I started writing here in January 2022.
The world was emerging from a pandemic, not with renewed confidence in the institutions meant to keep us healthy, but with deeper frustration, greater skepticism and sharper questions. And the people asking them weren’t only researchers. They were patients, arriving at problems scientists hadn’t yet thought to study.
Consider the Mucinex pregnancy. One day, someone posts on TikTok claiming the over-the-counter cold medicine may have helped their chances of conceiving. Within hours, there are 432 comments. A closer look reveals a rabbit hole: genuine biological plausibility, decades-old clinical studies too small and inconclusive to settle anything, and an entire line of inquiry quietly abandoned when IVF arrived and made the question seem less urgent.
As it turns out, guaifenesin, the active ingredient in Mucinex, may improve fertility. Or it may not. The science, remarkably, still is unclear.
The Preprint became a way to live at this frontier — the gap between what patients are asking and what medicine has answered — and to report on it with the same rigor we’d bring to any clinical question.
The heart of that work has always been people: Elizabeth Carr, the first American baby born from IVF; Andy Alison, the kind of public health civil servant who keeps the Medicaid system running without anyone knowing his name; Dr. Chailee Moss, an ob-gyn who, against the advice of nearly everyone, created a clinical practice to treat pelvic pain.
In a typical dispatch on any given topic, we might speak with half a dozen experts like this. Their insights shape the piece, but they appear briefly, in fragments. I’ve always wished readers could sit with them longer, not just for what they know, but for something rarer: their hope. There are extraordinary people working to bend the system closer to the people who most need it to work. We don’t hear from them nearly enough.
That’s what this podcast is for. We’ll talk to an online prescriber of GLP-1s, a physician leading the effort to make the Oura ring clinically useful, a Federal official coordinating women’s health initiatives on behalf of the current administration.
Our first episode is with Dr. Janelle Duah, who I was lucky to recruit to Maven Clinic a few months ago. She’s triple board certified in internal medicine, obesity medicine, and lifestyle medicine, and is fluid in discussing molecular pathways as she is engaging followers on her hefty social media accounts. She makes sense of the current revolution in metabolic health better than anyone I know.
You can listen to the first episode wherever you find your podcasts—including right here on Substack!
What my team is reading, building, and working against:
This week, a randomized controlled trial in JAMA showed that postpartum burnout in physicians is preventable. Dr. Erika Rangel and her team at Harvard enrolled 143 pregnant residents and fellows and followed them through six months postpartum. Half received standard institutional support. The other half received something better: a structured bundle that included Maven’s platform, a smart bassinet, a wearable pump, and faculty mentorship. Not only did the high burnout drop in this group drop from 65% to 35%, but they were ten times less likely to report career regret.
Medical training is not for the faint of heart. It also overlaps with the exact period many people want to start their families. Making the lives of parents just a little bit easier is not so hard, and it’s also not so expensive: this intervention costs ~$2,300 per participant, while burnout costs employers ~$7,600 a year. The math has always been obvious. Now the evidence is, too.
At ACOG’s annual scientific meeting a few weeks ago, the most crowded sessions focused on lifestyle medicine, menopause, and hormone therapy. I chatted with Dr. Chris Sizemore, Chief Medical Officer of Diana Health, who pursued additional training in integrative medicine, about the blurry but consequential distinctions between lifestyle medicine, integrative medicine, functional medicine, and longevity medicine — different disciplines orbiting the same question: how do you help patients feel truly well, not merely less sick?
In a sweeping piece on longevity medicine, Susan Dominus breaks news: we don’t begin life as young as we think—in fact, the egg a woman carries has been aging since she was born. Within two weeks though, the newly formed embryo resets its cellular machinery to biological ground zero. Altos Labs, Life Biosciences, and a constellation of billion-dollar competitors are attempting to replicate in aging adult tissue what every human embryo does automatically.
After a decade of false starts, a global consensus published in The Lancet has renamed polycystic ovary syndrome to polyendocrine metabolic ovarian syndrome. The new name has cascading implications for how PMOS is coded, funded, and managed. For a condition affecting 170 million women, 70% of whom remain undiagnosed, getting the name right is the first step in getting the medicine right.
