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.

What we eat day after day has an enormous influence on cardiovascular disease, diabetes, obesity, cancer, and even cognitive decline. And it is never too late to improve. A 2023 evaluation estimated that a sustained shift toward a healthier diet beginning at age 40 could add nearly ten years to life expectancy. Even making the change at age 70 was associated with gains of about five years.

Hippocrates understood the basic principle 2,400 years ago: “If we could give every individual the right amount of nourishment and exercise — not too much and not too little — we would have found the safest way to health.”

If your goal is long life and better health, you need to examine your lifestyles — that is, your food intake, exercise program, sleep habits, tobacco and alcohol use, and stress tolerance. The benefits of improving your lifestyles (for the long term, not just for a few weeks or months) will be multifold: feel better, improved health, less chronic illnesses, and a longer lifespan free of disease; call it a longer healthspan.

An excellent place to start the path of healthy lifestyles is with what you eat; for that, a good starting point is to look into your refrigerator. When thinking about what to eat, I suggest you follow the basics of the Mediterranean diet or its variation, the MIND diet. Your refrigerator tells a story of what you choose to eat. Ideally, its contents would be primarily fruits and vegetables, and fin fish. Moderate amounts of dairy, poultry, and eggs are excellent. Some meat is fine, but it is best if it is from animals grass-fed only. Do cut way back on added sugars. Outside your refrigerator there are olive oil, nuts, seeds, beans, whole grains, and wine. This diet has been repeatedly shown to be associated with better health, wellness, and a longer health span.

The MIND diet is like the Mediterranean Diet, with an added emphasis on berries, dark green leafies, and other colorful vegetables such as beets and sweet potatoes. Like the Mediterranean diet, it recommends lots of beans and nuts, whole grains, olive oil rather than butter, and limits pastries and fast foods, and avoids ultra-processed foods. It has been shown to benefit brain function and delay cognitive aging, although not all studies are consistent.

Diet need not be a stressful word

“Diet” is simply a shorthand description of what you eat. Everyone has a diet. A “diet” is not a punishment. It is a choice. Your choice. It can be whatever you want it to be. A healthy diet can be delicious, nutritious, satisfying, filling, and fun.

During my childhood, meat was the main attraction at dinner time. Vegetables were just “sides.” Today, I will try to cover two-thirds of my plate with vegetables. My wife keeps that refrigerator filled with veggies and fruits that are as fresh and local as possible, preferably organic.

Supermarkets, dollar stores, and gas station markets encourage us to purchase foods that are already processed or prepared by a manufacturer or foods from the deli bar. It is quick and easy, but many ultra-processed foods are calorie-dense, high in added sugars, sodium, and refined starches, and relatively low in fiber and other beneficial nutrients.

Disturbingly, Americans today obtain almost 60% of their calories from ultra-processed foods which in turn greatly increase our consumption of added sugars. Fast foods generally lack anything that looks like a vegetable, save the pickle and some ketchup; asking for fruit is a non-starter.

Consider instead straightforward ways of cooking “from scratch.” Steaming, stir-frying, sautéing, and baking are easy, take little time, and result in quality, tasty meals. Fresh vegetables are all flavorful on their own, although herbs and spices or a little olive oil can enhance their natural flavor.

Dark greens (e.g., spinach, kale, collards, dandelion, arugula, Swiss chard, etc.) with their high concentrations of micronutrients and fiber, should be consumed daily, either cooked or in a salad with other vegetables such as carrots, cucumbers, tomatoes, onions, or peppers that add color, texture, and more nutrients.

Fruits of assorted colors are equally important in a healthy diet. Fresh, local fruits are preferable, although frozen fruits are fine. Canned fruits usually contain added sugar. Berries (strawberries, blueberries, blackberries, raspberries, cherries) are high in polyphenols, which are beneficial for many metabolic processes and especially good for the brain. They are emphasized in the MIND diet. Yes, fruits do contain natural sugars, but not too much. Beware of fruit juices, which are usually loaded with sugar.

Grains — avoid refined white flour

The list of whole grains does not include refined white flour. White flour has little nutritional value and is found in most breads, pasta, cereals, cakes, pies, cookies, and pizza dough. This flour digests directly into sugar in your mouth and gut, where it is rapidly absorbed and jacks up your insulin levels increasing your risk for diabetes and cardiovascular disease. Consumption of these foods, in moderation, is acceptable as an occasional treat but not in a daily diet. Whole grains include whole wheat flour, brown rice, quinoa, barley, millet, and oatmeal. They do not have the germ, bran, or fiber removed, as do refined grains. Unlike refined grains, whole grains can lower LDL (“bad”) cholesterol and raise HDL (“good”) cholesterol. They are digested more slowly and do not lead to spikes in blood sugar and insulin levels.

