Paul Sax

ID Things to Be Grateful for -- 2025 Edition Looking back on these annual Thanksgiving posts, I notice an odd pattern: every few years, the intro turns into a kind of apology. As in, Yes, I know the title sounds upbeat, please don’t attack me. T...

Can we really be grateful for anything in the ID world in 2025?

Sure -- plenty of great advances!

Here are a half-dozen to celebrate (and be grateful for) in 2025, believe it or not. #idsky
blogs.jwatch.org/hiv-id-obser...

Certainly was surprising!

Three Myths About Antibiotics We Really Need to Retire Sneezes, penicillin allergies, and those strangely sacred 5- and 7-day courses.

Inspired by this rage-inducing ad, I offer 3 big misses on antibiotics that need to die.
paulsaxmd.substack.com/p/three-myth...

Thank you!

When AI Gets the Medical Advice Wrong — and Right A journalist recently reached out to ask about the shingles vaccine. We mostly talked through the usual topics — how common shingles is, why the vaccine works so well, and side effects. Plus, the whol...

Tested two different AI products with some medical advice. Prompt: "When people get shingles again, is it usually in the same location?"
OpenEvidence: Home run.
ChatGPT: Big whiff.
Plus, a chance to support the shingles vaccine -- so important! #IDSky blogs.jwatch.org/hiv-id-obser...

Escaped Research Monkeys and Imagined Infectious Risks Looking a little deeper, I found out what we really should be worried about.

Some thoughts on a different kind of ID story. #IDSky
paulsaxmd.substack.com/p/escaped-re...

Hot Takes from IDWeek: CDC, COVID, and Two Doses of Dalbavancin Every so often, you sit down for what’s supposed to be a lighthearted conversation and end up somewhere not just fun, but deeply enjoyable and even profound. That’s what happened when I joined my frie...

Really enjoyed chatting with Drs. Buddy Creech and Mati Hlatshwayo Davis. It was a totally unscripted conversation, one that just happened to be recorded by @idsainfo.bsky.social. Enjoy! blogs.jwatch.org/hiv-id-obser...

Thank you!

Should I Worry About the Pasta? The ID Doctor as News Translator What happens when we get texts about Trader Joe’s fettuccine — and what to do when infections make headlines.

Should I Worry About the Pasta? The ID Doctor as News Translator
(Hello #IDSky and #Medsky! Trying out some different venues for writing, so hoping you'll subscribe -- it's free!)
open.substack.com/pub/paulsaxm...

Favorite ID Fellow Consults: Johns Hopkins Edition Just back from a visit to the Infectious Diseases Division at Johns Hopkins, thanks to the kind invitation of current ID chief Dr. Amita Gupta and her predecessor, Dr. David Thomas. On a personal note...

Hey ID Fellows, what are your favorite ID consults? Asked that question during a recent visit to the ID division at Johns Hopkins, and here's what their fellows said. #IDSky
blogs.jwatch.org/hiv-id-obser...

Yes, There's Now a Google for Doctors How AI finally delivered on my colleague’s joke — and how it’s changing the way clinicians look up medical information.

There’s now a “Google for doctors.” OpenEvidence is fast, eerily good, and sometimes confidently wrong — so still needs supervision. Here’s how it works, and how it compares to the existing 10,000 Pound Gorilla of Medical Information, UpToDate. #IDSky open.substack.com/pub/paulsaxm...

Thanks, Isaac!

Two COVID Vaccine Studies -- One Actionable, the Other Not So Much As we await the results of placebo-controlled COVID-19 vaccine studies, what are we clinicians to do when our patients ask us whether they should get a booster this fall? What once was a no-brainer in...

Two Covid vaccine studies: A really clever observational study design, and another one making the media rounds. First one has clinically useful information, the second, not so much. #IDSky blogs.jwatch.org/hiv-id-obser...

Son as Doctor: Part 1, The Good Remembering my father, and times when he needed medical help — and called me. First of a two- (and maybe three-) part series

What happens when your dad calls you for ID advice?

My father’s first “consult” with me turned out fine -- hence The Good. It wouldn't always be this easy.

Part 1 of “Son as Doctor,” a story about medicine, family, and time. #IDSky open.substack.com/pub/paulsaxm...

Thanks, Paul! It will still mostly be ID-themed, but with less esoterica for a broader audience. And longer, more personal. At least that's how I'm planning it right now.

