The Grumpy Doc

Grumpy opinions about everything.

Our Shared Story Can Still Bring Us Together

By

On August 18, 2026

In Commentary

I’ve been a member of the Sons of the American Revolution for quite some time now. At the beginning of April, I started looking around for a Memorial Day event that we could join. I had assumed that my hometown of Charleston WV, being the state capital, would surely have an event since it is the 250th anniversary of the Declaration of Independence. I was surprised to find that none was planned.

I believed that it was especially important that a Memorial Day service be held here because West Virginia has, since World War II, one of the highest per capita rates of military service and combat casualties in the country.  So, another SAR member and I got together, and we planned our own event and arranged for it to be held on the state capitol grounds. At the end of our service, I looked out at the group that was gathered: there was no right or left, there was no red or blue, there was no conservative or liberal.  There were only proud Americans who had come together to honor our country, its veterans and its history.

Americans disagree about almost everything these days. Politics, religion, education, history, and even the meaning of patriotism have all become subjects of bitter debate. Too often, we define ourselves more by the groups we oppose than by the country we share.

Yet there are still opportunities to remember that before we were Republicans or Democrats, conservatives or progressives, we were Americans. The ongoing 250th Anniversary of the Revolutionary Era offers one of those rare opportunities to express what we share, not how we differ.

The semiquincentennial should be far more than fireworks, parades, and historical reenactments. It should be an invitation to rediscover the remarkable story we all inherited. The American Revolution was not perfect. The nation it created was imperfect from the beginning, carrying the stain of slavery, denying women equal rights, and often failing to live up to its own ideals. Those shortcomings do not erase the extraordinary achievement of creating a republic founded on the revolutionary belief that legitimate government derives its authority from the consent of the governed.

The founders left us more than a nation. They left us a challenge. Every generation has been asked to move the country a little closer to the principles expressed in the Declaration of Independence—that all people are created equal and possess inherent rights that no government should take away. Those words have inspired abolitionists, suffragists, civil rights leaders, immigrants seeking freedom, and millions of ordinary citizens who believed America could become better than it was.

That is a heritage worth celebrating together.

Organizations devoted to civic life have an important role to play in that celebration. Groups such as the Sons of the American Revolution, the Daughters of the American Revolution, the American Legion, Rotary clubs, Civitan clubs, veterans’ organizations, scouting groups, historical societies, libraries, museums, churches, and countless other local groups have spent decades preserving history, encouraging volunteerism, supporting education, and strengthening their communities. While each has its own mission and traditions, they all remind us that citizenship is more than voting every few years. It is an ongoing commitment to serving neighbors and improving the places where we live.

These organizations also offer something increasingly rare in modern America: opportunities for people with different political views to work side by side on practical goals. A community service project, a scholarship program, a veterans’ memorial, a food drive, or a history program rarely asks participants how they voted. It asks only if they are willing to help.

That is a lesson our country desperately needs. Social media and cable television often reward outrage. Algorithms profit by convincing us that our fellow Americans are enemies rather than neighbors. It becomes easy to believe that our differences outweigh everything we have in common.

History tells a different story. Americans have survived fierce political battles before. We have argued over the Constitution, endured civil war, struggled through economic depression and assassinations, fought world wars, and confronted profound disagreements about civil rights and social change. Our history has never been one of perfect unity. Instead, it has been a continuing effort to find common purpose despite deep disagreements.

The Revolution itself offers an example. The thirteen colonies differed enormously in religion, economy, geography, and culture. New England merchants, Virginia planters, Pennsylvania farmers, and South Carolina traders often had conflicting interests. Yet they discovered that some principles were more important than their differences. Their unity was never complete, but it was sufficient to build a nation. We face no less important a challenge today.

The 250th anniversary should encourage every community to host public readings of the Declaration of Independence, historical lectures, concerts, service projects, naturalization ceremonies, veterans’ recognitions, student essay contests, and volunteer events that welcome everyone. These occasions should not become platforms for partisan speeches. They should remind us that our history belongs to all Americans.

Celebrating our shared heritage does not require us to ignore the darker chapters of our past. Mature patriotism is honest enough to acknowledge failures while remaining grateful for the ideals that allowed those failures to be challenged and corrected. A confident nation can tell its whole story without either whitewashing its mistakes or denying its accomplishments.

Perhaps that is the greatest gift the 250th anniversary can offer is reminding us that America has always been a work in progress. Each generation inherits both the nation’s achievements and its unfinished work. If we can gather to honor the courage, sacrifice, and aspirations of those who came before us, perhaps we can rediscover something that has become increasingly scarce — the ability to see one another first as fellow citizens.

Our common heritage cannot solve every political disagreement. It will not erase ideological differences or end heated debates about the country’s future. Nor should it. Democracy depends upon vigorous debate. But it also depends upon something deeper — a shared commitment to our republic and our active participation as citizens. We need to become informed participants in our society and we need to vote and encourage others to vote.

As we celebrate America’s 250th birthday, the greatest act of patriotism is not winning another political argument. It is remembering that despite our many differences, we remain participants in the same remarkable American experiment. If civic organizations, veterans’ groups, historical societies, schools, churches, and local communities can help us rediscover that simple truth, they will have performed one of the greatest public services imaginable.

The founders gave us a republic, and they challenged each generation to preserve it and to improve it. Two hundred and fifty years later, that responsibility belongs to all of us.  We must not fail.

Image generated br author using ChatGPT.

Refusing the Needle: A History of Vaccine Resistance in America

By

On August 17, 2026

In Medicine, Uncategorized

Every vaccine the United States has ever rolled out has arrived with a shadow twin: a countermovement insisting the shot poses more danger than the disease it prevents, or that no government has the right to demand it. That pattern predates the country itself, and it has recurred with almost eerie consistency across three centuries — from the smallpox pustules of colonial Boston to the mRNA vials of 2021.

Colonial Boston and Smallpox

The story usually begins in Boston in 1721, during the sixth smallpox epidemic to strike the city since its founding. A ship called the Seahorse arrived from the Caribbean that April carrying a sailor with active smallpox, and within weeks the disease was moving through a city of roughly 11,000 people. By the time the epidemic burned out the following year, more than 6,000 Bostonians had been infected and about 850 had died.

The remedy that split the town in two was not vaccination in the modern sense but variolation, or inoculation — deliberately introducing live smallpox matter into a small cut in the skin, on the theory that a controlled, minor case would produce immunity without the risk of the full-blown disease. The technique had circulated for generations across West Africa, the Ottoman Empire, and Asia, and it reached Boston through the  injustice of slavery. The Puritan minister Cotton Mather learned of it from Onesimus, a man he held in bondage, who described having undergone the procedure himself in Africa. Mather corroborated the account with other enslaved Africans in Boston and read reports out of Constantinople before becoming inoculation’s loudest champion.

Physician Zabdiel Boylston put the idea into practice, inoculating his own son and two enslaved members of his household first, then expanding the program despite fierce opposition. The city’s medical establishment largely revolted. Dr. William Douglass, one of the few Bostonians who actually held a medical degree, led the case against inoculation on grounds that ranged from the religious objection, that deliberately spreading disease usurped divine providence, to a reasonable-for-the-time scientific worry that the practice itself was seeding new outbreaks. The argument did not stay academic. Someone threw a lit grenade through Mather’s window that November, with a note attached reading, in essence, that he could inoculate himself with the bomb. It failed to detonate.

The case against inoculation was never purely religious or clinical; it was tangled up with its origin. Opposition writers repeatedly invoked its African and Ottoman source as grounds for distrust, treating its foreign, non-Christian lineage as evidence of danger apart from any medical argument. One Boston pamphleteer asked why residents should “cherish the cruel Blood of Africa or Asia” in their bodies, and a London critic writing a decade later dismissed inoculation as a “barbarous and dangerous Invention” imported from Turkey that had wrought “Havock and Slaughter” once it took hold. Because the technique reached Boston through Onesimus, the racial dimension of the debate was impossible to separate from the medical one — critics were rejecting a treatment in part because of who had brought it, not because of what it did.

What makes 1721 more than a historical curiosity is that Boylston and his allies did something close to a clinical study. They tallied outcomes among the inoculated against outcomes among those who caught smallpox naturally, and the inoculated group fared markedly better. That comparison helped slowly tip opinion in inoculation’s favor over the following decades.  By the time George Washington ordered mandatory inoculation of the Continental Army in 1777, the practice — though still controversial — had become an accepted tool of public health.

The Gilded Age Leagues: Liberty, Quackery, and the Courts

Edward Jenner’s cowpox vaccine, introduced in 1796, eventually replaced variolation as the standard smallpox prevention. As vaccination spread across the Atlantic world through the nineteenth century, so did organized resistance. Britain passed an 1853 law making infant vaccination compulsory, and an 1867 act extended the mandate to age fourteen with real penalties attached for refusal. Britons who objected on religious, medical, or libertarian grounds organized the Anti-Vaccination League and, in 1867, the Anti-Compulsory Vaccination League, and within a few years it claimed over a hundred branches and roughly 10,000 members.

The British campaigner William Tebb carried that movement across the Atlantic. Following Tebb’s visit, Americans opposed to compulsory vaccination founded the Anti-Vaccination Society of America in 1879, and the New England Anti-Compulsory Vaccination League followed in 1882. These organizations drew on a mix of motives that will sound familiar to a modern reader: a libertarian objection to state intrusion into personal and parental decisions, religious conviction that disease and its prevention were matters for providence, and — more cynically — the financial interests of the era’s patent-medicine sellers and homeopaths, whose loosely regulated business model was directly threatened by a state-endorsed, evidence-based alternative.

The movement’s grievances were not entirely invented. In 1901, contaminated diphtheria antitoxin killed thirteen children in St. Louis, and contaminated smallpox vaccine killed several more in Camden, New Jersey, in the same year. Congress responded with the Biologics Control Act of 1902, the first federal law requiring licensure and safety standards for vaccine manufacturers — an early ancestor of the FDA’s modern oversight role. Those tragedies, however, did not settle the legal question of whether a state could force the issue. That came in 1905, when the Supreme Court decided Jacobson v. Massachusetts, upholding a Cambridge ordinance that fined residents who refused smallpox vaccination during an outbreak. The Court held that individual liberty was not absolute and could yield to a state’s power to protect public health — the first Supreme Court ruling on the subject, and one still cited today in disputes over compulsory vaccination and other public health mandates.

The ruling galvanized rather than pacified the opposition. Three years later, in 1908, opponents founded the Anti-Vaccination League of America in Philadelphia, built on the principle — in the League’s own words — that health was nature’s greatest safeguard against disease and that no state had the right to demand its impairment. It had the stated goal of abolishing what it called oppressive medical laws. Charles Higgins, one of the League’s most prolific pamphleteers, published tracts like his 1912 broadside “Open Your Eyes Wide!” arguing that vaccination was both dangerous and a violation of fundamental freedom. When Texas tried to require vaccination for public school attendance, the League’s arguments resurfaced in Zucht v. King, a 1922 case in which the Supreme Court again sided with the state.

Polio and The Vaccine Disasters of the 20th Century

By the mid-twentieth century, American vaccine skepticism had a new source of fuel, manufacturing failures serious enough to validate the movement’s oldest fear, that the shot itself might cause the disease. On April 12, 1955, officials announced that Jonas Salk’s inactivated polio vaccine, tested in a trial of 1.8 million children, was safe and effective, and the federal government licensed five manufacturers within days to begin mass production. One of them, Cutter Laboratories of Berkeley, California, shipped batches in which the virus-inactivation process had failed, leaving live, virulent polio virus in vaccine given to roughly 200,000 children across five states. An estimated 40,000 developed abortive polio, 200 were left with some degree of paralysis, and at least ten died. The program was suspended within weeks, federal oversight of vaccine manufacturing was overhauled, and vaccination resumed that fall under tighter controls.

The Cutter Incident became a formative episode in the history of American vaccine regulation and it had a lasting effect: a generation of parents who had watched the worst-case scenario for the trustworthiness of vaccines play out on the evening news, and that memory did not fade quickly.

Two decades later, a different kind of failure struck the flu vaccine. In early 1976, an Army recruit at Fort Dix, New Jersey, died of an influenza strain resembling the one responsible for the catastrophic 1918 pandemic. Fearing a repeat, the Ford administration pushed Congress to fund a crash national vaccination campaign, and nearly 43 million Americans were vaccinated within about ten weeks — an extraordinary logistical feat. The anticipated pandemic never arrived. Worse, as vaccinations proceeded, epidemiologists began detecting a modest but real increase in Guillain-Barré syndrome, a rare autoimmune paralytic condition, among recipients — roughly one additional case per 100,000 doses by later estimates. The program was suspended in December 1976, the CDC director was fired on live television, and the New York Times dubbed the whole affair a “fiasco,” a label that stuck for decades.

The Flu Shot’s Persistent Image Problem

Unlike smallpox or polio vaccination, the annual flu shot has never fully shaken a reputation for being optional, unpleasant, and only modestly effective in any given year. This is largely because the vaccine’s composition is re-engineered annually against strains predicted months in advance. That combination of a recurring injections, a variable and sometimes underwhelming efficacy rate, and the folk memory of 1976 has kept flu vaccination rates well below public health targets in most seasons, hovering in recent years around half of American adults, with substantial swings by age, region, and political affiliation. There is still the belief among some groups that the vaccine itself can cause flu even though flu vaccines do not contain live virus and cannot cause the disease.

COVID-19: An Old Argument at Unprecedented Speed

The COVID-19 pandemic compressed a century of vaccine controversy into about eighteen months. The mRNA vaccines developed by Pfizer-BioNTech and Moderna, along with a viral-vector vaccine from Johnson & Johnson, received emergency authorization by early 2021 after a development timeline that was, by historical standards, astonishingly fast. It was a point public health officials framed as a triumph of scientific investment and one that vaccine skeptics framed as a reason for caution. By September 2021, about 62 percent of Americans age twelve and older had received at least one dose, but demand had already begun slowing well before the country approached anything like universal coverage.

