I don’t live here anymore.

It was an odd thought, experiencing the present in the past tense. While we still owned the house for another two weeks and the movers had not yet arrived, we had already taken the animals and our valuables to my mother-in-law’s place across the Bay, and our last night sleeping in the house was days earlier.

Walking through the quiet, dark rooms, memories flooded back, and I remembered how different things looked when we bought this house. Over the past 7 years it changed as much as we did. In that time, we replaced the roof, installed new floors, re-did all the plumbing and electrical. We had to rip out the palm trees in the front yard when they got sick. The old, rotting deck was torn out. My wife repainted the home office a deep navy blue as a surprise when I was out of town.

I felt a lump in my throat when I noticed scuff marks on the walls from our now deceased pets Phoenix and Jack. Nostalgia for such tiny, mundane details reminded me of The National song “Weird Goodbyes”:

Memorize the bathwater, memorize the air
There'll come a time I'll wanna know I was here
Names on the doorframes, inches and ages
Handprints in concrete, at the softest stages

Our time in Florida got off to an inauspicious start—we moved to Tampa in fall 2019, just months before a novel virus shut down the world. The COVID-19 pandemic trapped us in the house for 2020 and most of 2021, delaying meeting people and putting down roots. We lived through multiple hurricanes, including close calls with Helene and Milton in 2024. We grappled with surging prices and political unrest. I bounced jobs multiple times from a start-up to Big Corporate to independent freelancer.

But there were plenty of good times, too. As we came out of lockdown, we started making friends, like our trivia team of local vets called “Kitty Magic,”1 the trainers at the local gym, jamming with musicians in Lutz, and the local RedBar chapter of watch collectors. There were concerts and trips to Disney and staycations exploring every corner of Florida from Tallahassee to the Keys. We took advantage of the perpetual sunshine with beach time and learning to scuba dive.

So it was with very mixed feelings that we packed up our cars and hit the road on Friday. Over the next three days we wound our way up the I-75 to I-95, past the DC Beltway, up the New Jersey Turnpike, and finally climbing the Catskills on I-87. Driving for 8 hours a day with four animals and cars loaded to the brim with essentials and belongings we didn’t trust to movers was certainly an “adventure.” On the first day, the dogs and cats both vomited, and one of them blew up their crate with poop. All you can do is clean it up and make the best of it. I treated it like the least fun version of a summer road trip.

When we pulled up to our last AirBNB yesterday, it was truly a full circle moment: Exactly 18 years ago this month, I left upstate New York for vet school on the West Coast. While I was sad this Florida chapter of our story was coming to an end, I remembered life often has a funny way of bringing you back in some way or another. Pretty much every place I’ve been for school or work, I ended up returning to later. Like the time I went back to Pomona to deliver an alumni address to graduating DVM students at WesternU, or spending years as a locum at Auburn after I thought I’d left it behind for good. Odds are good I’ll be back in Florida someday!

The sign above stands outside our favorite part of the Gulf Coast in Indian Rocks Beach. It’s a reminder to be courteous and not leave any garbage in the sand or water. But the reality is we all leave things behind when we move on… Houses. Memories. Friendships. Careers. Loved ones who pass on. A million little pieces of our hearts radiate out across the places we’ve been and the people (and animals) we touch, connecting us forever.

As we start this next chapter of our lives in New York, we will make new friends and memories and continue to leave our mark. I can’t wait to see what comes next.

—Eric

Musical Coda:

“Welcome to New York” — Ryan Adams covering Taylor Swift

Imagine you take your cat in to the vet because you noticed a large lump growing under his jaw. The vet takes a look and goes “Hmmm…” in an ominous tone of voice you don’t like. They say there are several benign explanations, like a reactive lymph node or an abscess, but that another possibility is a tumor. Your vet obtains a fine needle aspirate (FNA) sample to send off to a pathologist like me. A few days later, they call with seemingly bad news: It’s a type of cancer called lymphoma.

While you might be crushed and assume the worst, you really need to know what exactly you are dealing with—not all types of lymphoma are created equal, and some are less aggressive while others carry a grave prognosis.

One example of the former would be something called Hodgkin’s Disease, or more precisely, Hodgkin lymphoma, which is a type of blood cancer that is highly treatable with a 5-year survival rate of around 90% (especially if caught early). This is in contrast to all of the other variants, which are lumped together broadly as non-Hodgkin lymphoma (NHL). Viewers of the HBO comedy Curb Your Enthusiasm may be familiar with this distinction: In one episode, there is a running gag where Larry David repeatedly offends people by downplaying a character’s cancer diagnosis as no big deal because it’s “the good Hodgkins.”

What IS Hodgkin-like lymphoma??

Hodgkin’s lymphoma was first described in 1832 by Dr. Thomas Hodgkin when he evaluated several patients with painless swellings of their lymph nodes, sometimes accompanied by fever, lethargy, weight loss, and other symptoms. It is considered one of several types of cancer where a cure is possible, and several famous people have been in long-term remission of Hodgkin’s disease, including Microsoft co-founder Paul Allen, professional hockey player Mario Lemieux, and actor Michael C. Hall, who played Dexter on the eponymous series.

About half of cases of HL are associated with Epstein-Barr virus or other infections. In fact, recent research suggests the disease develops when the immune system gets confused responding to a threat and goes into overdrive:

Weill Cornell Medicine researchers have demonstrated, for the first time, that Hodgkin lymphoma cancer cells from patient samples are immune cells stuck in an “identity crisis.” […] The findings, published April 22 in Blood Cancer Journal, reframe Hodgkin lymphoma as a cancer of failed cell development, rather than simply uncontrolled growth, and suggest new diagnostic biomarkers to distinguish it from other related non-Hodgkin lymphomas.

Why am I bringing up a sitcom reference to people with lymphoma on a veterinary newsletter?? Believe it or not, cats actually develop a similar syndrome that has been dubbed Feline Hodgkin-like lymphoma (FHL) or simply Hodgkin-like lymphoma (HLL)1. While most pets and domestic species with lymphoma live an average of 9-12 months despite multi-agent chemotherapy, cats with FHL can survive for YEARS. However, pet owners—and even many vets—are generally unaware of this entity, and may jump to inappropriate decisions like aggressive medical care or even euthanasia when they see “lymphoma” on a report, so I want to raise awareness.

Clinical and pathology findings

FHL is not only more indolent than typical forms of lymphoma, it also looks different in the exam room and under the microscope. Here is a short summary of the features:

• Usually affects one or only a few lymph nodes (often in the head or neck region)

  • Most other forms of lymphoma in pets cause enlargement of lymph nodes throughout the body and present as Stage III or higher

• Nodes may wax and wane in size over time

• Mild, if any, systemic signs of illness

• Slowly progressive → prolonged survival without aggressive treatment

• Microscopic pathology findings:

  • Loss of normal node architecture

  • Large neoplastic lymphocytes within a mixed, reactive background

  • Presence of characteristic binucleated or multinucleated cells (see Table 2)

Here are some examples of RS and Hodgkin cells from a cat with FHL:

While the results vary a little between studies, special stains (such as immunohistochemistry) generally reveal that FHL is made up of a mix of neoplastic B-cells/plasma cells on a background of reactive but non-cancerous T cells. The large multinucleated Hodgkin and RS cells were once thought to be histiocytic in nature based on their appearance, but two studies found they were negative for macrophage marker IBA-1 and variably labeled with B-cell marker CD20. Many of the cells also express CD30, a marker of activation in both B and T lymphocytes, which fits the idea that HL/FHL is a case of an immune response gone haywire.

For the molecular clonality test PARR, results are often quite messy. Some cats with FHL have clonal B-cell results, while many have ambiguous or polyclonal results (presumed false negatives). I could not find data on flow cytometry for FHL, but I would assume it is also mixed and confusing.

Treatment and prognosis

In one small case series of cats with FHL, the median age was 7 years old, the gender ratio was 50/50 for males/females2, and the most frequent breed was domestic shorthair (~80%, although this is the most common cat breed in most countries, so I’d expect it to be overrepresented). All cats in the study had stage I disease (single node affected) with surgery to remove it and histopathology for definitive diagnosis. Around half of cats were asymptomatic, while about a third had decreased appetite and weight loss, and a few had other issues.

Long-term clinical follow-up was available for 10 of the 24 cats, none received chemotherapy. For 8 of those 10 cats, they were still in remission at the end of the study, with a median survival of 956 days (range 700 - 1,323). Two cats had progressive disease, though both owners declined additional treatment, and those patients died at 145 and 233 days. The generally favorable prognosis was similar to an older retrospective study by Walton et al, although a higher proportion of those cats were lost to follow-up or had euthanasia for reasons unrelated to lymphoma.

Summary and further reading

So in conclusion, cats get a unique form of Hodgkin-like lymphoma that is not terrible news. They tend to live a long time, especially if the abnormal node was removed with surgery. While FHL is considered uncommon to rare in cats, I suspect it is likely underdiagnosed due to lack of awareness and the unusual pathology findings.

FHL can be challenging to diagnose, and the best tests are a combination of cytology, histopathology, and IHC (“special stains”); I would generally discourage PARR or flow cytometry. If you are concerned that your cat has FHL instead of something more aggressive, it would be best to get a second opinion consult from a pathologist with a special interest in hematopathology and lymphoma subtyping.

For further reading on the importance of advanced lymphoma testing and classification, check out some of these other All Science articles:

References

1. Cottingham K. Understanding Hodgkin lymphoma cell origins could yield better diagnostics. Cornell Chronicle, April 24, 2026. Accessed 5/14/26.

2. Foiani G, Dell’Aere S, Vascellari M, Tiracorrendo F, Ghisleni G, Rigillo A, Perfetto S, Melchiotti E, Carminato A, Bianchi GBM, Roccabianca P. Feline Hodgkin-like lymphoma: A morphological, immunohistochemical, and molecular study. Vet Pathol. 2025 Nov;62(6):890-901.

3. Marconato L, Maga I, Iussich S, Benali S, Aresu L. Histologic, Phenotypic, and Molecular Characterization of Feline Hodgkin-Like Lymphoma With Classical Reed-Sternberg Cells. Vet Comp Oncol. 2024 Dec;22(4):574-580.

4. Newton JA, de Vicente F, Haugland SP, Scase TJ, Helm J. Extra-nodal subcutaneous Hodgkin’s-like lymphoma and subsequent regression in a cat. J Feline Med Surg. 2015 Jun;17(6):543-7.

5. Walton RM, Hendrick MJ. Feline Hodgkin’s-like lymphoma: 20 cases (1992-1999). Vet Pathol. 2001 Sep;38(5):504-11.

Dear Readers,

They say “April showers bring May flowers,” but so far, this spring in Tampa has been exceptionally dry—we are in the most severe drought in decades. In fact, we’ve received about an entire foot less rain than we would have in a typical year! There is a rather large pond on the golf course near us where we walk our dogs, and it is completely drained and bone dry for the first time I can remember living here.

Let’s hope we get some much needed rain soon 🤞 Even if we don’t, in a few weeks we will be moving to (literally) greener pastures in upstate New York. The spring bloom should be amazing to see, many towns near us celebrate with an annual tulip festival.

In this month’s edition of Field Notes, we have several articles of interest to vets and pet owners alike. First, I discuss how the range of heartworm infections is expanding. Then, I talk about a new type of urinary stones that might be associated with certain trendy diets. Finally, I provide details about an upcoming lecture I’ll be giving at the AVMA conference in July along with some stray links to other stories.

I hope you’re enjoying the start of spring and find this roundup useful!

—Eric

Heartworm “hot spots” expanding

Canine heartworm is a serious disease that can lead to heart failure and is caused by the nematode Dirofilaria immitis. Luckily, it is easily prevented with a number of topical and oral medications you can get from your family vet. To monitor this disease, the American Heartworm Society collects antigen test results from practices nationwide and publishes the results every three years. This April, they released 2025 data from >1,000 practices and animal shelters.

Here’s a quick summary of their findings:

• Data based on more than a million tests

• Most practices (59%) reported stable rates of infection, while roughly even numbers of practices reported increases and decreases in positive tests

• Some of the usual “hot spots” (defined as >100 cases/clinic) like Florida and Texas were joined by the Carolinas and southern Illinois

• The incidence in the top state, Texas, increased from 2.97% in 2022 to 3.78%

• New areas with “moderate” infection rates (6-25 cases/clinic) included expansions into southern California, southwest Colorado, east-central Wisconsin, and parts of Maine and Virginia

• There were ZERO heartworm-free states

In related news, the geographic ranges for ticks and the rickettsial diseases they carry is also expanding.

Why are these parasites spreading all over the map? One reason is probably the same as the Florida drought issue: Climate change. Warmer weather results in predictable increases in the ticks and mosquitos that carry these diseases, especially after floods and hurricanes. Urban development displaces wildlife that can carry these infections and increases contact with our pets. Finally, people moving across the country with dogs who are not on preventatives contributes to the expansion.

The clear implication is to make sure your pets are on appropriate heartworm and parasite prevention year-round, even in areas that “don’t have heartworm,” because that is becoming increasingly untrue anywhere in the US. Fortunately, these infections can be successfully treated, although the cost is much higher than prevention, and there can be side effects. When we adopted Kali from the Bahamas, she was infected with both heartworm and Ehrlichia, but today she is parasite-free and living her best life snuggled on the couch with our cats!

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Rare type of urinary stones on the rise

One of the veterinary institutions that has the most experience with bladder and kidney stones is the University of Minnesota Urolith Center. They accept samples of these stones when they are removed at surgery and analyze them chemically for research purposes and to make recommendations on management with food and medications. A recent story in VIN News highlights a rare type of stone that is suddenly being diagnosed at much higher rates: calcium tartrate tetrahydrate (CTT).

According to VIN News: “In the early 2020s, the Minnesota center tallied no more than 10 such stones in dogs each year. In 2023, the number rose to 11. Then, in 2024, to 28.” By 2025, it had surged to almost 200. While other types of stones like calcium oxalate dihydrate and magnesium ammonium phosphate (aka struvite) are far more common overall, CTT increased almost an order of magnitude in prevalence from 0.02% to 0.2% of cases over a very short period of time.

Researchers at the University of Minnesota were curious about what might be driving this increase and queried owners of dogs with this unusual stone about diet and medications. For those who responded, they found a source of tartaric acid in 76% of cases, and virtually all (96%) were associated with choline bitartrate, an additive to certain fresh pet foods and homemade diets. Three brands that were identified in multiple cases included Just Food for Dogs, The Farmer's Dog and Nom Nom.

You can read the UMN paper here:

Lulich, J., Koehler, L., Ulrich, L. and Furrow, E. (2025), Association of Diet and Calcium Tartrate Tetrahydrate Uroliths in Dogs. J Vet Intern Med, 39: e70093.

AVMA talk on medical misinformation

For anyone who is interested in attending the annual AVMA Convention or already registered, I will be delivering a continuing education talk for the Leadership & Professional Development track on Friday July 10th. The title of the lecture is “Speaking Out: How Veterinarians Can Lead in the Fight Against Medical Misinformation”. You can read the session description and objectives below:

Veterinarians are among the most trusted professionals in society, yet their voices are often absent from public conversations where science and medicine are most at risk of distortion. In today’s climate of medical misinformation, vaccine hesitancy, and politicized science, veterinarians have both an opportunity and a responsibility to lead. This session will introduce veterinarians, technicians, and animal health professionals to the essentials of science communication and advocacy, drawing from real-world lessons in social media, client interactions, and public discourse. We will explore the “credibility gap” that often separates scientific evidence from public understanding, and identify the red flags of misinformation—anecdotal claims, miracle cures, conspiratorial narratives—that undermine trust. The rising tide of veterinary vaccine hesitancy will be used as a case study in how misinformation can have real-world consequences for both animal and public health. Beyond simply correcting falsehoods, attendees will learn how to frame scientific information clearly, empathetically, and persuasively for diverse audiences. We will discuss practical strategies for using communication platforms such as Substack, Facebook, LinkedIn, and TikTok effectively, while avoiding common pitfalls that erode credibility. Finally, we will consider the broader moral imperative of advocacy: like canaries in the coal mine, veterinarians can serve as early-warning voices for society, speaking out not only for animal health but for the principles of science and public trust. By the end of this session, participants will leave with concrete tools to identify misinformation, engage confidently in public dialogue, and take greater ownership of their role as trusted advocates for science, health, and societal well-being.

Objectives:

1. Identify common red flags of pseudoscience and misinformation in veterinary and public health claims

2. Apply effective strategies for communicating scientific information clearly and credibly to non-expert audiences.

3. Analyze the case example of vaccine hesitancy to develop empathetic and evidence-based responses

4. Design social media or public messaging to advocate for evidence-based veterinary medical practices

I’m really looking forward to this session and hope to see some of you there in person!

Odds & Ends

Here are a few other things I’ve been checking out recently:

• Rethinking antibiotics for subclinical UTIs - This is a link to a Worms and Germs blog post by Dr. J. Scott Weese discussing a recent study that evaluated the outcomes of cats with chronic kidney disease and asymptomatic bacteria in their urine when treated with antibiotics vs benign neglect. They found that there was no difference in survival or CKD progression. Dr. Weese provides thoughtful commentary on the specific study as well as new guidelines that aim to reduce the unnecessary use of antibiotics in our patients.

