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Why do patients refuse statins backed by decades of data in millions of people yet eagerly inject peptides tested in fewer than 20? Emergency medicine physician and longevity practitioner Vikas Patel confronts this …
14 patients studied, thousands injecting: the peptide evidence gap [PODCAST]
Crypto. Bitcoin. Gold. Every few years, a new wave of thinking challenges the traditional dominance of the dollar. People look for alternative stores of value, something more stable, more independent, or more future-facing. But while everyone is debating what the next currency might be, we are overlooking the one that is already here, quietly gaining power behind the scenes: data. As artificial intelligence (AI), machine learning, and digital infrastructure continue …
How data monetization acts as a new digital currency
My patients don’t wait for me anymore. That’s not a complaint. It’s a clinical reality I had to sit with before I could do anything useful about it.
Patients started arriving at appointments having already run their symptoms through an AI chatbot. Sometimes they’d decided not to come in at all. Sometimes they were right. Sometimes they weren’t. I’ve spent the last several years building an AI-assisted triage and treat virtual …
AI chatbots and patient safety need physician design
Before the imaging, the lab work, or the referral, there is a moment when the body is already speaking.
The way someone walks into the room. The hesitation before sitting down. The guarded turn of a shoulder. The subtle shift away from one hip before pain is ever described.
Medicine once placed enormous value on these observations. Observation was not separate from diagnosis; it was the beginning of it.
Sherlock Holmes famously suggested …
Reclaiming the lost art of the physical exam
A little-known and misunderstood disease affecting as many as 12 million Americans, putting them at risk of potentially deadly complications, is often missed or misdiagnosed.
Primary aldosteronism (PA) is a serious condition that affects as many as 5 to 10 percent of adults with high blood pressure (BP). High BP is widely prevalent in the U.S., nearly half of all adults (almost 120 million individuals) have it. Yet, for many years, …
Primary aldosteronism hides behind high blood pressure
Thirty years ago, I ran a cardiac arrest in the operating room. The patient survived. The room eventually quieted down. The nurses began cleaning up. People moved on to the next case.
But I remember standing there afterward feeling exhausted and unsettled. It had been several months since my ACLS recertification, and during the code I caught myself mentally reaching for details of the algorithm that had once felt automatic. I …
Cognitive overload in cardiac arrest is a human problem
The week of Thanksgiving, my dad drove my mom to the emergency room for stomach pain so severe she could not stand up straight. Three days of tests. Specialists rotating in and out. No clear answer. Then, almost miraculously, she started feeling better on her own. The doctors sent her home on Thanksgiving Day with some pain management and a collective shrug. We sat around the table that night genuinely …
Artificial intelligence can prevent a delayed diagnosis
In a group text with fellow pediatricians, I received a message asking if anyone knew where a child could get a blood draw that was not the emergency room. The question came from a colleague on behalf of another physician friend. She was worried her son might be anemic because of how he looked pale and was unusually fatigued.
She had just switched jobs and her son was not covered yet …
Health insurance coverage loss threatens sick children
“Can we fit just a few more?” This was the question I was asked one snowy evening. Pretty soon, I found myself surrounded by no less than 20 people. They had all convened here to see the man lying in bed at the center of the room. He had struggled with cancer, which had progressed through numerous treatments, leading to his current intubated and sedated state. As an internal medicine …
How cancer care terminology harms patient choices
“I wish I could get a free boob job.”
It is a comment I heard more than once after sharing I was undergoing a double mastectomy. I understand the impulse, people do not know what to say. But the joke reveals something worth examining: how little most people understand about what this surgery actually costs you.
At 28, I found out I carried the breast cancer gene 1 (BRCA1) mutation. At 34, …
Breast cancer rehabilitation requires occupational therapy
A high school basketball player lands awkwardly after a fast break. For one second, the gym goes silent. He grabs his ankle. His coach runs toward him. His teammates stop moving. His parents, sitting near the sideline, do not know whether to hope he can stand up or pray that he will not try.
In that first minute, no one is thinking about professional titles. The question is painfully simple: Who …
Athletic trainer scope of practice is not a turf war
The recent outbreak of hantavirus infection on the Dutch cruise ship MV Hondius raises several questions and concerns. Dutch ornithologist Leo Schilperoord was the first person to die of hantavirus infection on the ship on April 11, 2026. He and his wife, Mirjam, 69, had recently visited northern Patagonia in Argentina, 1,500 miles north and before boarding the ship at a southern Argentine port. So far there have been eight …
Hantavirus cruise ship outbreak exposes CDC missteps
Medicine values speed, but patients often reveal themselves slowly.
We are expected to identify the problem, name it, code it, treat it, and move on. That process may be necessary in a pressured system, but it can also mistake a label for understanding.
A diagnosis can be useful. It can guide treatment, open access, and reassure patients. But it can also become a premature ending to a story that still needs to …
Time pressure in medicine narrows how we see
I come from a generation that does not believe in therapy. Not because we do not believe it is effective, but because we believe we can handle things on our own. If things are hard, we push through. If we need help, we figure it out independently. By the time I became a physician, self-reliance was not just a value, it was my tried-and-true survival strategy. I remember years ago, …
How physician therapy sparked a medical career transition
In medicine, patients are often seen as recipients of care rather than contributors to it. But their lived experiences bring something data alone cannot: context, meaning, and truth. Early in my exposure to clinical research, I understood it primarily through a quantitative lens. Outcomes were measured in numbers: complication rates, recovery times, and statistical significance. These metrics are essential, but they do not always capture what matters most to patients. …
Patient involvement transforms modern clinical research
Clinicians are trained to practice evidence-based medicine, yet the realities of care often reveal its limits. In many situations, the literature does not offer clear guidance for the patient in front of us. A large share of clinical decisions are made without high-quality evidence. This is not a failure of clinical judgment. It reflects a gap in how evidence is generated and delivered.
The traditional path from study design to publication …
Evidence-based medicine needs real-world data to evolve
There are few rituals in medicine as aspirational as the 24-hour urine collection. On paper we see an elegant examination. A direct measurement of renal function, grounded in physiology and liberated from the assumptions that plague our estimating equations. In practice, however, what we see is a plastic jug and a set of instructions that compete poorly with daily life. What we are left with is a quiet understanding, shared …
24-hour urine collection flaws expose clinical bias
“As a witness to so much sadness and pain, how do you keep from getting depressed?” As an internal medicine doctor, I have heard versions of this question for decades. And, despite a myriad of changes in my career, my answer has never wavered. And while there are many comedians and funny things, one particular evening more than any other reveals how …
How a Broadway comedy saved an internal medicine doctor
Think of the entire health care system as a chess game where the goal is to achieve a healthier population by checkmating against the “darker side,” which represents disease, poor outcomes, inefficiency, and the human suffering of untreated or delayed chronic conditions like pain.
The administrative burden crushing California medicine
Adam was twenty-four years old. He was a passenger in a car that struck a guardrail on the interstate. The airbag hit him in the face. He lost consciousness for a few seconds and was alert and walking by the time paramedics arrived.
The emergency doctor did everything right. CT scan, labs, neuro checks. The scan was uncertain enough (possible early changes after a head impact with witnessed loss of consciousness) …
Hospital room contamination is a prescribing problem
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