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

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

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

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

The Work Did Not Disappear

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

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

That work is not free. Its cost simply moved.

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

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

When Waiting Becomes a Bill

Consider something far more ordinary: waiting for the doctor.

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

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

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

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

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

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

People Eventually Route Around Friction

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

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

That matters because people eventually route around friction.

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

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

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

Health Professionals Pay Attention

The friction tax also falls heavily on health professionals.

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

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

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

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

Families Have Become the Integration Layer

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

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

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

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

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

Start Asking Who Pays

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

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

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

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

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

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

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One of the early signals to watch comes from PhaseV, which used the opening of the meeting to introduce its new AI-powered Enrollment Lab. The launch reflects a broader shift visible across SCOPE this year. Sponsors and CROs are moving upstream, earlier in the development lifecycle, to replace assumption-driven planning with evidence-grounded decision-making.

Enrollment remains one of the most persistent causes of trial delay. Protocols are often finalized before teams fully understand how inclusion and exclusion criteria interact with real world patient availability or with competitive trial pressure. PhaseV’s Enrollment Lab is designed to address that gap by allowing study teams to quantify true enrollment potential before protocol lock, not after sites have already struggled.

Built as a high impact extension of the PhaseV ClinOps platform, the Enrollment Lab leverages real world EHR data to model patient eligibility alongside patient level competition. Instead of relying on theoretical projections or late stage site surveys, sponsors can explore how specific protocol trade offs affect enrollment volume in real time. Small design decisions become visible for what they are, either barriers to access or opportunities to expand reach.

Raviv Pryluk, PhD, CEO and co-founder of PhaseV, described the intent as a shift from planning on paper to planning in clinical reality. By uncovering constraints early, teams can stress test their designs and ensure that studies are grounded in a verified patient population before site identification begins. That change in timing matters. It moves feasibility from a reactive step to a strategic one.

From a technical perspective, the Enrollment Lab extends PhaseV’s population first approach. Elad Berkman, CTO and co founder, emphasized the ability to translate protocol choices and competitive pressure into a clear view of real patient access. This precision guided modeling allows teams to evaluate alternative inclusion criteria, identify lightly contested patient segments, and surface geographic regions that may be overlooked by traditional planning methods.

Positioned early in the workflow, the Enrollment Lab establishes what is realistically achievable before resources are committed downstream. Once realistic enrollment potential is defined, PhaseV’s site identification tools can then prioritize investigators based on their ability to deliver against that plan rather than aspirational targets. The result is tighter alignment between protocol design, site selection, and execution.

As conversations continue throughout SCOPE, this launch is likely to gain strong traction among sponsors focused on shortening timelines without compromising scientific rigor. The message aligns with what many leaders here are emphasizing. Faster trials do not come from pushing sites harder. They come from designing studies that reflect how patients actually exist within health systems.

PhaseV is demonstrating the Enrollment Lab throughout the Summit, offering attendees a closer look at how real world data can be applied before the first site is ever activated. For an industry increasingly focused on predictability and patient centricity, this announcement sets an early tone for the news still to come out of SCOPE in the days ahead.

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When I read stories that appear throughout the book, the room becomes pin-drop silent. Not uncomfortable, but attentive. People lean forward. Some close their eyes. Others quietly wipe away tears. Even after reading these stories again and again, my own eyes still mist. These are not reactions to theory or argument. They are responses to a painful reality many recognize.

What becomes clear in those rooms is that the frustration is not isolated to one role or perspective. Patients speak about waiting and uncertainty. Clinicians describe exhaustion and moral strain. Innovators and policymakers wrestle with systems that move more slowly than the problems they are trying to solve. The details differ, but the throughline is the same: people want care that recognizes their presence and treats them as more than a process to be managed. When that recognition happens, the tone of the conversation changes.

Since its listing, the book has spent several consecutive weeks on Amazon’s Top New Releases list. That matters in a conventional sense. Still, rankings, whether in print or digital format, do not explain what happens when people hear their own experience reflected back to them with clarity and respect. Stories do that work. Many are weary of facts and figures deployed to justify positions rather than illuminate lived reality.

Human experience carries a different kind of truth. It does not compete with data, but it precedes it. When experience is named accurately, people do not feel persuaded. They feel recognized. That recognition opens space for reflection, dialogue, and ultimately for change.

A Question That Changes the Room

I finished a book talk and signing with The Marfan Foundation, and the impact lingers beyond the formal program. During the signing, people ask thoughtful, personal questions. I often ask permission to respond by reading a short passage from the book. Then I listen to stories of courage, love, and endurance that surface naturally and without prompting.

Parents speak about children. Siblings talk about one another. Families describe navigating medical uncertainty and emotional trauma over years, sometimes decades. Individuals share how they discover the strength they did not know they possessed, and how they learn to share that strength with others walking similar paths. These are not stories of abstraction. They are lived, detailed, and deeply human.

The Marfan Foundation is one of the patient and professional communities reflected in the book, and in the room, the reason is unmistakable. Physicians are spoken of by first name – Alan, Duke, Kim and Reed – not title. They are described not as distant experts, but as people who show up consistently and with care. These stories remind everyone present that even in the most complex conditions, care is sustained by relationships as much as by scientific excellence.

Between Two Meetings, on a Moving Train

As I board a Brightline train for the next meeting, the contrast stays with me in a quiet, persistent way. I am traveling from a gathering centered on shared human experience to SCOPE Summit 2026, a global convening focused on clinical trials and research infrastructure. The agenda centers on development planning, protocol optimization, patient-centric trial design, site engagement and recruitment, generative AI, and the technologies that move science from hypothesis to evidence.

One meeting is rooted in lived journeys, where science is received as hope amid uncertainty. The other is grounded in structure and precision, where science is designed, measured, and scaled. Both spaces matter deeply, and both are essential to progress. Clinical research is where rigor lives and where uncertainty is reduced in ways that allow care to advance responsibly.

Yet the transition between these two gatherings and two cities reveals something essential. People do not leave their humanity at the door of the operating room or the halls of science. They carry it with them into protocols, endpoints, enrollment decisions and trial participation. Patients do not experience trials as abstractions. They experience them as acts of trust layered onto already complex lives.

