Mamdani eats with his hands, ostentatiously

 

By Monica Showalter

As Chris Rufo has noted many times, the left has always been fascinated with the exotic.

Rep. Alexandria Ocasio-Cortez understood this. Now New York's top mayoral candidate, Zohran Mamdani, who's only been a U.S. citizen for seven years, plays this up even better for his wealthy white left-wing political base.

Here he is in all his glory, ostentatiously eating with his hands:

Zohran says his worldview is inspired by the 3rd world while eating rice with his hands pic.twitter.com/FDaQfcNSJv

— End Wokeness (@EndWokeness) June 29, 2025

Now, there are some cultures that eat with their hands, India, the land of his heritage, is one of them. But it's mainly southern India, with its ancient Ayurvedic tradition where this hand technique is used most, and with his light skin and Muslim background, he looks pretty northern.

But he's not really northern Indian, either. Having been raised in the palmy elite environments of Columbia University and only with the elites, you can bet he didn't grow up eating with his hands.

What's more he ... doesn't do it right. Eating with the hands is a practiced art, you don't just scoop up food like a caveman as the video shows him doing. I see some effort on his part to get it right, using only fingers, but his thumb action is extremely clumsy. He doesn't do it with the swift, practiced, almost mechanical grace I've seen people in Singapore (which has a large southern Indian community) or Sri Lanka doing. He's pretty hesitant, actually.

According to Food Republic, there is a right way to do it:

First, washing hands thoroughly before eating is key. Use your fingers to create a utensil and the food itself as a tool. Rice, a grain, or flatbread provides the foundation for runnier dishes like a curry or soup. Bunch up a cohesive bite on the plate, and use your fingers to scoop or pinch the food. Do not stick your fingers or palm in your mouth. Instead, use your thumb to push the food in. It takes practice, but your fingers can act as a sort of spoon.

 

It is also crucial to only use your right hand to touch food or drink, pass dishes, and greet others. To preserve cleanliness, the left hand is historically reserved for activities like going to the bathroom. More specifically, you should eat using only the thumb, index finger, and middle finger, and should only lick your fingers once you are done eating. Strict adherence to this custom varies, but in general, avoiding using the left hand while eating is very important.

He doesn't do it the right way. He does it more the cave-man way, counting on his white leftist supporters to be favorably impressed with how down in the mud with the proles of India he is. It's complete theatre, a showtime shoveling, not the real way he eats.

As Rufo notes:

The thing about Zohran Mamdani is that he is not an Islamist, but a regime leftist who understands that the symbols of the exotic Other are an extremely valuable currency within the world of the radical Left. He was able to very skillfully combine the outward appearance of the…

— Christopher F. Rufo ⚔️ (@realchrisrufo) June 25, 2025

And actually, he's a knife and fork man, eating even a burrito with those utensils,

This isn't even the worst
Zohran Mamdani's worst eating habit! Mamdani knows how to use a fork & knife but apparently saves it for when he's eating burritos on the subway like an animal.https://t.co/Rh534SJKkO

— Izengabe (@Izengabe_) June 30, 2025

Cripes, who eats a burrito with a fork and knife? It defeats the purpose of the burrito. Just shake it all out onto the plate and throw the wrapper away, dude. I bet he eats pizza the same way, which ought to get him drummed out of New York.

Rufo has seen this going on for awhile -- note the date:

America’s radical Left has always had a fetish for violent Third Worldism. Fifty years ago, they worshipped Che, Mao, Cabral. Now they make icons of Hamas paragliders and chant for “decolonization.” Same ideology, same play-acting, same seething fantasy of revenge.

— Christopher F. Rufo ⚔️ (@realchrisrufo) October 14, 2023

It's all about projecting the exotic. The exotic impresses white leftists (Tom Wolfe, in his Radical Chic long essay, noted this phenomenon, too), and Mamdani has found a way to impress them with his supposed eating skills. Too bad he doesn't eat that way and neither do people in India. His lack of skill is the big tell.

