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/
How fortunate that two of the things I love the most in life are associated with prolonged survival. Plus, a very important "recent" paper. Happy New Year! #IDsky #Medsky open.substack.com/pub/paulsaxm...
Two Things that Prolong Life and a Great Recent Paper
A Happy New Year gift to me and everyone who shares one or both of these enthusiasms.
open.substack.com
January 1, 2026 at 8:32 PM
How fortunate that two of the things I love the most in life are associated with prolonged survival. Plus, a very important "recent" paper. Happy New Year! #IDsky #Medsky open.substack.com/pub/paulsaxm...
How did a five-day antibiotic course become a cultural phenomenon?
A brief (ha ha, ID docs can't be brief) but riveting history of how the Z-Pak took over outpatient antibiotic prescribing.
Part 2 (the problems) coming soon. #IDSky #Medsky blogs.nejm.org/hiv-id-obser...
A brief (ha ha, ID docs can't be brief) but riveting history of how the Z-Pak took over outpatient antibiotic prescribing.
Part 2 (the problems) coming soon. #IDSky #Medsky blogs.nejm.org/hiv-id-obser...
How the Z-Pak Took Over Outpatient Medicine
Chances are, across this great land of ours, right at this very moment, someone is coughing, or sneezing, or struggling with a sore throat, or some combination of the above, and taking the antibiotic ...
blogs.nejm.org
December 29, 2025 at 10:35 PM
How did a five-day antibiotic course become a cultural phenomenon?
A brief (ha ha, ID docs can't be brief) but riveting history of how the Z-Pak took over outpatient antibiotic prescribing.
Part 2 (the problems) coming soon. #IDSky #Medsky blogs.nejm.org/hiv-id-obser...
A brief (ha ha, ID docs can't be brief) but riveting history of how the Z-Pak took over outpatient antibiotic prescribing.
Part 2 (the problems) coming soon. #IDSky #Medsky blogs.nejm.org/hiv-id-obser...
Some things really are MUCH better than they used to be.
Zero nostalgia for the old days when it comes to reviewing radiology images!
paulsaxmd.substack.com/p/one-thing-...
Zero nostalgia for the old days when it comes to reviewing radiology images!
paulsaxmd.substack.com/p/one-thing-...
One Thing That’s Undeniably Better in Medicine
Looking at radiology images, then and now.
paulsaxmd.substack.com
December 27, 2025 at 9:49 PM
Some things really are MUCH better than they used to be.
Zero nostalgia for the old days when it comes to reviewing radiology images!
paulsaxmd.substack.com/p/one-thing-...
Zero nostalgia for the old days when it comes to reviewing radiology images!
paulsaxmd.substack.com/p/one-thing-...
Wonderful working with you, Alainna! Happy Birthday and Happy Holidays!
(And I stayed up all night baking that 🎂)
(And I stayed up all night baking that 🎂)
Happy holidays from the Brigham ID crew (and happy birthday to me - so many nice treats and warm wishes from colleagues and friends around the hospital!) @mgb-id-fellows.bsky.social @paulsaxmd.bsky.social
December 27, 2025 at 9:47 PM
Wonderful working with you, Alainna! Happy Birthday and Happy Holidays!
(And I stayed up all night baking that 🎂)
(And I stayed up all night baking that 🎂)
“AZT killed more people than AIDS” is false.
I was a medical resident in the late 1980s. AZT wasn’t perfect, but it saved lives and was the first step on the way to modern HIV therapy.
Evidence, history, and context here. paulsaxmd.substack.com/p/no-azt-did...
I was a medical resident in the late 1980s. AZT wasn’t perfect, but it saved lives and was the first step on the way to modern HIV therapy.
Evidence, history, and context here. paulsaxmd.substack.com/p/no-azt-did...
No, AZT Didn't Kill More People than AIDS
Some statements are wrong enough to make your head explode.
paulsaxmd.substack.com
December 20, 2025 at 12:59 PM
“AZT killed more people than AIDS” is false.
I was a medical resident in the late 1980s. AZT wasn’t perfect, but it saved lives and was the first step on the way to modern HIV therapy.
Evidence, history, and context here. paulsaxmd.substack.com/p/no-azt-did...
I was a medical resident in the late 1980s. AZT wasn’t perfect, but it saved lives and was the first step on the way to modern HIV therapy.
Evidence, history, and context here. paulsaxmd.substack.com/p/no-azt-did...