What followed diverged from earlier vaccine controversies in one important respect, hesitancy did not fade as more safety data accumulated, and in some respects it hardened. One national longitudinal study found that COVID-19 vaccine refusal actually rose from about 41 percent of adults in 2021 to nearly 45 percent in 2022. Even as overall vaccination coverage climbed, belief in the vaccine’s broader social benefit fell sharply, from roughly 48 percent to 25 percent. Parental hesitancy about vaccinating children against COVID-19 rose by nearly 16 percentage points in just nine months of 2021 and 2022, notably concentrated among white and rural parents, a pattern that cut against the demographic profile of vaccine resistance in earlier eras of American history. By the 2025–26 respiratory virus season, CDC surveillance found that only about 16 percent of American adults had received that season’s COVID-19 vaccine, with somewhat higher uptake — about 31 percent — among adults sixty-five and older, who face the greatest risk from the disease.

COVID-19 did not create vaccine skepticism, but it sharply politicized and enlarged the anti-vaccine movement by tying vaccination to partisan identity, distrust of government and public-health institutions, and debates over mandates, individual liberty, and pandemic restrictions. Political leaders, partisan media, and online networks often framed vaccination less as a medical decision grounded in evidence than as a symbol of cultural allegiance or resistance to perceived government overreach. Anti-vaccine activists used that environment to spread misinformation and reach audiences far beyond earlier disputes over childhood immunizations. The result was a more organized “health freedom” politics in which skepticism about COVID-19 vaccines could spill over into opposition to other routine vaccines, making public health a continuing front in America’s broader political polarization.

The pandemic-era pattern echoes several of its historical predecessors at once: distrust of a fast-moving federal program (echoing 1976), suspicion of a technology many found unfamiliar and difficult to evaluate (echoing the original inoculation debates of 1721), and a fusion of libertarian and religious objection to government mandates (echoing the Anti-Vaccination League of America a century earlier).

A Recurring American Argument

Over the last 50 years, advocacy groups have questioned the growing number of childhood vaccines and raised concerns about vaccine ingredients, scheduling, and possible long-term effects. The movement gained momentum after publication in 1998 of a now-retracted paper by Andrew Wakefield that falsely suggested a link between the measles-mumps-rubella (MMR) vaccine and autism. Numerous large studies subsequently found no evidence supporting such a connection, and investigations revealed ethical violations and scientific misconduct in Wakefield’s work, but the damage was done and the foundation was laid for the modern anti vaccination movement.

Read across three centuries, American vaccine resistance is not one continuous movement so much as the same underlying argument recurring in new costumes. It is a tension between collective protection and individual or parental autonomy, sharpened at each turn by episodes — some tragic and real, like Cutter and the 1976 swine flu campaign, some largely fabricated, like William Tebb’s invented nineteenth-century casualty statistics — that gave skeptics evidence, or the appearance of it, to point to. The debate has never been resolved so much as relitigated, generation after generation, against whatever the era’s most feared disease happens to be.

Disclaimer: The author writes independently. The views expressed here are his own and are not made on behalf of, and should not be attributed to, any hospital, university, or other institution with which he is affiliated. This article is a work of historical journalism, not medical advice.

Image generated by the author using ChatGPT.

Sources

1. The Fight Over Inoculation During the 1721 Boston Smallpox Epidemic, Harvard SITN. https://sites.harvard.edu/sitn/2014/12/31/the-fight-over-inoculation-during-the-1721-boston-smallpox-epidemic

2. Benjamin Franklin’s fight against a deadly virus, The Conversation. https://theconversation.com/benjamin-franklins-fight-against-a-deadly-virus-colonial-america-was-divided-over-smallpox-inoculation-but-he-championed-science-to-skeptics-161569

3. A “Doubtful and Dangerous Practice”: The 1721 Boston Inoculation Controversy, Readex Report. https://www.readex.com/readex-report/issues/volume-10-issue-1/doubtful-and-dangerous-practice-1721-boston-inoculation

4. The 200-year history of the anti-vaxxer movement, Newsweek. https://www.newsweek.com/history-anti-vaxxers-vaccination-1358403

5. National Anti-Vaccination League, Wikipedia. https://en.wikipedia.org/wiki/National_Anti-Vaccination_League

6. History of Anti-Vaccination Movements, History of Vaccines (College of Physicians of Philadelphia). https://historyofvaccines.org/vaccines-101/misconceptions-about-vaccines/history-anti-vaccination-movements/

7. Anti-Vaccination Society of America, Wikipedia. https://en.wikipedia.org/wiki/Anti-Vaccination_Society_of_America

8. Anti-vaccination in America, National Museum of American History (Smithsonian). https://americanhistory.si.edu/explore/stories/anti-vaccination-america

9. Anti-vaccination in America, National Museum of American History (Smithsonian). https://americanhistory.si.edu/explore/stories/anti-vaccination-america

10. On this day, the Supreme Court rules on vaccines and public health, National Constitution Center. https://constitutioncenter.org/blog/on-this-day-the-supreme-court-rules-on-vaccines-and-public-health

11. Freedom, Rights, and Vaccine Refusal: The History of an Idea, PubMed / American Journal of Public Health. https://pubmed.ncbi.nlm.nih.gov/35080944/

12. Historical Vaccine Concerns, CDC. https://www.cdc.gov/vaccine-safety/historical-concerns/index.html

13. The Cutter Incident, Polio Network (citing CDC). https://polionetwork.org/archive/adig3shiiagcds4x1igpvp9u3istoo

14. The Cutter Incident, 50 Years Later, New England Journal of Medicine. https://www.nejm.org/doi/abs/10.1056/nejmp048180

15. 1976 Swine Flu Vaccination Program, David J. Sencer CDC Museum. https://www.cdc.gov/museum/online/story-of-cdc/h1n1/index.html

16. Reflections on the 1976 Swine Flu Vaccination Program, Emerging Infectious Diseases (CDC). https://wwwnc.cdc.gov/eid/article/12/1/05-1007_article

17. Biology:1976 swine flu outbreak, HandWiki (summarizing CDC and contemporary reporting). https://handwiki.org/wiki/Biology:1976_swine_flu_outbreak

18. The Long Shadow of the 1976 Swine Flu Vaccine ‘Fiasco,’ Smithsonian Magazine. https://www.smithsonianmag.com/smart-news/long-shadow-1976-swine-flu-vaccine-fiasco-180961994/

19. Swine Flu Immunization Program of 1976, Gerald R. Ford Presidential Library. https://www.fordlibrarymuseum.gov/digital-research-room/topic-guides/swine-flu-immunization-program-1976

20. Determinants and trends of COVID-19 vaccine hesitancy and vaccine uptake in a national cohort of U.S. adults, medRxiv. https://www.medrxiv.org/content/10.1101/2021.05.12.21257116.full.pdf

21. Changes in general and COVID-19 vaccine hesitancy among U.S. adults from 2021 to 2022, PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11141308/

22. Sociodemographic Trends and Correlation between Parental Hesitancy towards Pediatric COVID-19 Vaccines and Routine Childhood Immunizations, PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11126092/

23. Vaccination Uptake, Intent, and Confidence, RespVaxView, CDC. https://www.cdc.gov/respvaxview/dashboards/vaccination-behavioral-social-drivers.html

The Boss Wants His Money: Trump and The Transactional Presidency

By

On August 10, 2026

In Politics

Donald Trump has never been shy about asking for money, but the scale and personal involvement of his second-term fundraising is genuinely new. According to reporting from the Wall Street Journal published in late July 2026, Trump has raised more than $800 million from corporate donors and wealthy individuals since returning to office in January 2025. Donations have been spread across the White House ballroom, a planned presidential library, a super PAC, and various political committees. What makes the operation unusual is not just the total raised, but how hands-on Trump has been. The Journal describes him calling his lead fundraiser, Meredith O’Rourke, from the White House on a near-nightly basis to review a running tally of who has paid and who hasn’t, sometimes pushing her to ask specific donors for far more than she’d planned to request.

Where the Money Is Going

Four distinct pots have absorbed most of this money, and it’s worth keeping them separate because the ethical and legal questions differ for each.

The White House ballroom

Trump’s roughly $300 million ballroom project, which required demolishing the White House’s East Wing, is funded through the Trust for the National Mall, a nonprofit that normally partners with the National Park Service on Mall upkeep. Corporate donors named publicly or in congressional correspondence include Apple (reported around $25 million), Microsoft (about $10 million), Amazon (about $5 million), along with Altria, Caterpillar, NextEra Energy, Palantir, Lockheed Martin, Booz Allen Hamilton, Comcast, Reynolds American, and Carrier, which donated an air-conditioning system in kind. Alphabet’s Google contributed $22 million to the ballroom fund as part of a settlement over Trump’s YouTube suspension. The Trust itself could collect as much as $10 million in fees for managing the fund, according to Senate Democrats who have pressed the organization for more transparency.

The presidential library

Trump’s future library has become the default destination for money tied to legal settlements. SoftBank reportedly pledged $50 million. Disney’s ABC and Paramount’s CBS each paid $16 million to settle lawsuits Trump filed over news coverage, with most of each sum earmarked for the library. Meta paid $25 million and X’s owner, Elon Musk, $10 million, to resolve similar suits over his removal from their platforms. Trump has also said he intends to redirect leftover inaugural committee funds toward the library once his term ends.

The super PAC and political committees

MAGA Inc., the main pro-Trump super PAC, entered 2026 with close to $300 million on hand after raising about $102 million in the second half of 2025. Recent large checks include $25 million from OpenAI co-founder Greg Brockman, $20 million from Foris DAX (the parent of Crypto.com), and $11 million from private equity investor Konstantin Sokolov. Meta separately gave $10 million to a Trump-aligned political committee, on top of its ballroom and library contributions. A separate nonprofit, Securing American Greatness, is also raising money but does not have to disclose its donors.

Legal settlements framed as donations

This is the category that has drawn the sharpest criticism. Because Paramount, Disney, Meta, and X all resolved lawsuits Trump filed against them by directing money toward his library rather than his personal accounts, the payments read simultaneously as litigation settlements and as political tribute. Several First Amendment lawyers and members of Congress, including Senators Elizabeth Warren, Bernie Sanders, and Ron Wyden, have argued that at least the Paramount and Disney settlements function as disguised payments for favorable regulatory treatment, since both companies had matters pending before agencies Trump oversees, including Paramount’s merger review at the FCC.

A Separate Stream: Trump’s Own Businesses

Everything described so far involves money flowing to entities Trump controls politically but does not personally own. A different and arguably more direct channel runs straight into Trump’s personal finances, primarily his family’s cryptocurrency ventures. It deserves separate treatment because the money there isn’t a donation to a cause; it’s revenue to a business he and his sons own.

World Liberty Financial, launched in 2024 by Trump’s sons Eric and Donald Jr. along with several partners, issues a stablecoin called USD1 and a separate token called WLFI, and takes a majority share of net revenue from token sales. Trump’s own financial disclosures show he personally earned more than $57 million from the venture in its first several months, and by mid-2026 CBS News reported his total crypto-related income, including proceeds from a separate TRUMP meme coin, had passed $1 billion for the year, the largest single component of his roughly $2.2 billion in disclosed 2025 income. Forbes has separately estimated his stake in World Liberty at around $240 million and his share of WLFI tokens at roughly $175 million, with his sons’ individual stakes each estimated near $133 million.

Two transactions illustrate how this business has intersected with people who also have legal exposure to Trump’s federal government. In May 2025, an Abu Dhabi state-owned investment fund used $2 billion in USD1 stablecoins to take a stake in Binance, the world’s largest crypto exchange. Binance also holds the large majority of all USD1 in circulation. Binance’s founder, Changpeng Zhao, had pleaded guilty in 2023 to a money-laundering-related charge and served a four-month sentence. In October 2025, Trump pardoned him. When asked about the connection, Trump told CBS News he didn’t know who Zhao was. World Liberty’s lawyers have said the company played no role in the pardon and had no contact with the president about it, while acknowledging Binance provided the venture with free technical assistance.

Separately, the crypto entrepreneur Justin Sun invested $75 million in WLFI tokens and another $100 million in the TRUMP meme coin in 2025. This made him World Liberty’s largest outside holder and a featured guest at a Trump dinner for top meme coin buyers. At the time, Sun was fighting a 2023 Securities and Exchange Commission fraud lawsuit alleging he manipulated trading volume in his own Tron-based tokens. That case was paused within months of his investment and formally settled for $10 million in March 2026, without an admission of wrongdoing. The current SEC chairman has wound down crypto enforcement actions brought by the previous administration. Sun and World Liberty later fell into a bitter and still-unresolved legal dispute after the company froze his tokens, which is a separate matter from the SEC case but worth noting because it shows the relationship soured even as the earlier regulatory question was being resolved in Sun’s favor.

In a more recent example, Truth Social, controlled by Trump, has established a paid tier for early access to Trump’s posts. Subscribers will receive notice of the content of Trump’s posts prior to them being made available to the general public. The fee is $100,000 a month. Since his posts routinely send stock markets soaring or plunging depending on his announcements, this could be considered insider trading by those willing to pay the price to beat the market.

