cold and flus, researchers say. Well, okay, IN MICE. But it’s a start. The problem is, do they have the regulatory confidence to fully invest in that?

Stanford researchers identified 16-PGDH as a root cause of cartilage loss, claiming the mechanism works IN MICE, and also in human tissue samples. Epirium for now is doing Phase 1 trials for sarcopenia

Doctor, Doctor

How should you describe your situation to a doctor? You want to be respectful and honest with them, but if you dump a bunch of information they can get easily distracted in predictable ways. I buy Carl Feynman’s advice here to start with your diagnosis and key facts that seem most relevant and unlikely to mislead, then only later give the rest. Think of it as (polite) prompt engineering. LLMs can help you

Trust The Process

This is one way to do plastic surgery, but you’d better be damn sure you’ve solved the associated principal-agent problems and the surgeon has good taste:

Aella: my strategy this time was to go into the surgeon’s office, refuse to tell him my own concerns, ask “what would you do to make me look hotter”, and then blanket accept everything he suggested - even if I hadn’t thought I needed it.
rohit: --dangerously-skip-permissions

Perhaps you should focus more on establishing trust than trying to solve the problem yourself.
Also the person who most has to look at you will be you, so your preferences matter. Don’t fully ignore them

Cancer Screening

AI but not LLMs: New large study (n = 105,934) of AI in cancer screening that started in April 2021 finds strong results from Transpara Version 1.7.0. Gains plausibly were largely about workflow integration and use of risk scores, rather than AI as a standalone second reader.

I am deeply confused by the whole ‘we still don’t know if this would be worth the cost’ response. What cost?

Autism Everywhere All At Once

Autism as it is now super broadly defined and aggressively diagnosed may hit boys and girls in roughly equal measure. The marginal diagnosis clearly does net harm, and as explained previously there has been no actual increase in autism rates to explain

Severe cases (no language, socially unresponsive, etc.) have decreased

Justin Gregory Briggs: In the 20+ years I’ve been in the mental health field, the diagnostic criteria for autism have become so broad that they are clinically useless. Any spectrum that includes some of the most productive people on Earth and people who require 24/7 care is not interpretable

Other Mental Problems Everywhere All At Once

Jesse Arm also has a similar view to this, as do I:
TheLegalProcess (v3.0 | Instruction Not Therapy): Honored to be a contributor with @CarolynGorman_ on this issues brief and model legislation for @ManhattanInst . In 2025, IL and LA accelerated the use of universal mental health screenings in schools.

We take a contrarian view. Schools are not mental health clinics: ban them.
Universal mental health screening is ineffective at creating prosocial behavior and improved academic outcomes.

Source Data Verification

Adam explains some of the reasons clinical trials are inefficient.

After the site sends the data they collected to the sponsor, the sponsor sends a consultant to the site to pore through their paper records to make sure that every single data element the site collected matches the data the sponsor received.
That seems rather obviously crazy. Even the FDA now agrees. Yet Adam claims this is what typically happens.

The other big obvious problem is that our scientists have yet to learn the secret of mass production.
Unfortunately, today’s approach to clinical trials looks much more like NASA’s “Big Space” approach than SpaceX’s iterative approach. Each trial is created from scratch.

The clinical trials industry has a culture problem. In short, they don’t sufficiently acknowledge that they are an industry in the first place.

External Review Board

Why not let researchers choose their own accredited IRB, at the risk of taking some of the internal out of the review board? This is very much a ‘mostly disarm the IRBs’ proposal and I fully support it.