We looked around, found nothing, and shortly went back to sleep.

In the morning, my wife was opening our interior shutters, which are used to keep out sunlight, when she discovered… a bat.

What happened next seemed perfectly sensible at the time. I went to the garage, got a heavy leather glove, returned, and grabbed the bat while my wife opened the front door. We stepped outside, let it go, and it flew away. We were glad to have it out of the house and proceeded to fix breakfast.

I had just made two mistakes but did not realize it.

It was early August, and we had been staying at our vacation home in Kent County, Maryland, on the Eastern Shore. In a few days, we were back home in our retirement community just outside Baltimore. We have a lady who watches out for our vacation place when we are away. I asked her to arrange a pest control person to check out the house to see if there were other bats, perhaps in the attic. As it turned out, he arrived when we were back just before Labor Day to celebrate our 63rd anniversary.

We described what happened. He looked at me and said, “You really should go to the emergency room or see a doctor.”

My wife smiled and said, “He’s a doctor.”

“Well,” he replied, “I just want you to be safe.”

He looked around the entire house and found multiple places where a bat could slip in. He found a few bat droppings in the attic. Still, he thought this was probably a “one off.” Maybe the bat got in when the garage door was open or something like that. He said he would send us a proposal for caulking up the various holes he found. We were back home in Baltimore when we got a message from our property manager that he had sent his proposal, but he also said he really thought I should go to the emergency room. Up to now I had not paid much attention but having heard it multiple times, I decided to do some research.

What I learned

I turned to Open Evidence, an AI system that looks only at quality medical and scientific information. The answer was unambiguous. I should go to the emergency room, now.

Because the bat had actually been crawling on my head while I was asleep, and because it was no longer available for testing, I should receive rabies post-exposure prophylaxis (PEP.)

Bat bites can be so small that a person may never see or feel them. And rabies presents an unusual medical calculation: The probability that this particular bat was rabid and infected me was exceedingly small, but the consequence of being wrong was enormous. Once clinical rabies develops, it is fatal; there is no treatment. But PEP given before symptoms begin, is nearly 100% effective.

That was a clear wake up call.

The current guidance supports the central lesson. CDC says potential direct physical contact with a bat warrants assessment, and Maryland specifically advises considering treatment when bat exposure cannot reasonably be ruled out. CDC also advises not releasing a bat found in the home until public-health experts have been consulted, because testing the bat may determine whether PEP is necessary. Guidelines favor treatment whenever exposure cannot be excluded.

The last sentence is the key one.

Just to be clear, it is very uncommon for a person to develop rabies from a bat. In our area, less than 1% of bats are infected. I had no clear bite or scratch. The risk in my case was extremely small. The problem is if I do win the Lottery, that’s bad.

Bats are the source of most rabies cases, but these are rare. There were two deaths from rabies (neither person received PEP) in America last year but over 30,000 people were potentially exposed and received PEP.

The rabies virus travels from the bite site through peripheral nerves toward the spinal cord and brain. Once symptoms appear, the disease progresses to severe neurologic illness ending in coma and death. There is no reliably effective treatment once clinical rabies has developed. The opportunity to prevent the disease is therefore before symptoms begin.

What to do if you encounter a bat

I had not thought about rabies since I took the board certification exam in infectious diseases some 40 years ago. I worked with cancer patients, not the general population, so I had no experience other than book learning long ago.

It did not occur to me that the bat could have been rabid or that it might have bitten me, since I did not find evidence of a bite or scratch, nor was the bat aggressive. Not being worried about rabies, I did not think to kill the bat so it could be tested. Absent that testing, as I learned, I needed rabies post exposure prophylaxis or PEP.

I was talking with a speech therapist whose family had a cabin with “lots of bats flying around all the time.” She remembered as a kid being told that if you got bitten by a rabid bat or other animal, they would “inject you with 9-inch needles into your abdomen many, many times with lots of side effects.“ She wasn’t entirely wrong. The nine-inch needles were folklore, but the old rabies treatment really did involve numerous injections into the abdominal wall. The earliest vaccines descended from Pasteur’s 1885 work and were prepared from rabies-infected nervous tissue. They were far more cumbersome and produced substantially more adverse effects than today’s purified cell-culture vaccines.

Fortunately, that era of painful shots is long gone, but it was only in 1980 that the modern anti-rabies vaccine was licensed, so it is no surprise that the myth still abounds.

None of this means that bats are bad animals. Quite the contrary. Bats have been saddled with centuries of bad publicity, from witches to Dracula, when in reality they are among our most useful neighbors, gobbling huge quantities of insects like mosquitoes every night.

That said, the CDC reports that rabies exposures have recently increased. We just read that a rabid bat was found in a school about 20 miles from our home, and rabid bats have been reported in Los Angeles recently.

Post-exposure prophylaxis

My primary care physician called the local emergency room to determine if they had the PEP available, and learning that they did, and that they were “not too busy,” we headed off.

After signing in (“oh you’re here because of rabies”) we were ushered into the triage room where a doctor and nurse took a history. The doctor, obviously very experienced, said that there was no question that I needed PEP. He then looked at my wife and said, “You were asleep in the bed next to him, so the bat may have crawled on your head also.” “I have hair on my head,” she responded. “Yes, but he could have walked across your forehead, and you might not have been aware. You need PEP also.”

PEP for someone who has never previously been vaccinated against rabies consists of human rabies hyperimmune globulin, which supplies immediate antibodies, followed by four doses of rabies vaccine given on days 0, 3, 7, and 14 to give long lasting protection.

We went back to the waiting room and after a while we were ushered into the main area of the ER. They had to order PEP from the pharmacy, which took a while until it arrived. The hyper immune globulin dose is based on weight. For me it was 2.6ml and for my wife it was 1.7. If there had been evidence of a bite, some of the globulin would have been injected there. But for us it was divided into two shots, one into each thigh. And then the vaccine, 1ml, goes into the shoulder.

We now are back three days later for the second vaccine dose. We will still have day seven and fourteen to go.

I told this story to retired senior engineer who said she had grown up on a farm and would have done exactly the same thing with the bat. We had lunch with a family medicine physician; he also was not surprised that we just got rid of the bat. That made me feel better because, as is always easy in retrospect, it was not smart to try and catch the bat myself. But given that I did, I should have killed it so it could be checked for rabies. Chances are it would have been negative, and we would have escaped getting PEP.

But even more importantly, it never occurred to me that the bat might have bitten or scratched me on the head since I did not see any obvious evidence. I really should have been curious and looked up the proper course of action right away. Fortunately, the pest-control man knew enough to keep pestering us. Eventually, I listened.

So here is the lesson I would pass along. If you have direct contact with a bat (or other wild animal), don’t handle it yourself. Contact animal control or your health department so that it can be safely captured and, when appropriate, tested. If the animal is gone and can’t be tested promptly, seek medical advice about whether rabies prophylaxis is needed. Rabies is exceedingly uncommon. But this is one of those unusual situations in medicine where a very small probability is paired with an almost unimaginable consequence.

And should you need the shots, don’t worry about those childhood stories of enormous needles in the belly. Modern rabies prophylaxis is nothing like that. It is still a pain in the butt — although, in our case, mostly a pain in the thigh.

The post I Woke Up with a Bat on My Head. appeared first on Medika Life.

The obvious question is whether that’s safe. But another question interests me more. I have spent 36 years taking care of people with cancer. By the time someone reaches my office, an enormous number of decisions have already happened. Someone noticed something. They decided whether it mattered. Perhaps they waited. Perhaps they searched online. Eventually, they decided to tell another human being. Medicine usually enters the story after that decision. AI is beginning to enter before it.

