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The synthetic opioid market: Why cartel arrests do not stop the crisis

Conditions

March 28, 2026

Recently, I started a patient on high-dose buprenorphine because he could no longer get to his methadone clinic. He lost his leg this year to xylazine-associated wounds. The amputation was not the result of a single dramatic overdose, but of months of progressive tissue necrosis from repeated exposure to fentanyl adulterated with “tranq.” The infection spread. The vascular compromise worsened. Eventually there was nothing left to salvage. He now moves …

Bayesian reasoning in health care: When to refuse medical tests

Martin Bello, PhD

Tech

March 28, 2026

I was diagnosed with benign paroxysmal positional vertigo (BPPV). The diagnosis was not surprising. I had experienced several brief but intense episodes of vertigo, sudden, disorienting sensations that made it difficult to remain upright.

During one episode, I slumped against a bookcase. I did not lose consciousness, but the event was concerning enough that my physician suggested enhanced head and neck MRIs to rule out vascular causes. I have no fear …

The truth about opioid analgesics and nonsteroidal anti-inflammatory drugs

Pat Irving, RN & Richard A. Lawhern, PhD

Conditions

March 28, 2026

We live in a nation of needless pain! According to CDC data from 2021, over 50 million Americans (21 percent of adults) experienced chronic pain that persisted for more than three months. Among these, approximately 17 to 21 million U.S. adults currently experience persistent, high-impact pain on most days: pain that severely limits daily life or work activities.

Increasing numbers of these patients are being denied pain relief …

How high taxes and the California Medical Board fuel the physician shortage

Kayvan Haddadan, MD

Physician

March 28, 2026

Picture this. You finish another long day caring for patients who need you. You head home exhausted but fulfilled. Then the worry creeps in. Will another complaint land on your desk tomorrow? Will your take-home pay cover the mortgage in this state? You love California. You trained here. You built your life here. Yet more and more of us are scanning job postings in Texas, Florida, or Arizona, not because …

Occupational therapy in addiction recovery: Making daily life livable

Irving Gold

Conditions

March 28, 2026

Jonathan first met the health system on the floor of an emergency room.

He had drunk himself into a crisis, and the team did what they are trained to do: stabilize, monitor, and discharge. He got a lecture. He got a referral. He was given an AA meeting list. Then he got on with the long business of suffering.

For years, Jonathan bounced between moments of crisis and well-intentioned medical appointments that …

Why physician burnout is actually a loss of professional identity

Timothy Lesaca, MD

Physician

March 28, 2026

Most accounts of physician burnout begin with a familiar list: too many hours, too many clicks, too many patients, and not enough time. The diagnosis follows easily. Doctors are exhausted. Something inside them has been used up. Burned out. That explanation has the advantage of being familiar. It also has the potential to be incomplete. There is another way to understand what is happening, one that comes from an unlikely …

The Silent Variance: How patient friction destroys health care revenue

Donna Harvin‑Graham, MBA

Conditions

March 28, 2026

As health systems move into the 2026 fiscal year, CFOs and hospital boards have already approved their operating budgets. Capital is set aside for oncology expansions, MRI upgrades, and EHR enhancements. Revenue projections are built on patient volume, reimbursement assumptions, and clinical trial enrollment targets.

On paper, the math works. The P&L looks stable.

After more than 20 years in enterprise operations and financial systems, I know budgets fail long before the …

Statin safety and efficacy: What recent studies reveal

Cliff Dominy, PhD

Meds

March 28, 2026

Are you concerned about statins? In the past two weeks, cold hard statistics have cut through the fog of misinformation surrounding these best-selling drugs, focusing instead on the safety and efficacy of lowering your blood cholesterol level. No emotions or bias, just numbers. Welcome information for anyone who has enjoyed numerous trips around the sun and is looking forward to many more.

Middle age, that point in life when your invincibility …

Why physicians must reclaim their right to pause [PODCAST]

The Podcast by KevinMD

Podcast

March 27, 2026

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

Integrative pediatrician Mary Wilde discusses the article “The pause medicine never taught us to take.” Mary discusses how medical training conditions clinicians to fear rest and prioritize a treadmill of servitude over …

Night shift weight loss: a practical fasting guide for physicians

Aaron Grubner, MD

Physician

March 27, 2026

Working the night shift is brutal. Circadian rhythms are disrupted, backup help in true emergencies is limited, and even simple things like labs or imaging can take far longer than they should. But one of the biggest challenges is late-night snacking.

