ER physician building the next layer of human data. Founder of https://xitter.cf/t.co/E8F3gvvfGL. Inventor of BMD-001. Creating the MeNome—mapping the human experience.

Philadelphia, PA
Joined January 2012
Looking to write an angel check into someone building at the intersection of quantum materials and medicine. Smart wound dressings, biosensors, regenerative interfaces, novel diagnostics…real materials science translated into clinical use.
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Freestanding ED. 2:40 AM. She's 19. Fourth visit in five weeks for the same thing: vomiting that starts before dawn and stops for nothing. Hot showers help. Her workup is clean. It was clean the last three times. She leaves with a diagnosis of "nothing we can find" and a refill of the Zofran that already failed twice. I'm good at discharging her. But after a decade of the same thing, I finally learned something more. --- What I know now that I didn't know at her bedside: 1. A clean workup rules things out. It has never ruled anything in for her. The ED is built to find the thing that kills you tonight, and she keeps not being that thing. 2. There are a lot of her. Rome V, the new consensus guidelines for gut-brain disorders, came out in May. In its validation study of 30,000 adults across 15 countries, 42% met criteria for a disorder of gut-brain interaction. The ED sees the worst night of that number, one patient at a time. 3. She needed someone looking at her last 90 days. I had one bad night and a CT. 4. Public health does not require a state. In 2020 I was the Chief Physician for Delaware's Division of Public Health. The job was reaching people before they got sick enough to need me. Last month 20 million people watched me explain what the discharge paperwork leaves out. 5. The field moved. Rome V wrote digital, self-directed brain-gut behavioral therapy into its stepped-care pathway. Five years ago that sentence doesn't get past the poster session. --- A few years ago, I would have rolled my eyes at an ER doctor stamping his feet about a vitamin and chronic disease. I understand the eye roll. But eventually I learned that the room I was standing in wasn't the only room that mattered. My wife Kady and I built BellyMD around one idea: the patient at 2 AM was measurable months earlier, and nobody was measuring. With a small team and a lot of patients who were tired of hearing the word normal, we built the infrastructure that watches the same person over time, which is the one thing a blood draw and a CT in the ED cannot do. We've filed a patent on a compound for the hardest cases, and we're in a research collaboration with GWU on a blood test for the ones who look like her. Both are early. Neither comes with a guaranteed ending. Thousands of patients use it now, and a few hundred thousand people follow the work. Clinics and hospital systems come next year. I still work a few shifts in the ED, and I'm still the editor-in-chief of Emergency Medicine News. I'd rather be inside my specialty's arguments than outside them. Some nights I miss having a job where the worst thing I saw all day was also the thing I could do the most about. She'll be back in a few weeks. Her workup will be normal again. The ED will have done its job. I stopped believing that was the end of mine. Somebody has to be watching the days in between. That's the other room.
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Whatever health tech startups the Epic/ChatGPT integration “killed” today were already on hospice. It’s the same lesson the frontier models have been telegraphing for over a year—differentiation will come in the specialties, in the niches, and at the bedside.
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🎯🎯🎯🎯🎯🎯🎯🎯🎯🎯🎯🎯🎯
Super disappointed to see my good friends and physicians @ZekeEmanuel @drjohnwhyte go into a conversation about one of the most important topics of our time with such poor-quality talking points. Listening to two scientific experts resort to emotional & anecdotal arguments over and over, for or against AI, truly shows how disconnected we’ve become in our ability to debate and communicate with those we disagree with. I’m not sure if this is a result of watching Secretary Kennedy’s rise to power, but this is certainly not the right direction for us to go as scientists. Dr. Emanuel wrote a book called “eat your ice cream” as a way to grab attention, for perhaps a less than ideal piece of medical advice, but now he’s taking this approach in making hyper-specific, predictive claims about autonomous AI replacing human doctors. He does so using non-realistic, poorly applicable studies, and when appropriately called out for it, his defense is that he was not being selective in only including pro-AI written papers. Sure, that may be true, but he should still realize that the level of research he’s using to justify his extraordinary position is at the bottom of medical evidence hierarchy. Making recommendations based on low-quality evidence is unfortunately sometimes part of medicine, however we cannot take that same liberty when discussing the health/well-being of millions of patients and the value of a million+ physicians in the US. I’m not sure how much time Dr. Emanuel spends practicing medicine these days vs how much he interacts with AI-obsessed VC’s, as many of his points come off quite disconnected from current medical practice and education. He says medicine has never prioritized empathy or EQ in education, but he’s surprisingly missing the point here. Yes, early in med school much time is spent hammering science in the classroom, but then the last two years, as well as most of residency is focused on the humanistic aspect. This is where doctors are made. As someone who teaches resident physicians, I have seen time and time again brilliant test-taking med-students absolutely flounder once they begin working with actual humans. This is where I expected Dr. Whyte to shine and defend the humanistic