What a fake, phony, fraud he is. And you can bet many New Yorkers of south Asian descent are not going to be fooled. No wonder so many of his ideas are foolish nonsense. His bid to 'go native' when he isn't a true native is a big tell.

https://www.americanthinker.com/blog/2025/06/mamdani_eats_with_his_hands.html

Settler-Colonialist Zohran Mamdani Calls For "Seizing The Means Of Production"

 by Francis Menton

Last week I invited readers to get a good laugh out of New York Governor Kathy Hochul’s plan to avert impending energy disaster by green-lighting one nuclear power plant that optimistically might solve 5% of the problem when it is ready to operate in the 2050s. Now this week brings an even superior farce: A video clip has emerged of our settler-colonialist Democratic mayoral candidate Zohran Mamdani calling for “seizing the means of production.”

Mamdani’s victory in last week’s Democratic primary has led researchers to dredge up a treasure trove of his old tweets and video clips, each one more ridiculous than the next. An excellent roundup can be found here at Legal Insurrection. Some choice examples include: “VioIence is an artificial construct"; “Under capitalism, housing is a commodity from which landlords & developers extract huge profits while our communities suffer eviction, foreclosure & displacement.”; “We need to dramatically curtail the power & presence of the NYPD.”; and “[A] statue of Columbus remains in Astoria, in defiance of the values of humanity, empathy & justice that we stand for.”

But my favorite is a clip from a speech Mamdani gave at a Democratic Socialists of America conference in 2021. The New York Post today quotes some excerpts from the speech, among them Mamdani’s statements that issues socialists “firmly believe in,” include “boycotts, divestment and sanctions against Israel” and “the end goal of seizing the means of production.”

“Seizing the means of production” — now there’s a retro concept. The “means of production” was good commie talk back in the 19th century, when Karl Marx and his followers looked around and saw things like steel mills, railroad engine factories, iron foundries, coal mines, textile mills, and other such big facilities to make lots of stuff. It seemed obvious that those facilitie were where the greedy capitalists got their wealth.

But has Mamdani even looked around the New York City of today? What even exists today that you could call a “means of production”?

In New York City today, we produce almost nothing that is tangible. I wonder if Mamdani has noticed that.

In May 2016 I did a big post with lots of research titled “The Devastation Of New York City’s Economy.” The post documented the complete transformation of New York City’s economy from the 1950s to the time of the post, and in particular the almost complete disappearance of manufacturing. As noted in the post, in the aftermath of World War II, New York City’s economy had over 1 million manufacturing jobs, distributed among some 37,000 different companies. Those companies and people made a huge variety of products, most famously women’s clothing, where New York City was completely dominant and supported about 231,000 jobs. By the time of the post in 2016, the total number of manufacturing jobs in New York City in all industries was down to about 80,000. According to the most recent statistics from the New York State Department of Labor, the current number of manufacturing jobs in the City (May 2025) is only 57,700. That’s out of total private-sector employment of some 4,248,300.

Such manufacturing as continues to exist in New York City is reduced to a few specialized niches. For example, there continue to be specialized clothing manufacturers to make things like costumes for Broadway shows and samples for runway fashion shows. Are their sewing machines what Mamdani means by the “means of production”?

In the way of mass production of physical goods for human consumption, almost none of it occurs in New York City. Food? Obviously, we don’t grow that here. Clothing? Almost certainly, nothing in your wardrobe or mine was manufactured in New York City. Housing or other buildings? They are put together on site, but the materials almost all come from elsewhere (structural concrete is one exception). Automobiles? There are no assembly plants in the five boroughs; and if you know of a manufacturer of some kind of parts for the auto industry in New York City, I would like to learn of it.

But aren’t there some kind of “means of production” to make all the wealth that gets generated in the hundreds of big office buildings in Manhattan? I would love to see Mamdani’s plans to seize whatever this may be. When he sends in his shock troops to make the seizures, all he’s going to find are a bunch of laptops no different from what you could get at the Apple store.

How about the investment bankers and traders and hedge funders who make millions of dollars per year dealing in the capital markets? I suppose that their “means of production” mainly consists of the proprietary software that they use in their businesses. The bankers may know how to make big money using this software, but seized and distributed among the masses, it would be almost completely useless. It’s really quite funny to contemplate.

