Paul Sax

One of our infection prevention gurus made this exact analogy when I was whining to him about this annual ridiculousness.

Requiring Annual N95 Mask Fit Testing Is a Waste of Time and Money Is it time to replace annual N95 mask fit testing with a less expensive, evidence-based policy?

In this @nejm.org Voices post, I take on one of the more annoying and pointless rituals of hospital work -- the annual N95 fit test.
As one of the respected infection control specialists told me, it's not their fault. And I totally believe them. #idsky #medsky
voices.nejm.org/doi/full/10....

Raccoon Bites This isn't really about raccoon bites.

My friend John shared this story with me. I promise, it has an ID theme. You'll see.
open.substack.com/pub/paulsaxm...

Some Ruminations on CROI — Still the Best HIV Meeting CROI, which just wrapped up in Denver, is not like other scientific meetings — it’s quirky. Let me count the ways. There’s the name — the Conference on Retroviruses and Opportunistic Infections — coin...

CROI is quirky and selective. It meets in very cold cities.

And it remains the best meeting in HIV medicine.

Reflections from this year’s gathering blogs.nejm.org/hiv-id-obser...

Thanks, Tim. It's strange times at the FDA.
And this vaccine (based on these data) does not look like a good yearly option.

Two Things Can Be True: The FDA Process Was Inconsistent, and the mRNA Vaccine Data Were Disappointing Share Tweet Pin Mail SMS Any time I write about vaccines, especially mRNA vaccines, things get dicey. Any negative comments might fuel attacks from ...

Two things can be true:
1. FDA’s handling of Moderna’s mRNA flu vaccine review raises process questions
2. The data themselves were underwhelming

Here's my take, finishing up with perhaps the biggest disappointment -- it's a hit on pandemic preparedness.
blogs.nejm.org/hiv-id-obser...

Thanks. The more I interact with non-ID people (even doctors), the more I realize how angry (even to the point of being vengeful) some people are about certain policies that, in retrospect, were wrong.
Still does not excuse dismantling of public health/cdc, as it could lead to a disaster.

A Teacher Who Needed Teaching Learning how to teach, forty minutes at a time.

Learning how to teach in the year before medical school.
Truly on-the-job training.
open.substack.com/pub/paulsaxm...

Sometimes You Just Need to Get Input from a Real Human Being Share Tweet Pin Mail SMS If you’re not using AI in clinical medicine yet, allow me to strongly recommend you start — soon. Like ...

AI is terrific for quickly summarizing what guidelines say.

Here are 3 places clinicians can get input from actual human beings instead, one old-fashioned, a couple newer:
blogs.nejm.org/hiv-id-obser...

Hi Dimitri, he's certainly not popular among us ID docs!
Independent of him, the data on mRNA shots for flu are underwhelming. Somewhat more effective, but definitely more side effects. The real benefit will be rapid deployment for pandemic situations.

The Year Before Medical School Or, how I ended up teaching at a boarding school instead of pipetting in a research lab.

What did you do the year before medical school? I taught in an English "public school", and for the first few days, I was desperately trying to fit in. open.substack.com/pub/paulsaxm...

Now "free to read" -- great progress! One remaining barrier in Massachusetts: HIV testing of people unable to give verbal consent. Especially relevant when caused by critical illness, or a patient is the source of an occupational exposure.

open.substack.com/pub/paulsaxm...

This is one of the most perplexing myths ... it's practically at the level of being a conspiracy theory.

Not Watching Football A personal exploration of an unpopular view.

Used to really enjoy watching football.
Now, not so much. Actually, not at all.
A week before the big game, I decided to document what changed, with the 100% understanding that this is an unpopular perspective. (I'm ok with that!)
open.substack.com/pub/paulsaxm...

Another Thing That's Undeniably Improved in Medicine: Getting an HIV Test A Happy Birthday to a landmark policy change

Getting an HIV test used to involve a convoluted series of steps that ended up discouraging testing. It was bad for patients.