When Structure Forgets Experience

Too often, human experience is treated as something to be accounted for after systems are built, rather than as a foundation for their design. Trials are optimized for efficiency and compliance, yet struggle when recruitment falters, participation drops, or trust erodes. These outcomes are not solely technical failures. They are relational failures.

Patient-centric trial design is not a feature added late in development. It is a mindset that shapes questions, assumptions, and priorities from the start. Site engagement is not a procedural step, but a relationship built over time. Technology reduces burden only when shaped by empathy, context, and understanding.

Rare disease communities such as The Marfan Foundation understand this instinctively. When systems fall short, patients and families organize, advocate, and collaborate more intentionally. In doing so, they model what the broader system aspires to scale: trust, continuity, shared language, and partnership. People do not fragment their lives the way systems fragment care.

When Experience Finally Counts

At SCOPE, this question becomes practical rather than theoretical. I moderate a fireside chat with StuffThatWorks executives Yael Elish and newly appointed CEO Julie Ross, exploring what happens when patient experience is treated not as a marginal input but as the foundation of artificial intelligence itself. Billions of dollars are invested in pre-clinical discovery, yet clinical trials remain a costly bottleneck, often stretching beyond seven years before therapies reach patients.

One story from the book captures why this matters. A woman living with a chronic autoimmune condition follows treatment guidelines faithfully yet struggles with side effects that force her to stop therapy repeatedly. Her medical record reflects non-adherence, not struggle. It is only when she joins a patient-driven community where thousands share lived experience that patterns emerge her clinicians have never seen.

Within weeks, she learns how others adjust dosing, manage side effects, and balance treatment with daily life. When these experiences are aggregated and analyzed, they do not contradict clinical science. They complete it. What once looks like noise becomes a signal when the human story is allowed to remain intact.

This is why patient-derived models matter. Real-world evidence is not simply post-market surveillance. It is the accumulated story of how people actually live with disease, navigate treatment, and make trade-offs that controlled environments rarely capture. These data are not neutral artifacts. They are lives rendered into patterns with meaning.

Restoring What Was Lost

What I witness in quiet rooms, at signing tables, and in conversations that follow readings is not resistance to science. I see the same truth as a fireside chat moderator, alongside people dedicated to bridging patient voice, data, and science in ways that honor those it seeks to serve. What emerges, again and again, is a longing for connection.

People are not asking to be spared complexity, nor do they believe science belongs only in a sterile laboratory. They are asking not to be erased by it. They want science that recognizes them even as it advances, and systems that remember who they are designed to serve.

This is where Why People Matter ultimately resides. Healing does not begin when systems are optimized or when data moves faster. It starts when relationships are restored and when people feel recognized within the structures meant to help them. Science advances when trust is present, and trust grows when listening is treated not as an accessory but as a foundation.

If there is a path forward, it is not found by choosing between humanity and innovation. It is found by refusing to separate them. Data matters because people do. And when science remembers that progress becomes worthy of the lives it touches.

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In modern America, “the bread” has changed. It is no longer found in a Parisian bakery but in a community health center, a pharmacy, or a hospital admissions office. It is insulin, chemotherapy, biologics and mental health care. Access to these essentials increasingly depends not only on medical need but also on administrative thresholds, shifting eligibility rules, and delay mechanisms that quietly determine who waits, who deteriorates, and who absorbs financial collapse as collateral damage.

When Illness Becomes Economic Collapse

Medical debt has become the most visible expression of this misalignment. More than 100 million Americans now carry health-related debt, much of it incurred despite having health insurance. For millions of Americans, a single diagnosis can be enough to destabilize their household finances permanently. Medical debt damages credit, constrains housing and determines employment options. It fuels chronic stress that contributes to poorer health outcomes. It punishes people not for recklessness, but for uninvited illness.

The consequences extend well beyond ledgers. Individuals carrying medical debt are significantly more likely to delay or avoid needed care, skip prescriptions or postpone follow-up visits. Families report cutting back on food, utilities or rent to manage medical bills. In this way, illness becomes an economic accelerant, pushing people already close to the edge into deeper instability. Survival may be possible, but recovery, both financially, emotionally, and psychologically, becomes elusive.

For patients with serious illnesses such as cancer, autoimmune disease, or rare conditions, the stakes are far higher. Financial toxicity has been associated with increased mortality among cancer patients, as out-of-pocket costs lead individuals to delay treatment or abandon therapy altogether. This occurs at the same time that medical innovation has never been more promising. Targeted therapies, biologics, and personalized medicine are extending life and improving quality of life. The contradiction is stark: scientific progress accelerates while access narrows.

How Administration Became a Barrier to Care

At the center of this contradiction sits prior authorization. Originally intended as a utilization management tool, it has evolved into a pervasive barrier to timely care. Physicians report that prior authorization routinely delays necessary treatment and consumes hours of clinical time, while patients wait often in pain, sometimes in medical crisis. In oncology, delays can mean missed treatment windows. In neurology, they can mean needless pain or irreversible decline. In mental health, they can mean crisis escalation and hospitalization.

Denial rarely arrives as a clear refusal. More often, whether intentional or not, care is slowed until the patient deteriorates, disengages, or pays out of pocket. The system follows the rule, but the consequence is the weight that the patient carries. What was designed as stewardship increasingly functions as deterrence, too often transferring the burden of cost control to those least equipped to carry it.

Public programs meant to stabilize access have not been immune to this dynamic. Medicaid and Medicare, established as pillars of the American safety net in 1964, now operate amid growing instability. Eligibility thresholds are a moving target. Redetermination processes remove coverage for administrative reasons, rather than due to changes in need. Patients in active treatment lose coverage mid-course, forcing physicians to scramble and patients to panic. Coverage churn disrupts care and erodes trust, encouraging people to delay engagement with a system that is no longer structured to protect them when they are most vulnerable.

Taken together, medical debt, administrative delay, and coverage instability are not isolated policy failures but a systemic pattern. The modern sick-care system excels at episodic intervention but struggles with continuity, predictability, and lived experience. It measures success in transactions rather than trajectories, focusing on efficiency rather than consequences. Innovation thrives, while access to these medicines frays.

