Mykola Iabluchanskyi

In an earlier article, I described how evidence-based medicine (EBM) can slide into market economy-based medicine when diagnostic thresholds, trial designs, and treatment strategies are tuned more to commercial interests than to patient benefit. That analysis still assumed one fundamental safeguard: that the studies being cited actually exist. Today, even this assumption is under threat. A new and more dangerous phase has begun, in which fabricated references —citations to studies that were never conducted—enter the biomedical literature and quietly accelerate the shift toward market-driven medicine . For years, market forces have influenced how real data are produced and interpreted. Diagnostic criteria are lowered to expand treatment-eligible populations. Trials are designed as add-on studies that almost cannot fail. New, expensive drugs are tested in ways that favor them over older, cheaper ones. All of this distorts medicine, but at least it operates on a substrate of genuine studi...

  Modern medicine stands at a crossroads. What began as a noble framework — evidence-based medicine (EBM) — designed to ground clinical decisions in rigorous scientific data, has increasingly been co-opted by market forces. The result is a quiet but consequential transformation: from medicine guided by patient outcomes to medicine guided by pharmaceutical profit. Shifting the Goalposts A telling example emerged at the 2024 European Congress of Cardiology , where blood pressure diagnostic thresholds were lowered to align with American standards. While presented as a scientific update, many specialists openly questioned whether the true motive was expanding the market for antihypertensive medications. When diagnostic criteria shift in ways that dramatically increase the number of "patients," one must ask: who benefits most — the patient, or the industry? This pattern is not new. The same logic appears in cholesterol management, where statins — once revolutionary — are now bein...

Frailty in gerontology has a surprisingly recent history as a formal concept. For most of the twentieth century, clinicians recognized “frail” older patients, but lacked a precise language or tools to describe what they were seeing.  Early observations without a framework In everyday practice, many older people were described as “weak,” “frail,” or “run down,” but these were intuitive labels rather than defined clinical states. A chart could list dozens of diagnoses and largely “normal” lab values, yet the global impression remained: this patient “takes a hit” much worse than others of similar age and disease burden. There were almost no instruments to formalize this difference in reserve or vulnerability.  Twentieth‑century biomedicine focused on acute, organ‑specific disease: one disease, one organ, one lesion. Within that frame, an older adult with multiple chronic conditions and slow recovery was coded simply as an “elderly patient,” not as someone with a distinct syndrom...

  The Promise That Expired For more than a century, school and university life rested on a single linear contract: endure years of preparation now, and real life will begin afterward. Study hard, collect the right certificates, wait for the stamp of authority — then the doors will open. Learning was a queue, and the queue was the point. That contract has expired. In 2026, the world outside the classroom is moving faster than the syllabi inside it. Professions once considered stable are being rewritten in real time by AI systems. The idea of " front-loading " twenty years of education and drawing on static capital for the next forty is collapsing under the weight of its own assumptions. Students who step out of the waiting room no longer find a stable corridor — they find a high-speed moving train.  Their real deficit is not access to information. It is the sovereignty of judgment : the ability to decide what matters, what to trust, and what to do next, without outsourcing the...

 For decades, mental health has been measured in symptoms. We count panic attacks, chart the depth of low moods, and catalogue sleep disturbances as if a patient were a machine to be audited rather than a navigator trying to find their way through a storm. But if we shift our clinical perspective — from passive bearer of diagnoses to active participant in life — a different and more honest measure of wellbeing emerges: the quality of the decisions a patient is able to make every day . From Symptoms to Functional Capacity In the theory of functional systems , a decision is never a simple act of will. It is the final result of a complex neurobiological and social network striving toward a useful outcome. From this vantage point, the quality of a patient's choices is not a verdict on their strength of character. It is a mirror of the environment in which that choosing happens. When we document that a patient is depressed, we describe a static state. When we ask  why their decisio...

  Breathing is sustained without volitional input. Throughout sleep, periods of inattention, and systemic illness, brainstem respiratory networks maintain rhythmic drive to the respiratory musculature independent of conscious participation. In its automaticity, respiration resembles cardiac function — a vital cycle generated and regulated below the threshold of deliberate control. Respiration diverges from cardiac function, however, in one physiologically significant way: it is accessible to voluntary modulation . An individual can elect to pause before phonation, prolong exhalation to attenuate arousal, or alter respiratory rate in response to situational demands. This capacity for deliberate intervention reflects a structural feature of the nervous system — the convergence of automatic and voluntary control pathways within a single motor output — and has direct implications for the clinical application of breathing-based interventions. Automatic Respiratory Regulation Under base...

We have spent a century obsessed with a single number. How long did they live? Ninety-two. Eighty-seven. A hundred and one. We announce it in obituaries, track it in demographic reports, and celebrate it as proof of medical progress. But that number — lifespan — tells us almost nothing about the life it claims to measure. Two people can share the same lifespan and inhabit completely different existences. One crosses the finish line still recognizably themselves. The other stopped being present years before the body gave out. To talk honestly about aging, we need three coordinates, not one. Lifespan, healthspan , and wellspan — each asks a different question, and together they form the only framework that takes the whole person seriously. Lifespan Is Just the Clock Lifespan is time in its most stripped-down form: the interval between first breath and last. It is useful for statisticians, actuaries, and headline writers. It is far less useful for anyone trying to understand how a human...