Engaging that question informed “The Science Trust Conundrum: When Society Doubts Its Own Progress,” a planned discussion at the Oct. 29 Galien Foundation Forum at the New York Academy of Medicine. Bringing together the daylong Forum’s life sciences and patient-focused tracks, the panel examined a perplexing challenge: Scientific progress must be evaluated through discovery, and through the experiences of the people it is intended to serve.

Jeremy Levin, co-founder and executive chairman of Ovid Therapeutics and former chair of BIO, an industry leader whose journey has guided two global biopharma companies, guided the discussion with questions that built on each response. With Margaret (Peggy) Hamburg, MD, former FDA commissioner and co-president of the InterAcademy Partnership; Vardit Ravitsky, PhD, president of the Hastings Center for Bioethics; Julie Fleshman, JD, MBA, president and CEO of the Pancreatic Cancer Action Network; and this author, he connected questions of evidence, ethics, institutional conduct, patient experience and public communication.

The standing-room-only audience listened closely. At times, you could hear a pin drop, particularly when the discussion moved from the principles institutions profess to the consequences of decisions that affect people – people seeking solutions to health challenges. Levin set the conversational direction early: “Scientific progress doesn’t guarantee public trust.” The next question was whether the source of doubt lies in science itself or in the human systems speaking in its name.

What Do People Actually Doubt?

Levin opened with a question to Ravitsky: “When somebody says, ‘I no longer trust science,’ do they mean the scientific method or the people or the institutions claiming to speak for it?” The distinction matters because scientific inquiry, institutional authority and individual behavior are related, but they are not the same thing.

Ravitsky described the gap between confidence in individual health professionals and skepticism toward institutions. People may look into the eyes of a nurse or physician and experience competence and concern directly, while an agency or health system can feel distant and inaccessible. Scientific expertise also competes with a growing universe of self-appointed authorities, from social media personalities to people who confuse access to artificial intelligence tools with equivalent clinical or scientific judgment.

Rather than directing frustration toward an uninformed public, Ravitsky proposed a more demanding standard for experts and institutions. “Trustworthiness shifts the perspective,” she said. “It asks us, the experts, how do we become trustworthy? How do we earn your trust? How can we do better?” Her point reframed the problem: Institutional credibility must be examined through conduct, not simply asserted through credentials.

The implication reaches well beyond public education. When an institution asks people to accept a conclusion, it should be prepared to explain the evidence, the decision-making process and its own responsibilities. Scientific literacy matters, but greater public understanding cannot compensate for institutional behavior that fails to merit confidence.

Can the Science Be Right While the Institution Loses Confidence?

Levin moved directly from ethics to regulatory leadership, asking Hamburg whether an institution could make a scientifically sound decision and still lose public confidence. Her answer was yes, including for COVID-19 vaccines, where extensive scientific evaluation and public controversy coexisted.

Hamburg recalled a criticism she encountered at the FDA: “One of the accusations I heard from day one was you’re a black box.” The agency could reach evidence-based decisions while the people affected by them remained uncertain about how those decisions were made. She emphasized explaining not only what an institution does, but how and why it does it, while listening to the stakeholders whose lives and work it affects.

Transparency, in that sense, is more than releasing information. It requires clarity in reasoning, consistency in decisions, and a willingness to answer questions, even when an institution cannot satisfy everyone. Hamburg also emphasized the independence of scientific decision-making from inappropriate political, financial and ideological pressure, an issue that would return later in the discussion.

The challenge for the wider health ecosystem is straightforward. A scientific decision and its explanation are different responsibilities, and both matter. Institutions cannot assume that sound evidence will be self-explanatory to people encountering its consequences in their daily lives.

What Does Confidence Mean to Someone With Pancreatic Cancer?

Levin then shifted from the institution to the patient, asking Fleshman what makes a physician, clinical trial or investigational medicine worthy of confidence for someone facing pancreatic cancer. The question changed the stakes: For a newly diagnosed person, the need for credible information is immediate, personal and often urgent.

Fleshman described the expectation patients bring to care: “There’s going to be a path for me to follow and someone’s going to walk me through that path.” Yet patients may encounter delayed appointments, delayed testing and incomplete explanations of treatment choices. They may learn too late about clinical trials or about genetic and biomarker testing that could have informed their options.

PanCAN helps translate complex information into questions that patients can bring into their limited time with clinicians. That work does not replace medical judgment. It allows people to participate in decisions rather than becoming passive recipients of information they cannot readily interpret or use.

There is an important distinction between the scientific promise of a treatment and the patient’s ability to benefit from it. People do not encounter scientific innovation as a regulatory dossier or a conference presentation. They encounter it through physicians, appointments, decisions, waiting periods and access to care. Those experiences shape the credibility of the health ecosystem as surely as the published evidence does.

Communication Cannot Substitute for Conduct

Levin connected the preceding responses with a pointed question about communication: Was it too convenient to say that institutions simply needed to communicate better, or did they first need to change their behavior? That question deserves to sit at the center of any discussion about reputation in health.

My response began with a distinction: “Trust is not a campaign.” It cannot be manufactured by messaging or treated as an external asset that communicators can produce on demand. Reputation develops through the consistency of leadership, the culture that follows and the everyday experiences of people affected by institutional decisions.

Three obligations help define that responsibility: timely communication, transparency and truth. They become meaningful when reflected in decisions, especially when developments disappoint patients, investors or the public. Too often, an institutional conversation about difficult news begins with how to position the message rather than what people deserve to know and what the organization must do.

We also tend to speak about institutions as though they possess human character independently of the people who lead them. They do not. People establish policies, choose what to disclose, decide whether to acknowledge mistakes and determine whether organizational values survive difficult moments. Institutional credibility is the consequence of those human choices.

The same discipline is needed when discussing technology. Artificial intelligence can analyze data, identify patterns and augment clinical judgment, but it does not possess the human purposes we sometimes assign to it in our language. People build, train, deploy and govern those systems. The responsibility for ensuring that technology serves patients remains with them, not with the technology itself.

That distinction does not diminish innovation. It restores innovation to its purpose. Tools and institutions exist to serve humanity, and their effectiveness must ultimately be measured through what they enable people to understand, decide and experience.

Can a Leader Admit Not Knowing?

The pressure to project certainty is not limited to institutions. It is familiar in the examination room, where patients and families seek answers and professionals may feel compelled to provide them. During the panel, a brief example from my now-adult daughter’s experience with a rare disease illustrated the value of a physician willing to say that the underlying cause remained unknown.

Physician Nieca Goldberg, MD, at NYU Langone acknowledged uncertainty after years of inconclusive assessments. “I don’t know what this is, but together we will find out.”

The importance of that encounter was not the identity of the family involved, but the quality of the clinical response: A responsible expert did not substitute confidence for knowledge. The acknowledgment left room for further inquiry instead of closing it prematurely.

Ravitsky picked up that observation immediately, reflecting on her work communicating public health guidance during the pandemic. “We conveyed certainty when we didn’t have it,” she said, explaining how officials believed confident messaging would encourage people to follow measures intended to protect lives. The intentions may have been defensible, but the longer-term consequences of overstating certainty deserve examination.

When recommendations changed as new evidence emerged, members of the public were not always prepared to understand why. What scientists recognized as the normal development of knowledge could appear inconsistent to people who had been told that earlier judgments were settled. Ravitsky argued for respecting the public’s capacity to understand complexity rather than presenting scientific uncertainty as a weakness.

Levin carried the exchange to Hamburg with another connected question: What should leaders do when new evidence forces a change in recommendations? Hamburg emphasized the need to explain what is known, what remains unknown and what people can do now, while describing the work underway to answer unresolved questions. Leaders must be prepared to acknowledge mistakes and adjust course without disguising the reasons for doing so.

The exchange exposed a persistent problem in institutional life. People understandably seek direction, especially in a crisis, while leaders fear that candor will be mistaken for weakness. Yet an appearance of certainty can create a larger credibility problem when reality becomes more complicated than the original message allowed.

Does the Medium Create Misinformation, or Do People?

