A very well written and balanced piece on “critical psychiatry” by our former “Xer,” Dr. Samei Huda. cambridge.org/core/journals/…

Should be read by everyone interested in Long Covid, ME/CFS, and the like. Especially by those who think they know all the answers already.

I'm a cardiologist. A 42-year-old mother of two came to my office complaining of jaw pain and crushing fatigue. She ran half-marathons. Her EKG was normal. Another doctor had sent her home with anxiety medication. When I got her into the cath lab, I found severe microvascular disease — plaque choking the tiniest vessels of her heart, the ones standard angiograms routinely miss. Her heart had been starving in silence while everyone told her she was stressed. She is alive today. Too many women like her are not. Heart disease kills more women than every cancer combined. And medicine is still diagnosing it through a male lens. 84% of cardiologists report having patients in the past year whose heart disease was misdiagnosed by another physician. Women with a STEMI heart attack have a 59% greater chance of being misdiagnosed compared to men. Women with an NSTEMI — 41% greater chance. The reason is structural. For decades, we screened, tested, and treated women using a template built for men. Men's heart attacks announce themselves — the crushing chest pain, the clutched fist, the Hollywood collapse. Women's hearts whisper. Crushing fatigue that feels like wearing a lead vest. Jaw pain written off as TMJ. Nausea blamed on a stomach bug. An ache between the shoulder blades blamed on a long week. Shortness of breath blamed on being out of shape. For years, medicine called these "atypical" symptoms. They are not atypical. They are female-typical. Half of humanity is not a variant. And the biology runs deeper than symptoms. Women have smaller hearts and narrower coronary arteries. Plaque doesn't only clog the big highway vessels — it hides in the microvasculature, the tiny branches feeding the heart muscle itself. A woman can have a heart attack with a completely "clean" standard angiogram. SCAD — spontaneous coronary artery dissection — occurs 90% of the time in women. Often young, fit women with zero traditional risk factors. It's the leading cause of heart attack in women under 50, accounting for roughly one quarter of all cases in that age group. Most doctors have never diagnosed one. And some of the most dangerous cardiac risk factors are hidden in women's medical histories where no one thinks to look: Preeclampsia or gestational hypertension doubles to quadruples lifetime heart disease and stroke risk. Pregnancy is the body's first cardiac stress test — and these complications are early warning sirens, not closed chapters. Autoimmune disease — lupus, rheumatoid arthritis, psoriasis — far more common in women, turbocharges inflammation and plaque formation at any age. Cardiovascular disease in women aged 20-44 is projected to surge nearly 50% by 2050. The youngest patients in my practice keep getting younger. What every woman should ask her doctor — and what every doctor should be asking: "Given my pregnancy history, autoimmune status, and family history — what is my full cardiovascular risk?" If they don't ask about preeclampsia or gestational diabetes, volunteer it. "Should I have an Lp(a) test and a coronary calcium score?" Standard cholesterol panels miss too much. Lp(a) is genetic, one-time, and most women have never been tested. "My tests came back normal but my symptoms haven't stopped — what's next?" Normal stress tests and angiograms can miss microvascular disease, spasm, and SCAD. Persistent symptoms warrant coronary CT angiography or cardiac MRI. And if something feels wrong — say these exact words to your doctor: "I am concerned this could be my heart." That single sentence changes the workup. Do not soften it. Do not apologize for it. 80% of heart disease is preventable. But the playbook has to be built for female biology. Two decades ago, I wrote one of the first books warning that heart disease was the number one killer of women and that medicine was diagnosing it through a male lens. It was recognized by First Lady Laura Bush at the White House during the early years of the national conversation about women's heart health. I'm haunted by how much of that book I could republish today unchanged. The science has advanced. The awareness has grown. But the gap between what we know and what happens in the exam room is still costing women their lives. Share this with every woman you love — and every doctor who treats them. READ MORE: open.substack.com/pub/afshin…

