• From Washington, DC

• The Wall Street Journal reports,
  • “The Senate geared up Sunday for an all-night session of debate and amendment votes on the GOP’s “big, beautiful bill” [HR 1], after Republicans narrowly advanced the measure in a 51-49 vote that set up more push-and-pull before final passage.
  • “The 940-page legislation is driving a wedge between the GOP’s two wings, just as the party is racing to pass the measure early this week. Centrists have raised concerns about cutting benefit programs and straining state budgets, while fiscal conservatives are pushing for even more cuts to rein in federal budget deficits. 
  • “Proponents maintain that the opportunity to pass President Trump’s core agenda items—and pressure from Trump on holdouts—would propel the package over the finish line in the Senate, where the GOP has a 53-47 majority. 
  • “It’s a big, beautiful bill if you believe in cutting people’s taxes, securing the border, having a strong military and controlling government spending,” Sen. Lindsey Graham (R., S.C.) said on the Senate floor Sunday. “The bottom line is, we’re about to make history,” he said.”

• Here’s a link to the Journal’s explanation of the key provisions in the bill under Senate consideration. The Senate press gallery notes “The Senate will convene on Monday at 9:00 a.m. and begin the Vote-A-Rama on H.R. 1.” If the Senate passes the bill, then the Senate bill, which is based on the bill that the House passed in May, will go back to House for a vote. If the House approves the bill, then the bill will go to the President for signature into law.

• Beckers Payer Issues calls attention to five Medicare Advantage bills pending in Congress.

• There is only one Congressional hearing scheduled for this holiday week.

• The Wall Street Journal lets us know how “the Supreme Court dipped its toes into Trump 2.0” during its October 2024 term ended last Friday.

From the public health and medical research front,

• Fortune Well reports,
  • For all of the advancement in treating stroke victims over the past couple of decades, some concerns have remained almost constant. In medicine, we like to say that “time is brain,” meaning that every moment a stroke goes untreated, the potential for long-term brain damage or death escalates. In fact, every minute that the brain goes without blood flow, the average patient loses around 1.9 million neurons and about a week of independent life, experts say.
  • “As the vast majority of strokes are ischemic, with a blood clot blocking the flow of oxygen to the brain, clearing that clot swiftly is critical. This is true whether the clot is small or large and regardless of its density—but reliably removing the densest clots via mechanical means has proved an elusive task.
  • “Though these concerns, time and density, are not necessarily linked, both matter—one reason, researchers suggest, that a newly developed technology from Stanford University holds the potential to reshape how stroke patients are treated.
  • “The device, called a milli-spinner, is a tiny, powerfully rotating hollow tube outfitted with fins and slits. In action, both lab and swine tests demonstrate the ability to dramatically compact and shrink the size of blood clots, making it easier to remove them quickly and effectively—often on the first try.
  • “This has the potential to be a game changer,” says Greg Albers, director of the Stanford University Stroke Center and a longtime expert in the field. “The results are likely to translate well to clinical trials.”
    
• The New York Times tells us,
  • “Gary Sergott felt weary all the time. “I’d get tired, short of breath, a sort of malaise,” he said. He was cold even on warm days and looked pale with dark circles under his eyes.
  • “His malady was not mysterious. As a retired nurse-anesthetist, Mr. Sergott knew he had anemia, a deficiency of red blood cells. In his case, it was the consequence of a hereditary condition that caused almost daily nosebleeds and depleted his hemoglobin, the protein in red blood cells that delivers oxygen throughout the body.
  • “But in consulting doctors about his fatigue, he found that many didn’t know how to help. They advised Mr. Sergott, who lives in Westminster, Md., to take iron tablets, usually the first-line treatment for anemia.
  • “But like many older people, he found a daily regimen of four to six tablets hard to tolerate. Some patients taking iron complain of severe constipation or stomach cramps. Mr. Sergott felt “nauseated all the time.” And iron tablets don’t always work.
  • “After almost 15 years, he found a solution. Dr. Michael Auerbach, a hematologist and an oncologist who is the co-director of the Center for Cancer and Blood Disorders in Baltimore, suggested that Mr. Sergott receive iron intravenously instead of orally.
  • ‘Now Mr. Sergott, 78, gets an hourlong infusion when his hemoglobin levels and other markers show that he needs one, usually three times a year. “It’s like filling the gas tank,” he said. His symptoms recede, and “I feel great.”
  • “His story reflects, however, the frequent dismissal of a common condition, one that cannot only diminish older adults’ quality of life but lead to serious health consequences, including falls, fractures and hospital stays.”

• The Washington Post informs us,
  • In her mid 70s, Argie, a widowed former teacher, began feeling poorly. She was tired. Her stomach hurt. Sometimes she got agitated. And she seemed forgetful.
  • Worried, her grown children urged the woman, who asked that only her first name be used for privacy reasons, to consult a memory specialist in Baltimore, not far from her home.
  • Argie’s cognitive powers, the doctor concluded, were reasonably good. But her medicine cabinet was a real hazard: She was taking 21 different prescription drugs, for diabetes, high blood pressure and her kidneys. After an assessment by a team that included a clinical pharmacy specialist well versed in drug interactions, she’s now down to eight.
  • “Every time I went in to a doctor, they gave me another pill,” Argie said. She’s now less confused. Less agitated. Less nauseated. She said cognitive challenges are manageable, and she’s more energetic and steadier on her feet.
  • “That overload of drugs, known as polypharmacy, can be dangerous at any age but it’s particularly hazardous for elderly people, who often have multiple health conditions and whose bodies may not handle meds the same way they did when they were younger, said Nicole Brandt, a leading expert on geriatric prescribing at the University of Maryland.”
    
• Per Medscape,
  • “Posttraumatic headache (PTH) is frequently misdiagnosed and undertreated in nonspecialist settings, highlighting a critical gap in diagnostic accuracy, treatment access, and integrated care for this complex condition, new research showed. 
  • “Investigators found that patients with the condition are frequently misdiagnosed and undertreated in nonspecialist settings. Further, most are only correctly diagnosed with a migraine phenotype after evaluation by a headache specialist.
  • “A central message of our work is that the diagnosis of ‘headache’ is too often treated as a monolith — an endpoint rather than the beginning of a diagnostic journey,” study investigator Natalia Murinova, MD, clinical professor of neurology, and director of the headache clinic at the University of Washington (UW), Seattle, told Medscape Medical News.
  • “The results of the retrospective analysis were presented at the American Headache Society (AHS) Annual Meeting 2025.”