Levin next asked whether the volume and speed of modern communication, from cable news to social media, were themselves eroding public confidence. Hamburg had described how the demands on public health leaders intensified with round-the-clock news coverage and expanded further in the digital environment.

The response to Levin’s question distinguished the channel from the deeper problem. Digital platforms accelerate the movement of claims, but human choices determine what is published, amplified, believed and acted upon. The challenge is not simply that more people can speak. It is that visibility and influence are too often mistaken for expertise and evidence.

A person can now obtain an immediate answer from a digital tool, often without understanding the quality or limitations of the underlying information. That capability can be useful, but it should not be confused with clinical judgment or scientific authority. Technology changes the speed and reach of communication; it does not eliminate the need for discernment.

The issue is equally apparent in the physician-patient relationship. An experience raised during the panel involved a physician dismissing a patient’s information by asking, “Who are you going to believe, me or a patient?” The words were consequential because they treated professional authority and the patient’s perspective as competing claims rather than potentially complementary sources of understanding.

Another physician later performed a complex procedure that the first had rejected, ensuring my daughter would be able to eat without a feeding tube in the future. The lesson is not that clinical expertise should be disregarded. It is that expertise is strongest when it remains open to questions, evidence and the lived experience of the person receiving care. Communication is care when it makes that exchange possible.

When the Science Works but the System Struggles to Catch Up

Levin returned to Fleshman with a question about how patients facing pancreatic cancer should navigate uncertainty while making urgent treatment decisions. Her response brought together the panel’s themes of science, access, communication and human determination.

She described encouraging research presented at the American Society of Clinical Oncology meeting involving a KRAS-targeted therapy. The findings drew attention among researchers and spread quickly through news and social media, where patients and families followed them with intense interest.

Fleshman recounted the experience of Russ, a seriously ill pancreatic cancer patient, and his wife, Marne. After hearing about the investigational treatment, Marne worked to secure access through the medical institution, PanCAN, media outreach and the FDA. Although an expanded access pathway had been authorized, the practical process was difficult and took more than four weeks.

According to Fleshman, Russ improved substantially after receiving the medicine and was later able to travel and participate in advocacy activities. Yet the encouraging outcome also exposed the vulnerability of a system in which a patient’s opportunity may depend on a family member’s persistence and ability to navigate multiple organizations.

“The science worked beautifully but the system almost didn’t,” Fleshman said. Hamburg immediately urged that the barriers behind such delays be examined and corrected. Levin raised the disturbing question of how many patients might have died during a similar waiting period, moving the discussion from a hopeful individual outcome to a responsibility shared across the health ecosystem.

The friction tax paid by patients is measured in delays, anxiety, expense and opportunities that may disappear as disease progresses. Investment in discovery remains essential, but breakthroughs cannot fulfill their promise when the systems responsible for delivering them operate as disconnected parts.

Fleshman also protected the distinction between hope and evidence. Responding to an audience member, she acknowledged that the treatment was not a cure and that the clinical findings did not justify such a promise. Patients deserve hopeful possibilities and scientifically honest explanations in the same conversation.

When Science is Dragged Into Politics

With time running short, Levin moved to a question about the relationship between political direction and scientific judgment. Hamburg acknowledged that scientific agencies operate within government and that policy decisions may weigh competing public priorities, but she defended a stronger boundary against political interference in regulatory science.

Ravitsky added that robust evidence does not erase differences in human values. During the pandemic, communities weighed disease prevention against other pressing needs, including financial security, access to school and family safety. She also described a treatment conversation involving her mother in which a clinical recommendation had to be considered alongside the patient’s priorities for mobility, independence and quality of life.

These examples clarified a distinction running through the panel. Evidence can identify likely outcomes, but people must participate in determining which outcomes matter to their lives. The purpose of scientific knowledge is not to replace human judgment. It is to inform it.

Fleshman reminded the audience that biomedical research funding affects the options available to patients today and in the future. The concluding exchange returned to two related responsibilities: preparing health professionals to engage with people seeking healing and protecting scientific inquiry from political interference.

“Science is not a political party,” was my response. “It’s science dragged into politics.” Scientific institutions are accountable to society, but that accountability cannot mean allowing ideology to dictate evidence or political leaders to interfere with scientific work. Levin asked the audience to applaud those remarks, a moment that reflected the discussion’s return to the responsibilities of human leadership.

Humanity Remains the Measure

The planned meeting of the Forum’s life sciences and patient-centered perspectives was more than a matter of programming. It recognized that discovery and experience belong in the same conversation. Progress is incomplete if a scientific advance can be described in detail while the people who might benefit remain unable to understand or access it.

Levin’s questioning helped reveal that the challenge cannot be reduced to a lack of public education or the need for a more persuasive message. Ravitsky challenged experts to examine institutional behavior; Hamburg described the duties of scientific leadership; Fleshman made visible the costs of fragmentation. Their perspectives converged on a principle with consequences for every organization developing, regulating, communicating or delivering health innovation.

We often assign responsibilities to abstractions. We expect institutions to be ethical, technology to be responsible and systems to become patient-centered. Yet people make the choices that give those words meaning. Artificial intelligence does not independently decide whether time saved through automation becomes more appointments or more meaningful conversation. Health leaders make that choice, and patients experience the result.

The same is true of scientific communication. More information is not necessarily more understanding, and greater reach does not guarantee greater credibility. The objective is to help people distinguish what is established from what remains uncertain and to give them an informed voice in decisions that affect their lives.

The Galien Foundation celebrates the achievements of science, and the panel demonstrated why those achievements deserve a broader measure of success. Scientific progress expands what humanity can do. The people who create institutions, guide research, care for patients and govern technology determine whether that progress becomes meaningful in human lives.

The health ecosystem should defend scientific rigor while examining the barriers between discovery and care. It should embrace technology while preserving human responsibility and make room for uncertainty without abandoning direction. Science and innovation are designed to serve people, not the other way around. That is why people matter, and why humanity must prevail.

The post When Science Advances, Why Does Society Doubt Its Own Progress? appeared first on Medika Life.

Stephanie Rowell was standing on her parents’ front porch in July when a wasp stung her left arm.

Rowell, 53, took Benadryl, and her father started driving her to the nearest emergency room, about 25 minutes away. But after driving for 10 minutes they spotted a TruHealthNow urgent care facility in Purcellville, Virginia, and decided to stop, hoping she would get help faster.

“I thought I was going to die,” she said, recalling that she felt her throat tighten and found it harder to breathe.

Rowell, a manager at an agritourism business who lives in Round Hill, Virginia, has been uninsured since 2025, when she said she could no longer afford to buy coverage on her own.

After she checked in and disclosed that she did not have health insurance, Rowell said, a nurse practitioner saw her in an exam room and quickly diagnosed anaphylaxis, a severe and potentially life-threatening allergic reaction.

She said the nurse practitioner advised her that she needed a shot of epinephrine to reverse her symptoms.

Then the bill came, via a medical assistant.

“The medical assistant apologized and said I had to pay $400 for the shot up front,” Rowell said.

The Medical Service

Epinephrine is a naturally produced hormone, and a synthetic version is used as an injectable medication to treat severe allergic reactions, typically delivered via a single-dose prescription device called an EpiPen. It can prevent anaphylaxis from developing into anaphylactic shock, a life-threatening condition that occurs when the reaction causes a dramatic drop in blood pressure.

Because patients sometimes experience a recurrence of anaphylaxis after the initial reaction, it is recommended that patients be monitored in the hours after receiving epinephrine.

In addition to the injection, the urgent care’s staff checked Rowell’s vital signs, including her blood pressure, and a medical assistant monitored her for 30 minutes after she received the shot, according to Manbir Takhar, TruHealthNow’s medical director.

The Bill

$605: $400 for the medication, a $40 fee to administer it, and $165 for the visit to the urgent care center.

The Billing Problem: Emergency Care or Urgent Care?

Rowell said she was stunned that she was expected to pay before she received the shot of epinephrine. She returned to the waiting area to retrieve her wallet from her dad.

