Mykola Iabluchanskyi

The desire for a long life is ancient. The desire for a meaningful one — a life in which identity, purpose, and the coherent sense of self are preserved as long as the body endures — is considerably more recent. And it demands a fundamentally different approach to medicine than the one we currently practice. Modern medicine has achieved remarkable things. Hearts are sustained, lungs supported, laboratory values normalized, and survival extended across conditions that would have been rapidly fatal a generation ago. Yet something critical is being lost in the process. The body persists while the person fades. Memory unravels, character dissolves, agency retreats — and the medical system, organized around keeping biological systems running, often has no framework for registering this loss, let alone preventing it. We are winning the battle for years while losing the war for the self. This uncoupling — between the biological life that continues and the personal life that erodes — is the de...

Evidence-based medicine was conceived as a safeguard — a commitment to letting rigorous data, rather than tradition or authority, guide clinical decisions. Few would argue with that founding principle. Yet something has shifted. Across cardiology, gastroenterology, and beyond, a pattern is emerging that deserves serious scrutiny: the systematic alignment of clinical evidence with commercial imperatives. The 2024 European Congress of Cardiology lowered its blood pressure thresholds to match American standards, instantly expanding the pool of patients eligible for treatment. Specialists commenting online were blunt about their suspicions: that pharmaceutical market expansion, not improved patient outcomes, was the primary driver. Whether or not that suspicion is entirely fair, the question it raises is legitimate. When diagnostic thresholds shift in ways that consistently favor treatment over watchful waiting, we should ask who benefits. The pattern repeats across drug classes. Each gene...

Beyond isolated diagnoses The concept of the osteosarcopenic knot represents a critical shift in how we understand the aging process — and why so many conventional approaches to it fall short. In modern clinical practice, medicine tends to fracture the human body into isolated categories, treating sarcopenia, skeletal involution, and frailty as parallel but essentially distinct conditions, each assigned to its own specialist, its own protocol, its own set of outcome metrics. Yet when viewed through the lens of functional systems theory, these conditions are revealed not as independent pathologies running alongside one another, but as different facets of a single, unified narrative — one that involves the simultaneous erosion of the musculoskeletal and regulatory systems. Sarcopenia, characterized by the progressive loss of muscle mass and functional strength, and osteoporosis, defined by the depletion of bone mineral density and structural integrity, are inextricably linked at the biol...

A message to patients, families, and physicians Orthostatic hypotension is one of those conditions that hides in plain sight. The moment a person stands up and the world tilts — dizziness, a rushing darkness at the edges of vision, the instinct to grab something solid — rarely makes it into a medical chart. It happens too fast, too quietly, and too often to report every time. Yet for millions of people, especially older adults, this brief instability shapes entire days: which chair to sit in, whether to answer the door, whether to attempt the stairs alone. To patients You are not imagining it, and you are not simply "getting old." Orthostatic hypotension is a real, measurable, treatable condition — and understanding it is already the first step toward managing it. The strategies that help are often surprisingly practical: rising slowly, staying well hydrated, wearing compression garments, timing meals carefully, adjusting medications with your doctor's guidance. None of t...

Intelligence is often misidentified as a product or a specific human trait, yet it represents the universal grammar by which matter organizes itself into a state of self-reference. This process aligns with functional systems theory, where the system is defined not by its constituent parts but by the specific result it seeks to achieve. When intelligence reflects upon its own patterns, consciousness emerges as the natural outcome of a functional system achieving a higher level of internal integration. This is not a static property but a dynamic movement toward the unity of awareness in which the universe begins to know itself. The recursion of awareness Consciousness began as simple sensitivity, a cellular boundary distinguishing the inner self from the outer environment. As organisms grew in complexity, this sensitivity evolved into memory, emotion, and the first traces of selfhood. In human development, it expanded into language, mathematics, and ethics. Now, through machine intelli...

The paradox of biological persistence Modern medicine has reached a crossroads where the extension of human life has become its most complex challenge. While society has mastered the art of biological survival, it is only beginning to understand the art of meaningful endurance. A critical shift is required from a medicine focused solely on survival to one focused on wellspan. The objective is not merely to add years to a biological timeline, but to ensure that identity, agency, and the capacity for engagement remain vibrant. The longevity trap serves as a warning against the unintended consequences of extending the physiological timeline without a corresponding extension of coherence and joy. When medicine focuses only on the mechanical preservation of the body, it risks creating a state where individuals are physically present but functionally sidelined. The uncoupling of physiology and the self In contemporary clinical practice, there is an increasing uncoupling of the person from...

Hans Selye was one of medicine's great pioneers. But in one crucial argument, he confused a broken compass with a faulty map — and that confusion shaped decades of clinical thinking. Hans Selye transformed medicine. His concept of stress — the body's non-specific response to any demand — gave clinicians a unifying framework for understanding how disease and adaptation intersect. His influence was immense, his observations brilliant. Which makes it all the more important to identify precisely where his reasoning went astray. In his landmark book Stress Without Distress, Selye confronted a fundamental question: can we improve on the body's natural defense mechanisms? His answer was yes — and his reasoning appeared logical. Evolution, he argued, has shaped our adaptive responses over millions of years. But evolution is not perfect. Therefore, he concluded, we can sometimes do better by suppressing these natural reactions when they cause more harm than good. We can often imp...