CasesBlog - Health News and Commentary

Is Your Doctor Conflicted by Industry Payments When Recommending Treatment? A Government Website and Tim Ferriss' Idea Can Help You Find Out

2026-10-31T10:02:21.270-04:00

Before you say yes to a surgery or implant, you may want check one thing: who is paying your surgeon?

There's a free government tool called Open Payments that tracks every payment drug and medical device companies report giving to doctors and teaching hospitals — consulting fees, speaking fees, royalties, ownership, and and more commonly - free meals - lots of them.

Tim Ferriss highlighted it in his 5-Bullet Friday newsletter for a simple reason, captured in Charlie Munger's quote:

"Show me the incentive, and I'll show you the outcome."

How to use it:

1. Spot free agents vs. tied players. A doctor with $0 in payments is free to recommend any treatment. A doctor getting large, recurring payments from one company may be more likely to recommend that company's products.

2. The small stuff adds up. It's startling to see doctors collecting thousands of dollars per year in free lunches and dinners for themselves and their staff. Those meals alone don't make someone a bad doctor, but they show who has their ear.

3. It matters in big decisions. Ferriss shared his own case — choosing between two surgeons. One recommended a conservative, minimal approach and had $0 in tracked payments. The other recommended extensive surgery with implants and had received roughly $1 million from the company that makes those implants.

A payment doesn't mean your doctor is bad. Many top specialists consult because they're experts.

But if a doctor wants to put a specific device in your body, you deserve to know if they are paid by the company that makes it — whether it's $1M in royalties or $5K in catered lunches.

Links:

Open Payments Data: https://openpaymentsdata.cms.gov

Tim Ferriss - 5-Bullet Friday: https://go.tim.blog/5-bullet-friday-1/

H. pylori in 2026: From Ulcer Bacteria to Cancer Prevention

2026-10-26T19:57:00.000-04:00

Barry Marshall drank H. pylori in 1984 to prove it causes ulcers. He got the Nobel Prize in 2005. Now he and colleagues argue in this month's NEJM review that the same bacteria — responsible for 89% of non-cardia gastric cancers — should be treated to prevent cancer, not just ulcers.

1. Retire empiric clarithromycin triple.

Surveillance from the vonoprazan program: 22.2% clarithromycin resistance, 69.2% metronidazole, 1.2% amoxicillin in US/EU isolates. Dual clarithromycin-metronidazole resistance 11.7%. Worldwide increase in macrolide resistance now drives failure of standard therapies.

ACG 2024, endorsed by NEJM: do not use clarithromycin triple or levofloxacin triple empirically. Use only if susceptible.

2. Use the new first-line toolbox.

When susceptibility unknown (which is most cases):

a) Bismuth quadruple x 14d — PPI + bismuth subcitrate + tetracycline 500mg qid + metronidazole. Still achieves 85-90% despite metronidazole resistance due to bismuth effect. Remains preferred in ACG.

b) Rifabutin triple x 14d — PPI + amoxicillin 1g BID/TID + rifabutin 150mg BID. Resistance rare. Achieves ∼80% as 3rd-line, >90% as 4th-line when combined as VAR (vonoprazan + amoxicillin + rifabutin) in Japanese data.

c) Vonoprazan dual / triple — Vonoprazan 20mg BID is a PCAB, not a PPI. Potent, CYP2C19-independent acid suppression. FDA approved 2023. Dual (vonoprazan + amoxicillin 1g TID) and triple (add clarithromycin) both listed as acceptable empiric alternatives. Japanese trials: vonoprazan triple 72.8% → 87.9% vs PPI triple.

Practical point: Order molecular resistance PCR where available — stool or gastric biopsy for 23S rRNA (clarithromycin), gyrA (levofloxacin). It replaces culture for most decisions.

3. Think screen-and-treat for gastric cancer prevention.

IARC Working Group Report published in NEJM March 2026 summarized 36% reduction in gastric cancer incidence and 22% reduction in mortality with population eradication.

IARC now supports population-based screen-and-treat in high-risk populations, starting age ∼45, using active infection tests (13C-UBT or stool antigen, not serology). Japan's experience since 2013 insurance expansion supports feasibility.

Key caveat in the review: eradicate before extensive atrophy / intestinal metaplasia. Beyond that, risk is reduced but not abolished. Balance with stewardship and potential microbiome trade-offs (inverse association with esophageal adenocarcinoma, asthma).

Bottom line for your order set: Delete clarithromycin triple as default. Default to bismuth quadruple x 14d, or if penicillin-allergic patient can take it, consider rifabutin triple or vonoprazan dual. Document allergy status, prior macrolide/fluoroquinolone exposure, and send resistance PCR if available.

References

Li H, Megraud F, Marshall BJ. Helicobacter pylori Infection — Advances, Challenges, and the Road Ahead. N Engl J Med 2026;395:1621-1633. https://nej.md/4Bj3O58

IARC Working Group Report on H. pylori screen-and-treat for gastric cancer prevention (12 March 2026). https://www.iarc.who.int/news-events/iarc-working-group-report-on-helicobacter-pylori-screen-and-treat-strategies-for-gastric-cancer-prevention/

Screen-and-treat cuts gastric cancer incidence by 36% and mortality by 22% — IARC/NEJM summary. https://ureabreathtests.com/blogs/news/13c-urea-breath-test-vs-14c-stool-antigen-serology-a-2026-procurement-guide-for-h-pylori-screening-programs and https://oncodaily.com/blog/nieves-martinez-lago-new-nejm-sounding-board---gastric-cancer-prevention

ACG 2024 guideline shift: recommendation to use non-clarithromycin regimens; rifabutin triple and vonoprazan-amoxicillin dual as preferred empiric alternatives. https://tmedweb.tulane.edu/content/treatment_h_pylori_induced_ulcers

Rising macrolide resistance accounting for failure of standard therapies. https://bpgweb.azurewebsites.net/article/S0000-0000(25)00123-X/fulltext

Vonoprazan triple increased eradication 72.8% → 87.9% vs PPI. https://ichgcp.net/clinical-trials-registry/NCT04527055

1 in 4 cases of severe depression may be a body-clock problem

2026-10-25T19:44:00.000-04:00

A new study from the University of Sydney's Brain and Mind Centre is getting a lot of attention this week.

The paper: Tonini et al. Clinical and genetic correlates of a circadian subtype of depression in the Australian Genetics of Depression Study. British Journal of Psychiatry, Oct 21 2026. DOI: 10.1192/bjp.2026.10798

What they did: Analyzed 11,380 adults with severe, recurrent depression from the Australian Genetics of Depression Study.