After she handed over her debit card, she said, the medical assistant gave her the shot. Within a few minutes, she could feel her throat loosening and her symptoms eased.

“I asked, ‘If I didn’t have the money, would you have just let me die?’” Rowell said. “And they said, sorry, that is their policy.”

Officials at TruHealthNow, which privately owns and operates eight urgent care centers in Northern Virginia and Maryland, said Rowell was told its policy in emergencies is to first provide treatment before handling billing. “Our policy is we give the shot and worry about the money later,” Preet Takhar, TruHealthNow’s CEO, said in an interview with KFF Health News.

The company officials confirmed Rowell was asked to pay before she received the shot. They said the nurse practitioner first determined Rowell’s condition was stable and that she was asked for payment as the injection was being prepared.

The request for payment did not delay administering the shot, said Manbir Takhar, who is married to Preet Takhar.

“The patient was stable, and that is why we took the payment then,” she said.

Federal law requires hospital emergency departments to stabilize anyone who shows up, regardless of ability to pay. But urgent care centers generally don’t fall under that law unless they are owned by hospitals, said Barry Furrow, director of the health law program at Drexel University in Philadelphia.

Urgent care centers have proliferated across the country in recent years, offering quick access to care, especially for people who don’t have a regular physician or can’t immediately see one, and particularly after hours and on weekends. The clinics usually take insurance and charge patients who don’t have coverage.

More than 15,000 urgent care centers handled about 185 million patient visits in 2025, according to the Urgent Care Association, a national trade group.

Urgent care centers offer a wide range of primary care services, treating conditions such as sore throats, flu, sprained ankles, and minor cuts. While services vary, they are not intended to treat life-threatening emergencies such as heart attacks or traumatic injuries.

Yet people sometimes show up at urgent care centers when they need emergency care, usually because they do not realize the seriousness of their condition, said Alan Ayers, an urgent care industry consultant.

While urgent care centers, like most doctors’ offices, ask for an insurance card or payment up front, that should not happen for patients needing emergency help, he said.

“Collecting a copay at check-in is standard across outpatient medicine, and it’s a separate question,” Ayers said. “For a sore throat, it doesn’t matter much. For anaphylaxis, it should never come up.”

Doctors also face an ethical obligation to treat patients facing an emergency if they have the capability, without asking for up-front payment, said Arthur Caplan, professor emeritus and past head of the medical ethics division at the New York University Grossman School of Medicine.

In a lifesaving situation, “you don’t need to have a patient go fumbling around for a credit or insurance card,” he said. “If you have the skill to take care of someone, you should.”

Medical experts say patients should generally know when to seek care at a hospital instead of an urgent care facility. For example, if they have trouble breathing or are experiencing chest pain, they should head to the ER. But some cases are not as clear-cut.

“Patients do not always know the severity of their condition when they decide where to go for care, and a patient’s condition can change,” said Steven Sellars, CEO of the Urgent Care Association.

Sellars said urgent care operators establish their own policies for what to do when patients need emergency care, such as when to transfer patients to a hospital.

The Resolution

Rowell went home after leaving the urgent care center. Her brother stayed with her to watch her for complications. “I felt wiped out,” she said, noting it took several days until she felt completely better.

Her daughter posted a summary of her experience on a Facebook community group’s page, eliciting hundreds of comments.

Rowell said she wasn’t upset at the price but believed she shouldn’t have had to pay before receiving the epinephrine. The price for a generic EpiPen is about $175, according to GoodRx.

She said she now carries an EpiPen.

The Takeaway

When in doubt as to whether you are having a medical emergency, always err on side of caution and go to the nearest ER or call 911, said Ryan Stanton, president of the American College of Emergency Physicians.

People with life-threatening allergies should get a prescription for an EpiPen to keep at home or with them, said Stanton, who is an ER physician in Lexington, Kentucky.

The post She Needed an EpiPen. But First, an Urgent Care Asked Her To Pay. appeared first on Medika Life.

Moments like that happen millions of times a day. A major new study tells us that the eating disorders tied to those moments are growing all over the world.

What the New Study Found

In late October 2026, the journal JAMA Psychiatry published the largest look yet at anorexia and bulimia worldwide. Researchers with the Global Burden of Disease project studied 204 countries and territories from 1990 through 2023. Here’s what they found:

• About 18.1 million people were living with anorexia or bulimia in 2023.

• The number of cases rose 71% since 1990. Even after accounting for population growth and age, the rate still rose by about 21%.

• About 7 in 10 people with these disorders were women and girls. But that still left 5.5 million men and boys.

• More than 4 in 10 cases were young people between the ages of 10 and 24.

• Bulimia was far more common than anorexia, with 14.2 million cases compared with 3.9 million. Anorexia was most common in the late teens, while bulimia was most common in people in their early 30s.

• Australia had the highest rate of any country. Growth was fastest in East Asia, South Asia, and Southeast Asia.

• By 2050, the researchers expect 21.8 million people to be living with one of these disorders.

To be fair, the authors are careful about what their numbers can and can’t tell us. Some of the rise may come from better diagnosis, changes in how the disorders are defined, and the way the estimates were made.

The researchers say they can’t sort out how much each of these matters. Information from poorer countries is also thin. And the study left out binge eating disorder and several other eating disorders, so the true number of people struggling with food is almost surely higher.

My doctoral dissertation investigated binge eating in women over the age of 30. In my responses, one binge eater was 75. We can’t assume, therefore, that these disorders are confined to any age range.

Experts outside the study offered their own take. Fernando Fernández Aranda, who heads an eating disorder unit in Barcelona, said a quarter of the patients his team now sees are over age 45, so this isn’t only a young person’s problem. Another Spanish researcher, Mario Gutiérrez-Bedmar, said the steady rise, especially in bulimia, means we need to look hard at the role of social media.

These aren’t small problems. Anorexia has one of the highest death rates of any mental illness. When I read about this, I am, of course, reminded of the incredibly talented musician/singer Karen Carpenter, who had a severe eating disorder and died as a result.

Bulimia is often hidden, since most people with it are at an average weight. In fact, eating disorders can happen to people of any size, age, race, or sex.

Where Social Media and Wellness Influencers Fit In

So what about that teenager and her phone? A review of 50 studies from 17 countries found that social media use is linked to body worries and eating problems in people ages 10 to 24. It seems to work in three ways:

1. People compare themselves to others.
2. They come to believe they have to be thin or fit.
3. They start to see their own bodies as something to be judged. The risk was higher on photo-heavy apps, with trends like “thinspiration” and “fitspiration,” and for girls and young people who already felt bad about their bodies.

A second review of 21 studies found the same kind of links between social media use and eating problems, body dissatisfaction, anxiety, and depression in teens. It also pointed out that almost no research had looked at influencers in particular. This begs the question of why researchers aren’t looking into it, since we know influencers run multimillion-dollar businesses and millions follow their advice.

The gap is starting to close, and the news isn’t good. When Australian researchers studied 250 nutrition posts on TikTok, health and wellness influencers made up about a third of the people posting. Fitness creators made up almost another fifth. Nearly half of the weight loss posts were mostly or completely wrong when checked against the science. Registered dietitians posted the most accurate content.

And here’s the troubling part: a post’s accuracy had nothing to do with how many likes or shares it got. This isn’t new. Back in 2020, researchers in Scotland reviewed nine popular weight-loss bloggers, each with tens of thousands of followers. Only one met their standards for honesty, fairness, and evidence.

What about those “What I Eat in a Day” videos? In a 2025 study, videos that showed the influencer’s body made young women who already worried about their bodies feel worse about themselves and less willing to eat.

Still, the picture isn’t all bad, and it’s important to say so. Researchers still can’t prove that social media causes eating disorders. People who are already struggling may look for this kind of content, and then the apps feed them more of it.

Young people who understood how social media works and who felt good about their bodies were protected. And social media can help. One review found that more than a third of studies looked at it as a tool for good, such as online groups that support people in recovery. Not every wellness voice online is a problem, either. The most accurate posts came from trained dietitians.

