Paladin Family Practice

10/20/2026

Nearly 40 percent of FDA drug approval meetings over the last 20 years had a "patient voice" at the table tied to groups funded by the companies selling the drugs, and most never disclosed it.

That's not a patient voice. That's a second sales rep.

I don't take money from pharma or insurance. I work for you.

https://www.statnews.com/pharmalot/2026/10/13/many-patient-and-consumer-reps-on-fda-advisory-committees-ties-to-groups-funded-by-pharma/

Text me at 540-405-8688 or visit www.paladinfamilypractice.com

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

Nearly 40% of FDA advisory committee meetings over a 20-year period included either a patient or consumer rep with active ties to an advocacy group funded by pharma companies.

10/15/2026

For 80 years doctors have told men with low testosterone the same thing. Not if you've had prostate cancer. Never.

That rule came from one study in 1941 with a handful of patients. It became gospel anyway.

This spring Harvard and Johns Hopkins published a randomized trial in JAMA Internal Medicine. They gave 136 men with low testosterone, all prostate cancer survivors after surgery, either weekly testosterone shots or placebo. Sexual desire went up. Physical function went up. Aerobic capacity went up. Not one man in either group had a cancer recurrence.

It was 12 weeks. It was low grade cancer only, all treated with surgery, all with a clean PSA for two years. Longer studies are coming. This doesn't rewrite the rule for everybody.

But it does tell you the rule was built on almost nothing, and the men who were told "never" deserved better than that.

Low T is a symptoms problem, not a lab number problem. If you've got the symptoms, and somebody told you to just live with it, that's a conversation worth having.

Text me at 540-405-8688 or visit www.paladinfamilypractice.com

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2848537

10/14/2026

Hospitals now use AI to write up your bill. Insurance companies use AI to deny it. The two robots fight it out. Guess who pays for both.

That's not a joke. It's in Mercer's new employer survey. Health costs are jumping 8.2 percent next year, the biggest hike since 2003, and the report blames about a full point of it on AI billing software that generates more claims and higher level claims. Another point goes to the surprise billing dispute process. So a chunk of your raise next year is going to fund a software war.

Meanwhile a sinus infection still takes two weeks to get seen.

Here's my radical business model. You text me. I see you. No robot in the middle. One flat fee a month, no copays, no codes, no denial letters. Keep your insurance for the hospital. Use me for everything else.

The robots can fight over somebody else.

Text me at 540-405-8688 or visit www.paladinfamilypractice.com

10/06/2026

Last week it was blood draws. This week it's vaccines.

My patients can now get their vaccines right here in my office. One less stop.

I've partnered with Boxwell Pharmacy here in Wi******er to make it happen. If you have insurance, Boxwell bills it for the vaccine, and Lisa, my nurse, gives the shot. I still don't bill insurance for anything.

With Medicaid or no insurance, the health department is still the route, and I'll point you there.

People ask where I stand, so here it is. I'm a board certified family physician and an epidemiologist. I'm glad to go through the evidence with you.

The decision is yours. Your family is welcome here either way.

No lecture. No pressure. A straight conversation and a plan you're comfortable with.

Text me at 540-405-8688 or visit www.paladinfamilypractice.com

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

10/01/2026

Big news at Paladin: blood draws are here!

I've been looking forward to saying that. Lisa, my nurse, now draws blood right here in my office. No second stop for lab work. You sit down, she takes the sample, and you get on with your day.

The labs still run through Quest at the same cash prices my members already pay. Common annual labs (CBC, CMP, lipid panel, A1C) are often around $20-30.

Lisa draws Monday, Tuesday, and Thursday mornings, by appointment.

I'm excited about this one. One less errand. One less morning lost to your own health care. That's the whole idea behind this practice.

Text me at 540-405-8688 or visit www.paladinfamilypractice.com

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

09/30/2026

Your testosterone came back at 350. The lab says normal. You feel like garbage. Who's right?

