Precision Medical Care Newsletter November 2025
Wishing you a happy, healthy Thanksgiving!
As we gather around this season of gratitude, our practice wants to extend a heartfelt thank you to you, our patients and community. Caring for you and being trusted with your health is an honor we never take for granted. This time of year reminds us how important community, connection, and wellbeing truly are. Whether you’re celebrating with loved ones or taking time for rest and reflection, we hope your holiday is filled with warmth, nourishment, and joy. Thank you for being part of our practice family. We’re grateful for the opportunity to support your health today and in the year ahead.
From the desk of Dr. Agarwal
Where Healthcare Is Headed: Lessons from Leaders in Health 2025
I had the pleasure of attending Leaders in Health in London, where 180 top clinicians, researchers, and entrepreneurs gathered to debate how to advance health-optimization medicine.
One of the most striking conversations centered on the question: “Will machines ever consciously care?” Neuroscientist Shamil Chandaria made a compelling point: they don’t need to. Machines don’t require emotions or self-awareness to support human wellbeing. What they do need is alignment - the ability to understand what humans value, act in our best interest, and consistently reduce harm. Alignment simply means shared goals. The AI doesn’t feel your stress, but it can recognize it, interpret it, and respond in a way that helps. Consciousness is optional; attunement is essential.
While AI races ahead, the rest of healthcare isn’t keeping pace. Another topic discussed was how misinformation now spreads faster than medical evidence, amplified by platforms optimized for attention rather than accuracy. Wellness hacks go viral in minutes; real science takes years. This is why true leadership in healthcare matters, professionals who can translate complex science into grounded guidance, push back on harmful narratives, and help patients navigate a world where anyone with a ring light can claim expertise. At Precision Medical Care, we work hard to bring you cutting-edge information through the lens of medical experience and discernment.
A theme that came up repeatedly was subtractive medicine—the idea that healing sometimes comes from removing rather than adding. GLP-1 medications are a perfect example: much of their power comes from what they take away including excess hunger signals, inflammatory load, and metabolic noise. Similarly, practices like breathwork or mindfulness don’t introduce anything new to your biology. They simply reduce chronic stress inputs, lower threat signals in the brain, and create more room for your physiology to recover. Sometimes, less truly is more.
Another concept that resonated was antagonistic pleiotropy, a complicated term for a straightforward idea: what protects us in one phase of life may harm us in another. Inflammatory responses that defend us from infection in youth can contribute to chronic disease later. Hormones that support fertility early on reveal vulnerabilities as they decline. Aging isn’t just “more time passing” it reflects biology shifting its priorities.
Across the sessions, the message was clear: the future of medicine isn’t just about better technology. It’s about better interpretation, better alignment, better models of care, and better filters for the information we allow into our lives. Healing will come not only from precision tools, but from precision wisdom.
From the desk of Dr. Johnson
As Dr Martin Picard outlines in his recent publication “The future of medicine is understanding energy: the balance of energy resistance with energy flow”.
Living organisms are physical-energetic systems that must obey simple principles guiding energy transformation across physical and temporal scales. The energy resistance principle (ERP) describes behavior and transformation of energy in the carbon-based circuitry of biology. We show how energy resistance (éR) is the fundamental property that enables transformation, converting into useful work the unformed energy potential of food-derived electrons fluxing toward oxygen. Although éR is required to sustain life, excess éR directly causes reductive and oxidative stress, heat, inflammation, molecular damage, and information loss—all hallmarks of disease and aging. We discuss how disease-causing stressors elevate éR and circulating growth differentiation factor 15 (GDF15) levels, whereas sleep, physical activity, and restorative interventions that promote healing minimize éR. The ERP is a testable general framework for discovering the modifiable bioenergetic forces that shape development, aging, and the dynamic health-disease continuum.
Dr Picard outlines this principle in a conversation with Dr Mark Hyman in The Future of Medicine Is Energy: Dr. Martin Picard Explains Podcast.
Early diagnosis is key and survivorship is high for this common cancer that impacts women. Hormones don’t cause breast cancer but hormones do play a role in breast cancer.
Updates in Cardiology
Evolocumab (REPATHA) in Patients without a Previous Myocardial Infarction or Stroke
This NEJM study shows that evolocumab prevents first cardiovascular events, not just recurrent ones. In patients with atherosclerosis or diabetes but no prior MI or stroke,PCSK9 inhibition cut major events by 25% and had no safety penalty.
For prevention-first medicine, this confirms that aggressive LDL lowering might be effective before a crisis ever happens. This data strengthens the case for our approach at Precision Medical: early detection, early lipid control, and moving cardiology from reactive care of lowering risk aggressively to prevention by lowering risk predictively in those at higher risk due to cholesterol, inflammation and insulin resistance.
A new STAT article confirms that Medicare will now reimburse $1,000+ for AI-powered coronary plaque analysis (HeartFlow, Cleerly, Elucid, Caristo), with private insurers set to follow. This moves plaque quantification from a concierge add-on to a mainstream reimbursed pathway.
Preventive cardiology is increasingly accepted as an insurable benefit. Early plaque detection, soft-plaque analysis, and longitudinal tracking finally have reimbursement codes.
The Menopause Society has prepared these FAQs in response to some commonly asked questions about hormone therapy.
Question: Should hormone therapy be used to prevent heart disease?
