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August Monthly Review: ChatGPT In Epic
Death, taxes, another frontier lab healthcare launch inspiring truly insane LinkedIn takes. As much as I want to stay away, I repeatedly am the crewman unplugging his ears whenever we pass these sirens. So it’s not the first and probably not the last time we dial up the typewriter rather than tie ourselves to the mast. The full blow-by-blow timeline: Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe The End of the Standalone PHR (Jan 8): ChatGPT Health arrives for consumers, at the time powered by b.well. I was bullish on the approach in that the best way for the PHR to finally solve distribution was to meet consumers were they already are (i.e. When Horizontal Meets Healthcare (Jan 9): OpenAI for Healthcare puts out the shingle for enterprises, with SharePoint ingestion standing in for the EHR integration the product actually needed. Another One: Anthropic’s Healthcare Debut (Jan 16): Claude's version, on HealthEx rails instead of b.well, with Agent Skills for FHIR development as the one true vertical-specific investment. ChatGPT for Clinicians: The Trap Sprung (Apr 24): OpenAI filled in the missing GTM middle with a free product for verified clinicians, effectively peeling the enterprise wrapper off ChatGPT for Healthcare and taking the PLG fight directly to OpenEvidence. OpenAI’s Second Attempt at Health (Jul 31): a relaunch of their patient specific app, now branded Health in ChatGPT, where the privacy partition came out, the connectors thinned, and b.well disappeared in favor of first-party FHIR work against a smaller network Beyond a Shingle So what was announced now? Today, we’re introducing a new electronic health record integration that brings authorized patient context from Epic into ChatGPT for Healthcare, along with the Healthcare Public Data plugin for direct, structured access to official healthcare datasets like PubMed, DailyMed, and CMS Coverage. Together, these capabilities bring ChatGPT closer to the systems and sources healthcare teams trust, while supporting the controls and compliance healthcare work requires. The core portfolio is unchanged from prior announcements we delineated and discussed (aside from the relaunch of patient-facing). Since trade publications still seem to be confusing them by using the wrong names: Enterprise sales motion: ChatGPT for Healthcare Protecting their core product / PLG: ChatGPT for Clinicians Consumer/patient-facing product: Health in ChatGPT So really, this is a feature release (specifically for ChatGPT for Healthcare when it comes to EHR integration). What’s cool about it, though, is that we are moving beyond just putting out a shingle. Everything in the January enterprise launch was horizontalizable: Horizontal tech companies thus generally start verticalization with their “putting out a shingle phase”. Telling the world you’re open for business as a horizontal tech company reliably attracts early inbound interest from buyers who are already trying to force-fit horizontal tools into domain-specific workflows and are eager for any signal that the vendor intends to support their use case more directly. Nothing was really vertical specific, which is exactly what you'd expect from the ultimate hypergrowth horizontal company dipping their toes into specific industries. But eventually you have to stop changing the sign on the door and start changing the product. Can you guess where the horizontal product was going to run out of road? This is the core dilemma writ large: verticalization requires differentiation, while scale economics of consumer and horizontal push toward unification. I’ve buried the lede so deep here it will be painful to some readers, but what should be shocking to no one is that my perspective is that EHR integration is the only path that meaningfully resolves this tension for ChatGPT for Healthcare. Integration with Microsoft Sharepoint is fine, but it is categorically insufficient for any product that hopes to influence clinical decision-making. SMART Money Well here we are, eight months later! Real vertical investment has begun, which surprised a few people. One friend in the industry messaged me: “Absolutely no way Epic gave ChatGPT API access.” Looking forensically at the announcements, the integration is notably read-only across appointment notes, laboratory results, medications, and specialist documentation. So while I’m not a betting man, I'd wager the house this is a SMART on FHIR launch: That sounds a lot like USCDI! The recommended