The Strait also ships vaccines.

Save the Children has a consignment of urgently needed medicines stuck at a supplier’s warehouse in India. The road route is closed due to conflict. The usual fallback — air freight — has just doubled in price due to jet fuel prices. The charity’s chief executive, Janti Soeripto, put the situation to NPR earlier this month: “The transport for the drugs is more expensive than the drugs themselves.” That sentence is the story this piece is about. Not the Strait, not the oil, not even the war. The slow, awkward arithmetic by which a maritime closure thousands of miles away ends up determining whether a child in Kandahar gets a vial of antibiotics.

What the Strait actually carries

Commercial activity through Hormuz remains around 90 per cent below pre-war levels, according to analysis from the Council on Foreign Relations. Pre-conflict, around 3,000 vessels transited the strait each month; the latest House of Commons Library figures put current traffic at roughly five per cent of that. The strait is partially open, partially closed, and oscillating depending on the state of the Lebanon ceasefire and which side has most recently accused the other of violating it.

The pharmaceutical reading of those numbers takes a different shape. The Gulf Cooperation Council region serves as a transit hub linking Africa, Asia, Europe, India and the United States, and its pharmaceutical industry, valued at $23.7 billion, relies on imports through Gulf airspace and the strait for around 80 per cent of its product. Most of what matters most moves by air, not by container ship. Wouter Dewulf, professor at the University of Antwerp and a specialist in pharmaceutical logistics, told Al Jazeera last week that 35 per cent of pharmaceuticals move by air, and around 90 per cent of life-saving pharmaceuticals and vaccines do. He estimates that 22 per cent of global air cargo flows are exposed to disruptions in the Middle East.

Why a closed sea lane raises the cost of a mosquito net

The mechanism is rarely intuitive. India, which produces almost half of US generic prescriptions, depends on the strait for around 40 per cent of its crude oil imports — and that crude is the upstream feedstock for the petrochemicals used in active pharmaceutical ingredient manufacturing. With oil trading above $100 a barrel, the cost of producing the ingredient rises before a single tablet has been pressed. Indian air cargo rates have climbed 200 to 350 per cent on some routes, according to industry analysis, and war-risk insurance premiums for vessels transiting Hormuz have, by some measures, surged more than 1,000 per cent since late February.

The exposure is not abstract. The US Pharmacopeia has flagged that 48 per cent of US amoxicillin oral suspension is produced in Jordan, alongside a quarter of doxycycline hyclate capsules — common antibiotics, sourced from inside the conflict’s regional footprint.

It travels further than that. Jean Kaseya, director-general of Africa CDC, told reporters earlier this month that fuel shortages are pushing up the cost of producing mosquito nets, which are made from polyester, which is made from petrochemicals, which depend on a sea lane currently being charged at over a million dollars a transit when it is open at all. Malaria control is now, by an unobvious chain of reasoning, also a Hormuz story.

And the medicines that can’t wait

Of all the downstream consequences, the cold chain is the most exposed. Vaccines, insulin, biologics, and cancer therapies must be maintained within a narrow temperature range, typically between 2 and 8 degrees Celsius. Most of those products move by air, not sea, and most of the world’s high-volume air corridors run through Gulf hubs that have been variously closed, struck or rerouted around. Prashant Yadav, senior fellow for global health at the Council on Foreign Relations and one of the leading specialists in the field, has pointed to the timing problem with characteristic clarity: cargo carriers need roughly a week and a half to recover for every week of suspended shipments.

The arithmetic compounds.

It is partly a structural constraint. Yadav has also noted that European airlines and the two African carriers that have stepped in are unlikely to add new cargo capacity, as the disruption might continue for a few more months. Capacity is not bought overnight, and the current ceiling is, more or less, the medium-term one.

The countries most exposed are those already short of a buffer. The European Union has a stockpiling mechanism. The UK has flagged the risk of medicine shortages within weeks, but holds some reserve. The United States ordered a six-month stockpile of essential medicines last year. Sub-Saharan Africa, by contrast, imports around 70 per cent of its pharmaceuticals and runs far closer to the wire — arriving at this moment as aid budgets across major European donors are repackaged as investment rather than grants. Routine immunisation in much of the region relies on Gavi-procured stock that travels through the same air corridors, and the cold chain in those settings was already fragile before any of this began. How long current buffers hold is a function of variables nobody is in a position to forecast confidently. Bob Kitchen, vice-president of emergencies and humanitarian action at the International Rescue Committee, who is based in Nairobi, told NPR that he had not seen a comparable convergence in his career — pandemic, Ukraine and the current crisis included. A UN-managed depot in East Africa is currently holding stocks bound for Sudan, Ethiopia and other acute crises that cannot be released.

Save the Children’s drugs are still in India. As of late April, the strait remains effectively closed despite a conditional ceasefire, with Iran and the United States locked in a dual blockade as Pakistan-mediated talks continue. France and the UK have signalled that they will lead an international defensive mission once a sustainable ceasefire holds. None of that gets a vial to Kandahar this week.

What is the longer-term lesson? Supply chain analysts have been writing it for years, and now have a vivid case in front of them. A global medicine system optimised for cost works only as long as nothing goes wrong in three or four key chokepoints. Hormuz is one. The Suez and the Bab al-Mandeb are others. The Panama Canal is a fourth. The system functions until it doesn’t, and the people who feel the failure first are rarely the people the system was designed for.

Soeripto’s sentence is worth reading again. The transport for the drugs is more expensive than the drugs themselves. It is not, on its face, a sentence about war or oil or even shipping. It is a sentence about who, in a system held together by chokepoints, ultimately pays the bill. The strait will reopen. The arithmetic — and the question of who absorbs it — will not.

The post The Strait That Ships the World’s Vaccines appeared first on Medika Life.

From court decisions, recent analysis challenging vaccine skepticism polling results, and congressional testimony, the past month reflects a vindication of the value of immunization, scientific advancement and plain old common sense over ideology-based medical beliefs untethered from clinical evidence.

It would be nice to think that cooler heads have prevailed and we are seeing a return to science-backed decisions guiding American vaccine policy. But the reality is that a resurgent defense of immunization practices may be driven by two bigger forces: measles and midterms.

As I wrote five years ago, disease can be a powerful change agent. Thanks to the ultra-high effectiveness of the measles vaccine to prevent measles outbreaks, an entire generation of kids, parents and healthcare providers had never seen the disease or knew what kind of devastation it could bring. With measles out of sight and out of mind, it was easy for a small band of vocal critics to cast doubt on the value of the measles vaccine. Instead of building on a culture of collective action against disease, we allowed that small band of critics to grow into a chorus of public health freeloaders.

Measles had other ideas. With our weakening herd immunity – a result of declining vaccination rates – it didn’t take much for the virus to quickly reintroduce itself. Since the start of the year, there have been more than 1,700 cases of infection across 19 outbreaks throughout the country. We haven’t seen case numbers this high in 35 years. And if the deaths of American children from measles aren’t tragic enough, we are now on the verge of losing our status of officially eliminating measles. As a preeminent leader in immunology science, it is a startling embarrassment for the U.S. to accept this public health defeat.

Americans of all political stripes now seem to be paying attention. Following a decade of significant decline in vaccination, particularly among Republicans, there now is a push to back away from hardline anti-vaccine rhetoric ahead of the midterm elections. It’s easy to see why: at a time when measles outbreaks are a highly visible example of failed policy by the incumbent ruling party, politicians are not willing to risk being associated with practices that are out of step with the direction in which most U.S. voters want to go.

It’s telling that 66% of MAGA voters support vaccination as a requirement for kids to attend school. The measles outbreak has done a lot to educate people on the value of vaccines, which may be one reason why last week’s congressional testimony by RFK Jr., in which he was forced to admit that the measles vaccine is both safe and effective, and the timely appointment of Dr. Erica Schwartz, a physician and vaccine supporter, to lead the CDC may reflect the political liability posed by alternative vaccine doctrine in the months leading up to the midterm elections.

With growing distrust in federal vaccine messaging, there is a vacuum of credible sources for Americans to turn to for vaccine guidance. That void may actually be an opportunity in disguise for vaccine communicators.