Violence is Never Justified

Hugo warned of where this leads. When systems feel unreachable, when appeals are endless and context is stripped away, frustration hardens into despair—the search for bread. Despair does not always erupt visibly. More often, people delay care not because they are indifferent to their health, but because they are afraid of what seeking care will cost them financially and emotionally.

Violence is never justified. The murder of health insurance executive Brian Thompson must be condemned without qualification. It is a human tragedy, not a symbol, and should never be rationalized. At the same time, refusing to examine the conditions that fuel public rage that applaud the killer is a warning sign about how people experience health care as an institution that governs life-and-death decisions while feeling increasingly inaccessible and unaccountable.

In Les Misérables, bread was enough to keep Jean Valjean’s family alive, but it was the weight of rigid systems that nearly broke him. That distinction matters today. When access to health care is treated as something to be rationed through delay, instability, and administrative friction, survival may still be possible, but long-term stability is put at risk. Medical debt, coverage churn, and seemingly weaponized delays do not merely inconvenience patients; they reshape how people relate to illness, the government, and companies, and allocate care.

The path forward does not begin with sanctifying health care, nor with vilifying those who work within it. It starts with recalibration. Administrative tools must serve care rather than obstruct it. Eligibility for public programs must offer predictability, not whiplash. Access must be treated as infrastructure, something that must function under stress, not a privilege rationed through complexity. America’s health-care story is still being written. Its outcome will not be determined solely by innovation or cost control, but by whether systems are designed to work when people are most vuln

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Department of Health and Human Services Secretary Robert F. Kennedy Jr. has floated a seismic idea: adding autism to the list of conditions covered by the Vaccine Injury Compensation Program. The program, known as VICP, provides a system for families to file claims against vaccine providers in cases in which they experience severe side effects. Kennedy has also suggested broadening the definitions of two serious brain conditions — encephalopathy and encephalitis — so that autism cases could qualify.

Either move, experts warn, would unleash a flood of claims, threatening the program’s financial stability and handing vaccine opponents a powerful new talking point.

Legally, HHS “is required to undergo notice and comment rulemaking to revise the table,” said Richard Hughes, a law firm partner who teaches at George Washington University. The “table” is a list of specific injuries that the U.S. government accepts as presumed to be caused by a vaccine if those injuries occur within a certain time window. If someone can show they meet the criteria, they have a simpler path to securing compensation without having to prove fault. Autism is not in the table because a link between vaccines and autism has been thoroughly debunked.

If autism is added, Hughes explained, the VICP could face “an exorbitant number of claims that would threaten the viability of the program.”

Asked about its possible plans, an HHS spokesperson told CBS News the agency does not comment on future or potential policy decisions.

Carole Johnson, former administrator of the Health Resources and Services Administration, which oversees VICP, cautioned that the system is already overburdened: “The backlog is not just a function of management, it’s built into the statute itself. That’s important context for any conversation about adding new categories of claims.”

Dorit Reiss, a law professor at the University of California College of the Law-San Francisco, said that any such change would be exploited: “This can, and likely will, be used to cast doubt on vaccines.”

Compensation Without Causation

The Vaccine Injury Compensation Program was born of crisis. In 1982, “Vaccine Roulette,” a television documentary, aired nationwide, alleging routine childhood shots were causing seizures, brain damage, and even sudden infant death. The program alarmed parents and triggered a surge of lawsuits against vaccine makers.

“That led to a flood of litigation against vaccine makers,” recalled Paul Offit, a pediatric infectious disease specialist and vaccine inventor at the University of Pennsylvania. “I mean, to the point that it drove them out of the business. … By the mid-1980s, there were $3.2 billion worth of lawsuits against these companies.”

Were it not for the VICP, Offit said, “We wouldn’t have vaccines for American children. The companies — it wasn’t worth it for them.”

The National Childhood Vaccine Injury Act of 1986 created a no-fault system. Families who believed a vaccine caused harm could file a claim; if the injury appeared on the table within a set time frame, compensation was automatic. If not, claimants could present medical evidence. The system had two purposes: provide compensation and protect the vaccine supply.

From the beginning, the table was understood not as a scientific document but as a legal tool.

“It’s a legal document and things can be included for policy reasons even if the causation evidence is weak,” Reiss said. She explained, “The program is designed to be generous, to compensate in cases of doubt.”

But, she said, “autism is not in that category. The science is clear. Adding it would be pure politics.”

This tension — between law, science, and public perception — has defined the program for nearly four decades.

What Expansion Would Mean in Practice

Since 1988, federal data shows more than 25,000 petitions to the VICP have been adjudicated; of those, 12,019 were granted compensation and 13,007 were dismissed. About 60% of compensated cases involved negotiated settlements in which HHS drew no conclusion about the cause. Over the same period, billions of vaccine doses were safely administered to millions of Americans.

Adding autism to the VICP table would change that picture overnight.

Federal estimates suggest up to 48,000 children could qualify immediately under a “profound autism” standard, with potential payouts averaging $2 million per case, at an initial cost of nearly $100 billion, followed by annual totals of about $30 billion a year — dwarfing the current $4 billion trust, a new analysis finds.

“Any case where the symptoms appeared in the past eight years and the parents blame vaccines,” Reiss said. “I don’t know how many that would be. The fund has a surplus of over $4 billion. One seriously disabled child’s care can cost millions, so a significant number, say 100,000 compensations, might exhaust it.”

Furthermore, with only eight special masters handling cases, the system would also be paralyzed by backlogs.

The stakes are not just fiscal. If the fund collapses under the weight of autism claims, vaccine makers may question whether producing vaccines for the U.S. market is worth the risk. That would mirror the crisis of the 1980s, which led to the establishment of the VICP.

Autism and the Courts

In the late 1990s and early 2000s, Andrew Wakefield’s now-retracted paper alleging a link between the MMR vaccine and autism fueled a surge of VICP claims. By 2002, the VICP was swamped with petitions alleging vaccines had caused autism. The court consolidated thousands of cases into the Omnibus Autism Proceedings, selecting a handful of test cases to decide them all.

After years of hearings and expert testimony, the conclusion was unequivocal: vaccines do not cause autism. In 2010, the court ruled against petitioners on every theory of causation. The U.S. Court of Federal Claims affirmed, and the Court of Appeals upheld, the decision.

