Recent medical news followed by a review of pathophysiology, clinical manifestations, diagnosis, and treatment of myasthenia gravis.

News Articles:

1. New federal vaccine schedule (KFF): https://www.kff.org/other-health/the-new-federal-vaccine-schedule-what-changed/

2. HRT black box warning removal (FDA): https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy

3. More information about HRT warning label removal (Harvard Health): https://www.health.harvard.edu/womens-health/fda-removes-menopause-hormone-therapy-black-box-warnings

4. House votes to extend ACA subsidies (PBS): https://www.pbs.org/newshour/politics/in-a-rebuke-of-gop-leadership-house-heads-toward-vote-to-extend-health-care-subsidies

References:

1. Bird, S. J. Pathogenesis of myasthenia gravis. UpToDate. https://www.uptodate.com/contents/pathogenesis-of-myasthenia-gravis

2. Bird, S. J. Clinical manifestations of myasthenia gravis. UpToDate. https://www.uptodate.com/contents/clinical-manifestations-of-myasthenia-gravis

3. Bird, S. J. Diagnosis of myasthenia gravis. UpToDate. https://www.uptodate.com/contents/diagnosis-of-myasthenia-gravis

4. Bird, S. J. Overview of the treatment of myasthenia gravis. UpToDate. https://www.uptodate.com/contents/overview-of-the-treatment-of-myasthenia-gravis

Jody discusses ACA subsidies - what they are and why it matters that some of them are going away.

Resources:

1) Article on the Impact of Enhanced Subsidies Expiring (KFF)

2) News Article on the Republican Healthcare Plan (Reuters)

3) Interview About Subsidies Expiring (PBS)

4) Federal Poverty Level (healthcare.gov)

5) Reasons to Not Extend Enhanced Subsidies (CATO Institute)

Jody reviews LEGITIMATE information about hepatitis B vaccines in the wake of ACIP's recent recommendation to consider delaying vaccination for infants of non-infected mothers.

References & Links:

1) General Information on Hepatitis B Vaccines (OpenEvidence)

2) ACIP Press Release

3) Fact Check of the ACIP Press Release (PBS)

4) Impact of Hepatitis B Vaccines in the United States (CDC, pre-RFK)

5) Scientology Network Prescription for Violence (likely fake news)

Jody reviews pathophysiology, diagnosis, management, and prevention of kidney stones.

References & Links:

1) Curhan, G. C. Kidney stones in adults: Prevention of recurrent kidney stones. UpToDate. https://www.uptodate.com/contents/ kidney-stones-in-adults-prevention-of-recurrent-kidney-stones

2) Curan, G.C., Aronson, M.D., & Preminger, G.M. Kidney stones in adults: Diagnosis and acute management of suspected nephrolithiasis. UpToDate. https://www.uptodate.com/contents/kidney-stones-in-adults-diagnosis-and-acute-management-of-suspected-nephrolithiasis

3) Preminger, G.M., & Curhan, G.C. Kidney stones in adults: Evaluation of the patient with established stone disease. UpToDate. https://www.uptodate.com/contents/kidney-stones-in-adults-evaluation-of-the-patient-with-established-stone-disease

4) CDC Revives Debunked "Link" Between Childhood Vaccines and Autism (NPR)

5) Autism and Vaccines (CDC...FAKE NEWS!)

A novel non-opiate medication option for control of acute pain.

References:

1) OpenEvidence Information on Journavx

2) FDA Information on Journavx

3) GLP-1 Price Reduction Article (CNBC)

4) Vanderbilt LifeFlight Crash (WBRC)

Jody discusses insomnia and how to treat it from a primary care perspective.

Links & References:

1) FDA Info on Flu Vaccines

2) ACOG Position on Tylenol

3) AAP Position on Tylenol

4) Texas vs Tylenol Lawsuit

5) History of Government Shutdowns (USA Today)

6) CBT-I Coach App

7) Zammit GK. Ramelteon: a novel hypnotic indicated for the treatment of insomnia. Psychiatry (Edgmont). 2007 Sep;4(9):36-42. PMID: 20532119; PMCID: PMC2880941.