Health care providers, including pharmacists, are still the most trusted source for reliable vaccine information: 4 out of 5 Americans look to these professionals to provide the right mix of personalized, empathetic communication with credible safety and efficacy information. Their stories can carry the power of connection, compassion and candor that we need right now.

Vaccination may seem like a black and white decision for a lot of us, but health care providers know that many parents need help navigating the gray areas. How we tell those stories – and who tells them – is essential to strengthening the national conversation around immunization.

Working more closely together, vaccine makers, innovators in antibody science, medical institutions and non-profit advocacy groups can create more compelling, unified communications that reach people when they are closest to making immunization decisions. This can be done by leveraging the voices of medical professionals to convey the emotional value of protecting our children against preventable disease instead of defaulting to statistics-heavy, complex messaging; pulling those stories through in coordinated media and policymaker engagement; and linking back to credible research sources that feature more prominently in online searches.

If the current measles epidemic in the U.S. is a crisis of our own making, it’s our responsibility to leverage the harsh health and economic lessons from this experience. We must act, not for the political convenience of the midterm elections, but to create better, more durable immunization policies and communications that again can unite Americans against our common disease enemies.

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Over time, it becomes evident that the decisions made in boardrooms carry their greatest weight in those very moments. It would take years to understand it fully, but these moments were not isolated. They were the foundation for something I would later try to give voice to.

The Day the Ordinary Disappeared

In January 1975, I was traveling through Paris on my way to the United States. What should have been a routine journey became something else entirely. Terrorists fired two RPG shells at our plane. They missed us but struck a Yugoslav Airlines JAT aircraft on the tarmac nearby.

The randomness of it all was almost impossible to process. One moment, you are a traveler moving through the world, the next, you are told to hug the floor of the aircraft, confronted with how easily that world can be altered or taken away. I did not have the language for it then; however, I carried the feeling forward. Life is not guaranteed. It is a gift given to us to deploy.

In 1978, I was leading the first Think Tank Peace Mission to Egypt and Israel. There were no direct flights between the two countries. From Cairo, we flew to Cyprus, then to Tel Aviv.

An Air Cyprus flight had landed just before ours. It was overtaken by terrorists. An Egyptian Entebbe-like rescue was attempted. It failed. When we landed hours later, the aftermath was still there — the remains of the Egyptian military C-130 sat on the tarmac, destroyed and covered. It reinforces the adage, “that timing is everything.”

You do not process it fully in the moment. You carry it. An appreciation for what lies beyond our control. A respect for those who act with purpose, regardless of outcome. An understanding that we plan for the future, yet we live in the moment.

Years later, during my military service as a paratrooper and combat medic, that lesson was no longer abstract. It was immediate, urgent and often unfolding before me. I served six frontline combat tours in Lebanon, in places where the noise of conflict was constant and the margin between survival and loss was measured in inches.

I tended to friends and foes under fire. In those moments, there was no room for theory. Care was not a matter of courage or a concept; it was an instinctive action. Communication was not a strategy; it was survival. A word, a look, a clear instruction could steady someone, guide them and save them.

Where Care Is Action, Not Theory

War has a way of stripping away everything except what matters most. You see clearly how dependent we are on one another. You understand that courage is not the absence of fear; it is the determination to act despite it. You learn that presence, simply being there for another person in their most vulnerable moment, is one of the most powerful forms of care.

I thought I understood risk. I thought I had come to terms with uncertainty. Then life reminded me again.

On a flight to visit my parents in the United States, the Tower Air jet I was on caught fire over the Atlantic. Two engines on the left side were burning. We needed to find a place to land quickly or hit the ocean. There is a particular kind of silence that fills a plane in that moment. It is not panic. It is something deeper, more introspective. You feel time stretch. You think about the people you love. You consider what has mattered and what has not.

As we made our emergency landing in Gander, Canada, I remember not relief first, but reflection. Once again, life had placed me in a moment where its fragility was undeniable.

These experiences did not turn me away from the world. They pulled me closer to it. They shaped how I see people, how I listen and how I respond. They taught me that every interaction carries weight, that every conversation can matter more than we realize.

In recent years, I have traveled to Ukraine annually before and during COVID and now during the war, supporting friends and spending time in a small community facing circumstances most of us can only imagine from afar. There, I saw the same truths I had encountered earlier in life. Community becomes everything. Information becomes lifeblood. People look to one another not only for physical support, but for clarity, reassurance and meaning. Even in the darkest conditions, communication is not secondary to care. It is part of care.

Most in the business world know me through my work at FINN Partners as a health communicator, through my writing, speaking and advocacy as a champion of health innovation and a more human-centered health system. They see my professional journey. What they do not always see is the foundation beneath it. Decades of lived experience that have reinforced, time and again, that life is precious, that it can change in an instant and that how we show up for one another in those moments defines us.

At FINN Partners, I have found a community of colleagues who reflect these same values. There is an understanding that our work carries responsibility, and that we are capable of more when we challenge ourselves to rise to it. It is a culture that encourages each of us to think beyond the immediate and contribute to something more enduring.

That understanding became even more personal through my family. My wife and I have walked alongside our child as she navigates the complexities of a rare disease. There are highs and there are lows. There are moments of hope and moments of uncertainty. In those experiences, I have seen health care from another vantage point, not as a cohesive system, but as a series of human interactions that can either comfort or compound the challenge.

When you are a parent in those moments, you listen differently. You look for clarity in every word. You hold on to empathy when it is offered and you feel its absence when it is not. You come to appreciate that communication in health is not an accessory. It is essential. It shapes understanding, trust and the ability to move forward.

The Human Thread Through Every Moment

All of these experiences converge into a single, enduring belief. Communication is not separate from care. It is how care travels along its continuum. There are moments when that truth reveals itself outside the settings we expect.

On a transatlantic flight in 2001, turbulence turned severe. At one point, a call came over the intercom: “Are there any doctors aboard?” No one responded. Minutes later, the request broadened to “any health professionals.”

My wife looked at me and quietly suggested I press the call button.

I was escorted to a passenger, pale and wrapped in a blanket. He had lost and regained consciousness. I introduced myself warmly and began with simple questions to assess his awareness. His name. The President of the United States. The day we had taken off. He answered each one without hesitation. His vitals were stable.

I explained that I was not a physician, but a former military EMT. Given the turbulence and the length of the flight, dehydration and stress were likely contributors. I reassured him and suggested that he follow up with his physician upon landing and, if he needed me, not to hesitate to hit his call button.

As I returned to my seat, a man two rows behind called out, “I’m a neurologist. I would have handled that exactly as you did.”

It was meant as an affirmation. I received it that way. Yet it lingers differently. In that moment, the instinct to act had been replaced by the comfort of waiting. The systems we build, even when grounded in expertise, can condition us to hesitate when action is needed most.

In moments like these, care is not a title or a credential. It is the willingness to engage, communicate, and act.

Across the health ecosystem and in responsible business settings, success is often measured by growth, scale and financial performance. These are necessary markers of progress. They enable innovation, access and reach. However, there is a deeper measure that often goes unspoken. When we understand our role within the continuum of care and recognize the connection between balance-sheet decisions made in boardrooms and people’s experiences felt at the bedside, our work takes on greater meaning. It moves beyond what can be counted to what ultimately counts.

Over time, I came to understand that moments are not separate. They are connected. Each one revealing, in its own way, what happens when people are seen, heard and cared for, and what happens when they are not.

That understanding became Healing the Sick Care System: Why People Matter.

A life of observing, listening, engaging and caring was the kindling. The moments themselves were the spark. Together, they revealed a simple truth: when we lose sight of people, the system falters. When we honor them, it begins to heal.

That truth asks something of us.

It is not simply about words. It is about presence. It is about accountability. It is about the choice to act when action is needed. This is how humanity shows up in systems, and how those systems, in turn, earn the trust of the people they are meant to serve.

The post The Moments That Shape Us: Why Life and People Matter Most appeared first on Medika Life.

One example would be pain. Research published in the Journal of Neuroscience found that when people didn’t know how much a painful heat stimulus would hurt — when they watched a group of others who disagreed wildly about it — they felt more pain than when the group agreed. The heat itself didn’t change. Only the uncertainty did. That single finding opens a door onto something much bigger: the way the brain interprets incoming signals doesn’t just affect physical pain. In fact, it shapes every experience, every emotion, and every belief we form about the world around us.