What happens before you arrive

When you wake up with an unfamiliar pain, the choices available to you have changed significantly. For most of human history they were limited: ignore it, ask someone you trusted, or seek medical care. Then the internet gave us another option, and millions began typing symptoms into search engines. Now AI alters that interaction in a way that matters. A search engine gives you pages to sort through. An AI system gives you a conversation. You can describe where something hurts, how long it has been happening, what makes it worse, what medications you take, what you are worried it might mean. You can ask another question, clarify an answer, ask again. It can feel remarkably close to consultation.

I don’t think the answer is to tell people to stop asking AI about their health. People have always sought medical information outside doctors’ offices, and AI can be genuinely useful for some things. It can explain an unfamiliar laboratory result in ordinary language. It can help someone understand the difference between two treatments. It can generate questions to take to an appointment or help make sense of something a physician said, something the patient only half-absorbed while frightened or tired. Medicine asks people to absorb complicated information precisely when they may be overwhelmed, and a tool that helps close that gap has real value.

But there is a threshold where explanation quietly becomes reassurance, and that’s where the problem begins. A symptom does not have to disappear for someone to delay seeking care. It only has to become sufficiently explainable. A persistent cough becomes allergies. Fatigue becomes stress. A change in bowel habits becomes diet. A new lump becomes something probably benign. And most of the time, the reassuring explanation may actually be right. Most headaches are not brain tumors. Most back pain is not metastatic cancer. Most strange sensations that appear during an ordinary week will never become dangerous. That is precisely why triage is difficult. The challenge is not simply identifying the most likely explanation. It is recognizing the uncommon situation in which the most likely explanation is wrong.

When I meet a patient, I am not simply processing the words they say. I am trying to understand the story around those words. How quickly did this change happen? Does the symptom fit the rest of their medical history? Is there something about their age, medications, previous illness, or family history that changes what an otherwise ordinary symptom means? Sometimes the most important information emerges only because I ask a question the patient did not know was relevant. But here is the vulnerability built into any conversation with an AI system: much of what it knows about you is what you decide to tell it. You may not know what matters. And a confident, coherent answer can feel more complete than the information behind it actually is.

For years, physicians worried about patients arriving with information they found on Google. I suspect we are entering a much more consequential era. Patients may increasingly arrive after having already had a long conversation about their symptoms — with possible explanations, questions they want to ask, interpretations of laboratory results, and some sense of how urgently they should seek care. Sometimes that will make the medical encounter better. The patient may be better informed, the questions sharper, medical language less intimidating. A person who might otherwise have ignored a warning sign could even be persuaded to make an appointment. But the opposite can happen too. The conversation may reassure someone enough that the medical encounter never happens. Once AI becomes the first opinion, it can influence whether there is ever a second.

I write about the signals we often miss in our health and our lives. If you’re curious about what your own body may be telling you, my free 3-minute Capacity Checkup can help you see where strain may already be showing up in sleep, mood, focus, and body.

But after 36 years in medicine, I think one of the most valuable things a good clinician does is not simply answer the question a patient brings into the room. Sometimes it is recognizing that we should have been asking a different question all along.

The post Helen Mirren Says She Uses AI Instead of Going to the Doctor. That’s Not the Part That Interests Me. appeared first on Medika Life.

I told her it was more complicated.

A few days later, I read a study about hormone therapy and dementia. Researchers followed more than 180,000 postmenopausal women for an average of 13 years. Women who had used hormone therapy for at least a year had a lower risk of developing dementia. The association was strongest among women who started between ages 46 and 56.

In 2003, researchers from the Women’s Health Initiative Memory Study reported that women taking estrogen plus progestin had about twice the risk of probable dementia. It was a randomized trial. But the women in that trial were 65 or older. That detail got smaller somewhere between the medical journals and the doctors’ offices, smaller still by the time it reached how women understood their own bodies. The warning traveled farther than the population it actually studied.

Hormone therapy became something to fear. I watched it happen. Women became wary. Physicians became reluctant to prescribe it. A decision that should have turned on age, symptom severity, type of hormone, and individual risk became a simple rule: dangerous.

My patient’s question wasn’t really about dementia studies. Her cancer had forced her backward through her own medical history, and now that history was being reexamined through the lens of a terrible outcome. Medical warnings move out of journals into people’s lives. They attach to regret. They become the story people tell about their own choices.

The new study doesn’t erase the old one. Put them together and something becomes visible: one studied women 65 and older, the other found its strongest association with lower dementia risk among women starting between 46 and 56. The warning was built on a population that looks very different from the population now receiving it.

A third study adds to this. Researchers examining autopsied brains found less Alzheimer pathology among women who had used estrogen-only hormone therapy. We don’t know if this means anything — autopsy studies can’t prove what prevented anything. But neither can we keep treating a single finding from a 2003 trial of older women as though it applies equally to a 50-year-old having hot flashes every two hours, whose brain fog has made her work nearly impossible.

The question was never whether hormones are good or bad. It was which ones, for whom, at what age, for what.

If a woman sat across from me now considering hormone therapy, I would want to know what was happening in her life before we talked about treatment. Is she waking in hot flashes? Has her concentration fractured? Is anxiety moving through her day? What is her medical history and what does she carry into this decision? What does she want treatment to actually do?

These questions don’t become headlines. They’re closer to medicine.

My patient last week was frightened about cancer, not dementia. But underneath her question was what I hear whenever someone is trying to make sense of something terrible: Did I make the wrong choice? The woman in the 2003 trial was 65 years old. My patient made her decision at 50. But that warning didn’t stay in the journal. It moved out into the world and landed on every woman, at every age, in every stage of this transition, saying the same thing: don’t do this, it will damage you.

If you’re navigating menopause and trying to make sense of what’s changing and what actually deserves treatment, I wrote The Menopause Guide to help with exactly that — understanding the changes, sorting through your options, and preparing for a conversation with your clinician that’s grounded in what you actually need, not what you’re afraid of.

Get The Menopause Guide

The post Did We Get Hormone Therapy Wrong? appeared first on Medika Life.

Instead, she told people she still had “so many things” she wanted to achieve. Four days later, she was dead.

I know this differently than most people do, because I am a radiation oncologist. For 36 years, I have sat across from people with cancer while they talked about what came next. Sometimes that meant radiation or chemotherapy. Just as often, it meant a daughter’s wedding, a trip already booked, a grandchild arriving in December or whether they would be strong enough to get back into the garden in spring. I have heard each of these in the last month.

When I was younger, I assumed serious illness would change the way people thought about time. I imagined that once the stakes became high enough, the future would begin to recede and the present would take over. That isn’t what I have seen. People can understand that they are seriously ill and still make plans. They can discuss a frightening scan and then ask whether treatment will interfere with a vacation. They can know that a cancer is incurable and still wonder what they should buy their spouse for Christmas.

This isn’t necessarily denial. It is what happens when illness enters a life that is already in progress. The dog still needs walking. Someone needs groceries. The mortgage is due. There is a birthday next month and a friend coming for dinner on Saturday. Even when the medical facts have changed dramatically, much of Tuesday can still look like Tuesday.

On August 21, Parton spoke publicly about going through a difficult period with her health. That same day, she was admitted to Vanderbilt-Ingram Cancer Center in Nashville. She died there four days later. Her representatives said that she had been diagnosed with cancer and described her illness as a brief battle. They have not disclosed what type of cancer she had.