Pardons, Donors, and Business Partners

The crypto pardon is not an isolated data point. NPR identified at least fifteen former officials convicted or charged with public-corruption offenses who received Trump pardons or commutations after he returned to office, including former Illinois Governor Rod Blagojevich, former Nevada official Michele Fiore, and former Congressman Michael Grimm. Beyond that corruption-specific list, several pardons have gone to significant Trump donors whose giving preceded or closely followed their clemency. Nikola founder Trevor Milton, convicted of securities and wire fraud, had donated close to $2 million to Trump’s 2024 campaign before receiving a pardon. Former Republican Congressman George Santos, expelled from the House after a fraud conviction, was pardoned after having donated to and supported Trump. And in July 2026, Republican megadonor Adam Kidan, convicted in 2006 in the Jack Abramoff fraud and lobbying scandal, received a pardon just three days after donating to the leadership PAC of a Pennsylvania congressman Trump had campaigned alongside days earlier. This is a sequence Democratic critics called corruption in plain sight, though the congressman’s office said he had no role in the pardon decision.

In May 2026, congressional Democrats sent letters to seventeen pardon recipients asking whether their clemency involved any pay-to-play arrangement, estimating that the group had given Trump-aligned committees roughly $250,000 combined.

It’s worth noting a structural point raised by Justice Sonia Sotomayor in her dissent from the Supreme Court’s 2024 immunity ruling Because the Court held that a president cannot be criminally prosecuted for official acts, including the pardon power, a pardon exchanged for a bribe would, on her reading, be effectively unreviewable by the criminal justice system even if the exchange were provable. Whether that reading will be tested in a real case is itself uncertain, since the ruling is relatively new and no prosecutor within this administration would be likely to bring such a case.

Enthusiastic Donors, Reluctant Donors, and the Ones Who Said No

The donor pool is not uniform, and the differences are informative. Some money looks genuinely enthusiastic: Musk was already the largest Republican donor of the 2024 cycle before adding a further settlement payment, and newer entrants like Crypto.com, which had made almost no prior political donations, gave $10 million to MAGA Inc. with no apparent reluctance. Cryptocurrency and artificial intelligence firms in general, an industry seeking friendly regulatory treatment on digital assets, have been some of the most eager givers.

Other donations look more like compliance than enthusiasm. Microsoft told congressional investigators it was approached by a fundraiser working on the ballroom project and simply followed the instructions it was given on how to contribute, a description that reads as accommodating rather than eager. Comcast, by contrast, stated explicitly that its donation carried no conditions and was not intended to secure anything in return, a formulation that looks like an attempt to draw a clean legal line around the gift. Meta and Nvidia, when directly asked by lawmakers whether their donations were connected to a quid pro quo, notably declined to deny it, which is its own kind of data point.

At least one major institution appears to have refused outright. JPMorgan Chase chief executive Jamie Dimon said publicly that his bank had not donated to the ballroom fund because of the risk to its reputation of anything that could look like buying favors. That is a useful data point: it shows that at least one important financial institution judged the risk of giving to outweigh whatever access it might buy.

Fundraising, Bribery, Extortion, or Tribute? A Speculative Look

Here I want to be explicit that I am speculating, not reporting settled fact, because the honest answer is that these categories overlap and the law hasn’t caught up with the phenomenon.

Ordinary fundraising describes money given voluntarily to support a cause or campaign the donor genuinely favors without expectation of a specific official act in return. Some of this money likely fits that description, particularly gifts from ideologically aligned donors like Musk or crypto-industry executives who would probably give even without pending business before the administration.

Bribery, in the legal sense, requires something that a voluntary donation doesn’t, an explicit link between a payment and a specific official act, sometimes called a quid pro quo. That’s a high bar, and it’s exactly the bar that federal prosecutors would need to clear, and that the current Department of Justice, led by Trump appointees, is unlikely to pursue. Legal scholars quoted in outlets like NPR have used the word bribery to describe the corporate legal settlements, but no bribery charge has been filed, and it is difficult to imagine one being filed by this Justice Department against this president. I’d rate the likelihood of a legal bribery label being applied here as low, not because the underlying facts are unclear, but because the label depends on intent and that is something we cannot observe from outside.

Extortion is the word used most often by critics of the media settlements specifically, on the theory that Trump filed lawsuits many legal experts considered weak, then used the threat of protracted litigation and regulatory friction, such as a pending merger review, to extract payment. That framing has real support—multiple press-freedom organizations and legal commentators have used the word extortion to describe the CBS and ABC settlements in particular, and the underlying pattern, filing suit and then collecting money tied to a business approval the target needs, matches the ordinary meaning of the word reasonably well. It fits for the media settlements specifically, but less so for donations that were solicited without any accompanying lawsuit or investigation. Although it is possible there may have been sub rosa threats. 

Tribute is the least legally precise of the four words but may be the most descriptive for a meaningful slice of the ballroom and library money: recurring, expected payments from parties who depend on the goodwill of a powerful figure, offered less because of any single transaction than to maintain an ongoing relationship. The nightly tally, the personalized dollar targets, and the pattern of companies giving again shortly after a prior gift all resemble tribute more than either standard fundraising or a one-time bribe. This is my own interpretation rather than a term used by reporters or lawmakers and is offered as one plausible view rather than a conclusion.

My overall speculation is that all four are in play, unevenly distributed across roughly $800 million in payments. A portion is conventional political fundraising from true believers. A portion, concentrated in the media settlements, looks close to what most people would call extortion even if it never meets the criminal-law bar. A portion resembles tribute from companies managing an ongoing relationship with a powerful regulator. And very little of it will likely ever be provable as bribery in the narrow legal sense, whatever the appearance.

The crypto and pardon pattern arguably adds a fifth category that doesn’t fit neatly into fundraising, bribery, extortion, or tribute at all, because the money in that channel isn’t going to a political cause or a public-facing project; it’s going directly into a business that Trump’s family owns. Calling Sun’s $175 million in World Liberty and meme coin purchases, or Zhao’s earlier assistance to the venture, a donation understates what’s happening. It may look like ordinary commerce between a business and its customers, except that one side of the transaction also happens to control pardons and regulatory enforcement. I’d describe this as closer to direct personal enrichment than to any of the four original categories, and I’d flag it as the pattern most analogous to classic bribery in structure, a private benefit flowing to the officeholder personally rather than to a cause or nonprofit.  I do need to admit, again, no bribery charge has been filed, and Trump and his family have denied any connection between the business dealings and the pardons.

Is It Transactional? Does Trump Require Donations for Policy Decisions?

This is the most speculative question I’ll address, and I want to flag it clearly as speculation rather than something I can document. The circumstantial case for a transactional relationship is strong. Multiple donors with active antitrust, merger, or enforcement matters before the administration have given large sums with some companies winning federal contracts after donating. Trump’s own team has reportedly offered donors special access as an incentive to give. The Washington Post reported in June 2026 that a group of ballroom donors collectively won roughly $50 billion in federal contracts after their gifts, though a correlation of that kind does not by itself prove the contracts were awarded because of the donations rather than for unrelated reasons.

What I cannot responsibly claim, because no reporting I’ve found demonstrates it, is that Trump has made a specific, identifiable policy decision that would not otherwise have been made, in direct exchange for a specific payment. That kind of explicit linkage is exactly what would be needed to prove a transactional arrangement rather than merely an environment in which donors reasonably believe giving improves their odds. My honest opinion is that the relationship is transactional in a soft, ambient sense, donors give in part because they believe it helps, and the administration’s fundraisers have sometimes implied as much, without there necessarily being an explicit ledger where a specific check buys a specific ruling. That is a meaningfully different claim from the harder allegation being made by some of Trump’s critics.

The pardon cases and the crypto business narrow that gap somewhat, because the timing there is tighter and easier to observe than in the corporate donation cases: a pardon three days after a donation, an SEC settlement a few months after a $75 million investment, a pardon of a business partner’s founder shortly after that partner’s exchange helped anchor a Trump family stablecoin. Timing alone still isn’t proof of illegal, or even unethical activity and in each case the administration or the family business has offered a nonfinancial justification, that a prosecution was political, that a settlement reflected the merits, that a business relationship was coincidental to a legal one. I believe it likely that the pardon pattern reflects some degree of donor and business partner favoritism, based on the sheer number of cases and their consistent direction. At the same time, I recognize that in any single case establishing a quid pro quo is unlikely, since proving intent behind one discretionary pardon or one enforcement decision is difficult even with favorable timing.

Image generated by author using ChatGPT

Sources

1. Wall Street Journal reporting summarized in Politico’s Political Wire, “Inside Trump’s Unprecedented Fundraising Operation,” July 30, 2026 — https://politicalwire.com/2026/07/30/inside-trumps-unprecedented-fundraising-operation/

2. Mediaite, “Trump Reportedly Demanding Companies and Donors Pay Up,” July 30, 2026 — https://www.mediaite.com/media/news/the-boss-wants-this-money-trump-has-reportedly-been-demanding-companies-and-donors-pay-up/

3. Common Dreams, “‘Keep Bribing Him Forever’: Critics Appalled at New Details of Trump’s Corporate Shakedowns” — https://www.commondreams.org/news/trump-corruption-corporate-shakedowns

4. Election Law Blog, summary of WSJ “The Boss Wants This Money” report — https://electionlawblog.org/?p=157699

5. Sen. Elizabeth Warren and Rep. Dave Min, joint release on corporate ballroom donation responses, January 12, 2026 — https://www.warren.senate.gov/newsroom/press-releases/warren-min-release-new-details-on-trump-ballroom-donations-by-giant-corporations-with-business-in-front-of-trump-admin/

6. Sen. Ron Wyden and colleagues, letter on the Trust for the National Mall and ballroom fundraising — https://www.wyden.senate.gov/news/press-releases/wyden-colleagues-trumps-ballroom-is-a-political-fundraiser-for-big-corporations-to-earn-backroom-favors

7. Sen. Elizabeth Warren et al., October 24, 2025 letter on East Wing demolition and ballroom fundraising — https://www.warren.senate.gov/newsroom/press-releases/warren-blumenthal-wyden-van-hollen-markey-slam-trump-ballroom-vehicle-for-politicized-fundraising-influence-peddling-and-donor-access

8. HuffPost/AOL, “All The Donors Financing Trump’s Ballroom As He Demolishes The White House” — https://www.aol.com/articles/donors-financing-trump-ballroom-demolishes-211705192.html

9. Washington Post, “Donors won $50B in contracts after giving to Trump ballroom project, report says,” June 4, 2026 — https://www.washingtonpost.com/politics/2026/06/04/donors-won-50b-contracts-after-giving-trump-ballroom-project-report-says/

10. MSNBC/MS NOW, “Trump’s unprecedented fundraising highlights what’s different in his second term” — https://www.ms.now/rachel-maddow-show/maddowblog/trump-unprecedented-fundraising-operation-corruption

11. Reuters via AOL, “Trump-aligned MAGA Inc super PAC enters 2026 with $300 million stockpile,” January 2, 2026 — https://www.aol.com/articles/trump-aligned-maga-inc-super-031233625.html

12. Brennan Center for Justice, “Unprecedented Big Money Surge for Super PAC Tied to Trump” — https://www.brennancenter.org/our-work/analysis-opinion/unprecedented-big-money-surge-super-pac-tied-trump

13. Axios, “Paramount agrees to settle Trump lawsuit for $16 million over ’60 Minutes’ interview,” July 2, 2025 — https://www.axios.com/2025/07/02/trump-paramount-cbs-harris-interview-lawsuit-settlement

14. CNN Business, “Paramount settles Trump’s ’60 Minutes’ lawsuit with $16 million payout and no apology,” July 2, 2025 — https://www.cnn.com/2025/07/02/media/cbs-trump-60-minutes-paramount-settlement

15. NPR, “CBS bends to Trump’s power with $16 million settlement,” July 2, 2025 — https://www.npr.org/2025/07/02/nx-s1-5454790/cbs-settlement-trump-60-minutes-harris-interview-analysis

16. The Dispatch, “The Paramount Settlement Is Plain Extortion,” by Robert Corn-Revere, July 4, 2025 — https://thedispatch.com/article/paramount-settlement-trump-60-minutes-extortion/

17. Deadline, “Elizabeth Warren Says Paramount’s Trump Lawsuit Settlement ‘Could Be Bribery In Plain Sight'” (via Yahoo) — https://www.yahoo.com/news/elizabeth-warren-says-paramount-trump-155245906.html

18. Variety via AOL, “Democrats to Intro ‘Presidential Library Anti-Corruption’ Bill After Paramount, Disney Lawsuit Settlements With Trump” — https://www.aol.com/entertainment/democrats-intro-presidential-library-anti-153000822.html

19. IBTimes UK, “Amazon, Apple and Meta Donated Millions to Trump’s Ballroom Before Their Federal Investigations Were Quietly Dropped,” June 5, 2026 — https://www.ibtimes.co.uk/corporate-donors-trump-ballroom-federal-contracts-1800963

20. Rep. Dave Min, “Min, Warren, Lawmakers Question Giant Corporations On Trump Ballroom Donations,” December 2025 (includes Jamie Dimon quote) — https://min.house.gov/media/press-releases/min-warren-lawmakers-question-giant-corporations-trump-ballroom-donations

21. Fox News, “Warren-led inquiry draws new details on Trump ballroom donations from major corporations,” January 13, 2026 — https://www.foxnews.com/politics/warren-led-inquiry-draws-new-details-trump-ballroom-donations-from-major-corporations

22. Sen. Elizabeth Warren’s office, “Trump’s fundraisers asked Microsoft for its White House ballroom donation” — https://www.warren.senate.gov/newsroom/news-coverage/trumps-fundraisers-asked-microsoft-for-its-white-house-ballroom-donation

23. Quartz, “Nvidia, other tech giants grilled over money for Trump’s ballroom,” December 2025 — https://qz.com/trump-ballroom-nvidia-meta-apple-microsoft-amazon

24. TIME, “Who Is Paying for Trump’s $250 Million Ballroom—and Why,” October 23, 2025 — https://time.com/7327752/trump-white-house-ballroom-funding-donors/

