Conditions

The crisis in modern autism diagnosis

Conditions
November 2, 2025

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 …

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A poem about being seen by your doctor

Conditions
November 2, 2025

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 …

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The childhood risk we never talk about

Conditions
November 1, 2025

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 …

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Are we scared of the wrong environmental toxins?

Conditions
November 1, 2025

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 …

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A doctor’s fight to repair, not replace

Conditions
November 1, 2025

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 …

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The case for therapeutic nicotine use

Conditions
October 31, 2025

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. …

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A nurse’s view on the broken health care system

Conditions
October 31, 2025

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 …

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Carrier screening counseling must evolve

Conditions
October 31, 2025

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 …

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Why plain language isn’t enough for patients

Conditions
October 30, 2025

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 …

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Is infection the real cause of heart disease?

Conditions
October 29, 2025

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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Physician suicide prevention: a call to action

Conditions
October 29, 2025

I wrote last year about physician suicide as a silent epidemic. The silence is not lifting. The losses are getting closer. The grief is heavier. We all feel it. This month, we lost Dr. Nolan R. Williams. He advanced care for severe, refractory depression and pushed neural stimulation science forward. Then he died by suicide. His death landed like a shock wave across medicine and beyond and the …

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Who wants to live to be a hundred?

Conditions
October 29, 2025

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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Grief and leadership in health care

Conditions
October 28, 2025

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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CRISPR therapy offers hope for diabetes

Conditions
October 28, 2025

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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Rethinking cholesterol and atherosclerosis

Conditions
October 27, 2025

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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Why doctors need emotional skills to survive

Conditions
October 27, 2025

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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The debate on English tests for immigrant nurses

Conditions
October 26, 2025

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 frustrating bureaucracy of getting a vaccine

Conditions
October 26, 2025

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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Healing from the pandemic’s mental toll

Conditions
October 26, 2025

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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The infectious hypothesis of Alzheimer’s disease

Conditions
October 25, 2025

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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