Helpful Hints for You and the People You Love

Here are some simple steps that can make a real difference.

• Know the warning signs. Watch for eating in secret, guilt or shame after eating, constant dieting, trips to the bathroom right after meals, hidden food wrappers, exercising even when sick or hurt, and pulling away from friends. Remember that a person can look perfectly healthy and still be very sick.

• Check who is giving the advice. Before you follow food advice online, ask whether the person is a registered dietitian or a physician. Be wary of words like “detox,” “cleanse,” and “reset.” I have often been shocked by some of the statements I see influencers make about health, nutrition, and body physiology.

• Clean up your feed. Unfollow or mute accounts that leave you feeling worse about your body. The apps show you more of whatever you watch, so what you skip matters, too. The algorithm tracks you, and each time you visit a site or watch an influencer, it decides what to show you next. Don’t go there and see how the choices you are getting from social media change in response.

• Talk with your kids. Ask them which accounts they follow and how those videos make them feel. Don’t comment on anyone’s weight or body, including your own.

• Don’t forget men and older adults. Eating disorders often go unnoticed in boys, men, and people over 45 because no one expects to see them there.

• Speak up with care. If you’re worried about someone, talk in private and focus on your concern for them, not on food or weight. Say “I’ve noticed you seem stressed at meals,” not “You’re too thin.”

• Get help early. Eating disorders can be treated, and the sooner treatment starts, the better. A good first step is a primary care physician. The National Alliance for Eating Disorders has a free helpline run by licensed therapists at 866–662–1235, Monday through Friday, 9 a.m. to 7 p.m. Eastern time. If someone is in crisis or thinking about suicide, call or text 988.

That teenager with her phone doesn’t have to end up among the 18 million. A parent who asks a question, a friend who speaks up, or a single unfollow can change where she goes next. The numbers are rising, but so is what we know about how to help.

Dr. Farrell’s books are on her Amazon author page: https://www.amazon.com/author/drpatriciafarrell. They are also on Google Play Books. Search for “Patricia A. Farrell, PhD.”

The post 18 Million People Now Live With Anorexia or Bulimia, and the Numbers Keep Climbing appeared first on Medika Life.

A newly published cost-minimization analysis from Argentina offers one of the clearest economic assessments to date on how immunization budgets should be evaluated [1]. The study, conducted by the CINVE research group, compares two hypothetical hexavalent vaccination strategies, one containing whole-cell pertussis (wP) antigens, the other acellular pertussis (aP) antigens, and reaches a seemingly counterintuitive conclusion: the vaccine with the higher purchase price can result in lower total costs to the health system. These wP vaccines are known to have higher rates of side effects (adverse events), placing a significant additional burden on the healthcare system and society [2].

The findings of the study add to a growing body of evidence from previously published cost-minimization studies and go further than most, modelling wP and aP hexavalent strategies and highlighting the monetary benefits of lower reactogenicity.

A long-held assumption is now being challenged

Where the effectiveness of two strategies (or options) aiming to protect against the same pathogen is assumed to be similar, immunization budget holders will typically focus on acquisition cost alone. But a vaccination program’s costs extend well beyond the product: logistics, cold chain, additional appointments, staff time, adverse event management, and the productivity lost when parents take time off work or travel for care.

The evidence from Argentina suggests that this approach risks overlooking where the greatest costs actually occur: in adverse events and their subsequent consequences.

A global randomized controlled trial by Decker et al. assessed the risk of adverse events between wP and aP [3]. Many adverse events, such as pain, redness, and fever, are far more common among those who receive wP vaccines. Fever rates were between two and nearly five times higher among wP recipients [4]. Primary-series recipients are infants, many of these adverse events lead to primary care visits, generating direct costs to the system and households, along with distress that other studies link to reduced willingness among families to accept vaccination more broadly [2]. The impacts of these adverse events are often overlooked and not factored into budget considerations.

The long-held assumption that whole-cell vaccines are the economical choice is becoming increasingly difficult to defend. Assessed against total health care and societal costs rather than acquisition price alone, acellular hexavalent vaccination increasingly presents as the more favorable option.

The current vaccination situation in Argentina

Argentina’s public schedule currently uses three doses, and a single booster dose of a pentavalent wP-containing vaccine (combined with diphtheria, tetanus, Hib (Haemophilus influenzae type B), and hepatitis B antigens), alongside three IPV (Inactivated Poliovirus Vaccine) doses. This option is available through the public healthcare system; however, Argentina’s immunization program already recognizes the more favorable tolerability profile of acellular (aP) hexavalent vaccines by providing them to certain premature infants through Pan American Health Organization (PAHO) supported programs [5].

Those with the means to purchase the acellular vaccine, with its more favorable tolerability profile, can opt for it through the private market [5]. For most Argentinian infants, however, the wP vaccine remains the default option, as it is offered in the National Immunization Program. Families with private insurance have access to the better-tolerated aP formulation as a matter of course. The burden of adverse events and their associated costs falls disproportionately on the public system and the households it serves.

Can the ‘more expensive’ vaccine be the cheaper option?

The answer, according to the analysis of Argentina, is an unambiguous yes. The upfront acquisition cost of an aP hexavalent vaccine is substantially higher than its wP equivalent. In Argentina’s public sector, the PAHO Revolving Fund price is $21.54 per dose for the aP formulation, versus $4.90 per dose for the wP formulation. On a per-vial basis, the case for wP looks straightforward [1].

But the Argentina study exposes the flaw in this reasoning. The vaccine acquisition cost is only one line item in the budget. Modelling Argentina’s annual birth cohort of roughly 495,000 infants across the public sector (representing 94% of the birth cohort), the wP program’s total societal cost was $70 million: $7 million in acquisition costs, $5 million in programmatic costs, and $58 million in adverse event management. The aP program’s acquisition cost was higher at $32 million, with similar programmatic costs ($5 million), but adverse event management fell to $24 million — enough to bring total societal cost down to $61 million [1].

Total public sector costs fell by $9.1 million (~13.0%) under the aP scheme, driven by a $33.6 million reduction in adverse event management costs. In practical terms, this translated to 533,110 fewer primary care visits, 308,687 fewer emergency department visits, 2,868 fewer hospitalizations, and 1,654,129 fewer missed working days for parents [1].

The cost of adverse events is higher than many assume

The study’s most important methodological contribution may be its rigorous quantification of the costs of adverse events. The paper effectively demonstrates that adverse events are not simply clinical inconveniences. They consume healthcare resources at a scale that is seriously underestimated.

Adverse events management costs accounted for 64% of total costs under the wP hexavalent scheme [1]. It reflects the real-world consequences of administering a more reactogenic vaccine to hundreds of thousands of infants. Pain, redness, fever, prolonged crying, and, in rare but serious cases, seizures and hypotonic-hyporesponsive episodes each generate healthcare resource use: medications, outpatient visits, emergency visits, hospitalizations, and the parental time and travel that accompany them.

Notably, the economic model used adverse event data from Decker et al. 1995 [3]. The estimates from this study report smaller differences between wP and aP vaccines compared with more recent analyses, such as Zhang et al. 2014 [2] and Patterson et al. 2018 [6], which suggest a higher risk in the adverse event profiles of wP vaccination. Consequently, the estimates of savings related to adverse events presented for aP vaccination may be rather conservative.

Argentina is unlikely to be an exception

Comparable findings are emerging across different health systems, procurement models, and income settings. A previous whitepaper from Algeria, discussed in Medika Life [7], demonstrated that acellular hexavalent vaccination has improved vaccination coverage and simplified the vaccination schedule by reducing the number of appointments from 10 to 6. Overall, the higher upfront cost of adopting the new vaccine was offset by around 73% through savings generated by managing adverse events, improved logistics and transportation, and increased parental productivity.