• OpenAI vs Elon Musk - This might be the Silicon Valley trial of the century, and the results could have a huge impact on the market for LLM chatbots. I don’t have a lot of sympathy for either party here, and have previously written about the damage Musk did to the federal government through DOGE. That said, it’s hard not to agree with his core premise that OAI gained a lot of investment and recruiting advantages by promising to be a benevolent non-profit for society’s benefit and then totally reneged. If only there was a way both parties could lose!

• Man who sequenced human genome died - J. Craig Venter (79) passed away on Wednesday after complications of cancer treatment. He was a colorful scientist, entrepreneur and philanthropist most famous for racing the NIH’s Human Genome Project when he deemed progress too slow. His “shotgun sequencing” approach was faster than the clone-by-clone technique used at the NIH, and his rapid results arguably sped up both teams’ results. The winner of the “race” was ultimately declared a tie, and the two groups published their independent results within 24 hours of each other in Science and Nature.

Background & History

A classic mantra in anatomy and physiology states that “form follows function,” meaning that the structure of cells, tissues, organs, and our entire bodies look the way they do out of necessity. You could analyze medical records in a similar way. If you’ve ever gotten a copy of your pet’s file, you might see notes using the common “SOAP” format:

S - Subjective: Qualitative information, such as temperament, hydration, whether a patient seems depressed or neurologically impaired

O - Objective: Quantitative and physically verifiable information, such as heart rate, temperature, blood pressure, exam findings like a murmur, lab data, etc

A - Assessment: The working diagnosis or opinion based on the “S” and the “A.” This may include comments about the prognosis or expected outcome

P - Plan: Next steps in terms of tests, treatment, procedures, and follow-up

Other parts of the record, such as radiology reports, look completely different. These will usually describe the type of “study” (i.e. X-ray, ultrasound, CT scan, MRI, etc), the images available for review and their quality (in terms of positioning, exposure, and such), and a list of normal and abnormal anatomical structures.

The term “biopsy” was coined by French dermatologist Ernest Besnier in the late 19th century from the Greek roots for “life” and “to see.” It simply means to remove cells or tissue for examination. Biopsies are commonly performed to determine whether a mass is cancerous or not, although there are many other reasons for the procedure. Like the physical exam and radiology reports, a pathologist’s report has its own unique framework, terminology, norms and quirks.

Today, we’ll walk through the parts of a report with examples, and hopefully both vets and pet owners reading this leave with a better understanding of the often mysterious world of biopsy reports!

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Types of Biopsies

The term “biopsy” technically applies to evaluation of any cells, fluid, or tissue removed from the body. The specific procedure for large chunks that are fixed in formalin, embedded in wax, and stained with hematoxylin & eosin dyes is called histopathology (sometimes “surgical pathology” is used as a synonym). Direct preps of fine-needle aspirates, smears, swabs, and fluid removed from body cavities is referred to as cytology or cytopathology, and they are usually stained with a modified Wright’s or Papanicolaou stain and viewed at higher magnification (I.e. 50-100x oil lenses).

More recently, you may have heard about so-called “liquid biopsies.” This is a somewhat controversial term to refer to genetic and molecular biomarkers applied to samples from blood, effusions, and urine. The tests are often looking for DNA changes indicative of cancer in circulating tumor cells (CTCs), exosomes, etc. There is a lot less data backing up how useful these tests are, and the reports look at completely different parameters than traditional biopsies, so I won’t be addressing them here.

General Structure

The overall format of a pathology report—with a few minor exceptions—has remained largely unchanged for over 100 years. The basic parts consist of a descriptive section (think of this as a combination of subjective/objective from SOAP), a diagnosis or interpretation (the “A”), and comments (the “P”). These reports also contain patient ID information and some details on the history the physician or vet sent in with the sample. This is a mock-up from the College of American Pathologists:

Description

The description is the meat and potatoes of a biopsy report, where the pathologist documents everything they see without providing an opinion. You can think of it as the “just the facts, ma’am” section. One thing that can make the description section intimidating for general practitioners, patients, or pet owners to read is that it’s often filled with a lot of specialized jargon. Looking up unfamiliar terms with Google or ChatGPT can help decipher what’s going on. It’s also nice when pathologists explain less common terms using parentheses or other formatting (I often do this).

The microscopic description is common to histopathology and cytology, and documents what types of cells/tissues are present on the slide at high magnification, if they look normal or abnormal, presence of bacteria or fungi, foreign material, etc. There are often a lot of references to size, shape, color, and specific appearance. On cancer reports, the description usually mentions “margins,” or how much space there is between normal tissue and tumor (to see how complete removal was). The length of this section can range from a sentence or two to multiple paragraphs, depending on the type and complexity of the sample. For histopathology reports, there is also a gross description in addition to the microscopic. These comments describe how the tissue looks with the naked eye before processing, and might be something like: “2x3 cm pale, tan, rubbery, subcutaneous mass.”

In the beginning, a written description was necessary to provide a legal record of the sample because pathologists often work in remote facilities away from their referring physicians or veterinarians, attaching photos was not technologically feasible, and the original slides may not have been stored longterm. Today, the combination of regulations mandating minimum sample retention times (often years) and ease of adding images to reports might seem like it makes this redundant. However, in my opinion (and that of other pathologists), it still adds value. For one thing, it can be used for consulting or second opinion requests. For another, it also contains valuable information in the medical record for data mining in research and clinical trials1.

Interpretation

This is where the pathologist puts a label on the disease process and decides if the sample is most consistent with cancer, inflammation, an infection, or something else. You can think of this as basically the same as a diagnosis, although some veterinary labs call it an “interpretation” and suggest the ultimate diagnosis is up to the attending clinician who is actually seeing the patient. It’s a pedantic difference in wording to reduce liability risks, and one that I’m not sure provides much protection, but it is a common industry practice.

In some cases, the interpretation may be short and sweet, like “canine cutaneous histiocytoma” (a common benign skin tumor). Other times, it might be more of a “morphologic” diagnosis, or a string of anatomical and pathological terms along the lines of: “Moderate lymphoplasmacytic to mildly neutrophilic duodenitis with multifocal lacteal dilation and mucosal erosions.” Putting that into plain English: the location is the duodenum (small intestine), the suffix“-itis” means there is inflammation, and the infiltrate is composed of neutrophils, lymphocytes, and plasma cells, along with some damage to the surface lining and swelling of internal structures → it’s basically Inflammatory Bowel Disease.

You might ask, “Why doesn’t the pathologist just say IBD and be done with it??” The reason is that each one of those modifier words characterizes the specific “flavor” of the patient’s IBD, and might carry different treatment or prognosis implications.

Comments

For some really simple lesions, there may be no additional comments. However, it is quite common for pathologists to use this field to do one or more of the following:

• Ask for more clinical details or follow-up

• Discuss any quality issues (limitations based on small sample, crushed tissues, etc)

• Recommend additional tests, especially if the diagnosis is in doubt

• Provide information on prognosis, explain tumor grading

• Reference studies to back up their thought process (especially if it’s a rare disease)

The comments section is often rated as the most important part of the report by clinicians, as in this study:

A common situation where I use the comments is to explain my grading decisions for canine mast cell tumors (MCT), because the system is relatively new and comes with a lot of caveats and exceptions:

Another one is with lymph node samples suspected to be lymphoma. If the slides are not a slam dunk for cancer, I may recommend confirming with a molecular test like PARR. Even if I am sure of the diagnosis, following up with something like flow cytometry can give an oncologist more information about how to treat it.

Finally, as I put it in my semi-satirical post The Laws of Pathology: “The length of the comments is inversely proportional to the confidence of the pathologist”. If I am writing a novel-length treatise, you should know that this is something really bizarre!

Addenda, Photos, and Beyond

There are a variety of additional sections that might be added to your report. Digital photos of the lesion have become relatively common in veterinary biopsy reports. A picture is worth a thousand words, and even a few can say more to a GP or patient than the long description ever could.

Cancer cases often include a “synoptic report,” or a checklist of relevant features for that specific tumor. An example might look like this:

Then, there are two sections that sound almost identical, but are quite different:

• Addendum: This is when new information is added. A common situation is when “special stains” are requested. The pathologist might initially look at a lymph node and be unsure if it is reactive or cancer, so they order immunohistochemistry (IHC). Then when it comes back, they will write an addendum, such as “All of the lymphocytes were B cells, the diagnosis is B-cell lymphoma.”

• Amendment: An amended report is when something is changed from the original. This can be to correct a typo, but may also indicate a more substantial error that was caught and remedied. Many labs track pathologist amendment rates as a quality benchmark.

Reading Between the Lines

The surgeon Richard Selzer once wrote “Autopsies give us the facts, but not the truth.” The same could be said for biopsies. Pathologists are taking an extremely small piece of a patient’s body at a single point in time and trying to figure out what’s wrong with them based on that. They can be led astray for numerous reasons, ranging from too little tissue sampled, to damage to the specimen, to a lack of relevant medical history, and more. Some diseases are tricky to diagnose with a biopsy and may require imaging or other types of tests. Finally, the subjective experience of illness may not always match what is seen under the microscope: One patient may have minimal inflammation on their biopsy slide, but be in serious pain, while another could have a sample that looks markedly abnormal but experience no symptoms.

The upshot is reports may be written defensively, with a lot of hedging language around probabilities and uncertainty. This is likely much more common in large diagnostic labs like Quest or Labcorp on the human side, and Antech/IDEXX/Zoetis on the veterinary side. Sometimes having the primary care provider contact the pathologist can clear up any confusion and lead to a better outcome.

To handle the inherent ambiguity of pathology, it is often necessary to rely on multiple different tests before taking any serious action like chemotherapy, surgery, radiation, etc. Many diagnostic labs already have formal and/or informal consulting processes in place for serious diagnoses, but if you have any doubts or concerns, you or your physician/vet can request a second opinion.

What has your experience been with biopsies for your pets or your own health? Leave any comments or questions below!

—Eric

Further Reading:

“How to Read Your Pathology Report” — College of American Pathologists

“Understanding Your Pathology Report” — American Cancer Society

Dear Readers,

After the excitement of accepting my new job comes the less pleasant part: Getting ready to sell our house and relocate to a new state over a thousand miles away. For the past few weeks, my life has become all about boxes—sorting clothes, books, and random collectibles into a million cardboard containers. Moving consistently ranks as one of the most stressful life experiences, often beating out divorce, birth of a child, and other stressors. That shouldn’t come as any surprise as moving is disruptive and expensive. It requires coordinating realtors, cleaning, packing, selling or donating old stuff, working with movers, trying to secure new housing on a tight deadline. You’re also leaving behind a lot of friends and memories. What I try to keep in mind is that as horrible as the process is, eventually it works itself out and becomes a distant memory as you start a new chapter elsewhere. The only way out is through.

For this month’s Field Notes, I have several things of interest to share. The first main story actually makes me really angry, and concerns a fly-by-night online medication scam that hurt dogs across the country. The second main story is a personal one about the importance of blood donations in vetmed. Then, there are links and short blurbs to a handful of other neat articles I came across in recent weeks, including updates on the Dog Aging project, studies about AI in dentistry, and more. I hope you enjoy!

—Eric

Beware shady pet pharmacies!!!

This is a disturbing story about online pet pharmacies selling unsafe drugs to that should serve as a warning to both pet owners and veterinarians alike. First reported by VIN News, an online retailer calling itself WagLabs was selling a number of medications without a prescription, including one purporting to be cyclosporine, a powerful immunosuppressive drug often used to treat dogs with skin allergies and other serious conditions:

The listing above claimed to be endorsed by a veterinary dermatologist named Dr. Emily Carter. There’s just one problem: There is no veterinary dermatologist by that name! In fact, the accompanying headshot is a stock photo, and neither VIN news nor others who investigated could find evidence that such a vet even exists.

The problems went beyond the fake endorsement. Many pets treated with this “cyclosporine” from WagLabs reported serious side effects, including increased thirst, urination, and liver enzymes, among other symptoms. According to a similar story by the California Veterinary Medical Association, at least one pet was euthanized due to organ failure after taking those pills 😔

The American College of Veterinary Dermatology (ACVD) became aware of this problem in late January and filed a complaint with the FDA. While I could not find any response from the FDA, WagLabs stopped selling “cyclosporine” in mid-February, and looking at their website today, they no longer appear to be selling any products:

The original story was updated on March 25th:

VIN News has learned that a pet owner in North Carolina this month submitted a WagLabs product labeled as a 50 mg cyclosporine tablet to a laboratory for testing. The results, provided to VIN News by the pet's veterinarian, show the lab detected only one major substance: dexamethasone. Dexamethasone is a potent corticosteroid used in human and veterinary medicine. In the U.S., it is approved as an anti-inflammatory agent for dogs and other species. A prescription is required for use. As of this update, the WagLabs website no longer shows any products for sale.

Many vets online already speculated that the drug might be prednisone, dexamethasone, or another steroid, because of the adverse effect profile and the fact that it can effectively treat skin disease (and many other conditions). Furthermore, generic steroids are dirt cheap so—if you were an unethical sociopath—you could attempt to pass it off as a much more expensive drug like cyclosporine or Apoquel, sell it at steep “discount” and still make an enormous profit. Some dogs might even get better, although it appears the dosing of this powerful drug was extremely high.

In my opinion, there is a special place in Hell for folks who are willing to hurt animals to make a quick buck 🤬 All we can do is be on the lookout for unsafe medications online. Red flags that should alert you to (potentially dangerous) scams:

• Not requiring a prescription for Rx drugs

• Prices that seem too good to be true (they probably are !!!)

• Selling supplements that claim to be safer and more effective than real drugs

• Endorsements by vets without a paper trail showing any appropriate credentials

  • This is a growing problem, see: “Did a fake veterinarian sell you something? You’re not alone”

Giving and Receiving Blood

Last summer I wrote about the importance of animal blood donors:

Despite the need, pet blood donation is not well understood by the general public, nor are many owners aware that it’s an option. According to a study conducted in the UK, 70% of the 158 pet owners surveyed were not aware their animals could donate blood, but 89% of respondents indicated they would be willing to volunteer if their pet was an eligible donor

Just a few weeks ago, we experienced the lifesaving benefit of transfusions in one of our own pets. While my wife and I were in St. Kitts, her mom’s dog Benjamin stopped eating and was acting very depressed. He had bruising all over his abdomen, little pinpoint bleeds on his gums, and his stool looked like tarry coffee grounds. When his vet checked a CBC, his platelet count was zero. He had developed Immune-Mediated Thrombocytopenia (ITP).

Benjamin was transferred to a specialty hospital where they started steroids and vincristine. Despite this, his platelets refused to budge and he kept bleeding for days. They were able to make him feel better by giving him some fresh blood:

His condition was touch and go for a bit, but I’m happy to report he turned a corner after that first week. His platelets normalized, the bleeding stopped, and he started to feel like himself again! Today Benjamin is back to wolfing down his food and snuggling with his mom 😊

As I’ve previously mentioned, we enrolled both our cats in BluePearl’s blood bank program. They each recently donated, and both of their units of pRBCs were used within days! One cute new touch they’re doing is sending the owners of recipients cards “from” the donors with a picture and brief bio. The contrast between the photos of Bert posing handsomely and Ernie messily devouring a Churu treat sums up their personalities better than words ever could 😸

You can read more about animal blood banking here:

What I’m Reading

Before I go, here are a few other interesting stories you might want to check out:

• “When AI Misses the Diagnosis... who gets sued?” — This LinkedIn newsletter post by Substack vet is a great companion piece to my last article on the JAVMA study evaluating radiology AI. Her piece focuses on AI applications for dentistry, and she provides a great list of tough questions to ask sales reps who pitch you these products

• “No, ChatGPT did not cure a dog’s cancer” — Several people have asked for my thoughts on this viral story about an Austalian tech entrepreneur who claimed to have cured his dog’s cancer with a personalized mRNA vaccine “designed by” ChatGPT. As you would expect, the reality is far murkier: (a) The dog had multiple tumors (at least one was a mast cell tumor, grade/stage unclear), (b) they shrunk some but are still present, (c) the dog was also given a powerful immunomodulatory drug used in people at the same time, and (d) scientists actually designed the mRNA vaccine using multiple tools, and ChatGPT really just served as a research springboard like Google would have a few years ago

• “Recent Results From the Dog Aging Project” — Dr. Nancy Kay who writes provides a great summary of studies that are coming out of the Dog Aging Project, including risk factors for GDV (aka a “twisted stomach,” a life-threatening emergency), how dogs respond to home-prepared and raw diets, and insights into canine cognitive dysfunction (analogous to Alzheimer’s)

• “There’s a Good Reason You Can’t Concentrate” — In this NYT Op-Ed, computer scientist Cal Newport, who wrote Deep Work and Slow Productivity, makes the case that we need to treat technology disrupting our ability to focus and think like previous public health campaigns to stop smoking, start exercising, and eat a heart-healthy diet. He cites a number of studies showing that school bans on smartphones and changing how we use AI chatbots can result in promising improvements

I’ve written previously about the use of AI in veterinary pathology, radiology, cardiology, and more over the past few years. A lot of these articles were based on “anec-data” from personal experience, informed expert opinion, and limited proof-of-concept studies. Robust validation of these applications has been sorely lacking in vetmed, despite the fact that there are now many commercial services using AI to interpret x-rays, EKGs, blood smears, cytology, and urinalysis.