The Brain Is a Prediction Machine, Not a Camera

Your brain doesn’t work like a camera, passively recording what’s in front of it. It works more like a detective — making its best guess about what’s happening based on past experience, context, and whatever signals it can pick up in the moment. In fact, this is the way AI works the same way because it guesses what you intend when you are dictating to it. That’s based on what you have known to use before. It’s not original; it’s from something you’ve already said or thought.

Scientists call this predictive processing. Fancy words for something that’s simple. The brain is constantly generating a model of reality and checking it against what the senses report. Most of what you experience isn’t raw sensory data. It’s the brain’s best guess, already processed and interpreted before you’re even aware of it.

This has enormous consequences. Because your brain fills in gaps with guesses, your perception of any situation is shaped as much by what you expect as by what’s actually there. Research on how emotions are built in the brain confirms this same pattern. Feelings aren’t simple, automatic reactions that arise out of nowhere. They’re constructed — assembled by the brain from past learning, bodily signals, and whatever the surrounding context suggests is happening — all woven together into something that feels completely immediate and real. Fear, hope, dread, excitement — none of these are just responses to the world. They’re interpretations. And like all interpretations, they can be mistaken.

This might be unsettling to hear. But it’s also genuinely freeing, because it means your perception of reality isn’t fixed. It can be trained.

The Brain’s Thumb on the Scale

Here’s the catch. The brain doesn’t interpret experiences evenly. It has a strong, built-in bias toward the negative. This explains why negative information is so strongly entrenched in our minds. Negative information is stored more vividly in memory and carries more weight in the decisions we make than equivalent positive information does. This isn’t a character flaw. It’s an evolutionary feature.

Our ancestors survived by treating ambiguous situations as dangerous — if a rustle in the bushes might be a predator, it was safer to assume the worst and run. The cost of a false alarm was low; the cost of missing a real threat could be fatal.

In modern life, that same wiring creates serious problems. We’re exposed to more alarming information than any previous generation — not necessarily because the world is more dangerous, but because we carry a device in our pockets that streams us the worst of humanity around the clock. Research on how news consumption affects perception found that a steady diet of threatening content actively cultivates a distorted view of the world, pushing people to overestimate danger (The Scary World Syndrome) and feel a constant sense of impending doom that doesn’t match their actual circumstances.

In one study on risk perception during a health crisis, people overestimated their personal risk of dying from a disease by more than 270 times the actual probability. Their brains weren’t computing risk. They were amplifying fear.

Uncertainty makes all of this worse. Much worse. The same research that revealed how uncertainty increases physical pain also showed that not knowing what to expect activates a specific brain region — one that amplifies the intensity of an experience, for better or worse. And this effect isn’t limited to physical sensation.

Research on stress and health outcomes has found that the threat of losing a job can actually be more damaging to physical health than losing it outright, because the brain treats an uncertain threat as something to brace against continuously — a draining, exhausting posture that takes a real toll on the body over time. Sounds like burnout, doesn’t it? It isn’t just pain that uncertainty turns up. It’s almost everything the brain interprets as potentially threatening, which, given the negativity bias, covers a whole lot of ground.

What makes this particularly important in today’s world is that this feedback loop isn’t passive. The beliefs we form — shaped by perception, fear, and repeated exposure to alarming information — circle back and filter what we’re willing to notice next.

Research on how beliefs affect the brain’s processing of sensory information suggests that what we expect to see and feel actually controls what reaches our conscious awareness. Our beliefs aren’t just conclusions we reach. They become part of the filter that determines what evidence the brain even considers. This is like throwing the wheat away with the chaff.

What You Can Actually Do About It

Understanding how the brain constructs experience isn’t just interesting. It points directly to what we can do differently.

The first step is recognizing that your interpretation of a situation isn’t the same thing as the situation itself. When you feel dread about a conversation you haven’t had yet or are certain something’s going to go wrong, your brain is filling in a gap with a guess — shaped by past experience, current stress, and the negativity bias — not delivering a reliable preview of the future. That awareness alone, when you can genuinely hold onto it, changes your relationship with the feeling. You don’t have to argue with it or push it away. You just don’t have to treat it as truth.

The second step involves what you feed your brain. Because the brain builds its models of the world out of the patterns it encounters most often, the information environment you live in genuinely shapes how you perceive things — including things that have nothing directly to do with that environment. Heavy exposure to alarming content trains the brain to scan for threats even in neutral situations. Seeking out different perspectives, sitting with ambiguity instead of rushing to resolve it, and spending time in environments where uncertainty is met with curiosity rather than alarm — these gradually reshape the models your brain is running.

The third step is learning to treat uncertainty itself differently. That’s harder than it sounds, because not knowing really activates stress responses that narrow attention and make everything feel more urgent and more threatening. But evidence consistently shows that people who can stay open when they don’t know what’s coming — who can resist the pull toward premature conclusions — think more flexibly, solve problems more creatively, and make sounder decisions. The ability to hold more than one interpretation in mind at once isn’t a fixed personality trait. Like any other cognitive skill, it responds to practice.

None of this is an argument for forced optimism or pretending that hard things aren’t hard. Negative emotions carry real information and serve genuine purposes when they’re in proportion to what’s actually happening. The goal isn’t to replace one distortion with another. It’s important to notice when the brain’s interpretive machinery is running hot — turning not-knowing into catastrophe, amplifying uncertainty into doom — and to remember that what feels like reality is always, to some degree, something the brain has made.

The world you live in isn’t the world as it is. It’s the world your brain has built for you, piece by piece, out of everything it expects, fears, and has learned to look for. That’s not a reason for despair. Actually, it’s an invitation to get curious about the builder — and to ask whether the story it’s been telling you still has to be the only one.

The post Reality Isn’t What You Think: It’s How Your Brain Builds Everything appeared first on Medika Life.

Perhaps we should not have been surprised. He was always on the go, ate healthy meals, never smoked, and enjoyed being with friends.

He always seemed calm and collected, so on his 101st birthday, I asked how he had managed his stresses — his ship, the Canberra, was torpedoed during WWII with the loss of many of his buddies, and he was nearly killed. He had lost his daughter to cancer when she was forty, and his wife to cancer when she was 67. Yes, he had grieved greatly, but somehow, he was resilient and came back strong each time. He had been very sad but lived through his grief and always appeared unperturbed. “Well,” he said, “I guess I just let stress roll off my back.”

Organs decline about 1% per year.

One of the most important things that happens with aging, sort of like a car, “old parts wear out.” Most organ functions decline by about one percent per year. Of course, there is great variation from person to person, year to year, organ to organ, but 1% is a pretty good average to consider. We usually think of a person being in their prime through at least age 60. In many ways, that is correct, but you may be surprised to learn that the 1% decline starts in early adulthood and continues throughout life, speeding up as we age. Fortunately, most of our organs have significant redundancy so that we can tolerate these declines without any appreciable impact. But eventually, the decline may get to the point where we have a functional impairment that can be serious or at least impair our day-to-day activities.

I recently turned 84. I don’t feel “old,” but I do know I can’t do everything I used to do, or at least not as quickly. My hearing is less; my vision is reduced. My muscle mass and strength are definitely much less than they were in the recent past. My balance is OK, but not as good as it used to be, and so on. It has been a set of changes that came slowly at first but are now progressing faster. I always enjoyed splitting wood for the fireplace. I kept a woodshed filled with wood split and logs drying for a year before splitting. As time went on, I realized that I couldn’t keep at it for as long before wanting to take a break. As one friend in his early 80s told me, “I was fine until about age 78, and then it seemed that the aging process was suddenly there and moving fast.” Those declines, developing “under the radar” for decades, had accelerated and become overt.

The 1% Per Year Decline, Author’s image

Hearing decline begins at about age 25 but is not noticed until much later. Many of you will need reading glasses by age 40, even though you have had excellent vision for years; cataracts may occur later. Balance starts its inevitable decline early, although it, too, will not be noticed until much later. Meanwhile, internal organs, including the heart, lungs, and kidneys, are slowly declining, and so too is brain function, especially cognition.

