Stop doing peer reviews for free

Education
November 8, 2025

The unpaid backbone of a billion-dollar scientific publishing industry

Not long ago, I received yet another “urgent” peer review request from a major medical journal. The email hit all the familiar notes: “We value your expertise. Your contribution is essential to scholarly excellence. Please respond within 72 hours.”

I glanced at the journal’s website. Their open-access fee? $3,800. Reviewer compensation? Zero.

This is the quiet hypocrisy we’ve all come to accept: Journals charge …

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The human cost of health care automation

Physician
November 8, 2025

AI is rolling out in medicine faster than most of us can process. Ambient scribes documenting visits. Clinical decision support algorithms. Automated prior authorizations. The promises are compelling: reduced clerical burden, more face-time with patients, less burnout.

I wanted this. As a palliative care doctor and director of physician well-being at my institution, I’ve spent years watching colleagues drown in documentation and burn out from relentless task loads. When AI tools …

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The need for pediatric respite care

Conditions
November 8, 2025

My son Gideon is almost 12 years old. He is funny in that sharp, unexpected way that catches you off-guard. He is deeply expressive and full of life. He gives love and joy more freely than most kids his age. He is curious and social. He is healthy, and I am grateful for it. We are endlessly proud of who he is.

And, our family constantly walks the edge of breaking …

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A better way to talk about kids’ nutrition

Conditions
November 8, 2025

When parents bring their children to the clinic, they often expect quick advice: “Eat healthy. Exercise more.” But after years in practice, I’ve learned those generic prescriptions rarely work. Families leave feeling uncertain, children feel pressured, and real changes at home are hard to sustain.

That’s why I focus on a family-centered, personalized approach. Nutrition is not just about a child; it’s about routines, traditions, and stresses that affect the whole …

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Many seizures don’t look like the movies

Conditions
November 8, 2025

When most people think of seizures, they picture someone falling to the ground with violent shaking, the dramatic scenes we’ve seen in movies and television. While these tonic-clonic seizures (previously known as grand mal seizures) do occur, the reality is that many seizures look nothing like what Hollywood portrays. They are often subtle, easily missed, and can be mistaken for daydreaming or unusual behavior.

More than 3 million Americans have active …

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Breast cancer in teenagers is rare but real

Conditions
November 8, 2025

When people think about breast cancer, they picture middle-aged or older women. The pink ribbons, awareness campaigns, and even clinical guidelines overwhelmingly focus on adults. What’s almost never discussed is that, though rare, breast cancer can occur in teenagers. And when it does, the diagnosis is often delayed, with consequences that change a young life forever.

Breast cancer in adolescents is extremely uncommon, accounting for less than 1 percent …

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Reimagining medical education for the 21st century [PODCAST]

Podcast
November 7, 2025
YouTube video

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Internal medicine physician Robert C. Smith discusses his article “Why medicine needs a second Flexner Report.” In this episode, Robert explores how modern medical education has fallen behind the science it was …

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A pediatrician’s reckoning with behavior therapy

Physician
November 7, 2025

For decades, I practiced developmental-behavioral pediatrics with a focus on coordinated care, measurable goals, and clinical accountability. I believed that if we could define a child’s needs clearly and track progress with integrity, we could build systems that honored both science and dignity.

But I now realize I missed something critical.

After reviewing the #BanABA initiative and speaking with Dr. Henny Kupferstein, I’ve come to understand the full scope of harm linked …

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Opioid prescribing guidelines ignore metabolism

Conditions
November 7, 2025

My primary focus is on U.S. and international public health policy for treatment of severe chronic pain. I have been active for over 28 years as a health care writer and educator, with over 300 papers authored or co-authored in a mix of peer-reviewed journals and mass media.

I am a particular critic of what I believe to be the proven misdirection (a.k.a. “fraud“) committed by Federal and State …

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How AI is changing medical education

Education
November 7, 2025

When I started medical school, I imagined long nights memorizing anatomy, shadowing physicians, and, eventually, walking hospital hallways in a white coat, trying to solve the intricate puzzles that patients carry in their bodies.

What I didn’t expect was that some of the most important lessons wouldn’t come from a professor or a textbook but from conversations about algorithms, data, and machines that learn.

