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Why does lipoprotein(a) exist?

Conditions

November 15, 2025

I just read the new Cleveland Clinic Journal of Medicine introduction by its editor-in-chief, and it’s laying out the usual playbook: demonize lipoprotein(a) (Lp(a)), list all the terrible things it does, and hint that salvation is around the corner, pending results of a major pharmaceutical trial, of course.

It’s a neat narrative arc.

But it’s incomplete.

What’s missing is the one question almost no cardiology article seems willing to ask:

Why does Lp(a) exist …

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Why does lipoprotein(a) exist?

The myth of endless availability in medicine

Emmanuel Chilengwe

Conditions

November 15, 2025

For years, I believed that the best clinicians were the ones who never stopped. We covered extra shifts, skipped meals, charted past midnight, and proudly wore exhaustion as a badge of honor. My patients were happy, my colleagues admired my work ethic, and I was quietly unraveling.

The slow slide into burnout

Burnout didn’t arrive like a crisis; it crept in as a constant background hum. I began to dread the pager’s …

China’s health care model of scale and speed

Myriam Diabangouaya, MD & Vikram Madireddy, MD

Physician

November 15, 2025

Medicine is more than biology; it is organization. Every country builds its system of care according to its culture, economy, and priorities. In Japan, where I have spent the past few years, health care feels like an extension of social rhythm: precise, deliberate, quietly humane. In the United States, where I trained, the emphasis is on innovation and specialization, but often at the cost of coordination. Now, as I prepare …

A new autism care model in Idaho

Ronald L. Lindsay, MD

Conditions

November 15, 2025

Idaho has become the first state to end Medicaid funding for Applied Behavior Analysis (ABA) therapy. This marks a shift away from concerns about inflated billing and variable outcome metrics toward a model focused on measurable and inclusive care. As a pediatrician who participated in NIMH-RUPP trials and has observed the clinical evolution of ABA, I recognize the significance of Idaho’s decision. The state acted proactively rather than awaiting federal …

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A new autism care model in Idaho

What an FFR-CT score means for your heart

Monzur Morshed, MD and Kaysan Morshed

Conditions

November 15, 2025

He came to my office holding the results of his coronary CT scan. His eyes went immediately to the numbers, his voice tense: “Doctor, my FFR is 0.86. Do I need a stent?”

This is not an unusual question anymore. Coronary CT angiography with fractional flow reserve (FFR-CT) is rapidly becoming a common tool in cardiology. It gives us noninvasive insight into whether a coronary lesion is functionally significant. In plain …

Why clinicians must lead the health care tech revolution [PODCAST]

The Podcast by KevinMD

Podcast

November 14, 2025

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

Health care executive Kimberly Smith discusses her article “Why clinicians must lead health care tech innovation.” Kimberly explains why clinicians, who are on the front lines of patient care, are in the …

Advance directives not honored: a wife’s story

Susan Hatch

Conditions

November 14, 2025

For nearly a decade, almost every time my husband, Teddy, went into the hospital, they asked if he had an advance directive. And he did: It was notarized and given to any doctor he saw and any hospital he visited, including the one he died in.

But on the last day of Teddy’s life, the interventions he received were explicitly against his wishes as documented in his advance directive: no resuscitation, …

Why billionaires dress like college students

Osmund Agbo, MD

Physician

November 14, 2025

You notice them wherever they go. The new titans of industry dressed like college kids on their way to class. Recently, I saw a picture of Jack Dorsey, the founder of Twitter, in a plain cotton T-shirt and nerdy trousers. With his overgrown beard completing the look, he resembled a man emerging from months deep in the jungle after a survivalist contest. Then there is Mark Zuckerberg, perpetually clad in …

The therapy memory recall crisis

Ronke Lawal

Conditions

November 14, 2025

During a casual conversation about mental health, a friend admitted something striking: “I stopped going to therapy because I’d leave feeling great, but by the time I actually needed what we talked about, like in the middle of an argument or a panic attack, I couldn’t remember any of it. It felt like throwing money away.”

This confession revealed a silent challenge in mental health care. The issue isn’t finding the …

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The therapy memory recall crisis

A urologist explains premature ejaculation

Martina Ambardjieva, MD

Conditions

November 14, 2025

Most men have heard jokes about finishing too soon, but few talk about it seriously, even when it causes anxiety, frustration, or distance in their relationships. Premature ejaculation (PE) is one of the most common male sexual health concerns, yet it remains buried under stigma and silence.

