Paul Sax
@paulsaxmd.bsky.social
Harvard/Brigham Infectious Diseases doctor, writer, educator. Editor of Clinical Infectious Diseases. Prefer baseball to football, pizza to sushi, dogs to cats, Beatles to Stones. https://blogs.jwatch.org/hiv-id-observations/
Inspired by this rage-inducing ad, I offer 3 big misses on antibiotics that need to die.
paulsaxmd.substack.com/p/three-myth...
paulsaxmd.substack.com/p/three-myth...
Three Myths About Antibiotics We Really Need to Retire
Sneezes, penicillin allergies, and those strangely sacred 5- and 7-day courses.
paulsaxmd.substack.com
November 21, 2025 at 3:53 PM
Inspired by this rage-inducing ad, I offer 3 big misses on antibiotics that need to die.
paulsaxmd.substack.com/p/three-myth...
paulsaxmd.substack.com/p/three-myth...
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...
OpenEvidence: Home run.
ChatGPT: Big whiff.
Plus, a chance to support the shingles vaccine -- so important! #IDSky blogs.jwatch.org/hiv-id-obser...
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...
blogs.jwatch.org
November 18, 2025 at 9:41 PM
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...
OpenEvidence: Home run.
ChatGPT: Big whiff.
Plus, a chance to support the shingles vaccine -- so important! #IDSky blogs.jwatch.org/hiv-id-obser...
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...
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...
blogs.jwatch.org
November 13, 2025 at 10:55 PM
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...
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...
(Hello #IDSky and #Medsky! Trying out some different venues for writing, so hoping you'll subscribe -- it's free!)
open.substack.com/pub/paulsaxm...
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.
open.substack.com
November 9, 2025 at 9:47 AM
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...
(Hello #IDSky and #Medsky! Trying out some different venues for writing, so hoping you'll subscribe -- it's free!)
open.substack.com/pub/paulsaxm...
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...
blogs.jwatch.org/hiv-id-obser...
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...
blogs.jwatch.org
November 7, 2025 at 9:55 PM
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...
blogs.jwatch.org/hiv-id-obser...
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...
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.
open.substack.com
October 31, 2025 at 2:28 PM
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...
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...
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...
blogs.jwatch.org
October 28, 2025 at 11:32 AM
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...
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...
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...
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
open.substack.com
October 27, 2025 at 10:37 AM
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...
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...
Inspired by many others, I've started a newsletter to stretch my writing a bit. Hope you'll subscribe! #IDSky paulsaxmd.substack.com/about
October 25, 2025 at 5:48 PM
Inspired by many others, I've started a newsletter to stretch my writing a bit. Hope you'll subscribe! #IDSky paulsaxmd.substack.com/about
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...
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...
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...
blogs.jwatch.org
October 24, 2025 at 12:37 AM
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...
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...
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
blogs.jwatch.org/hiv-id-obser...
#IDSky 1/2
blogs.jwatch.org/hiv-id-obser...
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...
blogs.jwatch.org
October 17, 2025 at 3:34 PM
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
blogs.jwatch.org/hiv-id-obser...
#IDSky 1/2
blogs.jwatch.org/hiv-id-obser...
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
• 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
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 ...
tinyurl.com
October 10, 2025 at 10:55 AM
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
• 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
Tremendous honor -- thank you so much @idsainfo.bsky.social and especially @darcy-id-doc.bsky.social #IDSky
www.idsociety.org/education--t...
www.idsociety.org/education--t...
October 6, 2025 at 9:33 AM
Tremendous honor -- thank you so much @idsainfo.bsky.social and especially @darcy-id-doc.bsky.social #IDSky
www.idsociety.org/education--t...
www.idsociety.org/education--t...
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...
(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...
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 ...
blogs.jwatch.org
October 5, 2025 at 4:16 PM
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...
(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...
Reposted by Paul Sax
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...
Transcript: bit.ly/3Iu863j
Bid now to own her original artwork and support IDSA's mission: givebutter.com/c/pclXSb/auc...
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.
bit.ly
September 27, 2025 at 10:42 PM
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...
Transcript: bit.ly/3Iu863j
Bid now to own her original artwork and support IDSA's mission: givebutter.com/c/pclXSb/auc...