This is not a hypothetical discussion about a far-off future—veterinarians are employing these tools to make decisions about diagnosis, treatment, surgery, and euthanasia today. The question of whether or not these medical AI applications are accurate can be quite literally a matter of life and death, and we’re essentially flying blind. So when I saw that there was a brand-new study evaluating the performance of these systems published in JAVMA last week, I sat up and took notice.

Let’s dive into their findings in this edition of 5-Minute Paper!

The Study:

Ma D, Faulkner JE, Stander N, Raisis A, Joslyn S. Pilot study: external validation of commercial veterinary radiology artificial intelligence services shows deficiencies in interpretation of general practice-sourced canine abdominal radiographs.1 J Am Vet Med Assoc. 2026 Mar 20:1-8.

Abstract

Objective: To evaluate the diagnostic performance of commercial veterinary radiology AI platforms on general practice canine abdominal radiographs with confirmed diagnoses.

Methods: For this pilot study, canine abdominal radiographs with definitive diagnoses were collected and submitted to 6 AI platforms between September and December 2024. Confirmation of diagnosis was obtained with surgery, necropsy, CT, ultrasound, cytology, or treatment response when appropriate.

Results: 53 cases were selected and submitted to AI platforms. After platform rejections, 307 evaluations were available for analysis. When differentiating cases with pathology (51 of 53) and without pathology (2 of 53), platform performance was variable and mostly low to moderate, including mean accuracy (70% to 90%), balanced accuracy (60% to 65%), and Matthews correlation coefficient (-0.08 to 0.43). Across all platforms, classification of radiographic findings (labels) showed low sensitivity (28% to 78%), F1 score (28% to 51%), and positive predictive value (25% to 54%) due to frequent missed diagnoses. Matthews correlation coefficient was higher (0.16 to 0.45), as it was less impacted by label misclassification. Small intestinal obstruction, a critical finding, was often not identified, with a sensitivity of 23% to 69%.

Conclusions: Diagnostic performance varied between the 6 AI platforms tested and was overall low to moderate for this small sample. Even the best-performing algorithm had notable limitations, and none appeared suitable for clinical use in their current form.

Clinical relevance: Further independent external validations on a larger scale and performance gains are needed before AI platforms can be safely integrated into clinical practice.

What is this study about?

The authors compared the accuracy of six different veterinary radiology AI services to well-characterized cases with definitive diagnoses.

Who did the research?

Faculty at the Murdoch University School of Veterinary Medicine in Australia. Three of the authors are board-certified veterinary radiologists.

Who paid for it? Any conflicts of interest?

The study was funded by an intra-mural grant from Murdoch University. One author (SJ) owns a teleradiology service and a medical records system, which contributed case data to the study. No other authors reported disclosures, and none have a financial stake in any radiology AI companies. I deem the risk of financial bias to be very low.

What did they do?

This study pulled abdominal x-ray studies from retrospectively collected cases. Inclusion criteria were good-quality digital radiographic images with confirmation of a definitive diagnosis (by CT, surgery, autopsy, etc). They were reviewed blindly by one of the study radiologists, assigned a ground truth diagnostic label and classified as normal/abnormal and critical vs non-urgent. Then, they were anonymized, stripped of meta-data, and images were submitted as regular, paid cases to multiple AI services2. Importantly, the companies were not notified these were part of a research study (to reduce bias). They statistically compared cases at both a case level (true positives = abnormal ground truth, true negatives = normal ground truth, false positives = AI called abnormal but ground truth normal, and false negative = AI called normal but ground truth was abnormal) and a label-level (comparing specific diagnoses). Any cases rejected by an AI platform were excluded from calculating that service’s score, and for label-based assessment, they only evaluated diagnoses advertised by each company (to not penalize them for lesions outside their scope).

What did they find?

In total, 53 cases were included and submitted to the six AI services. Vetology rejected 11 cases (over 20%), all other services evaluated every case. At the simplest “case” level (binary call of normal or abnormal), sensitivity ranged from 71-90% (meaning 10-29% false negatives), and specificity and negative predictive values (NPV) were quite low for all. These results are summarized in Table 2:

As you can probably imagine based on the “meh” (at best) topline numbers for just calling normal vs abnormal, the results for specific diagnoses were quite a bit worse. Sensitivity ranged from 28% to 78% for specific conditions, and was <50% for 5/6 companies. Perhaps unsurprisingly, the service with the highest sensitivity (X Caliber) also had the highest rate of false positive errors. You can see an example of this in the first half of Figure 2 below:

The results got truly scary when they zeroed in on specific urgent, life-threatening conditions like an intestinal obstruction (which requires immediate surgery). Sensitivity was poor across companies (23-69%), and none had an overall accuracy score in the 90s. See Table 4:

In what might be the craziest example, the authors showed a case where a dog literally ate a rock (red arrows), and one service called it NORMAL!!! Another went off the rails and diagnosed a bunch of crazy nonsense 😱

What are the take-home messages?

While this preliminary study is not without some limitations (primarily the small sample size and cases derived from a teaching hospital rather than general practice), it is to my knowledge the largest and most robust published evaluation of radiology AI services in veterinary medicine. As a study conducted by academics without a financial interest who took many steps to reduce possible bias, I find these results compelling—and disturbing.

The authors raise legitimate concerns about over-reliance on AI based on the poor performance for serious conditions like GI foreign bodies. They recommend general practice vets become educated about how these systems work and their limitations, and to always cross-check any outputs from the AI models. They also urge our profession to publish larger, prospective, multi-center trials of these systems, and for the companies building them to be far more transparent about their data, methods, and algorithm performance. Given the author’s conclusion in the abstract, it’s hard to disagree:

Even the best-performing algorithm had notable limitations, and none appeared suitable for clinical use in their current form

On a final note, believe it or not, but there is even less independent research of AI systems in pathology. Let’s hope that changes soon 🙏

—Eric

Dear Readers,

Those of you who have followed this Substack for any length of time know the basic beats of my recent career story: the years under a non-compete, university locum work, and returning to practice last summer. This independent life came with some perks, like a lot more freedom to travel and speak my mind. Still, I always kept an eye out for full-time jobs that might be a good fit, but the right role never materialized…

…until now.

I am very pleased to announce that I’ve accepted a position as a clinical pathologist and laboratory director at an amazing specialty hospital in the northeast! My job will be a mix of diagnostic work, people management, and overseeing lab operations. This practice is one of those increasingly rare unicorns: one independently owned and operated by its doctors, with no corporate, venture capital, or private equity backing. They view pathologists and lab staff as integral members of the care team, and they’re aligned with my core values. It’s as close to a dream job as I could imagine.

You might be wondering what, if anything, will be different at All Science once I start this new job, so let’s get into it.

What’s going to change?

While this practice is independently run and has a rather generous social media policy, I will have to do a few things to comply with it. First, I will not be officially identifying my new employer on this newsletter and won’t be posting about specific cases or news related to them. I already do my best to not include any personal identifying information or call out individual companies in my articles, but keeping a tight firewall between my two worlds is the cleanest way to manage.

Next, you may have already seen the disclaimer below on my recent post about the European clinical pathologist well-being survey. I will be including it, or something with similar wording, in all future posts to make it clear that I am speaking for myself, not representing the practice’s views.

Finally, now that I will have a steady paycheck, I do not have the same need for revenue. So starting in April, I will be donating 100% of the proceeds—after Substack and Stripe take their cut—to charity. Initially this will continue to be the Humane Society of Tampa Bay; after we move, I will find and vet a new local shelter or animal-related non-profit organization. As before, nearly all of the posts will remain free to everyone, though keeping a paid tier does allow me to restrict some content if needed.

Why keep paid subscriptions turned on at all? Several reasons. For one, any dollar that goes to help animals as a result of my writing is a dollar that might not have been donated otherwise. To date, All Science readers have contributed more than $1,000 to homeless animals at HSTB, and that number will skyrocket when it is not 20% but 100% of net proceeds. Then there is the fact that other comparable newsletter and website providers (Beehiiv, Ghost, Mailchimp, etc) charge a steep monthly fee, while Substack is more affordable and provides a lot of growth tools, so I want to contribute to the platform’s continued success. Lastly, there has been anecdotal evidence to suggest that as the company pivots from growth to profitability, they may be penalizing free-only newsletters in visibility and new reader discovery.

What will stay the same?

What will not be changing is my commitment to bringing you the latest news and analysis in veterinary medicine! You can continue to expect monthly “Field Notes” digests of headlines for our profession, “5 Questions with…” interviews, cultural commentary, travelogues, and synopses of medical studies. I will be careful to pick my political battles, but I still plan to speak up on government actions that impact public health and education.

These are examples of some hard-hitting articles I would still happily publish:

Keep the faith

It’s been a long time in the “wilderness,” but the wait was worth it! I want to close on a note of gratitude by thanking everyone who has read my writing and sent me encouragement over the years. This newsletter gave me a sense of purpose when things were looking bleak, and your support means more than you know.

For my vet student and resident readers, I hope that the arc of my career proves that even in these chaotic times, with all the struggles our profession is facing, it’s still possible to chart a unique path and stick to your values. You will eventually find something great, even if you don’t see the perfect opportunity this minute. I’m reminded of Conan O’Brien’s farewell speech when he left The Tonight Show in 2010:

“To all the people watching, I can never, ever thank you enough for your kindness to me and I’ll think about it for the rest of my life. All I ask of you is one thing, I’m asking this particularly of young people that watch: please do not be cynical. I hate cynicism — for the record it’s my least favorite quality, it doesn’t lead anywhere.

Nobody in life gets exactly what they thought they were going to get. But if you work really hard and you’re kind, amazing things will happen. I’m telling you, amazing things will happen. It’s just true.”

His words resonate as much today as sixteen years ago.

If you work really hard and you’re kind, amazing things will happen.

I’m telling you.

—Eric

On Monday, my specialty’s journal Veterinary Clinical Pathology published a bombshell study with the ironically anodyne title “European Veterinary Clinical Pathologists Workplace Wellbeing Survey”1. In my opinion, the results of this survey should be a wake-up call to anyone who uses or runs a veterinary diagnostic lab, because they paint a picture of a specialty in crisis.

The authors sent their 32 question survey to members of the European Society of Veterinary Clinical Pathology and Diplomates of the European College of Veterinary Clinical Pathology in 2024 and 2025.2 As the two organizations overlap somewhat, respondents were only able to fill out the form once. The response rate was 75%3 for pathology specialists (n=92) and 43% for residents (n=13). The employment sectors of the participants included commercial diagnostic lab (41%), academia (37%), private specialty clinic (20%), and 1% each for drug company and government agency.

How satisfied were they with their profession? The results were… not great. Across the specialists, less than half (46%) strongly agreed with the statement “I have high satisfaction in my current job”, while 34% expressed moderate agreement. One in five (20%) were either neutral or dissatisfied. As Figure 2 below shows, the results get even more interesting when you subdivide them by their work setting. Perhaps unsurprisingly, the cohort with the highest overall career satisfaction held a hybrid role, working a mix of remote and in-person. In contrast, only 1/3 of those who worked either 100% at home or fully on-site were highly satisfied. The remote-only group also had more people who were strongly dissatisfied. Some possible explanations could include the effects of isolation or loss of consultation with colleagues. It could also be the case that the 100% remote folks are more likely to be reading high-volume cytology for big commercial labs, versus academia/independent.

Besides work setting, what are some of the other factors contributing to these less than stellar scores with their careers? Several themes jumped out at me, including burnout, low pay, and feeling like they were not utilizing their training.

Burnout

A stunning *64%* of the specialists said that they had experienced burnout or been close to it on at least one occasion! The rate for resident trainees was—surprisingly, perhaps—lower, but still almost 4 in 10. Many respondents expressed frustration at long hours, excessive case volumes, and aggressive productivity benchmarks. Only 62% of specialists agreed that their daily workloads were reasonable, and 1 in 10 strongly disagreed. Some attributed these issues to organizations that prioritized profit, as well as labor market mismatches:

In addition to the obvious concerns about work-life-balance and mental health, several worried that the caseload demands compromised diagnostic quality:

These complaints did not surprise me. A few weeks ago, I wrote about the high caseloads in diagnostic labs and how many organizations put the burden of efficiency on individuals despite counterproductive policies that slow them down:

“Minimum caseload benchmarks are often 40-50 cases a day, and if every case had only 3 slides—many cases had more—you’d be looking at 120-150 [slides/day]. It’s worth pointing out that such high caseloads would literally be illegal in the world of human medicine (at least in the US)—Regulations published by the Centers for Medicare and Medicaid Services cap the number of cytology slides evaluated every day at 100.”

Low Pay

As bad as the burnout scores were, the single most important concern for this group of clinical pathologists was compensation, substantially beating out the next runners-up of hybrid work and task variation:

Believe it or not, some pathologists in Europe are paid as little as €6 case! Even in the US, there are clinical pathologists compensated between $10-15/case. One expressed bitterness at being paid so much less than other specialists:

Note: I want to acknowledge that in the following paragraphs, the compensation numbers you see may seem high in a vacuum, but you have to remember these folks are highly-trained medical professionals that have hundreds of thousands of dollars in educational debt that required 12+ years of education.

We face similar issues in the North American market. Every few years, the American College of Veterinary Pathologists conducts a salary survey, and the most recent one was published in 2023. While I don’t think I’m allowed to share the specific internal data, I can show you publicly available salary data from the AVMA and tell you that the typical clinical pathologist now makes less than the average general vet:

In fact, the average starting salary for a newly-graduated DVM in the US is $137,727. As a board-certified specialist that spent four years in internship and residency—plus a PhD, NBD—I made $135,000 at a corporate diagnostic lab in 2020. Anecdotally, the salaries for clinical pathologists since COVID only seem to be going down: I have seen multiple recent postings on LinkedIn for <$100,000!

If you want to get really depressed, I personally know promising young clinical pathologists who are leaving our field to work in general practice, since it pays 30-50% better. What an absolute waste of their time and talent 😔

Underutilized Skills, Disruption from AI

A cornerstone of career satisfaction is feeling like you are doing a good job and making a difference in the world. Sadly, many clinical pathologists feel unappreciated. Our residencies include a large amount of training in clinical chemistry, assay development, and quality assurance. Yet many, if not most, clinical pathologists spend their time doing one small task (cytopathology), and other personnel with less education in certain areas are taking over:

And finally, as if the shrinking scope of responsibility and poor compensation weren’t bad enough, to add insult to injury these very same diagnostic companies are now trying to automate away the rest of our job description with AI to cut costs:

Talk about de-humanizing!

What Can We Do About This?

In my opinion, this survey confirms what I’ve long suspected: that veterinary clinical pathology is a field in jeopardy. In some ways, we have done this to ourselves. Many pathologists are conflict-avoidant and terrified to rock the boat when they are mistreated. Some older pathologists who ran successful independent labs sold out to corporate groups for a large retirement pay day. And many of us neglect the business side of the profession, leaving it to outsiders who do not have the best interests in mind for either us, practicing vets, or pets and their owners. These trends are bleak, and reversing them won’t be easy or happen overnight. However, I do have a few suggestions for different audiences:

Clinical Pathologists

• Share this study and discuss! Be willing to talk about compensation with your co-workers; taboos about discussing pay only give power to management

• Advocate for yourself in your workplace. If a situation is too toxic, leave. No job is worth your mental health

• Even better—get involved in management and/or our specialty organizations. We have ceded control to MBAs without relevant medical experience for too long

• Negotiate: They only offer these low salaries because enough people take them. If more people say no, they will have to raise the offering

Anatomic Pathologists

• Did you know there is an almost $30,000 gap in pay between anatomic and clinical pathologists?! Show solidarity with your CP colleagues in meetings with management or if you are in charge of hiring

Veterinarians

• You should also share this survey! More awareness always helps

• Consider patronizing independent labs instead of corporate ones. They may be a little more expensive, but you will get a more personal touch and better service

• Know that a slick salesperson may tell you that their AI-box is as good or better than an experienced pathologist, but there is a technical term for that: bullshit

• Keep burnout in mind when you opt to send in 30 slides for a case…

Management

• Remember that these are real people’s lives when you are trying to reduce “cost centers” by putting artificially low ceilings on pay

• I dunno, maybe stop trying to replace us with crappy AI that will hurt patients? (Just a thought)

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Dear Readers,

I’m currently writing this in the cool AC of Rituals Coffee House overlooking Frigate Bay on St. Kitts. For the past week, and the next two, I have been teaching 2nd year vet students at Ross University about the kidneys, electrolytes, and acid-base physiology and testing. This is my second locum block here after last summer and both times have been a blast. In a world where we constantly hear about how college students are struggling to read and using AI to cheat, that has not been my experience here at all. In fact, the students are whip-smart and keep me on my toes with thoughtful questions that challenge my own assumptions. It’s definitely true what they say:

“You don’t truly understand a subject until you can teach it”

Another component of the job is some light diagnostic work. Practicing in a place that is resource-constrained is a great reality check about spectrum-of-care for someone used to recommending tests that cost hundreds or thousands of dollars. It’s also a great opportunity to review samples with exotic diseases we don’t have in the States: a huge number of both the dogs and farm animals are either currently infected with, or previously exposed to, tropical tick borne diseases. Last July, I saw blood films from cattle with the spirochetes that cause relapsing fever (Borrelia theileri) and the parasite Babesia bovis. Neither is endemic in the US, primarily causing disease in Africa, Australia, South America, parts of southeast Asia, and of course, the Caribbean.

