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Conditions and diseases

Why MOG antibody disease is more than antibodies

MOG antibody-associated disease is typically understood as an autoimmune disorder in which antibodies target myelin oligodendrocyte glycoprotein, producing demyelination and relapsing neurological symptoms. This antibody-centered model has been clinically useful, but it may be incomplete in explaining why disease expression…

MOG antibody-associated disease is typically understood as an autoimmune disorder in which antibodies target myelin oligodendrocyte glycoprotein, producing demyelination and relapsing neurological symptoms. This antibody-centered model has been clinically useful, but it may be incomplete in explaining why disease expression varies so widely between individuals, why some patients recover remarkably well between attacks, and why similar immunologic profiles can lead to very different trajectories over time. In my independent conceptual …

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Why MOG antibody disease is more than antibodies

Conditions and diseases

The autism guideline that ignored its own evidence

Professional organizations rarely contradict themselves in public. When they do, the contradiction is usually buried in procedural language, masked by committee structure, or softened by the slow drift of policy. But occasionally, the inconsistency becomes visible in plain sight, not…

Professional organizations rarely contradict themselves in public. When they do, the contradiction is usually buried in procedural language, masked by committee structure, or softened by the slow drift of policy. But occasionally, the inconsistency becomes visible in plain sight, not because someone exposed it, but because two arms of the same organization published incompatible statements without noticing. That is what happened when the American Academy of Pediatrics (AAP) reaffirmed its …

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The autism guideline that ignored its own evidence

Conditions and diseases

Exercise after rehabilitation is not an optional extra

The day after a man completed a physical fitness assessment for people with disabilities, he came back. He did not return because we had forgotten a test. He was not asking for another consultation. He did not need a prescription.…

The day after a man completed a physical fitness assessment for people with disabilities, he came back. He did not return because we had forgotten a test. He was not asking for another consultation. He did not need a prescription. He came back carrying a box of pineapple cakes.

In Taiwan, that gesture means more than bringing dessert. The Taiwanese pronunciation of pineapple is associated with wang-lai, a phrase that sounds …

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Exercise after rehabilitation is not an optional extra

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Drugs and prescribing

Prescription drug suicide risk is still being hidden

What if you were an MD/researcher at a top 10 medical school who came face-to-face with a lethal side effect to a popular drug? But, when you tried to reveal it, you were engulfed by a legal and professional character…

What if you were an MD/researcher at a top 10 medical school who came face-to-face with a lethal side effect to a popular drug? But, when you tried to reveal it, you were engulfed by a legal and professional character assassination campaign that included threats against your academic position and journal publishing history, physical surveillance by private investigators, and even a home break-in?

That is the basic plot of the newly …

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Prescription drug suicide risk is still being hidden

Physician finance

Why physician burnout is really a money problem

The math I'd never done A few years ago I took a hard fall on our annual family ski trip and landed on my wrist. It wasn't broken. It wasn't even a bad injury by any medical standard, just a…

The math I’d never done

A few years ago I took a hard fall on our annual family ski trip and landed on my wrist. It wasn’t broken. It wasn’t even a bad injury by any medical standard, just a sprain. But sitting there holding my arm and waiting for the throbbing to settle, a single thought pushed everything else out of my head.

I’m a periodontist. I treat patients with my …

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Why physician burnout is really a money problem

Physician voices

Hospital accountability: Who owns the whole problem?

An essay by Eric Goldfarb, an information technology executive and patient advocate, opens with a story that feels almost too absurd to be true. I have written nine books of medical satire and thought I had seen it all, yet…

An essay by Eric Goldfarb, an information technology executive and patient advocate, opens with a story that feels almost too absurd to be true. I have written nine books of medical satire and thought I had seen it all, yet his experience shows that parts of our system still defy belief.

After Goldfarb’s eighty-eight-year-old father died, Goldfarb reviewed the hospital bill and noticed a charge for a pregnancy test. …

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Hospital accountability: Who owns the whole problem?

Physician voices

Frivolous malpractice lawsuits: Doctors can fight back

Medical malpractice litigation in the United States is the endless struggle to find meaning. Lawyers, plaintiff and defense attorneys alike, reject the notion that they are involved in a frivolous medical malpractice lawsuit. To protect themselves from this notion, they…

Medical malpractice litigation in the United States is the endless struggle to find meaning.

Lawyers, plaintiff and defense attorneys alike, reject the notion that they are involved in a frivolous medical malpractice lawsuit. To protect themselves from this notion, they use semantics. There are four words: legitimate, meritorious, frivolous, and malicious.