“That precedent is binding,” said Richard Hughes, a vaccine law expert at George Washington University and former VICP legal counsel. “Autism was litigated thoroughly and rejected. That still carries weight in the court today.”

The Ghost of Hannah Poling

Yet, the vaccine-autism debate has never quite faded. In 2008, the government conceded a case involving Hannah Poling, a girl with a rare mitochondrial disorder who developed autism-like symptoms after vaccination. Officials stressed the concession was specific to her condition, not evidence of a general link. But headlines told another story: “Family to Receive $1.5 Million in First-Ever Vaccine Autism Court Award.”

The Poling case fueled years of confusion.

Autism Science Today

The science is clearer than ever. Autism begins early in pregnancy, not in toddlerhood when most vaccines are given.

“Vaccinations … happened around the time families were recognizing symptoms of autism in their children,” said Catherine Lord, a UCLA clinical psychologist and specialist in autism diagnosis. “However, we now know that autism begins much earlier, likely as the fetus develops during pregnancy, so it cannot be an explanation.”

Peter Hotez, a pediatric infectious disease specialist and vaccine scientist at the Baylor College of Medicine who is also the father of a young adult with autism, underscores that point: “The drivers of autism are genetics and, in rare cases, environmental exposures during pregnancy, not vaccines. We’ve been over this ground for decades, and the evidence is overwhelming.”

Sarah Despres, former legal counsel to the secretary of Health and Human Services in the Biden administration and now a consultant to nonprofit organizations on immunization policy, adds that the compensation program itself is often misunderstood.

“The table was originally written as a political document,” she said. “The purpose of the program was to be swift, generous, and fair. … There would be cases that may not be caused by the vaccine but would be compensated if you went through this table injury scheme, where you don’t have to prove causation.”

What’s at risk: Harm from the Diseases Themselves

The stakes are not abstract. Measles, one of the most contagious pathogens on Earth, spreads so efficiently that one infected child can transmit it to 90% of susceptible contacts. Before vaccinations began in the 1960s, measles sickened hundreds of thousands annually in the U.S., killing hundreds and causing thousands of cases of encephalitis and lifelong disability. Complications included pneumonia, brain swelling, and, in rare cases, a fatal degenerative brain disorder called subacute sclerosing panencephalitis, or SSPE, that can strike years later. This year, a school-age child in Los Angeles County died of SSPE after contracting measles in infancy, before being eligible for vaccination.

Mumps was once a near-universal childhood illness. Though often dismissed as mild, it can cause sterility in men, meningitis, and permanent hearing loss. Outbreaks on college campuses, as recently as the 2000s, showed how quickly it can return when vaccination rates slip.

Rubella, also known as German measles, is mild in most children, but can be devastating during pregnancy. Congenital Rubella Syndrome, or CRS, caused waves of tragedy before the development of the vaccine: Thousands of babies each year were born blind, deaf, with heart defects, or with intellectual disabilities. In medical texts, autism itself is listed as one of CRS’ sequelae, or possible consequences — proof that rubella infection, not vaccination, can contribute to developmental disorders.

Measles, mumps, and rubella “are not trivial,” said Walt Orenstein, former head of the Centers for Disease Control and Prevention’s immunization program. “Fever, high fever, is common … and they have frequent complications.”

And yet, as these diseases fade from living memory, a counternarrative has gained traction. On Sept. 29, the nonprofit Physicians for Informed Consent, a group that disputes the scientific consensus on vaccines, announced it had mailed its “Silver Booklet” on vaccine safety to every member of Congress, as well as to President Donald Trump and Vice President JD Vance. The book claims that “vaccines are not proven to be safer than the diseases they intend to prevent,” and calls on federal leaders to punish states that restrict vaccine exemptions. (The booklet isn’t free. The group sells copies for $25 on Amazon.)

Scientists say this framing misrepresents the basic math of risk. “Measles is one of the most important infectious diseases in human history,” notes “Plotkin’s Vaccines,” the field’s authoritative textbook. “The widespread use of measles vaccines in the late 20th and early 21st centuries led to a further marked reduction in measles deaths. Measles vaccination averted an estimated 31.7 million deaths from 2000 to 2020.”

Kennedy’s possible move to expand the Vaccine Injury Compensation Program hinges on casting doubt — on suggesting that science is unsettled, that vaccines may be riskier than diseases.

“One tactic used to argue that vaccines cause autism is the use of compensation decisions from the National Vaccine Injury Compensation Program to claim such a link,” said Reiss of UC Law-San Francisco. “Even the cases that most closely address the question of vaccines and autism do not show the link that opponents claim exists, and many of the cases used are misrepresented and misused.”

Offit underscores the danger on the perception side. “When people see the Vaccine Injury Compensation program, they assume that any money that is given is because there was a vaccine injury,” he said.

Kathryn Edwards, an expert in pediatric infectious diseases and vaccine safety at Vanderbilt University, said, “Expanding compensation for issues that are not clearly related to vaccines … suggests that these conditions are related to vaccines when they are not.” She compared it to the removal of thimerosal, a preservative dropped from most childhood vaccines to ease public fears, despite no evidence of harm. “Now, we are still suffering from that action.”

Public health experts stress that such narratives invert reality. The very diseases being downplayed once killed or disabled tens of thousands of American children each year. As pediatrician, psychiatrist, and medical historian Howard Markel put it: “Back a hundred years ago, everybody lost a kid or knew a kid who died of one of these diseases. … We never conquer germs, we wrestle them to a draw. That’s the best we do. And so this is a real … handicap to the other side, the microbes who live to infect.”

Families and the Future

The hardest voices to reckon with are those of families. Parents of autistic children often feel abandoned — unsupported by disability programs, exhausted by care needs, searching for answers. Kennedy’s appeal to them is emotional, not scientific.

Reiss noted that families deserve far more support but argues that it shouldn’t come through VICP.

“The program is to award compensation to those injured by vaccines,” she said. “We should have more direct support — disability funding, disability aid. Kennedy has been taking HHS in the opposite direction, cutting services where we need more.”