path for the workflow they outline would be SMART on FHIR Their Health AI lead’s post is evocative of both standalone and EHR launch SMART, which another termed “ChartGPT” and “EHR Plugin” The implementation burden for SMART on FHIR is the lowest of the available integrative paths This is the team who literally did patient-facing SMART on FHIR with Epic last month Most importantly, if you’re a horizontal company, you generally still haven’t taken the full plunge and thus (overly) value reusability. SMART on FHIR is the logical compromise: healthcare-specific enough to matter, but standardized enough to reuse. Nobody Asked Judy Another friend asked “I thought they had to go to each health system, or did they go direct to Epic and now health systems opt in?” Given the trust paradigms in healthcare, this functionally cannot be Epic hoovering up all the data for OpenAI and shoving ChatGPT in their customers’ faces (or they would revolt). However, I do believe the aforementioned terrible coverage by TechCrunch and other outlets is probably responsible for that question, given the 325 million reference. When using FHIR as a business associate to an Epic customer, there is no EHR gatekeeping to speak of, as that isn’t how fhir.epic.com works: You register an app You pick your APIs You test against the sandbox APIs You list as “Ready for Production” Hospitals pick your app You test and go live with them Bluntly, nobody had to say yes or no in Verona (nor were they given the chance). Vendor Services (their next developer tier up that I doubt OpenAI is using quite yet in this initial release) certainly has contractual paperwork that some resent, but even there, the twin pressures of mounting antitrust and information blocking make outright gatekeeping increasingly fraught. My friend’s sentiment is, to me, representative of a broader industry neurosis, perhaps a sort of scar tissue of prior eras: people assume the gate is still there and never actually try the door. There are certainly other ways Epic (and any EHR) can put its thumb on the scale, but they are not so dumb as to stand in front of a federally mandated API and play bouncer at this exact moment in time. So I think they can and probably should go deeper, as this release is at best parity and at worst behind vertical-specific competition. OpenEvidence did a basic SMART launch with Sutter Health in February, allowing for more convenient evidence search by providers. They then add patient-context (the equivalent SMART on FHIR flow to what we see here) when Cedars-Sinai went enterprise-wide in May. UpToDate has four distinct applications across deeper workflows like patient engagement listed in Epic Showroom and announced a partnership with Epic to power Art at UGM Abridge and other ambient scribes have invested deeply into the deepest bidirectional clinical copilot workflow with integrations well beyond SMART on FHIR. In that light, the “Who is OpenAI primarily targeting here?” is clear. This release brings them into striking distance of OpenEvidence, but not the others quite yet. They are the only one of the three you can reach without building something truly Epic-specific. When will they go further? Competition is a great motivator to overcome the horizontal demons and start building things that can’t be reused: not across industries, not across EHRs, maybe not past the customer you built them for. That’s the price of actually verticalizing. The question is if and when OpenAI will be willing to pay it. Month in Review Here is the monthly review. As a reminder, this is a regular round-up of the month’s posts and other content to surface things you may have missed across regulation, litigation, interoperability, and beyond. AI assistance is used in these bullet summaries so I can focus on articles. Articles Published: None this month Video Content: The Information Exchange: Standards-based Thruple Edition (Aug 14): Back to school for us too, with Brad reporting in from the CMS Health Tech Ecosystem’s one year anniversary in DC. We get into the January CMS-0057 deadline, the fall rulemaking reading list, and why enrollment still keeps most apps off FHIR. The Information Exchange: Epic Dúnadan Edition (Aug 25): A UGM roundup with Ryan Brickner joining for the first time to check our takes against what the building actually thinks. Rangers, Ergo sitting on top of EHI, and a down-market lineup that needs some cuts. Regulatory: Stacked Deck, Bad Hand (Aug 05): ONC’s website refresh took the entire HIT Policy Committee record with it, so I rebuilt the archive and went