As a urologist, I often meet men who have struggled quietly for years, wondering whether what they experience is “normal,” if it can be …

Why medical organizations must end their silence

Marilyn Uzdavines, JD & Vijay Rajput, MD

Policy

November 14, 2025

Professional medical organizations, such as the American Medical Association (AMA), American Hospital Association (AHA), and American College of Physicians (ACP), do more than set policy. They are custodians of medicine’s ethical core, defenders of science, and guardians of public trust. Yet, at critical moments, these organizations too often fall back on a strategy of silence. That silence is not neutral. It carries real consequences.

Mixed messages, missed voices

Consider a recent example. …

The flaw in the ACA’s physician ownership ban

Luis Tumialán, MD

Policy

November 14, 2025

“The most expensive piece of medical equipment is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.” Dr. Atul Gawande, an endocrine surgeon practicing at Brigham’s Women and Children Hospital in Boston, Massachusetts, wrote those words in the June 1, 2009, edition of the New Yorker in an article entitled, “The Cost Conundrum.” In that article, Dr. Gawande compared health care expenditures …

Reclaiming physician agency in a broken system

Christie Mulholland, MD

Physician

November 14, 2025

“Health-care professionals are increasingly demoralised by pressure to prioritise their employers’ financial goals over patients’ needs and professional norms, as space for good work in a bad system narrows.” This statement from an October 2025 Lancet article spoke directly to my experience.

By all quantifiable metrics, I was successful. I’d just been promoted to associate professor in the number-one-ranked department in the country for my specialty. I had a rewarding leadership …

The hidden epidemic of orthorexia nervosa

Sally Daganzo, MD

Conditions

November 14, 2025

She had recently gone gluten-free and dairy-free to address persistent bloating and fatigue. She skipped breakfast to support her circadian rhythm, and she was careful to avoid sugar and processed foods. She was proud of her discipline, and her lab work looked fine, but over time, her meals had become more stressful than nourishing. Dining out made her anxious, and she had begun to worry about even small deviations from …

A question about maternal health and the rise in autism [PODCAST]

The Podcast by KevinMD

Podcast

November 13, 2025

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

Patient advocate and author Irene Tanzman discusses her article “A mother’s question about PCOS and her son’s autism.” Irene shares her personal journey as a mother to a son with severe autism …

Why early diagnosis of memory loss is crucial

Scott Tzorfas, MD

Conditions

November 13, 2025

Memory loss is one of the most common and anxiety-provoking complaints in medicine. Over the past five years, the evaluation of cognitive decline has become remarkably refined. No longer is memory loss assessed solely to “rule out dementia.” Today, clinicians have tools to detect the beginnings of Alzheimer’s disease or other neurodegenerative conditions before major symptoms appear, allowing patients to make informed decisions about their work, life, and health.

The first …

Why young people need to care about bone health now

Surgical Fitness Research Pod & Yoshihiro Katsuura, MD

Conditions

November 13, 2025

We all know high blood pressure and cholesterol can kill, but what about low bone mineral density? Bones are composed of calcium and phosphate, which is their mineral content. Bones low in calcium are said to have low bone mineral density, which can result in a condition known as osteoporosis. Osteoporosis develops over a lifetime and is impacted by your peak bone mass as a youth. Thus, most osteoporotic problems …

What burnout does to your executive function

Seleipiri Akobo, MD, MPH, MBA

Physician

November 13, 2025

We talk about burnout like it’s just being “tired” or “stressed.” However, it is not. It is a fundamental breakdown of the operating system: your brain. I know, because I’ve been there. I was the high-performer, the one who “got things done,” until my executive function packed its bags and left the building. If you’re feeling this way, you’re not weak; your system is simply overloaded. You have entered the …

The paradox of primary care and value-based reform

Troyen A. Brennan, MD, MPH

Policy

November 13, 2025

An excerpt from Wonderful and Broken: The Complex Reality of Primary Care in the United States.

In a health care system full of paradoxes, this is perhaps the most striking. Primary care delivering value-based care is seen by many as the solution for an inefficient, inequitable, and poorly-performing health care system. Yet it is a shocking mess of burnout and depletion. With all the radical intention of Lenin, we must …

Why physicians must lead the vetting of medical AI [PODCAST]

The Podcast by KevinMD

Podcast

November 12, 2025

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

Cardiologist Saurabh Gupta discusses his article “Physicians must lead the vetting of AI.” In this episode, Saurabh explores how artificial intelligence is reshaping medicine and why its future depends on physician leadership, …

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