Tag Archives: literature review

Dr. M’s SPA Newsletter Volume 16 Issue 20 – Healthcare Policy

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Failing Them

Why Are We?

We are failing our children, the next generation.

I have been spending an inordinate amount of time studying cellular biology and mitochondrial function in order to understand worsening disease trends. Thus, I want to revisit a landmark study that is one of the most comprehensive assessments of pediatric health ever conducted in the United States. Rather than examining a single disease or health outcome, Dr. Forrest and colleagues integrated data from multiple nationally representative surveys, mortality databases, and electronic health records encompassing millions of children to evaluate whether the health of American children has changed over the past 17 years. The answer was strikingly consistent: across virtually every major health domain, children in the United States are becoming less healthy. The investigators examined mortality, chronic physical and mental health conditions, obesity, functional status, sleep, puberty, physical symptoms, and emotional well-being between 2007 and 2023. Nearly every indicator worsened over time.

“From 2007 to 2022, infants (<1 year old) were 1.78 and 1- to 19-year-old individuals were 1.80 times more likely to die in the US than in the OECD18. The 2 causes of death with the largest net difference between the US and OECD18 were prematurity and sudden unexpected infant death for infants 12 months or younger, and firearm-related incidents and motor vehicle crashes for 1- to 19-year-old individuals. From 2011 to 2023, the prevalence of 3- to 17-year-old individuals with a chronic condition rose from 39.9% to 45.7% within PEDSnet, and from 25.8% to 31.0% within the general population. Rates of obesity, early onset of menstruation, trouble sleeping, limitations in activity, physical symptoms, depressive symptoms, and loneliness all increased during the study period.” (Forrest et. al. 2025)… and literature review.

Enjoy,

Dr. M

 

Dr. M’s SPA Newsletter Volume 16 Issue 19 – Pain

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Pain

Do we listen to its signal?

Pain: Your Body’s Built-In Warning System

Pain is one of the body’s oldest and most important protective mechanisms. It isn’t your enemy. It is a messenger.

Imagine walking barefoot across your living room and accidentally kicking the corner of the coffee table. The sharp pain that shoots through your toe isn’t there to punish you, it is there to protect you. Within fractions of a second, nerves carry a signal to your brain, telling you that cells and tissue have been injured. Your body immediately encourages you to stop what you’re doing. Protect the area and allow it to heal.

This is acute pain, and it serves an essential purpose for both protection and survival.

The problem arises when we stop thinking of pain as information and begin viewing it as something that simply needs to be eliminated. Over the past several decades, this mindset has increasingly influenced modern medicine. Around the turn of the century, pain was widely promoted as the “fifth vital sign,” emphasizing the importance of recognizing and treating it. While this movement helped address the undertreatment of pain, it also contributed, in some settings, to an emphasis on suppressing pain rather than understanding why it existed in the first place.

From an evolutionary perspective, pain is not a design flaw, it is a sophisticated communication system. It evolved to capture our attention, protect us from further injury, and encourage behaviors that promote healing. When we focus solely on silencing the signal without investigating its source, we risk missing the very message our bodies are trying to deliver, and deliver it will.

Pain is information

Every pain signal is your body’s way of saying, “Something isn’t quite right.”

Sometimes the cause is obvious like a sprained ankle, a cut, a burn, or a broken bone.

Other times the message is much more subtle.

….

Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 16 – Fake it Till You Make it

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Fake It Till You Make It?

One of the most misunderstood pieces of advice in our culture is the phrase “fake it until you make it.”
At face value, it sounds dishonest. It sounds like pretending to be something you are not. It sounds like confidence without competence.

But after nearly three decades in medicine, I have come to believe there is a deeper truth hiding inside that phrase.

Most success in life is not built on pretending. It is built on being willing to step into situations where you are not yet fully prepared, knowing that growth happens only when you are slightly or deeply beyond your comfort zone.

If I am being honest, much of my professional life has felt this way, and the depth vacillated based on the context.

When I finished my pediatric residency at the University of Virginia, I was 29 years old and knew just enough to realize how much I did not know. Medical school and residency provide an enormous foundation, but they also expose you to the staggering volume of knowledge that exists in the world. And that volume has only skyrocketed in the past 30 years.

The farther I traveled in medicine, the more I realized the horizon kept moving, often unattainable.
One experience from those early years remains crystal clear, almost like a scar from a wound.
I had been asked to give a lecture to the pediatric residents at UVA on electrolyte solutions and exercise physiology. I spent time preparing and thought I knew the material reasonably well. I walked into the room feeling confident.

Then the questions started….. and a literature review.

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 16 Issue 14 – The Adult Chair


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The Adult Chair, the Adolescent Chair and the Child’s Chair

The Adult Chair by Michelle Chalfant is a practical framework for emotional maturity, self-awareness, and healing old patterns that unconsciously drive adult behavior. The central premise is that most people move through life reacting not from their grounded adult self, but from unresolved emotional states formed during childhood and adolescence. She organizes this idea into what she calls the “three chairs”: the Child Chair, the Adolescent Chair, and the Adult Chair.