looking for the regulatory capture story everyone assumes is buried in there. Stacking the deck and winning the hand turn out to be very different things. The Sixth Generation of Patient Access (Aug 19): A quick catalog of the five generations of patient access we’ve layered on since HIPAA, and the two candidates now competing to be the sixth. One is planned. The other is the market routing around the plan entirely. Court cases: Three Cases Walk Into a Docket (Aug 06): Two surprise settlements cleared the board in a single week, and then Judge Maddox dropped ninety-four pages on Vyne v. Henry Schein. The sleeper is a DMCA holding that makes direct-to-database a considerably riskier business model. Epic v. Health Gorilla: Into the MDL (Aug 10): Nine class actions are headed to Miami, and the Panel signaled it wants to bring the case that spawned them along too. That would leave Epic arguing the requests were obviously fraudulent in one courtroom and unknowable in the other. Amazon v. Perplexity: Agents Are Legalized! (Aug 11): The Ninth Circuit vacated the injunction against Comet, holding that the user is the one accessing the servers rather than the company that built the agent. A real win for agentic access, and a much narrower one than the headline suggests. Veeva v. Epic: Come At Me, Bro (Aug 26): Epic’s response brief wants the dismissal affirmed and, unusually, wants the opinion published as precedent. Buried in it is Epic’s own description of what its non-competes actually prohibit, which current and former employees should read closely. EHRs: The Contract Epic Would Never Sign Today (Aug 04): A 1999 SEC exhibit catches Epic licensing nearly its entire product line, Tapestry included, to the company that became TriZetto. The marketing services menu attached to it is the part that will make you blink. Forecast from Verona (Aug 07): The Epic Almanac makes one argument six different ways: the AI is only as good as the networks behind it. Emmie headlines, Art’s context stack is the most ambitious part, and Penny finally gets an autonomous coding date on the calendar. Works With Epic MyChart (Aug 17): Epic’s first new Showroom category since the death of Workshop certifies hardware instead of software, badge on the box and all. Made for iPhone, but for blood pressure cuffs, and rough news for anyone selling the RPM stack sitting in between. UGM Hot Takes 2026 (Aug 20): Everyone else covered the AI announcements, so I went after Savvy deleting the payment gateway, Rangers as Boost with the timer removed, and a down-market lineup with too many entries. Plus the Health Grid tidbits I cannot help myself on. MyChart Central Grows Up (Aug 24): Device data and Emmie turn Epic’s identity hub into a full consumer platform, which is both a logical answer to ChatGPT and a bit of a mistake. It also happens to be the best scraping target Epic has ever shipped. Industry Analysis: The Wrong Yardstick (Aug 12): Vertical software keeps getting judged against Superhuman and Notion, which is the wrong bar entirely. Your user is comparing your product to a whiteboard and forty phone calls before lunch. Primitives vs. Abstractions (Aug 27): Developers want building blocks, systems of record prefer to hand out business logic, and both sides have a real case. There’s no test from the outside that separates the engineering reason from the competitive one, which is why this keeps ending up in court. Cross-industry Comparisons: The Two Kinds of Platform Power (Aug 18): Attention power and record power are different problems that keep getting handed the same regulatory toolkit. Congress’s latest swing at Big Tech shows both what’s possible and where it falls apart. The Dogs of (Platform) War (Aug 21): A CourtListener alert turned up a property management fight with healthcare’s exact shape and none of the Cures Act. Shell prospects, ghost accounts, a notetaker bot that came back to haunt someone, and a lawyer arguing both sides of the same theory in two states. Fractals All the Way Down (Aug 31): Yardi dominates property management right up until you zoom into one segment, where AppFolio owns it outright and Yardi doesn’t appear at all. Where you draw the line around a B2B software market is about to decide an awful lot of cases. Other News: If Judy Had the Courage (Aug 13): A short eulogy for the era when software was allowed to look insane: WinAMP, bold colors, and everything the grey chatbot era has taken from us. External Media: Portland Monthly Health Tech Meetup: Erin O’Brien channeled my own feelings - maybe it’s just