1. Medical journals are going the way of newspapers, as in "extinct" Who remembers newspapers? Pre-smartphone compendiums of world and local events on paper that required reporters to investigate and inform? When newspapers lost their classified ads, their financial fulcrum,…
1. Medical journals are going the way of newspapers, as in “extinct”
Who remembers newspapers? Pre-smartphone compendiums of world and local events on paper that required reporters to investigate and inform?
When newspapers lost their classified ads, their financial fulcrum, to Craigslist, they lost their readers and reporters. No one could pay staff or printing or distribution without readers and advertisers, and the business model is otiose, especially because of the printing …
An American Medical Association (AMA) policy from June 9, 2026, calls for prohibiting the sale, distribution, and marketing of concentrated 7-hydroxymitragynine (7-OH) products while supporting surveillance, additional research, and other public health measures for kratom, according to the AMA press…
An American Medical Association (AMA) policy from June 9, 2026, calls for prohibiting the sale, distribution, and marketing of concentrated 7-hydroxymitragynine (7-OH) products while supporting surveillance, additional research, and other public health measures for kratom, according to the AMA press release and the AMA House of Delegates report. This policy raises an uncomfortable question: Was the AMA duped on 7-OH?
For decades, the medical community has accepted a foundational principle of cardiovascular care: patients with non-valvular atrial fibrillation (AFib) require aggressive, lifelong stroke prophylaxis. When a patient also presents with stable coronary artery disease (CAD), standard practice has historically gone…
For decades, the medical community has accepted a foundational principle of cardiovascular care: patients with non-valvular atrial fibrillation (AFib) require aggressive, lifelong stroke prophylaxis. When a patient also presents with stable coronary artery disease (CAD), standard practice has historically gone a step further, layering an antiplatelet such as aspirin on top of an oral anticoagulant such as warfarin or a modern direct oral anticoagulant (DOAC). To frontline hospitalists and patients, …
Last week, KevinMD published my blog titled "The anticoagulant standard of care nobody tested." This week I'll continue with a discussion of patients who may have been harmed by anticoagulants. In 2001, two co-authors and I initiated a systematic review…
Last week, KevinMD published my blog titled “The anticoagulant standard of care nobody tested.” This week I’ll continue with a discussion of patients who may have been harmed by anticoagulants.
I have written a couple of previous articles regarding pharmaceutical advertisements on TV and in print. I noted that they used glitz to sell their products, and that this was not helpful for patients, especially as many new products had…
I have written a couple of previous articles regarding pharmaceutical advertisements on TV and in print. I noted that they used glitz to sell their products, and that this was not helpful for patients, especially as many new products had potentially more severe side effects than older ones and were often of no greater effectiveness. The only significant difference was that newer products were more expensive.
If you work in medicine long enough, you learn that science moves slowly. Regulation moves slower. And social media moves at the speed of caffeine and bad decisions. That collision is exactly what is happening right now in the peptide…
If you work in medicine long enough, you learn that science moves slowly. Regulation moves slower. And social media moves at the speed of caffeine and bad decisions. That collision is exactly what is happening right now in the peptide world.
One week the FDA tightens restrictions. The next week state medical boards issue warnings. Then telehealth companies pivot. Then compounding pharmacies change formulations. Then another peptide disappears from the market. …
I am a geriatrics and hospice and palliative medicine physician with over 20 years of experience. Over the years, I have seen how cannabis has helped my patients, and I am very comfortable with my patients using cannabis. But like…
I am a geriatrics and hospice and palliative medicine physician with over 20 years of experience. Over the years, I have seen how cannabis has helped my patients, and I am very comfortable with my patients using cannabis.
