Mykola Iabluchanskyi

For the Patient You get up from the couch, and suddenly the room spins. Your vision darkens at the edges. You grab the nearest wall and wait for it to pass. If this sounds familiar, you may be experiencing orthostatic hypotension (OAH) — a condition far more common than most people realize, and one with a clear explanation. What Is It? Orthostatic hypotension means your blood pressure drops significantly the moment you stand up. Medically, it is defined as a fall of at least 20 mmHg in your top blood pressure number, or 10 mmHg in your bottom number, within three minutes of standing. That brief drop reduces blood flow to your brain — causing dizziness, blurred vision, weakness, or that unsettling "going to faint" feeling. What Should Normally Happen? When you stand, gravity pulls blood downward into your legs and abdomen. Your heart briefly receives less blood and your pressure dips. Normally, sensors in your arteries detect this instantly and signal your brain to speed up y...

We have spent centuries measuring the success of medicine in the wrong currency. We count years lived, diseases defeated, laboratory values normalized. But we rarely ask the question that matters most to the person in the bed, the consulting room, or the quiet of an aging home: am I still myself? This is the question that Wellspan forces us to confront — and it is the question that should sit at the center of everything medicine does, and everything society values. Wellspan is not a technical term for a technical problem. It is the name for something every human being already knows intuitively: that there is a form of dying that happens long before the heart stops. It is the slow erosion of coherence — the fading of memory, purpose, agency, and the sense of authorship over one's own life. A person can be biologically alive and medically "stable" while the self has already gone quiet. This is the crisis our current frameworks cannot see, because they were not built to loo...

We are waiting for the wrong thing. The public imagination is fixed on a particular image of artificial intelligence: a machine that will one day wake up, grow its own body, open its own eyes, and walk into the world as something genuinely other. We debate when that moment will arrive. We write legislation for it. We build arguments about whether such a mind could ever truly feel. And while we look toward that imagined threshold, something quieter and more consequential is already happening. AI is not waiting to grow a body. It is borrowing ours. Every time a person returns to the same model to think through a difficult decision, work out a chapter, process a fear, or plan a week, a loop forms. The model generates; the person responds. The person's language, attention, and emotional reactions shape the model's next output. The model's output, in turn, shapes which thoughts feel natural, which framings seem obvious, which possibilities appear open. Over weeks and months, ...

We have long understood aging through the lens of individual organs — the failing heart, the stiffening artery, the declining kidney. Modern medicine has grown extraordinarily sophisticated at intervening in each of these systems in isolation. And yet, for all that sophistication, the fundamental question of why the body ages as a coordinated whole, rather than as a collection of independent failures, has remained stubbornly unanswered. The answer, emerging from the frontier of experimental gerontology, may lie not inside our cells or organs at all, but in the connective tissue that links them — the vast, largely invisible medium through which every physiological process in the body ultimately unfolds. Connective tissue is easy to underestimate. We tend to think of it as structural filler — the scaffolding that holds everything else in place. But this picture misses something profound. Connective tissue is not passive architecture. It is an active regulatory environment: a living matri...

There are books that inform, books that inspire, and rare books that do something more difficult — they hold a mirror to the machinery of power and dare the reader to look without flinching. Mykola Iabluchanskyi's memoir of the revival of classical university medical education at V.N. Karazin Kharkiv National University belongs firmly in that third, rarer category. Written from personal experience and revised a quarter-century later with the wisdom of hindsight, it is a document that transcends its subject matter and speaks to every society still wrestling with the inheritance of authoritarianism. On the surface, the book appears to be an institutional history — the story of how a medical faculty was born, attacked, nearly strangled, and ultimately survived within a Ukrainian university during the turbulent post-independence years of the 1990s. But to read it only at that level is to miss its deeper architecture. This is, at its core, a study of how bureaucratic systems weaponize p...

Somewhere in the cold water of a tidal pool, an octopus is doing something extraordinary. It is solving a puzzle, changing color in its sleep, and operating eight semi-independent arms — all at once. For neuroscientists and philosophers of mind, this creature is not just a curiosity. It is a living laboratory for one of the deepest questions in science: what is consciousness, and where does it live? The octopus split from the vertebrate lineage roughly 750 million years ago. Since that ancient divergence, our brains and theirs have evolved in near-total isolation, arriving at radically different solutions to the problem of intelligence. A human brain is a centralized command structure. The octopus nervous system is something else entirely: only about a third of its neurons sit in the central brain; the remaining two-thirds are distributed across its eight arms. Each arm can sense, plan, and act with considerable independence, raising a question that cuts to the heart of consciousness ...

Throughout history, countless stories recount extraordinary experiences that seem to defy our understanding of reality. Among these, prophetic dreams and visions are particularly compelling — moments when individuals glimpse future events or receive messages that later prove remarkably accurate. As a doctor, mathematician, and educator, I've always been fascinated by the intricacies of the human mind. Yet it wasn't until I had my own prophetic experiences that I began to truly appreciate the depth of this mystery. Over the years, I've been fortunate to experience three profound prophetic dreams and one vivid daytime vision. Each left an indelible mark on my understanding of consciousness and reality. The first involved my father and served as a harbinger of a significant life event. Initially cryptic, its details unfolded in reality with startling accuracy — my first indication that these phenomena might be more than coincidence. Two other dreams carried messages of deep ...

