Why do medications work differently in different people?

Friday. One drug, two people, two different responses. What's up?

American health care does not suffer from a shortage of opinions. Often the opinion falls short of the argument carried all the way to their conclusion.

There is no end of commentary. A take on drug prices. A thread about prior authorization. A panel on AI. What we rarely get is someone holding onto a single claim and following it down — through the biology, then the economics, and then the part where it implicates the person making the argument.

That is what we are doing in August. One argument, taken as far as I can take it. Long enough to be uncomfortable, sourced well enough to be argued with, and written as much for people outside medicine as for those inside it. Actually, maybe even more relevant to people struggling to find an answer to a difficult health problem.

I am a surgeon. I spent my career in metabolic disease, which means I spent it watching people be blamed for their own biology, for their obesity. I am also the author of Doctor AI Reimagining Healthcare, which is a book about rebuilding trust in a system that has spent most of it. Those turn out to be the same subject.

Some weeks the argument will be clinical. Some weeks it will be about money, or law, or the sentences we are not yet willing to say out loud in public. What they will have in common is that I will be frank, I will show my sources, and I will tell you where I think I might be wrong.

The first essay lands Friday.

It is about a drug that failed for a decade — but in reality had not failed at all. We gave it to the wrong patients, and then we blamed the patients. I think we are doing precisely the same thing right now with the most consequential medications of my career.

If that sounds like an argument worth following, subscribe. One email a week. Nothing else.