25. Yahoo News, “Major corporate interests and megadonors gave $239 million to fund Trump’s inauguration” — https://www.yahoo.com/news/major-corporate-interests-megadonors-gave-160337585.html

26. CBS News, “Trump made over $1 billion on crypto ventures last year, financial disclosure shows,” July 2, 2026 — https://www.cbsnews.com/news/trump-over-1-billion-on-crypto-ventures-financial-disclosures/

27. Forbes, “Trump’s Stablecoin USD1: Binance Holds 87% After Founder’s Pardon,” February 9, 2026 — https://www.forbes.com/sites/zacheverson/2026/02/09/trump-stablecoin-usd1-binance-holds-87-percent/

28. Public Citizen, “Conflict Coin: How the Trumps’ Billion-Dollar Crypto Stake Depends on a Company That Helped Iran Evade Sanctions,” May 1, 2026 — https://www.citizen.org/article/trump-crypto-world-liberty-financial-binance-iran-sanctions/

29. CBS News, “Trump on Binance cryptocurrency tycoon he pardoned: ‘I don’t know who he is'” — https://www.cbsnews.com/news/trump-binance-cryptocurrency-tycoon-he-pardoned-dont-know-who-he-is/

30. CBS News/60 Minutes transcript, “Trump pardon of crypto billionaire sparks concerns over his use of the pardon power” — https://www.cbsnews.com/news/trump-pardon-of-crypto-billionaire-sparks-concerns-over-use-of-pardon-power-60-minutes-transcript/

31. PBS NewsHour/AP, “Trump pardons Binance founder Changpeng Zhao” — https://www.pbs.org/newshour/amp/politics/trump-pardons-binance-founder-changpeng-zhao

32. Forbes, “Billionaire Justin Sun Sues Trump-Linked World Liberty Financial After He Invested $45 Million,” April 22, 2026 — https://www.forbes.com/sites/siladityaray/2026/04/22/crypto-billionaire-justin-sun-sues-trumps-world-liberty-financial-after-investing-45-million/

33. CBS News, “Crypto billionaire Justin Sun sues Trump family’s World Liberty Financial, alleging fraud,” April 22, 2026 — https://www.cbsnews.com/news/justin-sun-sues-trump-world-liberty-crypto-tokens/

34. Fortune, “Trump’s World Liberty Financial countersues crypto billionaire Justin Sun for defamation,” May 4, 2026 — https://fortune.com/2026/05/04/trump-world-liberty-financial-countersuit-justin-sun-defamation-allegations-of-fraud/

35. Finviz/Benzinga, “SEC Drops Charges Against Tron’s Justin Sun For $10 Million Civil Penalty” — https://finviz.com/news/332048/sec-drops-charges-against-trons-justin-sun-for-10-million-civil-penalty

36. Sen. Elizabeth Warren, “Warren Statement on the SEC Dropping Its Case Against Justin Sun,” March 5, 2026 — https://www.banking.senate.gov/newsroom/minority/warren-statement-on-the-sec-dropping-its-case-against-justin-sun

37. GovTrack Insider, “Corruption Concerns: A recap of official White House actions raising red flags in 2025,” January 16, 2026 — https://substack.govtrack.us/p/corruption-concerns-a-recap-of-official

38. IBTimes UK, “‘Corruption in Plain Sight’: Trump Pardons Convicted Fraudster Three Days After Campaign Donation,” July 30, 2026 — https://www.ibtimes.co.uk/corruption-plain-sight-trump-pardons-convicted-fraudster-three-days-after-campaign-donation-1811532

39. NOTUS, “Megadonor Received Trump Pardon Three Days After Donation to Pennsylvania Congressman,” July 29, 2026 — https://www.notus.org/pennsylvania/donald-trump-pardon-adam-kidan-ryan-mackenzie

40. NPR, “Trump pardons, DOJ moves hurt fight against public corruption,” May 13, 2026 — https://www.npr.org/2026/05/13/g-s1-121485/trump-pardons-public-corruption-justice

41. Forbes, “Democrats Investigate Whether Trump’s Pardons Were Pay-to-Play — Here Are the Big-Time Donors and Business Allies He’s Sprung Free,” May 7, 2026 — https://www.forbes.com/sites/alisondurkee/2026/05/07/democrats-investigate-whether-trumps-pardons-were-pay-to-play-here-are-the-big-time-donors-and-business-allies-hes-sprung-free/

42. Yahoo News/The New Republic, “Trump’s Pardons Since Jan 6 Spree Show an Infuriatingly Corrupt Trend” — https://www.yahoo.com/news/trump-pardons-show-infuriatingly-corrupt-162134383.html

Sleep Apnea: When Your Body Forgets to Breathe at Night

By

On August 7, 2026

In Medicine

Imagine spending eight hours in bed and waking up more exhausted than when you went to sleep. You’re getting plenty of time under the covers, but somehow your body never gets the rest it desperately needs. For millions of Americans, this isn’t just an occasional bad night—it’s a nightly battle with a condition called sleep apnea, where breathing repeatedly stops and starts throughout the night.
 
Sleep apnea causes repeated interruptions in breathing during sleep,  and it’s far more common than most people realize. Over 936 million adults worldwide aged 30-69 have some form of sleep apnea, though many don’t know they have it. The challenge is that the most dramatic symptoms happen while you’re unconscious, making it a disorder that often requires someone else to notice before you realize there’s a problem.
 
What Actually Happens During Sleep Apnea
 
The most common form is obstructive sleep apnea, which accounts for the vast majority of cases. During obstructive sleep apnea, the muscles in the back of the throat relax too much, causing the upper airway to collapse and interrupt breathing.  Think of it like trying to breathe through a straw that keeps getting pinched shut—your body is trying to get air, but the pathway keeps getting blocked.
 
Each pause in breathing, called an apneic event, lasts at least 10 seconds and can occur dozens or even hundreds of times per night.  When oxygen levels drop, your brain essentially sounds an alarm, triggering a brief arousal to restart breathing. These micro-awakenings fragment your sleep into tiny pieces, preventing you from getting the deep, restorative rest your body needs.  The termination of each apneic event is associated with a transient arousal from sleep, but these don’t register in your conscious memory. You don’t wake up in the morning thinking “I woke up 247 times last night.” Instead, you just feel terrible despite thinking you slept through the night.
 
 
There’s also central sleep apnea, which works differently. With central sleep apnea, the brain fails to send proper signals to the breathing muscles during sleep.  Instead of a physical blockage, it’s a communication breakdown between your brain and the muscles that control breathing. Some people even have complex sleep apnea, which combines both types.
 
How Sleep Apnea Gets Diagnosed
 
Doctors measure the severity of sleep apnea using the apnea-hypopnea index, which counts the average number of breathing pauses per hour.  An AHI between 5 and 14 events per hour is considered mild, 15 to 29 is moderate, and 30 or more is severe. Someone with severe sleep apnea might stop breathing more times in a single night than they’d care to count.
 
The gold standard for diagnosis is polysomnography—an overnight sleep study conducted in a specialized lab. During polysomnography, doctors monitor brain waves through an electroencephalogram, track oxygen levels with pulse oximetry, measure airflow through temperature and pressure sensors, and use respiratory belts to monitor chest and abdomen movement.  It’s like turning your body into a living data collection system for one night, with sensors measuring everything from your heart rate to how your legs move during different sleep stages.
 
For many people, though, home sleep testing is a more convenient option. Home sleep apnea tests use a limited subset of measurements—typically heart rate, oxygen levels, respiratory effort, body position, and nasal airflow.  While these portable devices can’t capture everything a full lab study can, they’re often sufficient for diagnosis and much easier to arrange.
 
Treatment Options: From Lifestyle Changes to High-Tech Solutions
 
The most effective treatment for moderate to severe sleep apnea is continuous positive airway pressure therapy, better known as CPAP. CPAP works by delivering air through a mask to keep airways open during sleep.  Think of it as a gentle wind tunnel that prevents your throat from collapsing. The device maintains constant air pressure, essentially splinting your airway open so you can breathe normally throughout the night.
 
But here’s the challenge: nearly half of patients don’t consistently use CPAP after the first month.  The mask can be uncomfortable, some people find the pressure sensation strange, and it takes getting used to sleeping with equipment on your face. For people who can’t tolerate CPAP or have milder cases, there are alternatives like oral appliances that reposition the jaw and tongue to keep the airway open.
 
Surgery is another option, though it’s typically reserved for specific situations. Surgical options include procedures to remove enlarged tonsils or adenoids, or to address abnormalities causing airway obstruction.  There’s even a newer treatment called hypoglossal nerve stimulation, which uses an implanted device to stimulate the nerve controlling tongue movement, keeping it from blocking the airway.
 
For some people, lifestyle modifications can make a real difference, especially with mild cases. Weight loss often helps since obesity is a major risk factor for sleep apnea.  Sleeping on your side instead of your back can reduce airway collapse, and avoiding alcohol before bed helps because alcohol relaxes throat muscles even more.
 
Sleep Apnea Versus Insomnia: Two Very Different Beasts
 
Here’s where things get interesting—and sometimes confusing. Sleep apnea and insomnia are fundamentally different disorders, yet they can look similar and even occur together. Sleep apnea is primarily a problem of abnormal breathing during sleep, while insomnia is an inability to fall asleep or stay asleep.
 
With insomnia, your brain is often the problem—it won’t shut off when you want it to. You lie awake with racing thoughts, or you fall asleep only to pop awake an hour later, mind already churning. People with insomnia are usually very aware that they’re having sleeping difficulties.  They know exactly how long they’ve been staring at the ceiling.
 
Sleep apnea operates differently. Many people with sleep apnea don’t realize they have breathing problems during sleep, as the awakenings are so brief they’re not consciously aware of them.  You might spend what feels like a full night asleep yet wake up exhausted. Your problem isn’t falling or staying asleep in the traditional sense, it’s that the sleep you’re getting is constantly interrupted and of terrible quality.
 
The plot twist is that these conditions can feed into each other. Sleep apnea causes numerous micro-awakenings that disrupt sleep and can lead to insomnia-like symptoms.  When you’re waking up dozens or hundreds of times per night, even if you don’t fully remember it, your sleep architecture gets shredded. This fragmentation can trigger the hyperarousal and sleep anxiety characteristic of insomnia.
 
Between 30-50% of people with sleep apnea also experience chronic insomnia symptoms,  a combination researchers call COMISA (comorbid insomnia and sleep apnea). This overlap creates treatment challenges because patients with both conditions may have difficulty tolerating CPAP due to frequent awakenings and an inability to fall back asleep with the mask in place.
 
How Would You Know If You Have Sleep Apnea?
 
This is the tricky part—you’re unconscious when it happens. Loud snoring, snorting, or gasping during sleep is a major warning sign, though not everyone who snores has sleep apnea and not everyone with sleep apnea snores.  If you live alone, you might never hear these sounds yourself.
 
Often, it’s a bed partner who first notices something’s wrong. They might observe you stop breathing, then suddenly gasp or snort as you restart. People with sleep apnea often toss and turn and show signs of restless nighttime sleep, sometimes waking up with sheets twisted and pillows scattered.
 
The daytime symptoms are easier to recognize. Waking with a headache, not feeling refreshed despite adequate time in bed, and feeling tired throughout the day, even to the point of dozing off, can all signal sleep apnea.  If you find yourself nodding off while reading, watching TV, or worst of all, driving, that’s a red flag. For many people, the only obvious symptom of sleep apnea is fatigue or excessive sleepiness during the day.
 
Other clues include waking up with a very dry mouth or sore throat (from breathing with your mouth open all night), frequent nighttime urination (sleep apnea can affect bladder sensation), difficulty concentrating, or mood changes. Some people even experience sexual dysfunction or decreased interest in sex due to the chronic sleep deprivation.
 
.The research suggests that some people may develop a heightened awareness over time, particularly if they also develop insomnia symptoms. Some patients with comorbid insomnia and sleep apnea may associate post-respiratory event awakenings with wakefulness, resulting in prolonged difficulty falling back asleep.  In these cases, what started as unconscious micro-arousals can evolve into conscious awareness and anxiety about sleep disruption.
 
Why This All Matters
 
The health consequences of untreated sleep apnea extend far beyond feeling tired. Sleep apnea increases the risk of high blood pressure, irregular heart rhythms like atrial fibrillation, heart disease, and stroke.  Each time your oxygen levels drop during a breathing pause, it stresses your cardiovascular system. Over months and years, this repeated stress can lead to serious complications.
 
There’s also the immediate danger of extreme daytime sleepiness. Excessive daytime sleepiness can cause microsleeps where you fall asleep for very brief periods—dangerous while driving or operating machinery.  The cognitive fog, mood disturbances, and reduced productivity affect quality of life even if you never have a serious accident.
 
The good news is that treatment works. With proper diagnosis and appropriate therapy—whether that’s CPAP, an oral appliance, surgery, or lifestyle changes—most people see dramatic improvements in their sleep quality and daytime functioning. The key is recognizing the problem in the first place, which requires paying attention to those subtle clues your body provides during the day about what’s happening at night.


 
Medical Disclaimer

The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.
Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.

If you are experiencing a medical emergency, call 911 or your local emergency number immediately.

The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.
 