Despres made the same point: “The goal of the program really was if there’s a close call, we’re going to err on the side of compensation. … And it’s really important that everyone understands that compensation does not mean that the vaccine actually caused the injury. … And I think we have seen statistics around the compensation program misused by those who would want to sow distrust in vaccines, to say vaccines are unsafe, when in fact … that’s not what this is.”

UCLA’s Lord urged a shift in focus. “For the last 50 years, science has focused on the biological causes of autism, which has led to great progress, especially in genetics,” she said. Of Secretary Kennedy, she said, “He could help more by acknowledging the value of science, but also the need to better attend to the actual lives of autistic people and their families.”

What Comes Next?

If Kennedy decides to move forward with such a plan, HHS would need to draft a rule, open it to public comment, and then defend the change in court. The pushback will be fierce: from scientists, from public health leaders, and from families who fear being misled yet again.

The debate over adding autism to the Vaccine Injury Table is not just a policy debate. The program was built on the principle of compensation without causation, a fragile balance designed to sustain both trust and supply. Adding autism could collapse that distinction entirely.

[KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.]

The post Inside the High-Stakes Battle Over Vaccine Injury Compensation, Autism, and Public Trust appeared first on Medika Life.

The proper terminology is “epistemic injustice,” whereby a person’s concerns are dismissed by someone else, causing that person to question their own perception of reality, or to make them feel “crazy.”

The article was describing the experiences of patients who were referred to a specialized clinic for vulvovaginal disorders. When I read the article and the term “medical gaslighting,” I reached out to the primary author, Dr. Chailee Moss, to have her come on my podcast (the link the episode is at the end of this article) to discuss her article and the “medical gaslighting” itself.

The findings of the article were eye-opening: less than half of patients said that past practitioners were supportive; a little more than a quarter were actually belittling, and one fifth were described as not believing the patient. What shocked me was that 20.6% of patients were given a recommendation to drink alcohol to relieve their symptoms. Moreover, 16.8% of patients felt unsafe during a medical encounter and 39.4% said they were made to feel crazy.

The actual narrative responses were also instructive, and they are reproduced here:

The most important takeaway from the article and my conversation was that we must do all that we can to ensure patients feel heard. Even if we can’t find something specific to treat, we should do our utmost to ensure that patients’ concerns are not perceived as being dismissed. This applies to all specialties, including critical care. Also, “drink more alcohol” should NEVER be a medical recommendation, in my opinion. It was a very important lesson for me, and it is one I will do my best to remember every day of my practice.

Listen to the podcast episode: https://www.healthcaremusings.com/the-freedom-fighters-of-medicine/

The post Can Doctors “Gaslight” Their Patients? appeared first on Medika Life.

Medika Life has covered the halls of JPMorgan in San Francisco, ViVE in Nashville, and the Digital Health Summit in Boston. But the outreach received before BIO—from stakeholders in Austin, Belfast, Milan, Riyadh, and Tulsa—suggested something seismic was shifting. At BIO 2025, that story came into focus: a world where health innovation is no longer limited by geography but defined by vision, investment and intention.

The Biotechnology Innovation Organization isn’t just where technologies are launched and global biotech identities are shaped. What we witnessed in Boston this year wasn’t just presence, but purpose. From Riyadh to Milan, leaders arrived not merely to exhibit, but to engage. They came to say, ‘We are here. We are investing. We are innovating.’ BIO 2025 stood out for its sheer scale and energy—a mosaic of emerging voices ready to help steer the next wave of life science breakthroughs.

Global Trends: Infrastructure, Incentives and Inclusion Drive Expansion

A common thread across these rising biotech regions is the power of public-sector catalysts. Investment in R&D tax credits, translational research centers, and workforce training has de-risked innovation for early-stage companies. Regions like Oklahoma and Northern Ireland exemplify how government partnerships with academia and industry can create a vibrant life sciences pipeline.

In parallel, digital innovation is enabling smaller regions to leapfrog traditional limitations. AI-led discovery, digital twins, and virtual trial platforms are reducing costs and increasing speed-to-data. This convergence of science and software is helping new hubs like Austin and Riyadh accelerate globally competitive capabilities in diagnostics, personalized medicine, and regulatory science.

“We’re not competing with Boston—we’re complementing it,” said a delegate from Invest Northern Ireland. “In a connected world, biotech ecosystems aren’t isolated—they’re collaborative nodes on a global grid.”

Meanwhile, leaders from Italy’s Ministry for Foreign Affairs and Saudi Arabia’s SFDA emphasized the importance of regulatory agility. Their message was clear: modern biotech requires modern policy. Whether through centralized ethics boards, digital review platforms, or alignment with international standards, regulatory transformation is essential to scale innovation.

These developments signal a broader inflection point—biotech is no longer about place. It’s about purpose, policy, and partnerships.

Austin: Where Tech Meets Translational Medicine

Austin is no longer just the city of live music and digital startups. With more than 300 life science companies and a 74% employment boom in biotech over the past five years, it’s transforming into a powerhouse of translational medicine.

Heavyweights like Thermo Fisher, Natera, and Luminex now call Austin home, joined by trailblazers such as Paradromics, Elligo Health Research, and Prophase Biostudios. These companies blend biotech, medtech, and AI in ways that are shaping the next frontier in diagnostics, therapeutics, and digital health.

“As one of the country’s fastest-growing emerging life sciences hubs, the Austin region is responsible for a significant portion of the biotechnology sector’s growth in Texas,” said Ed Latson, CEO of Opportunity Austin. “Our tech talent, VC ecosystem, and institutions like UT Austin are driving an uptick in innovations, with over 350 life science patents issued to Austin companies in the past five years.”

Austin’s 4.4 million square feet of science innovation space—plus another 1.1 million square feet under construction—signals that this rise is more than momentum. It’s movement.

Italy: From Scientific Legacy to Global Scale

Italy’s BIO 2025 pavilion was both a showcase and a statement: this country is stepping into biotech leadership. Long known for its academic excellence, Italy is now connecting its research infrastructure to industrial manufacturing and global markets.

With 770 production sites and the largest Contract Development and Manufacturing Organization output in Europe (€3.6B), Italy is scaling up innovation across oncology, AI diagnostics, and organ-on-chip development. Companies like BiomimX, Math Biology, Genenta Science, and InSilicoTrials are bridging cutting-edge science with clinical utility.

