“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
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“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
It used to be progressives who distrusted the experts. What happened? “Citing evidence, ignoring appeals to authority, reserving judgment, demanding more research—these are potentially exhausting traits in a conversational partner, but they’re also marks of a scientific mind. Rather than being “anti-science,” [Robert F] Kennedy [Junior] seems enchanted by it. His accusatory book “The Real Anthony Fauci” (2021) is packed with discussions of clinical studies, and it bears a blurb from a Nobel-winning virologist. (Anyone worried about the lack of public appetite for complex writing should contemplate the fact that this nearly five-hundred-page, data-drenched work of nonfiction has sold more … Read More
“Symptoms of hypothyroidism are nonspecific and poorly predict clinically significant thyroid dysfunction, especially in patients with underlying medical conditions and advanced age. Thus, it is essential to identify thyroid dysfunction before initiating therapy. Yet, it is estimated that about 30% of persons newly started on l-thyroxine treatment in the United States have normal thyroid function. When symptoms result in ordering thyroid function tests, an elevated thyroid-stimulating hormone (TSH) level should not trigger therapy without confirmatory TSH and free thyroxine (FT4) levels. Symptoms associated with overt hypothyroidism (elevated TSH, low FT4) usually resolve with l-thyroxine replacement, but therapy for subclinical hypothyroidism … Read More
“In the case of substance abuse, decades of research established a taxonomy that is more nuanced than simply alcohol abuse vs use. The National Institute of Alcohol Abuse and Alcoholism has established different usage patterns that have been studied both for their independent effects on functioning and how each might ultimately lead to the clinical entity of alcohol use disorder (Table). We propose an analogous taxonomy for digital media use that identifies patterns of use, irrespective of content, that could be problematic but, at a minimum, should be flagged as warranting further evaluation and potential remediation. Although in this Viewpoint … Read More
“Adam Kucharski, mathematical modeller and Professor of Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine in London, UK, was one of the most reliable expert sources for many reporters wrestling with the scientific debates and dilemmas [around COVID-19]. He has now distilled his experience from working on both the pandemic and the epidemiology of other disease outbreaks, such as Zika virus disease and Ebola virus disease, into Proof: The Uncertain Science of Certainty, an exceptionally clear and engaging account of how scientists demonstrate truth and falsity. By showing that the matter often requires us to accept uncertainty … Read More
“In 1990, it was hypothesized that humanity was approaching an upper limit to life expectancy (the limited lifespan hypothesis) in long-lived populations, as early gains from improved public health and medical care had largely been accomplished, leaving biological aging as the primary risk factor for disease and death; the rate of improvement in life expectancy was projected to decelerate in the twenty-first century; and e(0) [life expectancy at birth] for national populations would not likely exceed approximately 85 years (88 for females and 82 for males) unless an intervention in biological aging was discovered, tested for safety and efficacy and broadly … Read More
“Landeiro and colleagues computed the economic burden of four diseases (cancer, coronary heart disease [CHD], dementia, and stroke) in England using consistent methodology and a broad definition of disease burden. This analysis is an important advance that will allow policy makers, researchers, and other stakeholders to assess the absolute and relative burden of these diseases in a meaningful way. The Global Burden of Disease also uses a consistent methodology for estimating the burden of many diseases across countries. However, its methodology focuses only on mortality and morbidity, which are evaluated comprehensively, but does not account for many other costs included … Read More
“While overdose deaths and related outcomes, such as the prevalence of substance use disorders (SUDs), are helpful indices, they fail to capture the broader dimensions of drug-attributable harm, including non-overdose deaths, chronic disease morbidity, and other conditions that cause people who use drugs to live in a state of less than full health. [..] The DALY [disability-adjusted life-years, the sum of years lived with disability and the years of life lost due to premature death] index captures the health burden beyond overdose deaths and SUDs, to encompass other morbidity and mortality attributable to substance use. Such outcomes could include conditions … Read More
“Obesity spans a spectrum of health states, from an asymptomatic predisease risk factor—where excess adiposity (however defined) has yet to manifest overt signs or symptoms—to advanced disease stages complicated by downstream comorbid conditions, including diabetes, heart disease, and cancer. Obesity causes health effects and poses risks on a continuum; greater excess adiposity leads to higher health risk. In this way, obesity is analogous to many cardiometabolic risk factors, such as elevated blood pressure, dyslipidemia, and hyperglycemia. The location of adipose tissue also matters for some metabolic effects, whereas for others (for example, obesity’s mechanical effects), total adipose tissue affects functional … Read More