Fats and oils are not only acceptable in a healthy diet, they are essential. Get them from olive oil, avocados, nuts, and seeds. Avoid trans fats, which are found in many ultra-processed foods. Omega-6 fatty acids, found in most ultra-processed food, kept to a minimum, are needed for many body functions. The “good” fats include omega-3 fatty acids from finfish like salmon, tuna, mackerel, sardines, and others — wild-caught if possible. They are found in some plant-based foods like flax meal, but it is hard to get enough without a good fish.

Most beef is sourced from cattle placed in small pens and fed corn and soybeans to fatten them up. This fat is mainly saturated fat that clogs our blood vessels along with omega-6 fatty acids, which contribute to inflammation. Beef and lamb from animals grazed on grass for their entire life have much less fat and much-reduced omega-6’s. Select meats from animals without additives — either on the range, the feed lots, or after butchering. Additives include antibiotics, growth hormone, nitrites, and other chemicals that adversely affect your gut health. Recently, I have noticed meat packers adding liquid “to retain moisture and improve taste.” This is hogwash. All the extra liquid does is increase the weight of the meat so that you pay more!

Chickens are usually raised in structures where they never see the light of day. They are fed antibiotics and hormones to stimulate quick growth. Look for chickens that roam in the fields (free-range) and have not been fed additives. Likewise, eggs produced by hens similarly raised will be better for you; the yolks will have a brighter yellow-orange color.

Avoid added sugar

Declare added sugar to be your sworn enemy. Avoid it as much as possible. This is not easy since we have been trained to desire sweet tastes. Sugar is basic to sodas, baked goods, ice cream, and many yogurts and cereals and added to hundreds of other products. The upper daily “safe” limit for women is twenty-five grams of sugar. For men, thirty-seven grams. Consider that a 12-ounce can of soda contains about thirty-nine grams — the full complement for a man and well over that for a woman. A “Big Gulp” (32 ounces) is obviously dreadful for your health. Cultivate your natural taste for water.

Real cheese has natural color, so avoid those with added coloring. While yogurt itself is extremely healthy, yogurt containing fruit usually contains sugar. Try eating plain yogurt with your own fresh fruit added to it. Greek yogurt offers greater amounts of protein per serving. Look for “live culture” yogurt — that is, yogurt made from milk pasteurized before the cultures have been added, not yogurt pasteurized after the addition of cultures. Almost all flavored/fruited yogurts have no live cultures.

What yummy thing that is healthy can you eat that is not in your refrigerator? Dark chocolate that is 85% cocoa or more. It is inherently healthy. It contains caffeine, so be careful not to overconsume chocolate in the evening.

Feeding your bugs

You are eating not only for yourself but also for the bacteria in your intestines. There are 100 trillion of them in your gut microbiota (microbiome). They help maintain your immune system and intestinal lining cells and produce nutrients for your cells’ energy needs. The “food” your bacteria love is the fiber your intestinal enzymes cannot digest. The best sources of this fiber are vegetables, beans, fruits, and whole grains. If you do not consume adequate fiber, the “good” bacteria are starved.

Meanwhile, suppose you consume excess sugar, refined white flour, or too much alcohol. In that case, you are feeding the “bad” bacteria with detrimental results: increased intestinal permeability (“leaky gut”), local inflammation, systemic inflammation, the passage of toxins into the bloodstream, and an environment conducive to various complex chronic illnesses. Given Americans propensity to consume ultra-processed foods, it is not surprising that we suffer from a plethora of diseases induced or exacerbated by inflammation.

So, treat those “good” bacteria well. Beans, fruits, and whole grains, with their high fiber content, are called prebiotics. Live culture yogurts, live culture Kefir, non-pasteurized sauerkraut, kimchi, and other fermented foods, with their bacteria and yeasts, are called probiotics. They are all beneficial to your gut microbiome and health overall.

A final peek into the refrigerator

Look at the freezer in the watercolor. You will see a package of ice cream. It is there because we all need a treat, an indulgence. Just do not overdo it.