Anyway, these are the levels of ignorance and foolishness that we are dealing with.

https://www.manhattancontrarian.com/blog/2025-6-30-settler-colonialist-zohran-mamdani-calls-for-seizing-the-means-of-production

Democrats May Not Be Able to Resist Mamdani’s Pull

 Once upon a time, a New York member of the Democratic Socialists of America won the Democratic Party’s mayoral nomination, backed by the Working Families Party. This thirtysomething activist ran on a platform of publicly owned grocery stores, reallocating police funding to community-based mental health responders, and tenant-friendly policies. The primary election delivered a major surprise, with the socialist candidate capturing the Democratic line.

But then Byron Brown, the incumbent Democratic mayor of Buffalo, launched a write-in campaign against India Walton, the surprise nominee. Brown defied expectations, winning nearly 60 percent of the vote in the 2021 general election. He would still be mayor today had he not resigned in 2024 to become CEO of Off-Track Betting in western New York.

Could Brown’s experience repeat itself in New York City in 2025? Assemblyman Zohran Mamdani, a DSA member with WFP support, defeated former governor Andrew Cuomo to secure the Democratic line in this year’s mayoral race. Incumbent mayor Eric Adams, weakened by scandal and criticized for his willingness to work with President Trump on immigration enforcement, sat out the primary and instead registered as an independent for the November ballot.

The parallels with Buffalo—a longtime local incumbent challenged by a left-wing insurgent—are striking, but the differences are greater. Buffalo, though New York’s second-largest city, is just one-thirtieth the size of New York City. Write-in campaigns are rarely successful, but Brown needed only 38,000 votes to stage his comeback. As a four-term mayor in a shrinking Rust Belt city where political patronage remains strong, he had plenty of loyal allies to rally support. Adams will need far more votes to win his independent bid—though unlike Brown, he will appear on the ballot.

But New York is vast and diffusely governed. Its residents aren’t closely tied to municipal government for jobs or services, and many tune out local elections. Democrats outnumber Republicans almost six to one, and when they vote, they tend to stick with the Democratic line. Persuading hundreds of thousands of Democrats to back an independent—especially one with Adams’s baggage—will be a tall order. So will getting the city’s half-million registered Republicans to vote for a Brooklyn-machine Democrat.

The Adams camp is hoping for strong support from New York City’s black communities, along with a majority of the city’s Jews—many of whom are uneasy about Mamdani’s deep hostility toward Israel and longstanding Jewish-American institutions. Mamdani’s push to eliminate the specialized high school admissions test could prove divisive in Chinese and Korean communities, while his vocal criticism of Indian Prime Minister Narendra Modi may hurt him among the city’s Hindu voters. He also performed poorly in the Bronx. Adams has already played the “class card,” highlighting Mamdani’s privileged background: a tract of land in Uganda’s most fertile region, internationally renowned parents, and a lifestyle far removed from that of working-class New Yorkers.

Business leaders and the city’s billionaire class are alarmed at the prospect of New York electing an avowed socialist as mayor. They are preparing a major campaign to stop Mamdani—but it may be too late.

In 2015, the Republican Party underwent a wrenching transformation as Donald Trump seized control and turned it into a vehicle for MAGA populism. Many lifelong Republicans either left or were sidelined during this political realignment. That transition is now complete. Today’s GOP bears little resemblance to the party of a decade ago.

The Democrats, on the other hand, have resisted popular pressure to change. They are still wedded to the Baby Boomer Clinton/Obama/Biden consensus of a strong stock market undergirding generous entitlements, and a crusading view of American foreign policy, including generally strong support for Israel (though more qualified than Republican support). That may be changing. Bill Clinton, Hakeem Jeffries, and Chuck Schumer have all cheered Mamdani’s win, congratulating him and giving him some claim to be a new leader of the Democratic Party. If this trend continues, the Democrats will have to undergo their own catastrophic molting, shedding centrists and donors, as the party becomes something closer in appearance to the British Labour Party, with socialism and anti-Zionism at the center of its agenda. America may or may not like Democrats’ aggressively left-wing remodeling, but it seems that the process is under way.

Seth Barron’s next book, Weaponized, will be published in January.

https://www.city-journal.org/article/new-york-city-zohran-mamdani-democratic-party-byron-brown

Synthetic Nicotine Storms Onto the Vaping Scene

 1 in 12 teens, young adults surveyed vape unregulated form of nicotine

• Among 1,760 adolescents and young adults (ages 14-25 years) surveyed, 20.1% recognized products with the synthetic nicotine analogue 6-methyl-nicotine, and 8.4% said they had ever used one.
• These prevalence levels were observed within less than a year since the predominant delivery system for 6-methyl-nicotine entered the U.S. market.
• Synthetic nicotine analogues are not regulated as tobacco and have little clinical evidence but some concerning animal data.