Peru and South Africa saw similar patterns after adopting hexavalent vaccines: higher initial costs were substantially offset by reduced adverse events, lower programmatic expenses, and logistical efficiencies. Peru reported a reduction in logistical costs of nearly 60%, with roughly 44% of the initial cost increase recovered [8]. South Africa achieved overall savings of about $10 per child [9]. Projections from Paraguay and Uruguay estimate overall system savings of $2 million and $16.1 million, respectively, when comparing wP vs aP hexavalent vaccination [10,11].

A potential, and very rare, “double-win” for the health system

Evidence indicates that vaccination should be viewed as an investment, rather than an upfront cost, yielding up to 54 times the initial investment according to the WHO [12]. Much of this return on investment is calculated over a very long period, taking into account costs incurred by the medical system after vaccination, not just acquisition costs. The figure demonstrates the power of vaccines, leading to better health outcomes throughout childhood, fewer missed school days, and, in turn, better prospects later in life.

For a policymaker, on the other hand, the initial cost of a new vaccination program must be justified against a host of other healthcare interventions competing for health system resources. Long-term benefits calculated over many years are often insufficient to justify the expenditure. Because most of the savings in this case come from reducing the direct impacts of adverse events, they are realized in the short term. In addition, the societal costs of adverse events are reduced, with fewer children hospitalized and fewer parents taking time off work to care for sick children.

Healthcare decision-makers are often asked to choose between better outcomes and lower costs. The emerging evidence surrounding acellular hexavalent vaccination increasingly suggests that this may be one of the very rare situations in which both objectives can be achieved simultaneously.

[This consensus paper is based on the findings of a white paper discussing the findings of a group of vaccination experts focusing on pediatric immunization, supported by Sanofi. Intended for professional use.]

References

1. Ignacio Olivera, Eduardo Lopez, Carlos Grau Pérez et al. A cost-minimisation analysis: comparison of acellular versus whole-cell hexavalent paediatric vaccination strategies in Argentina, 16 September 2026, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-11039921/v1]
2. Zhang L, Prietsch SOM, Axelsson I, Halperin SA. Acellular vaccines for preventing whooping cough in children. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No.: CD001478. DOI: 10.1002/14651858.CD001478.pub6.
3. Decker MD, Edwards KM, Steinhoff MC, Rennels MB, Pichichero ME, Englund JA, Anderson EL, Deloria MA, Reed GF. Comparison of 13 acellular pertussis vaccines: adverse reactions. Pediatrics. 1995 Sep;96(3 Pt 2):557-66. PMID: 7659476.
4. Casabona, G., Shah, N., Choudhury, J., & Shah, U. (2026). Whole cell and acellular pertussis vaccines – rethinking the evidence. Expert Review of Vaccines, 25(1). https://doi.org/10.1080/14760584.2026.2689606
5. Olivera, I., Pérez, C.G., Lazarov, L. et al. Cost minimization analysis of a hexavalent vaccine in Argentina. BMC Health Serv Res 23, 1067 (2023). https://doi.org/10.1186/s12913-023-10038-0
6. Patterson, J., Kagina, B. M., Gold, M., Hussey, G. D., & Muloiwa, R. (2018). Comparison of adverse events following immunisation with acellular and whole-cell pertussis vaccines: A systematic review. Vaccine, 36(40), 6007-6016. https://doi.org/10.1016/j.vaccine.2018.08.022
7. Medika Life, An Expert Perspective from Algeria on Hexavalent Vaccine Adoption. https://medika.life/an-expert-perspective-from-algeria-on-hexavalent-vaccine-adoption/
8. Seinfeld J, Rosales ML, Sobrevilla A, López Yescas JG. Economic assessment of incorporating the hexavalent vaccine as part of the National Immunization Program of Peru. BMC Health Serv Res. 2022 May 16;22(1):651. doi: 10.1186/s12913-022-08006-1. PMID: 35570278; PMCID: PMC9109284.
9. Batson A, Glassman A, Federgruen A, et al. The world needs to prepare now to prevent polio resurgence post eradication. BMJ Global Health. 2022;7(12):e011485. doi: https://doi.org/10.1136/bmjgh-2022-011485
10. ID-308 – COST MINIMIZATION ANALYSIS OF THE HEXAVALENT VACCINE WITH ACELLULAR PERTUSSIS COMPONENT (HEXA PAC) VERSUS HEXAVALENT VACCINE WITH THE WHOLE CELL PERTUSSIS COMPONENT (HEXA PC). PARAGUAY 2025.Olivera Ignacio (1); Martínez Celia (2); Grau Carlos (1); Lazarov Luis (1); Dibarboure Hugo(1). Center for Economic Research, CINVE-Health, Montevideo, Uruguay; (2). Hospital de Clínicas, Asunción, Paraguay.
11. ID-307 – COST-MINIMIZATION ANALYSIS OF THE HEXAVALENT ACELLULAR PERTUSSIS COMPONENT VACCINE (HEXA PAC) VERSUS HEXAVALENT WHOLE-CELL PERTUSSIS COMPONENT (HEXA PC). URUGUAY 2025.Olivera Ignacio (1); Grau Carlos (1); Lazarov Luis (1); Dibarboure Hugo (1). Center for Economic Research, CINVE-Health, Montevideo, Uruguay.
12. WHO, Fully-funded Gavi, the Vaccine Alliance, is a lifeline for child survival, says WHO. https://www.who.int/news/item/28-03-2025-fully-funded-gavi–the-vaccine-alliance–is-a-lifeline-for-child-survival–says-who

The post Rethinking vaccine costs: how the “more expensive” vaccine can actually save health systems millions appeared first on Medika Life.

KYLE, Texas — Kenney Blewett was diagnosed with lung disease more than a decade ago but started experiencing flare-ups this year that made him feel like he couldn’t breathe.

Blewett described those flare-ups as “the scariest thing in the world,” said his wife, Cindy, adding that while the episodes typically lasted no more than a few minutes, they had become more frequent.

On top of that, simple tasks, like taking out the trash, left Blewett winded. He rarely left the house and had recently lost 45 pounds. “That sounds like cancer,” Cindy remembered one of his doctors said. It was clear, she said, that her husband’s poor health, tied to decades of smoking, was getting worse.

That’s why, on June 2, Blewett’s pulmonologist wrote him a prescription for a new medication to improve the terrifying breathing issues caused by chronic obstructive pulmonary disease, or COPD. But the prescription wasn’t immediately filled. Two days after that doctor appointment, Blewett received an email from Walgreens explaining that, “due to an insurance issue that we’re working to resolve,” the medication was delayed.

“He was hopeful that it would work,” Cindy said of the drug, two months after her husband’s death. “I wish we had the chance to find out.”

Insurance delays and denials have become an infamous feature of the American healthcare system, with nearly 7 in 10 adults calling them “a major problem,” in a January KFF Health Tracking Poll.

In June 2025, six months after UnitedHealthcare’s CEO was shot in New York, the Trump administration announced a highly publicized industry pledge, signed by dozens of major health insurers, to remove some of the barriers that block or delay patients from accessing doctor-recommended care. And yet that pledge was voluntary, and it carries no penalties if companies fail to comply. Indeed, a report published by KFF Health News in July found that some insurers that signed the pledge would not implement all the promised initiatives as originally outlined.

Insurers Hedge on Trump-Backed Pledge To Improve Denials Process

Last year, the Trump administration announced a voluntary pledge by dozens of insurers to improve prior authorization, which often requires patients to seek approval before treatments. But prior authorization remains commonplace, and there’s no evidence the government is trying to hold insurers to account.

In recent years, lawmakers in most states, including Texas, have attempted to address delays and denials by regulating the insurance industry in the absence of substantial federal reform. But most health insurance plans, including traditional Medicare policies and employer-sponsored offerings, which together cover more than half of all Americans, typically aren’t under state jurisdiction.

Even some medical office staff and pharmacy employees find the patchwork of state and federal insurance rules and regulations confusing, a problem that is poised to become more complicated as artificial intelligence plays a larger role in approving and processing claims.

“It’s just gotten completely out of hand,” said Matt Toresco, CEO of Archō, a patient advocacy and consulting company. He argued that patients need more assistance facing insurance hurdles.