Your everyday food choices directly affect your healthspan so take one more look into your refrigerator. It does not need to be perfect, ours certainly isn’t. But what fills most of those shelves, day after day, may have a surprisingly large influence on how many healthy years you have ahead of you. And no matter your age, it is never too late to adjust your eating habits.

The post What Does Your Refrigerator Say About Your Health? appeared first on Medika Life.

None of that was what frightened her most. What frightened her was the conclusion she kept reaching late at night. She had read enough to know that dementia can begin quietly, years before anyone gives it a name, and she wanted to know whether this was how hers was beginning. If it wasn’t, she wanted someone to explain why it felt so much like it.

I hear some version of this fear often enough that I have come to think it deserves a more precise answer than the reassurance women usually get, which is that it’s “just hormones.” That phrase is half right, and the half it leaves out is the part that matters.

Estrogen is not only a reproductive hormone. The brain carries receptors for it in regions that handle memory and attention, including the hippocampus and the prefrontal cortex, and estradiol appears to support how neurons use energy and maintain their connections. During perimenopause, estrogen does not simply decline; it fluctuates, sometimes sharply. When researchers at Weill Cornell imaged women’s brains before, during, and after menopause, they found measurable changes in brain structure and energy metabolism across the transition, many of which stabilized afterward. Work like this shows that the brain changes during menopause. It cannot show that any one woman’s missing word comes from those changes, and that is a line I am careful not to draw for a patient.

The cognitive data are similarly measured. In the Study of Women’s Health Across the Nation, which tested more than two thousand midlife women repeatedly over several years, verbal learning dipped during the transition and, in that original analysis, recovered after menopause. Later analyses suggested that some cognitive measures continue to change in the years surrounding menopause, although separating the effects of reproductive aging from chronological aging is difficult. These studies describe patterns across populations, not the future of any individual woman’s memory.

Clinicians sometimes describe a difference in texture between kinds of forgetting, though it is a pattern rather than a test. Tip-of-the-tongue lapses, where the word exists but won’t come when called, are common in menopause. They also occur with ordinary aging, and they can appear early in neurodegenerative disease. Lapses in which new information never seems to have been recorded at all, so that the same question returns within minutes, raise more concern. Neither pattern settles the question on its own, and noticing your own lapses is not reassurance either, because people in the early stages of dementia often notice and worry about their changes too. Brain fog during menopause is also not, by itself, evidence that dementia is more likely later; the relationship between menopause and long-term risk is far less direct than the experience of forgetting suggests.

In thirty-six years of medicine, I have come to believe that brain fog deserves evaluation rather than dismissal. A sound evaluation includes a careful history, a review of medications, an assessment of sleep that considers apnea, a neurological examination, and targeted blood tests for problems such as thyroid disease, low vitamin B12, and anemia. Depression belongs on the list, and so does the fragmented sleep that night sweats produce, which may account for more of the fog than estrogen does directly. Hormone therapy is not recommended as a way to prevent dementia, though treating disruptive symptoms sometimes restores enough sleep that thinking feels clearer. Symptoms that keep progressing, a decline in how someone manages daily life, or concern raised by family or colleagues all call for formal cognitive testing, not reassurance based on menopausal status alone.

If you’re in your forties or fifties and words have started slipping away, I wrote a short physician’s guide to brain fog during menopause: why it happens, what can make it worse, and what tends to help.

Get the free Brain Fog Brief →

She had come in braced for a single answer, and what I could honestly offer her was more careful than that. I would never tell a woman that a missing word means nothing simply because she is fifty-four. Neither would I let that missing word become a diagnosis before the other explanations have been examined. She deserved an explanation grounded in evidence, not a reassurance I couldn’t defend.

The post She Started Forgetting Words at 54. Her First Thought Was Dementia. 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.

That may sound obvious, but it is an important part of the vaccination journey that is easy to overlook. Much of the conversation understandably focuses on the science: which vaccines we need, how well they work and who should receive them. Far less attention is paid to what happens next. Developing an effective vaccine and running an effective vaccination programme are two different achievements.

Between recommendation and protection lies what we might call the last mile of vaccination. Booking an appointment, getting there, taking time away from work or caring responsibilities, understanding the recommendation, having confidence in the person giving it and, where necessary, coming back to complete the schedule. These practical details may seem mundane compared with the science behind a vaccine. In reality, they can determine whether that science ever translates into protection.

