Happy Study Time

I will be honest: I did not know what to write about, but as a “miracle,” this letter arrived at my house. Dr. Jonathan, My name is Arthur, and I do not agree with the superstition called “educational research.” I should clarify this early, because many people could get confused. This is not dysfunction; it is refinement. I work as an editor in a newspaper and as a writer, but I do not write every day. In fact, I let the pressure accumulate. I allow the anxiety to ferment. And when the deadline is close enough to threaten my dignity, I sit down and produce something disturbingly good. According to educational research—which I skimmed a few minutes before writing this to you—this behavior is considered “poor self-regulation.” Apparently, functional adults are supposed to distribute effort evenly, structure their environment, evaluate themselves calmly, and reward small progress. Isn’t this adorable? The same literature claims that excessive self-evaluation without healthy self-cons...

For decades, nutrition education was built like a pyramid: solid, hierarchical, and reassuring. Eat this first, limit that, count these nutrients, and health will follow. It was elegant, stable, and very Egyptian. The USDA 2025–2030 Dietary Guidelines draft quietly flips this structure upside down . Instead of placing nutrients at the base, it places context there: culture, access, time, behavior, and the food environment. Nutrients are still important, but they no longer hold the structure. The old model assumed people eat rationally, have access to ideal foods, and follow rules consistently. Clinicians know better. Patients eat under stress, within cultural traditions, and inside systems that often work against healthy choices. We now have not only an inverted—unsteady—pyramid, but one that is carb-shamed, pro-dairy, and productivity protein-driven . Bread, rice, grains: the fuel of civilizations. Then obesity and diabetes rates climbed, and we needed someone to blame. Carbs were con...

It has been a wonderful year (or we used to say so...). And now it’s ending. So let’s recap. Like every year before it, this one was filled with moments that shook us as humanity. Some loud, some silent. But in all of that, in the hills of eastern Nepal, these adults are learning the ABCDE strategy for chronic kidney disease . I mean, why is that so impressive?—be honest. Because in places where access to healthcare is limited, where formal education is rare, and where prevention is often dismissed as a luxury, we found that learning still happens and people can understand their bodies. They made it simple. Not simplistic—simple. And that simplicity turned out to be powerful. Because watching older adults—many of whom had never heard the term “ chronic kidney disease ”—raise placards spelling A-B-C-D-E was more than an educational exercise. Each placard raised was a small act of resistance against the quiet assumption that some lives are not worth explaining things to. This w...

  Since 1997, we’ve known that heart failure is a syndrome, and the positive predictive value increases when multiple findings are present. But is semiology the key? I wouldn’t say it gives us the best diagnostic accuracy. However, it does give us something far more valuable—the ability to think like real doctors again .   ☝ Davie AP, Francis CM, Caruana L, Sutherland GR, McMurray JJ. Assessing diagnosis in heart failure: which features are any use? QJM. 1997 May;90(5):335-9. doi: 10.1093/qjmed/90.5.335. PMID: 9205668.