HIV and ID Observations

August 2nd, 2025

The Short Political Half-life of a Medical Contrarian

In early May, I wrote about the surprising FDA appointment of Dr. Vinay Prasad to lead the FDA’s Center for Biologics Evaluation and Research.  Prasad is a UCSF hematologist-oncologist known for his views on COVID-19, oncology clinical trials, and his sometimes sharp-elbowed communication style, in particular directed at people with whom he disagrees. My goal was […]

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July 25th, 2025

Who Gets Sent to ID Clinic? A Field Guide to Outpatient Referrals

Sometimes people ask me what kind of cases get referred to ID doctors in the outpatient setting. Despite what the latest television series might suggest, it’s rarely suspected Ebola (fortunately) or Tsutsugamushi fever — a disease that is much more fun to say by its Japanese name than its common one, scrub typhus. (In Japanese, “tsutsuga” means […]

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July 17th, 2025

Ceftriaxone Is a Narrow Antibiotic Now — and Other Musings

In no particular order, 20 things I’ve found interesting lately — a mix of ID (mostly), language quirks, clinical stuff, even tennis, and an apology (#21) at the very end. Bonus videos embedded because we all need a break. 1. Isn’t it amazing how, over time, an antibiotic once considered “broad spectrum” later becomes the […]

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July 12th, 2025

The Patient Did Well — So the Insurance Company Won’t Pay

Sometimes, you can predict a bad outcome. Examples: Proposing marriage after an awkward first date — and doing so over gas station nachos. Moving to a Cambridge apartment with no off-street parking, then buying a Tesla Cybertruck. Trying to recruit for ID fellowships from a group of cosmetic dermatologists. But predicting what happens in clinical medicine? […]

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July 7th, 2025

Two Pandemics, Compared: Reflections on HIV and COVID-19

“Dr. Sax, what’s it like to have lived through two pandemics as an ID doctor?” The question came from a brand-new intern during afternoon sign-out. I took a breath — because wow, were they different. HIV: It Felt Like A Calling, One Miraculously Rewarded I started my internship in 1987, six years after the first […]

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June 27th, 2025

The Mystery of the Isolated Hepatitis B Core Antibody, Solved

(A post inspired by years of doing eConsults, an extremely common query about hepatitis B testing, and the latest BritBox series, “Core Antibody Confidential,” starring a grizzled detective with a faded suit and a haunted past.) Your electronic medical record lists “deficiencies” in health care maintenance for one of your patients, so you order hepatitis B […]

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June 20th, 2025

Federal HIV Guidelines Face a Shutdown — A Critical Loss for Clinicians and Patients

Each week, our HIV clinical group gathers to review active patients, share updates, and celebrate good news. On our whiteboard, we list four columns: Inpatients, Outpatients, Issues, and Celebrations. This week, under “Issues,” one of my colleagues wrote: HIV Guidelines:  ☹️ Yes, you read that right. This week, we learned that the federal HIV guidelines — long […]

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June 12th, 2025

Why the Sudden Firing of ACIP Members Should Put Every Clinician on High Alert

There are certain irrefutable verities when, like me, you’re an infectious diseases specialist married to a pediatrician. Here are our top two, which are deeply interrelated: Infectious deaths in children, or severe illnesses that lead to lifelong disability, are more devastating than similar events in adults. Each such case in a baby or child is […]

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June 6th, 2025

How ID Doctors Get Paid, Part 3: The Grab Bag Edition

If you’ve made it this far, congratulations! You’re now deep into the ID Reimbursement Rabbit Hole. Part 1 and Part 2 covered how ID doctors contribute immense value through patient care, stewardship, infection control, travel clinics — proudly fighting along the way for appropriate compensation as the “Loss Leaders” of the hospital. (Did you get your […]

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May 31st, 2025

How ID Doctors Get Paid, Part 2: Infection Control and Other Invaluable (but Often Invisible) Work

Before getting to today’s main topic, allow me a brief protest — three recent vaccine-related actions that reek of profound (and misguided) vaccine distrust from HHS leadership. They are: Cancellation of a grant to develop an H5N1 vaccine. Preparation for this looming pandemic threat is critical, and there’s arguably no better way than having a vaccine ready. […]

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