Bari Weiss built her entire public identity on the proposition that cancel culture was destroying American discourse. She wrote about it. She founded a publication around it. She championed the Intellectual Dark Web as brave thinkers being silenced for saying forbidden things. Scott Pelley said factually true things, without yelling, without cursing, without threatening anyone, in a staff meeting. He said Bilton had slender qualifications. He said Weiss was murdering 60 Minutes. He said these things because they are true and because saying true things in rooms where powerful people prefer comfortable silence is - per Weiss's own stated philosophy - exactly what journalists are supposed to do. She fired him. JVL names what this exposes precisely. They never wanted to end cancel culture. They wanted to control it. Some forbidden ideas - the ones MAGA likes - must be protected and platformed. Other ideas - the ones Bari Weiss dislikes - are genuinely verboten. Say them out loud and you lose your job. The Pentagon press office is now classified. Tim Miller was threatened with FARA for sharing a public news report. Comey is being prosecuted for seashells on a beach. The federal workforce faces proposed NDAs. Pelley was fired for refusing instructions to broadcast unverified assertions and then saying so in a meeting. The through line is not chaos. It is a consistent, documented project to determine who gets to speak, about what, to whom, and under whose authority. Cancel culture was never the target. It was always the tactic. Weiss just proved it by doing the thing she built her career opposing, the moment she had the power to do it.

For @dysclinic to review.

Interesting chart/paper on a putative association between sleep apnea and various psychiatric and/or neurologic conditions. Suggested to me by @nataliezzz3 . Worth a look, but out of my sphere of expertise, except for dementia. researchgate.net/publication…

Summary of OMB rule changes proposal regarding federal scientific grants. It’s all gone, folks. open.substack.com/pub/elizab…

New cholesterol guidelines: 5 takeaways from a cardiologist who helped write them - UChicago Medicine uchicagomedicine.org/forefro…

NPs visits are billed at 80%. We are less trained and less educated than MDs, but it allows for providers in rural areas and low paying specialities that physicians are abandoning. NPs also make speciality care more affordable working alongside MDs. Unfortunely not all NPs have the same education, training, fellowship and I hope we move towards standardized post grad training programs in the future.

Reposting. @tylerblack32 @sanilrege @drterrysimpson Kennedy’s Push to Curb Antidepressants Has Shaken Psychiatry nytimes.com/2026/05/24/scien… via @NYTimes

Worth a read. The interface between politics and medicine. @awaisaftab is quoted. @ProfRobHoward @dawso007 @DrAnnieHickox Kennedy’s Push to Curb Antidepressants Has Shaken Psychiatry nytimes.com/2026/05/24/scien… via @NYTimes

It’s apparently not inflammation, per se, that is responsible for long Covid. Association between post-COVID-19 neuropsychiatric symptoms and persistent glial activation in the limbic system: a TSPO PET study | Journal of Neurology | Springer Nature Link link.springer.com/article/10…

The most corrupt US president, ever. And we’ve had some corrupt ones. Trump Just Pardoned Himself and His Family Forever nytimes.com/2026/05/20/opini… via @NYTOpinion

Elective MRI Screening of the General Public—Buyer Beware jamanetwork.com/journals/jam…

Analysis of Alzheimer’s Drugs Stirs Debate About Their Effectiveness nytimes.com/2026/04/15/healt… via @NYTimes @ProfRobHoward @DrAnnieHickox @JRBneuropsiq @dawso007

nytimes.com/2026/04/04/busin… And then there’s the failing healthcare system. And the senseless war in Iran. And the immigration policy. And the justice system. The book is waiting to be written on how Trump has single-handedly destroyed the country beyond repair in 14 months.

Our new paper is out in @JAMAPsych! People with schizophrenia are 4-20x more likely to develop dementia before 65. But why? Alzheimer's in disguise? Medications? Cardiovascular disease? We tested these and other potential explanations in 155 people with severe, extremely treatment-resistant schizophrenia (SETRS), continuously hospitalized 20 years. None of them held up. Link to paper ja.ma/4uWAsGG and thread below 🧵

Worth a full read. Especially for the critical psychiatry folks. Judith L. Rapoport, Pioneer in biological psychiatry and in understanding O.C.D., Dies at 92 nytimes.com/2026/03/28/scien… via @NYTimes @DrAnnieHickox @ProfRobHoward @dawso007 @JRBneuropsiq @sanilrege

This will probably get me banned from X, but what the hell. nytimes.com/interactive/2026…

Just an interesting essay on the concept of NNT as it applies to individual patients, in the March 26 issue of the NEJM. @drterrysimpson