Timing isn’t about a calendar. It’s about protection.

Vaccination schedules aren’t arbitrary. The timing and spacing of doses reflect when people are most vulnerable to particular diseases, how the immune system responds at different ages and when further doses are needed to build or maintain protection. For babies and young children, delaying vaccination can therefore extend the period during which they remain susceptible to preventable disease.

But the principle doesn’t end with childhood. Increasingly, immunisation is being understood through a life-course lens: the protection we need changes as we move from infancy and adolescence through pregnancy, adulthood and older age. WHO’s Immunisation Agenda 2030 sets out an ambition for “everyone, everywhere, at every age” to benefit from vaccines. Some vaccinations establish protection early in life; others become relevant because our risks change, immunity may need reinforcing through booster doses, or new opportunities for prevention emerge as we age.

That matters increasingly as populations age. For the first time, adults over 65 now outnumber children under five globally, and the WHO estimates that nearly one billion people will be in this age group by 2030. WHO increasingly positions adult vaccination as part of healthy ageing, rather than something we largely complete in childhood.

The right protection matters. So does receiving it at the right time. A recent case in Italy is a stark reminder that diseases many people assume belong to the past have not disappeared. In August 2026, a four-year-old girl in Palermo who had reportedly not been vaccinated died following a probable case of diphtheria. A cousin of the same age also tested positive and was hospitalised. The full circumstances were still being investigated at the time of reporting, but the case is a sobering reminder of what can sit behind the clinical language of ‘vaccine-preventable disease’.

The schedule looks rather different from the kitchen table

On paper, an immunisation schedule can look straightforward. Now consider it from a parent’s perspective.

You have two children. You work shifts. The clinic isn’t nearby. An appointment means negotiating time off, arranging care for your other child and finding a way to get there. Then there is another appointment a few weeks or months later.

Perhaps you have questions too. You’ve seen something worrying online and aren’t sure whether it is true. You intend to ask a healthcare professional, but the appointment is short, your child is upset, and other patients are waiting. This is the point at which a well-designed health programme meets ordinary life. And ordinary life is messy.

The latest global figures show what is at stake. In 2025, 90% of infants worldwide, nearly 116 million children, received at least one dose of a vaccine protecting against diphtheria, tetanus and pertussis. But only 85%, around 110 million children, completed the three-dose series.

Behind every missed vaccination lies a unique set of circumstances, and there isn’t necessarily someone who decided against vaccination. A clinic may have been too far away. A day’s lost wages may have been unaffordable. An appointment might have been missed and never rearranged. Perhaps nobody explained clearly why another dose was needed.

An unvaccinated person is not necessarily a vaccine-hesitant person. Sometimes the barrier is belief. Sometimes it is a bus timetable.

That distinction matters because the solutions are completely different.

Convenience is more important than it sounds

Healthcare sometimes talks about convenience as though it were an added benefit. In prevention, it can be much more fundamental.

Every additional appointment creates another opportunity for life to interfere. That inconvenience is not distributed equally. For someone with a car, flexible working hours and a nearby clinic, another appointment may simply be irritating. For someone paid by the hour, living in a rural community, caring for several children or dependent on public transport, it can become a genuine barrier to healthcare.

WHO’s Behavioural and Social Drivers of Vaccination framework recognises that uptake is influenced by much more than attitudes towards vaccination. That matters because simplicity isn’t only about creating a better patient experience. It is also about access and, ultimately, equity. Making prevention overly complex risks placing the greatest burden on people who already face the greatest barriers to healthcare.

Why fewer injections and fewer journeys can matter

Combination vaccines offer a useful example. Rather than requiring a separate injection for every disease, they can provide protection against several diseases in a single injection.

Fewer injections have an obvious benefit for a child or parent, but they can also simplify the practical journey. Combination vaccines can reduce the number of injections and clinic visits and make recommended schedules easier to complete on time.
A recent independent systematic review also found some evidence of a potential benefit for vaccination timeliness, although the authors were clear that the quantity and quality of evidence remain limited.

Combination vaccines won’t solve every reason why vaccination is missed, and the evidence shouldn’t be stretched beyond what it shows. But the underlying principle matters: every unnecessary appointment or journey creates another opportunity for life to get in the way.

WHO has a useful term for part of this problem: a “missed opportunity for vaccination” when someone eligible for vaccination has contact with health services but leaves without receiving a vaccination they need.