This normal aging process of old parts wearing out is universal and is progressive, but you can slow it and sometimes reverse it, at least partially. Let’s use bone mineral density (BMD) as an example. BMD is easily measured to demonstrate the sturdiness of our bones — how strong they are. We start life with cartilage rather than bones. As we grow from toddlers to children to teenagers, calcium and other minerals, along with a protein-collagen matrix, are laid down in our bones, and they become increasingly strong, reaching a peak around the age of twenty. Once that age and that peak are reached, it can’t go up any further — that’s it. Then there is a plateau, and at about age thirty to forty it starts to decline at a rate of about 1% per year. At age twenty, men’s bone mineral density is, on average, higher than women’s.

Nevertheless, for women as for men, the decline is about one percent per year. Menopause changes this; the rate of loss increases to perhaps three percent per year for a few years and then returns to the one percent average decline until reaching osteopenia and then osteoporosis. There are three important points to consider. If you live long enough, your bone mineral density will decline to a level where, if you fall, a bone fracture becomes more likely. Since women start at a lower level and because they have this increased loss of BMD during menopause, they’ll reach that fracture threshold in life earlier than men. Since women tend to live longer than men, in total, more women than men will have a fracture at some point in their lives. We might just say this is one of the risks of living longer.

But why will you fall? Because your balance mechanism is likewise declining, and your muscle mass and strength are not as capable of “catching” your fall. The three combine together in a very negative manner!

Muscle mass and strength decline in a similar fashion, resulting in what doctors call sarcopenia. Most people lose perhaps 30% of their muscle mass between ages 50 and 70, and the loss continues at an even faster rate thereafter. Older individuals who exercise find it takes more effort to maintain their muscle mass and strength, but regular exercise and good nutrition have a significant beneficial impact and slow the process considerably.

Cognitive function is another example; your brain loses some of its abilities as you age. Cognitive abilities and brain volume do not decline in lockstep but do have a clear relationship. A fascinating study published in the journal Nature in April 2022, pulled together 123,984 MRI scans taken at over 100 institutions from 101,457 individuals ranging from 115 days post-conception to 100 years of age — from fetuses to centenarians. At the age of three years, the brain had reached 80% of its maximum size. The gray matter, which consists of the actual brain cells, reaches its maximum by about age 6, whereas the white matter, the inner connections between brain cells, does not reach its peak until the late 20s. The decline in brain volume thereafter is slow but accelerates after about age 50. These changes can be seen in the figure, which shows the growth trajectories of gray and white matter. The charts show volume (in mm3) across age, beginning before birth and ending at about 100 years.

If you are over 65, you have probably noted that you can’t memorize as well, recall names as quickly, etc. When I was in medical school, memorization was relatively easy; not so today! This is normal. This loss of cognitive function over time should not be confused with the disease Alzheimer’s. Nearly everyone who lives long enough will suffer from some cognitive decline, but only some will develop Alzheimer’s. As with BMD, you reach your peak cognitive function around age twenty; it plateaus for about 10 years, then starts that slow decline. Given the great redundancy in your brain, it is not noticeable for some time. Eventually, you reach a functional threshold where your cognitive function begins to impair your ability. This becomes more apparent when an older person is engaged in highly technical activities, very fast-paced activities, or stressful situations (emotional, physical, or health-related). Those cognitive challenges are less apparent in highly familiar situations.

This 1% annual loss is normal. No, it is not an exact number, nor is it the same for every person or every organ, nor is it exactly 1% in the same person at all times. But 1% is a good proxy for what is happening throughout your body throughout adulthood and into your elder years.

Slowing the aging losses

Here are some suggestions to slow that steady decline in functions. If you start at age twenty with very strong bones (i.e., a high BMD), then you have a longer way to go down before reaching that level of potential bone fracture from a fall. Perhaps too late for you if you are older, but encourage your children and grandchildren to eat a good diet, play/exercise daily, preferably outdoors, manage their stress, and get a good night’s sleep. And for their brains, do just the same (quality food, plenty of exercise, sound sleep, and managed stress) as for their other organs. Then, continually challenge their brains with new learning. Those with more years of schooling will start out with greater reserves, so the 1% decline will take much longer to cause difficulties. Muscle mass and strength are similar. Encourage them to build it up now as a teen. No need to be a muscled bodybuilder, but regular exercise and a good diet will mean more strength at the start of that long decline.

Most people seem to accept that, with age, comes a decline in function. “That is just what happens when we get older.” They may not like it, but they do not realize that they can substantially modify the downhill course. You can slow this continuing loss of body functions, including cognitive decline, and you can start at any age. It is never too late. It is not hard to do, and it does not cost money, but it does take time and persistence. It is all about how you move, what you eat, how you manage chronic stress, get adequate sleep, avoid tobacco, not too much alcohol, plus challenge your brain and keep socially engaged.

Stephen C Schimpff, MD, MACP, is a quasi-retired internist, professor of medicine, former CEO of the University of Maryland Medical Center, and author of Longevity Decoded — The 7 Keys to Healthy Aging, and is co-author with Dr. Harry Oken of BOOM — Boost Our Own Metabolism

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Suicide remains one of the leading causes of death in the United States, with young people particularly affected. These are not abstract figures. Each life lost represents a story interrupted, a family altered, and a community left to navigate grief and unanswered questions. Public health requires that we confront this reality not only with data, but with a commitment to building systems that respond to human experience in real time.

From Fragmentation to Continuity Across the Lifespan

For many years, suicide prevention in the United States has been shaped by dedicated organizations working across research, advocacy, education, and crisis response. The American Foundation for Suicide Prevention has played a central role in advancing scientific understanding, funding critical research, and advocating for national policy changes that recognize suicide as a preventable public health issue. Its work has helped elevate awareness, influence legislation, and bring suicide prevention into mainstream health conversations.

The Jed Foundation has taken a complementary path, focusing on upstream prevention by strengthening emotional health among adolescents and young adults. Through partnerships with high schools, colleges, and universities, JED has worked to embed mental health support within the environments where young people live and learn. Its programs have helped institutions move beyond reactive approaches toward more proactive models that build resilience, identify risk earlier, and foster a sense of belonging.

Each organization has demonstrated meaningful impact over time. Each has contributed to saving lives and shaping how mental health is understood. Their efforts, however, have largely operated within distinct domains. One has advanced national research and advocacy. The other has transformed youth and campus mental health systems. Both have addressed critical points along the continuum of care, yet the broader system has remained fragmented.

The decision to merge as equals reflects a recognition that suicide prevention cannot be addressed in silos. Public health challenges of this magnitude require continuity across the lifespan. Early emotional support, community-based intervention, crisis response, and long-term recovery must function as part of an integrated system rather than a series of disconnected efforts.

Connection, Not Scale Alone, Defines Public Health Impact

Public health is often described through infrastructure and policy. Those elements are essential, yet they are insufficient on their own. Public health is ultimately about connection. It connects evidence to action, systems to individuals, and care to lived experience.

Suicide prevention sits at the intersection of these connections. Risk is influenced by social conditions, access to care, stigma, and the environments in which people interact. Protective factors such as trusted relationships, purpose, and community support can alter outcomes when they are present and accessible. The challenge has not been a lack of understanding. The challenge has been delivering that understanding in ways that are coordinated, equitable, and sustained.

A unified organization has the potential to bridge long-standing gaps. It can align research with real-world application, ensuring that scientific insights inform programs that reach people earlier. It can connect youth-focused interventions with broader public awareness efforts, creating continuity rather than gaps as individuals move through different life stages. It can also strengthen advocacy by bringing together complementary perspectives into a more cohesive national voice.

Scale introduces both opportunity and responsibility. A larger organization can mobilize resources, influence policy, and expand reach. Public trust, however, is built in local and personal interactions. The effectiveness of this merger will depend on its ability to maintain proximity to individuals and communities while expanding its national impact. Size alone does not create connection. Intentional design does.

The combined organization is expected to operate with substantial resources, which creates an opportunity to accelerate progress. Resources must translate into accessible programs, stronger partnerships with schools and health systems, and tools that enable families, educators, and clinicians to act with confidence. Public health systems succeed when they reduce friction for those seeking help and make support visible before a crisis emerges.