But like many physicians, I was not formally trained in cannabis medicine. In fact, for the longest time I thought people smoked the leaves. It was only much later that I learned that …
I still remember the moment clearly. A patient stood in front of me, frustrated and exhausted. She had been prescribed medication for her diabetes months ago, yet her condition was worsening. As I reviewed her profile, everything seemed "correct." The…
I still remember the moment clearly. A patient stood in front of me, frustrated and exhausted. She had been prescribed medication for her diabetes months ago, yet her condition was worsening. As I reviewed her profile, everything seemed “correct.” The prescriptions were filled. The claims were processed. The system showed adherence.
But she looked at me and said something I couldn’t ignore: “I never really understood why I needed to take …
In 1997, the LA Times published my article titled "Good Medicine, Fewer Hospital Beds." Writing as an attending internist at a large public teaching hospital, I criticized a decision to spend $900 million on a massive 600-bed replacement facility. My…
In 1997, the LA Times published my article titled “Good Medicine, Fewer Hospital Beds.” Writing as an attending internist at a large public teaching hospital, I criticized a decision to spend $900 million on a massive 600-bed replacement facility. My experience affirmed what federal, state, and county analysts already knew: Resources were poured disproportionately into expensive acute inpatient specialty services, leaving primary care and out-of-hospital services for millions of …
I have spent years caring for patients with obesity, and one of the most meaningful parts of this work is seeing what happens when people finally receive comprehensive, evidence-based treatment. I have watched sleep apnea disappear, blood pressure normalize, joint…
I have spent years caring for patients with obesity, and one of the most meaningful parts of this work is seeing what happens when people finally receive comprehensive, evidence-based treatment. I have watched sleep apnea disappear, blood pressure normalize, joint pain ease, and liver disease reverse. I have watched people who spent years feeling dismissed by the health care system finally start to feel healthy and hopeful again. Those outcomes …
For most of my career as a bariatric surgeon, I told patients that surgery was the most reliable tool we had for significant, sustained weight loss. That conversation has fundamentally changed. In the past three years, GLP-1 receptor agonists, a…
For most of my career as a bariatric surgeon, I told patients that surgery was the most reliable tool we had for significant, sustained weight loss. That conversation has fundamentally changed.
In the past three years, GLP-1 receptor agonists, a class of medications originally developed for type 2 diabetes, have redefined what is medically achievable for patients with obesity. As someone who has performed hundreds of bariatric procedures and now helps …
Weeks after a FiercePharma webinar told drug reps to make the lab worker their first sales point and not the patient's doctor (to avoid a delay in "therapy adoption"), the three-day Fierce Pharma Engage conference in San Diego unveiled more…
Weeks after a FiercePharma webinar told drug reps to make the lab worker their first sales point and not the patient’s doctor (to avoid a delay in “therapy adoption”), the three-day Fierce Pharma Engage conference in San Diego unveiled more aggressive, stealth sales tactics.
At the well-funded meet-and-greet with 700 well-turned-out attendees, 150 speakers, and 56 corporate sponsors, we learned that:
1. AI will take over interactions with doctors (HCPs)
As a board-certified physical medicine and rehabilitation (PM&R) physician, I have guided patients through musculoskeletal care. Recently, my focus has shifted toward regenerative medicine, particularly platelet-rich plasma (PRP) therapy. What began as curiosity is now a strong commitment to understanding…
As a board-certified physical medicine and rehabilitation (PM&R) physician, I have guided patients through musculoskeletal care. Recently, my focus has shifted toward regenerative medicine, particularly platelet-rich plasma (PRP) therapy. What began as curiosity is now a strong commitment to understanding these therapies for patients who have exhausted conventional treatments.
This new focus led me to attend an intensive weekend course with experts from orthopedics, sports medicine, PM&R, rheumatology, and pain medicine. …
A recent report documented something remarkable: Americans on glucagon-like peptide-1 (GLP-1) agonists are falling in love with exercise for the first time. A man who struggled to walk to his mailbox now hikes seven miles a day. A woman who…
A recent report documented something remarkable: Americans on glucagon-like peptide-1 (GLP-1) agonists are falling in love with exercise for the first time. A man who struggled to walk to his mailbox now hikes seven miles a day. A woman who needed a cane ran her first five-kilometer (5K) race. A rock climber went from three workouts a week to five.