That raises some simple questions. Could vaccination happen during another healthcare appointment? Would a reminder help? Could an appropriate community or pharmacy setting bring vaccination closer to the person who needs it? Are we asking people to make additional journeys when we don’t need to?

Availability and accessibility are not the same thing. A vaccine can technically be available while remaining remarkably difficult for some people to receive.

Information matters. But so does the conversation.

Removing practical barriers is only half the job. People also need to understand what is being recommended and why.

That has become more difficult in an environment where someone can encounter dozens of claims about vaccination on their phone before having a few minutes with a healthcare professional. Some will be accurate. Others won’t. Many will lack context, while the most alarming can often be the most memorable.

Simply providing more information isn’t necessarily the answer. A parent asking whether a vaccine is safe isn’t necessarily opposed to vaccination. They may simply be doing what parents do: trying to make the best decision for their child. An older person asking why they need a vaccine they have never previously been offered isn’t necessarily hesitant either. They may reasonably want someone to explain what has changed.

Treating every question as resistance is a good way to lose confidence. Good health communication shouldn’t mean telling people what to think. It means listening carefully enough to understand the question being asked, answering it clearly and credibly and giving people the information they need to make an informed decision.

That is why a few minutes with a doctor, nurse or pharmacist can matter so much. CDC guidance describes a strong healthcare professional recommendation as a powerful motivator for vaccination and reports that parents receiving such a recommendation are four to five times more likely to have their child receive HPV vaccination.

If we expect healthcare professionals to have those conversations, we need to equip them properly. They need current evidence and straightforward ways of explaining benefits and risks. They need to understand the questions people are encountering outside the consulting room. And, wherever possible, they need enough time to listen.

A leaflet can provide information. A good conversation can build confidence.

One message won’t work for everyone

Good communication also means recognising that vaccination decisions aren’t made under identical circumstances. The questions of a new parent are unlikely to be the same as those of an adolescent, a pregnant woman, a healthy 40-year-old or an 80-year-old managing several health conditions.

Nor should we assume that the same information, delivered in the same way, will work equally well across different communities, cultures or countries. Communication works best when it starts with the person rather than the message.

The objective shouldn’t simply be to tell people to vaccinate. It should help someone understand what protection may be appropriate for them, why it matters, when it is recommended, where they can receive it and what to expect. That makes communication part of the vaccination journey rather than something added afterwards.

Vaccination doesn’t end when childhood does

Ask someone to picture vaccination, and there is a good chance they will imagine a small child sitting on a parent’s knee. Yet infectious disease doesn’t stop when we turn 18, and neither does the value of prevention.

Pregnancy is perhaps one of the clearest examples of why protection needs to be considered across life. In England, vaccination against influenza, pertussis and RSV is recommended at different points during pregnancy. Maternal vaccination can protect the mother, while, for some infections, antibodies passed to the baby can provide protection during those first vulnerable months. It is a reminder that vaccination can sometimes protect across generations as well as across years.

Needs continue to change in adulthood. In the United States, for example, the CDC lowered the routine age-based recommendation for pneumococcal vaccination from 65 to 50 in 2024, giving more adults the opportunity to receive protection at an age when the risk of pneumococcal disease begins to increase.

Recommendations will differ across countries, but the broader point holds true. We cannot reasonably expect people to keep track of every change in the protection that may become relevant to them over a lifetime. Health systems and healthcare professionals have to create those opportunities.

Access also remains deeply unequal. Influenza vaccination for older adults is included in national immunisation schedules in 89% of high-income countries but only 8% of low-income countries. For pregnant women, the corresponding figures are 87% and just 4%.

That gap isn’t simply about whether a vaccine exists. It is about whether health systems have built prevention into the way they care for people at different stages of life.

Living longer is only part of the story

Living longer is one of modern medicine’s great achievements. But simply adding years isn’t enough. The more meaningful measure is how many of those years people can spend in good health, independent and engaged with the people and things that matter to them.

The International Longevity Centre UK’s Healthy Ageing and Prevention Index reflects that broader idea, looking beyond lifespan to include measures such as health span, work span and wellbeing. The underlying argument is an important one: longevity shouldn’t be judged only by how long people live, but by whether societies invest in prevention and create the conditions for people to live those longer lives well.

My FINN Partners colleague Mark Chataway has written about this through the lens of the “longevity economy” in an Ebook on shaping the future of global health. Many older people want to continue working and contributing but are prevented from doing so by poor health, he argues, while a significant proportion of that ill health could be prevented, treated or delayed with interventions available today.