The Blewetts’ story illustrates how navigating these complexities remains a herculean task for patients and their caregivers.

Cindy has sought answers from Medicare; Kenney’s private Part D drug plan; his pulmonologist’s office; and Walgreens. She still has questions about who was responsible for the medication delay and how the holdup could have been prevented.

If the COPD flare-up Blewett experienced on the afternoon of Sunday, June 7, could have been avoided, she wondered, would he still have chosen to die by suicide that night?

‘Complex and Convoluted’

During that first week of June, Cindy said her husband repeatedly asked if his prescription — a liquid medication meant to be inhaled through the nebulizer machine Kenney owned — was ready to be picked up from Walgreens.

Cindy said she wasn’t initially surprised or worried by the delay. Since its acquisition by a private equity firm last year, Walgreens has cut thousands of jobs across the country, according to the Private Equity Stakeholder Project. Cindy said in August that their Walgreens pharmacy in Kyle seemed to her to have been understaffed for months, and that prescriptions were being filled more slowly.

When Cindy called the pharmacy a few days after Kenney’s appointment to find out more about the insurance delay, she said, a Walgreens employee told her the prescription required prior authorization. Also called preapproval or precertification, prior authorization is a practice widely used by health insurers that requires medical providers to seek permission before their patients may receive covered treatment.

But Cindy didn’t know which of Kenney’s insurers required prior authorization for this medication.

For years, she had helped manage multiple policies on behalf of her husband. Kenney was insured by Medicare parts A and B, the federal health insurance program for people 65 and older or with disabilities. But he also had a private Part D plan to cover drug costs through Wellcare Value Script, as well as a Medicare supplement plan through Blue Cross and Blue Shield of Texas — also called a “Medigap” plan — that paid for other out-of-pocket costs.

Initially, Cindy assumed that Kenney’s Part D plan had invoked prior authorization for his new medication. But because it was a liquid that is inhaled through a nebulizer machine, this drug was one of relatively few covered by Medicare Part B’s durable medical equipment benefit, not Part D.

The federal government had no record showing that this prescription had been billed to Kenney’s Part B policy, the Medicare agency told Cindy over the phone, she said.

Sarah Tanner and Myriea Amaya, spokespeople for Centene, Wellcare Value Script’s parent company, would not answer questions for this article.

After Kenney’s death, when Blewett sought clarification at the Walgreens pharmacy, she said the employee “kept saying different things.” She recalled his explaining that the prescription was submitted to Medicare Part B but without a necessary diagnostic code that the doctor should have included.

Carmen Lopez, a spokesperson for Walgreens, told KFF Health News in late September that the company “cannot comment on matters involving specific individuals.”

Subsequently, Cindy said, a district pharmacy supervisor for Walgreens reached out by phone, and told her the pharmacy tried to process the prescription through Part B on June 2, the same day as the pulmonologist appointment, but that the prescription was missing a diagnostic code from the physician. The supervisor said Walgreens sent a request for that code to the pulmonologist’s office later that day, Cindy recalled.

Kenney’s pulmonologist — Rajesh Shetty of LungDocs — did not respond to phone or email messages from KFF Health News. But Cindy said an employee at the practice told her they did not see a fax from Walgreens asking for a diagnostic code for the prescription.

Meanwhile, it couldn’t have been an issue with Kenney’s Medigap plan, since those policies don’t require prior authorization.

“Short of getting attorneys involved,” Cindy said, “I’m not sure how to find out what really happened.”

More Red Tape Ahead

Confusion surrounding these Part B and Part D distinctions is common, said Mike Hess, senior director of advocacy and regulatory affairs at the nonprofit COPD Foundation. “Medicare has gotten to be so complex and convoluted over the years,” he said, that even medical office staff and pharmacy employees often misunderstand the nuances.

And with the introduction of AI to the preapproval process, navigating insurance hurdles will likely get more complex for Medicare beneficiaries, doctors say.

Historically, traditional Medicare, unlike Medicare Advantage, used prior authorization sparingly. But in January, Medicare launched a pilot program in six states — Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington — testing the use of AI to preapprove some healthcare services.

It is intended to “root out waste in Original Medicare,” CMS Administrator Mehmet Oz has said, but physicians and patients say the program is creating more red tape for Medicare beneficiaries and leading to inappropriate denials. The pilot program does not currently impose prior authorization requirements on COPD medications, but industry experts expect the scope of the initiative will grow to include more services and states.

On the night of June 7, hours after her husband’s last COPD flare-up, Cindy Blewett was sitting on their back porch when she heard a loud noise. She assumed a picture had fallen off the wall in the living room. In fact, it was a gunshot. She discovered Kenney’s body in their bedroom.

“I can’t tell you how horrible it was,” Cindy said.

She said her husband had struggled with his mental health for a long time and had attempted suicide once before, years ago. His deteriorating health only made things worse, she said.

Kenney confirmed that much in a note he left. He told Cindy that she was a wonderful wife, mother, and grandmother but that his health was too poor to continue living.

A second COPD medication, which his pulmonologist ordered directly from the drug manufacturer during the June 2 appointment, arrived several weeks after Kenney’s suicide, she said.

“Perhaps, just perhaps,” Cindy said, “if he had received both medications in a timely manner, he would be here today, and we would have had many more years together.”

Do you have an experience with prior authorization you’d like to share? Click here to tell KFF Health News your story.

The post Patient Dies by Suicide After ‘Insurance Issue’ Delayed Medicine for Lung Disease Flare-Ups appeared first on Medika Life.

That question makes AI in Health: A Guide to Winning in the New Age of Intelligent Health more than a book about technology. It is a leadership guide designed to make people think long and hard about using AI in ways that improve care, support caregivers and remain accountable to the people health systems exist to serve. Lawry understands the technology, yet throughout the book he brings readers back to something more consequential: what these increasingly powerful tools mean for people.

A former Microsoft leader in health and life sciences, health-system executive, founder of health technology companies and now principal consulting firm Second Century Tech, Tom Lawry helped chart this field before health AI became a fixture of every conference agenda. That experience gives this second edition unusual authority. He understands how quickly the technology is changing while keeping his attention on the people who must live with its consequences.

Lawry Combines Leadership with Caring

In an endorsement appearing on the book’s back cover, I wrote: “Tom Lawry understands that AI has no purpose apart from humanity, making this book an indispensable roadmap for leaders who want innovation to amplify compassion, judgment and the human experience of care.” Having reviewed this new edition, I continue to believe that assessment is essential and belongs on the desk of anyone involved in health AI or seeking a state-of-the-art perspective.

Lawry is, without doubt, a fan of AI applications.  He recognizes the risks and responsibilities.  He also reflects on the struggle of the nation’s sick care system and sees that “AI has the ability to save health care from itself.”

Early in AI in Health, Lawry asks readers to consider two photographs of the same New York intersection, twenty years apart. In 1905, horses filled the streets around the Flatiron Building. By 1925, automobiles had replaced them. The buildings remain; the world around them has changed.

Lawry’s point is not simply that technology advances. Transformative technologies change how people prioritize workflow, how organizations operate and what society comes to expect, often before those living through the change fully recognize what is happening. Health care, he suggests, is standing at this intersection now.

That makes leadership the book’s essential subject. AI is no longer something health leaders can simply observe or delegate to the technology team. Lawry asks them to decide what problems it should solve, what values should guide its use, how the workforce should be engaged and who remains accountable when intelligent systems influence care.

From a Promising Pilot to Better Care

One of the edition’s strongest chapters concerns responsible AI. Lawry presents a hospital scenario in which an adverse-event prediction model yields an impressive overall improvement. However, a closer look reveals it performs far better for one patient population than another. The average result looks successful. Beneath it lies a more consequential question: Who benefits, who may be left behind and who is accountable for the difference? That is the kind of question every health leader should be prepared to ask before celebrating a successful pilot.

Lawry carries the point into governance: What is a tool designed to do, and for whom? What evidence supports its effectiveness? How does it perform across populations? What happens when it is wrong? Who owns the strategy, risk, monitoring and response? These are operational decisions with moral weight. A model can meet a technical target and still fail the people who need it most.