Now that we know the ending, everything before it looks different.

The canceled performance becomes a warning. The missed appearance becomes evidence. A doctor’s instruction not to travel takes on a significance it may not have carried when it was given. Separate events become a sequence, and the sequence begins to look as though it had been pointing toward the same destination all along.

I have watched families do this for years. They ask when things really changed. Was it when she stopped eating as much? Was it the weekend when he didn’t want to leave the house? Should we have understood what the fatigue meant? Was there a moment when everyone should have known?

Sometimes there is an answer. Often there isn’t, because illness is much easier to understand backward than forward. What Parton said four days before her death gives us a glimpse of where her attention still was. She was thinking about what came next.

The medical record looks orderly. Life isn’t.

When I began practicing oncology, I thought of serious illness as a series of recognizable thresholds. Diagnosis. Treatment. Response. Progression. Eventually, for some patients, the point when treatment could no longer do enough.

The medical record encourages that way of thinking. It puts dates beside events and turns a complicated human experience into a chronology that can fit on a screen. Living through illness is different. A scan can worsen while someone continues going to work. A person can receive radiation in the morning and pick up a grandchild from school that afternoon. Someone can understand perfectly well that a cancer is incurable and still make a restaurant reservation six months away. There is rarely a bell that rings when ordinary life becomes something else.

I had a patient once, a woman in her mid-sixties, who came to me complaining that she could no longer walk to the grocery store the way she used to. She had been going there three times a week — a routine that anchored her mornings. Now she was tired halfway there. She asked if radiation therapy would help her get back to it.

I told her the truth: probably not. She nodded, and we talked about treatment options. Six months later, during a follow-up visit, I asked how she was managing. “Oh, fine,” she said. “I order online now.” She had adjusted so completely that she’d already forgotten the walk was ever part of her life at all.

Over the years, I have become increasingly interested in this kind of adaptation. Someone starts taking the elevator instead of the stairs. The afternoon nap becomes necessary rather than optional. A person who always cooked begins ordering food. The weekend that once restored them no longer does. None of these changes feel important enough to mark on a calendar. We simply adjust around them.

What interests me is how long we can do this without realizing how much our world has changed. Life still works, so we assume our capacity hasn’t changed very much. Often it has. We have simply become good at spending less of it.

That observation extends far beyond cancer, which is why I built the Capacity Checkup — a tool that looks at sleep, mood, focus and body to help you see where your reserves may be thinning. Take the free 3-minute Capacity Checkup and see where it makes sense to pay attention first.

There was nothing left for Dolly Parton to prove

She had sold more than 100 million records. Her songs became part of American culture. Her Imagination Library, started in Tennessee, grew into an international program that has put hundreds of millions of books into children’s hands. During the pandemic, she donated $1 million to Vanderbilt University Medical Center to support research on the Moderna COVID-19 vaccine. What interests me is that apparently she wasn’t keeping score. She still had things she wanted to do.

After decades of treating older adults, I have become interested in people who keep something ahead of them — people who don’t think they’re finished. It doesn’t have to be important to anyone else. A trip works. So does a garden, learning a piece of music, seeing a grandchild graduate, finishing a book or getting strong enough to walk somewhere you haven’t been able to walk for a while. The project matters less than the fact that there is still a project. Perhaps that is why Parton’s comment from four days ago caught me more than the lists of awards and accomplishments. She wasn’t describing a completed life. She was describing the next part of it.

Maybe there is something good about leaving things unfinished. Death encourages the people who remain to turn a life into a finished story. I have watched people lose futures they desperately wanted, and there is nothing reassuring about that. But 36 years in oncology have made me see another side of it. Maybe feeling unfinished isn’t evidence that we failed to complete our lives. Maybe it is what being alive feels like.

As long as we are engaged with the world, there is another thing we want to see, make, repair, learn or give to someone else. We keep placing small bets on a future we cannot actually guarantee.

Most mornings, none of us thinks much about that. We make the reservation anyway. We buy the concert tickets. We plant something that won’t bloom for months. We tell someone we’ll see them at Christmas. We begin books we may take years to finish.

Dolly Parton had been doing some version of that for eight decades. She had gone from a one-room cabin in Tennessee to a career almost impossible to summarize. She had written thousands of songs, built companies, made an enormous amount of money and given a great deal of it away. Four days before she died, she was still talking about the things she hoped to accomplish.

After 36 years of watching people live alongside serious illness, I don’t hear that as a story about someone who failed to understand that time was running out. I hear something much more familiar. She still thought there would be a tomorrow. So do we. And most days, that is how we manage to live.

The post Four Days Before Dolly Parton Died, She Was Talking About the Future appeared first on Medika Life.

However, there is a question we rarely ask when introducing a new technology, administrative requirement or checkpoint process into health: “Did we actually eliminate work, or did we simply kick the can down the road and move it to someone else?”

Too often, what looks like efficiency on one side of the health ecosystem table is experienced as friction on the other. The insurer automates a process while a physician practice hires someone to navigate it. The hospital creates another digital portal, while the patient becomes responsible for connecting information that the health system has failed to connect with another. New technology promises to give clinicians time back, only to add another inbox, alert, or screen demanding attention.

In Healing the Sick Care System: Why People Matter, I describe fragmentation as one of the forces that separates people from the care they need and health professionals from the people they are trying to help. Friction is what that fragmentation feels like in our day-to-day life. It is the extra call, the repeated form, the missing information, the wasted hour and the handoff nobody owns. Worse, it is the yelling and arguing between the patient’s physician and the payer’s prior authorization approval team.

There is a cost to all of this. Call it the friction tax.

The Work Did Not Disappear

Prior authorization offers one of the clearest examples. It is intended to control unnecessary spending and encourage appropriate use of diagnostics and treatments. Those are legitimate, responsible goals. The problem amplifies when the administrative mechanism created to save money begins consuming enormous resources elsewhere.

The American Medical Association reported in 2026 that physicians and their staff spend an average of 13 hours each week completing prior authorization requirements. Physicians average about 40 authorization requests each week and 40 percent report having staff who work exclusively on prior authorization.

That work is not free. Its cost simply moved.

An insurer’s utilization decision results in forms, electronic submissions, phone calls, appeals, and follow-up work within a physician practice. Even when the authorization is eventually approved, someone has paid the friction tax. The patient may pay another portion through delayed treatment or by exhausting the effort required to fight for something a clinician has already determined to be necessary. In rare but tragic cases, the friction does not merely delay care. It helps determine whether care arrives in time.

We celebrate efficiency where it was created, without always counting the burden it created elsewhere.

When Waiting Becomes a Bill

Consider something far more ordinary: waiting for the doctor.

Physicians run late. Medicine is unpredictable and sometimes the person in the examination room needs more time than anyone anticipated. That is not friction. The friction is knowing the doctor is running 30, 60 or 90 minutes behind and failing to tell the next patient.

The technology needed to send a text saying, “Dr. Smith is running about 45 minutes late. Please adjust your arrival time,” is hardly futuristic. Airlines alert us when our flights are delayed. Restaurant buzzers tell us when a table is ready. A delivery app can show us a sandwich moving across town. Even items ordered from other countries have shopper apps to keep us posted on their global journeys.

Yet people still leave work, arrange childcare, drive to a physician’s office and sit for an hour because nobody communicated information the practice already knew. This is where a simple principle becomes very practical: communication is care. A timely message respects someone’s time, reduces anxiety and helps strengthen ties before the health encounter even begins.

