51 cases that reframe methylene blue serotonin syndrome

Medications
April 22, 2026

A patient walks into my office. She is 52, exhausted, brain-fogged, gaining weight, and six years into sertraline 100 mg. I mention methylene blue as a mitochondrial support at 10 mg orally.

She looks at me like I just suggested arsenic.

“My pharmacist said I can never take methylene blue because I am on an antidepressant. He said it causes serotonin syndrome.”

I hear this every week. And every week I have to …

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51 cases that reframe methylene blue serotonin syndrome

Therapeutic alliance in psychiatry matters more than ever

Conditions and Diseases
April 22, 2026

Each May, during Mental Health Awareness Month, the health care industry releases its usual statements about access to care, workforce stress, and the enduring shadows of stigma. I usually read them between back-to-back appointments, staring at a screen full of diagnostic codes. The systemic issues are always important, yet, amidst the charts, the 20-minute med checks, and the rhetoric, there remains a more profound question I have to ask myself …

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Therapeutic alliance in psychiatry matters more than ever

Why doctors struggle to listen to your body after an injury

Conditions and Diseases
April 22, 2026

For 26 years as a plastic surgeon, I have given my patients the same advice after surgery: Listen to your body. Pain, fatigue, and swelling are not inconveniences. They are signals. They are the body’s language, guiding us toward healing or warning us when we have gone too far. What I have learned this year, at 65, is how difficult that advice can be to follow.

In January, I was training …

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Why doctors struggle to listen to your body after an injury

IVF insurance coverage depends on your ZIP code

Conditions and Diseases
April 22, 2026

Two patients can have the same infertility diagnosis, need the same treatment, and see the same specialist. Yet one may move forward with insurance coverage while the other is left staring at a bill for tens of thousands of dollars. In the United States, that difference is often not medical. It is geography. As a biomedical scientist, I’ve seen how evidence should guide care. Yet for infertility, your ZIP code …

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IVF insurance coverage depends on your ZIP code

Ketamine therapy and the primacy of mind in modern medicine

Medications
April 22, 2026

In the modern clinic, we often operate under an unstated a priori assumption that if a phenomenon is real, its primary explanation must be molecular. As a psychiatrist, I find this reductionist bias increasingly apparent in how we conceptualize “breakthrough” treatments like ketamine therapy for depression or chronic pain. When we discuss how ketamine works, the conversation almost instantly gravitates toward the neurotransmitter system, synaptic plasticity, glutamate surges, and the …

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Ketamine therapy and the primacy of mind in modern medicine

The deadly reality of eclampsia and maternal mortality in Nigeria

Conditions and Diseases
April 22, 2026

Eclampsia is one of the most severe complications of pregnancy. It occurs when a woman with preeclampsia, a condition characterized by dangerously high blood pressure during pregnancy, develops seizures. In well-resourced health systems, preeclampsia is usually detected early and treated long before seizures develop. But in many parts of Nigeria, especially rural communities in the North, women often arrive at hospitals only after convulsions begin. By then, the disease has …

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The deadly reality of eclampsia and maternal mortality in Nigeria

Why cervical cancer screening drops after menopause, and why that’s dangerous [PODCAST]

Podcast
April 21, 2026
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

What if the moment women stop seeing their gynecologist is exactly when their cervical cancer risk matters most? Nenrot S. Gopep, a physician and public health researcher, joins the …

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Why cervical cancer screening drops after menopause, and why that’s dangerous [PODCAST]

How xenotransplantation could finally solve organ shortages

Conditions and Diseases
April 21, 2026

13 Americans will die today waiting for an organ transplant. That is a sobering line. Despite remarkable advances in transplantation medicine, the United States still cannot supply enough organs to meet demand. In 2024 alone, more than 3,400 Americans remained on the heart transplant waitlist while thousands more waited for kidneys, livers, and lungs. Yet a potential solution already exists, one that may soon move from research labs to operating …

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How xenotransplantation could finally solve organ shortages

How medication-assisted treatment impacts oral health

Conditions and Diseases
April 21, 2026

Medication-assisted treatment (MAT) helps manage withdrawal symptoms and cravings in individuals battling opioid addiction. Despite their effectiveness, these medications can cause xerostomia (dry mouth) and an increased craving for sweet foods. These factors together contribute to accelerated dental decay, gum disease, and oral infections. The U.S. Food and Drug Administration issued a warning in January 2022 about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use …

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How medication-assisted treatment impacts oral health

Physician-owned hospitals get a narrow CMS opening

Health Policy
April 21, 2026

You were told physician-owned hospitals were finished. That the 2010 legislation closing them out of Medicare was permanent. That if you wanted to own something, your options were a direct primary care practice, a concierge model, or a slow negotiation with the health system already employing half your colleagues. The hospital. The thing you actually trained to practice in. That was off the table.

