Hi @RobertKennedyJr I'm a cardiologist. I've spent twenty years watching Medicare deny my patients things they actually need — while stories like this one go on for years. RFK Jr. says HHS loses $100 billion a year to theft. Then he described what they found in Los Angeles. Criminals were walking into poor neighborhoods and offering people a $375 flat-screen TV for their patient number. "You don't ever have to go. We're just going to enroll you." Then they billed Medicaid roughly $6,000 a month — forever. A hospice is where you go to die. The average stay is measured in days to weeks. They found people enrolled two and three years later. Still alive. Still billing. Of course they never died — they were never sick. They found a hotel where every single room was a registered hospice. Twenty-nine of them. Zero patients. Just addresses. They shut down 800 hospices. And here's the detail that tells you everything: not one congressman called. Not one owner complained that patients were on the street. Nobody protested, because they all knew exactly what they were running. Now let me tell you what this looks like from inside a practice. I fight for prior authorizations on medications that prevent heart attacks. I get denied for imaging that finds disease early. I have patients rationing insulin. Every dollar in that hotel room was a dollar that didn't go to a nurse, a scan, or a drug that keeps someone alive. Fraud isn't a budget line. It's care stolen from patients who needed it. Two things I'd say if I ever got the room: Use AI to find the outliers. This is not hard. Every claim is already digital. Flag every provider billing five or ten standard deviations above their peers for a service, then audit them. A pattern like 29 hospices at one address, or a "terminal" patient billing for 36 straight months, is something an algorithm catches in an afternoon. We are using AI to read ECGs better than cardiologists — we can absolutely use it to catch a hotel room billing Medicaid. Then talk to practicing doctors. Not consultants. Not administrators. Physicians running busy clinics, who know exactly which codes get abused and which patterns are impossible, because we live inside the billing system every day. We could point at it in an hour. Almost nobody asks us. Catching fraud isn't about cutting care. It's the only way to fund it. Every stolen dollar has a patient's name on it. We just never learn which one.

I'm a cardiologist. A review published this morning just took a sledgehammer to the protein-maxxing era. And the most important detail isn't in the headline — it's buried in the human data. Lamming's lab at Wisconsin reviewed over 350 studies on protein restriction and aging, published today in Cell Press Blue. As @EricTopol put it, they define — for the first time — the hallmarks of protein restriction: Improved metabolic health. Induction of nutrient-sensing pathways. Decreased senescence. Improved mitochondrial function. An altered epigenome. And the promotion of healthy aging. Six hallmarks. From eating less protein, while still meeting your needs. 𝗧𝗵𝗲 𝗻𝘂𝗺𝗯𝗲𝗿𝘀 𝗳𝗿𝗼𝗺 𝘁𝗵𝗲 𝗺𝗼𝗱𝗲𝗹𝘀 Flies: up to 122% longer life. Rodents: 10-50%+ gains. Methionine restriction alone: 7-42% lifespan extension. Cutting isoleucine and valine: 23-65% in various setups — with less frailty and less cancer. 𝗧𝗵𝗲 𝗺𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺 𝘀𝗵𝗼𝘂𝗹𝗱 𝘀𝗼𝘂𝗻𝗱 𝗳𝗮𝗺𝗶𝗹𝗶𝗮𝗿 Excess protein — especially leucine, isoleucine, valine, and methionine — keeps mTOR switched on. mTOR is the growth accelerator. Keep it humming and autophagy shuts down, cells stop cleaning house, and senescent "zombie" cells accumulate. Restrict protein and it reverses. mTOR quiets. GCN2 activates autophagy. And FGF21 surges — driving fat burning, insulin sensitivity, and lower inflammation. This is the exact pathway rapamycin targets. The exact pathway fasting targets. We've been chasing it with drugs while telling everyone to eat more of the thing that blocks it. 𝗧𝗵𝗲 𝗵𝘂𝗺𝗮𝗻 𝗱𝗮𝘁𝗮 — 𝗮𝗻𝗱 𝘁𝗵𝗲 𝗳𝗶𝗻𝗱𝗶𝗻𝗴 𝘁𝗵𝗮𝘁 𝗰𝗵𝗮𝗻𝗴𝗲𝘀 𝗲𝘃𝗲𝗿𝘆𝘁𝗵𝗶𝗻𝗴 Levine's landmark Cell Metabolism study followed adults for 18 years. Those aged 50-65 with high protein intake had a 75% increase in overall mortality and a four-fold increase in cancer death. But here's the line nobody quotes: those associations were abolished or attenuated when the protein was plant-derived. Same amount of protein. Different source. Different outcome. And the age flip matters enormously: over 65, high protein was associated with reduced mortality. Your protein needs change with age — in the opposite direction from what the influencers say. 𝗧𝗵𝗲 𝗵𝗼𝗻𝗲𝘀𝘁 𝗰𝗮𝘃𝗲𝗮𝘁𝘀 Topol's own caution is right: this review rests largely on model organisms. So does most of the healthspan literature, including rapamycin — but "true in mice" isn't "true in humans," and I won't pretend otherwise. And Lamming himself gave the nuance that saves this from being clickbait: athletes consume enormous protein without developing metabolic disease. He suspects exercise protects them — the protein goes into building muscle instead of idling in growth pathways. So the finding isn't "protein is bad." It's that protein without exercise may be the problem. A sedentary person drinking protein shakes, eating protein cereal and protein water is chronically flooring a growth pathway with nothing demanding growth. 𝗪𝗵𝗲𝗿𝗲 𝗜 𝗹𝗮𝗻𝗱, 𝗮𝘀 𝗮 𝗰𝗮𝗿𝗱𝗶𝗼𝗹𝗼𝗴𝗶𝘀𝘁 If you're sedentary and eating 1.5-2g/kg because an influencer told you to — the data doesn't support it, and it may be working against you. If you lift hard 3-4x a week, that protein has somewhere to go. Different equation. And if you're over 70 or frail — do not cut your protein. Sarcopenia will kill you faster than mTOR will. Older adults and pregnant women need more, and the authors say so explicitly. I still believe the Mediterranean diet is the best diet on earth, and this review is the mechanistic explanation of why. It delivers moderate protein — mostly plants, legumes, nuts, fish. Lower methionine density. Olive oil, fiber, polyphenols. It hits every lever this paper describes without a single scoop of powder. Lamming's own lab tested it: a low-protein diet modeling the traditional Mediterranean and Okinawan patterns, head-to-head against Western and ketogenic diets. Western and keto increased fat mass and frailty. The Mediterranean-style diet reduced both and improved cardiometabolic markers. Traditional Okinawa ran about 9% of calories from protein. The blue zones didn't drink protein shakes. They ate beans, and they moved every single day.