People’s time has economic value. A national study published in The American Journal of Managed Care found that an ambulatory medical visit lasted an average of 121 minutes, including 37 minutes of travel and 84 minutes at the clinic. Researchers estimated the opportunity cost at $43 per visit in 2010, totaling approximately $52 billion annually across the United States. For every dollar spent reimbursing a physician visit, patients absorbed another 15 cents in the value of their time.

Those figures are more than a decade old; however, the principle is not. Every unnecessary 30 or 60 minutes has value, particularly for the hourly worker losing wages, the parent paying for childcare, the caregiver juggling another person’s needs or anyone forced to surrender a piece of the workday because a practice did not communicate.

According to the American Family Physician, 10 million patients visited a primary care physician this week. Multiply that experience across millions of appointments and waiting stops being a minor annoyance. It becomes an enormous invisible expense.

People Eventually Route Around Friction

There is another consequence to inconvenience that cannot be measured only in dollars. People change their behavior using their buying power.

Urgent care centers and retail clinics offer something traditional medicine too often lacks: walk-in availability, extended hours and shorter waits. Research examining retail clinic use has repeatedly identified convenience as an important reason patients choose these settings.

That matters because people eventually route around friction.

The growth of convenient care cannot be attributed to waiting rooms alone. Primary care shortages, appointment availability, location, cost and changing consumer expectations all played roles. Yet convenience became a competitive advantage because traditional primary care frequently asked patients to organize their lives around the system rather than designing the system around people’s lives.

The loss can be subtle. A walk-in clinic can treat a sore throat or an infection just as efficiently. What it cannot always replace is the long-standing relationship with a primary care professional who has known the patient over the years, notices changes, encourages prevention, and connects today’s complaint to yesterday’s history.

The convenient alternative solved a friction problem. It did not necessarily replace everything that was lost.

Health Professionals Pay Attention

The friction tax also falls heavily on health professionals.

A time-and-motion study published in Annals of Internal Medicine found that for every hour physicians spent in direct clinical face time with patients, they spent nearly two additional hours on electronic health records and desk work during the workday. Physicians also reported another one to two hours of personal time each night devoted largely to EHR tasks.

Some of that work is essential. Documentation protects patients. Medication reconciliation matters. Reviewing laboratory results matters. Safety checks matter.  The goal should never be completely frictionless medicine because some friction protects people from harm.

The problem is friction without corresponding value: entering information that already exists, moving data between systems that cannot communicate, clicking through low-value alerts or requiring highly trained clinicians to perform tasks that do not require their expertise.  How many times have you entered a doctor’s office and been greeted with a clipboard with papers on your medical history?

Every unnecessary minute has an opportunity cost. It is time unavailable for examining someone, explaining a diagnosis, listening to a family or simply looking another human being in the eye. When process begins consuming the relationship, efficiency has defeated its own purpose.

Families Have Become the Integration Layer

Another group quietly absorbs enormous friction: family and friend caregivers.

When organizations cannot coordinate, close connections often coordinate for them. They maintain medication lists, arrange appointments, call insurers, locate specialists, monitor portals, manage bills, and relay information from one clinician to another.

AARP estimated in 2026 that 59 million family caregivers provided 49.5 billion hours of unpaid care annually, work valued at approximately $1.01 trillion.

Not all of that time represents administrative friction. Much of caregiving is essential, personal and deeply human. Yet some portion exists because families have become the connective tissue between organizations and professionals that do not consistently connect.

We have created millions of unpaid care coordinators and rarely count their time as part of the cost of care.

Start Asking Who Pays

None of this is an argument against technology, utilization management or administrative oversight. Innovation can remove enormous amounts of friction. The challenge is determining whether it actually did.

Before introducing a new process or technology, health system innovators should ask: “How many steps does this remove? How many does it add? Whose time does it save? Whose time does it consume? What new work does it create? What happens to the person who lacks the time, digital skills, financial resources or family support to navigate it?”

Eventually, those questions should become measurable. They mean even push the fragmented health ecosystem to share and prioritize a common metric: patient and health professional experience.

Imagine evaluating innovation not only by clinical benefit and financial return but also by a friction score that measures time, clicks, handoffs, repeated information requests, administrative hours, delays, and work transferred to patients and caregivers.

A sick care system is not healed simply by adding more technology. It becomes healthier when innovation reconnects people, information and care rather than placing another obstacle between them.

The next great advance in health may not come solely from adding something new. It may come from finally recognizing the cost of everything we have already added. When a system saves itself time by consuming someone else’s, it has not eliminated cost. It has simply sent the bill to someone who cannot invoice it back.

The post The Hidden “Friction Tax” appeared first on Medika Life.

What Is Misophonia, Exactly?

The word misophonia comes from the Greek for “hatred of sound.” But that description sells it short. It isn’t simply an aversion to noise. It’s a disorder in which specific sounds, usually soft, repetitive, and made by another person, set off an intense chain reaction in the body and mind. Researchers define it as a condition characterized by strong emotional, physiological, and behavioral responses to sounds that most people barely notice.

The most common triggers include chewing, swallowing, lip smacking, slurping, throat clearing, sniffling, and breathing. Tapping on a keyboard, pen clicking, and the crinkle of a wrapper can also set it off. Some people also react to visual cues, such as watching someone’s jaw move, even without sound.

Estimates of how many people have misophonia vary, but multiple studies suggest that between 5% and 20% of the population experience symptoms significant enough to interfere with daily life. It often starts in childhood or early adolescence, with an average onset around age 12 to 13. It can persist for decades if left unaddressed.

What’s Happening in the Brain?

For a long time, people assumed this was a personality quirk or a sign of anxiety. New brain imaging research tells a very different story.

A landmark study published in Human Brain Mapping in early 2026 examined brain scans from 939 adults and found a specific connectivity disruption unique to misophonia. The culprit is a brain region called the anterior insula, a hub of the brain’s salience network. This is the area that decides, in a fraction of a second, what information deserves your full attention. In people with misophonia, the connection between the auditory cortex and the anterior insula is wired differently. The brain flags trigger sounds as urgent threats before the person has any chance to think about it.

Critically, this pattern did not appear in people with anxiety, depression, or autism, even when researchers analyzed the same brain data. It appears to be a misophonia-specific neural signature. That distinction matters enormously for treatment.

Earlier fMRI research confirmed that when a person with misophonia hears a trigger sound, specific regions fire up fast: the right insula, the anterior cingulate cortex, and the superior temporal cortex. Heart rate increases. Skin conductance rises. The emotional response arrives before reasoning can step in. This is why telling someone with misophonia to “just ignore it” is about as useful as telling someone with a broken leg to walk it off.

Research presented at the 2025 Misophonia Collaborative Forum added another dimension. Brain regions that become overactive during trigger exposure respond similarly whether a person is actually hearing the sound, watching a silent video of it, or simply imagining it. This tells us that misophonia isn’t purely a hearing problem. It involves memory, expectation, and mental imagery, too.

More Than Irritation: The Emotional and Physical Toll

The emotional range that people with misophonia report goes well beyond irritation. Anger is the most common reaction, but disgust, anxiety, panic, and even shame are also common. Physically, people describe muscle tension, sweating, nausea, a tightened chest, and a racing heart. The urge to flee the situation can feel overwhelming.

The source of the sound matters significantly. Research published in 2025 confirmed that sounds made by other people, especially people the listener knows, produce far stronger reactions than the same sounds made by strangers or machines. This is why family dinners can become unbearable war zones, while the same sounds in a crowded restaurant cause far less distress. It’s personal in the most literal neurological sense.