How they defined it: Need 3 of 6 features — seasonality, being a definite night owl, delayed sleep midpoint, 2+ hours social jet lag between work/free days, sleeping much more when depressed, and severe morning tiredness.

Result: 2,604 people, 23%, fit this "circadian depression" profile.

Why it matters:

Earlier onset, more episodes, more suicidality, more hypomanic and psychotic-like features

Worse response to SSRIs (OR 0.88) and SNRIs (OR 0.89) and more side effects

Distinct genetics: higher polygenic risk for ADHD, depression, anxiety, bipolar, plus BMI, triglycerides, IL-6, insulin resistance, and a strong genetic link to evening chronotype

The takeaway: For this group, disrupted clock may be driving the illness. Authors argue for circadian-focused care — consistent wake time 7 days/week, morning/midday/sunset outdoor light, regular meals/activity, plus clinical options like melatonin, light therapy, and melatonergic meds — rather than another round of SSRIs.

Don't stop antidepressants on your own. This is a provisional research subtype, now being tested in the MELODY trial.

References:

Original peer-reviewed paper (full text):

Tonini, E., Crouse, J.J., Shin, M., et al. Clinical and genetic correlates of a circadian subtype of depression in the Australian Genetics of Depression Study. British Journal of Psychiatry (2026).

https://www.cambridge.[STRIPPED 211 bytes]: https://doi.org/10.1192/bjp.2026.10798

University of Sydney official press release (Oct 21, 2026):

https://www.sydney.edu.au/news-opinion/news/2026/10/21/researchers-identify-circadian-subtype-of-depression-.html

MedicalXpress summary of the study:

https://medicalxpress.com/news/2026-10-circadian-subtype-depression.html

Smithsonian Magazine coverage with outside expert commentary:

https://www.smithsonianmag.com/smart-news/one-in-four-cases-of-depression-could-be-caused-by-a-dysregulated-body-clock-study-says-180989736/

Medical Republic detailed clinical summary with ORs and demographics:

https://www.medicalrepublic.com.au/depression-treatment-may-need-to-account-for-the-body-clock/130233

Travel Is Not Medicine For Everyone: What The WSJ Got Right, What It Missed, And Why Staying Local Can Be Healthier

2026-10-24T19:30:00.000-04:00

On August 28, 2026, The Wall Street Journal published "The Surprising Mental-Health Benefits of Getting Away" by Heidi Mitchell. The headline was seductive: travel is preventive medicine, and the further you go, the happier you are.

There is another group of people the article never really accounts for. They do badly when they travel. Travel disrupts their sleep and their food, and it makes them very unhappy. It leaves them feeling older and more depleted, not refreshed.

They are not outliers to be explained away. They are the other side of a story the WSJ told only in part.

This post presents both sides, and criticizes the research the WSJ used — fairly, with the original references.

What the WSJ argues

Mitchell's core claim is that travel forces the brain off cruise control. At home we make few new decisions. On a trip we navigate new food, new streets, new people, new decisions. That friction, she writes, builds confidence, sharpens memory, and enhances cognitive well-being.

She cites five lines of research:

1. Anticipation and short-term mood

A review of recent travel studies found improved mood and sleep that do not vanish on return, and even anticipation of a trip makes people happier about family, health, and finances.

2. Resilience that sticks around

Rory Mulcahy at the University of the Sunshine Coast found travel first produces a burst of happiness, which then builds psychological resilience — the ability to handle stress and recover from setbacks. The glow fades, resilience lasts up to four months. The effect kicks in with as little as one overnight stay, and travelers scored roughly 15% higher on well-being than non-travelers.

3. Go far, far away

Shu Cole at Indiana University found in a 2024 study of adults over 50 that the farther people traveled, the less depressed and lonely they were: international travelers best, domestic second, day-trippers third, non-travelers worst.

4. Make it difficult

Nanxi Yan at the University of Amsterdam, in a review of 125 studies, found mastery — meeting a real challenge with matched skill — drives lasting gains. Mountain climbers absorbed in a demanding task reported happiness directly correlated to that absorption.

5. Awe and authenticity

Paul Piff at UC Irvine found 2 minutes sitting quietly in nature at Lake Tahoe produced a 70% jump in awe and a 33% increase in happiness. James Petrick at Texas A&M found in 66 interviews with cruise passengers that travel strips away home roles — dad, boss, employee — and allows "existential authenticity," acting like who you really are.

It is a compelling narrative. It is also incomplete.

The critique: 5 problems with the WSJ's case

1. Correlation is presented as causation

Cole's study is observational, not randomized. People who can travel internationally are wealthier, healthier, more mobile, more socially connected, and less disabled to begin with. Cole attempted to control for this with a 6-year follow-up, but that does not eliminate healthy traveler bias — the people who were already declining did not travel at follow-up either.

Mulcahy's research, similarly, is based on surveys of more than 1,200 Australian tourists between 2020 and 2023. It shows frequent travelers have higher resilience. It does not prove travel created that resilience, and Mulcahy himself notes benefits were strongest for vulnerable people with weak coping skills, and weaker for people who already had moderate or high coping skills. In other words, if people already cope well at home, travel adds little.

2. The samples are not the people who do badly traveling

Cole: adults over 50. Mulcahy: Australian tourists. Petrick: cruise passengers who chose to be on a cruise and agreed to be interviewed. Piff: volunteers at Lake Tahoe who were willing to hike and kayak.

None of these are randomized samples of people who dislike travel, have sleep disorders, have food intolerances or gastrointestinal disease, or have anxiety about being away from home. When you exclude the people for whom travel is harmful, you get an average benefit.

3. Preliminary work

Piff's Lake Tahoe numbers are explicitly described in the WSJ as "preliminary results" from field experiments partly funded by a grant from the Lake Tahoe tourism board.

4. Awe, mastery, and nature are not the same as travel

This is the most important sleight of hand in the article.

The meta-analysis of 55 controlled clinical trials involving 4,400 participants over three decades that Mitchell cites did not study travel. It studied the ingredients of a good vacation — passive time in nature and active pastimes like hiking. Those ingredients exist at a local beach and a local park, without an airport.

Yan's 125-study review is about vacations and subjective well-being in general, not about distance. Piff's awe can be induced by 2 minutes in a local landscape. Mulcahy himself says benefits kick in with short trips close to home.

The WSJ then makes a leap: because nature, novelty, challenge, and awe help, far travel must help more. The data do not support the distance claim. They support the ingredient claim.

5. The costs are omitted

The article mentions no sleep disruption, no food disruption, no jet lag, no gut microbiome disruption, no travel stress, no loss of routine, no financial strain, and no infection risk.