(Pro-tip for vet students: Bovine babesiosis is a reportable disease in the US!)1

Outside of work, it’s a lot of fun to explore both St. Kitts and her sister island Nevis, which together form one sovereign nation. The scenic coastline is split evenly between the Atlantic Ocean and the Caribbean Sea, and the two halves have very different vibes. You can actually see both sides at once from Timothy Hill, the iconic tourist photo spot featured at the top of this post. The island has a laid back vibe and you can enjoy delicious seafood and ice cold Carib beers all over. Two can’t miss spots are the beach bar Ship Wreck and the famous Sprat Net.

Another must-see attraction on the island is hiking Mt. Liamuiga, aka Mount Misery (seriously!) While the view from the summit is breathtaking, it is a very strenuous climb that is not without risk. I wrote about my solo trek to the top, and what it reminded me about resilience, in this essay:

I’ve included a few highlights from St. Kitts in the photo gallery below. On a final personal note, I will have some exciting career news to share in the coming months! Stay tuned… 👀

What I’m Reading

I usually spend most editions of “Field Notes” writing about a handful of different medical and research topics. With my packed travel and teaching schedule, I had less time to put together a full round-up. So in its place, here are a few things worth sharing:

• Surge in rabies reports prompts public health concerns — This story by VIN News reports on the rise in rabies infections in wildlife in many states (OR, NC, NY, SC, and VT), along with an atypical case of rabies in a dog in Chicago

• Autoimmune lymphoproliferative syndrome (ALPS) in dogs — This is a blockbuster two-part case report in the Journal of Veterinary Internal Medicine about a week ago. It describes a never-before-seen genetic syndrome that mimics lymphoma in a litter of puppies (don’t worry: they recovered with immunosuppressive drugs 😊)

• Epidemiology of four major canine tumors in the UK — This is a massive study (>130,000 cases) of the breed risks and other characteristics for mast cell tumor, osteosarcoma, hemangiosarcoma, and melanoma. This impressive work was the result of collaboration between private practices and universities analyzing the Small Animal Veterinary Surveillance Network (SAVSNET) tumor registry

• New study shows ChatGPT Health failed to identify medical emergencies — It inappropriately triaged over half of true emergencies, and in some situations failed to recognize obvious suicidal ideation 😬 This is a scary reminder that Large Language Model (LLM) AI is very-much not ready for prime-time, at least when it comes to consumer-facing health applications.

  

• Mississippi health system shuts down clinics statewide after ransomware attack — Finally, this story from NPR on a cyberattack crippling the largest health system in Mississippi is literally a plotline on season 2 of The Pitt. Sometimes life imitates art!

Alright, that’s it for this edition of Field Notes. Stayed tuned for more focused articles in the coming weeks!

—Eric

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The other day I saw a post on LinkedIn asking pathologists to share productivity tips to improve their efficiency. People discussed macros, dictation, and other workflow hacks. Some even brought up using AI. Everyone in the conversation meant well and wanted to help others save time during their work day. Yet all I could think about was a pathologist friend who recently mentioned to me that they were behind that day because they were reviewing a bone marrow aspirate sample with 32 slides.

Thirty two!

Why so many? Because their lab, like many I’ve worked for over the years, does not have a limit on how many slides hospitals can submit. When I worked at Auburn and IDEXX, it was common to review hundreds of slides a day. It’s not hard to arrive at the number: Minimum caseload benchmarks are often 40-50 cases a day, and if every case had only 3 slides—many cases had more—you’d be looking at 120-150.

It’s worth pointing out that such high caseloads would literally be illegal in the world of human medicine (at least in the US)—Regulations published by the Centers for Medicare and Medicaid Services cap the number of cytology slides evaluated every day at 100:

“The maximum number of slides examined by an individual in each 24-hour period does not exceed 100 slides (one patient specimen per slide; gynecologic, nongynecologic, or both) irrespective of the site or laboratory. This limit represents an absolute maximum number of slides and must not be employed as an individual’s performance target.” (emphasis mine)

Let’s imagine how long that 32 slide bone marrow case would take to review: If you spent only a minute on each slide (which is not a lot of time for such a complex tissue), it would take over half an hour to look at everything before even drafting the report, and that’s not counting any time it would take to look up any references or contact the clinician to discuss the case.

Now consider that veterinary pathologists working in high-volume labs have an average turnaround time (TAT) per case that is well under 10 minutes! Management does everything it can to reduce TAT and slower pathologists may get in trouble. Can you see the problem here? We have an unrealistic expectation for throughput butting up against a policy choice that makes it almost impossible to meet.

The end result?

Frustration in the short term, burnout long term.

Submitting unlimited slides is by no means the only common lab policy that drags efficiency down. Many labs require little to no clinical data when submitting cases. Like slide caps, it is because they don’t want to add any “friction” to their actual customers, referring veterinarians. However, this can lead to delays in case handling when there is not enough information to make a diagnosis, and you have to call or email the vet for answers that should have been originally provided. Ditto for when a client calls in after a report is finalized to say “Oh, by the way, I should have mentioned X, could that change your interpretation?” which usually triggers going back to slides to look again and then editing the report.

Many labs are increasingly using slide scanners to digitize slides and send them to specialists all over the world. This can improve TAT by allowing instant consultation with colleagues across the globe, balance caseloads that vary between regions, and allow diversion when one lab is impacted by disruptions from weather, illness, power outages, etc. It usually works great for histopathology slides, which are fixed tissues cut to a uniform thickness. Cytology smears, on the other hand, are very uneven globs of cells and fluid, which can cause problems with image focus and lead to a higher rate of non-diagnostic cases. This is just a limitation of the current technology, and the most appropriate way to handle is rejecting those cases either for re-scanning or shunting to a pathway of review on a regular light microscope. Unfortunately, many managers pressure pathologists into reading out as many suboptimal cases as possible to make their metrics look superficially better.

For another example, pathologists in some labs face extremely high standards for quality. In the abstract, this sounds like a good thing. The problem is when this bar is unreasonably strict. There is one organization that holds pathologists to an error rate of less than one in more than a years’ worth of cases! What do you think such a standard does? It makes you spend extra time, time you don’t have, trying to rule out rare findings like a lone infectious organism as a CYA. This problem is compounded by the ones discussed earlier (excess slides, digital image quality issues).

Now, I want to zoom out beyond just pathology. I’ve worked in clinical practice off and on since graduation in 2012, and counterproductive policies impact workers there, too.

Working relief shifts over the past year, my appointment slots are often double or triple booked. This inevitably leads to delays, which stresses out the vets and techs providing care and sets up pet owners for frustration.

Short-staffing exacerbates the problem. Sometimes this is unavoidable due to people calling in sick or with last minute emergencies, but there is often not a lot of urgency around filling those gaps. On one recent busy shift, we were down 50% of the number of technicians that were supposed to be scheduled. By some miracle we got through it on time, but it was a rough experience I wouldn’t want to repeat.

Computerized metrics to micromanage workflow are another pain point. It’s becoming increasingly common to have software that tracks patients in and out of rooms down to the second. Ostensibly this data is supposed to promote shorter wait times for clients and to inform staffing practices; in practice, it mostly results in getting reprimanded if you fall behind.

Finally, there is the big, bad, bane of every doctor’s existence: charting and paperwork. Documentation expectations only go one direction: up, Up, UP! In the “old days,” a simple hand-written “SOAP”1 progress note would suffice for each encounter. Today, every visit is accompanied by a slew of digital intake forms, boxes to check, dropdown menus for diagnoses, duplicative entries for billing, separate discharge instructions, and more. It should not be surprising that one study in human medicine found doctors spent almost as much time on electronic records as patient care, and those software systems were cited as a top reason for burnout in another study.

As I was brainstorming the ideas for this post, I read a great piece on LinkedIn about the tension between operations and medical leadership in veterinary companies by . This part in particular stuck out to me:

“Organizations that are dominated by medical people tend to be inefficient and unfocused. Historically, this has been the norm in veterinary medicine—a fact that highlights the great potential for operational growth today. Conversely, veterinary companies dominated by operations often suffer significant morale and retention problems among medical teams. A number of practice groups last year provided stark examples: they prioritized revenue growth by making operations completely dominant over medicine, quickly losing veterinarians and support staff, which led to closed practices and hastened their demise.”

Andy’s point is that there needs to be balance—no organization will thrive if it prioritizes only medical concerns OR financial/operational ones. There has to be mutual respect and understanding between both domains for the best outcomes for patients, staff, and other stakeholders.

Likewise, I’d say that individual productivity efforts are necessary, but not sufficient, for optimal efficiency and throughput; organizational policies are often overlooked. A good rule of thumb is if everyone is struggling with the same problem, it is probably more of a policy issue than the fault of any specific doctor. To go back to my first example: It doesn’t matter if you find a trick that shaves 30 seconds off your case handle time if you are buried under 30 slides that will take you half an hour to review.

I would go even further and suggest that pinning efficiency problems exclusively on individuals is a toxic morale killer that contributes to the burnout in veterinary (and human) medicine that puts so much pressure on staffing in the first place. We need to do better to maintain a healthy profession.

—Eric

Dear Readers,

The climate in early 2026 is wild, both in terms of news events and actual weather. Last weekend the massive Winter Storm Fern dumped snow and ice across the country, with the Appalachian and midwest regions being hit particularly hard. That trend seems to be continuing with Winter Storm Gianna turning into a “bomb cyclone” that threatens blizzard conditions from the Carolinas to New England. Believe it or not, the Tampa-St. Pete area is actually predicted to get flurries tomorrow! While friends and family in upstate New York might sneer at a mere chance of minimal snowfall (that surely won’t stick), keep in mind that impact is based on whether an area is prepared for any given conditions—there aren’t exactly a lot of plows or salt trucks around town! I’m more concerned about icy roads and panicked drivers than the snow, so I plan to stay warm inside and hang out with the family 😊

As we wrap up a turbulent first month of the year, I wanted to share several news items about human and veterinary medicine you might find interesting. Read on below for stories about the return of the beloved ER show The Pitt, restarting federal veterinary loan repayment incentive programs, and a cool study that evaluates how ChatGPT does at generating client educational handouts.

Acclaimed medical drama The Pitt returns

One of the surprise streaming hits last year was the medical drama The Pitt on HBO. Starring Noah Wyle of ER fame, it debuted with almost no hype or marketing, yet quickly became a viral sensation on the strength of its characters and writing. The first season combined heroic scenes of saving critical patients with tackling thorny social issues like addiction and controlled substance diversion by doctors, how trauma centers manage mass shooting events, and even topical concerns like vaccine hesitancy. It swept the Emmy’s last fall with 13 nominations and 5 wins, including Outstanding Drama and Outstanding Lead Actor (Noah Wyle).

The Pitt is the rare medical show that has won the acclaim of not only TV audiences and critics, but also health care professionals, who praise its realism and message. Even vets love The Pitt—there are a lot more parallels than you might expect! Unlike other shows set in a hospital, like Grey’s Anatomy (focused on soap opera drama), House MD (more of a detective show), or Scrubs (mostly a comedy), The Pitt goes to absurd lengths to capture every detail of anatomy, terminology, and workflow so that you really feel like you’re working a 15-hour emergency shift with the staff. Dr. Dhruv Khullar, a hospitalist at NewYork-Presbyterian Hospital, wrote a glowing review of the second season for The New Yorker (“What ‘The Pitt’ Taught Me About Being A Doctor”):

What’s special about “The Pitt” isn’t that it’s medically accurate, although it is. (I even learned a few things about how to insert an emergency chest tube.) What’s special about the show is that it offers a kaleidoscopic view of how societal problems have come to pervade medicine. In recent years, I have written about E.R. overcrowding, the toll that caregiving takes on families, the physical consequences of global warming, language barriers in health care, discrimination against patients with sickle-cell disease, corporatization in medicine, and the promise and perils of artificial intelligence. “The Pitt” handles each of these themes, and many more, with nuance and grace. It’s as if the show’s creators absorbed every important conversation in health care today—and somehow transfigured it into good television.”

The new season debuted on January 8th and releases its episodes old school, one every week for the next few months. Three hours into this chaotic 4th of July shift—the ‘gimmick’ is every episode represents one real-time hour, like the show 24—and I’m already hooked. Check out the trailer below and then start watching!

Federal veterinary loan repayment program begins accepting applications again

One major issue facing veterinary medicine going back decades is a shortage of DVMs working in rural and farm communities. Back in 2008, when I was still in vet school, I wrote an editorial about this problem for Progressive Dairyman1:

“What’s driving my peers away from food animal medicine? The 2006 AVMA report concludes that the primary reason new graduates opt out of production animal medicine is financial concerns – particularly the debt-to-salary ratio. More than half of graduating veterinary students owe over $109,000 in educational debt [EJF: That number has risen to $169,000 in 2024], according to the DVM Newsmagazine’s March 2008 story, “Economic Emergency.” That same article lists some other interesting facts, such as veterinary school tuition nationwide increasing 100 percent since 1997, while vet salaries only rose 46.5 percent during the same time period.”

To help with the recruitment and retention of rural vets, Congress created the Veterinary Medicine Loan Repayment Program (VMLRP) within the USDA in 2010. Awardees must commit to working at least three years in one of several hundred designated shortage areas in 46 states. In return, they are given money towards their student loan repayment. Originally, it provided $25,000 per year up to a max of $120,000, although these totals have increased over time to keep up with student debt growth. The program has distributed over 1,000 grants during its existence.

This program was discontinued last year as part of the broader freeze on federal aid and grants. However, the VMLRP has been re-instated for 2026, the total amount of funding has more than doubled from $8 million to $18 million, and the award amounts have increased to $40,000 a year with an additional amount to account for taxes on these funds. The new maximum forgiveness amount has also increased to $166,800 per applicant over the lifetime of the program.

AVMA News has an accompanying article about the impact this program has on vets who have participated. Here are just a few stories from VMLRP awardees:

• “Receiving the VMLRP was life changing for our family… It allowed me to continue to grow and invest money and time in my new veterinary practice” —Dr. Jody Kull, beef/dairy consultant in PA + assistant teaching professor at Penn State

• “I’ve been on an income-based repayment plan since graduation, and my payments have been too low to even cover interest… Instead of another 20 years, I should be able to pay off the majority of my loans after three years of government service [with VMLRP]” — Dr. Emily Sabo, Assistant State Veterinarian for Utah

• “Because I was able to gain so much experience working with egg-laying chickens, I will continue to seek employment and professional opportunities in this field” — Dr. Katie Schlist, poultry veterinarian in Minnesota

Separate from the VMLRP is the Veterinary Services Grant Program (VSGP), which is also run by the USDA. They offer several types of funding for rural vets that can go towards equipment purchases, overhead, and continuing education costs. The VSGP Notice of Funding document provides details, and you can email questions to: grantapplicationquestions@usda.gov

If you or someone you know would like to apply for the VMLRP, you can find eligibility details and the required forms HERE

Can ChatGPT generate accurate client educational materials?

I spend a lot of time criticizing large language models and AI in this newsletter. That said, in the interest of balance, I also try to highlight where it has potential to do good. One area that has long seemed ripe for chatbots to improve efficiency and understanding with clients is assisting with drafting educational handouts and discharges. These documents normally take a long time to write, and it can be challenging to balance medical accuracy with keeping the wording understandable for a general audience.

That’s why I was intrigued to see a recent study evaluating this very use case published in the Journal of Veterinary Internal Medicine:

“Utility of ChatGPT in generating accurate client handouts for common veterinary internal medicine diseases”2

In brief, researchers at NC State and the University of Tennessee used ChatGPT-3.5 to generate client educational handouts for three common diseases (canine diabetes, feline inflammatory bowel disease, and canine immune-mediated hemolytic anemia).3 They took the outputs and asked 50 pet owners how useful and understandable they were. A pre-study survey showed that the vast majority of these clients had either not heard of the diseases or knew little about them. The data showed that owners had a significant increase in their understanding of them after reading the AI summaries. Their median satisfaction scores with the documents (graded from 0 to 5, with 5 being the best) were 4/5 for two of them (diabetes and IMHA) and 5/5 for IBD. The full pet owner survey results are summarized below in Table 3.

Okay, you might be thinking, it’s great if pet owners like it, but do veterinarians think they are accurate?? To answer that, the second part of this study asked 67 internal medicine specialists to assess the AI summaries. The majority of respondents indicated they would use them with minor or minimal/no changes (76% for IBD, 71% for DM, and 50% for IMHA); only 12-13% said they would not use them at all. Table 4 shows the distribution of opinions. The median accuracy score for all three handouts was 4/5. The medicine specialists did provide feedback on content they thought should either be added or removed, as well as general feedback on grammar and medical terminology.

Overall, I think this study shows the promise of using AI chatbots to help with paperwork in veterinary medicine. While the handouts weren’t perfect, and common sense dictates you should always proofread and customize the copy, the surveys show it doesn’t require a ton of editing. These positive results don’t surprise me; in fact, one of my first posts in 2023 showed examples of how ChatGPT could do a pretty good job generating discharge instructions for cats with diabetes and dogs after cruciate ligament orthopedic surgery. It’s also worth pointing out that this study was done with a much older version of ChatGPT (3.5), and the current version of 5.2 is much more powerful. I would suspect even less editing would be needed if this study were repeated today.