That takes healthy ageing out of the abstract. Prevention, whether through vaccination, screening, nutrition, physical activity, appropriate treatment or access to good healthcare, isn’t simply about avoiding an episode of illness. It can help people remain independent, productive and part of their families and communities for longer.

WHO’s wider life-course approach points in a similar direction. Health shouldn’t be considered as a series of isolated episodes of illness, but something shaped throughout life, with opportunities to intervene at important moments from pregnancy and childhood through adulthood and older age.

For a child, prevention can mean fewer days away from school. For a parent, fewer days away from work caring for a sick child. During pregnancy, it can mean protecting a mother and helping protect a baby at the very beginning of life. For an adult, it can mean remaining healthy enough to work and care for others. For an older person, avoiding serious infection can help preserve health and independence.

Prevention isn’t an abstract health-system outcome. This is what it looks like in people’s lives.

Perhaps we need to ask a different question

There will always be important debates about which vaccines should be recommended, when they should be given and to whom. Those decisions must remain grounded in good science. But once we know how to prevent a disease, there is another question worth asking: How easy are we making it for people to act on that knowledge?

Can people access vaccination, understand why it matters and get credible answers to their questions? Does their healthcare professional have the information and confidence to explain it? Can they realistically complete the recommended schedule? And are our systems designed around people who already find healthcare easy to navigate, or are we thinking hard enough about those who face the greatest barriers? These aren’t secondary considerations. They are part of whether prevention works.

Developing better vaccines remains enormously important. But scientific innovation can only achieve so much on its own. The next challenge isn’t simply innovation in what we develop. It is an innovation in how effectively we deliver it.

We need to make the right protection easier to access, understand and complete at the right point in people’s lives, while giving parents, caregivers, patients and healthcare professionals the information and support they need along the way.

A vaccine sitting in a fridge is a scientific achievement. A vaccine reaching the person who needs it, when they need it, is a public health success.

That is the journey that matters.

The post Vaccination: The Journey To Protection Shouldn’t Be The Hard Part appeared first on Medika Life.

Between those meetings sit two practical questions that diplomacy cannot settle on its own. What equipment will actually cut emissions, and who will pay to install it? Implementation runs through power grids, factories, data centers, farms and supply chains. Each one already operates at an enormous scale, and changing how it works means replacing or upgrading physical machinery, often one site at a time.

An industrial problem

“Climate is an industrial problem,” says Elliott Parker, CEO of Alloy Partners, a firm that co-creates startups with large corporations. “The technologies that matter most have to work inside energy systems, manufacturing, infrastructure and supply chains that are already enormous.”

That description fits the sectors where emissions are hardest to cut. Steel, cement, chemicals and heavy transport need new processes and materials, not only cleaner electricity. A breakthrough in a lab counts for little until it runs reliably inside a plant that cannot afford downtime.

AI has changed where the money goes

The rapid growth of AI has added new pressure. Data centers need large amounts of power and cooling, and investors have followed that demand. TechCrunch, citing PitchBook data, reported that climate tech venture deal value topped $14 billion in the first quarter of 2026, with most of it in sectors boosted by data center construction, including the built environment, grid infrastructure and dispatchable energy.

Some investors see a trade-off. “Decarb is dead for now,” one venture capitalist told The Wall Street Journal last month. The climate impact of the AI buildout will depend largely on whether new demand is met by low-carbon or fossil-fuel generation.

Resistance is also coming from the communities that host the buildings. Wired reported last month that opposition to data centers in the United States is driven less by global climate worries than by local ones, such as water use, rising electricity bills and pollution. Climate Week NYC itself saw activists interrupt a panel on AI and data centers. For the industry, that makes efficiency a condition for getting projects approved, alongside its value for the climate.

The two goals can overlap. Technologies that cool servers with less energy and water, recover waste heat or help grids absorb new load serve AI growth and emissions reduction at the same time. Those are the categories where hardware startups can find paying customers now.

What scarcity teaches

Countries that have long operated with limited water, land or energy offer a useful view of how resource technology reaches the market. Israel is one example. Modern drip irrigation was developed and commercialized there, and the country now relies on large-scale desalination for much of its drinking water.

