“Prediabetes is the most prominent risk factor of T2D [type 2 diabetes] with a yearly progression rate of 5–10% and a lifetime progression risk of 74%, and an independent risk factor for vascular diseases, cancer and neurodegenerative diseases. [..] Weight-loss-induced prediabetes remission (>5% of initial body weight) was explained by improved insulin sensitivity and reduced visceral adipose tissue (VAT) volume. At long-term follow-up, participants reaching weight-loss-induced prediabetes remission had a 73% reduced risk of developing T2D compared to those who only met the weight loss goal (but not prediabetes remission) and also had reduced signs of kidney and small vessel … Read More
All posts by Anupam
The commission argues our current global food production, distribution and consumption patterns are driving environmental damage, worsening our health and undermining some human rights. When examined across nine planetary boundaries, our food system probably violates six of them: Here are some suggested food distributions that would be consistent with the planetary health diet assuming an energy intake of 2400 kilocalories (kcal)/day: Food group Flexitarian food intake (grams per day) Vegan food intake (grams per day) GrainsA 196 196 RootsB 50 50 VegetablesC 300 500 Fruits 200 300 LegumesD 75 100 Nuts and seeds 50 50 OilsE 46 54 Sugar 30 … Read More
“Although physicians excel at mapping disease spatially (eg, locating tumors, charting lesions, pursuing biomarkers), patients organize their lives around temporal uncertainty. This pattern extends across episodic conditions. Patients often find that uncertainty between episodes causes more distress than the acute symptoms. They organize their lives around the possibility of recurrence, not the reality of crisis. Chronic episodic disorders do not fit easily into static disease models. Yet clinical coding captures diagnoses, not trajectories. Quality metrics reward event suppression, not functional recovery. A routine office visit might document recent symptoms but overlook emerging vulnerability. In many such conditions, success has been … Read More
“Public health is an organized effort to protect and improve the health of populations through education, policy, and preventive programs (Table). Within public health, the concept of primordial prevention is well-defined as population-level efforts to prevent risk factors for incident or worsening disease, such as water sanitation systems. Primordial care is the individual-level equivalent: a person’s efforts to prevent the onset or worsening of sickness for himself or herself. This cognitive framing is a crucial distinction; individuals engaging in primordial care do not necessarily see themselves as sick or requiring treatment that would compel entry into the medical system. Individuals … Read More
“Whereas PBMs [pharmacy benefit managers] act as intermediaries negotiating reimbursements with manufacturers and pharmacies, wholesalers operate on the acquisition side, purchasing pharmaceuticals from manufacturers and selling and distributing them to pharmacies, hospitals, and medical practices. Wholesalers compete to distribute drugs to pharmacies and medical practices — at least under the traditional business model, in which independent practices have an incentive to shop for lower-priced drugs. This market has become increasingly concentrated and transformed by vertical integration. Just three wholesalers — McKesson, Cardinal Health, and Cencora (formerly known as AmerisourceBergen) — control 98% of the wholesaler market. McKesson, the largest of … Read More
“In this Viewpoint, we question traditional approaches to teaching clinical reasoning that focus primarily on illness scripts and pattern recognition. We argue that, while pattern recognition comes naturally to humans, it is susceptible to cognitive biases that lead to diagnostic errors. Instead of emphasizing illness scripts, educators should aim to enhance diagnostic acumen by teaching learners to engage in critical thinking—in other words, reasoning from foundational principles of human pathophysiology. The importance of moving beyond pattern recognition will become increasingly urgent as generative artificial intelligence (AI) becomes central to the practice of medicine. Illness Scripts: Fast, but Risky As the … Read More
“The committee [The National Academies of Sciences, Engineering, and Medicine (NASEM) convened a multidisciplinary committee of individuals with expertise in alcohol exposure measurement, the relevant clinical outcomes, epidemiology, evidence synthesis, previous experience with the 2025 Dietary Guidelines for Americans, and public health] evaluated the associations between moderate alcohol consumption (defined in previous DGA versions as 1 drink or 14 g of alcohol per day for women and 2 drinks or 28 g of alcohol per day for men) and all-cause mortality, weight changes, certain types of cancer, cardiovascular disease, and neurocognition. [..] The standard drink size of 14 g of … Read More
“the number of people who reject all vaccines is quite small — so small that they are unlikely to compromise public health. The greater issue, the one we don’t discuss often enough, is the many parents who don’t identify as being opposed to vaccines but don’t always consent to them. Even before the Covid-19 pandemic, one-quarter to one-third of American parents were delaying vaccines or picking and choosing them cafeteria-style, deciding certain vaccines weren’t relevant to their family because they believed the risk for the disease was low. Some parents design their own vaccine schedules, often customizing for each child based on their perceptions … Read More
“early-onset cancer has emerged as a federal health priority. The Cancer Grand Challenges program, funded by the National Cancer Institute and Cancer Research UK, has allocated $25 million to uncover biological causes for rising rates. Early-onset cancer has also been highlighted as an area of scientific focus in the US National Cancer Plan. Research interest has concurrently surged, with the proportion of PubMed citations related to early-onset cancer more than tripling during the past 3 decades. Rising rates have also prompted recent shifts in policy, such as the US Preventive Services Task Force lowering the recommended initial age for colorectal cancer and breast … Read More
“First, numbers (even if approximate) should be used to describe risk probabilities. The meaning of verbal probability terms (eg, rare, common, or unlikely) varies among people and situations. A systematic review of 24 studies found that people interpreted “rare” to mean probabilities ranging from 0% to 80%, while interpretations of “common” ranged from 10% to 100%. Using numbers helps patients understand whether a rare risk is 4% or 0.004%. [..] One caveat to this recommendation is that nonnumeric communication may be appropriate when it is more important that a patient understands a category (eg, that their risk is “high”) than the exact … Read More