Yet those are real, measurable harms. Travel scrambles circadian rhythms and meal timing, which shifts gut microbiota diversity and increases gut permeability and low-grade inflammation — a phenomenon researchers now call "gut jet lag." Irregular sleep is associated with worse diet quality, worse inflammation, and worse mood. For people whose health depends on stable sleep and stable food, that is not a minor side effect. It is the main effect.

If travel breaks the two systems that regulate mood, immunity, and aging, it cannot produce the benefit it promises. For those people, it actively ages them.

The other side: rootedness

The Blue Zones research — Okinawa, Sardinia, Ikaria, Nicoya, Loma Linda — is often misquoted. There is no study that proves most centenarians never traveled more than 100 miles from birth. What those studies actually show is that centenarians lived with strong local social ties, daily physical activity built into life, a consistent local diet, and low chronic stress.

Those benefits come from rootedness, not from immobility per se. Rootedness is familiarity, mastery of your environment, social embeddedness, and predictability. For many people, that is what protects sleep, food, and mood.

A beach or park gives such people the WSJ's own mechanisms without the WSJ's costs:

Novelty without disruption: new light, new trail, new people, but home to their own beds and kitchens

Awe without jet lag: 2 minutes in nature is the same whether it's Lake Tahoe or their local shore

Movement without mastery pressure: walking, swimming, sitting in nature

Authenticity without anonymity: they can be themselves without losing their community

Local variety is not a lesser version of travel. For people whose sleep and food are fragile, it is the superior version.

Conclusion

Travel is not medicine. Nature is medicine. Novelty is medicine. Challenge is medicine. Social connection is medicine. Sleep is medicine. Stable food is medicine.

Travel is just one delivery system for the first three, and a terrible delivery system for the last two. The WSJ article confuses the delivery system with the drug.

If travel makes people deeply unhappy, if it disrupts their sleep and food and leaves them exhausted and relieved to be home, that is not a failure of their attitude. That is data about their biology.

They do not need to go far to get the benefits. They need to go where they can sleep, eat, move, and feel awe — and still be themselves the next morning.

Original references from the WSJ article

Mitchell, H. (2026, Aug 28). The Surprising Mental-Health Benefits of Getting Away. The Wall Street Journal. https://www.wsj.com/lifestyle/travel/mental-health-benefits-of-travel-834befc7

Cole, S., Hua, C., Peng, S., & Wang, W. (2024). Exploring the Relationship of Leisure Travel with Loneliness, Depression, and Cognitive Function in Older Adults. International Journal of Environmental Research and Public Health, 21(4), 498. https://doi.org/10.1186/s12877-024-05010-4 and https://www.mdpi.com/1660-4601/21/4/498 — Cited for the "farther = less depressed/lonely" claim. Observational study of adults over 50.

Mulcahy, R., Pourfakhimi, S., & Prayag, G. (2026). Frequent leisure travel, happiness, psychological resilience and quality of life. Journal of Travel Research. Survey of >1,200 Australian tourists in three studies 2020-2023. University of the Sunshine Coast summary: https://www.unisc.edu.au/about/unisc-news/news-archive/2026/september/more-short-holidays-close-to-home-boost-wellbeing-unisc-led-study-finds — Cited for resilience lasting up to four months and benefits from one overnight stay.

Yan, N., de Bloom, J., & Halpenny, E. (2024). Integrative review: Vacations and subjective well-being. Journal of Leisure Research, 55(1), 65-94. https://doi.org/10.1080/00222216.2023.2193180 — The 125-article review cited for mastery as a driver of lasting gains.

Piff, P. et al. (Ongoing, preliminary). Field experiments on awe at Lake Tahoe, University of California, Irvine. Preliminary results reported by WSJ and UC Irvine School of Social Ecology: https://socialecology.uci.edu — Cited for 70% awe and 33% happiness increase after 2 minutes. Partially funded by Lake Tahoe tourism board. Not yet published as a full peer-reviewed trial in the WSJ citation.

Petrick, J. F. et al. (Forthcoming, as described in WSJ). Existential authenticity in cruise travel. 66 interviews with cruise passengers. Texas A&M University. Cited as "will be published soon" in WSJ — no published reference available at time of WSJ article.

Meta-analysis cited in WSJ for nature/hiking ingredients: 55 controlled clinical trials, >4,400 participants over three decades, on passive nature activities and active activities like hiking and mental health. WSJ does not provide a full citation in the article text. Related evidence includes Coventry et al. on nature-based interventions and Grassini (2022) meta-analysis of nature walks, showing reduced depressive mood and anxiety.

Additional context on travel costs not cited in WSJ: Travel-Induced Circadian and Microbiota Disturbances: Implications for Athlete Health and Performance — Narrative Review, Wroclaw Medical University. Discusses "gut jet lag," reduced microbial diversity, increased gut permeability, and inflammation after long-distance travel.

ARB vs ACE Inhibitor for Cardiovascular Prevention: Same Protection, Better Tolerability, and Why Half-Life Matters

2026-10-23T19:28:16.311-04:00

For a decade we taught that ACE inhibitors save lives and ARBs are for when patients cough or have angiodema as sides effects of ACEI. That teaching is outdated for hypertension and vascular prevention.

1. Same efficacy

The ONTARGET trial changed practice. 25,620 patients with vascular disease or high-risk diabetes were randomized to ramipril 10mg, telmisartan 80mg, or both. The primary outcome - CV death, MI, stroke, or heart failure hospitalization - was 16.5% with ramipril vs 16.7% with telmisartan, RR 1.01. Telmisartan was non-inferior and conserved 95% of ramipril's benefit. Combination added no efficacy, only more hypotension, renal dysfunction and hyperkalemia.

Meta-analyses since have confirmed it:

27 RCTs, 125,330 high-risk patients without heart failure: no difference between ACE and ARB for CV death, MI, or stroke.

>2.9 million patients in real-world data: no difference for acute MI, heart failure, stroke or composite CV events.

Cochrane review of ACE vs ARB for primary hypertension, 9 trials, 11,007 patients: total mortality RR 0.98 [0.88-1.10], total CV events RR 1.07 [0.96-1.19], CV mortality RR 0.98 [0.85-1.13] - no evidence of difference.

For high CV risk without HFrEF, efficacy is a tie.

2. Fewer adverse events with ARBs

ACE inhibitors block kininase II. Bradykinin accumulates. That gives you the dry, persistent cough and angioedema.

Across large datasets, ACE inhibitors are 3.3 times more likely to cause angioedema and 32% more likely to cause cough vs ARBs. Cochrane found ARBs had 17% fewer withdrawals due to adverse events, RR 0.83, ARR 1.8%, NNT 55 over 4.1 years to prevent one withdrawal, driven almost entirely by cough.