Separately, Hal Wolf, President and CEO of HIMSS, the world’s largest health technology professional society and a center for global conversation on technology and health, has repeatedly emphasized that realizing AI’s promise requires leadership and governance. It is fitting that Lawry’s book will once again find itself on the shelves of the HIMSS Global Health Conference bookstore.

The book also earns its place as a working guide. Lawry moves from the principles of leadership and governance to practical exercises for building an AI leadership charter, setting a vision, engaging the workforce, selecting use cases and assessing vendors. These sections give teams a way to turn an ambitious conversation into decisions they can revisit and measure. The chapter on why promising AI projects fail to scale is especially useful for organizations surrounded by pilots but unsure which efforts deserve lasting support.

Readers who already know the technical vocabulary may find the AI primer familiar. They should keep reading. Its value lies in connecting that vocabulary to leadership choices, including when to automate a task, when to support professional judgment and when to leave a decision firmly with a person. Those distinctions matter greatly in health, where a confident answer can be mistaken for a correct one and a convenient workflow can conceal an inequitable result.

Kathleen McGrow, DNP, MS, RN, PMP, FHIMSS, FAAN, Global Chief Nursing Innovation Officer at Microsoft Health & Life Sciences, calls this edition “…both a strategic guide and a leadership manifesto for a healthcare system at a critical inflection point.” Her back cover assessment fits a book that treats workforce experience as central to AI strategy. Lawry asks leaders to involve the people delivering care in deciding where intelligent tools can genuinely help.

From Applications to Expectations

Lawry’s scope is broad, reaching from consumer expectations and clinical applications to workforce development and the future of medicine. The breadth makes the book relevant beyond hospital leadership. Developers, researchers, payers, communicators and policymakers all shape the conditions under which AI reaches people. Each has reason to ask whether a claimed improvement is visible in a patient’s life or a caregiver’s day.

AI technologies will continue to change at extraordinary speed. Lawry wisely builds this edition around leadership questions that should outlast any individual tool or product announcement. What problem are we solving? What evidence will tell us whether people benefit? Whose experience is missing from the design? How will we respond when the evidence changes? A leader who can answer those questions is better equipped for both the next generation of tools and the current one.

That is why this second edition belongs on the desk of anyone helping shape health AI. Lawry writes as a pathfinder who understands the technology while never losing sight of the people expected to benefit from it. His perspective draws not only from his years inside health systems and technology but also from his continuing work as a global advisor and, perhaps most importantly, as a constant observer.

He listens, questions and learns from the people confronting these changes in real time, bringing to AI in Health a perspective shaped by experience, curiosity and an enduring desire to understand what comes next. At a moment when intelligent tools can move faster than health systems can absorb them, AI in Health makes the essential case that greater intelligence becomes better care only when people are prepared to lead.

Available Now on Amazon

AI in Health is now available for pre-order on Amazon.

The post Tom Lawry’s AI in Health Asks the Question Leaders Need to Answer appeared first on Medika Life.

But there is another form of exercise worth adding to the discussion: high-intensity interval training, or HIIT.

The concept is simple. Imagine you are riding an exercise bike in the gym. You pedal at a moderate pace for about 2 minutes, then you increase the resistance and pedal as fast and hard as you can for 30 seconds. You will likely sweat and your leg muscles will start to burn. You then revert to the slower, easier pace for 90 seconds and then repeat the high intensity/low intensity duo for a total of 8 rounds with a few minutes of cool down at the end. The total time elapsed is about 20 minutes and just 4 minutes of intense exercise.

My colleague Harry Oken, MD and I wrote about this interval exercise approach in our book BOOM — Boost Our Own Metabolism. At the time, one reason for our interest was evidence that intense exercise, especially early in the morning, could produce a substantial increase in human growth hormone and other metabolic responses. Another was that just a few minutes of high intensity achieved the same benefits of a much longer Zone 2 type of exercise. HIIT is a good way to maintain or increase your V02max, a known longevity positive.

There is a just published study in Cell Reports Medicine that looks much more deeply at what is happening in the body during HIIT. Led by Dr. Paul Cohen and colleagues at Rockefeller University, they found that the multiple organs, not just muscle, immediately produces many proteins that reach the blood stream and travel to other organs, call it organ cross talk.

The researchers compared two very different forms of exercise. One group cycled continuously at moderate intensity for 90 minutes. The other performed six 30-second all-out cycling sprints, separated by recovery periods as described above. Consider that this amounted to just three minutes of actual high-intensity exercise and a total of 11 minutes of total time plus the warm-up and cool-down periods.

The difference in what happened inside the body was remarkable.

The researchers measured nearly 2,900 proteins circulating in the blood. Immediately after the sprint exercise, 714, nearly one-quarter, had changed significantly, all but a few having increased substantially. Within a few hours, the protein levels had largely reverted to baseline. But in the group that did only moderate intensity cycling for 90 minutes, only seven protein levels had changed immediately.

The exerkines did not derive only from the exercised muscle, but multiple other organs including adipose, liver, immune, pancreas, intestine, and brain cells.

The researchers then went to large United Kingdom biobank databases and found that the sprint-altered proteins tended to be those connected to a reduced risk of cardiac and metabolic diseases/disorders including type 2 diabetes, obesity, and cardiovascular health. Interestingly, some of the proteins released by sprint exercise correlated with proteins in the Biobank that are associated with a decrease in biologic age.

Think about that. Three minutes of extremely vigorous exertion triggered an enormous molecular response throughout the body, but 90 minutes of moderate paced exercise did not. More importantly, those sprint derived exerkines were associated with markers of better health and a lower biologic age.

Your muscles are talking to the rest of you

We used to think about exercise largely in mechanical terms. The heart pumps faster. The lungs move more air. Muscles contract and burn fuel. Do that repeatedly and the heart and muscles become stronger. But as I have written previously, resistance exercise causes muscles (and other organs) to release chemicals (proteins, peptides, metabolites, and other signaling molecules) that travel to other parts of the body and generally have a positive effect on other organs’ cells. Instead of calling them the usual name of cytokines, meaning released by the cell, it has become customary to call them exerkines instead. By whatever name, they are metabolically active and impact the metabolism of other cells.

The Rockefeller study found evidence of communication involving muscle, fat, the liver, immune system, gastrointestinal tract, pituitary gland and even the brain. High-intensity exercise appears to send out a particularly powerful burst of these molecular messages.

Some of the proteins stimulated by intense exercise were associated, in large population databases, with lower risks of metabolic and cardiovascular disease. Others were associated with biological aging. The study does not prove that changing these proteins prevents disease or extends life, the investigators themselves are careful not to make that claim, but it offers an intriguing explanation for why relatively brief periods of vigorous exercise can produce substantial health benefits.

Instead of thinking about one hormone or one metabolic pathway, we can now begin to see intense exercise as producing a coordinated, body-wide response. Muscles do not simply become stronger. They communicate. Other organs listen and respond. That may help explain why exercise has effects seemingly far removed from the muscles doing the work.

HIIT and the aging body

This becomes especially important as we age. One of the most useful measurements of cardiovascular fitness is VO₂ max, essentially the maximum amount of oxygen the body can use during strenuous exercise. VO₂ max tends to decline with age, and a low level eventually has very practical consequences. Walking rapidly through an airport, climbing a flight of stairs, carrying groceries, or keeping up with grandchildren becomes increasingly difficult.

HIIT is particularly effective at improving VO₂ max. Studies of older adults have found that interval training can produce substantial improvements in cardiorespiratory fitness, in some studies greater than those achieved with continuous moderate exercise.

That reserve capacity matters. Independence in old age depends not merely on being able to perform today’s activities, but on maintaining enough physiological reserve to continue performing them years from now.