Probably you. I'm a board certified family physician with a master's in epidemiology, and I'll tell you what your lab report won't: the number is not the whole story.

It's a snapshot. Testosterone peaks in the morning and slides all day. A man in his 30s runs 20 to 25 percent lower by 4 pm. About a third of men who test low once test normal on the repeat.

Normal means average. The lab range runs from about 264 to 916. So 350 is in range. So is 900. Nobody feels the same at both.

Total isn't what your body uses. Most of it is parked on a protein called SHBG. Free testosterone does the work, and it can be low while total looks fine. Those men have the same symptoms as men with low totals (JCEM, 2016).

Your receptor matters. Some men's receptors are less sensitive, so the same 350 does less. Two men at 350 can be living in two different bodies.

So I treat the man, not the number. Morning draw, repeated. Free T, SHBG, LH, thyroid, blood count, prostate. Then the questions that matter: drive, erections, energy, mood, sleep. Symptoms plus a level.

Text me at 540-405-8688 or visit www.paladinfamilypractice.com.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

Trusted Wi******er Family Practice VA with expert family doctors in Wi******er. Leading family medicine, physicians, and Wi******er doctors for your care.

09/25/2026

I'm a board certified family physician and a trained epidemiologist in Wi******er.
Three signs that make me order a testosterone test:

1. Your s*x drive is gone and morning erections went with it. The largest study of aging men in Europe (NEJM, 2010) found these track with low testosterone better than anything else. Tired is common. Tired plus this is different.

2. You lift, you eat clean, and you still lose strength and gain belly fat. Testosterone tells muscle to hold on and fat to let go. When it drops, the math turns on you.

3. Your mood went flat and your fuse got short. Men call that getting old. I call it a lab order.

The number is not the whole story. Symptoms show up at different levels for different men, and your level is yours, not the lab's. So I test in the morning, twice, and check free testosterone and SHBG, not just total. Then we talk about you, not your printout.

Text me at 540-405-8688 or visit www.paladinfamilypractice.com.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

Trusted Wi******er Family Practice VA with expert family doctors in Wi******er. Leading family medicine, physicians, and Wi******er doctors for your care.

09/14/2026

Paladin Family Practice has a nurse.

Meet Lisa Sempeles, LPN. She starts Monday, September 14.

I didn't find Lisa on a job board. I've worked shifts with her at urgent care. I've seen how she treats people when the waiting room is full and everyone is having a bad day. When it came time to hire a nurse, I knew who I wanted.

Her resume backs it up. Whole career in the Shenandoah Valley. LPN program with a 4.0. First nursing job on a locked dementia unit, with Covid hitting three months in. She stayed. Then more than five years in urgent care. In 2023 Valley Health gave her its Excellence Award for Compassion.

Here's what it means for my patients.

Blood draws in the office, starting by the end of the month. Same discounted lab prices, with common labs still around $20. No more trip to the lab.

Minor procedures are next. Stitches, draining abscesses, splinting, small skin biopsies. Things that used to mean urgent care and a two hour wait.

Faster answers. More hands. Same direct line to me.

Lisa is part time to start. As we grow, so do her hours.

I asked her what she loves about nursing. "It is a privilege, not a job." Then she said healing isn't always what the patient came in for. Sometimes it's a word, a smile, a touch. I'm going to steal that.

Off the clock she's with her family, at the beach, on a trail, or at the gym. For fun she reads up on medical conditions. Yes, really.

Since we opened, Paladin has been Lydia and me. Now there are three of us, settled into Suite 311 and growing. If you've been thinking about joining, this is a good time.

07/30/2026

Big news from Paladin Family Practice.

We're moving up to Suite 311, on the third floor. Same building, same parking, same front door. Just one floor up.

I'll start seeing patients in the new office after September 1st. I'll remind you before your visit, so don't worry about keeping track of it.

