I never thought much about my kidneys. I felt fine, I stayed active, and at 74 years old, I figured I was in pretty good shape. But kidney disease has a way of sneaking up on you. By the time most people find out they have it, they’re already in trouble. That could have been me—but thanks to the right care at the right time, I got a transplant before …
As an internist with a background in physics, I was taught to think in systems—to seek root causes, avoid assumptions, and apply data with precision. Early in my career, I practiced medicine exactly as I had been trained: Identify the diagnosis, follow the algorithm, apply evidence-based treatment. And in many cases, that worked.
But increasingly, I found myself caring for patients who didn’t fit cleanly into diagnostic boxes. Fatigue, brain fog, …
The day I first watched ketamine lift a human being out of despair, I was standing in a quiet room at the National Institute of Mental Health. The fluorescent lights hummed, the monitor ticked, and a young adult who had been drowning for months came up for air. Hours, not weeks. That speed rewired me as much as it rewired their brain. In the early 2000s, most of us were …
Historical, cultural, social, and political factors contribute to the disparities in reproductive health, making it a multifaceted and deeply rooted issue in the fabric of the United States. Historically, the legacy of slavery and the American eugenics movements established race-based medicine, systems, and stereotypes that continue to influence provider bias and patient mistrust, contributing to the ongoing inequities in reproductive health. Culturally, persistent stereotypes, particularly toward Black women, have led …
When I turned 50, I weighed 265 pounds. Over the next 12 years, through walking, yoga, and strength training, I lost 60 pounds and kept it off. But despite the discipline, I remained plagued by inflammation, pain, and sleep apnea.
Then last year, my doctor suggested tirzepatide (Zepbound), not just for weight loss but to treat my sleep apnea as well. That alternative diagnosis unlocked insurance coverage and led to a …
Funding from direct-to-consumer (DTC) “ask your doctor” drug ads has captured news media outlets and all but blocked important health stories like these. Read on.
1. “Hormone replacement therapy” (HRT) is back.
It is said that those who forget the past are doomed to repeat it, and nowhere is this more evident than the re-marketing of HRT to menopausal women who do not remember the first debacle (which increased the risk …
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Nephrologist Timothy Pflederer discusses his article “How value-based care transforms chronic kidney disease management,” highlighting how value-based care (VBC) is reshaping the treatment of chronic kidney disease and end-stage kidney disease. Timothy …
In medical training, there are moments when the question quietly shows up. It might be during a night shift, after a long stretch without sleep, or while catching up on charting. The thought is simple, but heavy: What if I had chosen something else? What if I had gone into engineering, or business, or any path that didn’t ask quite so much?
This reflection started as an assignment for a medical …
“Did I get dumber?” This poignant question from a medical student, asked in frustration after receiving a lower-than-expected grade, became the focus of a forty-five-minute academic coaching session. Simply put, my role as a learning specialist was to foster a mindset shift: from “my grade determines my self-worth” to “my grade reflects where I am in my learning right now and guides my next steps.” Helping the student build this …
An excerpt from The Clinical Research Handbook: A Practical Guide to Designing, Conducting and Publishing Clinical Research.
Research is a powerful force for change. Whether addressing global health care disparities, improving local community services, advancing technology, or exploring the frontiers of science, well-chosen research projects can solve practical problems and expand our understanding of the world. However, identifying the “right” question is often the hardest—and most critical—step in this journey.
This …
As a urologist, I see recurrent UTI patients nearly every day, and most cases are routine: nasty bacterial infections that appear in the bladder every few months. However, a recent patient turned out to be the zebra rather than the horse. This particularly lovely woman was 91, an Italian immigrant, and was accompanied by her adult son, who helped provide history and translate as needed. She sat calmly on the …
The ongoing opioid crisis, claiming over 70,000 lives annually in the U.S. according to the CDC’s 2023 data, presents a perplexing scenario where regulatory bodies, in their attempt to curb misuse, have inadvertently intensified challenges for health care providers and patients. The Centers for Disease Control and Prevention (CDC) issued its 2016 guideline for prescribing opioids for chronic pain, with revisions in 2022 to address misapplications, yet these efforts have …
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Attorney and wealth manager David B. Mandell discusses his article “Why physicians are unlike the ‘average’ investor,” highlighting why doctors face unique financial challenges compared to most U.S. investors. David explains the …
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As a cardiologist in New York City who treats a sizable Bangladeshi‑American community, I have witnessed otherwise healthy individuals exhibit concerning cardiovascular events, frequently in the absence of conventional risk markers. What unites them? Severe, protracted psychological stress brought on by prejudice, family court disputes, immigration problems, or financial instability.
The mechanisms of prolonged stress
Prolonged stress raises cortisol, adrenaline, and inflammatory cytokines via activating the sympathetic nervous system and hypothalamic‑pituitary‑adrenal (HPA) …
Coronary artery disease is still the world’s number-one killer.
That’s despite statins, PCSK9 inhibitors, stents, bypasses, and decades of lifestyle messaging.
We’ve gotten better at managing heart attacks, but we haven’t cured heart disease. Or prevented it. Or even figured out exactly what causes it.
As an internist and lipidologist (in recovery), I spent years chasing cholesterol numbers, especially HDL. I gave talks for Abbott. I pushed niacin like it was salvation. Then …
Today for the first time, I got flowers from a grateful patient.
And I reflect on how rough the week has been, all the things that seemed impossible and insurmountable, and everything that has brought me to this point. The patient is going on hospice, he’s going to die, yet he felt that I made a significant impact that he wanted to show his gratitude. And that almost brought me to …
American medical schools and universities once led the world in biomedical discovery, in large part due to federal funding. Public investment in science helped eradicate polio, unlock the human genome, and develop life-saving treatments for diseases once considered death sentences. But that era of reliable federal funding is ending under the current White House administration – and America’s research enterprise is at risk of going with it.
Over the past decade, …
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Physician Jessie Mahoney discusses her article “Ending burnout through structure, not gimmicks,” making the case that the most effective remedies for physician burnout are systemic changes—reasonable patient loads, thoughtful schedules, supportive leadership, …
I’ve worn many hats in my medical career—lab technician, Physician Assistant, Army Captain, and teacher. But no matter where I’ve served, one truth has followed me like a shadow: The most effective medical learning doesn’t happen in a classroom. It happens beside a patient, with blood pressure cuff in hand, chart under arm, and a mentor who knows when to step back and let you try.
The most powerful educational model …
American medicine has mastered a perverse art: paying more to achieve less.
We call it “cost-cutting,” but it is a system of engineered backwardness. We underfund clinical staff, then spend fortunes on lawyers to defend the inevitable errors. We employ armies to process bills while insurers employ armies to deny them. We treat the eyes, the teeth, and the mind as optional accessories, as if they could be unbolted from the …
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