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Health care strategist Dana Y. Lujan discusses her article “Is direct primary care sustainable in a downturn?” Dana explains how the rising cost of living and subscription fatigue are challenging the retail …
Economic reality tests the limits of subscription medicine [PODCAST]
On December 5, I started my hospital shift learning that the ACIP (Advisory Committee on Immunization Practices) had voted against offering universal administration of hepatitis B vaccine at birth, opposing the long-standing practice endorsed by experts. After a long day of examining newborn babies and counseling families, my mind drifted back to the announcement and unearthed a memory of a boy named Sam.
Sam was born a healthy newborn to loving …
Why ACIP’s ruling on universal hepatitis B vaccination endangers newborns
I have spent my career practicing medicine in the real world: caring for patients, managing uncertainty, and making decisions where the stakes are personal and immediate. In recent years, I have also spent considerable time designing and deploying medical software that uses artificial intelligence in live clinical environments. Together, these experiences have reshaped how I think about the future of our profession.
That combination of experiences has led me to a …
AI in medicine: Why it won’t replace doctors but will redefine them
Last week, I spent over two hours on a prior authorization for a patient who needed a medication she’d been stable on for years. Two hours of hold music, transferred calls, and faxed forms, while patients waited.
That same week, Anthropic announced Claude for Healthcare: An AI system that can verify coverage requirements, build claims appeals, and streamline prior authorizations in minutes. OpenAI launched ChatGPT Health days earlier. Both promise to …
Claude for Healthcare vs. administrative burden: a physician’s review
I come from a long line of physicians. My grandfather was a pioneer in pharmacy and biochemistry, so influential that a museum now bears his name. My father, also a doctor, was cut from a very different cloth. I have written before about our strained relationship and the heavy expectations placed on a child born into a family with a reputation to uphold. Those tensions shaped my early views …
The burden of being both doctor and family: an ethical reflection
I proudly bear the title of “Dad,” and my daughter is five (going on 15), fiery, carefree, and unmistakably precocious, yet still my silly, innocent, sweet little girl. I imagine many girls with older brothers develop a similarly spirited personality. However, with her brothers being slightly older, I’ve watched that same innocence gradually diminish in them, as they are being slowly exposed to life’s complexities through school, friends, and their …
A physician father on the Dobbs decision and reproductive rights
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Otolaryngologist Alan P. Feren and patient advocate Joyce Griggs discuss their article “Why health self-advocacy is an essential life skill.” Alan and Joyce share the personal journey of becoming a “chief health executive” …
Navigating the medical system requires specific life skills [PODCAST]
School had just started for the new school year. It was hot and humid. I had just retired from ICU nursing and behavioral health, a 46-year career and never skipping a beat. After several months of retirement, I couldn’t sit still. I was bored and had that nagging feeling that I wasn’t done yet with my career. Maybe that nagging feeling was guilt. Like you can’t quit. You can’t stop. …
A school nurse’s story of trauma and nurse burnout
There are many ways to say “no” in medicine.
“No, this antibiotic won’t help a viral infection.”
“No, this test won’t change our management.”
“No, that surgery carries more risk than benefit.”
And then there is the newest way:
“No, the algorithm doesn’t prioritize your health.”
Welcome to WISeR, short for “Wasteful and Inappropriate Service Reduction,” a Medicare pilot program that promises to usher artificial intelligence into health care decision-making with all the subtlety of …
WISeR Medicare pilot: the new “AI death panel”?
For years we have told patients the same thing when they have trouble finding a doctor: Go to your insurance directory, look it up, they can help you.
And despite saying that, many of us have quietly known for a long time that this advice is broken. We still give it. We give it hoping for the best, knowing there really are not many other useful options to offer at this …
Ghost networks in health care: Why physicians are suing insurers
There is a dangerous assumption circulating in skilled nursing facility (SNF) boardrooms: “If it’s documented in the EMR, we are protected.”