Unregulated synthetic nicotine analogues, namely 6-methyl-nicotine branded as Metatine in Spree Bar flavored vaping products, have gained "appreciable" awareness and youth among youth, the first prevalence survey showed.

In the survey of 1,760 people ages 14 to 25 years, 20.1% recognized 6-methyl-nicotine products, and 8.4% said they had ever used one, reported Adam M. Leventhal, PhD, of the Institute for Addiction Science at the University of Southern California (USC) in Los Angeles, and colleagues in Pediatricsopens in a new tab or window.

"Notably, these prevalence levels were observed within less than a year since Spree Bar, a major delivery system for the nicotine analogue, 6-methyl-nicotine, entered the U.S. market in October 2023," the group wrote.

"These study findings emphasize the need for targeted regulatory activities addressing synthetic nicotine analogues to prevent uptake among young populationsopens in a new tab or window," Leventhal and colleagues concluded.

Synthetic nicotine analogues are marketed in flavored vaping products that anti-tobacco groups argue appeal to youthopens in a new tab or window. While regulation of flavored vaping products in general has faced a tough battleopens in a new tab or window, the synthetic nicotine analogues are bypassing U.S. tobacco regulatory safeguards altogether.

These products fall into what the researchers called a concerning gap both because they are exempt from premarket tobacco product application (PMTA) requirements and because of their pharmacologic impact.

While toxicity in humans remains unclear for these products that have recently entered the market, "animal studies indicate that 6-methyl-nicotine produces systemic toxicity, including neurotoxic effects, potentially at levels higher than nicotine," with methylation at points on the nicotine molecule that might enhance its addictive potential and biological effectsopens in a new tab or window.

"Indeed, the Spree Bar website claims that Metatine (i.e., 6-methyl-nicotine) provides 'pleasure and enjoyment,' 'combines well with flavors,' 'tastes great,' 'poses no additional risk,' and is 'half the price' and 'tax exempt,'" Leventhal's group pointed out.

The cross-sectional study used data from the USC Tobacco Center of Regulatory Science-Teen and Young Adult Tobacco Study, for which participants were recruited through the CINT online platform that connects researchers with opt-in panels of U.S. residents interested in participating in surveys for compensation.

From May to June 2024, 1,760 youth, ages 14 to 25 years, completed the survey across 48 states. Females accounted for 50.2% of the cohort, with 68.4% identifying as heterosexual.

The group was oversampled for tobacco use, with 1:1 sampling quotas by age group (55.6% adolescent vs young adult) and tobacco use (55.3% ever-users vs never-users). E-cigarette use was the most common tobacco product reported as having been used in the past 30 days, at 20.5%.

Current users of any tobacco product had higher awareness of nicotine analogue products compared with never-users in demographic covariate-adjusted models (28.9% vs 14.8%; adjusted OR 2.19, 95% CI 1.66-2.89). That nearly 15% of youth who had never used any tobacco products were "nonetheless aware of these nicotine analogue products ... suggests that the marketing reach of vaping products with nicotine analogues extends beyond traditional tobacco use groups," the researchers noted.

The only demographic factor associated with lower awareness was the "other" racial category that included non-Hispanic Asian, Native American, Middle Eastern, and other minority groups as compared with non-Hispanic white youth (8% vs 21.5%; aOR 0.33, 95% 0.19-0.60).

Current tobacco users also accounted for nearly all of the synthetic nicotine analogue use (20.2% vs 0.6% among never-users; aOR 37.74, 95% CI 15.22-93.60), particularly combustible cigarette users (25.2% vs 2.6%; aOR 12.91, 95% CI 7.85-21.25).

"This pattern reflects prior research indicating that multiple nicotine product use is increasingly prevalent among young people, a trend that carries substantial implications for public health," Leventhal and colleagues wrote, noting that the adolescent brain is particularly sensitive to the effects of intoxicating agents.