Inspired by many others, I've started a newsletter to stretch my writing a bit. Hope you'll subscribe! #IDSky paulsaxmd.substack.com/about

What a Difference a Year Makes -- with Bonus Halloween Video At last year’s IDWeek — the annual meeting of the Infectious Diseases Society of America — a group of us veterans in the HIV/ID world wrapped up a busy day of symposia, abstracts, and posters with a l...

Spent a lot of time at #IDWeek2025 thinking about life as an ID specialist in the USA one year ago compared to now.

Summary: Times are tough, but the community and people remain strong. Stay that way, everyone.

(Plus can't-miss bonus video.) #IDsky
blogs.jwatch.org/hiv-id-obser...

Louie's Last Day Remembering Louie, and the gifts dogs give us.

Here's the personal note ... 😢 open.substack.com/pub/paulsaxm...

Another Bad Week for the CDC, and a Personal Note On Friday night, news broke that more than a thousand CDC staff received layoff notices — including people who track measles outbreaks, analyze data to craft policy, monitor employee safety, and, rema...

Not a good week for the CDC, re-hires notwithstanding. Still think it's anger about Covid policies that motivate these attacks -- but it's leading to a weakened agency that will harm all of us.
#IDSky 1/2
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DOTS: Optimism Around a “Negative” Dalbavancin Trial The DOTS randomized clinical trial of dalbavancin versus standard-of-care for Staph aureus bacteremia (SAB) just landed in JAMA, where it undoubtedly will be featured in numerous ID, hospitalist, and ...

What the DOTS trial of Staph bacteremia tells us:
• Dalbavancin d1 and d8 vs daily IVs for WEEKS
• No left-sided IE/CNS/prosthetics
• Dalba not superior by DOOR endpoint, but similar clinical outcomes.
Big implications for inpt care. More here! #IDSky tinyurl.com/3hjzkt96

Do you think clofazimine works? I can't think of a single clinical trial where a clofazimine vs a non-clofazimine arm showed that the clofazimine arm did better.

Yes, we use it -- but it sure would be nice to see some robust evidence that it's worth it.

Tremendous honor -- thank you so much @idsainfo.bsky.social and especially @darcy-id-doc.bsky.social #IDSky
www.idsociety.org/education--t...

Update on Louie and One Interesting ID Fact To quote my friend, he's "not dead yet", and we're glad for the time.

open.substack.com/pub/paulsaxm...

Update on Louie and One Interesting ID Fact First, I want to express my sincere thanks to all those who commented, emailed, and texted about our dog Louie. My family and I truly appreciate the concern and the feelings people shared about their ...

Update on the little guy -- plus one very interesting ID fact! (It's an ID blog, after all, not a dog blog.) #IDSky
(See next post if it doesn't open on your phone NEJM Journal Watch is working out some bugs.) blogs.jwatch.org/hiv-id-obser...

Blending Art, Medicine and Charity Ana Velez, MD, FACP, joins Paul Sax, MD, FIDSA, to share how her passion for art fuels her work in infectious diseases.

New #LetsTalkID! ID physician and artist Ana Velez, MD, FACP, joins @paulsaxmd.bsky.social to share how art shapes her work in ID and brings new meaning to medicine.

Transcript: bit.ly/3Iu863j

Bid now to own her original artwork and support IDSA's mission: givebutter.com/c/pclXSb/auc...

Very well put! So sad.

(Your dog and Louie could be related ...)

Thanks, Ilan. It's not good news from the work-up, as suspected. He probably has only a few days or weeks left.

(That's a really cute photo of Ricotta!)

My Dog Louie, the Best Dog Ever, Is Seriously Ill We got some bad news about our dog Louie, the world’s greatest dog. Writing his story here is therapeutic, so forgive the oversharing. In January, 2013, my wife forwarded me this email: She doesn’t us...

Wrote this one with tears in my eyes 😢

blogs.jwatch.org/hiv-id-obser...

Personally haven't used interferon for HCV in over a decade -- not since the great rush of HCV antivirals from 2013-16. Even when battling for insurance coverage, we knew that eventually we could treat people without this incredibly toxic (and not very effective) drug.

Hooray! Working on this one clinician at a time ... next up, "DAAs" for HCV!

C'mon, when was the last time someone used a something other than a "directly acting" antiviral for HCV?