My primary focus is on U.S. and international public health policy for treatment of severe chronic pain. I have been active for over 28 years as a health care writer and educator, with over 300 papers authored or co-authored in a mix of peer-reviewed journals and mass media.
I am a particular critic of what I believe to be the proven misdirection (a.k.a. “fraud“) committed by Federal and State …
I just read yet another article praising the new messiah of cardiology (Lipoprotein(a)) and urging every physician in America to start testing for it. The tone was familiar: solemn, scientific, and a little evangelical.
The message? “Measure Lp(a) once in every patient.”
The subtext? “Because we finally found the missing piece.”
If this feels like déjà vu, that’s because it is. We’ve been here before: first with total cholesterol, then LDL, then HDL …
I was diagnosed with type 1 diabetes mellitus in February 2024. Now it all made sense.
It all started in October 2020 when I passed out cold. I was rushed to the emergency room and 3 days later woke up to find I had a thyroid issue and lost 2 pints of blood. Four days later, after a blood transfusion, I was sent home. At that point, I thought I was …
As an internist and lipidologist, I’ve spent decades parsing data on statins, ezetimibe, PCSK9 inhibitors, and the endless parade of “LDL-lowering breakthroughs.” Yet the most potent, and perhaps the most underappreciated, intervention to prevent heart attacks each winter doesn’t come from a cardiology journal or a pharmaceutical rep. It comes from your local pharmacy fridge. For years, I’ve told my patients that getting a flu shot may prevent a heart …
A glass of wine with dinner. A cocktail on a Friday evening. A few beers over the weekend. For many of my patients, alcohol is woven seamlessly into daily life: a social lubricant, a way to unwind, even something they’ve been told might be “heart-healthy.”
Yet, in my clinic, I see the other side. A patient who comes in with fluctuating blood pressure, convinced their readings must be wrong. Another who …
It’s been weeks since the news broke of UniQure’s trial successfully slowing the progression of HD, and I still find myself breaking down in tears. I have been going about my life, doing the groceries, going to the gym, cleaning the house, and the tears keep coming unexpectedly. I am happy about the news, but that is not how it feels in my body. I have come to realize …
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 …
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 …
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 …
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 …
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 …
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 …
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 …
ADVERTISEMENT
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 …
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 …
When most people hear nicotine, they picture stained lungs, cigarette ads, or sweet-flavored vapes. But nicotine isn’t tar, benzene, or formaldehyde. It’s a potent nicotinic acetylcholine receptor agonist with real neurochemical effects, and in carefully selected patients, it can help. I’ve been using nicotine gum and lozenges for years in patients with fatigue, mild depression, and ADHD, not as a miracle cure but as a targeted cognitive and mood-enhancing tool. …
We ran as fast as we could. I glanced up occasionally at the nurse straddling my patient, her blonde waves obscuring her face as she furiously attempted to restart a non-beating heart. We pushed the hospital bed down hallways and around corners, narrowly missing people-filled stretchers lining the Emergency Department. I stood in the back while the experts took over. If she was ready to leave this world, I wanted …
Carrier screening has outgrown the language we still use to explain it.
For years, clinicians told patients they were either “a carrier” or “not a carrier.” But as the science has evolved, this binary approach is not only outdated; it is increasingly misleading.
Genetic carrier screening has entered a new era, and our counseling must evolve alongside it.
For decades, carrier screening was offered selectively based on ethnicity. Ashkenazi Jewish individuals were screened …
In modern medicine, the use of plain language is a fundamental clinical skill. This is especially critical when health decisions can profoundly affect a patient’s life, impacting their financial stability, ability to work, personal independence, and mental well-being, as well as their capacity for managing daily care, recognizing warning signs, and adhering to treatment plans. Considering the patient as a partner in their care, an informed decision can only be …
I was trained to treat heart disease like a plumbing problem. Cholesterol clogs the pipes, statins clear them out. LDL goes down, we high-five each other. But what if we’ve been chasing the wrong culprit all along?
A recent Japanese study looked at 50 plaques removed during coronary atherectomy. Every single one of those plaques tested positive for Chlamydia pneumoniae by PCR or immunostaining. That’s not “some,” or “most.” That’s …
Get free updates delivered free to your inbox.