These drugs proved what physicians should have said more clearly long …
A patient walks into my office. She is 52, exhausted, brain-fogged, gaining weight, and six years into sertraline 100 mg. I mention methylene blue as a mitochondrial support at 10 mg orally. She looks at me like I just suggested…
A patient walks into my office. She is 52, exhausted, brain-fogged, gaining weight, and six years into sertraline 100 mg. I mention methylene blue as a mitochondrial support at 10 mg orally.
She looks at me like I just suggested arsenic.
“My pharmacist said I can never take methylene blue because I am on an antidepressant. He said it causes serotonin syndrome.”
I hear this every week. And every week I have to …
In the modern clinic, we often operate under an unstated a priori assumption that if a phenomenon is real, its primary explanation must be molecular. As a psychiatrist, I find this reductionist bias increasingly apparent in how we conceptualize "breakthrough"…
In the modern clinic, we often operate under an unstated a priori assumption that if a phenomenon is real, its primary explanation must be molecular. As a psychiatrist, I find this reductionist bias increasingly apparent in how we conceptualize “breakthrough” treatments like ketamine therapy for depression or chronic pain. When we discuss how ketamine works, the conversation almost instantly gravitates toward the neurotransmitter system, synaptic plasticity, glutamate surges, and the …
I met him as a patient with a back condition, not a cardiac patient. A 70-year-old man who looked like he had outrun aging through sheer willpower and a well-worn bicycle. He rode more than a hundred miles a week,…
I met him as a patient with a back condition, not a cardiac patient. A 70-year-old man who looked like he had outrun aging through sheer willpower and a well-worn bicycle. He rode more than a hundred miles a week, had the resting heart rate of a seasoned athlete, and carried himself with the kind of confidence that comes from a lifetime of good health. His only complaint was lower-back …
GLP-1 medications are an effective tool for many people's weight loss journey, and they have changed the conversation around obesity, diabetes, and chronic disease. For many Americans, these treatment options may offer something that once felt out of reach: real,…
GLP-1 medications are an effective tool for many people’s weight loss journey, and they have changed the conversation around obesity, diabetes, and chronic disease. For many Americans, these treatment options may offer something that once felt out of reach: real, measurable weight loss and improved metabolic health. But as prescriptions surge and headlines celebrate dramatic transformations, an uncomfortable truth is often overlooked. Medication alone is not enough, and in some …
A publication in Nature in April 2026 reports that N-desethyl-fluornitrazene (DFNZ), a modified nitazene and µ-opioid receptor (MOR) superagonist, produced potent analgesia in rodents with less respiratory depression, weaker dopamine-linked reward signaling, lower withdrawal burden, and no clear tolerance or…
A publication in Nature in April 2026 reports that N-desethyl-fluornitrazene (DFNZ), a modified nitazene and µ-opioid receptor (MOR) superagonist, produced potent analgesia in rodents with less respiratory depression, weaker dopamine-linked reward signaling, lower withdrawal burden, and no clear tolerance or MOR downregulation. The study challenges the usual assumption that very high MOR efficacy must inevitably produce the full adverse-effect profile seen with conventional opioids. Opioid pharmacology has long been …
There is a sentence I have been practicing for two years. I believe peptide therapy works. It sounds simple. It is not simple. In the culture of evidence-based medicine, a culture I was trained in, believe in, and have practiced…
There is a sentence I have been practicing for two years. I believe peptide therapy works. It sounds simple. It is not simple. In the culture of evidence-based medicine, a culture I was trained in, believe in, and have practiced inside for over two decades, saying you believe something that the evidence has not yet fully validated carries consequences. Raised eyebrows at conferences. The careful distance of colleagues. The quiet …