This moment also offers a broader lesson for the health sector. Fragmentation is not unique to suicide prevention. Across chronic disease, health equity, and digital health, organizations often operate with shared purpose but limited alignment. The willingness of these two organizations to merge reflects an understanding that structural change may be necessary to achieve meaningful outcomes.

The integration process will require thoughtful leadership and a clear sense of purpose. Combining cultures, programs, and strategies requires discipline and humility. Success will not be measured by organizational scale or visibility. It will be measured by whether fewer individuals reach a point of crisis without support and whether more people experience a system that feels connected, responsive, and human.

Suicide is often described as preventable, which places responsibility on the systems designed to address it. Prevention requires more than awareness. It requires intentional coordination, early recognition, and sustained engagement across the continuum of care.

This merger does not resolve the complexity of suicide prevention. No single organization can. It does represent a meaningful step toward greater alignment in how society responds to one of its most pressing public health challenges. Connection is not an abstract ideal in public health. It is the foundation upon which progress depends.

For more information about both organizations, visit these organizations’ websites at afsp.org and jedfoundation.org. 

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Unfortunately, the system has frequently failed to live up to that ideal. I learned that from having a conversation with Matthew Zachary, CEO of We the Patients, a patient advocacy organization. In a recent LinkedIn post, in fact, Mr. Zachary wrote this:

Prior auth takes longer than the time between scan and surgery. Drugs get denied because someone flipped a spreadsheet cell from green to red. Surprise bills show up because the hospital was in network but the anesthesiologist’s LLC was not.

None of this is a glitch. This is the product working exactly as designed. Built to maximize profit and gaslight us into believing WE are the problem for not “navigating” it better.

This is horribly unfortunate, and Matthew Zachary is harnessing his anger at this reality to make a difference through his activism.

There are indeed a lot of problems with the current healthcare system, and fixing them will take a lot of time, effort, and work. And there is one thing we physicians can do to immediately help make things better for the patient: make an intentional effort to overwhelm our patients with compassion.

No one wants to be sick. No one wants to willingly engage with the healthcare system. And when they do, it is because there is a threat to their life and limb.

With the way the current insurance system is set up, it is not uncommon that patients face myriad barriers and pain points to get the care they need. I myself have experienced these barriers and pain points with my own healthcare and that of my family. It can add more stress to an already extremely stressful situation.

How can we help mitigate this stress? Overwhelm our patients with kindness and compassion. Give them a big smile; hold their hand; tell them that we will do everything to help them feel better.

And if they will not get better; if our patient is going to die, then we need to do everything in our power to ensure a death with dignity, comfort, and ease.

Aren’t we supposed to be doing this all along? Most definitely. And, as is the norm of the human condition, we tend to forget amid the drudgery of the day in and day out of working in healthcare and dealing with the very same barriers to care and pain points with which our patients are also dealing.

That’s why I’m so grateful for Matthew Zachary. He has the courage to share his incredible story of illness and recovery and his anger at the system that did not help promote his healing to try and do something about it.

And his story, and his activism, was a potent reminder for me to do all that I can to make my patients in the ICU as comfortable as possible, to make them feel as good as a critically ill person can possibly feel. Will I fail at times? Yes. But I pray that, for the rest of my career, I will keep trying to overwhelm my patients and kindness and compassion. That’s what I can do to help the healthcare system today.

Listen to the entire conversation: https://www.healthcaremusings.com/we-the-patients-are-really-pissed-off-my-conversation-with-matthew-zachary/

The post How Every Doctor Can Improve The Healthcare System Immediately appeared first on Medika Life.

Early in the book, Nosta writes, “The solved can never touch the whole.”  That line lingers. It captures the essence of his argument. AI can solve, generate, synthesize, and accelerate. Yet something about the human experience of thinking, the struggle, the friction, the meaning-making, exists beyond resolution.

This tension defines the book. It is not anti-technology. Nosta is deeply engaged with AI and candid about its value. He describes large language models as tools that “move faster and connect more disparate concepts than our minds could ever manage on their own.”  He is equally clear that this capability introduces a subtle risk. We may begin to outsource not just tasks, but thought itself.

That distinction matters more than many may be willing to admit.

From Tools to Thought

One of the most compelling contributions of The Borrowed Mind is its framing of AI not as the next step in computing, but as a turning point in cognition. Nosta traces a clear arc. Gutenberg unlocked words. Google unlocked facts. AI, he argues, is unlocking thought. 

That progression is elegant, yet also unsettling. Words and facts could be externalized without fundamentally altering the structure of human reasoning. Thought is different. It is intimate. It is identity. It is how we become.

Nosta reminds us that thinking once required effort, a type of natural friction that created sparks of innovation. “The distance between question and answer created space for our discernment.”  Within that space, judgment formed, curiosity deepened, and understanding took root.

AI compresses that distance. It removes friction. It delivers coherence with remarkable speed.  One of the book’s most important insights emerges here. Coherence is not the same as understanding.

Nosta introduces the concept of “anti-intelligence,” describing it as “fluency without understanding. Coherence without experience.”  AI does not think. It mirrors the structure of thinking. It produces language that resembles reasoning without sharing its origin.

In health, where evidence, interpretation, and judgment must coexist, this distinction is not academic. It is operational. It shapes how clinicians trust tools, how leaders deploy them, and how patients ultimately experience care.

The Seduction of the Socratic Mirror

One of the most original sections of the book is Nosta’s description of the “Socratic Mirror.” He draws a parallel between classical dialogue and modern AI interaction. Socrates asked questions to surface the truth. AI, in a different way, reflects our thinking back to us, reframed, extended and sometimes clarified.

Nosta writes that the model “…does not tell me what to think but creates the conditions under which my own thinking could deepen.” This is where the book moves beyond critique and into possibility.

Used well, AI becomes a cognitive partner. It expands perspective, accelerates exploration, and invites iteration. In clinical research, patient engagement, and system design, this capacity holds enormous promise.

Nosta does not romanticize the relationship. He recognizes its asymmetry. The model has no interior life. It does not ponder. It does not carry consequence. It does not bear responsibility. That responsibility remains human.

Rethinking the Fear of Displacement

A persistent anxiety runs beneath every conversation about AI. Many fear it will become a job slayer, a force that displaces rather than elevates human contribution. That concern is understandable, yet not new.

Every meaningful advance in technology has reshaped how people work. The wheel did not eliminate labor. It redefined movement. The stethoscope did not replace physicians. It extended their ability to listen and interpret. The tollbooth transponder did not end transportation roles. It changed the flow and focus of human involvement. Each innovation shifted roles, demanded new skills, and expanded what people could do.  AI belongs in that lineage.

What distinguishes this moment is not the elimination of work, but the redistribution of cognitive effort. The real risk is not that machines will think for us, but that people may become less inclined to think for themselves. Nosta’s warning is subtle yet profound. Surrendering curiosity, judgment, and reflection to systems that generate answers with ease risks dulling the very faculties that define human intelligence.

This is why The Borrowed Mind is such an important read at this moment. It does not dismiss concerns around job displacement. It reframes it. The central challenge is not protecting roles as they exist today, but strengthening the uniquely human capacities no system can replicate. Creativity, discernment, ethical reasoning, and the ability to navigate ambiguity are not diminished by AI. They become more essential.

The book offers reassurance without complacency. The future of work will favor those who sharpen their thinking, engage deeply with ideas, and remain active participants in their own intellectual development. The machine is not the adversary. Neglecting the development of one’s own mind is a danger.

Composite Intelligence and the Limits of the Machine

Nosta introduces “composite intelligence” to describe the interaction between human and machine cognition. Composite does not mean blended into sameness. It means distinct contributions working in concert. The model brings speed and breadth. The human brings depth.

This triad becomes one of the most useful frameworks in this book. AI excels in velocity and scale. Depth, the slow transformation of understanding, remains human. As Nosta writes, “Models do not ponder.” 

In health, this distinction is profound. Data can inform. Algorithms can suggest. The act of deciding, especially in moments of uncertainty, requires something more. It requires what Nosta elevates as the defining human contribution. Virtue.

Drawing on Aristotle’s concept of practical wisdom, Nosta reminds us that judgment is forged through experience, consequence, and accountability. A model can generate options. It cannot live with outcomes.