ASVCP digital cytology guidelines published

Finally, I had already mentioned that these guidelines came out in the form of a white paper on the ASVCP website. But I’m pleased to announce that on January 6th, they were formally published in our specialty’s journal Veterinary Clinical Pathology! Give it a read today 🤓

Citation:

Fish EJ, Hoepp N, Matlow JR, Ammersbach M, Steinberg JD, Freeman KP, Hancock TS, Cian F, Piccione J, Korchia J, Moore AR, Harr KE. Digital Cytopathology Quality Guidelines. Vet Clin Pathol. 2026 Jan 6.

PS: If you don’t have institutional access to VCP, you can download the full paper PDF on ResearchGate…

Alright, that’s enough for January Field Notes, stay warm and safe through these winter storms!

—Eric

“The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.” — George Orwell, 1984

Yesterday, federal agents executed Alex Pretti, a 37-year old US citizen and registered nurse at the local VA hospital. Immediately following the shooting, DHS officials claimed he was a “domestic terrorist” who approached officials with a gun and threatened to kill them. ICE officers claimed they feared for their lives and fired defensive shots.

Those were lies.

Video of the murder, which I will not link to here (but they are all over the internet), shows Pretti approaching with a cell phone to record ICE officers, who then harass and shove him and a woman next to him, followed by pepper spraying both. The officers begin to hit them, and Pretti moves his body to shield the woman. At one point, one of the five-plus ICE agents pinning Alex to the ground removes a handgun from his rear waistband—which he legally possessed and did not grab for during the encounter—and walks away with it. Seconds later there is a gunshot, followed by nine more.

ICE shot an unarmed man 10 times in the back at point blank range.

You don’t have to believe me, witnesses have filed sworn statements (at risk of perjury) in court. Here is an eye-witness account from someone a few feet away:

Here is one from a pediatrician who watched from his home and then tried to help:

This incident comes just two weeks after ICE shot and killed Renee Good in her own car. The pattern there was the same: Initial claims of a protestor attacking agents who feared for their life, only to be wildly contradicted by numerous bystander videos from different angles.

DHS said that Jonathan Ross, the agent who killed Good, was “run over” by her car and that he was treated for serious injuries at the hospital. Yet video shows him casually walking down the street after without any apparent injuries, and one recording captures a male voice (presumed to be Ross) saying “fucking bitch.”

At this point, the federal government has proven itself to be untrustworthy, and we should not take anything they say at face value without corroboration. Their lying and gaslighting will almost certainly continue. They said a Cuban immigrant died by suicide in an ICE detention center in Texas; a medical examiner ruled the death homicide after a struggle, which matched eye-witness accounts. This administration is digitally altering images of arrestees for propaganda. They are baselessly slandering their victims as terrorists while hiding their own faces and destroying evidence.

These are not isolated incidents by a long shot, and it is not just Minneapolis or Los Angeles or Chicago. Here is a short, non-comprehensive recap of ICE brutalities from around the country from a recent post by :

Here’s a video of ICE agents in Arkansas beating up an unarmed U.S. citizen. Here’s a video of ICE agents arresting two U.S. citizens in a Target. Here’s a story about a similar arrest. Here’s a video of an ICE agent brandishing a gun in the face of a protester. Here’s the story of ICE agents arresting a pastor who complained about an arrest he saw. Here’s a video of ICE agents arresting an American citizen and punching him repeatedly. Here’s a video of ICE agents threatening a bystander who complained about their reckless driving. Here’s a video of ICE agents arresting a man for yelling at them from his own front porch. Here’s a video of ICE agents making a particularly brutal arrest while pointing their weapons at unarmed civilians nearby. Here’s a story about another ICE killing, this one in Maryland, under dubious circumstances. Here’s a video of ICE agents savagely beating and arresting a legal immigrant. Here’s a video of ICE agents storming a private home without a warrant. Here’s a video of ICE agents pulling a disabled woman out of a car when she’s just trying to get to the doctor.

[…]

For the past year, ICE has been involved in a series of escalating incidents that rarely result in repercussions for anyone involved. ICE agents have recklessly caused traffic accidents and then, in one incident, arrested the person whose car they hit. They’ve tear-gassed a veteran, arrested him, and denied him access to medical care and an attorney. They have attacked protesters merely for filming them in public. They’ve pepper-sprayed a fleeing onlooker in the eyes from a foot away. They’ve pointed guns at a 6-year-old. They’ve knelt on top of a pregnant woman while they arrested her. They have arrested another pregnant woman, then kept her separated from her newborn while she languished in custody. They have repeatedly arrested American citizens, and they’ve even reportedly deported a citizen, directly contradicting court orders.

This isn’t about politics or views on immigration policy, it is about basic right vs wrong. I don’t care whether you are liberal or conservative, we should all be able to agree that the brutalities above are immoral and un-American.

If you feel compelled to go out and peacefully protest, I applaud you1. If you are too afraid: trust me, I get it. Whatever you decide, the least we can do is bear witness: speak up and state the truth plainly. Fact check their lies with independent sources. Document any wrongdoing you see with photos and video and share them widely.

They want you to be afraid and silent.

Don’t be.

“I explained to him how naive we were, that the world did know and remain[ed] silent. And that is why I swore never to be silent whenever and wherever human beings endure suffering and humiliation. We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented. Sometimes we must interfere. When human lives are endangered, when human dignity is in jeopardy, national borders and sensitivities become irrelevant. Wherever men or women are persecuted because of their race, religion, or political views, that place must – at that moment – become the center of the universe.”

— Elie Wiesel, Holocaust survivor; 1986 Nobel Peace Prize acceptance speech

Dear Readers,

Short post this week as I’ve been feeling under the weather. It started with a little bit of sneezing this weekend. By Monday, I had a sore throat and a runny nose, and Tuesday I spiked a fever with other flu-like symptoms. A rapid covid test at home was negative, but I didn’t go to urgent care for a flu test because I already missed the window for antivirals.

Not wanting to repeat the events of last summer, I cleared my calendar for the week and stayed home, resting and pushing fluids and OTC meds. Luckily, today I’m feeling a bit better and hope to be back to normal tomorrow or Saturday.

What upper respiratory bug got me will remain a mystery, but based on the fever, duration, recent holiday travel, and national trends, it was probably the flu. You can find a handy chart comparing the typical signs of flu, colds, and covid from the Cleveland Clinic here. Many of my friends, especially those with young kids, have come down with the same symptoms over the past few weeks. Like last year, we’re facing another bad influenza season across the country, as you can see in this figure from Your Local Epidemiologist:

The strain of flu that is predominantly circulating this year is not the typical H1N1 virus (nor is it in any way related to H5N1 avian influenza). Rather, it’s influenza H3N2. You can read more about what makes it different from virologist Dr. Angela Rasmussen:

Rasmussen Retorts

What You Should Do About H3N2 Flu

I was on CBC’s The Current yesterday to discuss how the current flu season is shaping up so far. Across many parts of Canada, flu is surging in children. Three kids have died in Ottawa. Pediatric hospitals are filling up in Montréal. There is an emergent strain of H3N2…

Read more

6 months ago · 89 likes · 24 comments · Dr. Angela Rasmussen

While this subtype (with its recent mutations) appears to be less well-matched to the seasonal flu shot, the vaccine still offers good protection against hospitalization and death. This is important because H3N2 is generally more severe than H1N1 (but no, it’s not a “super flu” as scaremongers on the news have dubbed it 🙄). Unfortunately, flu vaccination rates have been plummeting since the pandemic, in large part due to misinformation on social media and even coming from the current CDC (sigh).

Whatever virus got me down this week, I’m glad I got vaccinated for both flu and covid this fall. There’s a good chance I’d be a lot sicker for longer without them. Remember that flu season runs through May in the Northern Hemisphere, so if you haven’t gotten your boosters this year, it’s not too late! And if you’re older, I would talk to your doctor about the pneumococcal and shingles1 vaccines, too.

Stay warm and healthy, everyone!

—Eric

Come writers and critics who prophesize with your pen
And keep your eyes wide, the chance won't come again
And don't speak too soon, for the wheel's still in spin
And there's no tellin' who that it's namin'
For the loser now will be later to win
For the times, they are a-changin'

— “The Times They Are a-Changin’,” Bob Dylan (1964)

Dear Readers,

There are years, and then there are years. 2025 was definitely the latter, filled with violent (both metaphorical and literal) unrest. So much happened you could remake the worst version of Billy Joel’s “We Didn’t Start the Fire” with headlines from just the last 12 months. Considering that, I will be taking a somewhat “big picture” approach to my annual wrap-up post, rather than focusing on superficial highlights like Substack metrics or most popular articles.

The chaos started in January with the new administration ordering mass firings, cuts to education and scientific research, and dismantling life-saving foreign aid. Spring brought masked ICE agents grabbing immigrants off the streets for deportation, sometimes to overseas prisons like CECOT in El Salvador. Over the summer, there were high-profile political killings that triggered a crack-down on free speech. Meanwhile, the economy groaned and creaked under the pressure of rapidly fluctuating tariffs, yet the stock market continued to soar thanks to a boom in AI that many (including me) began to suspect was a speculative bubble. And that’s not even considering dozens of other major stories that were important over the last year.

Amid the backdrop of cultural and political tumult, it was also a momentous year for me personally. I turned 40 and officially entered middle age. We said goodbye to our beloved dog Jack. My pathology career hit the skids, requiring me to go back into practice to make ends meet. I took a hiatus from writing on Substack for almost two months over concerns it was impacting my job search, before deciding to pick the pen back up.

***

One of my highlights of 2025 was traveling to Sicily in April. It was not just a vacation, but also a heritage trip of sorts for both me and my wife; we visited the rural farm towns where our ancestors lived over 100 years ago. History loomed large over the visit—the island of Sicily is a melting pot of many cultures due to its position as a major trade hub in the Mediterranean and repeated conquests by everyone from the Arabs to Greeks, Italians, and Normans.

This was most apparent on the day we hiked through the Valley of the Temples in Agrigento. Here lay the ruins of seven Greek religious structures dating back to the 5th century BCE. They are some of the best preserved temples outside of Greece; while some like the Temple of Heracles below consisted of only a few pillars, others like the Temple of Concordia are almost completely intact. Staring at 2,500 year old columns that stood more than 60 feet in the air filled me with awe. I thought about the lives of the people who built them. What were their hopes and dreams? Could they imagine that their way of life would end in the not too distant future? Or that thousands of years later, tourists who dressed and spoke like aliens would come to capture images of their work on small magical devices?

Visiting ruins like those in Agrigento is a humbling reminder that nothing is permanent, and we are all impossibly small in the grand scheme of geological time. The tyrants that seem invincible today will soon be gone and forgotten by everyone but historians. As King George III sings in the musical Hamilton:

“Oceans rise, empires fall

We have seen each other through it all”

Looking back on ancient cultures also gives me the long view perspective, rather than getting wrapped up in fleeting ephemera. I don’t have any illusions that people in 2,100 CE will know who Eric Fish is, but it does encourage me to focus on mentoring the next generation, and producing things like essays and research studies that will outlast whatever latest outrage is going viral on Twitter (I refuse to call it X).

***

For the last few years, I have set a yearly “intention,” rather than traditional New Year’s Resolutions. After the political turmoil of 2024, my intention for 2025 was to FOCUS ON ART. To this end, I switched from reading mostly non-fiction (primarily science/economics) books to 70% fiction. I had forgotten the simple pleasures of getting lost in another world, and it was a lot of fun.

At the beginning of the year I reviewed Bonnie Garmus’s hilarious and touching novel Lessons in Chemistry, about a woman struggling to succeed in the sexist world of science in the 1960s. Other highlights included classics like Ernest Hemingway’s novella The Old Man and the Sea (which I bought at his house in Key West), to the original dystopian cyberpunk novel Neuromancer by William Gibson, and the excellent speculative short story collection Exhalation by Ted Chiang. A few weeks ago, I finished Vineland by Thomas Pynchon1, about a group of former 60s hippies and radicals fighting corrupt federal agents in Reagan’s America; one of Pynchon’s least cynical books, Vineland suggests that family and community are the bulwark against corruption.

Besides reading more fiction, I also devoted myself to guitar. I tried to practice every day, and instead of only learning songs from tabs, buckled down and studied theory and scales. I’d still consider myself an “advanced beginner” or maaaaaybe intermediate guitarist, but losing yourself in music is a wonderful way to forget the drama going on in the world.

So for 2026, I am setting my intention to…

GO WITH THE FLOW

Pretty much every year since the COVID-19 pandemic has been characterized by dramatic upheaval. Yet this is nothing new, as Bob Dylan sang 62 years ago. So much of life, from health to careers to politics, is beyond our ability to predict or control (sometimes to even comprehend). The only way to stay sane is to let go of the expectation that we have much sway over external events. As I wrote almost a year ago in my review of the animated movie Flow:

Water is an ever-present symbol in the film, and it is constantly flowing forward, propelling the action and our characters. With the title literally named FLOW, impermanence seems to be the main message: Things are constantly changing, the world moves on. We often can’t control the turbulent storms of life. What we can control are our own actions. You can choose to fight the current or go with it and make the best of what you find down river.

***

Throughout the year, this newsletter was a lifeline that kept me sane. I’ve always felt I express myself better through prose than speech, and the act of writing is both cathartic and allows me to process my thoughts. On weeks where my calendar was empty, it gave me purpose to sit down at my keyboard and draft essays for you. After several of my posts this spring about my job situation, I received an outpouring of supportive messages from readers, including several residents I worked with over the past two years; I will be forever grateful for your kind words.

I don’t pretend to know what 2026 has in store for any of us. Only the most foolish offer confident predictions. However, I can say I deeply appreciate each and every person who reads these emails, and I wish you all a happy and healthy New Year!

—Eric

Dear Readers,

Apologies for the lack of updates over the past few weeks. After Halloween, it always seems like a whirlwind sprint towards Thanksgiving, Christmas, and New Year’s Eve, and between work and holiday travel, writing has fallen by the wayside. Soon I’ll be heading to western New York to see family, and one of my favorite places to visit when I’m home is Niagara Falls—it looks sublime when it freezes over in the winter, so I thought that would be a great header photo for this post.

Despite my hectic schedule, I did want to share a few interesting stories I recently came across, including an update on the vet school accreditation lawsuit drama, news about a company experimenting with Ozempic for cats, and an inspiring story about ocean research and conservation. I hope you enjoy!

Please note: If the email version of this article is cut off for being “too long” you can always find the full length version (and all of my other posts) at: allscience.substack.com

Updates on AVMA-LMU accreditation lawsuit

This June, Lincoln Memorial University (LMU) sued the AVMA over a dispute about vet school accreditation standards, particularly concerning research facilities and funding, alleging an antitrust conspiracy to restrict the supply of veterinarians. I provided my take in this essay:

The AVMA filed a motion to dismiss the suit in September on the grounds that any harms to LMU were hypothetical and may never come to pass. Indeed, the AVMA-COE allowed LMU to proceed with plans to open a second campus in Florida. However, the US Department of Justice has now weighed in by filing a “Statement of Interest” in the lawsuit, which is akin to an amicus brief (or “friend of the court” filing).

While the DOJ statement does not definitively rule on the merits of LMU’s claims, it is important because it preemptively shoots down several of the AVMA’s arguments, specifically that they are not exempt from antitrust suits due to prior approval by the Department of Education or because the specific claims are tied to state practice acts rather than a dispute over federal law. As Lance Roasa, who is both a veterinarian and a lawyer, told VIN News:

“It reads like a judicial opinion… it's almost as if the DOJ is deciding the case while dismantling the AVMA motion to dismiss. It's strongly worded and not vague. In my opinion, it makes certain defenses much more difficult for AVMA attorneys.”

I understand that ending the suit without ruling on the substantive issues could have broad implications for other professional degrees, such as medical school, law school, etc. Nevertheless, it strains credulity that the same administration that is firing vets at the FDA and USDA, slashing university funding, rolling back consumer protection regulations, and voiding bans on non-compete agreements suddenly has a good faith interest in the health of the veterinary profession or safeguarding the public, and I question their motives.

It’s clear that however this case is resolved, scrutiny over AVMA-COE accreditation policies and procedures is not going anywhere. In a separate case, Tuskegee sued the AVMA over being placed on terminal accreditation status for deficiencies in their finances, clinical resources, and NAVLE board exam pass rate, although they quickly dropped it when the AVMA agreed to reconsider its decision. This summer, posts alleging bias in how the NAVLE scores are calculated went viral on Reddit and other social media platforms. In response they are inviting an independent audit of the NAVLE exam. This is a great first step; now more than ever, the AVMA needs to prove their standards are consistent, defensible, and transparent, or they risk losing any role in supervising veterinary education, an outcome that will certainly be bad for all stakeholders, from animals to pet owners, students, and veterinarians.

GLP-1 agonists for fat cats?

Obesity is not just a serious problem for people, but also our pets. Like us, they suffer from many diseases linked to excess body fat, including cancer, diabetes, osteoarthritis, pancreatitis, and more. In my review of Dr. Peter Attia’s book Outlive, I talked about how being overweight dramatically shortens lifespan in dogs. In fact, studies have shown as much as a 15% increase in lifespan—almost 2 years!—from keeping dogs lean:

Cats are particularly affected since over half in the US are overweight or obese! However, as most pet owners know, keeping them trim is easier said than done. While we humans control what goes into their mouths, our canine and feline friends have gotten quite skilled at manipulating us, tugging on our heart strings for bigger portions and treats. This is where GLP-1 agonist drugs like Ozempic might come in handy: by reducing their appetite, they might stop begging their owners, making it easier to feed them an appropriate diet.