 
Image generated by author using ChatGPT

Sources:
 
Mayo Clinic – Sleep Apnea: Symptoms and Causes
https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631
 
Cleveland Clinic – Sleep Apnea: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea
 
Merck Manual (Professional Edition) – Obstructive Sleep Apnea (OSA)
https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea-osa
 
StatPearls/NCBI – Obstructive Sleep Apnea
https://www.ncbi.nlm.nih.gov/books/NBK459252/
 
American Lung Association – Obstructive Sleep Apnea Symptoms and Diagnosis
https://www.lung.org/lung-health-diseases/lung-disease-lookup/sleep-apnea/symptoms-diagnosis
 
 

In Defense of Dr. Fauci

By

On August 3, 2026

In Politics, Science

Last week, an 85-year-old physician sat before a Senate committee and, for the first time in more than 250 congressional appearances spanning five decades of public service, declined to answer. Dr. Anthony Fauci invoked his Fifth Amendment right against self-incrimination over one hundred times, telling the panel that its chairman’s “evident obsession with calling for my prosecution” left him with no other reasonable choice. He was invoking his Fifth Amendment right against self-incrimination, not because he believed he had committed a crime, but because he no longer trusted that anything he said would be treated as testimony rather than ammunition. It was a stunning scene, and it should trouble anyone who cares about how this country treats its public servants once the politics of a crisis outlast the crisis itself.

Fauci’s career is, by any fair measure, one of the most consequential in the history of American medicine. He joined the National Institutes of Health in 1968 and led the National Institute of Allergy and Infectious Diseases from 1984 until his retirement in 2022, advising seven presidents from Reagan to Biden.  He was, for two decades, among the most cited scientists on earth. He helped transform HIV/AIDS from a near-certain death sentence into a manageable chronic condition, and his work undergirded PEPFAR, the President’s Emergency Plan for AIDS Relief, which is credited with saving more than 25 million lives worldwide. For that work, President George W. Bush — a Republican — awarded him the Presidential Medal of Freedom in 2008.  Doctor Francis S. Collins, former director of the National Institutes of Health, has called Dr. Fauci “a national treasure” and has stated that “Dr Fauci is the most dedicated public servant I have ever known. His contributions have saved countless lives from HIV/AIDS, Ebola and SARS-CoV-2, and will stand as a profoundly significant gift to humanity.”  None of that is in dispute even by his fiercest critics.

What is in dispute is his conduct during COVID-19, when he became the public face of a federal response that asked Americans to accept school closures, business shutdowns, masking, and eventually vaccine mandates. Senator Rand Paul, who now chairs the Senate committee investigating him, has spent years arguing that the National Institutes of Health funded research in Wuhan China contributed to the virus’s emergence, and that Fauci misled Congress about it under oath.

Ahead of last week’s hearing, Paul released more than 1,100 pages of Fauci’s pandemic-era diary entries, obtained after an eight-month search led by Health and Human Services Secretary Robert F. Kennedy Jr. Paul argued that what Fauci wrote privately differs from what he told the public. Paul has now pledged to seek a contempt-of-Congress vote, which he says could open the door to Justice Department prosecution.  Neither Paul nor Kennedy seems to understand that a diary entry is a statement fixed in time and may involve personal musing and speculation and that opinion and public statements can evolve as new knowledge becomes available.  Or perhaps they don’t care.

Reasonable people can criticize specific decisions made during the pandemic. Some restrictions may have lasted too long. Officials could have communicated uncertainty more clearly. Public health agencies sometimes failed to explain why recommendations changed, allowing confusion and mistrust to spread. The shifting public health guidance that so many Americans remember as evidence of dishonesty is, to most working scientists, simply what science looks like in real time: recommendations changed because the evidence changed, not because anyone was hiding the truth. But that is not to say those criticisms don’t deserve serious discussion.

What deserves equal recognition, however, is the unprecedented uncertainty confronting public health officials. They faced a rapidly evolving virus, incomplete data, overloaded hospitals, political polarization, and an information environment saturated with misinformation. Perfect decisions were impossible.

The main issue in contention is Senator Paul’s accusation that Dr. Fauci falsely testified that NIH never funded gain-of-function research at the Wuhan virology lab.  The element of funding is a technical issue. NIH did not directly fund research at the Wuhan lab; they provided a grant to a group known as EchoHealth who in turn funded research at Wuhan.  The second element requires a brief explanation of gain-of-function research.

Gain-of-function is laboratory research that deliberately alters a virus or other pathogen to give it new or enhanced biological properties—such as increased transmissibility, infectivity, or the ability to infect a new host—in order to better understand disease mechanisms, improve surveillance, or develop vaccines and treatments.  Senator Paul contends that the research did meet the gain-of-function definition while Dr. Fauci contends that it did not meet the federal guidelines in effect at that time and further that the research was not conducted on the SARS-CoV-2 virus and did not result in COVID-19.  He continues to maintain that his testimony accurately reflected NIH policy and definitions. Federal reviews, including one commissioned by the National Institutes of Health, have concluded that the specific EcoHealth-funded research did not meet the technical definition of gain-of-function in place at the time, a conclusion Fauci’s critics dispute but have not conclusively rebutted.

As these hearings have pointed out, there is not a single definition of gain-of-function among virologists or microbiologists. Some argue for a tighter definition while others do not.  To further add confusion to the question, the American Society for Microbiology has called for a more precise, evidence-based definition of the term gain-of-function.

It is worth being precise about what has and has not been shown. No evidence has emerged that the coronavirus was engineered or leaked from a laboratory; the scientific consensus still points toward a natural spillover event from a wild source.

The elements of perjury require two things: the person knowingly gave false testimony and did so with intention to deceive. Testifying to something that is believed to be true but is later proven to be false does not make the previous testimony perjury.  Because the underlying definitions in this charge are under intense debate in the scientific community, the basis for a perjury charge is extremely weak. But we know from recent experience with the reflecting pool that the lack of evidence does not stop the Trump administration from making unfounded criminal charges.

The perjury allegations remain only allegations, litigated in hearing rooms, press conferences, and cable news segments rather than in courts. And Fauci already received a preemptive pardon from President Biden before leaving office specifically to protect him from prosecution over pandemic-era statements — a fact Paul acknowledged, raising the question of exactly what additional legal jeopardy this pursuit is meant to produce.

That question points toward the real story here, which is less about virology than about power. Since President Trump’s return to the White House, several of Fauci’s most vocal critics — Kennedy chief among them — occupy positions from which they can direct the machinery of government at a single retired scientist. A congressional hearing that features senators trying to provoke Fauci by asking about tie colors and the day of the week, his attorney forcibly removed from the room, and a gallery of Trump-aligned activists standing by to testify about vaccine mandates is not a forum for discovering facts.

It is a stage for finishing an old argument by other means. They are attempting to turn a pandemic that killed more than a million Americans, into the fault of one man rather than a shared national failure, much of which occurred on Trump’s watch. And part of it may be personal, given how frequently Fauci found himself publicly correcting a president who does not forget being corrected.

This seems to me to be a case of selective persecution and part of the Trump revenge program.

Fauci may have been an imperfect messenger, and reasonable people can fault his early missteps on masking guidance or his sometimes brusque certainty in front of cameras. But there is a meaningful difference between legitimate oversight of pandemic policy — which Congress should absolutely conduct — and a years-long campaign whose stated goal, in Fauci’s own paraphrase of his chief antagonist, is to see him “behind bars.” When a senator with subpoena power spends a hearing pursuing a scientist’s diary rather than debating the substance of research policy, the effort looks less like accountability and more like retribution dressed up as investigation.  It is incredible to me that any reasonable person would believe that a man who spent his entire professional career trying to protect the American public from viral diseases would suddenly and intentionally try to trick them into wearing face masks and closing schools.

The American public deserves a legitimate, evidence-based scrutiny of pandemic-era policies . What the country has gotten instead, at least in the current hearings, looks  less like accountability than theater, and neither a scientist’s record nor the public’s understanding of what actually happened is served by a proceeding that produced a great deal of heat and, by most independent accounts, no new facts.

Public servants who make consequential decisions under uncertain conditions deserve scrutiny, not immunity from criticism. But they also deserve a process that seeks truth rather than a scalp. A man who spent fifty years fighting AIDS, Ebola, and a novel coronavirus should not have to plead the Fifth to protect himself from the country he served. That he felt compelled to do so says less about Anthony Fauci than it does about the politics that have consumed the men now pursuing him.  This is just one more in a string of embarrassments caused by the Trump administration that have brought shame to the American people in the eyes of the world.

Image generated by author using ChatGPT.

Sources:

1. NBC News, “Anthony Fauci invokes Fifth Amendment right not to answer questions at GOP-led Covid hearing” (July 29, 2026): https://www.nbcnews.com/politics/congress/anthony-fauci-5th-amendment-testify-covid-hearing-rand-paul-rcna589793

2. NewsNation, “Republican COVID-19 allegations against Dr. Anthony Fauci explained”: https://www.newsnationnow.com/health/what-fauci-is-accused-of/

3. The Washington Post, “Fauci’s critics have power. They’re coming after his pandemic record.” (August 2, 2026): https://www.washingtonpost.com/politics/2026/08/02/faucis-critics-have-power-theyre-coming-after-his-pandemic-record/

4. TIME, “Fauci Pleads the Fifth at Senate Hearing on COVID, Escalating Long-Running Clash With Republicans” (July 29, 2026): https://time.com/article/2026/07/29/fauci-fifth-amendment-senate-hearing-covid-rand-paul-republicans/

5. The Washington Post, “Rand Paul threatens to hold Fauci in contempt after he declines to answer questions” (July 29, 2026): https://www.washingtonpost.com/politics/2026/07/29/fauci-set-face-rand-paul-senate-gop-after-release-his-covid-diary/

6. AOL News, “Republicans ramp up attacks on Fauci”: https://aol.com/republicans-ramp-attacks-fauci-100000419.html

7. NIH MedlinePlus Magazine, “Meet Anthony S. Fauci, M.D., former Director of NIAID”: https://magazine.medlineplus.gov/article/meet-anthony-s-fauci-m.d-former-director-of-the-national-institute-of-allergy-and-infectious-diseases

8. Academy of Achievement, “Anthony S. Fauci, M.D.” (career timeline): https://achievement.org/achiever/anthony-s-fauci-m-d/

9. PBS American Masters, “Anthony Fauci biography and career timeline”: https://www.pbs.org/wnet/americanmasters/anthony-fauci-biography-and-career-timeline/26116

10. Encyclopaedia Britannica, “Anthony Fauci”: https://www.britannica.com/biography/Anthony-Fauci

Feeling a Bit Peckish? How a Centuries-Old British Word Might Be Sneaking Into Your Vocabulary

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On August 2, 2026

In Humor

If you’ve ever binge-watching The Crown, Ted Lasso, or any of the multitude of British mysteries, you’ve may have found yourself mimicking a British accent in the shower or casually saying “cheers” instead of “thanks.” You’re not alone — and you might be picking up more than just affectations. My wife and I are great fans of British mysteries, and I’ve been fascinated by the slang. “Ta”, “oi”, ” brilliant” and “no joy” are just a few of the terms I enjoy and all have equals in American slang.  There is one small but useful word that has no direct American parallel and is starting to sneak across the Atlantic. It’s peckish, and it’s worth a closer look.

What does it actually mean?

At its simplest, peckish means mildly hungry — not famished, not starving, just that gentle mid-afternoon nagging sensation that tells you it’s time to root around for a biscuit (or, if you’re American, a cookie). Being peckish means you’re a tad hungry, not starving, but hungry enough to poke around the kitchen.  Think of it as the polite, understated British cousin of “I could eat.”

There’s actually a second, older meaning too — irritable or peevish — though that sense has mostly faded from everyday use. Most modern speakers on both sides of the pond, when they use the word at all, use it strictly in the hunger sense.

Where does it come from?

The word dates to around 1785, built from the verb peck — as in what a bird does with its beak — combined with the suffix -ish, making it literally “disposed to peck.”  It evolved from the notion of nibbling or picking at food, suggesting a hunger not strong enough to warrant a full meal but rather a desire for something small and light.  The Oxford English Dictionary pushes the first documented use back even further, to the early 1700s.

All the pre-1988 OED citations for the word are British, which tells you something about how thoroughly it stayed home for nearly three centuries. One of the most celebrated uses comes from P.G. Wodehouse in 1936, where a character declares himself far beyond peckish — practically a homeless tapeworm. That’s the kind of comic understatement the British do so well, and it captures perfectly why the word is so appealing: it conveys hunger without any of the drama.

The Atlantic crossing

Here’s where streaming television enters the picture. Language-learning platform Babbel teamed up with Northern Arizona University researchers to measure cultural exchange between British and American English, analyzing millions of words and hours of speech — and found that British imports like bonkers, amongst, cheeky, and queue were among the fastest-growing British terms in American speech.

Peckish fits neatly into this trend. The March 2025 Netflix show Adolescence exposed American audiences to British slang and Generation Alpha online terminology that many of us had never encountered before, proving that a single binge-worthy hit can do more for vocabulary transfer than years of cultural proximity. Once Americans hear a word in context often enough — a character in Downton Abbey saying “I’m feeling rather peckish” before a garden party — the word starts to feel natural rather than foreign.

Why peckish, specifically, might stick

Not every British word makes the jump successfully. Some are too culturally specific (cheerio), some sound too pretentious (old chap), and others just don’t fill a gap that American English hasn’t already filled. Peckish, though, has a genuine advantage: it occupies a linguistic niche that American English handles clumsily. We have “hungry,” “starving,” and “famished” — all of which imply a more urgent need — and we have the clunky compound “I could use a snack.”

There’s also a certain aspirational quality at work. Borrowing British terms can feel like acquiring a touch of cosmopolitan polish, much the way earlier generations borrowed French culinary terms or Italian musical vocabulary. Saying “I’m a bit peckish” carries a different social flavor than “I’m kind of hungry.” It’s softer, less demanding, and perhaps a bit more amusing. For some speakers, that nuance is precisely the appeal.

