James Wilson, DO, FACP, FAWM, CTropMed®

A reminder there’s a digestible update about non-ventilator #HAP Epi, path, prevention of NV-HAP (from yours truly, and my good friend Dr Luke Buxton) Thanks to @Contagion_Live @KellyCawcuttMD for the opportunity to help #IDTwitter #MedTwitter #pulmtwitter #MedEd communities!

Nnnnoooooooooooooo…!!!!! This is heartbreaking… Every Sunday in the 90s was Star Trek Day as a family event. We would sit down together in Sunday afternoons as my father‘s favorite thing was Star Trek and the 90s gave us TNG for those of us in the no, otherwise called “the next generation“ for the casuals. And Patrick Stewart, excuse me: SIR Patrick Stewart, led us on adventures with grace and poise and determination, while showcasing what masculinity could look like opposite commander Ryker… As he continued his stage career as an incredibly accomplished Shakespearean stage actor and entered ever further into popular nerd as Professor Xavier/Professor X in the X-Men movies alongside Sir Ian McKellen, he only ever endeared himself ever further every comic con and Star Trek convention and inclusivity positive society and cultural touchstone, showing that he walked the walk so very often he lip service by those in his craft/field. God… We lose a giant today. "It’s our mortality that defines us. It’s part of the truth of our existence... Time is a companion who goes with us on the journey and reminds us to cherish every moment because they’ll never come again." -CAPT Picard, Star Trek Generations #StarTrek #picard #jeanlucpicard #PatrickStewart #Eulogy #deathanddying #fairwindsandfollowingseas #startrrkTNG #startrekthenextgeneration #MakeItSo nytimes.com/2026/10/29/arts/…

I have to say: INCREDIBLY insightful talk. Could not be more impressed by @RealDoctorMike He’s absolutely the real deal #chest2026 @accpchest @PulmCrit #AIinMedicine #AIMedicine #AIwontreplacephysicians #AIwontreplacedoctors #AI @OpenAI @AnthropicAI @OpenEvidence @nishamehtamd

#Vaccines are a miracle of modern medicine that actually began under two years ago with variolation and continued into vaccination (beginning with cowpox coming from VACCA meaning cow in Latin for the root word for “vaccine“). But why is it so distrusted? I think a lot of it comes down to having bad experiences of needles and pain and inflammation causing illness symptoms shortly after the vaccine. So therefore, if it makes you sick, it can’t be good for you, right? How many times we have to explain to people the very real point is to ensure that do have Matory response otherwise your immune system never turns on and you never really have seroconversion from these Pro inflammatory disease, modifying, and preventing therapies. But for many years in America, we have glorified the mundane and the ignorant. Think of every 1980s movie of the nerd being beaten up by the jock who got the girl and how the movie showcases the nerd delivering the comeuppance to the ignorant and violent and disdainful characters. But no one likes to be made to feel stupid. And confirmation bias is a very real problem. And med archive has been both a wonderful and a very terrible heart of the Internet. It’s terrible in the sense that even disastrously bad scientific papers, if you can even call them scientific, R “published“ online but are done so without any peer review. But if you want to see how somebody performed a study on a topic that you have a question about Baur study that you are already going to try and perform, you can see where they failed by going through med archive. But does no one want to think of the sheer Boone to Society that this discovery showcases? If you have anyone in your life who has suffered from cancer, then you know that they scour their lives to look and see if there’s some way they could’ve prevented themselves from getting it. If you smoke, often times you wish you had never. But who is to say this isn’t linked to blaming the victim? Since cervical cancer comes from HPV and is therefore a downstream effect some people will get from getting genital warts, who is to say that this isn’t the further blaming the victim, born out of rape culture? We shouldn’t be excited that we’ve knocked cervical cancer down because it limits the punishment that women get for having sex? These are very real statements. I’ve had to suffer, listening from men, especially that were more than happy to sew their royal oats as it were, and from women who said the best birth control was a Tic Tac between the knees because if they could hold that tick Tac and until they were married, they would never need birth control and they would never need an #HPVvaccine. But we know that this is simply victim blaming and we know that HPV and other parts of the body cause other problems and you can contract different strains of HPV in different ways than simply sexual contact. Think of people with painful plantar warts getting HPV vaccination and having a reduction in those plans are awards, and the data of the reduction in squamous cell carcinoma of the skin and patients that have HPV vaccination. Well, it may seem I’m simply bringing in unrelated problems into this discussion, I can assure you they are very real linkages and associations of how research in one area leads to improved outcomes and others that we never would’ve expected. The world‘s favorite example is pulmonary hypertension therapy with the side effect of its study therapy sildenafil that led to the most prescribed male medication in #Viagra. #MedTwitter #idtwitter #idxposts

Nation-states are their PEOPLE, and one need only wonder if consideration of life as sanctified is enough to save them? Would these foreign actors give pause were they EVER to believe that we have the same hopes and dreams and loves as they might, so perhaps even ONE less BS post could save ONE person hardship..? One wonders…