parts that are currently lacking in AI research studies. Instead, he was so often on the defensive and resorting to emotional arguments that he was unable to represent the anti-autonomous AI side well. Yes healthcare in our country is broken, yes we are all suffering, but this requires thoughtful solutions utilizing true evidence-based tools as opposed to AI-industry funded, “podcast-bro” level discussions and predictions. It’s no doubt that AI has a place within medicine and certainly has the capacity to improve care. I can’t imagine a single doctor thinking that improving care with technology is a bad thing. But what’s painfully obvious is that we’ve become quite comfortable making exaggerated claims to get attention, at the expense of further confusing an already overwhelmed public. Physicians, med students, and most importantly patients deserve better leadership and guidance in this space. Spending an hour spitballing stories about the one time AI got it right, or how Waymo got it wrong should be reserved for Joe Rogan and not the CEO of the @AmerMedicalAssn or a professor from an esteemed institution. We should be avoiding hyperbole & fear-mongering at all costs. We should be debating how to create quality & inclusive research to better understand where AI needs work, where the human touch is indispensable, and how future medical professionals should be trained. - a frustrated family medicine physician P.S. I didn’t know if I should laugh or cry when the moderator took the first break to share a commercial for another AI company 😅
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Dr. Rick Pescatore retweeted
It's very rare when doctors post on social media about Kratom and/or 70H and get it correct, this doc did! Thank you @Rick_Pescatore!
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Dr. Rick Pescatore retweeted
This is Evidence of somthing BIG. #AIinHealthcare
OpenEvidence is officially coming together with @SpringerNature to bring their portfolio, including Nature and Nature Medicine, into our platform. Springer Nature has been publishing for more than 180 years, across every major area of medicine and the basic science underneath it. Long enough that whatever got quoted at you on rounds is almost certainly in there.
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Dr. Rick Pescatore retweeted
Hospitals often wait for the "perfect" decision. The ED doesn't have that luxury. Editor @Rick_Pescatore uses the paradox of Buridan's Ass to explore how boarding, transfer delays, and institutional indecision create real risks for pts and clinicians. ow.ly/sZ1k50ZwNyE
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Dr. Rick Pescatore retweeted
This is fascinating ... biomarkers and digimarkers for future disease are everywhere. We need better filters to look at all the healthcare data we are potentially generating, act on the immediate, aggregate and measure change over time, and build better longevity plans. #Longevity
🔬 New study: Digital handwriting metrics predict early Alzheimer's onset. ✍️ Author: Shujie Deng. SVM achieved ROC-AUC 0.923, revealing motor hesitation. A non-invasive screening tool. Read more: explorationpub.com/Journals/… #Alzheimers #DigitalHealth #MachineLearning #OpenAccess
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A decade from now, I think we’ll look back on today as the first in a new era of patient-empowering digital twins and ML-driven biomarkers.
After a year, today we’ve finally published our MeNome app. It’s available on the App Store and at MeNome.belly-Md.com. DM for free premium access. This is the greatest thing I’ve done in my career, and we’re just getting started.
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After a year, today we’ve finally published our MeNome app. It’s available on the App Store and at MeNome.belly-Md.com. DM for free premium access. This is the greatest thing I’ve done in my career, and we’re just getting started.
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Dr. Rick Pescatore retweeted
Energy is the fundamental force that enables life, health, and healing. While we can learn a lot from our genes, they don’t fully dictate how we age and our ability to heal. Dynamic biological and energetic processes are a key part of the equation. I shared some thoughts on this on our TSEE YouTube channel: youtube.com/watch?v=E5zPWylQ… To dive into this topic further, you can check out these two articles from our Substack archives: • From Genetics to Energetics: tseenergy.substack.com/p/fro… • Energy: The Missing Dimension of Biomedicine: tseenergy.substack.com/p/ene… We’ve enjoyed connecting with the TSEE community, and we look forward to getting back to sharing new Substack articles after our summer break!
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Full after four bites. Normal endoscopy. Normal labs. Told it's stress. That's functional dyspepsia, and the mechanism has nothing to do with slow digestion. Quick thread:
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Treatment is incomplete across the board. PPIs, low-dose tricyclics, and prokinetics each help some patients. None help everyone. The one over-the-counter option with real trial data: enteric-coated peppermint and caraway oil, combined. NNT of about 3.
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Full breakdown, the paper behind it, and why the coating matters more than people assume, in this week's Dr. Rick's Picks: open.substack.com/pub/rickpe…
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1 in 5 women has a nickel sensitivity that often gets diagnosed as IBS. It's documented. It's in the guidelines. Almost nobody connects it. Four things your body already figured out that medicine keeps forgetting 🧵:
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There's exactly one person who sits in all those rooms. You're the only one who ever sees your whole life.
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