Inspired by a @nejm.org piece by Drs Brian Garibaldi and Steven Russell, I add my two cents on the physical examination.
Because limitations notwithstanding, it still matters. blogs.nejm.org/hiv-id-obser...
Because limitations notwithstanding, it still matters. blogs.nejm.org/hiv-id-obser...
What Use Is the Physical Examination in Current Medical Practice?
Share Tweet Pin Mail SMS A very interesting, quite scholarly perspective appeared in the NEJM last month called, “Strategies to Reinvigorate the Bedside Clinical ...
blogs.nejm.org
December 18, 2025 at 10:36 PM
Inspired by a @nejm.org piece by Drs Brian Garibaldi and Steven Russell, I add my two cents on the physical examination.
Because limitations notwithstanding, it still matters. blogs.nejm.org/hiv-id-obser...
Because limitations notwithstanding, it still matters. blogs.nejm.org/hiv-id-obser...
Giving travel advice is a common task for ID doctors, and here's a recent example. Thanks to @docdelrio.bsky.social for the advice!
(And Mexico City is amazing, highly recommended)
paulsaxmd.substack.com/p/going-to-m... #IDSky
(And Mexico City is amazing, highly recommended)
paulsaxmd.substack.com/p/going-to-m... #IDSky
Going to Mexico City? Here's Some ID (and Other) Advice
If you're an ID doctor, you'll be asked by friends for travel advice -- comes with the territory. Here's a recent example.
paulsaxmd.substack.com
December 13, 2025 at 9:52 PM
Giving travel advice is a common task for ID doctors, and here's a recent example. Thanks to @docdelrio.bsky.social for the advice!
(And Mexico City is amazing, highly recommended)
paulsaxmd.substack.com/p/going-to-m... #IDSky
(And Mexico City is amazing, highly recommended)
paulsaxmd.substack.com/p/going-to-m... #IDSky
Time for an ID Link-o-Rama! Dengue, malaria, HIV cure, ivermectin madness, and more make the cut. Enjoy. blogs.nejm.org/hiv-id-obser...
Dengue, Malaria, HIV Cure, and Others -- First Cold Snap of the Winter ID Link-o-Rama
Absolutely brutal temperatures arrived up here in Boston over the past week, just in time for the peak holiday season, and we’ve even had a dusting of snow. Here’s proof, in case you don’t believe me....
blogs.nejm.org
December 11, 2025 at 2:11 PM
Time for an ID Link-o-Rama! Dengue, malaria, HIV cure, ivermectin madness, and more make the cut. Enjoy. blogs.nejm.org/hiv-id-obser...
Remembering a particularly challenging infection my father had -- both for him, and for me. (And featuring drawings by my sister Anne!)
#IDSky #Medsky
paulsaxmd.substack.com/p/son-as-doc...
#IDSky #Medsky
paulsaxmd.substack.com/p/son-as-doc...
Son as Doctor: Part 2, The Bad
When a fever isn’t “just a virus”, and being the doctor-son gets much harder.
paulsaxmd.substack.com
December 6, 2025 at 10:56 PM
Remembering a particularly challenging infection my father had -- both for him, and for me. (And featuring drawings by my sister Anne!)
#IDSky #Medsky
paulsaxmd.substack.com/p/son-as-doc...
#IDSky #Medsky
paulsaxmd.substack.com/p/son-as-doc...
Can we really be grateful for anything in the ID world in 2025?
Sure -- plenty of great advances!
Here are a half-dozen to celebrate (and be grateful for) in 2025, believe it or not. #idsky
blogs.jwatch.org/hiv-id-obser...
Sure -- plenty of great advances!
Here are a half-dozen to celebrate (and be grateful for) in 2025, believe it or not. #idsky
blogs.jwatch.org/hiv-id-obser...
ID Things to Be Grateful for -- 2025 Edition
Looking back on these annual Thanksgiving posts, I notice an odd pattern: every few years, the intro turns into a kind of apology. As in, Yes, I know the title sounds upbeat, please don’t attack me. T...
blogs.jwatch.org
November 25, 2025 at 2:29 AM
Can we really be grateful for anything in the ID world in 2025?
Sure -- plenty of great advances!
Here are a half-dozen to celebrate (and be grateful for) in 2025, believe it or not. #idsky
blogs.jwatch.org/hiv-id-obser...
Sure -- plenty of great advances!
Here are a half-dozen to celebrate (and be grateful for) in 2025, believe it or not. #idsky
blogs.jwatch.org/hiv-id-obser...
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...