There is something about the combination of darkness, fatigue, and intermittent slow periods that makes it ridiculously easy to inhale a two-pound bag of potato chips without thinking twice. Research …

Why MRI classification systems improve spinal stenosis care

Francisco M. Torres, MD & Purab Patel

Conditions

March 27, 2026

The saying, “treat the patient, not the X-ray,” captures a core challenge we face in spine practice: Clinical symptoms and imaging findings often do not align, making it crucial to approach imaging with a structured framework. This lesson was evident when we treated two patients with strikingly different presentations. The first was a 35-year-old woman whose MRI report identified severe scoliosis and spinal stenosis. Yet, she was totally asymptomatic, with …

The death of medical swagger: How physician status has changed

Paul Dranichnikov, MD, PhD

Physician

March 27, 2026

Fifty years ago, being a doctor was like being a cross between a wizard and a rock star. People would whisper in awe when you walked by: “There goes Dr. High-and-Mighty, saving lives and curing everything from a runny nose to a broken heart!” My dad used to tell me stories about how he would get waved past security, cut to the front of lines, score doctor discounts, and park …

Atypical Parkinson disorders vs. Parkinson disease: key differences

Jerome Lisk, MD, MBA

Conditions

March 27, 2026

The terms parkinsonism, Parkinson disorder, and Parkinson syndrome are all synonymous and can be used interchangeably depending on which you prefer. All of these terms refer to the symptoms. To be diagnosed with a Parkinson disorder, you must exhibit two out of three of the following motor symptoms:

unilateral resting tremor
slowness of movement (bradykinesia)
muscle rigidity or stiffness (cogwheel rigidity)

This is with or without postural instability, which usually refers …

Why clinical medicine is harder than flying a plane

Olumuyiwa Bamgbade, MD

Physician

March 27, 2026

People often say doctors should perform like flight or rescue teams. The comparison sounds flattering. It is also incomplete. Pilots, ship captains, firefighters, coastguards, and rescue teams all work in high-stakes environments. They train hard. They lead under pressure. They make critical decisions with lives at risk. Medicine shares that gravity. But the real-world challenge of clinical medicine is often more complex, less controlled, and more exposed to uncertainties than …

What is often overlooked about male factor infertility

Erica Bove, MD

Conditions

March 27, 2026

As a reproductive endocrinologist, I spend a great deal of time trying to answer a deceptively simple question: Why is not this couple getting pregnant? Male factor infertility contributes to at least 40 percent of cases, and most reproductive endocrinologists recognize the importance of evaluating both partners early. In practice, however, the path to that evaluation is not always straightforward. In heterosexual relationships, patients may understandably focus first on the …

Preventing diabetic lower limb amputation with AI and offloading

Adwait Chafale

Policy

March 27, 2026

Globally, about $1 trillion has been spent on diabetes-related treatment, a 338 percent increase over the last 17 years, according to the International Diabetes Federation. And yet, 3.4 million deaths were related to diabetes in 2024. This shows the massive strain diabetes has placed on health systems worldwide. One of the most common and debilitating complications of diabetes is non-traumatic lower limb amputation. Diabetes …

The hidden health crisis of teenage online gambling

Kayvan Haddadan, MD

Conditions

March 27, 2026

As a physician who treats people with chronic pain, stress-related illnesses, and the lasting physical effects of emotional trauma, I have begun seeing a deeply troubling pattern in my exam room. Parents arrive exhausted, anxious, and physically unwell. Their symptoms rarely come from one obvious injury or disease. Instead, they stem from an ongoing emotional battle taking place right inside their own homes: their teenager’s struggle with online gambling addiction. …

The serpent and the staff: the ancient origins of the medical symbol

Neal Taub, MD

Physician

March 27, 2026

Every physician recognizes the serpent and the staff. It appears on hospital logos, medical schools, and ambulance doors, so familiar that few of us stop to ask what it actually means.

Many assume the symbol of medicine is the caduceus: two snakes, wings, and a staff. It is not. That emblem belonged to Hermes, the Greek god of commerce, negotiation, and speed. Its twin serpents represent exchange and trade, apt for …

Caregiver end-of-life decisions: Moving beyond advance directives

Kevin Haselhorst, MD

Physician

March 27, 2026

Advance directives pale in comparison to the real-time medical decisions caregivers make every day, whether to encourage medication, contact a specialist, call 911, or continue treatment for a loved one. National Healthcare Decisions Day (NHDD), observed each year on April 16, encourages individuals to complete an advance directive. But when the true day of reckoning arrives, when death seems imminent, disfigurement is likely, or mental capacity is lost, this document …

Why hormonal shifts make traditional dieting ineffective for midlife women [PODCAST]

The Podcast by KevinMD

Podcast

March 26, 2026

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

Metabolic health educator Marsha Shepherd Whitt discusses the article “Why ‘eat less, move more’ fails for midlife weight loss.” Marsha explains that weight loss struggles in midlife are often driven by physiology …

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