Yesterday, Dr. Céline Gounder and I caught up on a handful of issues in medicine and public health that we’ve been tracking closely. As always, Dr. Gounder brought data-driven insights from her expertise as a physician, journalist, and public health professional. We covered everything from the end of the government shutdown to some new studies that caught our eye, ranging from pregnancy and firearm-related homicide to caffeine and heart rhythms. I hope you find the session informative and enjoyable. Personally, I always have a great time chatting with Céline, and I always learn a lot in the process!

Closed captions (㏄) for the above video and a transcript option (📄) can be found beneath the video playback control bar above. A summary with timecodes can be found below.

Doctor’s Lounge — Inside Medicine Q&A Summary

(Summary aided by ChatGPT).

Government shutdown, ACA subsidies, and the CR (0:30–06:00)

We walk through how the funding lapse happened and why it became a health-policy fight: enhanced ACA premium tax credits (pandemic-era boosts) are expiring amid rising premiums. The bipartisan stopgap vote funds agencies and ends furloughs with back pay, but only guarantees a separate December vote on the ACA subsidies. There’s no guarantee of an extension yet. Politically, both parties face risk; practically, millions could lose affordable coverage without renewal.

Shutdown tactics and federal workforce “RIFs” (08:24–09:21)

We flag reports that shutdown conditions were leveraged to justify another round of CDC/HHS reductions in force (RIFs)—legally dubious, because the RIFs appear to have been ad-hoc personnel purges rather than carefully justified programmatic cuts. Expect disputes and litigation.

“Should we run for office?”—why policy ≠ campaigning (09:31–12:17)

We discuss why neither of us plans to run for office: invasive scrutiny, fundraising grind, and congressional dysfunction that delays impact for junior members. We both prefer to influence policy directly and support candidates who can do the electoral work.

FDA, menopause hormone therapy, and the black-box reversal (12:36–19:05)

We outline why lifting the boxed warning makes sense given re-analyses of Women’s Health Initiative data: the small signal of increases in cancer was tied to older regimens; there was no increase in breast-cancer mortality; and starting hormonal therapy before age 60 (or within 10 years of menopause) seems to improve the risk–benefit profile. Potential benefits include cardiovascular outcomes, fewer bone fractures, and possibly cognitive protection. We also note the communications challenge when good guidance comes out of an ...