The San Francisco-based biotech company Okava Pharmaceuticals has started a clinical trial called MEOW-11 evaluating their GLP-1 agonist drug in cats. In contrast to people, who need regular injections, Okava will be using a small implant about the same size as a microchip to slowly release the drug over time. They will initially be looking at the drug’s safety and efficacy for obesity in 50 cats, with the results expected mid 2026. If their first trial is successful, Okava plans to expand with larger studies evaluating other indications such as chronic kidney disease and diabetes for which GLP-1s have been shown effective in humans.

I have to say that when I first heard about using GLP-1 drugs in animals, I had some very mixed feelings. On the one hand, it is treating a preventable issue related to modernity and will-power. Yet I’ve had cats my whole life and can attest to how difficult it is to ignore their begging, and determined pets can also get very skilled at finding ways to steal food! The target price Okava floated is certainly not cheap at $100/month, but you have to consider that in context of how expensive it is to treat complications of obesity:

• Diabetes: Insulin can run $100-300 or more per vial, and may need to be bought every few months depending on the dose needed

• Cancer: CHOP chemotherapy for lymphoma can run $5,000-7,000

• Osteoarthritis: Surgery to repair torn cruciate ligaments in both knees can be in the five-figure range

In the end, I’d say I’m skeptical but intrigued; let’s wait for the data before deciding. If GLP-1 agonists are shown to be safe and highly effective at weight loss and lifespan extension in pets, it would be a boon to people who can afford it.

Scientific diving leads to new CA conservation law

This last story is a neat one that combines several of my hobbies, including diving, watch collecting, and scientific research. Diver and Substacker recently wrote about his ongoing participation in Oceana expeditions sponsored by the luxury watchmaker Blancpain. One of their main objectives was to sample environmental DNA (or eDNA) in the water around the Channel Islands in the Pacific off the coast of southern California to analyze the biodiversity of the region. From one article on the voyage in HODINKEE:

“Think of it like a crime scene investigation underwater. That water he collects in his bag, or the water he brings up from 100 meters deep in a specialized tethered drop bottle, is then processed back on the boat using vacuum pressure and filters that capture the DNA present in the medium. The water is then discarded, and the filters, labeled for each location and time, are taken back to a lab for analysis, revealing every living creature that has passed through the water, including us, I suppose.”

Their data has since shown that over 12,000 unique species pass through the water around the Channel Islands! As a result of their expeditions, California recently passed and Governor Newsom signed into law Assembly Bill 1056, which bans gillnet fishing, a practice that is very harmful to marine ecosystems. At a time when so many business, government, and scientific institutions are failing us, it is great to see inspiring examples of research findings driving successful conservation efforts. I would encourage you to check out Jason’s post along with the HODINKEE write-up for some amazing photos of sea lions, scorpion fish and other marine life swimming through gorgeous underwater kelp forests.

SWIMPRUF

Channel Islands Dispatch, vol. 3

I’d felt pretty smug about my drysuit so far. While the wetsuit divers were shivering between dives, pouring hot water down the front of their suits on the boat, I casually slipped out of my 1950s-tech rubber suit and polarfleece thermals, warm and dry. But you know what they say about pride going before…

Read more

7 months ago · 31 likes · 1 comment · Jason Heaton

This will probably be the last All Science article of 2025 until my annual review post around New Year’s Eve/Day. In the interim, I wish you all a warm and joyful winter holiday with friends and family!

Cheers,

Eric

Today I had a very unsettling interaction online. It started when drinking my morning coffee and reading about the recent Hollywood dust-up where Quentin Tarantino slammed actor Paul Dano. A follow-up Google search revealed something peculiar: The AI summary got Tarantino’s statements completely backwards! Look at the screenshot below and compare to his actual quote:

“[Dano] is weak sauce, man. He is the weak sister. [Daniel Day-Lewis] is eating him [alive]. Austin Butler would have been wonderful in that role. [Dano’s] just such a weak, weak, uninteresting guy,” Tarantino said, per Variety. “Daniel Day-Lewis shows that he doesn’t need a strong foil. The movie needs it. He doesn’t need anything. It’s supposed to be a two-hander and it’s not! … you put him with the the weakest F*&^ing actor in SAG? The limpest dick in the world?”

Now, you might be saying to yourself, “Eric, you have too much free time on your hands,” or “Why do you care what movie stars say about each other?” Fair enough! However, I do think it provides a great example of several problems intrinsic to large language model chatbot summaries. First, and most obviously, it shows how poor their accuracy can be. Second, because Google is the most widely used search engine in the world, and these AI summaries are placed prominently at the top of the page, many are going to simply take whatever they say for granted. It’s bad enough that people increasingly just skim headlines instead of reading articles, but now we have to deal with blatant falsehoods injected into our search results.

“AI derangement syndrome”

That’s actually just the set-up for the negative interaction. I went to post my experience on a subreddit called r/BetterOffline. I thought that community might be interested because they are highly critical of AI and frequently discuss issues related to ChatGPT, Gemini, and other LLMs. Much to my surprise, my post was immediately deleted by the moderators.

When I messaged them to ask why it was taken down, they told me the post was “AI slop”!!

The conversation got nastier from there, with the moderator ultimately snapping “You have 23 community karma, stop pretending like you’ve contributed a single thing to this place. It’ll be a better community without you.”

I was stunned: WTF just happened? How did sharing a post about the problems of AI slop get labeled as slop itself??

Some people clearly loathe these chatbots so much that they see it lurking in every shadow, and can’t wait to tear down anyone they suspect of using ChatGPT (even if they didn’t). Commenters on the internet have dubbed this behavior “AI Derangement Syndrome” or “Anti-AI Psychosis.”

The new witch hunt

As is my wont, I think there are some broader lessons to be found in this anecdote about anonymous maniacs on the internet. I’m by no means the only person to be caught in the cross-hairs of the AI witch hunt. Every day on Substack I see some pile-on attacking a viral article as “obvious slop”; having people say the same about me when it was 100% false makes me certain a lot of them are baseless, too.

Recently, fans of the online battle royale game Fortnite blew-up over claims that graphics in the game were generated with AI tools, such as this one:

Believe it or not, the graphic designer who created that decal received hate mail and even threats from angry gamers! Sean Dove finally debunked it by showing a time lapse video of him creating the illustration manually, layer by layer:

Similar accusations have been lobbed at students for cheating on homework and exams, with often dire consequences ranging from failing grades to losing a scholarship. While it’s certainly true that many students have been using ChatGPT and similar tools to do their assignments, it is absolutely not universal, and the allegations are often based on very flawed “AI detection” software or crude heuristic “tells.”

The madness has gotten to the point where any writing that uses an em-dash or lacks typos is assumed to be robot copy! Sorry, Emily Dickinson, I guess you were just an early pioneer of “slop” in the 1800s 🙄

This creates a perverse situation where some of the sharpest students will be accused of cheating due to their high-quality work, while weaker ones can potentially use chatbots to cheat and take steps to cover their tracks (like introducing minor errors and tweaks to throw off AI detectors).

A future where everything is in doubt

All of this really bums me out. This climate of finger-pointing creates a no-win scenario, where whether or not you choose to use LLMs (in either a minimal or heavier capacity), angry mobs may attack you.

I spent this week working on two different pieces for All Science, and ended up publishing neither. The drafts were meandering, I couldn’t get the tone or the closing points right. Was I tempted to use ChatGPT to help me through the writer’s block? Sure was! However, I refused because not only do I take great pride in my writing, but I believe that the best pieces come from struggling with a topic until you find the perfect angle. And yet sharing some original writing about the pitfalls of LLMs still got me on the receiving end of pitchforks!

This problem goes beyond the hurt feelings of individual artists. Consider generative AI tools to create life-like images and even videos. The technology has come a long way since the six-fingered hands and uncanny lighting that gave away DALL-E images immediately. Google’s recently released Nano Banana Pro1 model produces scarily-accurate images like these:

We are not prepared for a world where anything we see online can potentially be a computer-generated deep-fake. This will rapidly erode our already fragile sense of shared reality, and the ubiquity of synthetic media will actually enable bad behavior, because people can now say any photographic evidence of wrongdoing is plausibly an AI hoax.

This is what I think the anti-AI witch hunt is really about: Fear of a rapidly-approaching future where you can never be 100% certain something you didn’t witness in person is true. The original artist is often an incidental casualty.

How do we cope?

Verifying anything important with trusted sources rather than relying on anonymous accounts on social media will become more important than ever. We may be able to make progress with better watermarks and forensic tools to confirm originality of content, although this will require the tech companies’ collaboration. Individual writers, musicians, and graphic artists might want to practice “defensive creativity” by documenting intermediate steps that show their work, like the Fortnite illustrator Sean Dove.

It’s ultimately going to take years of society getting used to these tools for us to adapt and find a healthy-ish equilibrium. In the mean time, you can help by not screaming at artists and shaming them for using AI (because they may very well be innocent).

—Eric

Like millions of American kids, I grew up watching Mr. Rogers’ Neighborhood on PBS. His puppet show taught generations of children the importance of traditional values like acceptance, kindness, and empathy. Fred Rogers was also way ahead of his time in talking about mental health and managing feelings in an often scary world, concepts that today we would probably label as “mindfulness” or “dialectical behavioral therapy.”

Fast forward to 2025, and I can’t shake the feeling that a lot of the people currently in charge are in desperate need of Mr. Rogers and his lessons. We just ended the longest government shutdown in history (over healthcare subsidies for the poor and middle class) where this administration repeatedly fought in court to deny people food assistance. Masked federal agents are arresting anyone they suspect of being an illegal immigrant (including legal immigrants and citizens) and often violating their civil rights. Corruption in business and government is rampant, with bribes being transparently traded for favors and pardons, especially using crypto that financially benefits the president’s own family. Tech titans like Elon Musk celebrate slashing social security and AIDS assistance to poor nations even as they collect billions in federal subsidies paid for by your tax dollars. Congress has all but abdicated any oversight authority and the Supreme Court is largely rubber-stamping these abuses of power.

As if all of that wasn’t depressing enough, millions of Americans actually cheer this on! Two of the most common phrases to sum up this era are “the cruelty is the point” and “F$%& your feelings”. Our country is intensely divided, and a lot of days I despair we’ll ever be able to come together again, heal, and move forward. To sum it up, I’m often running short on hope.

In times like these, one of Fred Rogers’ most famous quotes comes to mind:

When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping [and] you’ll know that there’s hope”

Rogers went on to urge journalists to stop focusing exclusively on the negative and highlight those who rush towards disasters to save their fellow man. Even though this world can be filled with ugliness, we should take comfort in the fact that so many everyday people, from EMTs to doctors and nurses, firemen, police officers, and the clergy work around the clock to relieve suffering after tragedies.

As with everything in the 21st century, that phrase has gone through its own cycle of “controversy,” with some suggesting that it lets people off the hook for taking action to help themselves or solving systemic issues1. I think that criticism distorts what Rogers meant. First of all, his message was intended to soothe young children who can’t make sense of the complexities of the adult world. Second, it should be obvious that seeing folks serving others in need inspires hope and joy, whereas cynicism breeds apathy. Finally, I would argue that it does not absolve adults of responsibility; if anything, it suggests we should join those helpers on the front line!

Even in the worst of times, there are always generous people coming to the aid of others, and we should focus on them at least as much as those causing trouble. Here are just a few examples…

Erez Reuveni was a lawyer for the Department of Justice for over 15 years. He was thrust into the spotlight this spring when he refused to lie in court about immigrants like Kilmar Abrego Garcia that were scheduled to be deported to Venezuela. Reuveni was put on leave and shortly after fired. Since then, he has fought back by filing whistleblower complaints about what he saw at the DOJ and will be testifying in contempt proceedings against the administration. Recently, he joined the non-profit legal organization Democracy Forward to use his expertise to represent immigrants, the poor, and those with civil rights claims, saying “all people have a right to safety, liberty, due process, and to me personally, it’s very important to fight the fight that articulates that point of view.”

This summer, the Senate passed a budget bill that zeroed out federal funding for the Corporation for Public Broadcasting (CPB), the agency that created PBS, NPR, and funds many affiliate public media outlets. With that massive funding cut, those small local stations are more reliant on individual donations than ever before. So John Oliver, who hosts the HBO comedy-news program Last Week Tonight, took it on himself to auction off many wacky items from his show—including an original Bob Ross painting that was never before on the public market—to raise money for the Public Media Bridge Fund. They ended up raising over $1.5 million dollars, along with increasing awareness of the plight of public media. If you want to give to a local station you can visit https://adoptastation.org/, and you can watch the whole segment below2:

In my own neighborhood, the non-profit Feeding Tampa Bay stepped up to support federal workers who were fired or furloughed during the shutdown. During those six weeks, they distributed an additional 200,000 meals a week (on top of their usual 1.9 million/week)! I’m happy to say that I donated to FTB and also volunteered to sort and load food in their warehouse. It felt really good to get out of my head and into the community giving back, and I plan on continuing to work with them. There is no better cure for feeling helpless than taking action, even in small ways.

We’re all inspired by grand gestures, but you don’t need to be a philanthropist with deep pockets or a politician fighting for justice or a trauma surgeon working over the holiday to make a difference. Small acts like helping someone with their luggage on a plane or giving up a seat for someone push back against the poisonous sense that society is a selfish free-for-all. Even a smile and friendly chitchat with an exhausted retail worker on Black Friday could make someone’s week.

As the days grow shorter and colder, and we find ourselves discouraged by the news all around us, remember to look for those underreported acts of service. I don’t know if karma is true in the cosmic, metaphysical sense, but one thing is certain: every time we say a kind word or do a good deed, we make the world a little better. When you gather with family and friends this holiday season, don’t just give thanks for your blessings, resolve to become one of the helpers and fight back. Darkness can only be driven out by light, and it is all of our responsibility.

—Eric

Dear Readers,

The header image for this edition of Field Notes is the gorgeous Golden Ears mountain range in British Columbia, Canada. They were the stunning backdrop for my daily commute during a locum block outside Vancouver a few weeks ago. If you ever have the chance to visit, I highly recommend it!

Today we’ll be discussing some recent industry stories I thought were worth your time. They include drugs approved for New World Screwworm, reports of viral outbreaks that might be tied to vaccine hesitancy, and thoughts on a recession in veterinary medicine and the AI economy. As always, please share any questions or comments below!

—Eric

Screwworm Updates

In last month’s Field Notes, I wrote about the ongoing threat of New World Screwworm (NWS) in Mexico and Central America. There have been several updates worth mentioning. To start with, at the end of August, a person in Maryland was diagnosed with the first human case of screwworm in the US. The infection appears to have been acquired during travel to El Salvador, rather than domestically. The USDA has set up surveillance traps in Maryland, Virginia, and the District of Columbia (all of which have been negative).

Second, there are now several new treatment options to combat this parasite! The FDA has conditionally approved Dectomax-CA1 for cattle. This injectable form of the anti-parasitic drug doramectin can kill the Cochliomyia hominivorax larvae and prevent re-infestation for 21 days. Doramectin was already approved to treat other insect and nematode (worm) infestations in cows and pigs. The meat withdrawal is 35 days.

A few weeks ago, the FDA also granted emergency use authorization for Credelio (lotilaner) to treat NWS in dogs. This is an oral medication that comes in the form of chewable tablets. Credelio has a high margin of safety and demonstrates “100% overall effectiveness… against C. hominivorax larvae at 24 hours.”

While veterinarians and the public need to remain vigilant monitoring for any possible cases of NWS, it is great to see us getting new treatment options to help the animals who become infected.

Virus Outbeaks and Vaccine Hesitancy

The Pan-American Health Organization recently announced that Canada can no longer be considered measles free amid more than 5,000 cases, including two deaths (both babies), and transmission over 12 consecutive months. Canada first eliminated measles in 1998 and maintained that status until now. The United Status eliminated measles in 2000, and because we were able to stamp out small outbreaks along the way, we remained technically “measles-free.” However, we are likely to lose that status in early 2026 as the virus continues to spread throughout the country.

Why is measles surging across the Americas? The key factor is a declining MMR vaccination rate in children. Measles is among the most contagious viruses known to man: It has a “basic reproduction number” between 12 and 18, meaning that a single person with measles would be expected to infect up to 18 other people! That is why we need at least 95% vaccination rates to ensure “herd immunity,” a term for enough people who are immune to break transmission chains. Unfortunately, these rates have been dropping for years, most acutely after the COVID-19 pandemic. The rate of MMR vaccination in young school children is now only ~92%:

Another story about a different virus highlights the importance of animal vaccines. The CDC recently published a report about a cat from a feral colony who tested positive for rabies. Contact tracing found over 300 people were potentially exposed, and a subset required post-exposure prophylaxis (PEP). The CDC concluded:

“Trap-neuter-return programs that do not incorporate rabies prevention components might inadvertently increase risks for humans and animals.”