"Given that nicotine and nicotine analogues may interact through common neuropharmacological pathways, the long-term consequences of concurrent exposure are largely unknown and merit further investigation," they added.

Study limitations included the design that precluded temporal or causal conclusions, and possible reporting bias from the self-reported (albeit anonymous) sampling in a group not nationally representative.

"Updating federal policies to include nicotine analogues in the PMTA process would be impactful; however, states and localities can implement their measures in the meantime. For example, California recently enacted a law subjecting nicotine analogues to the same regulatory standards as other tobacco products," the researchers wrote. "Despite these efforts, federal action remains essential to ensure comprehensive regulation of synthetic nicotine analogue products."

Disclosures

The study was supported by the National Institute on Drug Abuse.

Leventhal and co-authors disclosed no relationships with industry.

Primary Source

Pediatrics

Source Reference: opens in a new tab or windowSanchez LM, et al "Awareness and use of vaping products with a nicotine analogue among adolescents and young adults " Pediatrics 2025.

https://www.medpagetoday.com/pulmonology/smoking/116322

'ACIP Members Show Inexperience, Lack of Understanding at First Meeting': Critics

 If observers were waiting for a moment when the newly anointed members of the CDC's Advisory Committee on Immunization Practices (ACIP) made a clear case against U.S. vaccine science, it didn't happen during the group's 2-day meeting

opens in a new tab or window last week.

Instead, panelists repeated old COVID grievancesopens in a new tab or window, re-litigated solved issues around thimerosalopens in a new tab or window and the measles, mumps, rubella, and varicella (MMRV) vaccine, and asked basic questions about epidemiologic methods underpinning high-quality science, some observers told MedPage Today.

"We have people who are asking questions of the CDC like it's a college epidemiology class, not understanding basic principles," said James Lawler, MD, MPH, of the University of Nebraska Medical Center's Global Center for Health Security in Omaha. "It's embarrassing for the United States and it makes me incredibly sad."

One sticking point for panelist Retsef Levi, PhD -- a professor of operations management at the Massachusetts Institute of Technology -- was that CDC's vaccine effectiveness studies used a test-negative design that he claimed oversampled for people who'd been vaccinated. An "alternative explanation," he said of the high number of vaccinated people in the study, "would be that the vaccine is actually making you more vulnerable for multiple viruses."

Ruth Link-Gelles, PhD, MPH, of the CDC's National Center for Immunization and Respiratory Diseases, who has been leading the agency's vaccine effectiveness studiesopens in a new tab or window for years now, explained that the cases are older people hospitalized with acute respiratory illness, and are at baseline more likely to be vaccinated than the general population.

"When you're up to 90% of those populations being vaccinated, of course you're going to have perceived over-representation of that population winding up in the hospital with COVID," Lawler told MedPage Today. "This is just a reflection of the fact that he doesn't understand basic principles of epidemiology."

A lack of understanding of decades of work in epidemiology and infectious disease was particularly on display when it came to panelists demanding randomized controlled trials (RCTs) for COVID vaccines, the critics said.

"In an ideal world, we would have RCTs for everything," Lawler said. "But you have to think about the practicality of doing that, the timeliness, the cost, the ethics of doing that. Is it ethical to randomize a high-risk person to placebo in 2025?"

He noted that the first test-negative studies confirmed what the initial COVID vaccine RCTs showed, and subsequent prospective cohort studies also aligned with those test-negative studies.

"You have all these data that give you a consistent arc from the beginning of the utilization of vaccines in the pandemic until now, where we've consistently reinforced the findings of these test-negative studies with other studies that are more rigorously executed," he said.

Nonetheless, FDA ex officio ACIP member Tracy Beth Høeg, MD, PhD, went so far as to say the CDC's vaccine effectiveness studies were misleading.

"I think I share with a lot of people on this panel the desire to see randomized controlled trials to minimize these types of bias," Høeg said. "So we aren't sitting here wondering if we're being misled by the data."

No epidemiologist or infectious disease expert would feel misled by CDC's vaccine effectiveness data, Lawler said.

"These are not serious, legitimate arguments by people who understand the science extensively," he added. "These are, generously, arguments that are made by people who don't really understand the epidemiology and how these vaccines are tested and evaluated."

