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Medical student Umayr R. Shaikh discusses his article “The impact of CDC’s new childhood immunization guidance.” Umayr argues that recent CDC changes, moving vaccines like flu, Hep B, and meningococcal from universal …
Shift from universal to optional vaccination risks normalizing preventable disease [PODCAST]
Physicians are often described as leaders of the health care team. The language shifts, quarterback, captain, final decision-maker, but the implication is constant: someone is clearly in charge. At the bedside, the reality feels more complicated.
In every functioning system, there is a final point of responsibility, the person who answers when outcomes are poor. In medicine, that person remains the physician. We sign the charts. We carry the malpractice risk. …
Why physicians are absorbing risk, not leading
In our modern professional landscape, we are witnessing a phenomenon I call the Schism of Time. It is not just a gap in age; it is a fundamental difference in how we perceive value, and “spend” the hours of our lives.
As technology accelerates, the cadence of our work shifts. We see a friction between the “Deep Time” often championed by seasoned leaders, rooted in legacy, patience, and incremental growth, and …
The Schism of Time: Bridging the generational gap in the workplace
There are moments in life when everything you imagined for yourself fits inside a single envelope. This week, every fourth-year medical student in the United States will open the same one at the same moment. Some people scream. Some people cry. And a few people quietly realize their life just went somewhere they never planned to go. Match Day is the moment medical students learn where their futures begin. Last …
What Match Day teaches us about unexpected life paths
“Try not to work the night shift if you can.” Many physicians have said this to patients. Some have said it to colleagues. Often, we say it because we understand the science: Working through the night comes at a physiologic cost. Night-shift work is associated with weight gain, chronic fatigue, disrupted sleep, insulin resistance, and increased long-term risk of obesity, type 2 diabetes, hypertension, and cardiovascular disease. Circadian disruption affects …
The biological cost of night-shift work on circadian rhythms
As a pain physician with over 20 years of experience treating patients with chronic pain, I hear the same plea almost every day: “Doctor, it hurts, please help.”
As an author and patient advocate, I wanted to verbalize the daily reality of chronic pain.
Chronic pain affects an estimated 24.3 percent of U.S. adults (approximately 60 million people) as of 2023, with 8.5 percent (about 21 million) experiencing high-impact chronic pain that …
Chronic pain management: Balancing relief and regulation
I walked through a beautiful hallway the other day, the kind hospitals and clinics seem to favor now, polished floors, warm lighting, and old oak paneling on the walls. It looked less like a medical building and more like the lobby of a boutique hotel. At the end of the hallway sat a receptionist who was having a bad day. Or maybe she was just doing her job. She glanced …
Why modern medicine feels more like a bureaucracy than a profession
When artificial intelligence systems talk to us, we tend to focus on what they can do for patients, clinicians, and the health care system. But what happens when they start talking to each other about us?
Earlier this year, a new platform called Moltbook, essentially Reddit for AI agents, launched with hundreds of thousands of autonomous “moltbots” posting (on any topic), debating, and upvoting without any human participation. The platform has …
AI agents in health care: What they say when we aren’t listening
At the end of September 2025, a gene therapy company released results from a clinical trial showing that a breakthrough procedure reduced the progression of Huntington’s symptoms by 75 percent over three years. Researchers collected data from 12 participants who received the therapy and compared the data with two types of control groups.
The company’s drug, AMT-130, shows unprecedented outcomes, so why is the FDA slowing …
Huntington’s disease gene therapy: FDA reversal delays AMT-130
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Retired emergency department nurse Amy Dinaburg discusses her article “Lowercase PTSD: Why emergency staff are still hypervigilant.” Amy reflects on the relentless pressure of the COVID-19 pandemic where nurses were forced to …
Emergency nurses struggle to turn off survival mode after the pandemic [PODCAST]
In the hallowed halls of medical school, we are often screened for traits that make the “ideal doctor”: high empathy, meticulous perfectionism, and a profound sense of duty. We are the fixers, the ones who find deep meaning in the intersubjective space between healer and patient. Yet, there is a shadow side to this personality architecture that no one talks about, an underlying proclivity toward rejection sensitivity.
The very traits that …
Why perfectionism in medicine leads to moral injury
“Let’s Fly.” Captain Burnham’s words on the USS Discovery were more than a command. They were a declaration of trust, of forward motion, of refusing paralysis.
That is the question before us now: What happens when children with disabilities grow up?
For decades, pediatrics treated disability as a childhood condition. The grant language, the fellowship training, the systems of care, all built on the assumption that disability ends at eighteen. But children …
Adult disability care transition: Why medicine must grow up
For decades physicians have dreamed of a simple technological solution to one of modern medicine’s most corrosive burdens: documentation. The electronic health record promised efficiency but delivered something quite different: extra burden. Physicians now spend hours each evening completing notes, clicking boxes, and reconciling fields, what has become known as “pajama time.” The keyboard has often replaced eye contact. The screen has displaced the patient. Ambient AI scribes arrived with …
The hidden risks and rewards of AI scribes in medicine
For years we have searched for the causes of aging inside the cell. Researchers study mitochondrial dysfunction, DNA damage, and the accumulation of senescent cells. But the real bottleneck in aging may not lie inside the cell at all. It may lie in the system that keeps those cells alive. During my years working in emergency medicine, I often saw patients whose blocked coronary arteries had been successfully opened during …
How the microvasculature drives the human aging process
Anyone that has suffered a herniated disc knows that the road to recovery can feel like a spiritual journey. The searing pain can be so extreme that it leads us to prayer. We may even question the very design of the human body. Why would an all-powerful, wholly good Creator of the Universe endow man with the capacity to experience so much agony? To fear the electric jolt caused by …
Herniated disc recovery: a physician’s personal journey
In medical school, we only learn a fraction of what we need to know to succeed as doctors. The rest, we learn serendipitously through role modeling, trial and error, and other venues. Without luck, however, we may not learn these factors at all. It turns out that unspoken forces, the so-called “hidden curriculum,” may have a greater impact on our personal and professional outcomes than most people realize. As educators …
The hidden curriculum: What medical school does not teach you
Since 2023, while volunteering at an amputee sports competition in Los Angeles, I encountered athletes whose amputations resulted from complications of diabetes. In many cases, limb loss did not begin with a catastrophic injury, but with gaps in preventive care that allowed small, manageable wounds to progress into irreversible outcomes.
Participants traveled long distances to attend the competition, seeking peer support and health information that was often unavailable in their home …
Diabetic foot complications prevention: Stopping amputation before it starts
As a nutritional scientist and educator, I spend a lot of time thinking about the heart through a lens of physiology, metabolism, and medicine. I aim to reduce risk for cardiovascular disease by sharing evidence-based nutritional strategies. As a human, I realize an equally dangerous health risk can begin in one’s emotional heart. We are hardwired for connection. In this regard, the heart seems simultaneously the strongest and most fragile …
The physiology of heartbreak: hormones, ischemia, and healing
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Internal medicine and functional medicine physician Shiv K. Goel discusses his article “Agentic AI in medicine: the danger of automating the doctor.” Shiv analyzes the new ARPA-H “ADVOCATE” program which aims to …
Autonomous AI agents could strip the soul from medicine [PODCAST]
Modern health care works tirelessly to treat illness and save lives, yet it often intervenes after disease has already taken hold. The system prioritizes acute treatment over prevention, despite overwhelming evidence that early intervention and public health strategies save more lives, earlier, and at far lower cost. While dramatic rescues capture attention, the quieter work that could prevent disease is often underappreciated, leaving patients and communities to face preventable health …
The hidden cost of ignoring public health infrastructure
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