“Italy’s presence at BIO Boston reflects years of work by the Italian Trade Agency to promote an integrated system of scientific expertise, high-tech supply chains, and a talent-rich ecosystem,” shared Erica Di Giovancarlo, Director of the ITA New York Office.

Initiatives like the Montalcini Global Biotech Tour and policy instruments from the Ministry for Foreign Affairs support this ambition.

“Pharma is one of Italy’s top global exports,” noted Mauro Battocchi, Director General. “That would be unthinkable without a strong base in R&D, regulation, and manufacturing.”

Northern Ireland: Precision Science with Global Reach

With 250+ companies and $2.5 billion in revenue, Northern Ireland’s life sciences sector has grown 75% in just three years. The delegation to BIO was led by Invest Northern Ireland and featured companies from drug discovery (AMPLY), CRO services (Almac, Celerion), and diagnostics (Randox).

Queen’s University Belfast and Ulster University deeply anchored the region’s ecosystem. Global companies are noting that Celerion recently relocated its UK Phase I operations to Belfast’s new iREACH facility, betting on local talent and translational research capacity.

From scientific rigor to export capability—145+ countries and counting—Northern Ireland proves that locale doesn’t limit global vision.

Oklahoma: Equity-Focused Innovation with Local Roots

Oklahoma’s biotech renaissance is rooted in intentionality—it is focused on equity, local workforce development, and community-based innovation. Biosciences now contributes more than $16 billion to the state’s economic impact, with more than 750 companies and 42,000 jobs.

The Oklahoma delegation at BIO emphasized sustainability, manufacturing, and health equity, with standout organizations including Wheeler Bio, BioTC, ParaNano, and Utopia Plastix.

“We’re not here to be a branch office,” one delegate told me. “We’re here to bring Oklahoma’s soul to the bioscience table.”

With significant support from the Oklahoma Center for the Advancement of Science & Technology (OCAST), OKBioStart, and the University of Oklahoma, this state is redefining what it means to be an innovation hub.

Saudi Arabia: A New Powerhouse for Biotech Partnerships

Saudi Arabia came to BIO with a clear strategy and global ambitions. Led by His Excellency Prof. Dr. Hisham Saad Aljadhey, CEO of the Saudi Food and Drug Authority (SFDA), the Kingdom made its voice heard across two key sessions.

At “Global Biotechnology at a Crossroads,” Dr. Aljadhey discussed Saudi Arabia’s modernization of clinical trials and regulatory frameworks, aligning with international standards. At “Partnering for Progress,” he showcased the Kingdom’s integrated biotech ecosystem, spanning R&D, data, manufacturing, and patient care.

Beyond BIO, the SFDA delegation engaged with Harvard University and global pharmaceutical leaders and joined a private sector roundtable hosted by BIO and the U.S. Chamber of Commerce. These engagements reflect Saudi Arabia’s commitment to cross-border collaboration, secure supply chains, and sustainable innovation infrastructure.

With leaders from the Saudi Ministry of Health, King Faisal Specialist Hospital, and the National Institute of Health also in attendance, the message was clear: Saudi Arabia is ready to be a regional biotech hub with global reach.

The New Map of Global Innovation

This isn’t just a reshuffling of zip codes. It’s a redrawing of the innovation map—pushed forward by ecosystems committed to inclusion, science, sustainability, and scale.

These five rising regions aren’t simply showing up. They’re standing up—challenging legacy thinking, collapsing silos, and reminding the world that leadership in life sciences doesn’t require a familiar address. It requires ambition, alignment, and action.

At BIO 2025, the message was unmistakable: where you innovate matters less than why you innovate—and for whom.

From Austin’s AI-powered translational medicine to Saudi Arabia’s regulatory reinvention, the next wave of breakthroughs will be shaped not by old borders but bold commitments.

Expectations are high. Patients in Milan and Muskogee, Belfast and Boston, Riyadh and Rochester are not waiting for innovation to trickle down. They are looking globally—for the fastest path to solutions that sustain and save lives.

The future of biotech is already in motion. It’s inclusive. It’s intentional. And it’s unstoppable.

The post BIO – Biotech Without Borders  appeared first on Medika Life.

When I asked him what sparked joy — my now-standard question for new consults — he didn’t hesitate.

“Travel,” he said, his eyes lighting up. “Dozens of countries. I love learning how people live, eat, think.”

Then he paused. “But if I had to choose just one?”

He leaned forward, almost conspiratorially.

“Japan. Lived there over 25 years.”

I perked up. “Hontō ni?”

“Eh? Hontō hontō!” he beamed.

And just like that, the oncology suite turned into an izakaya.

We chatted in Japanese for several minutes — I, a Black man from the Pacific Northwest with a Japanese wife and a daughter who had attended college in Kyoto; he, a white man with a surprising Tokyo accent and stories that could have filled a dozen ryokans.

The nurses outside the curtain must’ve been baffled.

There we were: two middle-aged men, dressed like surgical extras, speaking rapid-fire Japanese about onsen, natto, and konbini snacks.

In radiation oncology, these are the moments you don’t forget.

The Kind of Joy You Can’t Buy

When our conversation drifted back to English, we kept circling the same theme: experience.

He told me about sleeping in the Sinai desert under a blanket of stars.

About sipping strong coffee in Addis Ababa.

About riding motorcycles through Southeast Asia before Google Maps existed.

What he didn’t talk about were things.

No fancy watches.

No new Teslas.

No gadgets.

Just the texture of moments lived.

And it hit me: the joy that lit up his face wasn’t the kind you get from opening a box.

It was the kind you earn by stepping into the unfamiliar. The kind that asks something of you — and gives back more than it takes.

The Science of Why It Feels So Good

We tend to think happiness is about comfort.

But psychologists like Dr. Laurie Santos (of Yale’s wildly popular Science of Well-Being class) suggest that the happiest people spend less on stuff and more on experiences.

Why?

Because of experiences:

• Give us stories we can retell
• Bring us into contact with others
• They are often tied to personal growth
• Don’t lose their sparkle the way objects do

A new phone gets old fast. But your first tuk-tuk ride in Bangkok? That stays with you.

There’s even a term for the trap we fall into with material things: hedonic adaptation.