Research also finds that trigger sounds interfere with a person’s ability to concentrate on what they’re doing. People with misophonia are measurably worse at staying on task when triggers are present. Over time, the condition leads many people to avoid shared meals, open offices, public spaces, and sometimes their own families. The social and professional consequences can be severe.

Who Gets Misophonia?

Misophonia shows up across populations, but some groups appear more vulnerable. A 2025 systematic review found that between 12.8% and 35.5% of autistic people experience it, with 79% of those individuals also having anxiety, OCD, or other sensory sensitivities. It also appears frequently alongside mood disorders and obsessive-compulsive disorder in the general population.

Misophonia is not currently listed as a stand-alone diagnosis in the DSM-5 or ICD-11. But the field is moving toward formal recognition. In 2022, a consensus definition was published for the first time. Since then, standardized assessment tools have been developed, prevalence studies have grown in size and rigor, and clinical trials have finally begun.

What Can Actually Help?

Good news arrived in 2026 in the form of the field’s first randomized controlled trials, meaning research with a real comparison group and rigorous standards. Two studies confirmed that specific forms of therapy produce meaningful reductions in misophonia symptoms.

Cognitive behavioral therapy, or CBT, remains the most studied approach. A 2025 review presented at the World Tinnitus Congress confirmed that CBT delivered by both psychologists and audiologists significantly reduces the impact of misophonia on quality of life. Online CBT programs also show positive results, though dropout rates are higher than with face-to-face treatment.

Acceptance and commitment therapy, or ACT, also showed strong results in 2026 trials. ACT doesn’t try to eliminate the emotional response. Instead, it teaches people to tolerate distress without letting it control their behavior. For misophonia, this can mean staying at the dinner table, completing a workday in a shared office, or staying present in a relationship that might otherwise be derailed by triggers.

On the technology front, researchers at Duke University’s Center for Misophonia and Emotion Regulation are collaborating with a team at the University of Washington to develop a sound-suppression platform that uses headphones and an app. The goal is to allow a person to select which specific sounds they want filtered out while still hearing everything else.

Perhaps the most exciting frontier is neurostimulation. Clinical trials are underway to test whether transcranial magnetic stimulation, which uses magnetic pulses directed at specific brain regions, can calm the misfiring salience network at its source. If successful, this approach would be the first to directly target the underlying brain mechanism rather than managing its downstream effects.

You’re Not Alone, and You’re Not Broken

If any of this sounds familiar, the most important thing to know is that misophonia is real, it’s measurable, and it isn’t a personal failure. It also isn’t a life sentence. With the right support, people can and do find ways to manage their reactions, protect their relationships, and reclaim spaces that triggers have stolen from them.

Science has only recently begun to take misophonia seriously. The brain imaging findings of 2026 that show a disorder-specific neural signature are exactly the kind of evidence that turns skeptics into allies and moves conditions from the margins of medicine to its center. That shift is happening now.

Talk to a psychologist or psychiatrist who is familiar with sensory processing disorders. Be honest about what triggers you, how strongly, and how much it costs you in daily life. You deserve a professional who takes this seriously, because the science finally does.

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Its leaders were visible throughout the convention, participating in discussions on biopharma innovation, precision medicine, artificial intelligence, investment, genomics and policy. Partnership announcements emerged throughout the week. Delegations moved between panel discussions and private meetings with investors, entrepreneurs, researchers, and industry leaders. The message was clear. Abu Dhabi is making a strategic effort to become a notable player in biotechnology and the life sciences.

The timing is not accidental.

Around the world, governments increasingly view biotechnology as a strategic investment industry. Scientific innovation drives economic growth. Advanced therapeutics create new manufacturing opportunities. Genomics and precision medicine are reshaping approaches to disease prevention and treatment. Nations that attract talent, investment and scientific expertise position themselves at the forefront of one of the century’s most consequential industries and life-sustaining movements.

Abu Dhabi is determined to be among those countries.

Building the Innovation Foundation

Substantial investments and partnerships in infrastructure, research, education and health innovation support the Emirate’s ambitions.

In April 2025, Abu Dhabi launched the Health, Endurance, Longevity and Medicine (HELM) Cluster, an initiative designed to establish a globally competitive ecosystem spanning biotechnology, pharmaceuticals, medical technology, genomics, digital health, artificial intelligence and advanced manufacturing.

Officials project the initiative will contribute AED 94 billion to the economy by 2045, attract more than AED 42 billion in investment and create approximately 30,000 jobs.

Those figures reflect more than economic development goals. They signal a growing recognition that biotechnology is a cornerstone of future growth and global competitiveness.

The Emirate is not starting from scratch. Organizations including M42, PureHealth, Mubadala Bio, Khalifa University, and the Mohamed bin Zayed University of Artificial Intelligence have established a foundation that combines research, clinical capabilities, advanced analytics and investment resources. The UAE Genome Program has surpassed 900,000 sequenced genomes, making it one of the world’s largest population genomics initiatives and providing a valuable resource for scientific research and precision medicine.

These investments provide the ingredients necessary to compete. Partnerships provide the opportunity to accelerate progress.

Building Through Collaboration

Biotechnology has long been a collaborative enterprise among private equity and entrepreneurs, academic medicine and corporations, and, now, nations working side by side with other countries’ governments.

Scientific discovery depends on the exchange of knowledge among researchers, entrepreneurs, clinicians, manufacturers, regulators, and investors. No single country possesses every advantage. Successful ecosystems learn how to connect their strengths with those of others.

Abu Dhabi’s recent actions suggest its leaders understand this reality more than anyone else. They act on it.

During the BIO International Convention, the Department of Health – Abu Dhabi announced a strategic collaboration with Sanofi focused on vaccine development and life sciences innovation. The previous year at BIO in Boston, the Department established a partnership with Boehringer Ingelheim that expanded access to the company’s OpnME research platform, creating new opportunities for translational research and scientific discovery.

An additional 2025 agreement was signed with Abbott, focused on pharmaceutical innovation, manufacturing capabilities, and emerging technologies.

These were not isolated announcements. They represented a broader effort to connect Abu Dhabi with leaders across the global life sciences community. That strategy continued at BIO 2026.

On June 23, 2026, the Department of Health – Abu Dhabi announced a strategic partnership with Biocom California, one of the world’s largest life sciences associations representing more than 1,800 biotechnology, pharmaceutical, and medical technology organizations. The agreement creates a formal gateway between the California innovation ecosystem and Abu Dhabi’s growing life sciences sector, strengthening opportunities for collaboration among researchers, entrepreneurs, investors, and innovators across both markets.

The significance of the announcement extends beyond California. It reflects Abu Dhabi’s effort to connect itself to some of the world’s most influential innovation networks and to participate in the exchange of scientific knowledge, talent, and investment that increasingly defines biotechnology leadership.

Moving Up the Biotech Value Chain

If the Biocom agreement demonstrated Abu Dhabi’s commitment to global collaboration, a second announcement made the Emirate’s ambitions even clearer.

On June 24, 2026, the Department of Health – Abu Dhabi, M42, and Mammoth Biosciences announced a partnership to advance gene-editing therapies, clinical research, and advanced therapy manufacturing in Abu Dhabi. The agreement seeks to leverage insights generated through the Emirati Genome Program while supporting the development of next-generation treatments for inherited diseases.

This announcement stands out because it moves beyond ecosystem building and into the development of future therapies.