There was no shortage of other controversial topics brought up by panelists. Robert Malone, MD, alleged that "hot lots" of COVID vaccines were to blame for causing more serious adverse events. Levi suggested that the vaccine caused evolutionary pressure that led to new mutations -- even though the COVID Delta variant evolved before vaccines were available, Lawler noted.

Paul Offit, MD, of the Children's Hospital of Philadelphia, pointed out that the measles vaccine has been around for more than 60 years and "that has in no way changed the virus."

"Even though you have a highly vaccinated population ... the vaccine still works. That's true of COVID too," he told MedPage Today.

Even the committee's lone infectious disease and pediatrics expert Cody Meissner, MD, of the Geisel School of Medicine at Dartmouth, raised the issue of dying "from" versus "with" COVID -- which certainly wasn't a concern for the 2024-2025 season as hospitals no longer test everyone for COVID, Lawler and Offit said. They also noted that studies showed that even early in the pandemic, most people who were COVID-positive and died in a hospital died from COVID.

Meissner also said COVID was a "rare illness" in kids, which Offit took issue with, noting that 2,800 children have died from COVID in the last 5 years, leaving behind thousands of bereaved families.

Meissner was, however, the voice of reason on a presentation about thimerosalopens in a new tab or window given by Lyn Redwood, RN, who was president of the World Mercury Project, which became Children's Health Defense, and has alleged that her son's autism was due to vaccination. (A presentation on thimerosal prepared by the CDC was removed from the meeting's website, which Malone said was a directive of HHS Secretary Robert F. Kennedy Jr.'s office.)

"I'm not quite sure how to respond to this presentation," Meissner said. "This is an old issue that has been addressed in the past."

Indeed, only about 5% of flu shots given annually contain thimerosal, experts said.

Similarly, Martin Kulldorff, PhD, presented on the combined MMRV vaccine, despite noting that the CDC urged a preference for separate vaccines -- the MMR vaccine and a separate varicella vaccine -- for the first dose in 2009.

Today, most pediatricians give separate vaccinations, so it's not clear why this needs to be discussed again, the outside observers said.

Are these topics new to those who don't have expertise in pediatrics, infectious disease, and epidemiology? In the past, all ACIP panelists had expertise in at least one area relevant to vaccinology. But many of the new panelistsopens in a new tab or window have no such background, including Levi and his focus on operations management. One is a psychiatrist, one is an emergency physician, and one has a doctorate in nursing.

Medical organizations have highlighted this lack of expertiseopens in a new tab or window, and several decided not to attend the meeting, including the American Academy of Pediatrics, the Pediatric Infectious Diseases Society, and the Society for Adolescent Health and Medicine.

The Infectious Diseases Society of America did not send a representative to the meeting, but told MedPage Today that it wasn't a boycott; rather, liaisons were invited to attend just a few hours before the start of the meeting.

Lawler noted that while some of the arguments made during the meeting may sound "reasonable and logical" to untrained ears, they "don't have a strong basis in data and science and are just used to impart more doubt, and that undermines confidence."

"We fired 17 peopleopens in a new tab or window who had the kind of expertise and experience that would give us the advice that would benefit this country," Offit added. "We don't have that anymore. We have anti-vaccine activists who have been shouting from the sidelines for decades, and now they're making public policy."

https://www.medpagetoday.com/infectiousdisease/vaccines/116343

Some Hormone Therapies Linked to Young-Onset Breast Cancer

 

• Hormone therapy may be used by young women to relieve symptoms from hormone-­related conditions, menopause, or gynecologic surgery.
• Use of estrogen hormone therapy was inversely associated with young-onset breast cancer.
• Long-term use of estrogen/progestin hormone therapy was positively associated with young-­onset breast cancer, as was use among women with an intact uterus and ovaries.

While use of estrogen hormone therapy was inversely associated with young-onset breast cancer, estrogen/progestin hormone therapy was linked to a higher incidence among certain subgroups, according to a pooled cohort analysis.

Among over 450,000 women ages 16 to 54, hormone therapy of any type was not associated with incident young-onset breast cancer (HR 0.96, 95% CI 0.88-1.04), but ever estrogen hormone therapy use had an inverse association (HR 0.86, 95% CI 0.75-0.98), reported Katie M. O'Brien, PhD, of the National Institute of Environmental Health Sciences, and colleagues in Lancet Oncologyopens in a new tab or window.