At first glance you might think “munchies” would fill the gap. Both words describe mild, snack-worthy hunger rather than genuine meal-time starvation, but they diverge pretty sharply in tone and implication. Peckish is neutral and polite — the kind of word that fits comfortably in a country house or a BBC drama — while the munchies carries strong cultural baggage, most notably its well-documented association with cannabis use, and it implies something more compulsive and urgent than the genteel nibbling that peckish suggests. Same basic stomach situation, very different vibes.​​​​​​​​​​​​​​​​

What makes peckish particularly well-suited for adoption is its practicality. It names a common experience with precision and brevity. In an era when snacking has become a cultural norm—when meals blur into grazing—the need for a word that captures “not quite hungry, but getting there” is more relevant than ever. Peckish sits softly with a single, breezy word. It’s casual, it’s precise, and it has a pleasant sound. Words that fill empty conceptual slots tend to survive.  American English may not have invented peckish, but it has room for it.

My prediction is that peckish will continue its quiet migration into American casual speech, particularly among younger, streaming-heavy audiences. It probably won’t replace “hungry” wholesale, but it could settle comfortably into the same type of informal usage that “hangry” now occupies — a colorful, specific alternative for a specific feeling. Language, after all, tends to absorb what’s useful and charming, and peckish is both.

In the meantime, if you find yourself three episodes deep into a British drama and muttering “I’m a bit peckish” while wandering toward the kitchen to grab a cuppa and a bag of crisps, congratulations — you’ve been linguistically colonized.

Image generated by author using ChatGPT.

Familial Hypertriglyceridemia

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On July 28, 2026

In Medicine

When Fat in the Blood Runs in the Family

Most people know they should keep an eye on their cholesterol. But triglycerides — another type of fat circulating in the blood — often fly under the radar. For some families, though, high triglycerides aren’t just a lifestyle problem. They’re baked into the DNA. Familial hypertriglyceridemia (FHTG) is a hereditary condition in which the liver chronically overproduces fat-carrying particles, sending triglyceride levels well above what diet alone can fully explain. It’s more common than most people realize and is frequently under diagnosed.   If left unaddressed it can trigger serious complications including pancreatitis and heart disease.  

One of my earliest disappointments as a young physician was a patient with familial hypertriglyceridemia. He was in his late 20s and his triglycerides were running in the critical level. We tried multiple interventions and he was referred to multiple specialists.  Unfortunately, he wasn’t able to make the lifestyle changes he needed to make and progressively got worse and worse before passing away in his mid-30s. Fortunately, we have better treatments now, but this still is potentially a dangerous disease.

This article walks through FHTG, what it is, what causes it, how it presents, how it’s diagnosed, and what modern medicine can actually do about it.

What Is Familial Hypertriglyceridemia?

Triglycerides are the most common form of fat in the body. After you eat, calories that your body doesn’t immediately need are converted into triglycerides and stored in fat cells. Between meals, hormones release these fats for energy. When this system gets stuck in the “on” position — or when the body doesn’t clear triglycerides efficiently — blood levels climb.

FHTG, technically classified as Type IV familial dyslipidemia, is a genetic disorder in which the liver overproduces very low-density lipoprotein (VLDL) particles — essentially the trucks that carry triglycerides through the bloodstream. The result is persistently elevated triglyceride levels, typically in the moderate-to-severe range, sometimes severe enough to become medically dangerous.

Normal fasting triglycerides are generally below 150 mg/dL. Borderline high falls between 150 and 199. In FHTG, levels often run 200–500 mg/dL or higher, and some patients can exceed 1,000 mg/dL, a threshold at which the risk of acute pancreatitis rises sharply.

Etiology: The Genetic Story Is More Complicated Than Expected

For decades, FHTG was described in textbooks as a straightforward autosomal dominant disorder — meaning one copy of a faulty gene was enough to cause the condition, and each child of an affected parent had a 50% chance of inheriting it. That picture has been substantially revised by modern genetics.

It turns out that FHTG is primarily polygenic — driven not by a single dramatic mutation but by the cumulative effect of many small genetic variants.  Studies have now identified more than 300 independent genetic locations associated with plasma triglyceride levels. No single gene tells the whole story. Instead, a person inherits a kind of genetic “load” that creates susceptibility — and whether that susceptibility becomes clinically apparent often depends on environmental triggers.

The genes involved all play a role in how the body metabolizes fat-carrying particles. Heterozygous (single-copy) variants in these genes are common in most FHTG patients. The much rarer and more severe familial chylomicronemia syndrome (FCS) both copies are defective producing extreme triglyceride elevations and a very different clinical picture.

Environmental factors that worsen FHTG include obesity, poorly controlled diabetes, alcohol use, a diet heavy in refined carbohydrates and sugars, estrogen-containing medications, and certain drugs such as corticosteroids and beta-blockers. In many patients, the genetic predisposition only becomes clinically obvious when one or more of these environmental triggers is present — which explains why the condition often goes undetected until adulthood.

Symptoms: The Quiet Condition

One of FHTG’s most deceptive features is that it is often silent. Many people carry the condition for years without a single symptom, discovering it only through routine blood work or a family history investigation. This is why widespread lipid screening is so important — FHTG doesn’t announce itself with chest pain or obvious physical signs, at least not initially.

When symptoms first appear, they are often subtle and tend to reflect either the degree of triglyceride elevation or the presence of associated conditions. In cases of moderate elevation, patients might experience vague fatigue, weight gain, or features of metabolic syndrome — high blood pressure, elevated blood sugar, increased waist circumference.

At higher triglyceride levels, more distinctive signs can emerge. Xanthomas, yellowish, waxy deposits of fat under the skin, may appear, particularly around the eyelids (xanthelasmas) or over the elbows, knees, or tendons. The liver may enlarge (hepatomegaly), reflecting fat accumulation. An eye exam may show lipemia retinalis — a milky or salmon-pink discoloration of the retinal blood vessels — visible with an ophthalmoscope when triglycerides are extremely high.

The most dangerous symptom is severe abdominal pain signaling acute pancreatitis. When triglycerides exceed 1,000 mg/dL, the pancreas can become inflamed as it is overwhelmed by fat-rich particles. This is a medical emergency. Nausea, vomiting, and upper abdominal pain radiating to the back are warning signs that warrant immediate evaluation.

There is also an increased risk of early cardiovascular disease in FHTG patients, particularly when metabolic syndrome is present, though the relationship between triglycerides alone and heart disease risk is more nuanced than it is with LDL cholesterol.

Diagnosis: Getting the Full Picture

Diagnosis begins with a standard fasting lipid panel — a blood test that measures total cholesterol, LDL, HDL, and triglycerides. In FHTG, the hallmark findings are elevated triglycerides and VLDL, often accompanied by low HDL (the so-called “good” cholesterol). LDL levels may be normal or even low, which can sometimes falsely reassure both patients and physicians.

Because many things can raise triglycerides — including a meal eaten before the blood draw, excess alcohol, diabetes, hypothyroidism, kidney disease, and certain medications — the first step is ruling out secondary causes. A thorough personal and family history is essential. A clinician who asks about triglycerides in parents or siblings or even children is doing exactly what the guidelines recommend.

The “familial” part of the diagnosis is confirmed when multiple first-degree relatives are found to have elevated triglycerides, when the elevation persists despite controlling for secondary causes, and when the pattern fits what we’d expect from a heritable condition appearing across generations.

Genetic testing can identify specific variants in the related genes, but it is not required for a clinical diagnosis and is not routinely performed. Genetic testing may be ordered when the clinical picture is severe or ambiguous, or when distinguishing FHTG from the rarer familial chylomicronemia syndrome which has treatment implications such as the emerging targeted therapies.

Current guidelines also recommend evaluating for cardiovascular risk in patients with mild-to-moderate FHTG, and for pancreatitis risk in those with severe elevations.

Treatment: A Layered Approach

Lifestyle First

The cornerstone of FHTG management — at least for mild-to-moderate disease — is lifestyle modification, and it can be remarkably effective. Cutting refined carbohydrates and added sugars is particularly powerful. Saturated fat primarily raises LDL cholesterol, but it is carbohydrates that drive hepatic triglyceride production. Alcohol is another major player. Even moderate consumption can substantially raise triglycerides in susceptible individuals, and abstinence often produces dramatic improvements.

Weight loss, regular aerobic exercise, and tight blood sugar control in patients with diabetes or prediabetes round out the lifestyle toolkit. Estrogen-containing contraceptives or hormone replacement therapy should be reconsidered in women with FHTG, as estrogen directly stimulates hepatic VLDL production and can push levels dangerously high.

Pharmacologic Options

When lifestyle changes aren’t enough, several drug classes are available. Fibrates (such as fenofibrate and gemfibrozil) are the most established triglyceride-lowering medications and can reduce levels by 30–50%. They work primarily by activating receptors that enhance triglyceride clearance.

Omega-3 fatty acids at prescription doses (2–4 grams per day) provide another option. High dose eicosapentaenoic acid (EPA), specifically the formulation icosapent ethyl (Vascepa), has demonstrated cardiovascular benefit in a major clinical trial in high-risk patients with elevated triglycerides who are already on statin therapy.

Niacin (nicotinic acid) was once widely used but has fallen out of favor after clinical trials failed to show cardiovascular benefit on top of statin therapy, despite its triglyceride-lowering ability.  It is also poorly tolerated due to its side effect profile and patients frequently are noncompliant.

Statins are prescribed primarily to manage cardiovascular risk and LDL cholesterol rather than to lower triglycerides directly, though they have a modest effect on the latter.

Emerging Therapies

Perhaps the most exciting development in recent years is the arrival of RNA-based medications targeting apolipoprotein C-III (APOC3) — a protein that inhibits the clearance of triglyceride-rich particles. By silencing the gene that produces APOC3, these drugs can achieve dramatic reductions in triglyceride levels even in patients who don’t respond to conventional therapies.

Olezarsen received FDA approval in 2024 for patients with familial chylomicronemia syndrome. Its application in FHTG more broadly is an active area of clinical investigation. Similarly, drugs targeting angiopoietin-like proteins are under study, offering the prospect of precision medicine approaches to a condition that has long resisted fully effective treatment.

Prognosis: Manageable, But Not to Be Ignored

The prognosis for FHTG is generally favorable when the condition is identified and managed appropriately. Unlike some other inherited lipid disorders, FHTG is not automatically associated with dramatically elevated cardiovascular risk — particularly when LDL and HDL levels are otherwise reasonable. This distinguishes it from conditions like familial hypercholesterolemia, where premature heart disease is nearly inevitable without treatment.

That said, FHTG patients frequently carry additional cardiovascular risk factors as part of the metabolic syndrome package that must be addressed in its own right. The American Heart Association has noted that this clustering of risk factors likely elevates cardiovascular risk in FHTG patients beyond what triglycerides alone would predict.

The more immediate and measurable danger in FHTG is pancreatitis. When triglycerides are severely elevated, the risk of a potentially life-threatening inflammatory episode of the pancreas is real. Repeated bouts of pancreatitis can cause chronic damage, that impairs digestive function and increases the risk of pancreatic cancer. Preventing severe hypertriglyceridemia through consistent management — lifestyle, medication, or both — is not optional for high-risk patients.

With appropriate care, most patients with FHTG can expect to live a normal lifespan. The key predictors of outcome are compliance with dietary and lifestyle changes, appropriate use of medication when indicated, regular lipid monitoring, and attention to comorbidities like diabetes and hypertension. Family members of affected individuals also should be screened.  

Bottom Line

Familial hypertriglyceridemia is one of those conditions that rewards attention and penalizes neglect. It runs quietly in families, often masked by other lifestyle factors until a crisis — a pancreatitis episode, an unexpected cardiovascular event — brings it to light. Modern genetics has revealed it to be more complex than once thought, driven by a mosaic of variants rather than a single defective gene. Treatment has evolved accordingly: from basic dietary counseling to sophisticated RNA-based drugs that target the fat metabolism pathway at the molecular level.

If you have a family history of high triglycerides, early heart disease, or pancreatitis of unclear cause, it’s worth having a conversation with your doctor about a fasting lipid panel and a careful family history review. Knowing is the first step to managing.

Medical Disclaimer

The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.

Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here. 

If you are experiencing a medical emergency, call 911 or your local emergency number immediately.

The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.

Image generated by author using ChatGPT.

Sources

• MedlinePlus – Familial Hypertriglyceridemia

• NCBI StatPearls – Familial Hypertriglyceridemia (2024)

• Wikipedia – Familial Hypertriglyceridemia

• PMC – Genetics of Hypertriglyceridemia (Dron & Hegele, 2020)

• PMC – Understanding Hypertriglyceridemia: Integrating Genetic Insights (2024)

• PMC – Diagnosis and Treatment of Hypertriglyceridemia

• PMC – Severe Hypertriglyceridemia and Chylomicronemia Syndrome

• PMC – Pancreatic and Cardiometabolic Complications of Severe Hypertriglyceridemia (2024)

• Springer – The Genetic Basis of Hypertriglyceridemia

• Medscape – Hypertriglyceridemia: Background, Etiology, Pathophysiology

• PMC – Olezarsen for Familial Chylomicronemia Syndrome (2024-2025)

• Endocrine Society – Evaluation and Treatment of Hypertriglyceridemia (Clinical Practice Guideline)

• Cleveland Clinic – Hypertriglyceridemia: Causes, Risk Factors & Treatment

The Lost Cause: How the South Rewrote Its Own Defeat

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On July 23, 2026

In History

An Idea Born From Defeat

Nobody plans for a myth. The Lost Cause grew out of a very specific and very human problem: how do you explain to a grieving, ruined society that the cause it sacrificed everything for was not just defeated but morally indefensible? Roughly eighteen percent of white Southern men of military age died fighting for the Confederacy, an almost unfathomable toll for any society to absorb. For the widows, mothers, and veterans left behind, the idea that all of that loss had been in service of preserving slavery was, as one historian has put it, simply unthinkable.