Mammoth Biosciences was co-founded by Nobel Prize-winning scientist Jennifer Doudna, whose pioneering work helped bring CRISPR gene-editing technology into medicine. Under the agreement, Mammoth will contribute its proprietary gene-editing platform, M42 will provide genomics, health, and clinical research infrastructure, and the Department of Health will support the regulatory and research environment needed to advance development.

The collaboration includes plans to introduce Mammoth’s lead clinical candidate, MB-111, into Abu Dhabi’s research ecosystem, support advanced gene-editing clinical trials, establish advanced therapy manufacturing capabilities, and develop local expertise through workforce training programs.

Perhaps most significantly, the partnership highlights how Abu Dhabi is leveraging its genomics investments. The Emirati Genome Program has created one of the world’s most comprehensive population genomics initiatives. The Mammoth agreement represents an effort to translate those insights into therapies targeting inherited diseases.

As H.E. Dr. Noura Al Ghaithi noted when announcing the partnership, Abu Dhabi is focused on translating genomic insights into therapies to address some of the most complex inherited diseases affecting populations in the region and worldwide.

Leadership Matters

The prominence of Abu Dhabi at BIO 2026 reflects sustained engagement from senior leaders. H.E. Dr. Noura Khamis Al Ghaithi, Undersecretary of the Department of Health – Abu Dhabi, and Dr. Mohamed Al Ameri, Division Director of Genome and Biobank at DoH, are among the officials representing the Emirate’s vision throughout the convention.

Their participation reflects a broader commitment. During Abu Dhabi’s 2025 strategic mission to the United States, approximately 40 representatives from 12 organizations attended more than 20 strategic meetings, conducted 16 institutional visits, participated in 9 BIO-related panels, and established 7 new partnerships and agreements.

Such activity underscores an important point. Building a biotechnology ecosystem requires more than investment capital. It requires leadership, patience, and a willingness to build relationships across borders and disciplines.

A Must-Watch Innovation Hub

For decades, discussions about biotechnology leadership have focused on a familiar collection of cities and regions. Boston, San Diego, Basel, London, and Singapore earned their positions through scientific excellence, entrepreneurial activity, and investment.

Abu Dhabi is pursuing a different path.

The Emirate is leveraging capital, scientific infrastructure, genomics, artificial intelligence, policy support, and international partnerships to establish a presence in the global biotechnology landscape. Its strategy recognizes that modern biotechnology advances through collaboration and that scientific leadership increasingly depends upon connecting talent, expertise, and resources across borders.

BIO 2026 demonstrated that Abu Dhabi is no longer simply expressing an ambition to participate in the life sciences sector. Through initiatives such as the HELM Cluster, partnerships with organizations including Sanofi, Boehringer Ingelheim, Abbott, Biocom California, and Mammoth Biosciences, and investments spanning genomics, research, and advanced therapies, the Emirate is laying the foundations for a biotechnology ecosystem with global aspirations.

Whether Abu Dhabi joins the ranks of the world’s leading life sciences hubs remains to be seen – but it should be watched closely. What is increasingly difficult to overlook is the depth of its commitment and the speed with which effort is being translated into action.

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A growing body of research is connecting GLP-1 receptor agonists, the class of drugs behind brand names like Ozempic, Wegovy, Mounjaro, and Zepbound, to a serious eye condition that can cause permanent vision loss. The condition has a long medical name: non-arteritic anterior ischemic optic neuropathy, or NAION. Eye specialists sometimes describe it as a stroke of the optic nerve. And once the damage is done, there is currently no treatment that can undo it.

This article is not written to frighten you or push you off your medication without talking to your physician. Millions of people are benefiting from these drugs every day. But the question health experts are now asking out loud is this: when a rare side effect starts appearing in large numbers of people, does it stay rare?

What Are GLP-1 Drugs and Why Are So Many People Taking Them?

GLP-1 stands for glucagon-like peptide-1. These drugs mimic a hormone your gut naturally releases after eating. They slow digestion, reduce hunger, and help control blood sugar. Originally developed for type 2 diabetes, they became household names when studies showed they could also produce significant weight loss.

The popularity of these drugs has been extraordinary. Roughly 15 million people in the United States are currently taking GLP-1 medications, and that number keeps climbing. Many of these users do not have diabetes at all. They are taking the drug specifically to lose weight, often without a full picture of what the long-term risks might look like.

The Eye Condition No One Was Expecting

NAION occurs when blood flow to the front portion of the optic nerve is cut off or severely reduced. The optic nerve is the cable that carries visual signals from your eye to your brain. When that nerve loses its blood supply, even briefly, it can suffer damage that leads to permanent partial or total vision loss in that eye. Health authorities, including the World Health Organization, confirm that this vision loss is usually permanent.

The condition is not brand new. It was already known to affect adults over 50, people with high blood pressure, and people with diabetes. What caught researchers off guard was a cluster of cases appearing in people who had recently started taking semaglutide-based medications.

The alarm was first raised in 2024, when physicians at Massachusetts Eye and Ear, a Harvard Medical School-affiliated hospital, published findings in the journal JAMA Ophthalmology. Their retrospective study of more than 16,000 neuro-ophthalmic patients found that people with type 2 diabetes or obesity who were taking semaglutide had a significantly higher rate of NAION compared to those taking other medications. Among diabetes patients in the study, semaglutide users showed a hazard ratio of 4.28, meaning the risk of developing NAION was more than four times higher than in comparable patients on other glucose-lowering drugs.

A separate Danish and Norwegian study that same year, drawing on data from more than 424,000 patients with type 2 diabetes, found that once-weekly semaglutide use more than doubled the five-year risk of NAION compared to patients taking other diabetes medications.

A Small Percentage Times Millions of People

Here is where the math matters. NAION is classified as “very rare,” meaning it may affect up to 1 in 10,000 people. The European Medicines Agency, which regulates drugs across 27 countries, formally added this classification in June 2025, recommending that product information for Ozempic, Wegovy, and Rybelsus be updated to include NAION as a side effect. The World Health Organization issued its own safety alert shortly after.

But consider what “very rare” actually means when tens of millions of people are taking a drug. If even 1 in 10,000 semaglutide users develops NAION, and 15 million Americans are using GLP-1 medications, that translates to roughly 1,500 potential cases in the United States alone. And that figure is based on the most conservative estimate.

The American Optometric Association’s clinical guidance report put it bluntly: “There is a low risk of serious ocular side effects. But a low risk of a big number is a big risk.”

The University at Buffalo researchers who published a related case series in JAMA Ophthalmology noted something else that raised eyebrows. NAION almost always strikes one eye at a time. But some patients on GLP-1 drugs were presenting with the condition in both eyes simultaneously, which is considered atypical and potentially more alarming.

The Research Is Still Sorting Itself Out

To be fair, the picture is not entirely clear-cut. A large February 2025 retrospective study that pooled data from 37 million diabetes patients across 14 international databases found that semaglutide users showed about 14 to 15 NAION cases per 100,000 patients annually, and when compared to other GLP-1 drugs, the risk was not significantly different. This suggests the vision risk may apply to the entire class of GLP-1 medications, not just semaglutide specifically.

A separate large cohort study published in JAMA Network Open, covering 185,000 individuals on GLP-1 drugs, found a slightly higher risk of developing diabetic retinopathy, but a similar rate of NAION compared to those on other treatments. And two studies presented at the American Academy of Ophthalmology’s 2025 annual meeting offered conflicting signals: one tied GLP-1 drugs to increased NAION risk and diabetic retinopathy risk, while another suggested the drugs might actually protect against dry age-related macular degeneration.

