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Physician and health care reform advocate David K. Cundiff discusses his article “Ecovillages and organic agriculture: a scenario for global climate restoration.” David challenges the IPCC’s failure to model a fully organic …
Ecovillages and organic farming could reverse global warming [PODCAST]
In engineering, a feedback loop is meant to stabilize a system. In medicine, feedback guides us toward better outcomes. But in applied behavior analysis (ABA), feedback has become a trap, recycling failure under the guise of science, and leaving children and families caught in its circuitry.
The closed circuit
Stevens’ feedback loop diagrams are elegant in their simplicity: arrows circling back, showing how inputs and outputs can stabilize a system. In healthy …
Applied behavior analysis criticism: the closed feedback loop
A piece circulating in the direct primary care community made a confident claim: that the best DPC physicians will not need employer-aligned models or adjacent entities because individual consumer demand will sustain them. Fully booked by individuals, insulated from institutional complexity, answerable to no one but their patients.
It is a satisfying idea. It is also an empirically untested one.
The history of DPC is built on physicians willing to challenge entrenched …
The future of employer-aligned DPC and physician autonomy
The moment I decided to become an American-trained dentist, I was holding a textbook in India. I was a first-year dental student in India when it happened. I had just bought my textbooks for the semester, the thick, heavy kind that feel important in your hands, and I started flipping through them.
Page after page, I kept noticing something. The authors. Their names. Their affiliations. Almost all of them were from …
Navigating the international dentist U.S. pathway
When someone you love is in a different location and suffering while you are safe, a heavy silence begins to fill the room. This survivor guilt is one of the most difficult burdens to carry because it turns even the smallest joys, a hot cup of tea, a peaceful morning, or a moment of laughter, into something that feels like a betrayal. The heart constantly asks: Why them and not …
Coping with survivor guilt: wisdom from Saadi Shirazi and Viktor Frankl
At the end of December 2025, the American Medical Association (AMA) Journal of Ethics ceased its operations, now just a relic of the past. Its inception began in September 1999 with a journal theme entitled “Virtual Mentor Launches with a Nod to William Osler.” It references ethical decision-making, praise for Sir William Osler’s Aequanimitas, and the experience of the spoken word from a doctor to a patient’s ears. Its …
Medical ethics and AI: Why losing oversight endangers patients
When my small-group facilitator asked whether withdrawing life support is morally different from withholding it, my classmates offered the usual responses: autonomy, prognosis, and suffering. My mind was somewhere else entirely. It was the first time I had understood something that I had never questioned.
In medicine, categories exist to serve people; in Jewish law (Halakha), people often exist to serve categories. For years I never saw the cost until we …
End-of-life care and religion: Reconciling Jewish law and medicine
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Pediatrician and certified coach Jessie Mahoney discusses her article “Disruptive physician labeling: a symptom of systemic burnout.” Jessie argues that the rising number of “disruptive” labels slapped on highly skilled doctors is …
“Disruptive” behavior is often a cry for help from depleted doctors [PODCAST]
During a busy morning, a junior nurse notices a discrepancy between a patient’s medication order and the usual dosing protocol. The unit is short-staffed, rounds are running behind, and the attending physician appears visibly rushed. The nurse hesitates, worried about slowing the team down or appearing inexperienced.
The unit manager who is present during rounds, notices the nurse’s hesitation and pauses the discussion. Rather than pushing forward, the manager says, “Before …
Psychological safety in health care: Why speaking up saves lives
The single scariest moment in my medical career was not as a student, or a resident with the first dying trauma patient in front of me. Nor was it in Iraq on November 2, 2003, when two Chinooks were shot down and my ER was overwhelmed with trauma after trauma. It was the very first day as an attending in the ER. Up until then, in every single case in …
Evaluating the U.S. Surgeon General nominee: Why clinical experience matters
My wife is dying.
The day has yet to be determined, but the causes are certain. Stage 4 metastatic pancreatic and liver cancers will allow her a few weeks more in which to say goodbye to a large circle of family and friends. She has decided not to undergo chemotherapy or radiation that at best might extend her life by a few weeks, at the cost of the quality of whatever …
Lessons from 47 years: long-term marriage and palliative care
Imagine a world-class anesthesiologist at a major hospital in Manhattan. She is fully credentialed, board-certified, and has been saving lives at that facility for 5 years. On her day off, she wants to pick up an extra shift at a surgery center 3 blocks away that is currently short-staffed and desperate for help. Logic says she should be able to walk in, show her “Ready-to-Work” status, and start. Instead, she …
Health care credentialing is broken: How to fix the staffing crisis
A pharmaceutical representative recently brought lunch to my office to present a new drug. The drug may help some patients. The food was abundant. The room was full, with excess all around, including leftovers that were eventually thrown away. None of that is unusual in American medicine.
What has become unusual, at least for me, is how hard it now is to separate the plate in front of me from the …
Why I stopped accepting pharmaceutical-sponsored lunches
The repeal of the “X-waiver” in the Consolidated Appropriations Act of 2023 was widely celebrated as a long-overdue step toward expanding access to buprenorphine for opioid use disorder (OUD). By removing the requirement for supplemental training and a special DEA designation, policymakers hoped to normalize treatment and reduce barriers for clinicians.
Yet nearly two years after, buprenorphine prescribing remains inconsistent across the country. Only one in four Americans …
Why buprenorphine prescribing still lags after the X-waiver repeal
“Why are you studying that? Philosophy won’t help you save lives.” If I had a dime for every time someone said this to me, I could single-handedly fund an entire class’s medical school tuition. Being a pre-medical student who majored in philosophy feels like being the only person asking “why” in a room full of people asking “how.” I have thought to myself many times that there is no balance …
Philosophy in medicine: Why doctors need to ask “why”
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Internal medicine physician Corinne Sundar Rao discusses her article “Physician on-call compensation: the unpaid labor driving burnout.” Corinne argues that the term “call” is a euphemism used to extract free labor from …
Unpaid on-call shifts are driving doctors into early retirement [PODCAST]
I first learned to respect silence over a chessboard. Two players sit across from one another, the clock ticking audibly, 64 squares holding more possibility than certainty. You arrive, survey the position, and wait. You gather information, recall principles, recognize patterns, and only then commit, knowing that every decision constrains the future in ways you cannot fully predict.
Now, as a third-year medical student on clinical rotations, I find myself standing …
What chess taught me about clinical reasoning and humanism
I never imagined that providing standard, evidence-based medical care, and explaining that care clearly to patients, could put me at risk of federal prosecution.
Yet that is the position I find myself in today.
I am a board-certified family medicine physician and the founder of a small queer- and trans-owned clinic providing gender affirming care. Our clinic is now at the center of a Department of Justice appeal after we Read more…
Physician free speech rights under fire: the DOJ vs. patient education
He came in wanting to get his smile back. I did not know he was also asking for his life.
He sat down in my chair and did not say much at first.
That happens a lot in a MassHealth practice in Massachusetts. People come in with more than just one problem. They carry shame, years of avoiding problems, and a lifetime of being told by systems, situations, and sometimes even their …
Treating methamphetamine-associated dental disease in safety-net clinics
In my first week of anesthesiology residency at the Hospital of the University of Pennsylvania, I learned two things at once: how to keep other people breathing and how it feels to lose your own air. My chest filled with liters of lymphatic fluid. A scan showed lungs that looked like lace. The diagnosis was LAM, lymphangioleiomyomatosis, a rare, estrogen-sensitive lung disease that overwhelmingly strikes women in their reproductive years.
At …
Reproductive care for rare diseases: the missing playbook
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