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...
blogs.jwatch.org
September 26, 2025 at 5:29 PM
I'm doing another required learning module, and alas it's back to the usual grind:
- start video
- try to fast-forward (disabled)
- run in background while doing other menial tasks
- take exam to get "Certificate of Completion"
Any evidence that this drudgery actually improves anything?
- start video
- try to fast-forward (disabled)
- run in background while doing other menial tasks
- take exam to get "Certificate of Completion"
Any evidence that this drudgery actually improves anything?
An online required learning module that didn’t have me scrambling for the "fast forward" button? I’m stunned -- but impressed. Curious what module pulled off this miracle? Here are the details: blogs.jwatch.org/hiv-id-obser... #IDSky #MedSky
When Required Learning Modules Surprise You (In a Good Way)
Like most clinicians, I have a checkered history with required online learning modules. You know the drill: click play, get lectured in monotone about hand hygiene or fire safety, then spend the next ...
blogs.jwatch.org
September 23, 2025 at 9:11 PM
I'm doing another required learning module, and alas it's back to the usual grind:
- start video
- try to fast-forward (disabled)
- run in background while doing other menial tasks
- take exam to get "Certificate of Completion"
Any evidence that this drudgery actually improves anything?
- start video
- try to fast-forward (disabled)
- run in background while doing other menial tasks
- take exam to get "Certificate of Completion"
Any evidence that this drudgery actually improves anything?
Still time to register! Reasons to attend:
- updates on antibiotics and immunizations
- "can't miss" diagnoses
- expert approaches to C diff, H pylori, STIs, tick-related infections
- viral hepatitis/HIV for PCPs ... and MORE!
Live-streaming -- join us from anywhere!
idprimarycare.hmscme.com
- updates on antibiotics and immunizations
- "can't miss" diagnoses
- expert approaches to C diff, H pylori, STIs, tick-related infections
- viral hepatitis/HIV for PCPs ... and MORE!
Live-streaming -- join us from anywhere!
idprimarycare.hmscme.com
Infectious Diseases in Primary Care
Harvard CME: The Comprehensive Infectious Disease Update—Prevention, Diagnosis, Treatment
idprimarycare.hmscme.com
September 23, 2025 at 10:43 AM
Still time to register! Reasons to attend:
- updates on antibiotics and immunizations
- "can't miss" diagnoses
- expert approaches to C diff, H pylori, STIs, tick-related infections
- viral hepatitis/HIV for PCPs ... and MORE!
Live-streaming -- join us from anywhere!
idprimarycare.hmscme.com
- updates on antibiotics and immunizations
- "can't miss" diagnoses
- expert approaches to C diff, H pylori, STIs, tick-related infections
- viral hepatitis/HIV for PCPs ... and MORE!
Live-streaming -- join us from anywhere!
idprimarycare.hmscme.com
truly impossible to remember these criteria, who agrees?
Lost Generation - 1883-1900
Greatest Generation - 1901-1927
Silent Generation - 1928-1945
Baby Boomer - 1946-1964
Generation X - 1965 - 1980
Millennial - 1981-1996
Generation Z - 1997-2012
Generation Alpha - 2013 - present
Lost Generation - 1883-1900
Greatest Generation - 1901-1927
Silent Generation - 1928-1945
Baby Boomer - 1946-1964
Generation X - 1965 - 1980
Millennial - 1981-1996
Generation Z - 1997-2012
Generation Alpha - 2013 - present
September 23, 2025 at 1:49 AM
truly impossible to remember these criteria, who agrees?
Lost Generation - 1883-1900
Greatest Generation - 1901-1927
Silent Generation - 1928-1945
Baby Boomer - 1946-1964
Generation X - 1965 - 1980
Millennial - 1981-1996
Generation Z - 1997-2012
Generation Alpha - 2013 - present
Lost Generation - 1883-1900
Greatest Generation - 1901-1927
Silent Generation - 1928-1945
Baby Boomer - 1946-1964
Generation X - 1965 - 1980
Millennial - 1981-1996
Generation Z - 1997-2012
Generation Alpha - 2013 - present
The latest in the controversy between 3 vs 2 drugs for HIV treatment -- now in advanced HIV disease, with the DOLCE study. @drlaurajwaters.bsky.social #IDSky #HIVsky blogs.jwatch.org/hiv-id-obser...