It may not be anymore. But the …

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Physician-owned hospitals get a narrow CMS opening

The $500,000 drug and the cost of modern medicine

Medications
April 21, 2026

I met him as a patient with a back condition, not a cardiac patient. A 70-year-old man who looked like he had outrun aging through sheer willpower and a well-worn bicycle. He rode more than a hundred miles a week, had the resting heart rate of a seasoned athlete, and carried himself with the kind of confidence that comes from a lifetime of good health. His only complaint was lower-back …

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The $500,000 drug and the cost of modern medicine

Bridging the gap between a chronic disease diagnosis and treatment

Physician
April 21, 2026

Early in my career, I saved a man’s life, and he was not pleased. Mr. H came to see me for knee pain. With my training still fresh, I moved through a standard review of systems. When I asked about cardiac symptoms, he mentioned that for several weeks, walking more than a block caused chest pain that resolved with rest. The knee was forgotten. I explained the cardiac risk, ordered …

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Bridging the gap between a chronic disease diagnosis and treatment

When shared decision making gives way to medical paternalism

Physician
April 21, 2026

“Why haven’t they scheduled your dad for his feeding tube placement? They just want another family conference.” I sighed and told my mother we may have to fight. The physicians caring for my father seemed ready to overrule her decision, even though she held his medical power of attorney. When I spoke with an intern, I explained that our family had not changed our mind about the course of treatment. …

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When shared decision making gives way to medical paternalism

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The reality of PrEP access and HIV prevention in Georgia

Conditions and Diseases
April 21, 2026

“I just do not want my life to change,” said my patient. “It does not have to. With the medicine we have now, people with HIV can live a perfectly normal life,” I responded. As a family physician in the Atlanta area, I see patients at all stages of their HIV journey, some newly diagnosed and scared, others living with the virus for years, undetectable, thanks to daily medication. What …

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The reality of PrEP access and HIV prevention in Georgia

I have cerebral palsy and I’m a doctor. Here’s what policy cuts mean for patients like me. [PODCAST]

Podcast
April 20, 2026
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

What happens to patients with disabilities when the government signals their lives don’t matter, and what does that mean for the doctors fighting alongside them? Ashna Shome, a pediatrics resident with cerebral palsy, …

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I have cerebral palsy and I’m a doctor. Here’s what policy cuts mean for patients like me. [PODCAST]

Medical expert testimony vs. advocacy in the courtroom

Physician
April 20, 2026

In Opinions, which is section 9.7.1 of the American Medical Association (AMA) Code of Medical Ethics, a physician serving as an expert witness has a duty to act as an objective, independent professional whose opinions are based on science, and not act as an advocate whose opinions win lawsuits. The question, which I now raise, is: “Are opinions expressed by a medical expert, which have 95 percent confidence (the …

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Medical expert testimony vs. advocacy in the courtroom

25 of 32 years of life expectancy came from this

Medical Education
April 20, 2026

In 1900, life expectancy in the U.S. was 47 years for men and women combined. By 2025, the figure had risen by about 32 years. Many U.S. citizens attribute this increase to the development of modern medicine and widespread availability of antibiotics. However, while antibiotics have indeed contributed, they are overshadowed by changes that most of us take for granted and simply do not think about.

Treatment of public water supplies, …

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25 of 32 years of life expectancy came from this

The family caregiving truth nobody wants to admit

Conditions and Diseases
April 20, 2026

There’s a moment that happens in almost every family caring for an aging parent. It usually begins the same way. Someone leans in, frustrated, exhausted, sometimes whispering, sometimes shouting, and says, “My family is crazy.”

As a geriatric psychiatrist, I hear this often. What’s interesting is that everyone says it. Every sibling group thinks the others are unreasonable. Every adult child believes they’re the only one who sees things clearly. Every …

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The family caregiving truth nobody wants to admit

AI medical misinformation fooled every major chatbot

Health Technology
April 20, 2026

Every major AI chatbot fell for bixonimania, a fake disease made up by a team from the University of Gothenburg in Sweden, led by researcher Almira Thunstrom. Dr. Thunstrom uploaded two fake studies about a made-up skin condition termed as bixonimania to a preprint server in early 2024. The papers described the disease as characterized by sore eyes and dark pigmentation around the eyes supposedly caused by blue light …

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AI medical misinformation fooled every major chatbot

Leaving clinical practice for medical advocacy and purpose

Physician
April 20, 2026

Two days after Christmas, I walked into a store and saw Easter Cadbury Eggs already on the shelves. Not a single mattress sale for Presidents’ Day in sight. Just a clean leap from tinsel to tulips, as if the world had quietly decided to skip the expected steps and sprint ahead. It struck me because that is exactly what my life feels like right now. For decades, I lived inside …

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Leaving clinical practice for medical advocacy and purpose

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