Physicians writing on KevinMD about the diseases they treat and the people who have them: cancer and its screening arguments, pain and the drugs that treat it, diabetes and the obesity argument, mental illness and who gets treated for it, and the decisions at the end of a life. Five maintained records draw on this archive: Cancer: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, End of life: what physicians say, in their own words, Diabetes and obesity: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.
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 …
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Is infection the real cause of heart disease?
Extreme longevity
People claim they want to live to be 100, yet is that a good thing? How you get there may make all the difference. Here’s my take on Blue Zones and the prospect of living to 100. “Blue Zone” is a nonscientific term popularized twenty years ago by Dan Buettner, a National Geographic explorer who studied five geographic regions where many people live to be over ninety or 100. …
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Who wants to live to be a hundred?
I didn’t understand why, especially since I had just spoken with him before his travels. The day my son’s father, Joseph, died, I was sitting in a nail salon. A friend from the military called, offering condolences. I didn’t understand why; until I checked social media and saw the news of an airplane crash. My heart knew before my mind could process it.
Six years later, same month, just five days …
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Grief and leadership in health care
In a major advance in medicine, a man with type 1 diabetes is making his own insulin again, this time using genetically engineered donor islet cells. Researchers provided the new cells with an invisibility cloak to allow them to escape immune detection. After three months of follow-up, his body had not only accepted the new tissue but was quietly producing insulin. This single-patient proof-of-concept study gives hope to the millions …
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CRISPR therapy offers hope for diabetes
A recent Washington Post article called for earlier detection of atherosclerosis and a shift from “ischemia-centric” thinking to an “atheroma-centric” model. That’s progress, but it’s still missing the most important piece: Plaque isn’t the root cause.
For 50 years, we’ve built a trillion-dollar cardiology machine around the cholesterol hypothesis. Statins, PCSK9 inhibitors, ezetimibe, inclisiran, Lp(a) drugs, all circling the same biochemical drain. LDL plays a role, yes. But LDL is …
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Rethinking cholesterol and atherosclerosis
HBO’s The Pitt collected thirteen Primetime Emmy nominations this year, winning both Outstanding Drama Series and Outstanding Lead Actor in a Drama Series for Noah Wyle. But the recognition was not just for great television. The series struck a cultural nerve because it captured something raw and real: the emotional side of medicine. Viewers saw the chaos of an emergency room after a mass casualty event, the head physician …
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Why doctors need emotional skills to survive
As a research scientist who is devoted to ensuring that immigrant nurses have successful U.S. careers, the issue of internationally educated nurses’ (IENs’) cross-culture language competence has recently been both a sensitive and front-and-center issue pervading my work. In my more than 30 years in the health care sphere, the topic is now reaching a fever-pitch as IENs increasingly enter the U.S. health care workforce and play a critical role …
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The debate on English tests for immigrant nurses
At age 81, I speak and write voluminously as a health care educator specializing in public health policy and practice for the treatment of pain and addiction. My wife and I are also careful about getting our periodic vaccinations for flu and COVID-19. A few days ago we responded to an invitation from our pharmacy to drop in for our shots on a walk-in basis. The process turned out to …
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The frustrating bureaucracy of getting a vaccine
The pandemic changed us in ways that cannot be measured by infection rates alone. Beyond the physical toll, it left lasting scars on our mental health. Fear, uncertainty, and isolation became daily realities. As a health professional and researcher, I wanted to understand how people could begin to heal. During my doctoral work, I studied adults who engaged in different wellness practices after the pandemic. Some found relief in nature: …
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Healing from the pandemic’s mental toll
When I tell colleagues that I offer Valtrex (valacyclovir) and low-dose lithium orotate to patients worried about developing Alzheimer’s, the silence in the room thickens. Someone always asks, “Where’s the randomized controlled trial?” That’s exactly the problem. We keep waiting for perfect evidence while the disease eats away at people’s brains.