Legitimate is whimsical. It is in the eyes of the beholder. According to lawyers, all claims are legitimate.

Legitimate is conflated with …

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Frivolous malpractice lawsuits: Doctors can fight back

Health policy

Fentanyl interdiction will not end the overdose crisis

Overdose deaths are falling in the United States, a sign of genuine progress. But President Trump's claim that his administration has nearly stopped drugs from entering the country by sea confuses an interdiction statistic with an overdose-prevention strategy. Trump has…

Overdose deaths are falling in the United States, a sign of genuine progress. But President Trump’s claim that his administration has nearly stopped drugs from entering the country by sea confuses an interdiction statistic with an overdose-prevention strategy.

Trump has repeatedly asserted that his administration reduced maritime drug arrivals by 97 percent or more. That figure, however, merely compares drug seizures across two selected months. Because seizures measure what …

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Fentanyl interdiction will not end the overdose crisis

Physician voices

Why medicine needs both high-tech and high-touch care

The path to a career in medicine often begins with a singular, heroic narrative: the promise to work hard and save lives. This is a noble ambition, and the surgeons and specialists who master complex procedures are essential to our…

The path to a career in medicine often begins with a singular, heroic narrative: the promise to work hard and save lives. This is a noble ambition, and the surgeons and specialists who master complex procedures are essential to our craft. But as one spends decades in clinical practice, the reality of medicine shifts. We realize that the most profound work we do often has little to do with acute …

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Why medicine needs both high-tech and high-touch care

The Podcast by KevinMD

Doctors are now the second opinion, AI is the first [PODCAST]

Your patients are asking ChatGPT what's wrong with them before they call your office, and getting an answer in seconds. In this episode, Tod Stillson, a board-certified family physician, medical device inventor, and health care entrepreneur, explains how AI chatbots…

Listen on Spotify · Apple Podcasts

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Your patients are asking ChatGPT what’s wrong with them before they call your office, and getting an answer in seconds. In this episode, Tod Stillson, a board-certified family physician, medical device inventor, and health care entrepreneur, explains how AI chatbots became the new waiting room, and what that means for the doctor who used to be the first call. You …

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Doctors are now the second opinion, AI is the first [PODCAST]

Physician voices

Who owns administrative harm no single decision caused?

Health care organizations make difficult decisions every day. Compliance introduces a new requirement because regulation demands it. Quality establishes another process because patient safety demands it. Finance adjusts staffing because margins demand it. Operations changes workflow because access demands it.…

Health care organizations make difficult decisions every day. Compliance introduces a new requirement because regulation demands it. Quality establishes another process because patient safety demands it. Finance adjusts staffing because margins demand it. Operations changes workflow because access demands it. Information technology implements a new platform because efficiency demands it. Leadership introduces artificial intelligence because transformation demands it.

Individually, each decision may be reasonable. Collectively, they may create an operating environment …

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Who owns administrative harm no single decision caused?

Conditions and diseases

Health care affordability starts with healthier patients

In Western medical training and clinical practice, one of the first questions a clinician traditionally asks is: "What is your chief complaint?" The patient tells a story. The clinician listens, asks questions, performs an examination, develops a differential diagnosis, and…

In Western medical training and clinical practice, one of the first questions a clinician traditionally asks is: “What is your chief complaint?” The patient tells a story. The clinician listens, asks questions, performs an examination, develops a differential diagnosis, and recommends appropriate treatment.

But what if our current health care delivery model itself were the patient? Its chief complaint might sound something like this: “Doctor, I am becoming unaffordable.” And then, …

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Health care affordability starts with healthier patients

Physician voices

A Muslim American physician on what an MD cannot shield

As a physician, for the longest time, I thought my MD title, this profession, would be a shield in a world full of so many challenges. I was and am wrong. Growing up as an immigrant in the United States,…

As a physician, for the longest time, I thought my MD title, this profession, would be a shield in a world full of so many challenges. I was and am wrong.

Growing up as an immigrant in the United States, I became more acutely aware of my differences after September 2001. Due to my background, skin tone, complexion, name, religion, everything about me stood out. During this formative period, I …

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A Muslim American physician on what an MD cannot shield

Physician voices

Physician credentialing delays should carry a consequence

Physicians are taught to accommodate. A clinic runs behind. We stay late. A colleague calls out. We cover. Credentialing takes longer than expected. We send another document. An administrator needs another week. We wait. Much of this is appropriate. Health…

Physicians are taught to accommodate. A clinic runs behind. We stay late. A colleague calls out. We cover. Credentialing takes longer than expected. We send another document. An administrator needs another week. We wait.