All that changed (finally) in 2006 -- real progress! #IDSky #Medsky

open.substack.com/pub/sensible...

Rabies Is Terrifying -- and the Challenge of Managing the Low Risk of a Dreadful Disease Three case reports of human rabies recently appeared in the MMWR. Reading each one served as a reminder of just how horrifying this infection is when it strikes — which very fortunately is quite rare ...

Rabies is undoubtedly terrifying. Three recent case reports highlight both the clinical severity and the importance of prevention. But how broadly should we apply prevention when the risk for so many exposures is very, very low? #IDsky #Medsky blogs.nejm.org/hiv-id-obser...

Thanks!

ID Learning Unit: Clinically Important Streptococcal Infections You Need to Know Dr. Paul Sax offers a “Strep Infections 101” course — the ones you should remember, and why, with perhaps a few fun facts thrown in.

Thanks, Paul! That strep one goes back to how truly mystified I was by the taxonomy of those bugs when an ID fellow -- a mystification that persists today! blogs.nejm.org/hiv-id-obser...

The Story Behind My Most Famous Blog Post The origins of "How to Figure Out the Length of Antibiotic Therapy"

Revisiting "How to Figure Out the Length of Antibiotic Therapy", and how it came to be. Sobering that my greatest claim to writing fame is now over 15 years old, implying a subsequent lack of inspiration. 🤷‍♂️ #IDsky #medsky paulsaxmd.substack.com/p/the-story-...

My wife loves another group of 7 painter, Tom Thompson.

Despite my ambivalence about ABIM and our endless recertification requirements, the question-writing committee experience was excellent. Met some smart, nice people, and we were all trying to get the questions right, and relevant. But I've been off that committee for 6 years or so now.

I hear the same is true for the Mac OS update. Uh oh.

Influenza -- So Familiar, Still So Mysterious In what feels like the fastest-peaking influenza season in quite some time, I find myself returning to a familiar answer when asked questions about this miserable virus: “We just don’t know.” At least...

One of the most honest answers in medicine remains: “We just don’t know.”

Especially true for the flu -- timing, transmission, vaccines, all still full of surprises.

Five questions, five reflections on why the flu keeps humbling us. #IDsky #Medsky blogs.nejm.org/hiv-id-obser...

Dear Readers: Who Are You? Checking in at the three-month point in this writing journey.

Interesting poll results! (Still time to vote.)
paulsaxmd.substack.com/p/dear-reade...

Thank you!

How the Z-Pak Took Over Outpatient Medicine, Part 2: The Reckoning Share Tweet Pin Mail SMS Part 1 of this azithromycin series explained how the drug became ubiquitous. In Part 2, we’ll explore why many ...

Azithromycin: once a pharmacologic breakthrough, now a textbook case of overuse.
Part 2 explores resistance, muddled diagnoses, and the cases where it's still arguably the drug of choice. #IDSky #Medsky

blogs.nejm.org/hiv-id-obser...

Two Things that Prolong Life and a Great Recent Paper A Happy New Year gift to me and everyone who shares one or both of these enthusiasms.

How fortunate that two of the things I love the most in life are associated with prolonged survival. Plus, a very important "recent" paper. Happy New Year! #IDsky #Medsky open.substack.com/pub/paulsaxm...

How the Z-Pak Took Over Outpatient Medicine Chances are, across this great land of ours, right at this very moment, someone is coughing, or sneezing, or struggling with a sore throat, or some combination of the above, and taking the antibiotic ...

How did a five-day antibiotic course become a cultural phenomenon?

A brief (ha ha, ID docs can't be brief) but riveting history of how the Z-Pak took over outpatient antibiotic prescribing.

Part 2 (the problems) coming soon. #IDSky #Medsky blogs.nejm.org/hiv-id-obser...

One Thing That’s Undeniably Better in Medicine Looking at radiology images, then and now.

Some things really are MUCH better than they used to be.

Zero nostalgia for the old days when it comes to reviewing radiology images!

paulsaxmd.substack.com/p/one-thing-...