Scientists are careful to note that none of the current evidence proves that GLP-1 drugs cause NAION. What exists is a statistically significant association that has now been observed across multiple studies, multiple countries, and multiple drug databases. That is enough to prompt regulatory bodies to act and researchers to dig deeper.

Who May Be at Highest Risk?

Physicians are paying special attention to patients who already have underlying vascular risk factors. High blood pressure, high cholesterol, diabetes, a history of cardiovascular disease, and a structural eye condition called a small optic disc are all considered risk factors for NAION independent of GLP-1 use. When these pre-existing vulnerabilities are combined with a medication that may affect blood flow to the optic nerve, the potential for harm may be higher.

The symptoms to watch for are specific and sudden: vision loss in one eye that seems to come on without warning, often noticed upon waking. There may be a dark or blurry area in part of your field of vision, or a sense that something has been “wiped away” in one corner of sight. There is typically no pain, which is part of why people sometimes wait before seeking care. Any of these symptoms should be treated as a medical emergency.

Where Things Stand Right Now

As of June 2026, the European Medicines Agency has updated its labeling requirements for semaglutide to include NAION. The World Health Organization has issued a formal safety alert. And a multidistrict litigation involving GLP-1 vision loss lawsuits was consolidated in the Eastern District of Pennsylvania in December 2025. Legal analysts report that over 1,800 lawsuits had been filed by mid-2025, with more expected as scientific review continues.

The U.S. Food and Drug Administration has not yet added a NAION warning to American drug labels for semaglutide. Novo Nordisk, which manufactures Ozempic and Wegovy, has not yet updated its U.S. prescribing information to reflect the risk. Public health advocates and some legal experts have called for a black box warning, the FDA’s highest-level alert.

The American Academy of Ophthalmology and the North American Neuro-Ophthalmology Society have both weighed in, stating that they do not recommend that all semaglutide users stop their medication immediately if they develop NAION, since the benefits of the drug may still outweigh individual risks, depending on the patient’s overall health. But both organizations agree that sudden vision changes of any kind require immediate medical evaluation.

What This Means for You

If you are currently taking a GLP-1 medication for weight loss or diabetes management, here are the most important things to keep in mind.

1. Do not stop your medication without talking to your physician. For many people, the health benefits of these drugs are substantial, and an abrupt stop can create its own risks.
2. Tell your physician if you have existing eye problems, high blood pressure, or a history of cardiovascular disease. These factors may influence how closely you should be monitored.
3. Take sudden vision changes seriously. If you wake up one morning and something looks wrong with one eye, that is not something to wait out. Call your physician or go to an emergency room. Time may matter.
4. Ask questions. Ask your physician whether NAION has been discussed in your care plan. Ask whether your specific risk factors warrant more frequent eye exams. You have the right to that conversation

The Larger Question

GLP-1 medications have been genuinely life-changing for many people. They have helped reduce the burden of obesity, lower cardiovascular risk, and control blood sugar in ways that were difficult to achieve before. None of that is in dispute.

But when a drug reaches the scale of tens of millions of users, even rare side effects become a public health question. A risk that affects fewer than 1 in 10,000 people in a clinical trial still produces thousands of real individuals with real and permanent vision loss when multiplied across the population taking these drugs. Those individuals deserve answers, updated labels, and the chance to make informed decisions before the lights go out.

Research is ongoing. Regulatory conversations are happening. In the meantime, staying informed, staying in communication with your physician, and taking any sudden change in vision seriously are the most important steps you can take.

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Bringing Conversational AI to Scientific Research

The announcement arrives as artificial intelligence continues to reshape nearly every corner of the health sector. Much of the attention has focused on applications designed for consumers seeking information or clinicians seeking support in managing increasingly complex workloads. Briya is directing its attention to a different priority audience: medical researchers in academia, hospitals and life science companies.

The decision reflects a recognition that scientific inquiry often remains constrained by barriers that have little to do with science itself. Researchers routinely navigate fragmented data sources, technical requirements, analytical platforms and resource limitations before they can begin testing a hypothesis or exploring an observation.

The Next Step in Briya’s Evolution

Briya is executing on the established understanding that artificial intelligence can help reduce those barriers.

Researchers using AIRE will be able to explore public health information, including data from the U.S. Centers for Disease Control and Prevention, through a browser-based conversational interface. Rather than writing code, users can ask questions in natural language, refine their inquiry through dialogue and review the analytical pathway used to produce results.

“The last few years proved that AI can generate answers,” Briya co-founder and CEO David Lazerson told Medika Life. “The next challenge is making AI capable of generating trustworthy science. That requires a fundamental shift from general-purpose AI systems to research environments built around transparency, epidemiological methodology and scientific accountability.”

The announcement represents the latest step in Briya’s evolution. Founded in 2020 by Lazerson and Chief Technology Officer Guy Tish, the company initially centered efforts on helping organizations connect fragmented health data while maintaining privacy protections, governance requirements and institutional control over sensitive information.

Medical records rarely exist in a single location. Information is often distributed across electronic medical records, laboratory systems, imaging platforms, physician notes and institutional databases. Briya developed a federated approach that allows information to remain within source organizations while supporting approved research across participating data environments.

AIRE expands that mission from data access to data exploration.

The platform is designed to support cohort construction, endpoint validation, treatment pathway analysis, chart review and the exploration of structured and unstructured clinical information. Researchers interact with the platform through conversation rather than code, allowing them to start with a scientific question rather than a technical workflow.

The strategy mirrors an approach that has proven successful in other areas of artificial intelligence. Consumer platforms such as ChatGPT and Perplexity accelerated adoption by allowing users to experience the value of AI before deciding whether additional capabilities justified a subscription.

Reducing the Distance Between Questions and Answers

Briya is applying a similar philosophy to research. Many health technology companies continue to pursue adoption through enterprise purchasing processes, institutional pilots and lengthy implementation cycles. The Briya approach places the researcher at the center of the experience and allows investigators to determine the platform’s value through direct, frequent use.

The company believes that approach may be particularly meaningful for researchers working outside large academic medical centers and major pharmaceutical companies. Those institutions often have access to dedicated data science teams and sophisticated analytical resources. Smaller universities, physician-scientists, public health investigators and community-based researchers may not.

The absence of resources does not diminish the importance of the questions they seek to answer. In fact, as many attending HLTH EU head from Amsterdam to BIO International in San Diego, many of the biggest life-changing advances start in smaller research settings.

Giving Researchers a Seat at the Table

A physician observing an unusual treatment response, a public health researcher investigating a local health pattern, or an early-career investigator evaluating a new hypothesis all face the same challenge: transforming observation into evidence. That process frequently requires technical expertise and infrastructure that are not universally available.

Reducing those barriers could expand participation in research and potentially broaden the range of questions being explored. Accessibility alone, however, is not enough.

Scientific inquiry requires transparency, reproducibility and methodological rigor. Researchers must understand how conclusions are reached, what assumptions influence an analysis and where potential bias may exist.

A Move from Observation to Evidence

Recognizing those requirements, Briya recently appointed internationally recognized epidemiologist Professor Jonathan Samet, MD, MS, as Chief Epidemiologist. Dr. Samet is Professor of Epidemiology and Occupational and Environmental Health, and the former Dean of the Colorado School of Public Health.

“Scientific rigor and accountability cannot be layered onto AI after the fact,” Dr. Samet told Medika Life. “If these technologies are going to play a meaningful role in healthcare research, transparency, reproducibility and epidemiological methodology must be built directly into the system itself.”

Samet added that researchers need to understand more than an AI-generated conclusion: “Researchers need to understand not only what an AI system concludes, but how it reached those conclusions and what risks may exist along the way.”