On academic rounds in the ICU, after positing back to the new intern, in the 2nd month of their physicianhood, that their working etiologic diagnosis was flawed; while offering every OMS/MS/PGY's favored format of MCQ of probable DDx including their IMprobable dx, they again chose their initial answer. DESPITE the rounds discussion. When I corrected that it was NOT that, do you know what the response was..? "...that's not what #OpenEvidence said..." I asked them to show me the prompt they utilized to ask for OE to sift through the available literature. And it was... flawed.. to say the least.What ensued was a 5 minute papal decree of pontification. We have NOT been doing a good job as a community & profession of teaching these new and soon-to-be-clinicians to THINK. CLINICALLY_AND_CRITICALLY. If you don't have a working knowledge, a level of MASTERY, in a topic: how can you know when the LLM pulled the wrong set of studies to review? Not all literature is made equal. GENERALLY it pulls guidelines & landmark trials. But what happens when you're now visiting Esoteria..? You know, the land of esoteric questions. My mentor in my first fellowship advised me that to best prepare for fall PGY4 by reading/knowing guidelines. Not memorize them; be able to reason through them all. As an ID fellow, there were only DOZENS. But, 6 months in at our 2nd mentoring sitdown, I told him that I had gone through all the guidelines at least once, and the major ones (UTI, SSTI, bacteremia, etc) SEVERAL times as consult coverage went on. He said: "Great. Now toss that out. Guidelines are for non-specialists." So: What did he MEAN by that..? We all have to have a framework; where to start. #Guidelines allow all-comers to start the path of tx, but it's for us to be able to see where perhaps the consulting team fell off said path, or when we needed to intentionally deviate from it. The #IDSA C diff guidelines reviewed studies that mostly dealt w mod to severe CDI. They publish recs in 2018 regarding CDI removing Flagyl from the equation. The works of Zar, Nijjar-Debbiny, Stevens, and more, are largely ignored in mild disease. I mean, Zar even has a SCORING SYSTEM named for him in C diff that is largely the criteria that the CDI classification system is BUILT upon. The outcry: swift. Flagyl = viable tx for outpatient CDI. Further studies completed and more reviewed. The GI docs (ACG) publish competing guidance to the updated 2021 IDSA guidance. ACG leaves in narrow window for Flagyl in non-severe mild disease. Why the disparity? I can only speculate. ALL TO SAY: Train the AI to your patterns & do prompt design training. Because scanning title+abstract+n-value+CI+conclusion does NOT a physician make, as COVID showcased. But: unless you advise a "journal club," largely that's what AI does also. Studies ALREADY SHOW we're offloading TOO MUCH cognitive load to AI. As a Chair in #UME and faculty in #GME, it's EVIDENT. I recommend to them that they hold off on AI for A&P until they can write up 90% of their daily charting As&Ps without looking up every detail. Until then, they're just skipping the development of a #physician's true tool: clinical reasoning. That's the WHOLE POINT of the training. Give the knowledge base in UME, train them how to talk and analyze in the order we all understand, then case after case after case of patients until they know normal to abnormal and which abnormal to which abnormal, all while highlighting #empathy, #professionalism, and #physicianleadership. #meded #physicianled #AI #medtwitter #idtwitter #idxposts #FOAM #FOAMed #FOAMim #FOAMcc #FOAMid #academicmedicine #criticalcare #idcrit #AIinmedicine @DrNeilStone @DrToddLee @BradSpellberg @wwrighID @mohammad @DrDiGiorgio @djschuett @PulmCrit @pulmtoilet @IdVilchez @ABsteward @medrants @joshuadhartzell @Cortes_Penfield @IDiots_pod @JAMA_current @NEJM

I just... I mean C'MON..!!! #Lyme disease from a LAB..?!?! #Spirochetes are ANCIENT... #Syphilis and #Leptospirosis and LYME are all similar in organism with syphilis and Lyme being strikingly similar in the type of acute presentation (chancre and target lesion, respectively) and then latency to progression, with Leptospirosis being more so acute degradation from the "-itis" But I just CAN'T... #idtwitter #idxposts #medtwitter @IdVilchez

For the #physicians #physician #physicianled #physicianledcare #medtwitter #idtwitter #idxposts @ABsteward @BradSpellberg @DrToddLee & @IDiots_pod (even though you're north of the border and across the pond, we need your help now more than ever), his article discusses the challenges facing scientific medicine in the U.S., including political influences, the rise of sectarian practices, and the need for physician-led innovation and reform in health care. Historical Divide Between Scientific and Sectarian Medicine American medicine has long contrasted scientific medicine rooted in laboratory research with sectarian practices like homeopathy and eclecticism.The Flexner Report of 1910 discredited sectarian schools, but these practices persisted outside mainstream medicine. Evolution of American Medical Education and AHCs Medical schools in the 1800s, influenced by the Scottish Enlightenment, emphasized scientific principles.The rise of academic health centers (AHCs) linked medical education, research, and hospitals, becoming major economic and research hubs. Decline of Physician-Scientists and Impact of Healthcare Industry Physician-scientists declined from 1.5% of physicians in 2014 to 1.3% in 2020, with less laboratory exposure in medical training. AHCs grew as economic powerhouses, but physician burnout increased due to administrative burdens and EHR demands. Rise of Modern Sectarian and Alternative Medicine CAM practices like naturopathy and holistic medicine gained prestige, often operating outside regulation. The wellness and influencer industry, valued over $500 billion, promotes pseudoscientific health products and lifestyle claims. Political and Cultural Shift with MAHA Movement The MAHA movement, linked to populist and libertarian ideals, promotes wellness industry interests and criticizes big pharma. The 2025 MAHA report falsely claims overmedicalization and industry corruption, undermining trust in scientific medicine. COVID-19 Misinformation and Industry Influence Wellness influencers spread misinformation about COVID-19 vaccines, promoting unproven cures like ivermectin. Some CAM practitioners actively oppose vaccines, claiming they cause harm and promoting natural immunity myths. Recommendations for Reinforcing Scientific Medicine Revise medical education to emphasize research, leadership, and entrepreneurship among physicians. Empower physician entrepreneurs to lead health technology innovations, especially within life sciences clusters. Conclusion The resurgence of sectarian practices and political interference threaten scientific medicine. Strengthening physician leadership and modernizing medical training are vital to counteract misinformation and preserve scientific integrity.