This is where the book resonates most deeply for those working in health. Intelligence is becoming abundant. Discernment is becoming scarce and, therefore, more valuable.

The Risk of the Borrowed Mind

The book’s title is not metaphorical. It is a warning. Nosta argues that as engagement with AI deepens, internal dialogue begins to change. The model becomes a cognitive tuning fork, subtly shaping how questions are framed, how ideas are explored, and how answers are anticipated. This dynamic is not inherently negative. It can elevate thinking, accelerate learning, and make complex domains more accessible. Dependency remains the concern.

Reliance on generated thought risks weakening the muscle of original thinking. Access can be mistaken for understanding. Individuals may become, in Nosta’s words, “cognitive clones.” 

This concern is particularly relevant in health ecosystems already strained by time, complexity, and administrative burden. The temptation to offload cognitive work will be strong. The discipline to remain intellectually engaged will be essential.

A Book About AI That Is Not About AI

What makes The Borrowed Mind stand apart is that it is not ultimately about technology. It is about humanity. Nosta writes, “This book is not really about technology. It is about you.”  That idea anchors this work.

Readers are challenged to consider what it means to remain “the authors of our own minds.”  Not passive recipients of generated insight, but active participants in meaning-making.

This question sits at the center of the health ecosystem’s future. As AI becomes embedded in clinical workflows, research, and patient engagement, the issue is not whether it will improve efficiency. It will.

The deeper question is whether it will deepen humanity or dilute it. Will it create space for clinicians to think more deeply, connect more meaningfully, and act more wisely? Or will it create a system that values speed over reflection, output over understanding, and coherence over truth?

Nosta offers no simple answers. He offers a framework for asking better questions.

The post “The Borrowed Mind” – Reclaiming Thought in an Age That Wants to Do It For Us appeared first on Medika Life.

This story also ran on NBC News. See below.

West Virginia’s Public Employees Insurance Agency enrolls nearly 215,000 people — state workers, as well as their spouses and dependents. The new law, which will take effect June 10, will allow plan members who have been approved for a course of treatment to pursue an alternative, medically appropriate treatment of equal or lesser value without the need for another approval from the state-based health plan.

“This legislation is rooted in a simple principle: if a treatment has already been approved, patients should be able to pursue a medically appropriate alternative without being forced to start the process over again — especially when it does not cost more,” Gov. Patrick Morrisey said in a statement after signing the bill into law on March 31.

“This is about common sense, compassion, and trusting patients and their doctors to make the best decisions for their care,” he said.

Delegate Laura Kimble, the Republican from Harrison County who introduced the legislation, told KFF Health News the measure offers “a rational solution” for patients facing “the most irrational and chaotic time of their lives.”

From Arizona to Rhode Island, at least half of all state legislatures have taken up bills this year related to prior authorization, a process that requires patients or their medical team to seek approval from an insurer before proceeding with care. These state efforts come as patients across the country await relief from prior authorization hurdles, as promised by dozens of major health insurers in a pledge announced by the Trump administration last year.

The West Virginia law was inspired by Eric Tennant, a coal-mining safety instructor from Bridgeport who died on Sept. 17 at age 58. In early 2025, the Public Employees Insurance Agency repeatedly denied him coverage of a $50,000 noninvasive cancer treatment, called histotripsy, that would have used ultrasound waves to target, and potentially shrink, the largest tumor in his liver. His family didn’t expect the procedure to eradicate the cancer, but they hoped it would buy him more time and improve his quality of life. The insurer said the procedure wasn’t medically necessary and that it was considered “experimental and investigational.”

Related coverage

After Series of Denials, His Insurer Approved Doctor-Recommended Cancer Care. It Was Too Late.

Eric Tennant’s doctors recommended histotripsy, which would target, and potentially destroy, a cancerous tumor in his liver. But by the time his insurer approved the treatment, Tennant was no longer considered a good candidate. He died in September. Read More

Becky Tennant, Eric’s widow, told members of a West Virginia House committee in late February that she submitted medical records, expert opinions, and data as part of several attempts to appeal the denial. She also reached out to “almost every one of our state representatives,” asking for help.

Nothing worked, she told lawmakers, until KFF Health News and NBC News got involved and posed questions to the Public Employees Insurance Agency about Eric’s case. Only then did the insurer reverse its decision and approve histotripsy, Tennant said.

“But by then, the delay had already done its damage,” she said.

Within one week of the reversal in late May, Eric Tennant was hospitalized. His health continued to decline, and by midsummer he was no longer considered a suitable candidate for the procedure. “The insurance company’s decision did not simply delay care. It closed doors,” his wife said.

Had the new law been in effect, Kimble said, Tennant could have undergone histotripsy without preapproval, because it was a less expensive alternative to chemotherapy, which his insurer had already authorized. The bill was passed unanimously by the state legislature in March.

U.S. health insurers argue that most prior authorization requests are quickly, if not instantly, approved. AHIP, the health insurance industry trade group, says prior authorization acts as an important guardrail in preventing potential harm to patients and reducing unnecessary health care costs. But denials and delays tend to affect patients who need expensive, time-sensitive care, studies have shown.

The practice has come under intense scrutiny in recent years, particularly after the fatal shooting of a health insurance executive in New York City in late 2024. Americans rank prior authorization as their biggest burden when it comes to getting health care, according to a poll published in February by KFF, a health information nonprofit that includes KFF Health News.

Samantha Knapp, a spokesperson for the West Virginia Department of Administration, would not answer questions about the law’s financial impact on the state. “We prefer to avoid any speculation at this time regarding potential impact or actions,” Knapp said.

In a fiscal note attached to the bill, Jason Haught, the Public Employees Insurance Agency’s chief financial officer, said the law would cost the agency an estimated $13 million annually and “cause member disruption.”

West Virginia isn’t an outlier in targeting prior authorization. By late 2025, 48 other states, in addition to the District of Columbia and Puerto Rico, already had some form of a prior authorization law — or laws — on the books, according to a report published in December by the National Association of Insurance Commissioners.

Many states have set up “gold carding” programs, which allow physicians with a track record of approvals to bypass prior authorization requirements. Some states establish a maximum number of days insurance companies are allowed to respond to requests, while others prohibit insurance companies from issuing retrospective denials after a service has already been preauthorized. There are also a crop of new state laws seeking to regulate the use of artificial intelligence in prior authorization decision-making.

Meanwhile, prior authorization bills introduced this year across the country, including in Kentucky, Missouri, and New Jersey, have been supported by politicians from both parties.

“Republicans in conservative states see health care as a vulnerability for the midterm elections, and so, unsurprisingly, you’ll see some action on this,” said Robert Hartwig, a clinical associate professor of risk management, insurance, and finance at the University of South Carolina. “They realize that they’re not really going to get much action at the federal level given the degree of gridlock we’ve already seen.”

Last summer, the Trump administration announced a pledge signed by dozens of health insurers vowing to reform prior authorization. The insurers promised to reduce the scope of claims that require preapproval, decrease wait times, and communicate with patients in clear language when denying a request.

Consumers, patient advocates, and medical providers have expressed skepticism that companies will follow through on their promises.

Becky Tennant is skeptical, too. That’s why she advocated for the West Virginia bill.

“Families should not have to beg, appeal, or go public just to access time-sensitive care,” she told lawmakers. Tennant, who sees the bill’s passage as bittersweet, said she thought her husband would have been proud.

During Eric’s final hospital stay, Tennant recalled, right before he was discharged to home hospice care, she asked him whether he wanted her to keep fighting to change the state agency’s prior authorization process.

“‘Well, you need to at least try to change it,’” she recalled her husband saying. “‘Because it’s not fair.’”

“I told him I would keep trying,” she said, “at least for a while. And so I am keeping that promise to him.”

—–

NBC News health and medical unit producer Jason Kane and correspondent Erin McLaughlin contributed to this report. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

The post After Man’s Death Following Insurance Denials, West Virginia Tackles Prior Authorization appeared first on Medika Life.

In fact, there is a lot. Some of it requires help from your physician, but most depends on your lifestyle, preferably begun in midlife or even sooner. But it is never too late to start. Even with early evidence of developing dementia, making changes can be of tremendous help.