In ONTARGET, telmisartan was better tolerated. Better tolerability is better real-world effectiveness.

3. Not all ARBs last 24 hours

Half-life decides trough-to-peak ratio and early-morning coverage, when most CV events occur.

Losartan: 2h parent, 6-9h active metabolite

Eprosartan: 5-7h

Valsartan: 7h

Azilsartan: 11h

Irbesartan: 11-15h

Candesartan: 9-13h

Olmesartan: 12-14h

Telmisartan: 24h

Olmesartan is similar to azilsartan, candesartan and irbesartan and is surpassed only by telmisartan. Losartan, eprosartan and valsartan are short half-life ARBs.

Head-to-head: Telmisartan 80mg significantly reduces 24-hour BP vs losartan 50mg, with the largest difference in the last 6 hours of the dosing interval - the critical early-morning period. Telmisartan provides smoother, more consistent 24-hour control and better early-morning BP control than losartan/HCTZ.

Telmisartan is also the only ARB with a 24-hour half-life, insurmountable AT1 binding, and partial PPAR-gamma activity. Olmesartan, is the second longest at ∼13h, with the highest AT1 selectivity and very potent BP lowering.

Losartan works, but once-daily it often doesn't cover 24 hours and many patients need BID dosing.

Practical take

For cardiovascular prevention: ACE = ARB for outcomes. ARB > ACE for tolerability. And within ARBs, choose a true 24-hour agent - telmisartan or olmesartan - over losartan if you want forgiving once-daily coverage and morning protection.

References

Results of the ONTARGET and TRANSCEND studies - ONTARGET non-inferiority - https://pmc.ncbi.nlm.nih.gov/articles/PMC2672448/

Cochrane: ACE inhibitors versus ARBs for primary hypertension - https://www.cochrane.org/CD009096/HTN_angiotensin-converting-enzyme-ace-inhibitors-versus-angiotensin-receptor-blockers-for-primary-hypertension

ARB half-life comparison - olmesartan 12-14h, telmisartan 24h, losartan 4-6h - https://inpharmd.com/inquiries/10132

Telmisartan vs losartan 24h BP control and early morning benefit - https://www.droracle.ai/articles/106939/can-i-switch-from-telmisartan--hctz-to-losartan--hctz-

ACE vs ARB safety - fewer cough/angioedema with ARB - https://consultqd.clevelandclinic.org/ace-inhibitor-and-arb-therapy-practical-recommendations

2.9M patient observational study - similar CV outcomes, lower AE with ARB - https://www.uspharmacist.com/article/ace-inhibitors-versus-arbs-1

Your Face Might Know More About Your Health Than You Think: Mass General FAHR-Face AI Pattern Recognition Model

2026-10-20T21:20:16.706-04:00

A new study published this week in Lancet Digital Health is getting a lot of attention for a simple, slightly unsettling claim: a single photograph of your face could help predict biological age and, in cancer patients, risk of dying. I went back to the original paper, not just the headlines, because the details matter.

A very old idea

This is not a new observation. Around 400 B.C., in the Book of Prognostics, Hippocrates described what he called the face of impending death — what we now call facies Hippocratica:

"a sharp nose, hollow eyes, collapsed temples; the ears cold, contracted, and their lobes turned out; the skin about the forehead being rough, distended, and parched; the color of the whole face being green, black, livid, or leaden."

For 2,400 years, doctors have been taught to look at the face to judge if someone is failing. What is new is trying to make that look quantitative, consistent, and scalable with AI.

What they actually built

The team at Mass General Brigham built a foundation model called FAHR-Face — Foundation Artificial Intelligence for Health Recognition-Face.

First, they trained a masked autoencoder on over 40 million face images. No age labels, no health labels — just learning to reconstruct faces.

Then they fine-tuned that foundation into two tools:

1. FAHR-FaceAge: estimates biological age from a photo. Biological age here means "how old you look physiologically" not how many birthdays you've had.

2. FAHR-FaceSurvival: trained directly to predict survival outcomes. Fine-tuned on 34,363 photographs of patients treated with radiotherapy at Harvard-affiliated hospitals.

Both were tested on held-out Harvard patients and an independent external cohort of 4,892 cancer patients from Maastro in the Netherlands.

What they found

FAHR-FaceAge is good at age. Mean absolute error of 5.1 years on public datasets, outperforming prior models, and consistent across race and across the lifespan.

More interesting is what happened in cancer patients:

Median deviation between face age and chronological age was 1.1 years, but 33% of patients looked 5+ years older, and 17% looked 10+ years older.

Those who looked older had lower survival across all age and race groups. Those in the highest deviation group (>20 years older) had 21.3% 90-day mortality vs 6.4% in those who looked 10+ years younger.

Face-age deviation alone had a C-index of 0.57 for survival.

FAHR-FaceSurvival was more direct:

Highest-risk quartile had more than triple the mortality of the lowest: adjusted hazard ratio 3.23.

In the 3,820-patient test set, 52.5% of those in the top decile (64 of 122 patients) died within 90 days, compared to 2.1% in the lowest decile.

The key: the two models are independent. Correlation was only R=0.22. Combined, they fit survival better than either alone.

Where is the AI looking? Hippocrates was close.

FaceAge: nasolabial folds, forehead immediately above the orbits, and temples / temporalis area. With older age, attention shifts more to temples and forehead.

FaceSurvival: area below the eyes and including the nasal bridge / around the nose. Pattern stays consistent across all ages.

Read that again next to Hippocrates:

Hippocrates: "sharp nose, hollow eyes, collapsed temples"

FAHR-FaceAge: nasolabial folds, forehead, collapsed temples

FAHR-FaceSurvival: below the eyes (hollow eyes) and nasal bridge (sharp nose)

The overlap is striking. The 2026 AI attention maps are landing almost exactly on the regions Hippocrates flagged in 400 B.C. as portending death. What the paper does not do is say whether it's wrinkles, loss of volume, hollowing, color, or something else — the maps show where, not what. The authors state no biological mechanism was identified.

Robustness: makeup, angle, lighting, expression didn't change results much. Most plastic surgeries didn't either, rhinoplasty added ∼1.1 years in age.

Lifestyle: heavy alcohol, drug use, and smoking were associated with looking older, with a dose-response for smoking: current > former > never.

Why it might matter, and why it doesn't yet

The clinical hook is frailty. Doctors are trained to eyeball how healthy or frail a patient looks. That eyeball is subjective. A photo is cheap, non-invasive, scalable.

But this is model development, not a clinical trial. No decision threshold has been validated, and no study has shown that using it improves outcomes. It was trained on Boston-area cancer patients, majority white. Mass General Brigham has filed a provisional patent.