because it’s August and beautiful, but the monthly edition of the PDX Health community meetup was a ripper. Make sure to reach out if interested to join for the next one. STAT’s Coverage of Epic This Month: Brittany Trang of STAT did a fantastic job of breaking the FTC investigation that’s been lurking, as well as UGM related coverage, so I had to give her her wish of a meme. Fall Conferences: I’m pumped to be kicking off my fall conference season in NYC at Nabla Accelerate next month, which Chrissy provided the link to apply for. Here’s the rest of my schedule in case you want to meet up: Commonwell (Redwood Shores, CA): Oct 13-14 Open@Epic (Madison, WI): Oct 21-22 eHealthExchange (Austin, TX): Oct 27 Sequoia Project (Austin, TX): Oct 28-29 HLTH (Vegas): Nov 15-18 RSNA (Chicago): Nov 29-Dec 3 Posts I Liked: HTI-6 Should Unbundle API Certification: Josh Mandel makes the case that HTI-6 should split (g)(10) into separate authorization and data certifications, so a PACS or a genomics platform can certify only the role it actually performs. Imaging is the urgent example, but the structure solves a much bigger problem. On implementing ePrior Auth with Epic: Scott Rossignol’s field notes from a live ePrior Auth build on Epic, including the two app registrations nobody warns you about and the CPT mapping problem waiting at the end. CMS-0057 implementations are going to be such a beast. Healthcare point solutions are starting to look a lot like streaming services: Spencer Dorn runs the cable-to-streaming arc against health IT and lands squarely on the bundling half of the cycle. Bundling can be good! It can also be bad! Life is nuanced. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
Marvel Tokon: Fighting Souls' Biggest Secrets Are Already Online
Make mine Marvel, and mute some keywords.
iOS 27: What's New With the Mail App
Apple's Mail app is getting some useful updates in iOS 27, with Apple making big improvements to search and introducing new AI features. Search iOS 27 has an overhauled search system that extends to the Mail app. Instead of surfacing results based on keywords and recency, Mail app search ranks results by relevance and intent. Search results that come up in Mail are more relevant than before, so you find exactly what you're looking for.
Founders seize on Indian court ruling to revive criticism of Google's ad business
The ruling drew support from founders, while lawyers said it could force platforms to revisit how they handle trademarked keywords.
Grand Rounds April 10, 2026: Impact of Behavioral Science-Based Electronic Health Record Tools on Deprescribing for Older Adults (Julie Lauffenburger, PharmD, PhD)
Speaker Julie Lauffenburger, PharmD, PhD Associate Professor of Medicine Brigham and Women’s Hospital and Harvard Medical School Keywords Adaptive trial design; Behavioral science; Deprescribing; electronic health record; EHR; Inappropriate […]
Grand Rounds April 10, 2026: Impact of Behavioral Science-Based Electronic Health Record Tools on Deprescribing for Older Adults (Julie Lauffenburger, PharmD, PhD)
Speaker Julie Lauffenburger, PharmD, PhD Associate Professor of Medicine Brigham and Women’s Hospital and Harvard Medical School Keywords Adaptive trial design; Behavioral science; Deprescribing; electronic health record; EHR; Inappropriate […]
Your Thymus and Your Healthspan
Our thymus gland plays a central role in the development or our immune system, specifically for supporting T cell development (how these cells got their name, maturation and differentiation in the thymus) and discriminating between self and foreign, non-self antigen proteins with production of dendritic cells. As we age, our thymus gland shrinks—the process known as involution—with progressive change from spongy to fatty tissue, with loss of functionality. But this process, with respect to timeline and extent, markedly varies from one person to the next. And to make things even more complicated, our thymus gland anatomy and precise location in the chest also is highly variable. So the famous Frank Netter diagrams from the 1960s (such as at left below) don’t capture the remarkable heterogeneity that a random set of 12 chest CT scans (below at right). What I consider as 2 landmark papers in Nature this week (here and here) used AI to quantify health of the thymus in 2 large cohorts, and then correlate the metric to a broad array of health outcomes. In this edition of Ground Truths, I’m going to cover three questions: (1) How was thymus health determined by AI?; (2) How is thymus health linked to key clinical outcomes? and (3) Are there ways we can promote a healthy (aka rejuvenate) thymus gland in our later years? Subscribe 1. How was thymus health determined by AI? This was accomplished by extensive work developing and validating an AI pipeline for 2 stages, the first for localization and segmentation of the thymus bed, and the second to quantify a digital marker, termed the thymic health score. There’s a lot to this algorithmic development, so I won’t go into all the details, but just provide a rudimentary outline of what was done. The 1st stage used supervised learning with 2 radiologists reviewing 2,461 chest CT scans. That work trained a 3D U-Net model to automatically identify the thymic bed’s 3D cropped region using center of mass coordinates, which reached 99.8% accuracy. The 2nd stage used a foundation model that was pre-trained with SwAV (which stands for Swapping Assignment between multiple Views), a self-supervised model, that generated a high-dimensional thymus representation of 4,096 features. That compares to the radiology reductionist and subjective scoring of 0 to 3 where 0 means the thymus is fully degenerated and fatty, and 3 is considered dense, intact glandular soft tissue. Notably, the self-supervised learning (SSL) performance was superior to supervised (AUC ~0.75 vs 0.55, respectively) reflecting the shallowness of the 0-3 classifier vs SSL’s holistic, self-taught AI. The thymic health score ranged from 0 to 100, with the highest number indexed to fully preserved thymic health. The algorithmic work extended to explainability with both Shapely value distribution, meaning the model was holistic not relying on any “magic” pixel, and occlusion sensitivity, demonstrating the model’s performance was not affected by ribs, sternum, lung tissue, but rather focused on the thymic bed directly. Below are a few saliency maps from the occlusion sensitivity that indicate the thymic bed focus, not affected by neighboring structures, using the jet color scale. Now the AI was ready for processing ~25,000 CT scans, each over 30 MB files, from the 2 large participant cohorts to provide a thymic health score, it did so in less than 14 hours, which is less than 2 seconds per scan! Share 2. How is thymus health linked to key clinical outcomes? The two cohorts were the National Lung Screening Trial, NLST (N=25,031) and the Framingham Heart Study, FHS (N=2,581) each with baseline demographics and long term follow up of >12 years for health outcomes. From the NSLT, you can see below that increased age and body-mass index were correlated to reduced thymic health. And, overall, men had reduced thymic health scores compared with women. There are a lot of graphs in the paper for outcomes, for both the NLST and FHS cohorts. To simplify the major outcomes, below is a composite Figure with striking reduction of all-cause mortality and for the different causes of death. The results were consistent between the 2 cohorts. For example, the cardiovascular mortality hazard ratio average was 0.57 in NLST and 0.38 in FHS (weighted to be 0.53 for the aggregate). The reduction of mortality also extended to digestive diseases and pulmonary disease (data not shown below). Lung cancer incidence was reduced by 36% for high vs low thymic health (Figure below, with a panel -incidence and b panel-mortality, adjusted for age, sex, BMI, smoking status). Notably, there was a smoker’s paradox: lower incidence and improved survival for lung cancer in smokers who had a high thymus health score. Smoking was associated with lower thymic scores whereas alcohol was not. Higher thymic health was linked to higher HDL cholesterol, lower triglycerides, lower fasting blood glucose, and lower systolic and diastolic blood pressure. Inflammation biomarkers, such as C-reactive protein and interleukin-6, were elevated in the people with lower thymic health scores. In their second paper, the same team looked at the relationship between thymic score and outcomes for 3,476 patients receiving cancer immunotherapy. The non-small cell lung cancer progression-free survival was reduced in patients with low thymic health score. A parallel relationship for survival was seen for other types of cancer including melanoma, breast, and kidney with a 44% lower risk among high thymic scores (Figure). A similar pattern was seen with different immune checkpoint inhibitors. The thymus health score outperformed programmed death ligand-1 (PD-L1)and tumor mutation burden (TMB) assay of the tumor and was an independent prognostic marker of progression-free survival. In this dataset, a direct