Details below, but the most important steps are regular exercise — resistance and aerobic, a high protein, high fruit, and vegetable, but low sugar diet, good sleep, reduced stress, no tobacco, limited alcohol, intellectual challenges, and social engagement, along with attention to high blood pressure, high cholesterol, and high blood sugar or diabetes.

The causes of dementia

It is best to think in terms of risk factors rather than direct causes. There are multiple types of dementia, but the most common is Alzheimer’s disease. It has many possible risk factors, often in combination, in any individual. Among the most important are high blood pressure, type 2 diabetes, elevated LDL cholesterol, obesity, high intake of ultraprocessed foods, being sedentary, not dealing with chronic stress, inadequate deep sleep, smoking, an unchallenged brain, and lack of social engagement.

Untreated high blood pressure damages the blood vessels supplying the brain, as does poorly controlled type 2 diabetes. Diabetes correlates with a 10 to 15 times greater risk of Alzheimer’s. Like the rest of the body, brain cells can become insulin-resistant, depriving them of their primary fuel—glucose —hence the term “type 3 diabetes.” Add to this elevated LDL cholesterol, which leads to plaque deposition in the large blood vessels, analogous to that seen in the heart’s coronary arteries.

Obesity is a definite risk factor, especially as it predisposes to diabetes, but also produces chemicals that cross the blood-brain barrier and cause inflammation. The combination of blood vessel damage and inflammation is clearly associated with the development of Alzheimer’s disease.

Being sedentary, along with eating excess ultraprocessed, sugary, fatty, and salty foods and smoking, are known to correlate with dementia, as does persistent lack of restorative sleep and continuing low-level chronic stress. Maintaining good muscle mass through appropriate exercise not only supports muscle and bone density but also releases chemicals that positively impact brain function. Substantial exercise literally enlarges the brain’s hippocampus and prefrontal cortex, both critical to cognition.

Among the presumably less important risk factors for dementia are some chronic infections, often undetected, such as chronic Lyme disease, which can cause persistent low-level brain inflammation. So too can a variety of neurotropic viruses, such as the varicella-zoster virus that causes chickenpox and shingles. The varicella-zoster virus (VZV) remains dormant in the nervous system after chickenpox infection but is reactivated in older age as herpes zoster (shingles). It is believed that this virus causes long-term chronic inflammation in the brain while dormant, and then amplifies inflammation when reactivated as shingles.

There are other causes of inflammation. An unbalanced colonic microbiome is common. There is a gut-brain axis, meaning the two systems send messages back and forth, which can be altered by the microbiome. This axis can help or hinder normal inflammation maintenance in the brain.

The gut bacteria convert high-fiber diets into short-chain fatty acids (SCFAs), which, in mice, lead to reduced microglial (the brain’s immune cells) activity and a lower degree of brain inflammation. Aging mice normally have reduced SCFAs, but a high-fiber diet increases SCFAs and reduces inflammation in their brains. The key message is that a healthy colonic microbiome can help to prevent the development of Alzheimer’s disease.

The mouth has its own microbiome. Chronic oral gum infections, known as periodontal disease, often go unrecognized, disrupting the oral microbiome and inducing a chronic state of inflammation that produces a steady flow of damaging chemicals that affect the brain. The bacterium Porphyromonas gingivalis is a frequent cause of periodontal infection, but it can also directly affect the brain. It produces a toxic enzyme called gingipain, which crosses the blood–brain barrier and directly damages neurons. P gingivalis has also been found in the brains of deceased Alzheimer’s patients.

Even the eye microbiome has been shown in a January 2026 article in Nature Communications to have an adverse impact on the brain if it includes Chlamydia pneumoniae, a common cause of pneumonia and sinus infections that, in some people, infects the retina and, from there, travels to the brain, amplifying inflammation.

Several environmental toxins have been implicated in Alzheimer’s development. Lead is a known neurotoxin. Once in the body, it can persist in bones. We tend to think of it in old lead paint, but it is common in many city water supplies (remember Flint, Michigan) and was common in leaded gasoline until about 1980. Leaded gasoline suggests that many older people may have elevated bone lead levels.

Lead is also occasionally found in food and air. In a prospective study reported in February 2026, bone lead levels correlated with the onset of Alzheimer’s disease and all-cause dementia in a representative sample of Americans followed for 30 years in the National Health and Nutrition Examination Survey (NHANES _III). The authors speculate that up to 18% of dementia cases could be avoided with reduced lead exposure.

Various other metals (e.g., arsenic, zinc, mercury, and cadmium) and biotoxins (produced by molds, especially Aspergillus, bacteria, and viruses) are believed to be correlated with the onset and progression of dementia through the production of cytokines (compounds produced and released from cells) that cause neuroinflammation and neurodegeneration.

Microplastics (particles less than 5 mm in diameter) have been implicated as a potential cause or predisposing factor to Alzheimer’s disease, although the data are limited. It is known that they can cross the blood-brain barrier and, in animal models, elicit neuroinflammation and neurodegeneration. Microplastics can be found in the brains of many people at autopsy. Still, the quantity in the brains of those with dementia tends to be many times higher, suggesting both a cause and a dose-response relationship. Microplastics are found in air, food, and water. It is not known which microplastics are potentially important, nor which route might be most important — inhalation, skin absorption, or ingestion. Finally, be aware that these are correlation studies, not causal studies.

Hearing loss not only causes social isolation but also directly leads to brain atrophy and “cognitive overload,” meaning the brain cannot process inputs as effectively and has fewer resources left for memory and thinking. The combination leads to an increased risk of dementia. Visual loss, common with age-related cataracts, as well as macular degeneration, glaucoma, and diabetic retinopathy, has the same impact as hearing loss.

Bear in mind that all of these are correlation studies. Correlation does not equal causation, but when they are found in study after study, they are likely actual risk factors.

Note also that many of these risk factors create or amplify chronic low-level inflammation. It is the inflammation that is doing much of the damage. Inflammation means that your immune system, the system that normally protects you from disease-causing agents like bacteria, is constantly turned on at a low level, damaging your brain without you knowing it until years later, cognitive decline becomes obvious.

What you can do to avoid dementia

It is not unlike what I described for slowing normal cognitive aging, but with more intensity and a broader range of inputs.

Let’s start with the medical side of it

Most physicians do not look or know to look for many of these predisposing conditions, but since you do, ask to have them checked for you. They will most likely check your blood pressure, cholesterol, and blood sugar, for different reasons.

High blood pressure is a clear predisposing factor. Unfortunately, nearly 50% of Americans have hypertension >130/80), with the prevalence increasing to about 70% of adults over age 60, but many are unaware, and even less, perhaps 20–25%, are adequately treated. Be sure you are being treated appropriately.

Type 2 Diabetes is a profound predisposing factor to Alzheimer’s disease. What both high blood pressure and diabetes have in common is that they cause inflammation in the brain, blood vessels, and neurons. Over time, they also lead to reduced blood flow to the brain. Over ten percent of Americans have diabetes, with the prevalence rising with age. Only about 50% are adequately treated and controlled. Here, again, be sure you know if you have diabetes and follow your doctor’s advice on management.

High LDL cholesterol (the “bad” type), especially when combined with hypertension and diabetes, can lead to plaques in the blood vessels supplying the brain, similar to those in the coronary arteries. Just one more adverse cause of reduced blood flow to the brain. Only slightly more than 20% have adequate management of all three key factors. So be sure to have your physician review your blood pressure, blood sugar, and cholesterol status, and follow their advice, remembering that lifestyle changes might be adequate (see below), but, if not, there are effective medications.

Obesity is a significant predisposing factor. If you are obese and have had difficulty with weight reduction, you and your physician might want to consider GLPs like Wegovy or Zepbound.

Ask to be checked for lingering chronic infections, such as Lyme disease. Visit your dentist and dental hygienist every six months for a prophylaxis. You will not only be preserving your oral health but also reducing your risk of dementia. You should be tested for lead and other heavy metals.

Consider the shingles vaccine if you are 50 or older. Multiple studies have shown that it reduces dementia by about 20% for at least seven years after vaccination. Less clear is how long the effect lasts after that or whether a booster is necessary. Certainly, it is an easy way to get a dual benefit — less likelihood of dementia while also reducing the occurrence of shingles and possibly even heart disease.