There may also be benefits for the brain. Exercise improves cerebral blood flow and stimulates biological pathways involved in neuroplasticity, the brain’s ability to adapt and maintain connections. Studies of HIIT in older adults have reported improvements in aspects of executive function, working memory, and attention, although the evidence is still developing. There is reason to believe that HIIT done regularly for many months reverses some of the losses of aging in the brain, both in the cortex and the hippocampus, slowing or even reversing some of the declines in normal cognitive aging and lowering the risk of dementia, but these are as yet unproven. We can say that maintaining cardiovascular fitness and remaining physically active are important components of maintaining brain health.

But HIIT does not mean sprinting

Here an important caution is necessary, especially for older adults.

The Rockefeller participants performing six all-out sprints were young, healthy adults. I certainly would not recommend that an 80-year-old who has been sedentary climb onto a bicycle tomorrow and attempt six or eight maximal 30-second sprints.

“High intensity” is relative. Someone who has been sedentary or who has cardiovascular, pulmonary, or significant muscle loss should discuss vigorous exercise with their physician, and if approved, begin under the guidance of a personal trainer or physical therapist. The objective is not exhaustion. It is to periodically ask the cardiovascular and metabolic systems to work substantially harder than they do during ordinary activity, followed by recovery.

Don’t give up your walk or your weights

HIIT should not replace other exercises. Continue walking. Continue cycling, swimming or whatever aerobic activity you enjoy. And especially as you grow older, include resistance exercise at least twice a week. Muscle mass and strength are essential for getting out of a chair, climbing stairs, maintaining balance, and preventing frailty. These are the essential elements of retaining independence.

Think of high-intensity intervals as an addition, a very useful addition. Once or twice a week, if your health permits and your doctor agrees, consider adding a few brief periods during your usual aerobic exercise when you substantially increase the intensity and then recover. As fitness improves, the duration or number of intervals can gradually increase.

The remarkable message from the Rockefeller study is that our bodies notice the difference.

Three minutes of intense exertion caused hundreds of proteins and metabolites to change, initiating communication among organs throughout the body. We are only beginning to understand what all those molecular conversations mean. But they reinforce something we already know. Exercise is among the most powerful medicines available to us. As we age, the goal is not to become an athlete. The goal is to preserve enough strength, cardiovascular capacity, balance, and brain function to continue doing the things that make life enjoyable. And most importantly, it is to maintain independence.

Walking matters. Strength training matters. And now we have a reason to pick up the pace.

It suggests to me, and as Dr Oken I wrote in BOOM — Boost Our Own Metabolism, a regular program of HIIT, once or twice a week for just 20 minutes, is beneficial to our health. At age 84, I plan to redouble my efforts to do it at least once a week, maybe two.

It is never too late to start and sometimes it pays to go a little faster.

The post A Few Minutes of Intense Exercise Can Change Your Body appeared first on Medika Life.

No one asked what he was taking. No one asked why he stood sideways in the bathroom mirror every morning, pulling up his shirt and frowning. And no one noticed that his heart rate was lower than it should have been for a boy his age.

Dalton is a composite, drawn from the stories of many families. But what happened to him, and what didn’t happen, is real. It’s happening in homes across the country.

It Was Never Only a Girls’ Problem

For decades, when we talked about body image, eating disorders, and the harm done by images in the media, we talked about girls. Girls were the ones being told to be thinner, and girls were the ones being admitted to hospitals. Parents, physicians, and schools learned to watch girls for trouble.

Boys were left out of that conversation, and they’re still being hurt by it.

In Ontario, Canada, researchers studied more than 11,600 hospital stays for eating disorders in children and teens between 2002 and 2019. For boys, hospital stays rose by more than 400%. For every boy sick enough to need a hospital bed, many more are struggling where no one sees it.

Part of the reason is the way we look for trouble. In 2020, researchers who reviewed what’s known about eating disorders in boys and young men found that the screening tools physicians use were mostly designed with girls in mind. They ask about wanting to be thinner, not about wanting to be bigger. A boy with a serious problem can answer every question the “right” way and never be flagged. The same review found that treatment programs were also built mostly for girls, and boys may do worse in them as a result.

That’s the main problem. Boys’ body worries usually center on muscle, not thinness. So a boy in real danger can look like a boy in great shape.

What Boys Learn, and What They Buy

Boys learn early what kind of body earns respect. They see it in superhero movies, in older boys at school, and in grown men joking about getting “shredded.” They learn that this body is what they should work toward, even if it costs them their health. And now they see that message on their phones every day.

In 2025, Common Sense Media surveyed more than 1,000 boys ages 11 to 17 across the United States. Nine out of ten said they see messages about body image online. About two out of three of the boys who saw content about how men should look and act said it showed up in their feeds without them searching for it. About 1 in 4 said social media makes them feel they should change how they look.

Boys don’t just watch. They act. A University of Minnesota study of nearly 2,800 middle and high school students found that more than 90% of the boys had exercised more in the past year to build muscle. More than one-third had used protein powders or shakes, and nearly 6% said they had used steroids. These were ordinary kids, not top athletes.

The influencers boys follow often make money from what they promote. Many earn a share of every protein powder or fat burner sold with their discount codes. Some push far more dangerous products. In 2023, the Center for Countering Digital Hate found that TikTok videos promoting steroids and similar drugs under certain hashtags had been viewed up to 587 million times in the United States over three years. The group also found 35 influencers on the app linking to websites that sold these drugs.

The harm is real. Researchers at the University of Toronto found that more than 1 in 4 boys and young men in a national Canadian sample had symptoms of muscle dysmorphia strong enough to be of real concern. Muscle dysmorphia is a condition in which a young man believes he’s small and weak, even when he isn’t. Most boys who have it have never heard its name.

The products carry their own risks. A study published in the New England Journal of Medicine estimated that supplements send about 23,000 people in the United States to the emergency room each year, with weight-loss and energy products among the most common causes.

Why Parents and Physicians Miss the Signs

When a boy is in trouble with his body, his trouble often looks like success. A boy who works out every day seems disciplined. A boy who eats “clean” seems healthy. A boy who drinks protein shakes seems like every other kid on the team. Adults praise these habits. And boys are taught not to talk about their feelings, so a boy who feels ashamed keeps it to himself.

Physicians aren’t always asking, either. In 2025, a survey of more than 800 Canadian pediatric specialists found that 17% had seen at least one young patient in the past year who needed medical care because of a performance-enhancing supplement or drug.8 Most of those patients were boys, and almost a third were only 10 to 12 years old. Yet more than half of the physicians surveyed said they never asked their young patients about these products.

The stakes are high. In the United States, men die by suicide at about four times the rate of women. Boys and men are less likely than girls and women to ask for help.

So what can we do? Parents can learn the signs. Watch for a boy who panics when he misses a workout, trains through injuries, follows strict food rules, spends long periods checking his body in the mirror, skips family meals, or has powders and pills you don’t recognize. Talk with him about health and strength, not size. Ask what he’s watching and whom he trusts online. And make a simple family rule: before he takes anything meant to change his body, he talks to you, and ideally to his physician, first.

Physicians need training to look for danger in boys, not just girls. At every checkup, they can ask boys two simple questions: “What are you doing to change your body?” and “Are you taking anything to build muscle or lose fat?” They can compare heart rate, growth, and weight with earlier visits. And they can take a parent’s worry seriously, even when the boy in the exam room looks strong.

If you’re worried about a boy and feel brushed aside, it’s okay to ask for a second opinion or a referral to a specialist in adolescent medicine or eating disorders. If a boy you love is struggling or talks about hurting himself, call or text 988 to reach the 988 Suicide and Crisis Lifeline.

Boys aren’t less at risk than girls. They’ve simply been overlooked. It’s time we changed that.

I’ve written much more about this in my new book, “Built to Be Seen: How Influencers and Supplement Sellers Endanger Boys and Young Men.” It’s a short read, a 74-page paperback to be published shortly on Amazon, written in plain language for parents, coaches, teachers, and young men themselves. It explains how social media finds boys, what’s really in the supplement aisle, the dangers of steroids and online testosterone clinics, and the warning signs to watch for.

The post Boys Are Risking Their Health to Look Like Influencers, and Almost No One Is Checking appeared first on Medika Life.

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.