And the same ethical questions Hippocrates never had to face: if a selfie can estimate mortality risk, who gets to use it?

References

Original study in The Lancet Digital Health:
https://www.thelancet.com/journals/landig/article/PIIS2589-7500(26)00079-8/fulltext

FaceAge Research Study — upload a photo and get a research readout (IRB-approved, open to public):https://faceage.bwh.harvard.edu

Does AI Make Colonoscopists Worse Without It? A 2025 Lancet Study Suggests Yes.

2026-10-19T20:09:15.402-04:00

In August 2025, Lancet Gastroenterology & Hepatology published a finding that complicated the AI-in-medicine success story.

The study, led by Dr. Marcin Romańczyk at H-T Medical Center in Tychy, Poland, re-analyzed data from four Polish centers that introduced a real-time AI polyp detection system in 2021-2022. The system highlights suspected polyps with a green box during colonoscopy.

The question was not whether AI improves detection when switched on — prior data showed it does — but what happens to unassisted performance after clinicians adapt to it.

The result: The rate at which physicians found at least one precancerous polyp during colonoscopy fell from 28.4% before AI exposure to 22.4% when the same physicians worked without AI after three months of use. That is a roughly 20% relative decrease in detection when working unaided.

Romańczyk's hypothesis is attentional rather than skill-based: “We are subconsciously waiting for the green box to come out to show us the region where the polyp is and we're not paying so much attention.”

It's not about forgetting how to be a doctor

The researchers aren't claiming that 26 years of training evaporated in 3 months. They're describing something psychologists call the safety-net effect.

If you know a system will catch things for you, you scan a little differently. Less vigilant. More passive. You let the box lead your eyes, instead of leading it.

A similar study in breast screening from Manchester found non-experts read mammograms worse when they knew they could push a button for AI help. It's human, not just medical.

So far we have not trained doctors on the second-order effects of AI: how to stay sharp while using assistance, how to avoid over-reliance, when to trust the box and when to distrust it.

The same pattern is happening in radiology, pathology, ophthalmology, dermatology. AI improves performance when it's on. The question this Polish study raises for the first time with hard clinical data is: what does it do to performance when it's off?

Limitations should be noted

Observational design. The patient groups before and after AI exposure were different. Age, bowel preparation and other factors were not fully controlled.

Short duration. Three months is a short period to infer durable skill loss in physicians with decades of experience.

The author emphasizes he is not opposed to AI assistance and continues to use it, but argues that deployment has outpaced research on human-AI interaction.

Implication

The data suggests a dependency effect. As AI becomes standard, health systems will need to consider how to preserve unassisted competency — through interface design, maintenance of practice without AI, and routine measurement of detection rates both with and without assistance — to ensure performance remains resilient when the system is unavailable.

References

Budzyń et al., "Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study," Lancet Gastroenterology & Hepatology 2025.

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(25)00133-5/abstract

Boy kibble’: a convenient high-protein meal but with a nutrition gap

2026-10-17T10:31:53.549-04:00

What is “boy kibble”?

Social media has a new meal-prep trend called “boy kibble” - essentially a simple bowl of rice plus ground meat (beef, turkey, or chicken), sometimes with avocado.

It is the high-protein counterpart to the earlier “girl dinner” snack plate, popular especially among men focused on muscle and convenience.

Experts note the appeal: it supports protein goals, encourages home cooking over takeout, and removes decision fatigue.

What is the problem with “boy kibble”?

The typical “boy kibble” plate is roughly half protein and half carbohydrate, with vegetables often optional - far from the usual recommendation of half vegetables, one-quarter protein, and one-quarter carbs. It also leans heavily on animal protein and lacks the plant diversity of diets such as the Mediterranean pattern.

Dietitians suggest treating it as a starting point: add frozen or pre-cut vegetables for fiber and micronutrients, and rotate proteins and sides occasionally so the same bowl every day does not become a long-term nutrient shortfall.

Plant based meals may be best

A longer-term alternative worth considering is a plant-based dietary pattern. Research from Valter Longo (USC Longevity Institute) supports a “longevity diet” that is mostly plant-based (high in legumes, whole grains, and nuts, with optional fish), moderate in protein, and paired with time-restricted eating or periodic fasting-mimicking cycles.

Epidemiological and model-organism data link this approach to better healthspan and lower risk of age-related disease compared with higher animal-protein intake (see Longo & Anderson, Cell 2022; and related USC work).

"I'm busy and I don't have time to cook": consider meal kits

For convenient plant-based meal prep without starting from scratch, Purple Carrot is a fully vegan meal-kit service that delivers pre-portioned ingredients and recipes (or ready-to-eat options). Reviews consistently note flavorful, varied dishes that work for people transitioning toward more plants.

References:

CNN Wellness, “It’s simple and maybe delicious, but is ‘boy kibble’ healthy?” (Oct 14, 2026)
https://www.cnn.com/2026/10/14/health/boy-kibble-wellness

Longo VD, Anderson RM. Nutrition, longevity and disease: from molecular mechanisms to interventions. Cell. 2022. https://www.cell.com/cell/fulltext/S0092-8674(22)00398-1

Purple Carrot: https://www.purplecarrot.com

Dermatologists are at their best at 10 years of experience - and AI is getting closer in competency

2026-06-06T10:15:22.406-04:00

A recent study in JAMA Dermatology provides a realistic view of AI versus human performance in diagnosing skin cancer.

Key finding: AI surpassed dermatologists with <3 years of experience, matched those with 3–10 years, but remained inferior to experts with >10 years of experience.

The Study

Researchers tested modern AI models (including foundation models) against 652 physicians on 1,117 realistic dermatology cases with clinical and dermoscopic images.

Top AI accuracy: 72%

Humans by experience:

<3 years: ~68%

3–10 years: ~72%

10 years: 74.2% (highest overall)

Why Experience Still Wins

Seasoned dermatologists integrate subtle clinical context, patient history, and rare presentations that current AI struggles with. AI excels as a supportive tool - especially helpful for novices, triage, education, and areas with limited specialist access - but does not yet replace expert judgment.

Takeaways

Patients: Prioritize experienced specialists for concerning skin lesions. AI may improve initial screening and access, but expert care remains essential for early skin cancer detection.

Physicians: Use AI as a collaborator to reduce workload and support trainees, while continuing to build your own expertise.

Future: Hybrid human-AI systems are the path forward.

What are your thoughts - will AI close the gap soon?

References:
Anriot et al. JAMA Dermatology (2026).
https://jamanetwork.com/journals/jamadermatology/fullarticle/2849416

How Seasonal Allergies May Trigger Anxiety and Depression - A Possible Link

2026-05-24T10:54:00.000-04:00

A new study by our team was published in The Journal of Allergy and Clinical Immunology and revealed a striking seasonal connection between allergies and mental health.