If you are over 65, you have likely gotten regular influenza vaccines. Recent data published in April 2026 show that the standard vaccine has some protective effect, and the higher-dose vaccine has an even greater effect, at least for the 2–3 years of follow-up in the studies.

If you have significant hearing loss, work with an audiologist to determine the best approach for you. Fortunately, there are now devices that can assist at a reasonable price. If you have significant vision loss due to cataracts, the evidence is strong that correction will significantly reduce your risk.

Early life

Those who start adulthood with the “strongest” brains have “more room” for loss, suggesting that it is advisable to encourage your children and grandchildren to be as well educated as possible.

Lifestyle modifications

Your doctor can be a major source of assistance in limiting your chance of dementia, but of even greater importance is what you can do for yourself with lifestyle modifications, especially exercise and diet.

Maintaining your physical health is one of the most important things you can do to avoid dementia. If you smoke, get help to stop; it’s critical. Then, start with exercise. The science is clear: those who move are at much reduced risk of dementia. Aerobic exercise, like walking, cycling, or swimming, helps your heart and lungs deliver more blood to the brain. When doing aerobic exercises, push to the point where you are breathing somewhat heavier than normal and, although you can respond to a question, you are too busy breathing to engage in a conversation.

When a group of 120 young adults aged 28 -56 was randomized to a steady moderate to vigorous exercise regimen for 12 months or not, those who exercised had brains that appeared “younger” after one year. In contrast, the control group showed no significant change between MRIs taken at the beginning and end of the year. VO2 max increased substantially over the 12 months in the exercise group but not in the control group.

And those who regularly engage in resistance exercises are at an even lower risk. In fact, resistance exercises may be the single most important thing you can do to prevent dementia. Choose a variety of exercises that maintain and strengthen your upper, core, and lower body muscles. Plan to use a resistance weight you can fully move, like a biceps curl, for only 8–12 repetitions. Remember that these exercises release chemicals called myokines or exerkines that stimulate the brain, heart, and blood vessels. They can stimulate growth of the hippocampus and other parts of the brain, perhaps by releasing brain-derived neurotrophic factor (BDNF). Exercise also stimulates the liver to release exerkines. One of these, called GPLD1, reverses memory loss in aging mice.

Various studies have shown that regular resistance exercise is critical to maintaining brain function and brain volume. Leg power is especially effective in reducing cognitive aging.

In addition to regular aerobic activity and at least twice-weekly resistance training, consider high-intensity interval training (HIIT). Dr. Harry Oken and I discuss this in detail in our book BOOM — Boost Our Own Metabolism. In brief, ride an exercise bike at a comfortable resistance and pace for a few minutes to warm up, then increase the resistance and pedal as fast as you can for 30 seconds. Your legs should ache, and you may be sweating. Drop back to a comfortable pace for 90 seconds. Repeat eight times. Studies indicate that this can enlarge your hippocampus, the brain’s processing center, by as much as 50% or more over six months. More neurons are produced, connectivity is enhanced, and cognitive abilities are maintained or improved. HIIT is also the most efficient way to improve your VO2 max.

What you eat, or do not eat, and what you drink are of critical importance. Avoid ultraprocessed foods, excess fast foods, sugar (such as candy, sodas, and ice cream), and foods that are digested directly into sugar (such as white bread and other white-flour products—pastries and donuts). A good “diet” to follow is the Mediterranean diet or its cousin, the MIND diet. The former emphasizes healthy grains, seeds and nuts, legumes like beans, good oils such as olive oil and avocado oil, and cold-water fish (salmon, mackerel, sardines). Eat somewhat less dairy and poultry and relatively little red meat.

As for red meat, processed meats like bacon, jerky, and many deli meats are unhealthy, whereas meat from 100% pasture-raised animals is probably healthy. The MIND diet is based on the Mediterranean diet but emphasizes green leafy vegetables like spinach, kale, and collards, as well as berries over other fruits. When participants in a long-term study at Rush University Medical Center followed these diets, their brains at autopsy showed less evidence of Alzheimer’s compared to those who ate a “less healthy” diet.

If you like coffee or tea, you will be pleased to know that in a long-term study of 131,000 individuals followed for up to forty years, those that drank two to three cups of coffee (but not more) had an 18% reduction in dementia onset compared to those in the lowest intake group. The findings were similar for tea, with a 14% reduction. Presumably, coffee and tea with their many chemicals reduce inflammation, reduce oxidative damage, improve the lining of blood vessels, reduce blood-brain barrier leakage, and enhance neurons’ ability to communicate. Notably, decaf coffee did not have the same effect.

Also consider fasting. Just avoiding eating after dinner and before breakfast is a good start, or pushing breakfast off for a few hours.

Restorative sleep is very important to avoid dementia. Deep sleep is the time when the brain cleanses itself of toxins and other waste materials. It is also when memories are formed and the hippocampus, the brain’s processing center, is “emptied” so it can begin again tomorrow. Don’t listen to people who say they can get by with less than about seven hours of sleep.

Most Americans are living with low-level chronic stress. Stress releases a series of compounds that stoke chronic inflammation in the brain and elsewhere. Ways to reduce stress include exercise, a healthy diet, meditation, Tai Chi, yoga, and avoiding, when possible, those things, people, and situations that lead to your stress.

Your brain needs to be used and challenged. Do creative activities like chess, art, writing, learning a musical instrument, dancing, or learning a foreign language.

Computer-assisted cognitive training. All studies have not been effective, except for a 20-year follow-up clinical trial published in February 2026 by Johns Hopkins involving 2021 adults over age 65. This study evaluated a cognitive training program initiated in 1999 and followed through to dementia onset in 2019. Alzheimer’s was reduced by 25% among those who did computer-based cognitive speed training, with a 6- to 12-month booster. Speed training asked the person to identify a center object (like a car) on the computer screen while locating a peripheral target (like a road sign) on a screen, with the speed increasing as the user improved. The other arms of the trial, looking at memory and reasoning, did not lead to reduced dementia.

“This study shows that simple brain training, done for just weeks, may help people stay mentally healthy for years longer,” said NIH Director Jay Bhattacharya, M.D., Ph.D. “That’s a powerful idea — that practical, affordable tools could help delay dementia and help older adults keep their independence and quality of life.”

Humans need social engagement. Call it “cognitive engagement.” Make and keep friends, meet regularly with others, and get involved in group activities. It’s enjoyable, and it’s critical. The Rush Memory and Aging Project followed about 2000 individuals with an average entry age of 79 for nearly 8 years. In their February 2026 article in Neurology, the authors looked at lifetime cognitive enrichment activities and found those in the highest cohort had a 38% lower risk of developing Alzheimer’s disease. Those with the highest level of lifetime enrichment who did develop AD did so 5 years later than those with the lowest levels. Similarly, their rate of cognitive decline over the course of the study was slower.

Where possible, merge your creative, active, and social activities, such as group Tai Chi, dancing, or walking together. Consider dancing. If you are learning a new step, your brain must follow the music and move your body to the new step; a dual cognitive function and social engagement, with some aerobic exercise.

Remember that there is no one risk factor for dementia, so “bundling” lifestyle changes makes the most sense, a logical concept that is supported by a research study in Finland that showed multiple steps taken together slowed cognitive decline in high-risk seniors. It helps to have help with structured support so that lifestyle changes become consistent rather than relying on willpower alone.

Putting it all together

This may at first glance seem overwhelming. But you can address your risk step by step and have fun doing so. Remember that the 7 Keys to Healthy Aging not only reduce your risk for Alzheimer’s disease but are also very effective in preventing the development of many chronic diseases, such as cardiovascular disease, diabetes, and obesity, so start with these and pick one or two to address first. I would suggest diet and exercise, as they are likely the most important. But before you start anything discussed here, talk with your doctor to see if these suggestions are appropriate for your personal situation. And while there, discuss the items you need their help with — especially elevated blood pressure, blood sugar, LDL cholesterol, and excess weight. No matter your age, it is never too late to start.

Can this really prevent Alzheimer’s?

There are no guarantees. But following these suggestions will have a major impact on your risk of developing Alzheimer’s disease. It will also go a long way to preventing other chronic diseases like heart, lung, kidney disease, or cancer. That’s a very good return on your investment of time and energy.

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