No. Hormone therapy is not recommended for primary or secondary prevention of cardiovascular disease. The effects of hormone therapy on coronary heart disease (CHD) vary depending on when it is initiated in relation to time since menopause and age. In younger women who are within 10 years of menopause onset, there is a favorable effect on CHD and all-cause mortality that needs to be considered against potential rare increases in risks of breast cancer, venous thromboembolism, and stroke. Women who initiate hormone therapy 20 to 30 years after the onset of menopause are at higher risk of coronary heart disease, venous thromboembolism, and stroke than women initiating hormone therapy early in menopause.
Question: Should hormone therapy be used to prevent dementia?
No. Hormone therapy is not recommended for prevention or treatment of cognitive decline or dementia. At the present time, we do not have evidence that the use of hormone therapy in women undergoing menopause at the usual age prevents dementia. It may have cognitive benefits when started in women after hysterectomy and oophorectomy before menopause onset. The risk of dementia was increased in women aged older than 65 years who initiated conjugated equine estrogens plus medroxyprogesterone acetate in the Women’s Health Initiative Memory Study.
Question: Does hormone therapy prevent bone loss and protect against fracture risk?
Yes. Hormone therapy is US-government approved for prevention of bone loss and can be used for this purpose in women who do not have contraindications and who are appropriate candidates. Hormone therapy prevents bone loss and reduces fracture risk in healthy, postmenopausal women, with dose-related effects on bone density. Hormone therapy is not US-government approved for treatment of osteoporosis, and other management strategies should be considered in women with osteoporosis. Stopping hormone therapy results in initial rapid bone loss and potentially in transiently increased fracture risk with longer-term protection.
Unless contraindicated, women with premature menopause should use hormone therapy to prevent bone loss and reduce fracture risk until the average age of menopause when treatment may be reassessed.
Question: I am in my 60s. Is it too late to start hormone therapy?
It depends. There is nothing magic about the age of 60 with regard to starting hormone therapy. More important are time since menopause, with risks being lower in women who are within 10 years of menopause onset, existing contraindications, risk factors for cardiovascular disease and breast cancer, and reasons for initiating hormone therapy (eg, bone protection, hot flash management). Hormone therapy should not be used for prevention of heart disease, dementia, or aging in general. Shared decision-making between women and their clinicians is essential, because these discussions are often nuanced.
Question: Should hormone therapy be used for weight loss?
No. Hormone therapy has favorable effects on body composition but typically does not result in weight loss. There is a link between adiposity and menopause symptoms. Adiposity, and particularly central adiposity, is associated with increased vasomotor symptom severity. Although weight loss via lifestyle intervention has been associated with decreased frequency and severity of vasomotor symptoms, the effect of weight loss medications on vasomotor symptoms is limited. There is preliminary evidence that hormone therapy use may augment response to weight loss medications, but additional study is needed before this can be recommended as standard practice in clinical care.
Question: Are there benefits to starting hormone therapy before menopause onset?
No. There is no data to support the use in perimenopause to “prevent” menopause or chronic disease. Although hormone therapy can be used for symptom management in perimenopause, it is not a high-enough dose to prevent pregnancy or to control heavy menstrual bleeding. It can be used in combination with a progestin-containing intrauterine device that does provide contraception. Alternatively, a low-dose hormone contraceptive pill/patch/ring may also be an option for contraception, management of heavy menstrual bleeding, and symptom management in perimenopausal women.
Question: Are there different indications for the use of systemic and vaginal estrogen?
Yes. Low-dose vaginal estrogen is used for management of genitourinary symptoms, such as vulvovaginal dryness, itching, irritation, and pain with sexual activity, along with urinary symptoms of urgency and frequency. There are also data suggesting that it reduces the risk of urinary tract infections in postmenopausal women. Systemic estrogen is US-government approved for management of vasomotor symptoms and prevention of bone loss and may have some beneficial effects for sleep and mood. Systemic estrogen may also be effective for management of genitourinary symptoms, but the use of low-dose vaginal estrogen is preferred in women who are only experiencing these symptoms. For women on systemic hormone therapy who continue to experience genitourinary symptoms, the addition of local, low-dose estrogen may be needed.
Notable podcasts and new articles
Dr. Catherine and Dr. Jila review highlights from menopause society meeting
Precision Prevention of Alzheimer’s, an emerging approach with Dr. Richard Isaacson, check out his app for brain support exercises and lifestyle support, too: https://retainyourbrain.com/#!/
https://podcasts.apple.com/us/podcast/the-dr-hyman-show/id1382804627?i=1000735376959
GLP therapies for women with “normal” BMI
Mild cognitive impairment: definitions and implications with Mayo Clinic
Bitters and feeding for gut health with expert microbiologist Kiran Krishnan
https://share.google/iHrMzlXZymJuboDpw
Endometriosis: an autoimmune, auto inflammatory condition with metabolic impacts
Aging and Obesity/stress:
https://apple.news/AM3_n9f0pTlyC7la8dhbtTQ
Insulin Resistance and Aging Brain health:
White matter changes and VMS (Vasomotor Symptoms)
https://pmc.ncbi.nlm.nih.gov/articles/PMC9841446/
Dr. Johnson's Naples Dates
January 7th-January 17th
February 3rd-February 10th
February 18th-February 24th
March 10th-March 24th
*More dates to come for 2026*