 Former Confederates faced the psychological and political task of explaining catastrophic loss, human devastation, and the failure of a slaveholding social order they had claimed was divinely sanctioned and constitutionally sound. So, a different story took shape, and it took shape fast. Even before the war had formally ended, Confederate leaders were already laying the rhetorical groundwork. In his farewell address to the Army of Northern Virginia the day after Appomattox, Robert E. Lee thanked his men for four years of “unsurpassed courage and fortitude,” framing the surrender as a matter of being overwhelmed by superior numbers and resources rather than a defeat on the merits of the cause itself.

The term “Lost Cause” itself entered print in 1866, when the Richmond journalist Edward Pollard published a book titled The Lost Cause: A New Southern History of the War of the Confederates. Pollard’s argument was strategic rather than sentimental. Having lost the war on the battlefield, he wrote, the South still had a “war of ideas” left to fight, and that war could still be won.

At its core, The Lost Cause is less a historical interpretation than a civil religion and propaganda project, designed to preserve white Southern honor and racial hierarchy under new conditions.  It is hard to overstate how much that single phrase came to shape the next century and a half of American memory.

Pillars of a Comforting Fiction

Historians who study the Lost Cause generally point to a recognizable cluster of claims that, taken together, formed its core. Secession and the war, in this telling, had little or nothing to do with slavery and everything to do with defending states’ rights against federal overreach. The antebellum South was recast as a place of benevolent enslavers and a contented, loyal enslaved population. Confederate soldiers were honorable men fighting a defensive war, not traitors who took up arms against their own government. Military defeat was attributed almost entirely to the Union’s overwhelming advantage in manpower and industrial capacity, never to any failure of Confederate leadership or to the moral weakness of the cause. Robert E. Lee, in particular, was elevated into something close to secular sainthood. African Americans were described as “faithful slaves,” loyal to their masters and the Confederate cause and supposedly unprepared for freedom.  Reconstruction was portrayed as a vindictive, corrupt imposition on a prostrate South, justifying the violent reassertion of white political control that followed. Finally, the myth insisted that though the Confederacy had fallen politically, the “spirit” of the South survived and might “rise again” if white Southerners preserved their distinctive culture, honor, and racial order. In this way, the Lost Cause provided continuity between antebellum slavery, wartime rebellion, and postwar white supremacist politics.

Every one of these claims runs directly against the documented record. The secession declarations of South Carolina, Mississippi, Georgia, Texas, and other states say plainly and repeatedly that the preservation of slavery was the cause, not an incidental issue among many. But factual accuracy was never really the point of the Lost Cause. Its purpose was psychological and political: to let the white South live with its defeat, and, just as importantly, to lay the moral groundwork for restoring the racial order that the war had supposedly settled.

Spreading the Story: Memorial Societies, Veterans, and the Pen of Jubal Early

The earliest carriers of the Lost Cause were not generals but grieving women. Ladies’ Memorial Associations formed across the South almost immediately after the war, organizing the reburial of Confederate dead and the upkeep of cemeteries. Their work was tender and local at first, but it built the emotional infrastructure — the rituals, the orations, the sanctified ground — on which a much larger ideological project would later be built.

Among former Confederate officers, the most consequential figure in shaping the Lost Cause as formal history was General Jubal Early. Early devoted much of his postwar life to defending Lee’s reputation and to attacking the record of Lee’s subordinate James Longstreet, whom Early and his allies scapegoated for the defeat at Gettysburg, protecting Lee from any share of the blame. Through groups like the Southern Historical Society, Early and like-minded veterans worked to control the historical record of the war, vetting books and articles to make sure they conformed to the approved narrative.

But the organization that did more than any other to plant the Lost Cause permanently in American culture was the United Daughters of the Confederacy, founded in 1894. The UDC’s reach extended into nearly every institution that shapes how a society remembers itself: cemeteries, churches, civic ceremonies, street names, and above all, public school textbooks. Led by figures such as Mildred Lewis Rutherford, the UDC reviewed and effectively censored history textbooks used across the South, blacklisting books that strayed from the Lost Cause storyline and rewarding those that conformed to it.

The UDC’s other great instrument was the monument. Beginning in earnest around the turn of the twentieth century and continuing well into the Jim Crow era, the organization raised money for hundreds of Confederate statues and memorials across the South and beyond.  Surprisingly, at least 14 confederate monuments were established in West Virginia, a state that itself seceded from the Confederacy.

 The timing of the monument wave is revealing: most went up not in the immediate aftermath of the war but decades later, in the 1890s through the 1920s, precisely as Jim Crow segregation laws were being written into state codes.  Confederate iconography was being erected at the same time Black political and civil rights were being systematically stripped away. In 1904 the UDC even campaigned for so-called “faithful slave” monuments, intended to memorialize the fiction of contented, loyal enslaved people.

Churches also played a central role, effectively transforming the Lost Cause into a “culture religion” that blended Christianity with Confederate civil mythology. Clergymen like J. William Jones, sometimes called the “Evangelist of the Lost Cause,” framed Confederate soldiers as Christian martyrs and linked fidelity to Southern memory with fidelity to the faith, sanctifying the cause and its leaders. Rituals such as Confederate Memorial Day, graveside decoration, and monument dedication ceremonies functioned as recurring liturgies that reinforced the myth, with symbols like “Dixie,” the battle flag, and the gray uniform serving as quasi-sacred emblems

These organizations presented themselves as guardians of memory, but in practice they curated a highly selective recollection that emphasized honor, sacrifice, and white unity, while erasing slavery, Black agency, and Confederate internal dissent.

Popular culture did its own work alongside the formal organizations. D.W. Griffith’s 1915 film The Birth of a Nation, a massive commercial and cultural success, was adapted from a novel sympathetic to the Ku Klux Klan.  It presented Reconstruction as a period of Black misrule rescued by Klan heroism. Margaret Mitchell’s 1936 novel Gone with the Wind and its 1939 film adaptation did similar work in a softer key, romanticizing the antebellum plantation South for a national, as well as Southern, audience.

A Useful Story for the Whole Country, Not Just the South

It would be a mistake to treat the Lost Cause as a purely Southern phenomenon that was merely tolerated by the rest of the country. Northern white Americans had their own reasons to embrace a version of the war that didn’t dwell too long on slavery or its aftermath. As the decades passed and the Gilded Age’s industrial culture left many white Americans disillusioned, a sentimental story of Northern and Southern soldiers as equally brave men fighting on opposite sides of a tragic but honorable conflict offered a tidy path to national reconciliation. Popular fiction of the era often symbolized this reunion literally, pairing a wealthy Northern man with an impoverished but spiritually superior Southern woman as a stand-in for the reunited nation.

That impulse for reconciliation came at a steep price and the price was paid almost entirely by Black Americans, whose claims to full citizenship and civil rights were quietly set aside so that the white North and the white South could embrace one another over Confederate graves. The historian David Blight argued that this national reunion was built directly on top of the abandonment of Reconstruction’s promises.

From Veterans’ Memory to Civil Rights Backlash

The Lost Cause did not simply persist after its turn-of-the-century peak; it surged again whenever white supremacy felt politically threatened. Its second major resurgence came during the civil rights movement of the 1950s and 1960s, when Confederate flags, monuments, and rhetoric were deployed by segregationists as symbols of resistance to federal civil rights enforcement and to the broader push for racial equality. The display of Confederate iconography on state capitol grounds and on state flags during this period was viewed by many as a calculated act of contemporary political defiance dressed up as heritage and not a simple continuation of nineteenth-century commemoration.

Politically, the Lost Cause served the interests of Southern Democratic elites and white supremacist movements seeking to roll back Reconstruction and to legitimize Jim Crow segregation. By re-framing the war as a righteous defense of self-government and by portraying Reconstruction as illegitimate “Northern rule,” the myth provided a moral vocabulary for resisting Black voting, officeholding, and civil equality. Supporters of the Lost Cause were not simply being nostalgic; they were engaging in active political work, using historical distortion to shape contemporary policy.

By the mid-twentieth century, professional historians had begun dismantling the Lost Cause’s factual claims in earnest. Scholars such as Eric Foner, Barbara Fields, David Blight, and others reoriented Civil War and Reconstruction history around the documentary evidence: the secession declarations, the wartime speeches, the Confederate constitution’s explicit protections for slavery. Among professional historians today, the Lost Cause is treated not as a contested interpretation but as a settled case of historical negation — a comforting story constructed and maintained for reasons that had little to do with what actually happened.

How the Lost Cause Shows Up Today

The most visible modern flashpoint has been the fight over Confederate monuments. The removal of statues in cities such as New Orleans and Charlottesville in the 2010s, and the surge of removals following the 2020 protests over the killing of George Floyd, were not really arguments about bronze and granite. They were arguments about which story of the war and which set of values a public square should honor.

The Lost Cause also survives in quieter, more subtle ways. Many people still describe the Civil War as a conflict over “states’ rights.” They often leave out the specific right Southern states were determined to protect: slavery. Family heritage organizations, such as the Sons of Confederate Veterans, continue much of the commemorative work begun by the United Daughters of the Confederacy. Some textbooks and museum exhibits are still being revised to remove decades of Lost Cause interpretation, though this action is currently coming under attack. Popular culture also continues to romanticize the antebellum South as gracious and orderly, while overlooking that its economy depended on enslaved labor.

For many Americans, this version of history became the story they learned as children. Ideas learned early are often the hardest to change. Understanding the Lost Cause as a myth rather than a mere mistaken interpretation is crucial, because it underscores that this narrative was consciously constructed to serve specific social and political ends. It helped white Southerners cope with defeat, but it also justified the continued subordination of African Americans and shaped national memory in ways that obscured the realities of slavery and racial violence. Its persistence into the present suggests that struggles over the historical narrative are inseparable from struggles over power: how Americans remember the Civil War is bound up with how they understand inequality, citizenship, and the responsibilities of the modern state.

Why the Story Still Matters

The Lost Cause endures, I think, because it solves a problem every defeated society faces: what do you do with the dead, and with the cause they died for, when that cause turns out to have been wrong? The honest answer — that hundreds of thousands of men died defending a system built on human bondage — is almost unbearable to sit with, and the Lost Cause offered, and still offers, an alternative that lets descendants feel pride instead of horror. That emotional utility is precisely what has made it so durable, and precisely why dismantling it has taken historians the better part of a century and is, by most accounts, still unfinished work that may never be complete.

Sources

1. “Lost Cause | Meaning, Myth, Ideology, History, Significance, & Facts,” Encyclopaedia Britannica.

2. Caroline Janney, “The Lost Cause,” Encyclopedia Virginia, Virginia Humanities.

3. “The Lost Cause: Definition and Origins,” American Battlefield Trust.

4. “Lost Cause of the Confederacy,” Wikipedia.

5. “United Daughters of the Confederacy,” Wikipedia.

6. Sue Sturgis, “TWISTED SOURCES: How Confederate propaganda ended up in the South’s schoolbooks,” Facing South.

7. “Lost Cause,” 64 Parishes.

8. “Lost Cause Myth,” The Inclusive Historian’s Handbook.

9. “Origins of the Confederate Lost Cause,” JSTOR Daily.

10. Solomon Crenshaw Jr., “Daughters of Confederacy Put Up Statues, Indoctrinated Generations, Historians Say,” BirminghamWatch.

11. “The Lost Cause Myth: How the South Flipped the American Civil War Story,” The Valentine Museum.

Eating Well for the Long Run: How Your Nutritional Needs Change as You Age

By

On July 20, 2026

In Medicine

Growing older is often described as a gradual process, but many of the body’s changes begin earlier than most people realize. By our thirties, we slowly begin to lose muscle mass. By our fifties and sixties, our metabolism slows, bones become more fragile, digestion changes, and our bodies become less efficient at absorbing certain nutrients. None of this means declining health is inevitable. In fact, one of the most powerful tools for maintaining strength, independence, and quality of life is something we do every day: eat.

The nutritional needs of older adults are different from those of younger adults—not because the body suddenly requires exotic foods or expensive supplements, but because it becomes less forgiving of nutritional shortfalls. While calorie requirements often decline as physical activity decreases and muscle mass diminishes, the need for high-quality nutrients remains the same or even increases. Nutritionists refer to this as the challenge of nutrient density: getting more nutrition from fewer calories.

The goal of eating well in later life is not simply to prevent disease. It is to preserve muscle, maintain cognitive function, support the immune system, protect the heart and bones, and help people remain active and independent for as long as possible.

Protein: The Cornerstone of Healthy Aging

Protein is perhaps the most important of all nutrients as we age. Beginning around age 30, adults lose approximately 3 to 8 percent of their muscle mass each decade. After age 60, the rate often accelerates. This gradual decline, known as sarcopenia, contributes to weakness, slower walking speed, impaired balance, increased risk of falls, and loss of independence. During illness or hospitalization, muscle can disappear surprisingly quickly, making recovery more difficult.

The problem is compounded by what scientists call anabolic resistance. Aging muscle simply does not respond to protein as efficiently as younger muscle. Older adults must consume more protein—and distribute it more evenly throughout the day—to stimulate muscle repair and growth.

The Recommended Dietary Allowance is 0.8 grams of protein per kilogram of body weight— that’s about 80 grams for a 160-pound adult. For reference, a 4 oz serving of salmon has about 22 grams of protein. Many geriatric nutrition experts recommend 1.0 to 1.2 grams per kilogram daily for healthy adults over age 65. Those recovering from surgery, injury, or serious illness may require1.2 to 1.5 grams per kilogram, but only under medical supervision.

Equally important is timing. Many Americans consume very little protein at breakfast, a modest amount at lunch, and most of it at dinner. Research suggests muscle responds better when approximately 25 to 30 grams of protein are consumed at each meal.