The new space has multiple exam rooms and a private bathroom. It has room for a growing team. What won't change is what you already know. A small, private office. Care that stays personal and direct.

About that growing team. I have an announcement coming soon. Here's a hint. Before long you may be able to get your blood drawn right here in the office instead of making a separate trip to the lab.

One change for new members. Enrollment now includes a one-time fee. $150 per adult. $50 per child. $300 maximum per household. It covers the work of bringing a new patient into the practice: requesting your records, building your chart, and setting up your direct access to me.

Nothing changes for current members.

And for the families already with us. If you've been enrolled at least six months and want to add a family member, I'm glad to waive their enrollment fee.

More good things coming.

Questions? Text me at 540-405-8688 or visit www.paladinfamilypractice.com.

Dr. Lawson Smith
Paladin Family Practice

06/11/2026

I wanted to briefly touch on a clip that has been making the rounds on social media. It features Bryan Ardis, who is a chiropractor, speaking with podcast host Rebecca Weiss about GLP-1 medications like Ozempic and Wegovy.

Link: https://www.facebook.com/share/v/1HZXcf6FDM/?mibextid=wwXIfr

The problem with the clip is that he is not really addressing the fair concerns about these medications. There are real things to discuss with GLP-1 medications: nausea, vomiting, constipation, gallbladder disease, pancreatitis risk, muscle loss if patients are not getting enough protein or resistance training, cost, supply issues, and weight regain if the medication is stopped without sustainable lifestyle changes. Those are fair concerns.

Instead, he builds a misleading argument around what these medications are made from.

First, he says there is “no GLP-1” in Ozempic or Wegovy. That is technically true, but it is misleading. Ozempic and Wegovy contain semaglutide, which is a GLP-1 receptor agonist. That means it is designed to activate the same receptor as your body’s natural GLP-1 hormone. Semaglutide is not the exact native GLP-1 hormone, because native GLP-1 is broken down very quickly in the body. The medication was modified so that it lasts much longer. This is common in medicine. We often modify natural hormones or peptides to make them last longer or work more predictably. Examples include long-acting insulin analogs, long-acting testosterone esters, and other modified peptide or hormone-based medications.

Second, he suggests that Ozempic or Wegovy contain exendin-4 from Gila monster venom. That is not correct. Exendin-4 is a real peptide that was originally identified from the Gila monster, and it led to the development of exenatide, which is an older GLP-1 medication sold as Byetta or Bydureon. But Ozempic and Wegovy are not exenatide. They are semaglutide. Semaglutide is a modified analog of human GLP-1, not Gila monster venom.

There is also a broader point here. Many medications have been developed from compounds first identified in plants, bacteria, fungi, animals, or venoms. That does not automatically make them dangerous. ACE inhibitors, for example, were developed after research involving snake venom peptides. Digoxin comes from foxglove. Penicillin came from mold. The source of a discovery does not determine whether a medication is safe or unsafe. What matters is the actual molecule, the dose, and how it behaves in the body.

The phrase “the dose makes the poison” is important here. Venom contains many different compounds. Scientists may identify one specific peptide from that mixture, study it, modify it, purify it, and turn it into a medication. That is very different from injecting venom. Presenting it as “this comes from venom” without explaining that distinction is fear-based and misleading.

So my main concern with the clip is not that GLP-1 medications are perfect. They are not. They have side effects. They are not appropriate for every patient. They should be used with attention to nutrition, protein intake, strength training, long-term planning, and medical monitoring.

But the argument in this clip is not a serious discussion of those real risks. It is mostly using technical-sounding claims to create fear. The accurate summary is this: Ozempic and Wegovy do not contain native GLP-1, and they do not contain Gila monster venom. They contain semaglutide, a GLP-1 receptor agonist designed to activate the GLP-1 receptor and last longer than the body’s natural GLP-1 hormone.

This post is for educational purposes only and does not constitute medical advice. Talk to your doctor before making any decisions about testing or treatment.*