Pyotr Anokhin’s functional systems theory looks like “old Soviet physiology” only if we judge it by publication dates. Conceptually, it belongs much closer to contemporary AI, cybernetics, and control theory than to classical reflex diagrams. At its core, TFS is not about muscles and nerves; it is about how any system acts purposefully, stabilizes itself, and learns from its own errors. Crucially, this logic scales: the same conceptual loop can describe a neuron, an animal, a machine-learning agent, a hospital, or a city. Traditional neurophysiology treated behavior as a chain of reflexes: stimuli arrive, responses follow. This linear model works for simple, short‑latency reactions but breaks down when we try to explain planning, strategy shifts, or long-term goals. Reflex theory is always oriented to the past; it has no conceptual room for the future. Anokhin reverses the arrow. For him, the primary element is not the stimulus but the result. Organisms act because they must achieve s...

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...

The uniqueness of the biological system Every human body functions as a complex, self-regulating entity known in science as a functional system. The primary objective of this system is to maintain a state of internal balance, or homeokinesis, despite the constant changes occurring in the environment. When a person is diagnosed with hypertension, this internal balance is disrupted, and the "set point" for blood pressure becomes abnormally high. To correct this, we introduce antihypertensive medications as external factors designed to help the body return to a more favorable state. However, because every individual is a unique biological system, the way the body accepts, processes, and eventually eliminates these medications is never identical from one person to the next. For many years, the standard approach to treating high blood pressure has relied on the convenience of the twenty-four-hour dose. Pharmaceutical companies strive to create "long-acting" formulas t...

For centuries, humanity has placed itself at the center of the story of intelligence — the lone narrator in a universe otherwise silent. But that story is changing. As biological, digital, and quantum forms of cognition begin to converge, we are entering an era that demands a more expansive definition of what intelligence is, where it lives, and what it is for. The passage from human intelligence to what we might rightly call Natural Intelligence is not a disruption of the natural order — it is the natural order, unfolding across a new and wider canvas. The assumption that intelligence belongs uniquely to the human brain was always a limitation of perspective rather than a fact of nature. Intelligence, at its core, is a process: the capacity of a system to perceive, adapt, and generate meaning from its environment. By that definition, the mycelial networks threading through forest floors, the collective behavior of ant colonies, and the emergent reasoning of a large language model are...

We often think of our inner lives as private realms, sealed off from the world around us. Yet our mental and emotional states quietly shape the environments we share. The way we feel and focus doesn’t stop at the edge of our skin — it ripples through families, teams, and communities, influencing how people connect, collaborate, and decide. When one person is exhausted or fearful, it colors their words, their patience, their choices. Over time, inner chaos spills outward: meetings tense up, communication frays, trust erodes. A family that can’t discuss mistakes calmly often mirrors that rigidity in workplaces. A society that silences its people eventually recreates that pattern in its politics. Stability grows from self-regulation; the condition of the system depends on the resilience of its individuals. Still, these links also mean small changes matter deeply. A simple pause, a moment of honesty — “I need a break” — can shift the tone of an entire environment. Decision-making is a sh...

Medicine measures many things. It measures the speed of recovery, the length of hospital stays, the reduction of inflammation, the stabilization of a lesion. Yet the most important question — the one that should precede all measurement — is rarely asked clearly enough: what, exactly, are we trying to achieve? The Trap of Short-Term Targets The temptation in clinical practice is to replace the ultimate goal with the nearest visible one. We focus on shortening hospital stays, limiting the extent of myocardial infarction, suppressing pulmonary inflammation, sealing a gastric ulcer. These are not wrong objectives. But when they are treated as ends in themselves, rather than as milestones on the way to something larger, they become a kind of medical tunnel vision — and tunnel vision, in medicine, causes harm. The problem is not negligence. It is, more often, a quiet erosion of the strategic goal: the physician remains technically competent while losing sight of the person sitting across t...

Modern medicine is in quiet crisis — not one of technology or resources, but of concept. The most persistent source of clinical disappointment is a philosophical misunderstanding that has embedded itself at the heart of medical practice: the rigid equation of health with "normality" and disease with its deviation. The Two Frameworks: Sanos-Patos vs. Norm-Pathology Medicine operates with two foundational frameworks, and conflating them has consequences. The sanos-patos binary — health versus disease — is a sound clinical observation: the two states are distinct, yet deeply interconnected and mutually defining. Health and disease are better understood as dynamic emergent states arising from the body's adaptive responses rather than as fixed categorical opposites. The norm-pathology framework, however, introduces a different logic — one that is far more problematic. It reduces disease to a mere deviation from a fixed healthy standard and implicitly treats health as a unive...