For years, this logic held up. Compliance was a game of checkboxes. Did the nurse educate the patient? Check. Did the patient verbalize understanding? Check. Is the care plan signed? Check.
But the regulatory landscape has shifted beneath our feet. The Department of Justice (DOJ) and CMS are no longer just …
SNF discharge planning: Why documentation is no longer enough
Holding my mother in my arms as she took her last breath changed the way I understand care. That moment, Easter Monday in Canada, was heartbreaking and transformative. Her unwavering faith and peaceful passing contrasted sharply with the confusion that followed when CPR began despite her do-not-resuscitate (DNR) order. I felt helpless.
The experience became the catalyst for my commitment to advocacy and ethical clarity. It taught me that even well-intentioned …
How honoring patient autonomy prevents medical trauma
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Medical oncologist, geriatrician, and physician scientist GJ van Londen and Chief of Genetic and Genomic Medicine at the University of Pittsburgh School of Medicine Gerald Vockley discuss the article “FDA delays could …
Regulatory red tape threatens survival of rare disease patients [PODCAST]
We’ve been thinking about remote patient monitoring (RPM) the wrong way.
Picture this. A patient comes home from the hospital after a cardiac scare. They’ve got a smart scale on their chest, maybe a blood pressure cuff on the counter, and a nurse scheduled to stop by later in the week. The care team, the patient, and the tech are all working together in the hopes that things don’t get worse.
The …
Why remote patient monitoring needs a preventive shift
Eight years ago, motivated by concern for my six grandchildren and future generations, I began a systematic study of climate change through the assessment reports of the Intergovernmental Panel on Climate Change (IPCC). That work led me to focus on a central omission in mainstream climate modeling: The failure to model global conversion to exclusively organic agriculture.
In 2024, the preprint journal SSRN published my scenario to reduce net projected greenhouse …
Ecovillages and organic agriculture: a scenario for global climate restoration
Pick up a bestselling nonfiction book today and you’ll see confident claims about habit change, dopamine detoxes, and rewiring the “default mode network.” These ideas now circulate in podcasts, blogs, and social media as if the brain were an appliance that simply needs the right setting. But in real life, human behavior is not so easily reconfigured.
What I’ve observed is that habits, motivations, and compulsive patterns are shaped not only …
Why sustainable habit change requires more than willpower
Environmental justice, health disparities, and climate change are deeply interconnected, with climate change acting as a threat multiplier that exacerbates existing health inequities, particularly among marginalized and underserved communities. Environmental justice refers to equitable and meaningful involvement in environmental policies, regardless of income, race, etc. Historically marginalized communities of color, the low-income population, and indigenous people are disproportionately exposed to ongoing as well as historical environmental policies. Health disparities arise …
How environmental justice and health disparities connect to climate change
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President and chief executive officer of the National Psoriasis Foundation (NPF) Leah M. Howard discusses her article “Pharmacy benefit manager reform vs. direct drug plans.” Leah analyzes the recent emergence of direct-purchase …
Sustainable legislative reform outweighs temporary discount programs [PODCAST]
A vacant expression covered the face of a 14-year-old boy who lay almost lifeless in a hospital bed, completely unaware of the frantic hustle that surrounded him. Once an extraordinary student-athlete, intracerebral hemorrhage unjustly robbed him of his robust character. This was my most significant interaction with a patient. I knew him not as the student-athlete, nor the boy from neurosurgery, but as my youngest brother. With limited access to …
Examining the rural divide in pediatric health care
“Turn on, tune in, drop out” was a rallying cry for liberation. “What a long, strange trip it’s been” is how we nostalgically narrate the aftermath. Psychedelic-assisted therapy now sits somewhere between those two cultural bookends: a rapidly professionalizing clinical enterprise and a booming, loosely regulated marketplace of “retreats” selling healing, insight, and transcendence.
The science behind psychedelics is more real than ever. So are the risks. The problem is …
Psychedelic retreat safety: What the latest science says
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