Two Drugs, Not Three: The DOLCE Study in Advanced HIV Disease
Three-drug therapy has been the standard of care for HIV therapy for so long it’s difficult to shake the view that it must be more effective than two drugs. This is particularly the case for those wit...
blogs.jwatch.org
September 22, 2025 at 12:32 AM
The latest in the controversy between 3 vs 2 drugs for HIV treatment -- now in advanced HIV disease, with the DOLCE study. @drlaurajwaters.bsky.social #IDSky #HIVsky blogs.jwatch.org/hiv-id-obser...
An online required learning module that didn’t have me scrambling for the "fast forward" button? I’m stunned -- but impressed. Curious what module pulled off this miracle? Here are the details: blogs.jwatch.org/hiv-id-obser... #IDSky #MedSky
When Required Learning Modules Surprise You (In a Good Way)
Like most clinicians, I have a checkered history with required online learning modules. You know the drill: click play, get lectured in monotone about hand hygiene or fire safety, then spend the next ...
blogs.jwatch.org
September 10, 2025 at 2:29 PM
An online required learning module that didn’t have me scrambling for the "fast forward" button? I’m stunned -- but impressed. Curious what module pulled off this miracle? Here are the details: blogs.jwatch.org/hiv-id-obser... #IDSky #MedSky
Hepatitis B transmission, dalbavancin for staph bacteremia, alpha-gal allergy, vaccine policy shifts, too much screening in pt care ... Some end-of-summer ID musings, with scattered other thoughts silly and not ID-related at all. And tennis, of course! #IDSky blogs.jwatch.org/hiv-id-obser...
End-of-Summer Musings -- Hepatitis B, Dalbavancin, Alpha-Gal, and More
The last time I did one of these quick “musings” posts, I listed 21, and someone asked me, “Why 21?” The answer — obviously — is that I originally planned on writing 20, but then had to add a 21st, ju...
blogs.jwatch.org
September 5, 2025 at 4:30 AM
Hepatitis B transmission, dalbavancin for staph bacteremia, alpha-gal allergy, vaccine policy shifts, too much screening in pt care ... Some end-of-summer ID musings, with scattered other thoughts silly and not ID-related at all. And tennis, of course! #IDSky blogs.jwatch.org/hiv-id-obser...
For us ID doctors, the CDC has been a rock. Data, guidelines, surveillance, travel advice -- all there, vetted by experts, referenced, reliable. Perfect? No. But watching its dismantling now breaks my heart. Some thoughts: blogs.jwatch.org/hiv-id-obser...
Watching the Chaos at the CDC -- with Sadness and Alarm
Throughout my career as an infectious diseases doctor, the CDC has been a rock-solid source. Need reliable data on an outbreak? The CDC. Need thoughtful, evidence-based guidelines? The CDC. Need an au...
blogs.jwatch.org
August 30, 2025 at 5:30 AM
For us ID doctors, the CDC has been a rock. Data, guidelines, surveillance, travel advice -- all there, vetted by experts, referenced, reliable. Perfect? No. But watching its dismantling now breaks my heart. Some thoughts: blogs.jwatch.org/hiv-id-obser...
When we care for PWH who have virologic suppression, but possible or confirmed NRTI resistance, can we switch them to a simple oral treatment -- once-daily BIC/FTC/TAF? This study says yes, with results strengthened by proviral DNA testing. #IDSky #HIVSky www.sciencedirect.com/science/arti...
Bictegravir, emtricitabine, and tenofovir alafenamide versus ritonavir-boosted protease inhibitor-based antiretroviral therapy in people with HIV and viral suppression on second-line therapy in Haiti:...
Patients on second-line protease inhibitor-based regimens in low-income and middle-income countries have high rates of nucleoside reverse transcriptas…
www.sciencedirect.com
August 28, 2025 at 12:07 AM
When we care for PWH who have virologic suppression, but possible or confirmed NRTI resistance, can we switch them to a simple oral treatment -- once-daily BIC/FTC/TAF? This study says yes, with results strengthened by proviral DNA testing. #IDSky #HIVSky www.sciencedirect.com/science/arti...