We analyzed Google search trends in the U.S. from 2020 to 2025 and found that peaks in searches for “allergies” (especially allergic rhinitis) consistently lined up with increased searches for “depression” and “anxiety.” These mental health search spikes occurred during the classic allergy seasons — spring (March–May) and fall (September–November) — often rising at the same time or within a few weeks after allergy symptoms surged.

There are at least two likely mechanisms:

- Sleep disruption caused by nasal congestion, sneezing, and itchy eyes

- Systemic inflammation from allergy-related cytokines that can affect brain function and mood

Even in 2020, when the COVID-19 pandemic added extra stress, the allergy-anxiety pattern was clearly visible.

Bottom line for patients and doctors:

Allergies aren’t just annoying — they can genuinely impact mental wellbeing. Better allergy control (especially improving sleep) during peak seasons may help protect mood.

This study highlights why allergists should routinely discuss sleep and mental health with patients, and why public education during allergy season should include mental wellness tips.

https://www.jacionline.org/article/S0091-6749(25)01680-X/fulltext

Disclosure: The study was authored by my team.

The evolutionary advantage of having hair

2025-07-08T20:46:00.006-04:00

Apparently, when our ancestors moved from the trees to the ground in the African savanna, they needed to shed their body hair so they can get cool and they needed to develop hair on their head to keep their brain cool.

Hair also plays a critical importance in sharing to the other members of the species our age and physical condition.

https://www.wsj.com/science/biology/human-hair-evolution-brain-sun-protection-9f109694?st=HQ5gjr&reflink=article_copyURL_share

Exercise for a minute every 20 minutes every day

2025-07-07T09:58:00.001-04:00

Vigorous Intermittent Lifestyle Physical Activity (VILPA)

Here is my suggestion for you: Exercise for a minute every 20 minutes every day.

Turn on your watch timer to ring every 20 minutes, When the timer goes off, do squats for 1 minute and keep repeating during the day. The first thing you’ll notice is that you may be surprised how much time you spent in inactivity.

The second thing you will notice is how much better you will feel 😊

Higher fiber intake is associated with lower cancer risk and mortality

2025-07-06T09:53:00.001-04:00

If fiber was a pill, you would take it for sure!

Higher fiber intake has been associated with better health outcomes in multiple studies. Here is another reminder that fiber has been linked to lower risk of cancer and lower cancer mortality:

https://x.com/humanos_me/status/1941128584547950617?s=46

Premature hair graying associated with faster aging

2025-07-05T09:46:00.001-04:00

This is something we intuitively knew for years: If you hair start getting gray at an early age, it is likely that your aging faster.

This 2018 study confirms a link between premature hair graying and worsening cardiovascular and metabolic parameters:

- higher systolic blood pressure

- higher diastolic blood pressure

- Higher blood glucose

- Lower HDL

https://t.co/QJDMXIC0fV

The Surprising Link Between REM Sleep Onset and Dementia Risk

2025-02-01T14:01:00.003-05:00

Sleep is one of the most vital pillars of our overall health, yet it’s often overlooked in our fast-paced world. While we know that deep sleep is crucial for physical recovery and REM (Rapid Eye Movement) sleep supports mental well-being, recent research has uncovered an intriguing connection between how quickly you enter REM sleep and your risk of developing dementia—specifically Alzheimer's disease.

The Role of Sleep in Brain Health

Before diving into the specifics of this groundbreaking study, let’s first understand why sleep matters so much for brain health. During sleep, particularly during deep sleep, the brain activates what’s known as the glymphatic system . Think of this as the brain’s nightly cleaning crew. This system flushes out toxins, including amyloid plaques—the very substances implicated in Alzheimer's disease. Without adequate deep sleep, these harmful proteins can accumulate, potentially leading to cognitive decline over time.

But here’s where things get even more fascinating: REM sleep, which is associated with dreaming and emotional regulation, also plays a critical role in maintaining mental sharpness. Recent studies suggest that not only the duration but also the timing of REM sleep could be key indicators of long-term brain health.

References:

https://www.ucsf.edu/news/2025/01/429346/delayed-rem-sleep-could-be-early-sign-alzheimers

https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.14495

What Is REM Latency, and Why Does It Matter?

REM latency refers to the amount of time it takes for someone to enter their first period of REM sleep after falling asleep. In a new study exploring its relationship with dementia risk, researchers found some striking results:

Low Risk Group: Individuals who entered their first REM phase within 98 minutes of falling asleep had the lowest risk of dementia.

High Risk Group: Those whose first REM cycle began more than 198 minutes after going to bed were at significantly higher risk.

To put this into perspective, imagine two people going to bed at 9 p.m.:

Person A enters their first REM stage by 10:30 p.m., roughly 90 minutes later—a healthy range.

Person B doesn’t reach REM until nearly 2:30 a.m., exceeding 190 minutes. This delay places them in the high-risk category.

These findings are significant because they provide actionable insights using data easily accessible through modern sleep trackers. By monitoring your REM latency each night, you can gain valuable feedback about your brain health and take proactive steps if needed.

How Can You Use This Information?

If you own a wearable device like an Oura Ring, Fitbit, or any other advanced sleep tracker, chances are it already gives you an idea of your REM latency. Here’s how you can use this information to optimize your sleep hygiene and reduce your dementia risk:

Track Your Sleep Patterns Regularly

Consistently monitor when you fall asleep and when your first REM cycle begins. Most apps will display this data clearly, allowing you to calculate your REM latency.

Improve Sleep Hygiene

Establish a consistent bedtime routine. Avoid screens, caffeine, and heavy meals close to bedtime.

Create a relaxing pre-sleep environment—dim lights, calming music, or meditation can help signal to your body that it’s time to wind down.

Address Underlying Issues

If your REM latency consistently falls outside the optimal range, consider consulting a healthcare provider. Conditions like sleep apnea, insomnia, or chronic stress may interfere with your ability to transition smoothly into REM sleep.

Consider Genetic Testing

For those concerned about their genetic predisposition to Alzheimer’s, tests like the APOE gene test can offer additional clarity. Knowing your genetic risk allows you to focus on mitigating modifiable factors, such as poor sleep habits.

Why This Matters Now More Than Ever

The beauty of this discovery lies in its practicality. Unlike many aspects of our biology that feel beyond our control, sleep is something we can actively manage. With tools like sleep trackers becoming increasingly sophisticated, we now have the power to monitor and improve one of the most fundamental processes affecting our brain health.