Much of this is appropriate. Health care is complicated, and functioning organizations depend on people extending one another reasonable grace. But there is a point at which accommodation stops being professionalism and starts becoming an incentive.

I was …

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Physician credentialing delays should carry a consequence

Drugs and prescribing

3 realms every drug development leader must bridge

Pharmaceutical research and development (R&D) has never lacked scientific ambition. The more challenging issue is transforming good science into programs that operate efficiently, address the right questions, and ultimately enhance patient care. This necessitates a different type of R&D leader.…

Pharmaceutical research and development (R&D) has never lacked scientific ambition. The more challenging issue is transforming good science into programs that operate efficiently, address the right questions, and ultimately enhance patient care. This necessitates a different type of R&D leader.

Traditional research leadership often emphasizes depth in a scientific discipline. While that expertise is crucial, modern drug development is no longer a series of isolated scientific tasks; it is a …

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3 realms every drug development leader must bridge

Health policy

Why pediatric practice succession models are changing

The historical model of local pediatric practice was straightforward: A physician built a practice, cared for generations of families, and eventually passed ownership to younger physicians as retirement approached. That model sustained local pediatrics for decades. Today, however, the foundation…

The historical model of local pediatric practice was straightforward: A physician built a practice, cared for generations of families, and eventually passed ownership to younger physicians as retirement approached. That model sustained local pediatrics for decades. Today, however, the foundation that supported it has shifted. For many practices, the traditional path to succession is no longer viable, forcing physicians to consider new ways to preserve the practices they’ve spent their …

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Why pediatric practice succession models are changing

Conditions and diseases

A second opinion abroad should clarify, not just differ

The messages usually arrive with the same tension: "My doctor recommends surgery. A hospital overseas says it may have another option. Which answer should I trust?" Patients who contact us for second opinions abroad are rarely looking for a medical…

The messages usually arrive with the same tension: “My doctor recommends surgery. A hospital overseas says it may have another option. Which answer should I trust?”

Patients who contact us for second opinions abroad are rarely looking for a medical argument to win. Most are trying to make a difficult decision without regretting it later. They want to know whether the diagnosis is complete, whether the proposed treatment is necessary, and …

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A second opinion abroad should clarify, not just differ

Physician voices

What my dog taught me about physician well-being

I have a confession. For years, I thought my dog was being difficult. She won't eat unless I'm nearby. Not in the same house. Nearby. She'll wait while I answer emails, put away groceries, or finish one more task. If…

I have a confession.

For years, I thought my dog was being difficult. She won’t eat unless I’m nearby. Not in the same house. Nearby.

She’ll wait while I answer emails, put away groceries, or finish one more task. If I’m moving from room to room, she watches me instead of eating. Only when I finally stop does she lower her head to her bowl.

I’ve joked that she’s stubborn. Lately, I’ve started …

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What my dog taught me about physician well-being

Drugs and prescribing

BPC-157 is promising but unproven, a surgeon warns

Decades in the operating room have taught me that the brain is akin to a spiderweb: fragile, interconnected pathways. When trauma or disease hits neural tissue, our toughest battle is protecting blood flow, controlling swelling, and keeping cells alive under…

Decades in the operating room have taught me that the brain is akin to a spiderweb: fragile, interconnected pathways. When trauma or disease hits neural tissue, our toughest battle is protecting blood flow, controlling swelling, and keeping cells alive under extreme stress. That’s probably why researchers are captivated by BPC-157, or Body Protection Compound 157.

This synthetic 15-amino-acid peptide mimics a tough protective protein found naturally in human gastric juice. Unlike …

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BPC-157 is promising but unproven, a surgeon warns

The Podcast by KevinMD

When patients ask for a knee surgery brand they don’t understand [PODCAST]

A patient asked for her knee surgery by its brand name. She used the term perfectly. She just had no idea what it actually meant. Orthopedic surgeon Cory Calendine, who does nearly 700 to 800 hip and knee replacements a…

Listen on Spotify · Apple Podcasts

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

A patient asked for her knee surgery by its brand name. She used the term perfectly. She just had no idea what it actually meant. Orthopedic surgeon Cory Calendine, who does nearly 700 to 800 hip and knee replacements a year, returns to unpack how marketing is quietly reshaping what patients ask for in the exam room. This episode is …

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When patients ask for a knee surgery brand they don’t understand [PODCAST]

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