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Implosion or Explosion?

At this moment, there’s really only one story that matters in American politics: Is Donald Trump going through a rough patch, or are we watching something deeper unravel? If you talk to Republican strategists or peek at the conversations that ripple through Washington, the mood has shifted. This isn’t normal turbulence. It’s the kind ofContinueContinue reading “Implosion or Explosion?”

Favorite Apple Watch Apps

Five major “epochs” of human brain development

The five major “epochs” of human brain development, identified by a recent study, are Childhood(birth to age 9), Adolescence (9 to 32), Adulthood (32 to 66), Early Aging (66 to 83), and Late Aging (after 83). These epochs are characterized by distinct patterns of neural rewiring, with major turning points occurring at ages 9, 32, 66, and 83. The five epochs of brain developmentContinueContinue reading “Five major “epochs” of human brain development”

Delaware Rural Health Overhaul

Governor Matt Meyer announced Delaware’s application for up to $1 billion from the federal Rural Health Transformation Program, part of a $50 billion national effort. The plan assembles 15 projects aimed at transforming healthcare delivery in Kent and Sussex counties, home to nearly 40% of Delaware’s population. Core goals: expand access, lower costs, and strengthenContinueContinue reading “Delaware Rural Health Overhaul”

Paris Holiday Gone Sideways: Apple Watch Sends SOS

A Split Second in ParisCrossing a street near the Louvre, I had no time to react before an inebriated Parisian ran a red light and struck me in the pedestrian lane. My Apple Watch immediately detected the impact, sent an SOS message to my three children (my emergency contacts) and summoned an ambulance. I lostContinueContinue reading “Paris Holiday Gone Sideways: Apple Watch Sends SOS”

Charley Varipapa 1951-2025

My Brother is Gone

It is with deep sadness that I share the passing of my beloved brother Charles Varipapa, DDS, cosmetic dentist, bon vivant, Italophile, and master story teller. Charley was loved by his mother, brothers, nephews, nieces and friends. He had an outsized influence on everyone he met: brilliant, funny, exacting, and generous to a fault. CharleyContinueContinue reading “My Brother is Gone”

Comparison of enfortumab vedotin (EV, aka Padcev) and pembrolizumab (Keytruda) in metastatic urothelial/bladder cancer

What we know of their benefits, limitations, and toxicities. Mechanisms & therapeutic role (in metastatic bladder cancer) Enfortumab vedotin (EV) EV is an antibody-drug conjugate (ADC) targeting nectin-4 (a cell-surface adhesion molecule expressed in urothelial carcinoma). The antibody binds nectin-4, is internalized, and releases a cytotoxic payload (monomethyl auristatin E, MMAE) inside the cancer cell,ContinueContinue reading “Comparison of enfortumab vedotin (EV, aka Padcev) and pembrolizumab (Keytruda) in metastatic urothelial/bladder cancer”

Goliath’s Curse

Luke Kemp’s Goliath’s Curse is a brilliant, unnerving, and strangely hopeful journey through the rise and fall of civilizations. Like Sapiens meets Mad Max, it exposes a central truth: the bigger and more unequal societies become, the more fragile they are. Drawing on thousands of years of history and cutting-edge data, Kemp argues that the real cause of collapse isn’tContinueContinue reading “Goliath’s Curse”

The US ‘Healthcare’ System is a Mess

A recent and important PBGH white paper reveals the fundamentally chaotic and arbitrary nature of U.S. commercial healthcare pricing, demonstrating that provider rates have no correlation to quality and vary dramatically without logical justification 😳 Key Findings The study analyzed data from five major employers (including Boeing, Qualcomm, and Denver’s city/county government) across multiple geographicContinueContinue reading “The US ‘Healthcare’ System is a Mess”