Moreover, understanding the importance of REM latency adds another layer to the broader conversation around dementia prevention. While there’s no single “magic bullet” to prevent Alzheimer’s, combining strategies—such as optimizing sleep, staying physically active, eating a balanced diet, and managing stress—can collectively lower your risk.

Final Thoughts

The link between REM sleep onset and dementia underscores just how interconnected our bodies and minds truly are. Prioritizing quality sleep isn’t just about feeling rested; it’s about safeguarding your future self against debilitating diseases like Alzheimer’s.

So tonight, before you drift off, think about the incredible work your brain is doing behind the scenes. And remember, every minute counts—not just in terms of how long you sleep, but when your brain starts its vital REM cycles. Sweet dreams!

Updated 02-01-2025

Forkhead box O3 protein (FOXO3) genes and longevity

2023-04-15T07:00:00.002-04:00

Approximately 25–32% of the overall variation in adult lifespan is accounted for by genetic differences that become particularly important for survival after the age of 60.

Forkhead box O3 protein (FOXO3) is a transcription factor involved in the regulation of genes involved in many cellular processes, including DNA repair, tumor suppression, immune function, and resistance to oxidative stress. Some variants of FOXO3 are associated with longevity in humans.

FOXO3 is on chromosome 6.

FOXO3A encodes a key regulator of the insulin–IGF1 signaling pathway that is known to influence metabolism and lifespan.

A study of long-lived men of Japanese ancestry [Willcox et al. (2008) Proc Natl Acad Sci USA 105:13987–13992] and 1,762 German centenarians/nonagenarians and younger controls provided evidence that polymorphisms in this gene were indeed associated with the ability to attain exceptional old age. Replication in a French centenarian sample generated a trend that supported the previous results.

rs9400239 (C,T and T,T) has been associated with increased lifespan. The T allele is the one associated with longevity.

Centenarians represent the top percentiles of their respective birth cohort-specific age distributions and have outlived most of their peers by several decades. Only 4% of male and 5.6% of female 90-year-olds and 15–17% of 95-year-olds in Germany are likely to become 100 years themselves. Centenarians represent a highly selected phenotype. The genetic contribution to survival is strongest at very advanced ages, centenarians may be particularly enriched for beneficial variants in “longevity assurance genes”.

rs2802288 (A;G and AA), has been associated with increased lifespan. The A allele is the one associated with longevity.

rs2764264 (C;T), has been associated with increased lifespan. The C allele is the one associated with longevity, particularly among men.

rs2802292 (G;T) has been associated with increased lifespan. The G allele is the one associated with longevity.

rs1935949 (C;T) demonstrated a significant association with longevity but only among women.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2650329/

https://www.snpedia.com/index.php/Longevity

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992870/

Apolipoprotein E (ApoE) genes: rs429358 and rs7412

2023-04-14T09:00:00.001-04:00

The apolipoprotein E (ApoE) gene makes a protein which, when combined with fat, becomes a lipoprotein.

The lipoprotein ApoE is a very low-density lipoprotein, responsible in part for removing cholesterol from the bloodstream. Variations in ApoE affect cholesterol metabolism, which in turn alter your chances of having heart disease and in particular a heart attack or a stroke. Variations in ApoE are also associated with altered odds of having Alzheimer's disease and other diseases.

There are 3 allelic variants of ApoE, as defined by two SNPs, rs429358 and rs7412 known as:

- ApoE-ε2
- ApoE-ε3
- ApoE-ε4

The proteins produced by these genes are called ApoE2, ApoE3, and ApoE4.

The most common variant overall is the "standard" ApoE-ε3, and therefore more people inherited one ApoE-ε3 from each parent than any other of the possible pairs of variants.

Apo-ε2/ε2 - rs429358 and rs7412 (T;T) (T;T) - has the lowest risk.

Apo-ε3/ε3 - rs429358 and rs7412 (T;T) (C;C) - is the the most common.

Apo-ε4/ε4 - rs429358 and rs7412 (C;C) (C;C) - has 11 times higher increased Alzheimer's risk.

References:

https://www.snpedia.com/index.php/APOE

Where does your state rank in terms of life expectancy? Only Hawaii is over 80 years

2023-01-13T15:14:00.019-05:00

People in some southern states can expect to die 8 years younger than the average American, according to a data compilation that highlights the disparities in US life expectancy.

While Americans lived for 79 years on average in 2020, those in Mississippi can expect to reach just 71.

For comparison, people in Hawaii — which has the highest life expectancy — live to 80 on average.

The Daily Mail credits the summary to an online pharmacy, NiceRx, it's probably just a compilation of publicly available data.

References:

https://www.dailymail.co.uk/health/article-11627841/Where-does-state-rank-terms-life-expectancy.html

New option for H pylori treatment: Voquezna

2023-01-12T14:53:00.007-05:00

The Food and Drug Administration (FDA) has approved the following new medication for the treatment of Helicobacter pylori (H. pylori) infection in adults.:

- Voquezna Triple Pak (vonoprazan, amoxicillin, clarithromycin)
- Voquezna Dual Pak (vonoprazan, amoxicillin)

Vonoprazan, which gives the name of the medication, is an oral small molecule potassium-competitive acid blocker.

H. pylori eradication rates were 84.7% and 78.5% with Voquezna Triple and Dual Pak, respectively.

Voquezna Triple Pak is supplied as a carton containing 56-tablets and 56-capsules divided into 14 daily dose blister cards. Each daily blister card contains 2 vonoprazan tablets (20mg each), 4 amoxicillin capsules (500mg each), and 2 clarithromycin tablets (500mg each).

Voquezna Dual Pak is supplied as a carton containing 28-tablets and 84-capsules divided into 14 daily dose blister cards. Each daily blister card contains 2 vonoprazan tablets (20mg each) and 6 amoxicillin capsules (500mg each).

References:
https://www.empr.com/home/news/voquezna-triple-dual-pak-approved-for-h-pylori-infection-treatment/

Physiological Effects of Ancient Religious Chants

2022-11-18T15:55:00.015-05:00

Several studies have explore the effects of religious changes, such as OM, on physiological parameters such as heart rate, blood pressure and heat rate variability (HRV).

Overall, the effects were considered beneficial.

For example, a brief chanting of OM (5 min) might enhance parasympathetic nervous system activity, promote relaxation, and provide calmness.

Rhythm formulas that involve breathing at 6 breaths per minute induced favorable psychological and possibly physiological effects. Breathing at 6 breaths per minute is very close to so called resonance frequency breathing for most people.