The idea is that we quickly get used to new pleasures.

The house, the car, the clothes — they stop thrilling us.

But experiences?

They stay vivid.

I wrote about a similar theme in 10 Tiny Habits That Make You Healthier, Calmer, and Harder to Kill — the idea that intentional living creates lasting joy, not just fleeting dopamine hits.

My Favorite Journeys

Some of my favorite travel memories come from places that required a little more effort than, say, Paris or London.

• Egypt: navigating the frenetic, poetic chaos of Cairo traffic, then standing in stillness before the pyramids.
• Turkey: sipping tea in the shadow of the Blue Mosque, hearing the call to prayer echo across centuries.
• Japan: of course — always Japan — with its contradictions, its grace, its reverence for detail.
• Indonesia: maybe my favorite of all, where time moves differently and kindness is a national trait.

These places didn’t just offer a change of scenery. They offered a shift in me — the way I saw others, the way I understood culture, the way I experienced time.

What Travel (and Cancer) Teaches Us

My patient and I shared one more truth that day: that illness, like travel, strips you down to what matters.

It makes you see the world in a different light.

It humbles you.

And if you let it, it can open you.

Sometimes I think the best journeys aren’t measured in miles, but in mindset.

You don’t have to get on a plane.

You just have to notice something new.

Final Thoughts

That day in the exam room, two men with nothing in common on paper laughed like old friends, because we shared a language — and not just Japanese.

We shared curiosity.

And in that moment, amid machines and masks and schedules, we were both simply human.

Let the numbers tell the story.

• Free Download: “Debunked: 7 Health ‘Facts’ That Are Quietly Hurting You — Grab It Here.”
• Liked this story? Read “25 Ways to Reduce Your Cancer Risk” or “What Dying Men Confessed When No One Was Listening.”

Author bio: Michael Hunter, MD, is a cancer doctor, travel junkie, and collector of patient wisdom. His new ebook, What Dying Patients Taught Me About Living, is available here.

P.S. If this story resonated with you, follow me for weekly insights from the clinic and beyond.

The post Clinic Notes: I Didn’t Expect to Speak Japanese Today appeared first on Medika Life.

After cardiac surgery, patients are at risk for both high and low blood sugar, which can lead to serious complications. Managing these fluctuations requires careful insulin dosing, but existing protocols often fall short due to the unpredictable nature of ICU care and differences among patients, say the investigators. 

To address this challenge, the research team created a reinforcement learning model, named GLUCOSE, that recommends insulin doses tailored to each patient’s needs. In tests using data from real-world ICU cases, GLUCOSE matched or even outperformed experienced clinicians in keeping blood sugar levels within a safe range—despite having access to only current patient data, while doctors used full patient histories. 

“Our study shows that artificial intelligence can be thoughtfully and responsibly developed to support, rather than replace, the clinical judgment of health care professionals,” says co-senior corresponding author Ankit Sakhuja, MBBS, MS, Associate Professor of Medicine (Data-Driven and Digital Medicine) and a member of the Institute for Critical Care Medicine at the Icahn School of Medicine at Mount Sinai. “In complex and high-pressure environments like the ICU, tools like GLUCOSE can provide real-time data-driven guidance tailored to individual patients. This kind of decision support can enhance safety, reduce the risk of complications, and ultimately allow clinicians to focus more of their attention on critical aspects of patient care.” 

The research team trained GLUCOSE using reinforcement learning, which allowed the system to learn optimal decisions through trial and error. They also used advanced methods—conservative and distributional reinforcement learning—to ensure the model made cautious, reliable recommendations. The model was then rigorously evaluated and compared to real-world clinical practices. 

While the results are promising, the researchers caution that GLUCOSE is not intended to replace doctors. It serves as a clinical decision support tool, offering suggestions that physicians can choose to follow based on their judgment and the broader clinical picture. 

The model could eventually be integrated into electronic health record systems to provide real-time insulin dosing guidance in the ICU, helping reduce complications and improve outcomes. Future steps include adapting the tool for use in other hospital settings, running clinical trials, and exploring ways to integrate it into routine care. 

One current limitation is that the model does not yet factor in nutrition data, which may affect longer-term glucose control. Still, the ability of GLUCOSE to make accurate recommendations based on limited real-time data highlights its potential to enhance safety and efficiency in postsurgical care. 

“Our goal is to develop AI systems that meaningfully augment the capabilities of health care providers and ultimately improve patient outcomes,” says co-senior corresponding author Girish N. Nadkarni, MD, MPH, Chair of the Windreich Department of Artificial Intelligence and Human Health, Director of the Hasso Plattner Institute for Digital Health, and Irene and Dr. Arthur M. Fishberg Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Chief AI Officer of the Mount Sinai Health System. “By learning from real-world clinical data and delivering personalized recommendations in real time, models like GLUCOSE represent an important advance toward integrating trustworthy data-driven tools into the clinical workflow. This study offers a glimpse of how AI can be thoughtfully embedded into care to support providers in delivering safer, more precise treatment.” 

The paper is titled “A Distributional Reinforcement Learning Model for Optimal Glucose Control After Cardiac Surgery.” 

The study’s authors, as listed in the journal, are Jacob M. Desman, Zhang-Wei Hong, Moein Sabounchi, Ashwin S. Sawant, Jaskirat Gill, Ana C. Costa, Gagan Kumar, Rajeev Sharma, Arpeta Gupta, Paul McCarthy, Veena Nandwani, Doug Powell, Alexandra Carideo, Donnie Goodwin, Sanam Ahmed, Umesh Gidwani, Matthew A. Levin, Robin Varghese, Farzan Filsoufi, Robert Freeman, Avniel Shetreat-Klein, Alexander W. Charney, Ira Hofer, Lili Chan, David Reich, Patricia Kovatch, Roopa Kohli-Seth, Monica Kraft, Pulkit Agrawal, John A. Kellum, Girish N. Nadkarni, and Ankit Sakhuja. 

The study was funded, in part, by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health grant 5K08DK131286, and by the Clinical and Translational Science Awards (CTSA) grant UL1TR004419 from the National Center for Advancing Translational Sciences. Research reported in this publication was also supported by the Office of Research Infrastructure of the National Institutes of Health under award numbers S10OD026880 and S10OD030463.  