8) Bennett T, Bray D, Neville MW. Suvorexant, a dual orexin receptor antagonist for the management of insomnia. P T. 2014 Apr;39(4):264-6. PMID: 24757363; PMCID: PMC3989084.

9) Episode-Specific Reference Material (OpenEvidence)

(Doctor) Dale Hutchens is a recent cochlear implant recipient. He and Jody discuss his experience with hearing loss, receiving the implant, and brain training. Stick around for a special performance by Dale at the end of the episode!

Links:

1) Dale's Performance Video

2) Sample Distortion Video 1

3) Sample Distortion Video 2

4) Sample Distortion Video 3

5) Sample Distortion Video 4

6) Sample Distortion Video 5

7) Alvin & The Chipmunks Theme

8) R2D2 Sounds

9) Mr. Roboto by Styx

Updates on current medical news, Jody's Epocrates exodus, and a review of hepatitis B pathophysiology, diagnosis, and treatment.

References:

1. Lok. A. S. F. Hepatitis B virus: Screening and diagnosis in adults. UpToDate. https://www.uptodate.com/contents/hepatitis-b-virus-screening-and-diagnosis-in-adults

2. Lok. A. S. F., Hepatitis B virus: Overview of management. UpToDate. https://www.uptodate.com/contents/hepatitis-b-virus-overview-of-management

3. CDC ACIP Presentation: https://www.cdc.gov/acip/downloads/slides-2025-09-18-19/03-su-mmrv-508.pdf

4. ACIP Recommendation Statement: https://www.hhs.gov/press-room/acip-recommends-chickenpox-vaccine-for-toddlers.html

5. Tang LSY, Covert E, Wilson E, Kottilil S. Chronic Hepatitis B Infection: A Review. JAMA. 2018;319(17):1802–1813. doi:10.1001/jama.2018.3795. https://jamanetwork.com/journals/jama/fullarticle/2679946

6. OpenEvidence Conversation: https://www.openevidence.com/ask/4dde6fd5-1bca-4a86-a6f3-3a335f0334a1

7. AAP Recommended Vaccine Schedule for Children & Adolescents: https://publications.aap.org/redbook/resources/15585/AAP-Immunization-Schedule

8. Vaccine History (Hep B Foundation): https://www.hepb.org/prevention-and-diagnosis/vaccination/history-of-hepatitis-b-vaccine/

9. Vaccine History (CDC): https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a3.htm

Jody reviews recent developments in the US healthcare dystopia, then discusses pathophysiology, diagnosis, and treatment of gout.

References:

1) Merriman, T. Gout: Pathophysiology. UpToDate. https://www.uptodate.com/contents/gout-pathophysiology

2) Gaffo, A. L. Gout: Clinical Manifestations and diagnosis. UpToDate. https://www.uptodate.com/contents/gout-clinical-manifestations-and-diagnosis

3) Gaffo, A. L. Gout: Treatment of Flares. UpToDate. https://www.uptodate.com/contents/gout-treatment-of-flares

4) Perez-Ruiz, F. Gout: Pharmacologic urate-lowering therapy and treatment of tophi. UpToDate. https://www.uptodate.com/contents/gout-pharmacologic-urate-lowering-therapy-and-treatment-of-tophi

5) Neogi, T. Gout: Nonpharmacologic strategies for prevention and treatment. UpToDate. https://www.uptodate.com/contents/gout-nonpharmacologic-strategies-for-prevention-and-treatment

6) https://www.science.org/content/article/attempt-oust-cdc-director-sparks-key-resignations-agency-officials

7) The CDC's Vaccine Chief on Why Quitting Was His Only Option (The Daily via Spotify)

Music:

https://youtu.be/8GliyDgAGQI?si=F8NBaxJeaezO9V2Y

In a spin-off of last week's episode, Jody discusses making life and death decisions as a healthcare professional.