We all know the look of a patient about to crash. The monitor has not flatlined yet, but the story is already in the vitals: The pulse is racing, the pressure is dropping, the skin is clammy.
That is the U.S. economy right now. Debt overload looks like a chronic hemorrhage. High interest rates are a sustained hypertensive crisis. Political paralysis is the family arguing in the hallway while the patient …
Treating the economy like a crashing patient
I see it every week in my practice: Patients obsessed with their cholesterol numbers. LDL, HDL, triglycerides, the full alphabet soup. They have been trained to believe these numbers hold the keys to life and death.
But here is something I cannot stop thinking about: When you look under the microscope, an atherosclerotic plaque (the thing that clogs arteries and leads to heart attacks) looks an awful lot like a tuberculosis …
Why we may be fighting the wrong enemy in heart disease
I am an internist and, once upon a time, a card-carrying lipidologist. I have spent years watching medicine’s “standards of care” quietly stretch like elastic waistbands. What begins as a targeted therapy for a small group of high-risk patients slowly expands until everyone and their grandmother is expected to be on it. That phenomenon has a name: guideline creep.
How it works
The cycle is simple:
What is guideline creep in medicine?
As physicians, we are trained to prescribe, to fix, to optimize. Our patients expect it, and frankly, so do we. I built a career around lipid panels, trial data, and prescriptions meant to shave percentage points off cardiovascular risk. But lately, I find myself offering something far less high-tech and far more radical: a walk.
Walking is slow. Impractical. Rarely the efficient choice. Which is exactly why it matters.
Everywhere around us, …
Your nervous system does not need another hack. It needs a walk.
As a practicing internist and lipidologist, I have long been trained to believe in the cholesterol hypothesis. Statins were not just recommended; they were the gospel. Lower LDL, save lives. That mantra was repeated at every lecture, every conference, every guideline committee.
But like many dogmas in medicine, the cracks are there if you dare to look. And some of the most damning cracks are found in a set of randomized …
The ignored clinical trials on statins and mortality
In my practice, I care for many patients obsessed with longevity. They fast, they microdose, they meditate, they cold plunge, they gulp down supplements by the handful. They optimize their labs with the fervor of a hedge fund manager optimizing a portfolio. They read Peter Attia and Andrew Huberman like scripture.
And yet, they still die.
This is not cynicism; it is reality. Over the years, I have watched patients do everything …
The myth of biohacking your way past death
As a physician, I spend most of my days telling patients to walk more, eat better, stress less, and maybe, just maybe, go to bed before midnight. So when I came across a piece on ancient Roman and Greek health habits, I had to laugh. Turns out, they were doing a lot of things right — without fitness trackers, $12 smoothies, or a trillion-dollar wellness industry.
We like to think of …
Ancient health secrets for modern life
A new gene-editing therapy just dropped LDL cholesterol by 69 percent — with a single injection. One shot, permanent effect. Cue the headlines: “Game-changer!” “End of statins!” “Revolution in heart disease!”
Here we go again.
Let’s be clear: I’m not anti-innovation. I’m not against gene therapy. I’m against making the same mistake again and again, just with better marketing and shinier tools.
VERVE-102 is the latest miracle-in-a-vial — a CRISPR base-editing therapy that …
One injection dropped LDL by 69 percent. Should we celebrate?
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 …
Could antibiotics beat heart disease where statins failed?
For decades, you were told that whole milk was the devil in a glass. Doctors (including me), dietitians, and public health agencies told you to toss the red cap and grab the blue — skim, 1 percent, or 2 percent milk. Why? Because whole milk had fat. And fat, particularly saturated fat, was supposed to clog your arteries like grease in a kitchen drain.
Except we were wrong.
The fat in whole …
The truth about fat in whole milk and your health
In the late 1970s, a Japanese biochemist named Akira Endo discovered a compound from fungus that inhibited HMG-CoA reductase, the enzyme responsible for making cholesterol. It was an academic curiosity at the time. No one knew if lowering cholesterol would prevent heart attacks—it just lowered a number on a lab slip.
That compound eventually became lovastatin, and in 1987, Merck brought it to market with no proof of improved outcomes—only a …
Are we repeating the statin playbook with lipoprotein(a)?
We’ve medicalized nearly everything in life—birth, aging, sleep, even boredom. Now, in the spirit of efficiency, we’ve begun medicalizing death itself.
In his unsettling essay “The European way to die,” French novelist Michel Houellebecq warns that the normalization of euthanasia and assisted suicide is not a sign of progress but of profound cultural decay. I didn’t expect to find myself agreeing with him.
As a physician for over three decades, I’ve …
Why medicalizing death could strip it of meaning
The end of my belief came on a fall night in 2011. I was driving to a suburban restaurant to give a paid dinner talk on Niaspan for Abbott Labs. It was a typical night for a physician speaker—slide deck polished, HDL-cholesterol optimism intact. Then the results of the AIM-HIGH trial came over public radio. Niacin, when added to a statin, had no cardiovascular benefit. My world cracked. I never …
Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years
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