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Emergency physician Drew Remignanti discusses his article “A world without vaccines: What history teaches us about public health.” In this conversation, Drew reflects on historical lessons from smallpox, polio, and measles to …
How misinformation endangers our progress against preventable diseases [PODCAST]
Most people now manage pieces of their health on a phone, from steps to sleep to blood pressure cuffs that talk to the cloud. Digital therapeutics go a step further. They are not wellness trackers or meditation apps. They are medical treatments delivered by software, built on clinical evidence, cleared by regulators, and prescribed or recommended by clinicians to prevent, manage, or treat a diagnosis. That is the core idea, …
The rise of digital therapeutics in medicine
Lipoprotein(a) [Lp(a)] was, until recently, an underrecognized cardiovascular risk factor. However, extensive research over the last 15 years (including vast genome-wide association studies) has confirmed an independent, causal link between elevated lipoprotein(a) levels and atherosclerotic cardiovascular disease (ASCVD). The science has shown that, despite their small size, Lp(a) particles can have a substantial health impact, and as many as one in every five individuals worldwide has elevated levels (defined as …
Lipoprotein(a): the hidden cardiovascular risk factor
For the third time in six weeks, a 34-year-old woman sat in an emergency room, desperate for help, and for the third time, the system failed to see her. It saw her dehydration, severe enough to require IV fluids. It saw her malnutrition, with electrolyte imbalances that required correction. It saw her vision problems, concerning enough for an ophthalmologic consultation. It saw everything except the person suffering. Each time, the …
Systematic neglect of mental health
Teen girls are turning to chatbots, not for homework help, but for the questions they’re too afraid to ask anyone else. Not their parents. Not their teachers. Sometimes not even their closest friends. Instead, they whisper their fears into an empty chat box late at night, hoping the words land softly somewhere.
These aren’t silly or shallow questions. They’re small windows into a generation growing up online, trying to feel safe …
What teen girls ask chatbots in secret
Paraphimosis is a urological emergency characterized by the inability to reduce a retracted foreskin over the glans penis, leading to vascular congestion, edema, and potential tissue necrosis. While paraphimosis can result from local trauma, poor hygiene, or iatrogenic causes, it is increasingly recognized as a clinical manifestation associated with underlying systemic disease, particularly diabetes mellitus.
Diabetes mellitus, especially when undiagnosed or poorly controlled, exerts profound effects on local tissue immunity, wound …
Paraphimosis and diabetes: the hidden link
Not long ago, a friend told me, “I switched insurance and can’t find a doctor who will take me.” Another said, “I left a leading integrated health plan after going on Medicare and now no one will see me.” These aren’t isolated complaints. They’ve become the new reality in an affluent U.S. region: It’s easier to buy a multimillion-dollar home than to find a new primary care doctor.
I saw this …
Silicon Valley’s primary care doctor shortage
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Board-certified pediatrician and certified coach Jessie Mahoney discusses her article, “Why don’t women in medicine support each other?” She explores how scarcity, competition, and cultural conditioning have discouraged women physicians from advocating …
Why women in medicine need to lift each other up [PODCAST]
Tonight, my lab quietly changed what it considers a “normal” ApoB. On Monday, my patient’s ApoB of 98 mg/dL was comfortably green. On Tuesday, that same number was flagged high, a 30-point swing in the normal range overnight. No new evidence. No new trial. No public health crisis. Just a reference-range recalibration. And with that one quiet adjustment, millions of people who went to bed “normal” may wake up “abnormal.”
Reference …
The problem with laboratory reference ranges
Two years ago, I took a single 20 mg dose of escitalopram. Like millions of others, I was prescribed this antidepressant with the expectation that it would help, or at worst, have mild side effects that would pass. Instead, I experienced an immediate and severe adverse reaction. What I could not have imagined then was that the symptoms would not resolve; they have persisted and, over time, have only worsened.
Since …
My persistent adverse reaction to an SSRI
Carrier screening has outgrown the language we still use to explain it. The rapid expansion of genetic testing has uncovered new layers of complexity in how conditions present, how results should be interpreted, and how patients experience and act on genetic information. To practice responsibly in this era of Genetic Carrier Screening 3.0, clinicians must understand not only what we are testing for, but how and why the results look …
Why carrier screening results are complex
Autism was never meant to be diagnosed in 15 minutes.
The original vision, born in war-torn Vienna and postwar Baltimore, called for deep observation, multidisciplinary insight, and time. But somewhere between the ideal and the insurance code, we lost the standard.
Today, families navigate a system built for speed, not truth. And children pay the price.
The ideal vs. reality
In theory, pediatricians perform routine developmental surveillance. Screenings like the M-CHAT happen at 18 …
The crisis in modern autism diagnosis
I come to you with stories
I cannot name.
They press against my chest
waiting for a moment when
it feels safe
for them to be set free.
Pain is a language
I find difficult to speak aloud,
and the silence between us
feels like a waiting room
that will never empty,
pressing in on me,
catching my breath.
Two strangers,
white walls between us,
your eyes move toward the clock,
while mine look at my folded hands
resting in my lap.
I wonder
am I just a time …
A poem about being seen by your doctor
Picture this: It’s your second month of residency, and you’re deep into a hectic ED shift. The pressure is on; you’re managing patients, making decisions, and trying to get better. Then, a mistake happens. Not one that results in significant harm to the patient, but maybe you miss a diagnosis, fumble a procedure, or are just overwhelmed in general. You know failure is part of growth, but that doesn’t make …
A doctor’s cure for imposter syndrome
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Certified coach and professor Kathleen Muldoon discusses her article, “The humanity we bring: a call to hold space in medicine.” She shares how her experience as a mother in the neonatal intensive …
Why humanity matters in medicine [PODCAST]
Parents are inundated with advice and guidance on all manner of topics from an array of sources, but as a pediatric emergency medicine physician, I have been astonished to realize that parents hear almost nothing about the risk that actually poses the greatest threat of causing serious harm to their children. Approximately 10 percent of children in the United States experience sexual abuse, with one in four girls and somewhere …
The childhood risk we never talk about
As an internal medicine physician practicing in Southaven for more than eight years, I’ve learned one simple truth: Prevention is often more powerful than treatment. Every week, I see patients who wish they had come in sooner, before diabetes, hypertension, or heart disease quietly took hold. These conditions rarely appear overnight; they build over years of small imbalances in diet, stress, and lifestyle. The encouraging news is that small, steady …
Small habits, big impact on health
Like you, I receive many emails concerning environmental toxins. Many of their claims are based on conjecture rather than scientific evidence and are delivered in a panicked manner, implying that you or a family member is doomed if you do not act quickly. It is especially annoying that they often target minor issues rather than major ones. For example, they have emphasized the danger of artificial sweeteners. However, if one …
Are we scared of the wrong environmental toxins?
Author note: This piece is based on a series of conversations with Dr. Meng Xu, one of China’s leading cardiac surgeons. His voice, vision, and uncompromising devotion to valve repair inspired every word. Though he prefers to remain out of the byline, his story is the one being told.
It was 11:48 p.m. on August 14, 2021, China’s Qixi Festival, a day for lovers and a celebration …
A doctor’s fight to repair, not replace
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Physician executive Joseph Pepe discusses his article, “A doctor’s guide to preparing for your death.” He shares practical and compassionate advice on planning for life’s inevitable end, from organizing essential documents and …
How to prepare for your death [PODCAST]
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