Excellent sources include fish, poultry, lean meat, eggs, Greek yogurt, cottage cheese, beans, lentils, tofu, soy products, nuts, and seeds. Dairy proteins such as whey are especially rich in leucine, an amino acid that plays a central role in stimulating muscle protein synthesis.

Nutrition alone, however, is only part of the equation. Resistance training—even with light weights or resistance bands—works hand in hand with adequate protein to preserve muscle throughout later life.

Carbohydrates: Choosing Quality Over Quantity

Carbohydrates have acquired an undeserved reputation in many popular diets. In reality, they remain the body’s preferred source of energy and are especially important for the brain, which relies heavily on glucose to function.

The key is not eliminating carbohydrates but selecting healthier ones.

As we age, our bodies often become less sensitive to insulin, making blood sugar regulation more challenging. Highly refined carbohydrates—white bread, pastries, sugary beverages, and many processed snack foods—cause rapid spikes in blood glucose followed by equally rapid declines. Over time, these fluctuations may contribute to weight gain, insulin resistance, and type 2 diabetes.

Complex carbohydrates digest more slowly, providing a steadier release of energy while supplying vitamins, minerals, and fiber. Whole grains such as oatmeal, barley, brown rice, and whole-wheat bread are excellent choices. Fruits, vegetables, beans, and lentils provide carbohydrates along with antioxidants and phytochemicals that support overall health.

Contrary to popular belief, potatoes are not inherently unhealthy. Preparation matters. A baked potato with its skin offers potassium, vitamin C, and fiber, whereas deep-fried potatoes or heavily buttered mashed potatoes provide considerably more calories and saturated fat.

Many older adults find that emphasizing minimally processed carbohydrates improves energy levels and helps maintain stable blood sugar throughout the day.

Fiber: The Unsung Hero

Fiber is one of the most overlooked nutrients in the American diet, yet it becomes increasingly important with age.

Digestive motility naturally slows as we grow older. Physical inactivity, inadequate fluid intake, and medications—including opioid pain relievers, some antidepressants, calcium supplements, and certain blood pressure medications—can further contribute to constipation.

Fiber helps keep the digestive system functioning normally by increasing stool bulk and promoting regular bowel movements. But its benefits extend well beyond the gastrointestinal tract.

A high-fiber diet lowers LDL (“bad”) cholesterol, slows glucose absorption, improves blood sugar control, supports healthy gut bacteria, and increases feelings of fullness, helping many people maintain a healthy weight.

Current recommendations suggest approximately 30 grams of fiber daily for older men and about 21 grams for older women, although most Americans consume substantially less.

Good sources include fresh fruits, vegetables, legumes, oats, bran cereals, nuts, seeds, and whole grains.

Fiber should always be increased gradually while maintaining adequate fluid intake. Without sufficient water, increasing fiber can actually worsen constipation.

Healthy Fats Continue to Matter

Fat remains an essential nutrient throughout life.

Healthy fats provide energy, help build cell membranes, assist in hormone production, reduce inflammation, and allow absorption of the fat-soluble vitamins A, D, E, and K.

Perhaps most importantly, healthy fats support cardiovascular health, an increasingly important consideration with advancing age.

Monounsaturated fats found in olive oil, avocados, almonds, pecans, pistachios, and peanuts remain among the healthiest dietary choices.

Particularly valuable are the marine omega-3 fatty acids EPA and DHA found in salmon, trout, sardines, herring, and mackerel. Numerous studies have shown that these fats lower triglyceride levels and are associated with improved cardiovascular health. Some research also suggests they may help preserve cognitive function, although evidence remains mixed.

Plant sources such as flaxseed, chia seeds, walnuts, and canola oil provide alpha-linolenic acid (ALA), another beneficial omega-3 fatty acid.

By contrast, trans fats should be avoided whenever possible, while saturated fats from fatty meats, butter, and highly processed foods are best consumed in moderation.

Hydration: The Forgotten Nutrient

Water is not technically a nutrient, yet it may be one of the most important components of healthy aging.

Older adults are especially vulnerable to dehydration for several reasons. The sensation of thirst becomes less reliable with age, kidney function changes, and many medications—including diuretics—promote fluid loss. Some older individuals intentionally drink less because of concerns about urinary urgency or nighttime trips to the bathroom.

Even mild dehydration can produce fatigue, headaches, dizziness, constipation, confusion, kidney stones, urinary tract infections, and an increased risk of falls.

Unlike younger adults, older people should not rely solely on thirst as a signal for their fluid needs.

Most healthy older adults benefit from drinking fluids consistently throughout the day. Water is the best choice, but milk, tea, coffee, soups, and water-rich foods such as melons, oranges, cucumbers, tomatoes, and berries all contribute to hydration.

The color of the urine offers a practical guide. Pale yellow generally indicates adequate hydration, whereas dark yellow urine often suggests that additional fluids are needed, although certain medications and vitamins can alter urine color.

Calcium, Vitamin D, and Bone Health

Bone is living tissue that is constantly remodeled throughout life. With age, bone breakdown gradually exceeds bone formation, increasing the risk of osteoporosis and fractures.

Adequate calcium remains important, but vitamin D is equally critical because it enables calcium absorption from the intestine. Unfortunately, aging skin produces less vitamin D in response to sunlight, and many older adults spend less time outdoors.

Dairy products, fortified plant milks, canned salmon with bones, and leafy green vegetables contribute calcium, while fatty fish and fortified foods provide modest amounts of vitamin D.

Because deficiency is common, many physicians recommend vitamin D supplementation based on blood test results.

Vitamin B12: A Common but Often Silent Deficiency

Vitamin B12 deserves special attention because deficiency becomes increasingly common after age 60.

Normal absorption requires adequate stomach acid to separate vitamin B12 from proteins in food. Aging, along with medications such as proton pump inhibitors and metformin, often reduces stomach acidity.

Symptoms may develop gradually and include fatigue, numbness or tingling in the hands and feet, difficulty walking, poor balance, memory problems, depression, and anemia.

Fortunately, crystalline vitamin B12 found in supplements and fortified foods bypasses many of these absorption problems and is highly effective in preventing or correcting deficiency.

Do Supplements Become More Important?

For many older adults, the answer is yes—but only selectively.

The ideal source of nutrition remains a balanced diet rich in vegetables, fruits, whole grains, legumes, lean proteins, dairy or fortified alternatives, nuts, seeds, and healthy oils. Foods contain thousands of biologically active compounds that supplements cannot fully replicate.

Nevertheless, certain supplements become increasingly useful as people age.

Vitamin D is among the most commonly recommended because deficiency is widespread and can adversely affect bone and muscle health. Vitamin B12 supplementation is appropriate for many older adults, particularly those taking metformin or acid-suppressing medications or those with laboratory evidence of deficiency.

Calcium supplements may be useful when dietary intake is inadequate, although obtaining calcium from food is generally preferred because large supplemental doses have been associated with possible cardiovascular concerns.

Protein powders and ready-to-drink nutritional shakes can help individuals with poor appetite, difficulty chewing, chronic illness, or increased protein requirements. Whey protein is especially effective because of its high leucine content.

Omega-3 supplements may benefit individuals who rarely consume fish, although eating fish remains the preferred strategy.

One supplement attracting increasing attention is creatine monohydrate. Long used by athletes, creatine has substantial evidence supporting its ability to improve muscle strength and enhance the benefits of resistance exercise in older adults. When taken in appropriate doses by healthy individuals, it appears remarkably safe, though people with significant kidney disease should consult their physician before using it.

In contrast, the evidence for many heavily marketed anti-aging supplements—including collagen powders, testosterone boosters, proprietary muscle blends, and high-dose antioxidant formulas—is considerably weaker. Some may offer modest benefits in selected circumstances, but many lack rigorous scientific support.

See my earlier post for more information: Supplement Smarts: What Seniors Should Know Before Reaching for That Bottle

Eating for Health, Not Simply Longevity

Nutrition is not about adding years to life alone. It is about adding life to those years.

A healthy diet cannot stop aging, but it can influence how well we age. Adequate protein helps preserve muscle and independence. Healthy carbohydrates provide steady energy. Fiber supports digestive and cardiovascular health. Unsaturated fats protect the heart and nourish the brain. Proper hydration reduces illness and maintains physical and mental function. Carefully selected supplements can fill nutritional gaps when food alone is insufficient.

Perhaps the most encouraging news is that it is never too late to benefit. Studies consistently show that older adults who improve their diet, remain physically active, and maintain adequate protein intake can increase muscle strength, improve balance, reduce the risk of chronic disease, and enhance quality of life—even well into their seventies, eighties, and beyond.

The old saying that “you are what you eat” may oversimplify nutrition, but it captures an enduring truth. As the years accumulate, every meal becomes another opportunity to nourish not just the body, but the ability to continue living fully, independently, and well.

Medical Disclaimer

The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.

Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here. 

If you are experiencing a medical emergency, call 911 or your local emergency number immediately.

The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.

Image generated by author using ChatGPT.

References

Bauer J, Biolo G, Cederholm T, et al. Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People. Journal of the American Medical Directors Association. 2013.

Deutz NEP, Bauer JM, Barazzoni R, et al. Protein intake and exercise for optimal muscle function with aging. Clinical Nutrition. 2014.

Volpi E, Campbell WW, Dwyer JT, et al. Is the Optimal Level of Protein Intake for Older Adults Greater Than the Recommended Dietary Allowance? The Journals of Gerontology: Series A. 2013.

U.S. Department of Agriculture & U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2025–2030. https://www.dietaryguidelines.gov

National Institute on Aging. Healthy Eating As You Get Older. https://www.nia.nih.gov/health/healthy-eating

National Institutes of Health Office of Dietary Supplements. https://ods.od.nih.gov

European Society for Clinical Nutrition and Metabolism (ESPEN). Guideline on Clinical Nutrition and Hydration in Geriatrics. https://www.espen.org

Trump, MAGA, and the Politics of Permission

By

On July 18, 2026

In Commentary, Politics

Donald Trump did not invent a new American bigotry. He did something more subtle—and perhaps more consequential. He transformed long-standing resentments into a political identity and gave many people permission to express views they had previously kept private.

The central question surrounding the Make America Great Again movement is: has it created a new ethical worldview, or has it simply exposed attitudes that have long existed beneath the surface of American society? The answer is probably: both.

The resentments themselves are not new. Long before Trump entered politics, historians and political scientists documented the enduring influence of racial resentment, nativism, religious nationalism, and cultural anxiety. Many Americans believed their country was changing too quickly and that immigration, globalization, and shifting social norms threatened a way of life they once took for granted.

American history offers countless examples. Anti-immigrant movements flourished in the nineteenth century. Segregation and white supremacy were embedded in law for generations. George Wallace’s “law and order” campaigns, Pat Buchanan’s culture-war speeches, and the Tea Party’s reaction to Barack Obama’s presidency all reflected recurring fears that “real America” was slipping away.

Obama’s election encouraged hopes that the nation had entered a post-racial era, yet research continued to show that racial and cultural anxieties remained powerful undercurrents. Trump did not create those sentiments. He recognized them, embraced them, and gave them a simple narrative.

“Make America Great Again” is more than a campaign slogan. It tells a story of loss, restoration, and retribution. It suggests that something valuable has been taken away and that reclaiming it is both necessary and morally justified. For many supporters, it became less about policy than identity.

Trump’s most significant innovation was not ideological but cultural. Previous politicians often relied on coded language while preserving at least the appearance of restraint. Trump discarded those conventions. He mocked opponents, encouraged inflammatory chants, proposed banning Muslims from entering the country, and described immigrants as “poisoning the blood” of America. Many supporters interpreted this not as recklessness but as authenticity—a rejection of what they viewed as the constraints of political correctness.

That shift changed more than political rhetoric. It altered the boundaries of acceptable public behavior. Conduct once viewed as disqualifying became, for many supporters, evidence of courage and honesty. Loyalty increasingly outweighed character. Offending critics became proof that one was willing to stand up to elite opinion.

Political scientists describe this process as norm erosion. Laws remain the same, but the unwritten rules governing public life gradually weaken. Loyalty becomes more important than truth, institutions are trusted only when they favor one’s own side, and democratic restraints come to be seen as obstacles rather than safeguards.

Trump did not invent this dynamic. Populist movements throughout history have divided society into virtuous insiders and corrupt outsiders. His contribution was to make that style of politics a daily spectacle. Political conflict became a struggle between patriots and traitors, real Americans and dangerous enemies. Once politics is framed in existential terms, compromise becomes betrayal and restraint begins to look like weakness.

It would be inaccurate to say Trump created prejudice from nothing. A more persuasive argument is that he reduced the social cost of expressing it. Social norms matter because they define the boundaries of acceptable conduct. When prominent public figures use inflammatory language or repeat conspiracy theories without losing support from their followers, those boundaries inevitably shift.

Supporters who might once have hesitated can now dismiss criticism as media bias or political correctness. The line between prejudice and plain speaking becomes increasingly blurred.

This may prove to be Trump’s most enduring legacy. Even if his personal political influence fades, the standards governing public discourse may not return to where they once were. Future politicians can imitate the style—its confrontation, norm-breaking, and appeals to grievance—even if they reject parts of Trump’s agenda.

That is why the distinction between creating prejudice and legitimizing it matters. If Trump merely invented these impulses, defeating one political leader might solve the problem. But if he tapped into deeper currents already present in American society, then the challenge extends far beyond one election.

Trump is best understood as both symptom and accelerant. He gave shape to existing resentments, transformed them into a powerful political identity, and lowered the barriers against openly expressing them. The prejudices themselves were not new. The confidence with which they could be publicly displayed—and sometimes celebrated—was.

Whether that change proves temporary or enduring may become one of the defining questions facing American democracy.

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