Last year, I wrote about disturbing studies showing that pet owners were increasingly resistant to routine vaccinations, a trend I’ve personally witnessed on shifts. There also appears to be a correlation between attitudes about human and animal vaccinations, with those who expressed skepticism about getting shots for themselves being more likely to have an unvaccinated pet, and also to oppose mandatory rabies vaccination programs.

Clearly, we have a growing public health issue on our hands, and it is incumbent on those of us in vetmed to do our best to counter the misinformation that makes people afraid to vaccinate themselves or their pets against deadly illnesses. Even for “less serious” diseases, it’s a good idea to prevent illness for yourself and others in the community! I got my flu and covid shots last month and would urge you to talk to a healthcare provider about doing the same.

Veterinary Industry in Recession?

Back in August, I wrote about employment data showing the US economy was weakening as well as anecdotes suggesting veterinary medicine specifically was struggling. Many people in the animal health industry still think it is “recession proof” or “recession resistant,” and shrug off declining visits and client spend.

We now have some concrete evidence corroborating my concerns. A new study by former AVMA Chief Economist Matthew Salois, PhD and colleagues at Cornell (“Anticipating the downturn: business cycle forecasting for veterinary practice strategy in the United States”) sheds light on recent and predicted future market trends.

The researchers looked at inflation-adjusted veterinary revenue and modeled it against macroeconomic indicators going back decades, and found that veterinary medicine has its own business cycle that is related to, but separate from, the broader economy, and can lag those trends. Their model shows that veterinary service expenditures surged during the COVID-19 pandemic followed by a reset to baseline.

However, they also found that “the industry entered a recessionary phase in late 2024. Prediction intervals suggest persistent negative growth through mid-2026.” Keep in mind that any such recovery assumes no major changes to the economy from present conditions.

In the Discussion section, Salois and his authors break the veterinary business cycle into distinct phases:

• Recovery

• Expansion

• Contraction

• Recession 👈 we are here

They have different practice recommendations for the good times vs the lean times. I have created an infographic to illustrate some of the broad themes, but this is greatly oversimplified, so I recommend you read the full paper to get the nuance.

What’s Going On With AI??

Any discussion about the US economy wouldn’t be complete without talking about AI, because it has been responsible for most of the GDP growth and a surging stock market in 2024-2025. Given this close dependence, there’s one question on every investor’s mind:

Does AI represent a *bubble* ? And if so, when will it pop and how bad will it be??

I’ve started and scrapped a number of posts on that topic since the summer, always feeling conflicted because I am not a financial professional or a subject matter expert in AI. However, sometimes outsiders can see things that insiders miss, and I feel like I owe it to my readers to provide my perspective. My basic thesis goes like this—Financial crises happen when a perfect storm of conditions occur:

1. A narrative about huge returns investing in a new area drives greed and FOMO

2. Excessive and risky debt inflates the bubble

3. External shock(s) deflate excitement, capital flees, loans default

If that debt is intertwined with mainstream banks, point #3 becomes dangerous to not just Wall Street, but also Main Street. We’ve seen this cycle many times before with the boom and bust of the railroads (19th century), the dot-com bubble (1999-2001), and the mortgage crisis (2007-2008) and Great Recession.

In my personal opinion, the rapid growth and outsized investment in large language model (LLM) AI meets all of these conditions. While LLMs are cool and powerful, the narrative has gotten way ahead of its actual capabilities, with people talking about AI imminently taking over all jobs and/or destroying humanity (spoiler alert: neither will happen). Data center buildouts that were initially funded by investor dollars and company profits are shifting to opaque, high-interest private credit loans and ‘special purpose vehicle’ debts that are owned by regular banks and pension funds. And finally, the shocks are a combination of government policies that are hurting the economy and a sudden market realization that the returns from AI might not justify the exponential capital expenses (CapEx).

During speculative bubbles, there is often a lot of fraud and circular dealing. Things reached a fever pitch this summer when almost weekly the big tech players were announcing investments in each other for sums so large they might as well be Monopoly money. This infamous Bloomberg infographic illustrates the madness:

Then, just a few weeks ago, OpenAI spooked the markets with a series of boneheaded mistakes where Sam Altman flipped out on one of his own investors for asking about their revenue on a podcast interview and their Chief Financial Officer suggested OpenAI might need a bailout.

Since then, things have been sinking. The Nasdaq, which is a proxy for the tech industry, went from huge returns over the past two years to closing in the red over the past month. AI heavy-spenders like CoreWeave, Oracle, Meta and Palantir have cratered over the past three months. And the chip giant Nvidia that just passed a $5 trillion market cap is showing signs of slowing growth. All eyes are on their earnings report this Wednesday, and if they don’t show evidence of continued boom times, the whole sector might crash.

Big time investors seem to be tipping their hands, as Peter Thiel and Softbank just dumped all of their Nvidia stock, and Michael Burry—yes, the guy from the Big Short who called the housing bubble—revealed he was massively shorting Nvidia and Palantir. Only time will tell if they were right or not, it’s certainly going to be an interesting ride…

For anyone interested in further reading, I would suggest several articles from people smarter than me with more expertise in this area:

• “OpenAI, Nvidia fuel $1 trillion AI market with web of circular deals” (Bloomberg)

• “Will data centers crash the economy?” (, Substack)

• “How high are OpenAI’s compute costs? Possibly a lot higher than we thought” (Financial Times)

• “Global Crossing is reborn…” (Praetorian Capital)

• “Meet CoreWeave, the AI Industry’s Ticking Time Bomb” (The Verge)

• “Oracle is already underwater on its ‘astonishing’ $300bn OpenAI deal” (Financial Times)

Conflict of Interest Disclosure: I have rotated my personal investment portfolio away from the tech sector based on my convictions about an AI bubble. I have also made decent profits shorting some of the companies above. This is not financial advice, make sure to do your own research.

Closing Thoughts: News You Can Use

If you think it’s a bummer to read about bad news, it’s also not a barrel full of monkeys writing about it! Some people might accuse me of being a Debbie Downer or even catastrophizing, but my goal with everything I share in this newsletter is to empower you with information to take action when and where appropriate. For some things, like screwworm, knowing what to look out for is useful for farmers, pet owners, and vets alike, and now we luckily have new tools in the arsenal to treat the problem. For vaccine hesitancy and declining rates, you might not be able to change the behavior of an entire nation, but you can keep yourself and your family protected with immunizations, and have the kind of delicate one-on-one conversations with skeptics in your life that might change someone’s mind.

Looking at both the economic and AI market trends, forewarned is forearmed. For individuals and organizations who shares my worries, now is a great time to reassess your financial situation and risk appetite, not after a market downturn is underway. Making sure you have a cushion of savings in case of any job disruptions or investment losses is advice that will never go out of style. And remember, even when times are tough, things always eventually bounce back. Smart decision making will keep you well-positioned to weather any storms in the meantime.

I’m going to let you in on a secret: A lot of tests in medicine are unnecessary.

Actually, it’s not a secret at all, but a well-known issue in healthcare.

When we say “unnecessary,” this can mean several different things. One possibility would be a test for a condition the patient is extremely unlikely to have, like an exotic infection only found outside the US for a patient with no travel history. Another could be one where the test results won’t change the treatment plan or add clinically useful information (such as prognosis). This could also mean a test that is not validated or can’t provide the information desired.

Over-ordering diagnostics has a number of harmful impacts on patients, ranging from higher medical bills, to stress and anxiety, to complications from sample collection or exposure to radiation (for imaging tests). These negative effects are amplified because tests tend to drive more tests: A weird result on one will require follow-up to figure out what, if anything, it means. And for common tests like routine bloodwork, you should know that the way reference ranges are calculated only covers 95% of normal patients, so the odds of having an “abnormal” result by chance on a panel with a dozen or more parameters is quite high.

The financial aspect is particularly relevant to veterinary medicine, where clients often have limits on the amount of money they’re willing or able to spend on their pets. The so-called “minimum database” recommendation of a complete blood count (CBC), chemistry panel, urinalysis, and imaging of the chest and abdomen can often run in excess of $1,500!

Most physicians (about 75% in one survey) agree that over-testing is a serious concern, the hard part is understanding why it happens, and what to do about it. As someone who has advanced training in laboratory diagnostics and still practices clinical medicine, I think that I am uniquely well-suited to discuss this problem. So today, let’s tackle the issue head-on!

An Epidemic of Low-Value Testing

How common are such “low-value” diagnostics? Estimates from individual studies suggest that anywhere between 40 and 60% of tests provide little to no benefit! A 2013 meta-analysis by researchers at Harvard Medical School looking at inappropriate diagnostic test ordering found that almost 1 in 5 tests were unnecessary (“over-utilization”). This rate did not differ much between studies in the US or other countries, nor did it vary by test type (hematology, chemistry, microbiology, etc).

To be fair, this meta-analysis also looked at under-utilization of diagnostics, meaning tests that should have been ordered but were not. Their results actually suggested under-utilization was more common than over-utilization (44.8% vs 20.6%). The authors of the study summed up this seeming contradiction in a blog post:

“It’s not ordering more tests or fewer tests that we should be aiming for, it’s ordering the right tests, however few or many that is”

While I could not find specific studies looking at over-testing or overdiagnosis in veterinary medicine, the prevalence is likely at least as high as in human healthcare.

Examples of “Bad” Diagnostics

What are some examples of tests that “should not” be run? This is a tough question because there are a truly staggering number of possible options a healthcare provider could order, and a test that would be appropriate for one patient might be a waste of time or money for another. Quest and Labcorp offer thousands of specific assays, and the catalog for veterinary diagnostic companies like Antech and IDEXX list hundreds of test codes that can be ordered separately or in combinations.

In 2012, the American Board of Internal Medicine (ABIM) launched the “Choosing Wisely” campaign to highlight examples of low-value diagnostics, drugs, and procedures that were not routinely recommended. In the 11 years after, the initiative expanded to more than 21 countries and published over 600 recommendations. While the formal Choosing Wisely campaign ended in 2023, a number of professional societies continue to update those guidelines. Some of the recommendations include1:

• Patients who faint but don’t show any other neurologic signs don’t need a CT/MRI

• Don’t order a frozen section biopsy (STAT) unless it will impact immediate care

• Pre-op chest X-rays don’t add value for routine procedures in healthy patients

• Start with a TSH to screen for thyroid disease (rather than full panel of T3, T4, etc)

• Base plasma transfusion needs on a patient’s bleeding status, not clotting times

For the veterinary side, there are a few groups that put out best practice documents, like the AAHA guidelines and ACVIM consensus statements. However, these are usually broad in scope and based more on expert opinion than published evidence (because it is often lacking). I’m not aware of any organization in our field that has specifically investigated effective utilization of diagnostics.

When I think about diagnostics in veterinary medicine that are low-value, here are a few that jump out:

• Cytology of mammary masses in dogs

  • Cannot accurately differentiate benign from malignant tumors

• Regular X-rays of the skull for sinus/nasal pathology

  • Poor detail compared to CT, rhinoscopy, and other modalities

• Anti-platelet antibody testing for immune-mediated thrombocytopenia

  • High rate of false positives and negatives

  • Does not change management or improve outcomes

• Many FIP diagnostics

  • Most cats have been exposed to feline coronavirus, so serology has poor sensitivity and specificity

  • PCR for feline coronavirus can be useful when run on body cavity effusions, but it is not accurate when run on blood or previously-stained cytology slides

• AI diagnostics in radiology and pathology

  • These often have little to no published data to show that they work

  • “Black box” nature means it can be impossible to troubleshoot weird results

• Novel “cancer screening tests”

  • Often not validated

  • Many can’t tell you where or what cancer might be present, so they often trigger a frustrating fishing expedition work-up

Reasons for Inappropriate Ordering

I don’t think most clinicians consciously think to themselves “I am going to order a pointless test.” Rather, there are a lot of subtle reasons that lead physicians and veterinarians to err on the side of ordering a test vs a more conservative approach.

Defensive Medicine

As the ABIM survey graphic above shows, a major driver of test ordering in human medicine, and likely veterinary medicine as well, is fear over legal liability. In fact, just yesterday the New York Times published a story on “the worst test in medicine” (continuous fetal monitoring), with lawsuits being one of the main factors:

“Obstetricians are more likely to get sued than doctors in any other medical specialty. Monitoring records often become critical evidence, with expert witnesses on each side offering competing interpretations.

In July, Ms. Gunn represented a Missouri family who won $48 million — the state’s largest malpractice verdict in decades — after using monitoring records to claim that a hospital was responsible for a baby’s cerebral palsy. In a similar case that month, a Pennsylvania court ordered a hospital to pay $207 million. A Utah judge went even higher in August, awarding $950 million to the family of a brain-injured baby.”

It’s not hard to see how the threat of an eight or nine figure malpractice settlement, to say nothing of insurance premiums or damage to career, leads to an excessively cautious approach! In that same 2014 ABIM survey of physicians, 91% said that medical malpractice reform would significantly reduce such “defensive medicine.”

I’d also argue that fear of judgment from colleagues is a closely related phenomenon. The conditioning starts early, with med students seeing their faculty members questioning, or even chastising, the case management of referring clinicians. Nobody wants to look like an incompetent doctor that missed an obvious diagnosis, so running an extra test or two to CYA can seem like a small price to pay.

Diagnostic Uncertainty

In a perfect world, every disease would be black and white, and doctors would have 100% certainty in their diagnosis and treatment plan. Unfortunately, in the real world this is often not the case. Patients can have atypical presentations of common diseases, where they lack many of the key signs and symptoms. They can also have multiple concurrent pre-existing conditions, and be on several medications, which muddies the waters.

A practitioner might be correct about a patient’s diagnosis, but lack confidence and defer to more testing to reassure themselves. I would argue that my doctors performed a lot of unnecessary infectious disease tests when I was hospitalized last summer because they were not confident it was simply a case of community-acquired pneumonia (it was).

Research has shown that younger doctors are less tolerant of diagnostic uncertainty than older colleagues, as noted in this study from the Journal of Veterinary Medical Education:

“Results suggest pathology professionals become more tolerant of ambiguity (TOA) throughout their careers, independent of increasing TOA with age, and that navigating ambiguity might be more difficult for trainees than for professionals. Educational interventions might help trainees learn to successfully navigate ambiguity, which could impact psychological well-being.”

Helping younger colleagues navigate these “gray areas” of medicine may reduce unnecessary testing.

Not Understanding How the Test Works

In some cases, a misunderstanding about how an assay actually works can lead to ordering something inappropriate, or even a misdiagnosis. There are plenty of examples:

— Running a saline agglutination test incorrectly or when it isn’t called for → False positive IMHA diagnosis (My first All Science article was on this issue!)

— FIP PCR run on previously-stained cytology slides → Feline coronavirus is an RNA virus, so the cellular material on a slide that has been sprayed with a bunch of chemicals and stains will be exposed to RNAses and other compounds that degrade the viral genome (false negative)

— Running a test for a rare pathogen (I.e. Leishmania in a US dog with no travel history) → When the prevalence of a disease is very low, most positive results are likely false positives

— Submitting flow cytometry or PARR on blood with very rare atypical cells → any possible positive signal will be buried in background noise (false negative)

Excitement About New Technology

Doctors are scientists at heart, and many of us are eager to try out new devices and procedures because we’re largely a pro-technology group. However, just because there is a splashy new test on the market doesn’t mean it is better than the existing standard!

Right now, artificial intelligence is all the rage and there has been an explosion in “AI-powered” lab and radiology tests. Last summer I wrote a piece about the many problems with a new machine learning thermography device that claims to be able to “rule out cancer” without a biopsy:

Likewise, another trendy topic has been screening blood tests that claim to detect cancer earlier. Many of these have low sensitivity and/or specificity, and none to my knowledge have demonstrated that earlier diagnosis improves survival times to justify their expense.

Financial Incentives

Finally, we have to talk about the elephant in the room: $$$

While I don’t think money is the major motivation for ordering tests—and physicians surveyed reported it as one of their lowest considerations—it is undeniable that diagnostics make up a substantial portion of hospital revenue.

In veterinary medicine, many DVMs are paid on a percentage of their production, so ordering more tests means a higher salary. Most vets I know are in it for the love of animals, and a lot are frankly terrible at business, frequently discounting their own services. The most plausible impact of financial considerations seems to be in marginal or gray area situations where you can think of arguments for and against running a particular diagnostic, and it serves as a tie-breaker, of sorts.

Solutions

At this point, hopefully I’ve convinced you that excessive testing is a problem, and discussed some common reasons why it happens. What do we do about it? I think there are three groups of stakeholders that can make a difference: medical organizations, individual clinicians, and patients (or pet owners).

Institutions

Efforts like “Choosing Wisely” and the ASCP guidelines for responsible testing are a great start! We desperately need similar efforts in veterinary medicine, and organizations like the AVMA, AAHA, and ACVIM should lead the way.

One of the big limitations is a lack of research in this area. I would argue that veterinary academia should prioritize conducting comparative effectiveness research on existing tests at least as much as developing new tests, especially since the private sector has less incentive to publish any information that reduces the market for their own products, and there is no equivalent to the FDA or CMS-CLIA.

Veterinary schools should also strive to set a better example for students and not denigrate the choices of their colleagues; they were not in the room with the owner or pet, so they don’t know all of their considerations. CVMs could also start introducing the concept of “spectrum of care” and formulating flexible care plans.

