I am an internist and, once upon a time, a card-carrying lipidologist. I have spent years watching medicine’s “standards of care” quietly stretch like elastic waistbands. What begins as a targeted therapy for a small group of high-risk patients slowly expands until everyone and their grandmother is expected to be on it. That phenomenon has a name: guideline creep.
How it works
The cycle is simple:
As a physician provider in my State Physicians Health Program, I have watched brilliant colleagues flicker out. Not because they lacked skill or grit, but because the system treated their humanity like an optional feature. We train physicians to master physiology, not how to metabolize grief. We celebrate heroics, not healing. Then September arrives, Suicide Prevention Month, and we draft statements. The statements are sincere. They are not sufficient. It …
I have spent decades learning about how bodies and brains work, but nothing has taught me more about complexity than raising my autistic son. He is nine, curious, brilliant, and completely captivated by chemistry. He can explain the structure of an atom with more clarity than most high school students.
But when we step into the real world (classrooms, stores, even family gatherings), sometimes his brain does not get to shine. …
I never expected that iron deficiency anemia would change the course of my life. I felt off. Tired in a way that sleep could not fix. Foggy, weak, emotionally distant. At first, I thought I was just worn down from work and the daily grind. I was not myself, physically, mentally, or emotionally.
Eventually, I was diagnosed with iron deficiency anemia, a condition many associate with mild fatigue or simply “not …
Kidney stones are not only about what you eat or the genes you inherit. They are also about where you live and how hot it gets. Every summer, urologists notice the same pattern: as the temperature climbs, so do the visits for kidney stones. Because heat and humidity do not just make us sweat, they change how our bodies handle water and minerals. Dehydration concentrates the urine, crystals form more …
As physicians, we are trained to prescribe, to fix, to optimize. Our patients expect it, and frankly, so do we. I built a career around lipid panels, trial data, and prescriptions meant to shave percentage points off cardiovascular risk. But lately, I find myself offering something far less high-tech and far more radical: a walk.
Walking is slow. Impractical. Rarely the efficient choice. Which is exactly why it matters.
Everywhere around us, …
An excerpt from Understanding High-Risk Pregnancy: A Patient’s Guide to Prenatal Complications.
What is a high-risk pregnancy?
You may find it strange that there is no single accepted definition of what constitutes a high-risk pregnancy. Probably more than half of women will have at least one risk factor that could be an issue, but for most of these women it will minimally affect their pregnancy care or the outcome. For other …
In the hierarchy of health care professionals, I supposedly stand on one of the lowest steps of that ladder. Some say I am just a CNA. Some say I am the backbone of nurses and physicians. I say: I am a strategic part of this ladder. I do not have the medical knowledge or skills of a physician nor of a nurse. But what I do have is a heart …
As a practicing internist and lipidologist, I have long been trained to believe in the cholesterol hypothesis. Statins were not just recommended; they were the gospel. Lower LDL, save lives. That mantra was repeated at every lecture, every conference, every guideline committee.
But like many dogmas in medicine, the cracks are there if you dare to look. And some of the most damning cracks are found in a set of randomized …
The door closes with a soft click, sealing me inside a room that smells of alcohol and cotton swabs. The light is too bright, pouring down from overhead panels that have withstood the test of time. The entire room is bathed in a white-wash of light, leaving no shadows, except those that lie within me. A token landscape or two adorn the antiseptic walls, attempting to distract me from the …
Varicocele is one of the most common findings in men being evaluated for infertility. Roughly 15 percent of all men have one, and the number climbs to about 40 percent among men with fertility problems. Yet despite how common it is, a varicocele remains a confusing diagnosis. Some men are told they need surgery right away, while others are advised to do nothing at all.
The truth is somewhere in between. …
Gasping for breath, Michael (name changed) pushed back in his chair. His legs felt like lead weights. He could not delay the rescue call any longer. The oxygen in his blood had dipped into the 80s.
An X-ray showed a shadow over the lower part of Michael’s right lung, and the hospital admitted him to treat a pneumonia. A smoker for decades, he was relieved a few days later to be …
Across the world’s earliest civilizations, healers turned to nature as their pharmacy. Ancient systems like Ayurveda in India, Unani (Hikmat) medicine in the Middle East, and early European herbalism developed sophisticated therapeutic practices rooted in plants and natural compounds, many of which are still clinically relevant today.
Take turmeric, for example. Traditionally simmered in milk or prepared as a paste, it was used for its healing and anti-inflammatory properties. Today, biomedical …
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When I was in my studies as a psychiatry resident, I learned about an interesting field called metabolic psychiatry, which focuses specifically on ketogenic therapies to treat psychiatric conditions. This is a nascent field at this time, with no extensive clinical trials like we have for medications, though some small trials exist. I even have some patients who have been on ketogenic diets (not prescribed by me) …
In my practice, I care for many patients obsessed with longevity. They fast, they microdose, they meditate, they cold plunge, they gulp down supplements by the handful. They optimize their labs with the fervor of a hedge fund manager optimizing a portfolio. They read Peter Attia and Andrew Huberman like scripture.
And yet, they still die.
This is not cynicism; it is reality. Over the years, I have watched patients do everything …
For twenty years I have been the mother of a child with a life-threatening food allergy. I know what it is to watch my son’s throat close, to see terror in his eyes, to hear him beg not to die. It felt like time slowed down as we waited for epinephrine to work. Those moments are seared into me. They are not, and never will be, a joke.
That is why …
There is evidence that coconut oil may be a potent weapon in the battle against Alzheimer’s disease and other types of dementia and, perhaps, psychological problems such as depression.
Not just any coconut oil will do the trick, though. Virgin coconut oil (VCO) is extracted from fresh coconut meat without the use of high heat or chemicals, preserving its natural nutrients, flavor, and aroma. VCO is typically pressed from fresh, moist …
As a physician, I spend most of my days telling patients to walk more, eat better, stress less, and maybe, just maybe, go to bed before midnight. So when I came across a piece on ancient Roman and Greek health habits, I had to laugh. Turns out, they were doing a lot of things right — without fitness trackers, $12 smoothies, or a trillion-dollar wellness industry.
We like to think of …
I have been a pediatrician for over two decades. I have seen trends come and go: juice boxes demonized, co-sleeping debated, and screen time limits revised. But nothing has reshaped the pediatrician-parent relationship more profoundly than one thing: the internet.
These days, I do not just answer questions; I navigate a misinformation minefield.
It is common now for parents to walk into my exam room not seeking guidance, but ready for a …
Three years after mpox shocked the world, a silent crisis is unfolding in Africa while the rest of the world seems to have moved on.
When mpox (formerly called monkeypox) grabbed global headlines in 2022, it seemed like the next big pandemic threat. Three years later, the story looks very different depending on where you are. In Africa, mpox is still spreading and cases are rising in some countries. In the …
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