Artificial intelligence felt distant at first, something for …

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The collapse of developmental pediatrics

Physician
November 7, 2025

The terrain I refused to leave

At Madigan Army Medical Center, I built a diagnostic model that delivered autism answers in under 30 minutes. No shortcuts, just smarter care. A Ph.D. pediatric nurse practitioner performed triage. I conducted the Screening Tool for Autism in Toddlers (STAT-MD), a targeted autism screening protocol developed at Vanderbilt, confirmed criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and families left …

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Why the U.K. junior doctor strike matters

Physician
November 7, 2025

In mid-November, thousands of junior doctors in Britain will again step away from their posts. Not for comfort. Not for gain. For something harder to name.

They have been praised as heroes and treated as expendable, thanked in speeches while their pay erodes and their patience thins. I heard one young doctor say she still loves medicine, but cannot serve a system that sees her as replaceable. She stayed through staff …

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How to adopt AI in health care responsibly

Tech
November 7, 2025

To give you an idea of how rapidly AI adoption has occurred, I recently reviewed the minutes of a company leadership meeting from last year. The topic of AI was almost entirely absent, receiving only minimal discussion. Compare that activity to today, where we’ve developed dozens of applications that actively utilize some form of AI, and hold daily meetings where it is the sole topic of discussion.

If your organization’s experience …

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Why physicians must not suffer in silence [PODCAST]

Podcast
November 6, 2025
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Neurologist Scott Abramson discusses his article “Why ‘the best physicians’ risk burnout and isolation.” In this YouTube-optimized episode, Scott reflects on the ancient Talmudic teaching that warns how pride and perfectionism can …

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Is Lp(a) testing the new messiah?

Conditions
November 6, 2025

I just read yet another article praising the new messiah of cardiology (Lipoprotein(a)) and urging every physician in America to start testing for it. The tone was familiar: solemn, scientific, and a little evangelical.

The message? “Measure Lp(a) once in every patient.”

The subtext? “Because we finally found the missing piece.”

If this feels like déjà vu, that’s because it is. We’ve been here before: first with total cholesterol, then LDL, then HDL …

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Is it time for the VA to embrace virtual care?

Tech
November 6, 2025

Is it time for the Department of Veterans Affairs (VA) to fully embrace virtual care?

The VA has long been one of America’s great health care innovators. From pioneering electronic health records to building one of the first truly integrated care systems, the VA has often been decades ahead of the private sector.

But today, the system is straining. Nearly 94 percent of VA facilities face physician shortages, and 79 …

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Pharmacy benefit manager reform vs. direct drug plans

Meds
November 6, 2025

Much has been made of the move by President Donald Trump and the pharmaceutical industry to offer direct-purchase drug programs at heavily discounted rates. Following the announcement of these new programs and TrumpRx, we’ve heard news and opinion pieces from every major outlet, but missing in the conversation is one of the most important voices: the patient. Key questions remained unanswered:

“What does this mean for my care?”

“Does this work with …

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The psychological trauma of polarization

Physician
November 6, 2025

The human psyche is built for connection. Our evolutionary history, our families, and our communities shape us to seek cooperation, mutual respect, and shared purpose. We are, by design, social beings whose sense of safety depends on trust and belonging.

When that natural orientation toward unity is fractured; when instead we encounter hostility, harsh language, or dehumanization, it cuts against the grain of who we are. What might once have been …

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Quality metrics in medicine vs. patient trust

Physician
November 6, 2025

The woman sits across from me, hands folded around a list of her medications.

We review the cholesterol guidelines. I explain the evidence. She listens carefully, then says, almost apologetically, “Doctor, I know what the data says. I just don’t want to take another pill.”

There is no anger in her voice, only fatigue, the quiet exhaustion of someone who has lived long enough to know her own limits.

I pause, because this …

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My journey to a type 1 diabetes diagnosis

Conditions
November 6, 2025

I was diagnosed with type 1 diabetes mellitus in February 2024. Now it all made sense.

It all started in October 2020 when I passed out cold. I was rushed to the emergency room and 3 days later woke up to find I had a thyroid issue and lost 2 pints of blood. Four days later, after a blood transfusion, I was sent home. At that point, I thought I was …

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