connect with thymus score and adaptive immune function was noted with a correlation before cancer treatment for both T-cell diversity and thymus T-cell production (a metric known as T cell receptor excision circles). Thymus Removal Study There is a highly relevant citation about thymus function before moving onto ways to rejuvenate it. In 2023, a very important study of thymus removal during cardiothoracic surgery was published, with 1146 patients undergoing thymus removal vs 1146 matched controls (mean age 55 years). The adverse outcomes for thymus removal were striking, with a 2.9 higher risk of all-cause mortality and doubling of cancer incidence, 1.5 fold increase in cancer mortality, and 1.5-fold increase in autoimmune diseases. The immune function showed marked compromise after thymus removal, as reflected by CD4+ and CD8+ T cells (Figure below) Share Ground Truths 3. Are there ways we can promote a healthy (aka rejuvenate) thymus gland in our later years? In recent months we’ve learned a lot about the process of thymus involution and the pathways by which this may be modulated. Thymus involution is primarily due to loss to thymus epithelial cells (TECs) and there are 2 subtypes with different functions: the cortical, responsible for positive selection of T cells, and the medullary, for negative selection. When adipose tissue infiltrates the thymus, thymic adipocytes are pro-inflammatory, knocking out T-cell output. Likewise, systemic inflammation, or “inflammaging,” from smoking, obesity, and chronic stress promote thymic adipocytes. Now, from preclinical studies, we know about key pathways that account for these processes. Historically, back in 2014, FOXN1 was recognized as a single master transcription factor essential for TEC function, with studies in mice with forced FOXN1 upregulation leading to thymus regeneration. That laid the foundation for potential regrowth of quiescent thymus cells. It took awhile to find pathways to accomplish this goal and to even refute its role as the master regulator. The Liver-Thymus Axis Feng Zhang and his team recently showed that injection of an mRNA vaccine to the liver encoding DLL1, IL-7 and FLT3-L in combination, factors known to support thymopoiesis (Figure), successfully enhanced immune function in aged mice. However, the effect was transient. The FGF21 Story Two reports in 2025 addressed the thymus gland’s production of FGF21, a growth factor (fibroblast growth factor 21) and its control of thymus involution. This growth factor is also produced by the liver, but it doesn’t have impact on the thymus in aged rodent models. In contrast, The liver’s hepatocyte growth factor (HGF) has been shown to reverse senescent TEC structural changes. Growth hormone stimulates production of insulin growth factor-1 (IGF-1) in the liver and the thymus. Two small studies in human participants (TRIIM, for Thymus Regeneration, Immunorestoration, and Insulin Mitigation) of 6 and 50 people, respectively, treated with combined human growth hormone, metformin and DHEA, suggested the potential of slowing epigenetic aging and improving thymus mass and function. But the combination of drugs, small sample, and lack of controls make conclusions murky. Increased thymus FGF21 led to increased CD8 T cells in old mice and extended healthspan and improved physical performance. Building on the previous FOXN1 data, ablation of β-klotho, the obligatory co-receptor for FOXN1, accelerated thymic aging. The benefit to FGF21 was confirmed in a companion paper using an FGF21 knock-in mouse model showing thymus enlargement and increased TECs throughout the lifespan. (schematic Figure below). The accompanying editorial for these 2 papers speculated: “The proposed link between age-associated thymus involution and organismal aging is intriguing, and suggests we might seek to achieve systemic rejuvenation by counteracting thymic involution.” Other Factors Lessons from the Axolotl (Mexican Salamander) In an elegant set of experiments of the axolotl (Figure), known for its complete thymus regeneration after total surgical removal, mediators were identified. Surprisingly FOXN1 was dispensable. But midkine, a growth factor, appeared to be the driver, the initiator of thymus cell growth, survival, and repair. Other components that contributed were Postn+ (periostin-expressing mesenchymal niches) and Ccl19, a chemokine protein from the bloodstream. RANK and RANKL RANK (receptor activator of nuclear factor κB its ligand (RANKL) have been considered key regulators of medullary TECs. In a study of both aged mice