That history continues in today’s startups. According to PLANETech, Israel’s climate technology community, more than 1,500 active startups in the country are working on industrial and climate challenges. Research institutions such as the Technion and the Weizmann Institute of Science supply engineering, chemistry and physics talent.

Kerem Nevo, VP and Head of the Growth Division at the Israel Innovation Authority, highlights the links between research and industry. “Our highly interconnected innovation ecosystem has a proven ability to bridge academia and industry, transforming cutting-edge research into commercially viable technologies,” he says.

Global companies and investors already treat Israel as a place to build. According to the Israel Innovation Authority’s 2026 High-Tech Status Report, 511 multinational companies operate in the country. Israeli tech companies raised about $14.6 billion in 2025, up 30% from 2024, and foreign investors accounted for 70% of that venture capital.

Bringing buyers to the technology

Deepening those ties is the purpose of PLANETech Week, which runs October 18-22, featuring nearly 30 events and an expected thousands of attendees. International investors, corporate leaders and delegations will meet Israeli startups working on waste, critical minerals, construction, sustainable aviation fuels, data centers, energy and mobility. Partners include Siemens Energy, Microsoft, Ormat New Ventures and Volkswagen Group’s Konnect innovation hub, alongside the Israel Innovation Authority.

The week’s flagship event, PLANET Connects, takes place October 21 at the Einav Cultural Center in Tel Aviv, with a startup exhibition, a B2B meeting area and a main-stage plenary with international speakers.

“PLANETech Week is designed to bring this ecosystem to the international conversation on climate action and put it in front of the investors and industrial partners who can deploy it at scale,” says Rotem Trivizki, Director of PLANETech.

Companies to watch this week

Several of the companies taking part in PLANETech Week are working on the challenges described above. Their solutions draw on materials science, physics, and chemistry, and are built into technology that has to perform at an industrial scale.

• NanoTherma is developing thin thermoelectric panels built on nanomaterials that capture low-temperature waste heat inside server racks and convert it into electricity.
• IDE Technologies, the Israeli company behind some of the world’s largest desalination plants, offers high-recovery treatment that recycles water from data center cooling towers.
• BH Grid Solutions tracks a data center’s carbon emissions hour by hour and helps operators and tenants shift computing work to cleaner hours and locations.
• Starstone makes a biogenic, zero-carbon cement that reduces reliance on the high-temperature kilns used in traditional cement manufacturing.

The measure that matters

COP31 will produce negotiated text, and climate weeks will produce announcements. The harder test is how many pilots turn into purchase orders, and how many purchase orders become equipment running inside grids, plants and data centers.

That work happens at events like PLANETech Week, in meetings between engineers who have built something and companies with the budget and sites to deploy it. The world’s climate goals will be met or missed in thousands of those decisions.

The post Meeting Climate Goals Will Depend on the Machines That Run Industry 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

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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.

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She asked: “If they got all the cancer out, why do I still need radiation?” It should have been easy to explain. Instead, I found myself saying things like “to be safe” and “to reduce recurrence risk” without actually telling her what her risk was without treatment, how much radiation might reduce it, or what that difference meant for her. I was describing what we did, not why it mattered for the person in the room. That question has stayed with me. It is the question that changed how I practice.

The question has changed

For most of my early career, breast radiation meant a fairly predictable course: five days a week, often for five or six weeks, treating the entire breast. The discussion was not nuanced. What I spend time asking now is completely different: How much treatment does this particular woman actually need?

That shift has moved through all of cancer medicine. We are getting better at identifying cancers that carry completely different risks even when they look similar under a microscope and arise in the same place. Breast cancer is not one disease. A small, estrogen-sensitive cancer in a woman in her seventies is biologically and clinically a different problem from an aggressive triple-negative cancer in a woman in her thirties. Tumor size. Lymph-node involvement. Hormone receptors. HER2 status. Age. Systemic treatment. These characteristics change not just how aggressive we need to be, but whether we need to be aggressive at all. The word breast cancer tells us where the disease started. It does not tell us the whole story. As we became better at measuring those differences, my conversations with patients changed too.

What “we got it all” actually means

When a surgeon says the cancer was completely removed, that statement has a specific meaning: the tumor came out with a rim of normal tissue around it, and a pathologist found no cancer cells at the edge. That is excellent news. But it does not mean zero percent chance that an individual cancer cell remains somewhere in the breast. No imaging can find a microscopic cluster. No surgeon can see it during an operation.