However, long-term use (>2 years) of estrogen/progestin hormone therapy was positively associated with young-­onset breast cancer (HR 1.18, 95% CI 1.01-1.38), as was use among women without hysterectomy or bilateral oophorectomy (HR 1.15, 95% CI 1.02-1.31).

Estrogen/progestin hormone therapy was more strongly associated with estrogen receptor-negative disease (HR 1.44, 95% CI 1.11-1.88) and triple-negative disease (HR 1.50, 95% CI 1.02-2.20) compared with other subtypes.

"Young women might use hormone therapy to relieve symptoms from hormone-­related conditions, menopause, or gynecological surgery, but the risks and benefits of doing so have not been thoroughly investigated," wrote O'Brien and colleagues. "Altogether, the results of this large-­scale investigation, in conjunction with mostly consistent results from previous studies of postmenopausal womenopens in a new tab or window, provide key information that might be useful for establishing clinical recommendations regarding hormone therapy use in young women."

In a press releaseopens in a new tab or window, co-author Dale Sandler, PhD, also of the National Institute of Environmental Health Sciences, noted that "these findings underscore the need for personalized medical advice when considering hormone therapy."

"Women and their healthcare providers should weigh the benefits of symptom relief against the potential risks associated with hormone therapy, especially EP-HT [estrogen/progestin hormone therapy]," he said. "For women with an intact uterus and ovaries, the increased risk of breast cancer with EP-HT should prompt careful deliberation."

In a commentary accompanying the studyopens in a new tab or window, Christelle Lévy, MD, of the Centre Francois Baclesse Centre for Cancer in Caen, France, wrote that a "one-size-fits-all strategy is probably not the best approach," considering young women eligible for hormone therapy often present with various clinical and biological profiles.

"Recommendations for young women should consider knowledge of the benefit-risk profile of hormonal therapy and the unanswered questions in this domain (such as biological and genomic features of cancer cells at a young age or the impact of endogenous and exogenous factors on the initiation and neoplastic progression), emphasizing the importance of prospective trials that are truly missing compared with the abundant literature available for postmenopausal women," she added.

For this study, O'Brien and colleagues pooled data from 459,476 women across prospective cohorts in North America, Europe, Asia, and Australia. Mean age was 42, 79% were white, 14% were Black, and 5% were Asian; 12% had undergone a hysterectomy, and 5% had undergone bilateral oophorectomy. Overall, 15% of the study participants reported using hormone therapy, with estrogen/progestin (6%) and unopposed estrogen (5%) being the most common types.

Of these women, 2% developed young-onset breast cancer (diagnosed before age 55; median follow-up 7.8 years). Women who developed young-­onset breast cancer during follow-­up were slightly younger at enrollment (mean 40.7 years) and less likely to be postmenopausal (14% vs 21% in the full pooled sample).

HR estimates for associations were largely similar across menopausal status, age, body mass index, race, geographical region, and birth year.

O'Brien and colleagues acknowledged that their study had limitations, including the fact that they were unable to adjust for alcohol use or physical activity, and they did not have any data on BRCA1/2 or other known breast cancer predisposition genes. Moreover, they noted that their results may not be generalizable to all groups, since the pooled sample was made up primarily of white women from North America.

Disclosures

The study was funded by the NIH Intramural Research Program.

The study authors had no disclosures.

Lévy had no disclosures.

Primary Source

Lancet Oncology

Source Reference: opens in a new tab or windowO'Brien KM, et al "Hormone therapy use and young-onset breast cancer: a pooled analysis of prospective cohorts included in the Premenopausal Breast Cancer Collaborative Group" Lancet Oncol 2025; DOI: 10.1016/S1470-2045(25)00211-6.

Secondary Source

Lancet Oncology

Source Reference: opens in a new tab or windowLévy C "Hormonal therapy for young-onset breast cancer: current understanding and lessons" Lancet Oncol 2025; DOI: 10.1016/S1470-2045(25)00268-2.

https://www.medpagetoday.com/hematologyoncology/breastcancer/116344

CMS to Test Prior Authorization Model in Traditional Medicare

 The Centers for Medicare & Medicaid Services (CMS) announced a new experimental model

opens in a new tab or window late last week to streamline some prior authorizations under the traditional Medicare program, but some politicians and experts are concerned that it could result in more delays in care.