References:

Physiological Effects of Cryptic Ancient Religious Chants. Abhijit. V. Bodne Varsha Patond. Journal of Pharmaceutical Research International, Volume 33, Issue 60B, Page 1042-1048 DOI: 10.9734/jpri/2021/v33i60B34711 Published: 23 December 2021
https://journaljpri.com/index.php/JPRI/article/view/6842

Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study. BMJ. 2001 Dec 22; 323(7327): 1446–1449. doi: 10.1136/bmj.323.7327.1446 PMCID: PMC61046 PMID: 11751348
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC61046/

Immediate Effects of OM Chanting on Heart Rate Variability Measures Compared Between Experienced and Inexperienced Yoga Practitioners. Int J Yoga. 2022 Jan-Apr; 15(1): 52–58. Published online 2022 Mar 21. doi: 10.4103/ijoy.ijoy_141_21 PMCID: PMC9015091 PMID: 35444369
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015091/

Understand risk better by using "micromort" unit

2022-10-27T17:24:00.004-04:00

A micromort (from micro- and mortality) is a unit of risk defined as a one-in-a-million chance of death.

Micromorts can be used to measure the riskiness of various day-to-day activities.

Activities that increase the death risk by roughly one micromort, and their associated cause of death:

Traveling 250 miles by car (collision) Travelling 1,000 miles (1,600 km) by jet (collision) Travelling 6,000 miles (9,656 km) by train (collision)

Increase in death risk for other activities on a per event basis:

Giving birth (vaginal) – 120 micromorts
Giving birth (caesarean) – 170 micromorts
AstraZeneca vaccination against COVID-19 – 2.9 micromorts
COVID-19 infection at age 10 – 20 micromorts
COVID-19 infection at age 25 – 100 micromorts
COVID-19 infection at age 55 – 4,000 micromorts
COVID-19 infection at age 65 – 14,000 micromorts
COVID-19 infection at age 75 – 46,000 micromorts
COVID-19 infection at age 85 – 150,000 micromorts

More info here: https://en.wikipedia.org/wiki/Micromort

Dopamine elevation after a cold bath

2022-10-27T17:18:00.000-04:00

Dopamine elevation after cold bath is due to stimulation of pain receptors in the skin, at 2 minutes in the video below: https://www.youtube.com/watch?v=QmOF0crdyRU Norepi, Epi and dopamine were all increased with cold water exposure. Dopamine increased 250% over baseline and that increase was sustained after the exposure for up to 3 hours. The sweet spot is alert but calm. That was achieved via the cold exposure. Calm/alert state. Cold exposure can be equivalent to coffee without the jitters. Mnemonics: D Dopamine Drives Determination and motivation C Cold water exposure Calm/alert state At 42 minutes. Chocolate increases dopamine 150% for a few minutes. Sex increases dopamine 200%. Nicotine increases dopamine 250% for a few minutes. Same increase with cocaine. Amphetamine increases dopamine 10 times. Exercise, if you like it, increases dopamine 200%. If you don't like the exercise, dopamine does not go up. Postpartum depression can appear after every big win, not just labor. That lower mood can last a long time. It is due to lower baseline dopamine levels. At 55 minutes. Cold bath can counteract this because it may increase baseline dopamine level for at least a portion of the day. We all have dopamine set point. More on cold water exposure at 1 hr 30 minutes. Safety parameters: 30 to 40F degree water can put someone in the state of cold shock and they can die. Cold water exposure always causes release of epinephrine, even after you are cold-water adapted. Increase in epi and nor-epi is immediate. Dopamine levels increases slowly to the point of 250% over baseline. It takes 3 hours for dopamine to go back to baseline. How to deal with the cold in a peaceful manner: Relax in the cold, breathe slowly, widen your gaze - switch from portrait to landscape mode. At 1 hr 35 minutes. Velvet beans contain L-DOPA at 1 hr 58 minutes. Dopamine and prolactin work in push-pull fashion. Increase in dopamine is linked with lower prolactin.

First use of the hastag #MedTwitter was in 2009

2022-10-21T14:49:00.003-04:00

The first use of the hastag #MedTwitter was in 2009 by one of my accounts @DrVes, did not know about this until this year.

@blogborygmi "should the Twitter awards be a series of tweets" -Twitter structure is not suitable for that, although #MedTwitter can be used
— Ves Dimov, M.D. (@DrVes) January 6, 2009

Did you know that the first medical journal club on Twitter was started by an allergist/immunologist @DrVes? #MedTwitter: If you’re interested in connecting with the allergy & immunology community, try: #AIMedEd. We’d love to interact & learn from other specialties https://t.co/XblWN4zjdm
— Corinne Happel, MD, FAAAAI (@DrCorinneHappel) December 10, 2020

Tom Jones at 81, sings about aging on his new album

2021-06-27T07:00:00.001-04:00

NPR and Bob Boilen | June 7, 2021: "We're publishing this Tom Jones Tiny Desk (home) concert on his 81st birthday. It's a poignant moment in the life of a singer whose career spans 56 years and more than 100 million records sold; the passing of his wife, Linda, in 2016 after 59 years of marriage was devastating and resulted in the longest break between recordings of his career. But now Tom Jones is back with a new album, Surrounded By Time, and ready to share his deepest feelings, channeling songs by others with a voice still rich and muscular.

The songs on the album (and for this Tiny Desk) deal so eloquently with time and aging. Tom Jones sings Bob Dylan's "One More Cup Of Coffee" and going "down to the valley below." Then, he takes on Malvina Reynolds' folk tune "There's No Hole In My Head" and turns it into a fierce statement about being yourself.

When Tom Jones was 33, and after one of his infamous shows in Las Vegas, jazz composer Bobby Cole presented him with the song "I'm Growing Old." With lyrics including "I'm growing dimmer in the eyes / I'm growing fainter in my talk / I'm growing deeper in my sighs / I'm growing slower in my walk." Tom Jones didn't feel old enough to do it justice, but he held on to it. His performance here brought me to tears and is well worth the wait."

Middlescence = time between adolescence and senescence

2021-06-26T07:00:00.001-04:00

Middlescence is defined as the time between adolescence and senescence.

"It is a paradox of life that we do not begin to live until we begin to die. Death begins at thirty, that is, deterioration of the muscle cells sets in."

https://royalsocietypublishing.org/doi/pdf/10.1098/rsnr.2020.0008

From the video below: Life begins at 40: the biological and cultural roots of the midlife crisis | The Royal Society. In this lecture, Professor Mark Jackson, winner of the 2018 Wilkins-Bernal-Medawar Medal, explores a rich range of historical sources to argue that the midlife crisis emerged as a result of demographic changes, new biological accounts of ageing, and deepening anxieties about economic decline, political instability, rising level of divorce, and the impact of family breakdown on social cohesion.

Watch the Q&A here: https://youtu.be/q9erYW2KsUg