Clinicians

Individual physicians and veterinarians are the ones who actually order these tests, so we are in a key position to address the problem. We should constantly be asking ourselves:

• Will this test change what I do, or am I just curious or seeking reassurance?

• What is the evidence this will improve length or quality of life for my patient?

• Am I submitting the right type of test on the right sample to answer my question?

• Has this test been rigorously validated by an independent organization?

Patients

At the end of the day, patients (and pet owners) have the ultimate control because they can give or withhold consent for any care plan. I would recommend asking tough questions of your doctor, and the list below from the Choosing Wisely campaign provides some helpful prompts. If they don’t feel something is necessary, you can always consider a second opinion, but I would caution against serial “doctor shopping” to get what you want; note that in the ABIM survey, a common reason for ordering a low-value test was to placate an insistent patient!

Inappropriate testing is a serious issue, but together we can make better choices. If you have any comments or questions, leave a message below!

—Eric

Dear Readers,

It has been a while since I have published an interview on All Science, and today we have a very special edition of “5 Questions…” with ! Dr. Smoliga is a Professor and Director of Research at the Tufts University School of Medicine, in their Physical Therapy program in Seattle, WA. Interestingly, he originally trained as a veterinarian before shifting careers into human sports medicine research! James writes about science for a general audience in his Substack newsletter “Beyond the Abstract” 👇

Beyond the Abstract

Deep-diving into health research, sports science, and academia to uncover the real stories behind the headlines—written by James Smoliga, DVM, PhD, professor at Tufts University School of Medicine.

By James Smoliga, DVM, PhD

Dr. Smoliga graciously provided thought-provoking answers to my questions about bad research practices, how to interpret supplement health claims, and his views on the recent funding and policy changes happening in academia. I hope you enjoy!

—Eric

1. You recently wrote about your unusual career path, graduating from vet school at Cornell in 2003 before pivoting into a PhD focused on exercise physiology, followed by working exclusively in human sports medicine and physical therapy. In what ways has your comparative medical background informed your post-DVM work? What veterinary skills and/or ways of thinking have proved especially valuable? In contrast, what are some notable areas where animal research does NOT translate to people?

I think my comparative background gave me a different way of thinking—one that complements everything else I do. At the core, I’m trained as a clinician: I think in terms of diagnosing, managing, and preventing disease and injury. Even though that training was originally focused on animals, the same foundational process applies to human health. When I look at a research finding, I automatically ask, “How does this ultimately improve patients’ lives?”—but I arrived at that question through a very different educational system than most people in human healthcare. That perspective has shaped how I approach both problems and solutions.

Even though translational medicine isn’t my main area of focus, my veterinary background has helped me engage critically with that field. I’ve never done hands-on animal research—and never had much desire to—but I’ve found myself immersed in it indirectly. For example, during early research on resveratrol (the antioxidant compound often associated with red wine), we had to determine an appropriate human dosage. The published studies ranged wildly—from 5 mg to 5,000 mg—and many relied on shaky assumptions about animal-to-human dose conversions. A colleague and I dug into that literature and ended up publishing a paper clarifying how those translations should actually be done.

“Even though that training was originally focused on animals, the same foundational process applies to human health”

Most of my current work is in human sports science and exercise physiology, and that expertise came directly from the human side. Animal models can teach us a lot about fundamental physiology, but they’re often limited in how well they capture complex human phenomena—especially in elite sport. It’s one thing to learn basic principles of exercise physiology or tissue biomechanics from animal studies, but quite another to model the physiology of a world-class endurance athlete. Similarly, sports injuries like concussions or sub-concussive impacts are almost impossible to replicate meaningfully in animals. You can’t realistically simulate the pattern of head impacts experienced by an American football player—seasonal, episodic, and spanning years of development—using species with completely different brain anatomy and biomechanics.

Just as we say in veterinary medicine, “Cats are not small dogs.” By the same logic, mice and rats are not small humans. Animal models can be valuable tools, but they’re still models—and sometimes we need to remind ourselves of that.

And for anyone interested in how I switched from veterinary medicine to human sports medicine, I’m always asked about that, so I wrote up a post on my background story.

2. I first came across your writing on Substack through your essay “P-hacking: How to Make Almost Any Study Look “Significant.” It was a great exploration of an all-too-common technique where researchers essentially tweak their analysis parameters until they find something worth reporting. Why is this such a big deal? What are some other examples of problematic practices that people should be on the lookout for? And how can we reduce this behavior to improve the quality of studies?

Science is supposed to be a transparent, objective process: we ask questions, collect data, and analyze it to find answers. But when incentives creep in—whether financial, career-related, or simply emotional—it becomes easier to set ourselves up to find the answers we want to find. P-hacking is one way that happens: running analyses over and over, tweaking variables, and slicing data until something finally looks “statistically significant.”

Beyond the Abstract

p-hacking: How to Make Almost Any Study Look “Significant”

If you’ve ever skimmed a health headline, browsed a nutrition blog, or glanced at the results section of a scientific paper, you’ve probably seen the magic phrase: “statistically significant” or p < 0.05…

Read more

10 months ago · 21 likes · 20 comments · James Smoliga, DVM, PhD

Sometimes this happens with good intentions. A researcher truly believes an intervention works and just wants to “prove” it. Other times, it’s driven by the structural pressures of academia—publish or perish, chase grant funding, and aim for results that seem exciting enough to get accepted. That environment makes it tempting to shape data into a compelling story rather than an accurate one. I’m not suggesting most scientists are deceitful; in many cases, they’re just navigating a system that rewards outcomes over integrity.

A close cousin of p-hacking is selective reporting—publishing only the results that support the desired conclusion while leaving out the ones that don’t. The problem is that it’s almost invisible. We can’t see what wasn’t reported, so we often have no idea what the full dataset looked like. One of the best ways to mitigate this is trial pre-registration, where researchers publicly define their questions, primary outcomes, and analysis plan in advance. When done properly, it allows readers to compare what was planned versus what was reported, making it harder to cherry-pick favorable results or reframe a null finding as a success.

“When those failures eventually come to light, as they often do, they can erode public trust in science as a whole”

The danger in all this is that it creates false confidence in research findings. Resources then get funneled into interventions that don’t actually work, putting patients at risk or delaying the discovery of genuinely helpful treatments. An extreme example of this is the research fraud (which involved more than just p-hacking and selective reporting), behind the entire beta-amyloid hypothesis underpinning Alzheimer’s drug development. This research shaped drug development, with billions of dollars being spent on drugs that didn’t work, while patients suffered.

When those failures eventually come to light—as they often do—they can erode public trust in science as a whole. People are told to “trust the science,” but then see entire research areas crumble when the methods behind them are scrutinized. Even if these cases aren’t typical, they have an outsized impact on how the public perceives scientific credibility.

3. One of your most cited papers is a review article about resveratrol, which was hyped as a longevity supplement by Dr. Oz and other wellness influencers, although there is minimal high-quality evidence in clinical trials showing benefit. In that paper and others, you argue for smarter outcome selection and trial design in supplement research. If you could rewrite one widely cited supplement study from scratch, what endpoints, populations, and analytic choices would you change—and why? What tips would you give my readers for determining whether a study discussed in the news is robust and reliable?

That’s a tough question, because so many supplement studies are limited by design and end up telling us less than they appear to. I was fortunate to begin studying resveratrol back in 2006, though I’ve since moved on to other topics. I still think there’s credible evidence that it can benefit human health, but—like many supplements—it’s been both overhyped and misunderstood. Early on, it was hailed as a miracle compound; later, it was dismissed as ineffective in humans. The reality, as usual, lies somewhere in between. I’ve written before about the disconnect between human and animal resveratrol research, and I think that tension captures the larger truth: there may well be some genuine benefits, but it’s difficult to know how—or whether—they translate to clinically meaningful outcomes in people, and how that compares to other interventions (e.g., exercise or other drugs). It’s hard to answer the question about effectiveness, when we can’t even agree on what dose we should be exploring in human research!

Longevity research is especially challenging. We take these supplements hoping to extend healthspan or lifespan, but those are outcomes that unfold over decades—and they’re influenced by countless confounding factors like socioeconomic status, diet, exercise, and genetics. Since no one can run a 40-year randomized trial, researchers rely on surrogate outcomes in shorter-term studies—things like cholesterol levels, inflammation markers, or mitochondrial activity. The problem is that those surrogates don’t always translate into real clinical benefits. A supplement might lower LDL cholesterol, for example, without actually reducing the risk of heart attack or extending life. When the events we care about are rare and take years to develop, establishing true cause and effect becomes incredibly difficult.

Animal models can sometimes help bridge that gap. If a compound consistently improves healthspan or lifespan in animals—and produces favorable changes in validated biomarkers over one or two years in humans without side effects—that’s encouraging. But even then, it’s not proof. Translating from model systems to human health is rarely straightforward.

“Since no one can run a 40-year trial, researchers rely on surrogate outcomes in shorter studies... The problem is those don’t always translate into real benefits”

If I could redesign a widely cited supplement study from scratch, I’d prioritize three things:

1. Appropriate populations — Studying people who actually represent the target users, not just a convenience sample of the general population or college students.

2. Clinically meaningful outcomes — Measuring things that matter to people’s lives, not just minor biomarker shifts. Also, these need to be something that we would actually expect to change in the population of interest.

3. Transparent design and analysis — Pre-registered protocols, independent replication, and public data sharing to minimize bias.

For readers trying to judge whether a supplement study, or any study, seems reliable, a few quick checks go a long way:

1. Look for the source. Is there a journal citation, and does it come from a reputable, peer-reviewed outlet?

2. See if findings are replicated. One flashy study means very little; independent confirmation means much more.

3. Follow the funding. Was it sponsored by the company selling the product, or an independent group?

4. Check the population. Does the sample resemble you or the group the claims are aimed at? (I see this often in sports science studies, where there is a big headline about performance enhancement, but the study was done in 12 recreationally-active college students... those results are unlikely to translate to competitive athletes).

5. Gut check the magnitude. If the results sound too good to be true, they probably are—whether it’s media hype or something more serious, like data manipulation.

Ultimately, supplement research isn’t inherently bad—it just needs to be interpreted in context. Most claims fall somewhere between potentially interesting and prematurely definitive, and the difference often comes down to study design, not just the molecule in question.

4. One of the many things the COVID-19 pandemic revealed is how important public trust in scientists and doctors is, and how easily it can be lost. As someone who blogs about bad science online, how do you approach debunking myths and misinformation? How can healthcare providers and scientists do a better job communicating with the public?

When I write about misinformation, I try to combine three things: the facts themselves, my interpretation of those facts, and the reasoning behind that interpretation. My goal isn’t just to say what’s wrong, but to show how I arrived at that conclusion.

First impressions matter, so I think it’s important to make my stance clear right from the beginning. If a piece is going to debunk a myth, I say so upfront—otherwise readers may stop halfway through and assume the original claim is true. At the same time, I avoid clickbait titles. If we’re asking people to trust science, we can’t rely on the same tactics that erode trust elsewhere.

I also try to explain why people might believe misinformation in the first place. Many of these ideas make intuitive sense, especially to people who haven’t spent decades in the field. I have more than 20 years of experience in sports science now, but as a 17-year-old high school track athlete, I was completely taken in by pseudoscientific training gadgets and “miracle” supplements. Remembering that helps me communicate with empathy. If I mock people who fall for bad science, I’m forgetting that I once could have been one of them.

Another key principle is humility. I’d rather be slow and right than fast and wrong. Before writing, I do my homework—even on topics I think I know pretty well—and if I’m uncertain, I say so openly. I invite readers to correct me if they think I’ve missed something. That transparency builds credibility far more than pretending to have all the answers.

“As a 17-year-old athlete, I was completely taken in by pseudoscientific gadgets and “miracle” supplements—Remembering that helps me communicate with empathy”

But we also need to be clear on what our goal is in science communication. Are we trying to help people make better decisions, or are we trying to score points on social media? Too often, it’s the latter.

One example that stood out this year was when some conservative politicians claimed that U.S. taxpayers were funding “transgender mouse” research. Many scientists immediately mocked them, assuming they had confused transgenic with transgender, and launched into explanations about how transgenic mice save lives. The problem was that there was federally funded research on animal models aimed at understanding transgender health. So in “fact-checking” the claim, many scientists got their own facts wrong. CNN later issued their own correction—yet, most of those scientists didn’t. It was a missed opportunity to add context and nuance, and instead it reinforced the perception that scientists can be partisan or dismissive. That’s the kind of misstep that erodes trust. I was so frustrated by the knee-jerk mockery I saw from some scientists—and by how much it risked damaging public perceptions of science more broadly—that I wrote an opinion piece about it for The Chronicle of Higher Education. My point wasn’t about taking political sides or defending / refuting any particular claim; it was about how moments like that can shape public trust, and how much our credibility depends on communicating with accuracy and respect.

Ultimately, empathy and curiosity go a long way. If someone is vaccine-hesitant, it’s usually because they care deeply about their own health or their family’s health. That’s common ground, not a divide. We won’t convince everyone, but we can reach those who are open-minded if we approach them with respect rather than ridicule.

5. You are no doubt familiar with the huge challenges facing universities and researchers right now, ranging from large, generalized funding cuts at the NIH and NSF, to cancellations of specific grants based on subject matter, to shake-ups in leadership and policy at the NIH, CDC, FDA, etc. How are you and your lab navigating this uncertain environment and managing the smaller pool of resources available for science? What do you think institutional science in the US and abroad will look like in the decades to come?

I actually don’t have a laboratory and have never been part of the grant-funding cycle—and I’m thankful for that. My career path has been atypical, but it’s given me a valuable degree of independence.

When I was at High Point University, my colleagues and I were fortunate to design and build a 15,000-square-foot human performance laboratory—world-class in every way. The university had generous support from donors and tuition, and our goal was to give students high-quality, hands-on experiences rather than focus narrowly on faculty grant production. The lab was designed as a hub for learning and discovery, not a machine for chasing funding. Some faculty still pursued grants, but there was no institutional pressure to do so. Like most others, my primary job was teaching.

That freedom came with an important benefit: I wasn’t bound by the conflicts of interest that a grant-driven research agenda can create. I’m not suggesting that most researchers act unethically—far from it—but when your livelihood and career progression depend on securing the next grant, and that next grant depends on producing “positive” or novel results, the incentives can quietly distort science. The current system has delivered tremendous innovation and countless life-saving breakthroughs, yet it also has built-in vulnerabilities. We need to acknowledge that—and use this moment to rethink how we do science.

“We need stronger support for independent researchers conducting replication studies, because replication, transparency, and synthesis are just as essential as discovery”

We absolutely still need to fund principal investigators, but perhaps there are parallel career pathways that could strengthen the system without relying on a perpetual cycle of grant-seeking. This period of uncertainty could actually be an opportunity: a time for scientists to apply their expertise beyond advancing their own research agendas—to engage in public communication, synthesize and audit existing evidence, and help fortify the foundation of the scientific enterprise itself.

Universities need to recognize the value of these roles, and graduate programs should prepare students for more than just the “future funded PI” track. Science thrives when it includes a diversity of functions—not everyone needs to be a grant-funded investigator. We need scholars who ask hard questions about assumptions and methodology, who bridge disciplines, and who rigorously test whether celebrated findings hold up. We also need stronger support for independent researchers conducting replication studies, because replication, transparency, and synthesis are just as essential to progress as discovery itself.

There’s great potential in emphasizing an educator–scholar model, where faculty teach and mentor while contributing to science in integrative ways—roles sustained by tuition rather than grants. These faculty wouldn’t be expected to simply publish more papers, but to enhance scientific quality through education, synthesis, and critique. That shift could actually make research more efficient. Yes, today’s funding cuts are disruptive, but they also highlight how much money has been wasted chasing findings that were never likely to pan out—often because of flawed assumptions or insular thinking within disciplines.

If we diversify how we define and reward scientific work, we could see a far better return on investment—not just in dollars, but in the strength, reliability, and integrity of the science itself. I wrote about this earlier this year for Nature.

BONUS: What are three things you would recommend to the audience? These can be books, newsletters, podcasts, TV/movies, etc.

Great question—and a hard one to narrow down! Within the themes I’ve touched on here, my three picks would be:

1. Range by 1

This book makes the case for being a generalist in a world that often prizes specialization. As a veterinarian-turned-sports-medicine researcher who now teaches physical therapy students, I see myself reflected in that model. Range helped me appreciate that breadth of perspective isn’t a weakness—it’s an asset. Generalists connect dots that specialists might never notice, and that mindset has shaped how I approach both science and teaching.

2. Bad Pharma by Ben Goldacre

I think this should be required reading for anyone in healthcare or research. Goldacre dives deeply into issues like p-hacking, selective reporting, and the misuse of surrogate outcomes—the very topics we’ve discussed here—and backs them up with hard data and real-world consequences. It’s an eye-opening look at how systemic flaws in evidence generation can have tangible, sometimes deadly effects.

3. The Coddling of the American Mind by and

I initially expected this to be a book about political polarization, but it turned out to be much more. It traces cultural and psychological shifts that have reshaped how we think, communicate, and handle disagreement. Beneath that, there’s a powerful philosophy about open-mindedness, resilience, and how we engage with ideas we don’t like—principles that apply not only to social discourse but to scientific inquiry as well.

Thanks again to Dr. Smoliga for his time and excellent answers! If you have any questions or comments for him, please leave a comment below