See the journal paper for conflicts of interest: https://www.nature.com/articles/s41746-025-01709-9. 

About Mount Sinai’s Windreich Department of AI and Human Health   

Led by Girish N. Nadkarni, MD, MPH—an international authority on the safe, effective, and ethical use of AI in health care—Mount Sinai’s Windreich Department of AI and Human Health is the first of its kind at a U.S. medical school, pioneering transformative advancements at the intersection of artificial intelligence and human health.  

The Department is committed to leveraging AI in a responsible, effective, ethical, and safe manner to transform research, clinical care, education, and operations. By bringing together world-class AI expertise, cutting-edge infrastructure, and unparalleled computational power, the department is advancing breakthroughs in multi-scale, multimodal data integration while streamlining pathways for rapid testing and translation into practice.  

The Department benefits from dynamic collaborations across Mount Sinai, including with the Hasso Plattner Institute for Digital Health at Mount Sinai—a partnership between the Hasso Plattner Institute for Digital Engineering in Potsdam, Germany, and the Mount Sinai Health System—which complements its mission by advancing data-driven approaches to improve patient care and health outcomes.  

At the heart of this innovation is the renowned Icahn School of Medicine at Mount Sinai, which serves as a central hub for learning and collaboration. This unique integration enables dynamic partnerships across institutes, academic departments, hospitals, and outpatient centers, driving progress in disease prevention, improving treatments for complex illnesses, and elevating quality of life on a global scale.  

In 2024, the Department’s innovative NutriScan AI application, developed by the Mount Sinai Health System Clinical Data Science team in partnership with Department faculty, earned Mount Sinai Health System the prestigious Hearst Health Prize. NutriScan is designed to facilitate faster identification and treatment of malnutrition in hospitalized patients. This machine learning tool improves malnutrition diagnosis rates and resource utilization, demonstrating the impactful application of AI in health care.  

For more information on Mount Sinai’s Windreich Department of AI and Human Health, visit: ai.mssm.edu  

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“The fault, dear Brutus, is not in our stars, but in ourselves…”
— William Shakespeare, Julius Caesar.

That quote haunted me for years, long before I ever held a linear accelerator’s joystick or delivered radiation to a tumor curled around someone’s spine.

Back then, I didn’t fully grasp its relevance to my work.

Now, after decades in oncology, I see it with stark clarity.

Because here’s the truth:

Up to 42% of cancers are preventable — not through miracle drugs or genetic luck, but through modifiable, everyday choices.

This observation isn’t about blame.

It’s about power.

And it’s time we stopped whispering about it.

Even through the fog of risk, we can walk toward healing. 42% of cancers are preventable, and every step counts.

🔁 Why Cancer Isn’t Just Bad Luck: The Myth of Randomness

When patients hear “cancer,” the next question is often whispered:

Did I cause this?

It’s a painful, complicated moment.

I always remind them: no one deserves this, and no one gets cancer from one bad meal or missed screening.

But I also tell them we know that cancer is not a lightning strike.

Yes, some cancers come from sheer genetic chaos.

But others arise from a slow, silent drift, shaped by inflammation, environment, and habit.

🔁 Inflammation and Obesity: The Hidden Cancer Risks

You don’t see inflammation in the mirror. But it shapes your fate.

Low-grade, chronic inflammation — often fueled by excess fat, poor diet, poor sleep, and stress — is a known contributor to several cancers, including colorectal, breast, and liver.

Chronic inflammation in the etiology of disease across the life span – Nature Medicine

www.nature.com

We once thought of obesity as a cosmetic issue. Now we understand it as a biological amplifier of cancer risk:

• Fat cells release cytokines and estrogen-like compounds
• These can trigger DNA damage and tumor-promoting environments

I’m not judging anyone’s weight. I’m inviting a deeper understanding of how the body works — and how we can gently steer it.

Diseases desperate grown,
By desperate appliance are relieved,
Or not at all.”
— Shakespeare, Hamlet.

Sometimes, small daily shifts are our most potent medicine.

🔁 How Alcohol, Smoking & Diet Tip the Scales

If you asked me what four lifestyle changes would make the biggest impact on global cancer rates, I’d say this:

1. Stop smoking
2. Drink less alcohol
3. Eat more plants and fewer processed foods
4. Move

🥃 Alcohol

Alcohol is a group 1 carcinogen, the same class as tobacco and asbestos.³

It increases the risk for at least seven cancers, including breast and colorectal.

And even “moderate” drinking has risks, especially for those with other risk factors.

No level of alcohol consumption is safe for our health

. www.who.int. int.

🍽️ Diet

Ultra-processed foods cause inflammation, metabolic dysfunction, and now, higher cancer risk.

A 2023 study in The Lancet tied them to a 29% increased risk of colorectal cancer.⁴

It’s not about moral purity. It’s about stacking the odds in your favor.

Prevention Isn’t Perfection. It’s Daily Poetry.

When I talk to patients, I don’t hand them guilt. I hand them a possibility.

• A walk after dinner to quiet insulin spikes
• A decision to swap soda for tea
• A full night of sleep instead of doomscrolling

These things may seem small, but they are acts of devotion, not just to the body, but to the life it still wants.

Though this be madness, yet there is method in’t.”
— Hamlet.

Health is not about perfection. It’s about rhythm.

About small, quiet methods repeated until they shape destiny.

The Truth I Wish More People Knew

When people find out I’m a cancer doctor, they usually ask about treatments.

But the conversation I wish we had more often is this:

What can I do now, before the diagnosis, to change the story?

The answer isn’t sexy. It’s not a pill or a breakthrough headline.

It’s this:

Cancer isn’t always random. And your choices — however small — are not meaningless.

You deserve to know that.

A Gentle Invitation

I don’t write this to scare you.

I write it because knowledge is power, and silence is not protection.

Here’s the truth:

• Cancer is common.
• Up to 42% is preventable.
• That prevention is made of ordinary acts repeated with quiet courage.

What’s one habit you’ve changed for your long-term health? I’d love to hear.

The post Cancer Isn’t Random: What 42% of Diagnoses Have in Common — and How You Can Lower Your Risk. appeared first on Medika Life.