I’m an internist and lipidologist who’s spent years watching the medical establishment chase the wrong villains, like cholesterol, salt, …
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The infectious hypothesis of Alzheimer’s disease
When the FOURIER trial was published in 2017, cardiologists and lipidologists everywhere hailed it as proof that lowering LDL with PCSK9 inhibitors “saves lives.” But when you actually read the data, not the press releases, it’s hard not to shake your head.
Over a median of 2.2 years, evolocumab (Repatha) reduced nonfatal heart attacks by about 0.9 percent and had no significant impact on death. The absolute risk reduction for all-cause …
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The high cost of PCSK9 inhibitors like Repatha
While work-related stress continues to be a major cause of burnout, new research shows that non-work stressors like caregiving demands, financial instability, and personal life conflicts also greatly increase the risk. Yet, the dominant narrative has not caught up, and many still believe burnout is only a workplace problem, overlooking the deeper, life-wide imbalance it often reflects.
Recently, I spoke to a nurse on sick leave for the third time …
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Why non-work stress fuels burnout
Jodie Green and I have been following each other on social media for a couple of years, and we finally had a conversation a few months ago. We discussed our appreciation for the work each of us is doing to support doctors and all other health care professionals, including my efforts and Jodie’s with her organization, the Clinician Burnout Foundation. We’re amplifying meaningful resources that are available for …
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Why wellness programs fail health care
For decades, I treated patients with chronic pain. One truth became evident early: most older adults prescribed narcotics use them responsibly. My clinical acumen, shaped over more than forty years, intuitively knew this to be true. Still, I understood that intuition and opinion alone are insufficient. Compassion in medicine must be paired with objectivity.
Now the data confirms what practice long suggested. A national survey of adults aged 50 and older …
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Treating chronic pain in older adults
An 18-year-old was admitted to our ICU with a questionable diagnosis. The drug screen did not reveal what he had taken. Our ICU intensivist speculated he ingested bath salts. Bath salts came to the U.S. around the 2010s. It was cheap and, even better, considered a “legal high” as it was not detectable in drug tests. Josh came to the emergency room psychotic, paranoid, and hallucinating, with hypertension and SVT. …
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A nurse’s story of hospital bullying
The names read like a roll call of Black excellence: congressman John Lewis, the civil rights icon who walked across the Edmund Pettus Bridge and helped change America; congresswoman Sheila Jackson Lee, the tireless advocate for justice who represented Houston for nearly three decades; Aretha Franklin, the Queen of Soul whose voice defined generations; reverend Dr. Calvin O. Butts III, the prophetic voice from Abyssinian Baptist Church who fought for …
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Pancreatic cancer racial disparities
Many people have become “burned out” on the word burnout. Many doctors do not resonate with the term, feeling it describes personal struggles, when systemic issues are the root cause of the challenges facing health care professionals. They offer “moral injury” as a more accurate description. Clinicians can experience either or both at any time during their career.
Recently speaking with Shari Morin-Degel, I appreciated her sharing that because she had …
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Why burnout prevention starts with leadership
SGLT2 inhibitors have transformed care for people with type 2 diabetes. They not only lower blood sugar but also reduce cardiovascular events and slow the progression of kidney disease. Given these successes, many have asked whether the same benefits extend to people with type 1 diabetes (T1D).
The answer is not straightforward. In T1D, SGLT2 inhibitors remain off-label, and the biggest concern is the increased risk of diabetic ketoacidosis (DKA). Still, …
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Are SGLT2 inhibitors safe for type 1 diabetes?
A brilliant, like-minded cardiologist recently shared with me “A Reappraisal of the Lipid Hypothesis” by Dr. Robert DuBroff, published in The American Journal of Medicine. It should be required reading for every physician who has ever written “continue statin” without a second thought.
DuBroff’s analysis reviewed 29 randomized controlled trials of cholesterol-lowering therapy conducted after modern trial regulations were adopted. The results were quietly devastating:
Re-examining the lipid hypothesis and statin use