The Child Chair represents the emotional self formed in early childhood. This is the place of vulnerability, fear, shame, abandonment, loneliness, and unmet needs. When people react from this chair, they often feel helpless, emotionally flooded, overly dependent on validation, or afraid of rejection. Many adult relationship conflicts, according to Chalfant, are actually wounded children (in adult bodies) interacting with each other while wearing grown-up clothing and carrying iPhones. Same child like nervous system. Better accessories. Think of the statement: lipstick on a pig, you cannot dress up dysfunction and make it disappear.

The Adolescent Chair reflects the defensive coping strategies people develop to protect the wounded child. This includes control, perfectionism, blame, avoidance, rebellion, people-pleasing, passive aggression, and emotional shutdown. The adolescent self seeks power and protection but often creates disconnection and conflict. Chalfant argues that many high-achieving adults unknowingly operate from this chair, appearing successful externally while internally driven by fear, insecurity, or the need for approval.

The Adult Chair is the goal….

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 32 – Year in Review: 2025

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The Year in Review – 2025

Articles and Points of Interest:

1) Microplastics in the Brain – From Science Advances: “Human health is being threatened by environmental microplastic (MP) pollution. MPs were detected in the bloodstream and multiple tissues of humans, disrupting the regular physiological processes of organs. Nanoscale plastics can breach the blood-brain barrier, leading to neurotoxic effects. How MPs cause brain functional irregularities remains unclear. This work uses high-depth imaging techniques to investigate the MPs within the brain in vivo. We show that circulating MPs are phagocytosed and lead these cells to obstruction in the capillaries of the brain cortex. These blockages as thrombus formation cause reduced blood flow and neurological abnormalities in mice. Our data reveal a mechanism by which MPs disrupt tissue function indirectly through regulation of cell obstruction and interference with local blood circulation, rather than direct tissue penetration. This revelation offers a lens through which to comprehend the toxicological implications of MPs that invade the bloodstream.” (Huang et. al. 2025)

2) From Nature Medicine: “Brain insulin responsiveness is linked to long-term weight gain and unhealthy body fat distribution. Here we show that short-term overeating with calorie-rich sweet and fatty foods triggers liver fat accumulation and disrupted brain insulin action that outlasted the time-frame of its consumption in healthy weight men. Hence, brain response to insulin can adapt to short-term changes in diet before weight gain and may facilitate the development of obesity and associated diseases.” (Pullman et. al. 2025)….

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 31 – Poly Vagal Theory, Stephen Porges, PhD

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I think that this is an important time to pause and relook at Polyvagal Theory before continuing with Beyond Behaviors.

Polyvagal Theory: Current Status, Clinical Applications, and Future Directions (Porges, S. 2025)

“Social behavior and the capacity to manage challenge are dependent on the neural regulation of physiological state.” S. Porges


When I dove into Stephen Porges’s 2025 review of the Polyvagal Theory (PVT), I felt like I’d stepped into a crossroads where neurobiology, clinical practice, trauma science, and human experience collide. This paper isn’t merely a summary of three decades of work (all of which I have read); it’s a spirited defense of a paradigm that’s been both celebrated (by me) and contested (by others). What follows is an honest appraisal of what the article teaches us, where it sparks real insight, and where it may fall short, especially through the lens of evidence-based medicine and developmental neurophysiology. (I also went deeper into his 2022 paper in Frontiers in Integrative Neuroscience for the biophysiology of the ANS)

At its heart, the article argues that the autonomic nervous system (ANS), through a set of hierarchically organized circuits centered on the vagus nerve, is not just a background player in stress and homeostasis, but a core regulator of social engagement, physiological flexibility, and behavior. Dr. Porges situates his theory as an alternative and expansion to classical views that treat sympathetic (fight/flight) and parasympathetic (rest/digest) branches as functional opposites. Instead, he proposes a three-component hierarchy: the ventral vagal complex (VVC) supporting social engagement, a mobilization circuit mediated by the sympathetic nervous system or fight or flight state, and a dorsal vagal circuit that facilitates shutdown or immobilization under extreme threat…..

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 25 – Tough Conversations

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Speaking Truth in Love: The Weight of Avoidance in Pediatric Metabolic Health

After completing the second round of our Asthma and Obesity Metabolic Pilot Program at Salisbury Pediatrics, I left the clinic reflecting deeply on what I witnessed. It crystallized a truth that is uncomfortable but undeniable: the greatest health threats to our children today are not infectious or accidental, they are metabolic. Diseases once reserved for adulthood: insulin resistance, fatty liver, hypertension, early vascular aging are now appearing in children who should be free to run, play, and thrive.

In modern society, conversations about weight and metabolic dysfunction have become relatively taboo. This is not to say that children of normal or low weight are immune; they, too, can be at risk. However, the excess-weight group carries the highest statistical burden. Too often, clinicians hesitate to speak truth to families for fear of offending, shaming, or overstepping. In doing so, we risk silence becoming complicity and allowing preventable disease to take root in the very children we are charged to protect.

Much of this epidemic is not born of individual failure but of systemic neglect. Government-funded, poor-quality school meals, cheap processed foods, and relentless marketing of sugar and refined carbohydrates have built an environment where metabolic injury is almost inevitable. When a child’s daily fuel is engineered for shelf life instead of cell life, the outcome is not accidental, it is predictable. Our pilot program lab results are a painful window into that truth…. and a literature review on eczema and anaphylaxis.

Enjoy Dr. M

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