His appointment reflects a broader challenge facing artificial intelligence in research environments. While generative AI systems can produce clear and persuasive responses, researchers and institutions must be able to evaluate the methods, assumptions and analytical pathways behind those outputs.

Trust, governance and cybersecurity have become as important as speed and convenience. Health information remains among the most sensitive categories of personal data. Institutions considering AI-enabled research environments must evaluate privacy protections, security controls and governance requirements alongside scientific capabilities.

Briya says its architecture is designed to allow data to remain within source organizations while supporting anonymization, compliance controls and auditable pathways for approved analysis.

Briya’s decision to open access to AIRE arrives at a time when researchers are under increasing pressure to produce meaningful scientific output while navigating growing volumes of health information. The platform’s no-cost entry point reflects a broader shift occurring across technology, where organizations increasingly recognize that adoption begins with customer experience. By allowing researchers to engage directly with data through a conversational interface, Briya is reducing barriers that have traditionally separated scientific questions from scientific exploration and adoption.

The announcement broadens the conversation surrounding artificial intelligence in health. Much of the industry’s attention has focused on consumer and clinical applications. Briya is directing attention to another critical constituency whose work influences every future therapy, diagnostic and public health intervention.

As HLTH Europe begins, the company is making the case that empowering researchers may represent one of the most consequential applications of artificial intelligence in health. If successful, the approach could help accelerate discovery, expand participation in research and provide investigators with a direct path from observation to evidence to implementation.

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The Centers for Medicare & Medicaid Services released the rules on June 1. That deadline was set last year in the GOP tax-and-spending law known as the One Big Beautiful Bill Act, which established a work requirement for certain people enrolled in Medicaid, the state-federal health insurance program for people with low incomes or disabilities.

Medicaid agencies are scrambling to rework IT systems and make sure they have staff to effectively enforce the rules, while also keeping enrollees from losing coverage for administrative reasons, such as difficulty navigating state eligibility portals.

The newly announced regulations offer a clearer picture of what roughly 18.5 million Medicaid enrollees will have to do to prove they qualify for benefits.

Jim Torres, who helps people enroll in health coverage at the Samuel U. Rodgers Health Center in Kansas City, Missouri, said a “very small percentage” of his clients have heard of the changes coming to Medicaid.

“These folks have very busy lives. They’re doing the best they can to get by,” he said. “It’s just not a top-of-mind thing for most of them.”

Health policy researchers and consumer advocates said enrollees should keep a few things in mind as the Jan. 1, 2027, rollout approaches in most states.

1. The work rules won’t apply to everyone.

The new rules will apply to people covered through what’s known as Medicaid expansion. Since 2014, more than 40 states and the District of Columbia have decided to allow more people into their Medicaid programs, generally low-income adults without dependents. Georgia and Wisconsin offer coverage to some people in this group, so they’ll be subject to the rules.

Children and pregnant people, as well as individuals with disabilities who receive Social Security payments — all groups that already qualify for Medicaid — won’t be subject to the rules. Nor will people determined to be “medically frail,” or too sick to work.

People subject to the work rules are “crowding out” people in the Medicaid program who are “truly in need,” CMS Administrator Mehmet Oz claimed during a June 1 press call. “Work requirements are going to turn this around, we hope.”

The rules are set to take effect in most places in January. Nebraska started enforcing them in May. Montana plans to start in July but won’t kick people off until October. Arkansas will do a “soft” launch in July — it will start enforcing the rules but with no penalties until next year.

2. States will take your word that you’re too sick to work. For now.

Federal officials have stressed that states should make the process of reporting hours and requesting exemptions as simple as possible for Medicaid enrollees by creating automated systems and using existing data sources, such as unemployment and education records.

If states cannot determine you’re performing 80 hours of qualifying activities a month using those data sources, you may be allowed to “self-attest” to that in 2027, health policy researchers said.

People will also be allowed to “self-attest” that they are too sick to work in 2027, and do so one time in 2028. Then states will start asking for proof, if they can’t find it through available data.

But after the initial rollout, the burden of proof is likely to still fall on many enrollees, said researchers and consumer advocates.

People may need to dig up pay stubs, medical records, and doctors’ notes and submit them for state review, said Morgan Henderson, who has studied Medicaid work programs in Georgia and Arkansas at The Hilltop Institute, a research center at the University of Maryland-Baltimore County.

“The higher this manual reporting burden, the less people are going to do it,” he said. “That means that we’re going to see coverage drop-offs.”

3. The rules are tougher than expected for people too sick to work.

One of CMS’ primary goals has been to “protect vulnerable populations” through “strong exemptions to make sure people who can’t reasonably be expected to work are not subject to the requirements,” Dan Brillman, a deputy administrator at the agency, said during the June 1 press call.

Consumer and patient advocates, however, said the final rules’ exemptions are more restrictive than expected. Enrollees will eventually have to provide documentation, such as a statement from a medical professional, to prove that a health condition keeps them from working. And each individual state will have to determine the severity of beneficiaries’ medical conditions.

“Someone could be medically frail in Nebraska but not medically frail in Delaware,” said Carolyn Sheridan, associate director of state policy for the National Organization for Rare Disorders, which lobbies for patients with rare diseases. She said her group had hoped the rules would offer a standardized definition of who counted as medically frail and not leave the decision up to states.

Trump administration officials have publicly crusaded against fraud in government health programs, such as Medicaid, and states could face financial penalties for incorrectly granting people exemptions from the work rules, said Jennifer Tolbert, who researches Medicaid at KFF, a health information nonprofit that includes KFF Health News.

“States may be more cautious,” she said. “That will likely lead to people losing coverage who may still be eligible.”

4. Only certain qualifying activities count.

Enrollees can satisfy the rules by working 80 hours a month. They can also be enrolled in college courses, volunteer through a community organization, or do “in-kind” work that doesn’t result in pay.

The rules set out, in detail, how many academic credit hours translate to 80 hours a month — students need to be enrolled in six credit hours per semester to meet the “half-time” requirement. An unpaid internship can count toward the 80 hours.

People can also prove they’re volunteering with “a document from a community service organization.”

Consumer advocates say it might be hard for people to obtain proof they’re performing these kinds of informal activities. But supporters of the rules say volunteerism can already be tracked.

“If you run into trouble with the law and the judge says, ‘Hey, you need some volunteering and community service to serve your time,’ there are already ways that we verify that,” said Niklas Kleinworth, who works on state health policy for the conservative Paragon Institute.

5. You have time to prepare.

Make sure your state Medicaid agency has your current mailing address and keep your eye on your mailbox, said researchers and consumer advocates. State Medicaid agencies must inform you in two ways if you’ll be subject to the rules — by either regular mail or email, and by one other form of communication, such as a text or phone call or by posting a notice online.

“The important stuff comes by mail,” Henderson said.

And check in with your state Medicaid agency, said researchers and advocates. Some states, including Arkansas, California, and Wisconsin, have already posted information about the work rules on their websites. If you can’t find what you’re looking for there, visit or call a local office. A caseworker should be able to tell you whether you’ll be subject to the rules.

“Get ahead of this,” said Joan Alker, who is executive director of the Georgetown University Center for Children and Families and studies Medicaid. “So that you don’t end up going to the pharmacy one day and they say, ‘Oh, you’re not insured anymore’ when you’re trying to get your prescriptions refilled.”

KFF Health News correspondent Samantha Liss and senior correspondent Rachana Pradhan contributed to this report.

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