Under the model, known as the Wasteful and Inappropriate Service Reduction (WISeR) Model, "CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process" under traditional Medicare, the agency said Friday in a press releaseopens in a new tab or window, adding that the model will help "patients and providers avoid unnecessary or inappropriate care and [will safeguard] federal taxpayer dollars."

The WISeR Model will test new technologies including artificial intelligence to see whether they can expedite the prior authorization processes for certain items and services "that have been identified as particularly vulnerable to fraud, waste, and abuse, or inappropriate use," the press release noted. "These items and services include, but are not limited to, skin and tissue substitutesopens in a new tab or window, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis."

The model excludes inpatient-only services and emergency services, as well as "services that would pose a substantial risk to patients if significantly delayed."

The announcement came only a few days before the Justice Department announced a major healthcare fraud takedown that included $1.1 billion in alleged Medicare fraud related to the use of skin substitutes.

"As alleged, certain defendants targeted vulnerable elderly patients, many of whom were receiving hospice care, and applied medically unnecessary amniotic allografts to these patients' wounds," the Justice Department said in a press releaseopens in a new tab or window. "Many of the allografts allegedly were applied without coordination with the patients' treating physicians, without proper treatment for infection, to superficial wounds that did not need this treatment, and to areas that far exceeded the size of the wound."

The seven defendants charged in the wound care scheme -- for which some allegedly received "millions" in illegal kickbacks -- are located in Arizona and Nevada; five of them are medical professionals, according to the department.

Companies selected to participate in the WISeR Model "must have clinicians with appropriate expertise to conduct medical reviews and validate coverage determinations," CMS said. And although technology will help in the initial process, any final decisions regarding denial of coverage "will be made by licensed clinicians, not machines."

The model will be tested initially only in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington, the agency said in a Federal Register noticeopens in a new tab or window.

Rep. Suzan DelBene (D-Wash.), whose state is impacted by the new model, sounded a note of concern. "It's baffling how in one breath the administration is trying to take a victory lap on insurers streamlining prior authorization in Medicare Advantage, and in the other instituting the same delay tactics in traditional Medicare," DelBene said in an email to MedPage Today. She was referring to the administration's announcement last Mondayopens in a new tab or window that it had reached agreements with major insurers to simplify -- and in some cases cut down on -- the use of prior authorization by health plans, including those participating in Medicare Advantage.

"Traditional Medicare rarely utilizes prior authorization, a factor that many seniors take into account when choosing between it and Medicare Advantage," DelBene said. "The recent announcement leaves us with more questions than answers, especially given the lack of meaningful bipartisan engagement with Congress beforehand. I'm working to get clarity from the administration on how these changes will be implemented and what accountability patients and providers have when care is unnecessarily delayed or denied."

DelBene is the chief sponsor of the Improving Seniors' Timely Access to Care Actopens in a new tab or window, which would establish a standard process for electronic prior authorizations and encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines, among other provisions.

Michael Baker, director of healthcare policy at the American Action Forum in Washington, a center-right think tank focused on domestic economic and fiscal policy issues, also had some concerns. While WISeR seeks to address fraud, waste, and abuse, it "does so in a way that won't achieve broad impact on Medicare fee-for-service spending or quality of care," he said in an email.

"The model participants are not healthcare providers or systems; they are technology companies that wouldn't normally be a part of the healthcare system beneficiaries interact with," Baker said. "Adding a duplicative third party to the already established Medicare Administrative Contractor network, particularly one that may be using untested artificial intelligence, machine learning, or algorithmic decision logic, may only increase the overall administrative burden and delay beneficiary care."

"This model also appears to be at odds with the commitment to reducing prior authorization the Trump administration recently touted," he continued. "Introducing new services subject to prior authorizations for Medicare beneficiaries while claiming credit for reducing other prior authorizations is counterintuitive and inconsistent. In the Federal Register notice, CMS cited market research from Medicare Advantage organizations as the inspiration for the WISeR model. Those same organizations, however, have committed to reducing prior authorization due to beneficiary concerns and the changing care environment."

https://www.medpagetoday.com/publichealthpolicy/medicare/116317