That is where radiation comes in. After breast-conserving surgery, radiation substantially reduces the chance that cancer will return in the breast. For generations of women, that combination allowed us to preserve the breast without sacrificing cancer control. But there is another part of the story: not every woman benefits by the same amount.

Some women can consider skipping radiation

This is one of the things that surprises many patients: there are women with breast cancer for whom radiation after lumpectomy may reasonably be omitted. Two landmark trials followed carefully selected older women with favorable, hormone-sensitive breast cancers after lumpectomy. Radiation substantially reduced the chance of local recurrence. Without radiation, roughly 1 in 10 women experienced a local recurrence within 10 years; with radiation, it was closer to 1 in 100. But that large reduction in local recurrence did not translate into longer survival. At 10 years, overall survival was essentially the same whether women received radiation or not.

That creates a very different conversation. Suppose one treatment reduces a woman’s chance of cancer returning in her breast but does not appear to change how long she lives. Is that treatment worth having? There isn’t one answer. One woman may say, “I want to do everything reasonable to minimize the chance this cancer ever comes back.” Another may say, “If my risk is already low, avoiding another treatment matters more to me.” Both can be rational choices. My job is not to tell someone that radiation works. My job is to help her understand how much it is likely to help her.

Less radiation does not necessarily mean worse treatment

The amount of radiation we deliver has changed too. For years, five or six weeks was standard. Then strong evidence showed that shorter courses worked just as well for many patients. Three- to four-week schedules became common. Now some appropriately selected women can complete breast radiation in five treatments. Others may not need the entire breast treated at all. Partial-breast radiation focuses treatment on the region surrounding the original tumor, where recurrence is most likely.

To someone who learned medicine under the assumption that more treatment equals better treatment, this sounds counterintuitive. It shouldn’t. The goal of cancer treatment is not to deliver the maximum amount of therapy a person can tolerate. It is to deliver enough.

A mastectomy doesn’t always eliminate the need for radiation

I hear this question regularly too: “If the whole breast is gone, why would I need radiation?” The logic makes sense. A mastectomy removes almost all breast tissue. For many women with early-stage breast cancer, no radiation is needed afterward.

But a mastectomy does not automatically make the risk of recurrence disappear. Cancer can extend beyond the breast into lymph nodes or surrounding tissues. Certain combinations of tumor size, lymph-node involvement, and other features can leave enough risk that radiation to the chest wall and regional lymph nodes meaningfully reduces the chance of recurrence. This is why two women who both undergo mastectomy may receive completely different recommendations. One may need no radiation. Another may benefit substantially from it. The operation is only part of the story.

The deeper shift

When I started in this field, I spent much of my thinking on how to deliver radiation effectively while protecting the normal tissues around the tumor. That remains enormously important. But somewhere in the middle of my career, another question became equally important to me: How much treatment does this person actually need?

I cannot point to the moment that changed. It happened gradually, through hundreds of conversations with women after treatment. I began paying more attention not only to whether treatment worked, but to what we were asking someone to endure for the benefit we expected it to provide.

And I started asking myself a harder question: Did I know that benefit existed before I recommended treatment? Or did I know it theoretically? There is a difference.

The theoretical position is: radiation prevents recurrence. The specific position is: How likely is this woman’s cancer to return without radiation? How much will treatment lower that risk? What does that difference mean to her? How does she weigh it against the inconvenience, side effects, and risks of treatment? That is a different conversation. It respects her time, her body, and her right to decide how much benefit is enough. I was not having that conversation early enough.

Sometimes the answer to “how much treatment” is more than a patient expected. A woman may undergo a mastectomy and still benefit substantially from radiation. A tiny tumor may have biological characteristics that make more treatment appropriate. But increasingly, the answer can also be less. Less surgery. Less radiation. Fewer treatments. Smaller treatment areas. For some carefully selected women, no radiation at all.

I did not learn this from being a better doctor. I learned it from listening to women describe what treatment actually costs them. That is not retreating from cancer. It is understanding what progress in cancer medicine actually looks like. When I began my career, progress often meant finding ways to treat cancer more aggressively. Thirty-six years later, I think progress sometimes means having enough evidence to know when we don’t have to.

The question I couldn’t answer well early in my career is the one I now spend the most time trying to answer: How much treatment does this particular woman actually need?

Your health deserves the same kind of individual attention. Take my free 3-minute Capacity Checkup to see where sleep, mood, focus, and physical capacity may be asking for more attention.

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