and human thymus cell cultures, their key role was confirmed, with multiple benefits of resorting TEC function, recruitment of progenitor cells, and T cell development. Subscribe Summing Up This body of work strongly supports the health of the thymus gland as a critical regulator of human healthspan, not just a correlate or link. The new landmark studies are reinforced by the regenerative biology experimental models that have shown, via an array of mediators, that healthspan of aged mice is at least in part dependent on thymus gland function and its critical role for maintaining adaptive immunity. It sure seems that we’d be better off having an immune reservoir of naive T cells instead of a profile in older adults of exhausted, low quality, memory T cells, with a senescent phenotype. It is striking that we ignored the importance of the thymus gland for many decades. A wake-up call was the results of the thymectomy matched control study reviewed here, with the opposite of high thymic health score improved health outcomes. The convergence of AI and healthspan here is notable. The exceptional and laborious work for developing and validating (no less explaining) the AI to quantify thymus health set the foundation for probing the connect the major health outcomes in two cohorts with extensive follow-up. We’ve never had a way to meaningfully quantify the thymus gland before, so this represents important leverage of supervised, self-supervised, and transformer models. The study wouldn’t have been possible without AI. And it begs the question as to whether there are ways we can maintain our thymus at a high health score. But it’s not so simple to rejuvenate our thymus. There are multiple risks including the induction of autoimmunity, increasing the risk of cancer, and inducing a pro-inflammatory state. For example, factors that increase TEC proliferation could compromise the medulllary negative selection process and leak out auto-reactive (self-attacking) T cells. Thymic cells could be induced to proliferate, but we know, for example, that growth hormone and IGF-1 are associated with an increase risk of cancer. If thymus rejuvenation doesn’t clear out the accumulated senescent cells in older adults, then inflammation within the gland could block the production of TECs. Keeping these risks in mind, we now have identified many ways to keep our thymus healthy as we age that undoubtedly will be tested in clinical trials going forward. Ultimately, the benefit-to-risk tradeoffs will be defined. In the meantime, we have desperately needed an immunome. As I’ve stressed in multiple prior Ground Truths, we have no test in the clinic to assess a patient’s immune status! It was very encouraging for me to get an email from Hugo Aerts, the senior author of the landmark papers in the days after they were published: “I also wanted to say that your Substack on “Why We Need an Immunome” was inspiring for this work. We found it a very compelling perspective and greatly enjoyed reading it.” Just having an assessment of a person’s immune status via a chest CT scan, with millions of these performed per year, might help in guiding the right immunotherapy for cancer (e.g. more intensive, combinations for those with low thymic health scores) and help define people who are increased risk for age-related diseases of cancer, cardiovascular, and neurodegenerative. The main theme of Super Agers is that we now have many layers of data (genetics, proteins, biomarkers, organ clocks that can be integrated via multimodal AI) for us to define a person’s specific risk decades before one of these age-related diseases leads to symptoms, enabling prevention. From the new studies this week, we can add thymus health score as yet another way to understand a person’s risk, a window into their adaptive immune system and healthspan. And perhaps someday we will be able to safely rejuvenate the thymus, or maintain its health through one’s life, and use the thymus health score to monitor. NB: I wrote this post (No A.I.) A Quick Poll Loading... ********************************************************************* Thanks to Ground Truths subscribers (now > 200,000) from every US state and 212 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. Please join! If you found this interesting PLEASE share it! Share Ground Truths Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered. Leave a comment Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support 47 summer interns in 2025! We aim to accept even more of the several thousand who will apply for summer 2026.