Dark Matter Pragmatism

Psychiatry, biotech, AI, and the hidden machinery of healthcare. Serious analysis, practical implications, minimal fluff.

By Adam D. Borecky

· Launched 10 months ago

The Side Effects Your Drug Didn’t Cause

The Side Effects Your Drug Didn’t Cause
Across 250,000 patients, 49% of placebo recipients report side effects from inert pills. Between 5 and 25% quit because of side effects they cannot…
May 25•Adam D. Borecky, MD
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The Power Law of Psychiatric Prescribing

The Power Law of Psychiatric Prescribing
Why 600 Clinics Decide Which Drugs Succeed
Apr 5•Adam D. Borecky, MD
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The Mirage of the Next-Generation Antipsychotic

The Mirage of the Next-Generation Antipsychotic
How Wall Street turned a methyl group into a nine-figure IPO
Aug 24, 2025•Adam D. Borecky, MD
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A Nation of Mystics in the Clinic: Psychiatry, Psychedelics, and the Case for Respectful Naturalism

A Nation of Mystics in the Clinic: Psychiatry, Psychedelics, and the Case for Respectful Naturalism
Why neuroscience can explain mystical experience without explaining it away
Jan 3•Adam D. Borecky, MD
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The PHQ-9 Was Not Built for This Patient

The PHQ-9 Was Not Built for This Patient
How a screening number became a diagnosis, a treatment target, and a payment.
Jun 23•Adam D. Borecky, MD
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Most problems in healthcare aren’t mysteries. They’re consequences. Essays on psychiatry, biotech, and the systems that shape care.

Recent posts

The Route Problem in Psychiatry

The Route Problem in Psychiatry
An effective antidepressant was pulled from the market — not for safety or efficacy reasons, but because no one could figure out how to deliver it.
Mar 22•Adam D. Borecky, MD
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Notes from the 2026 Stanford AI4MH Symposium

Notes from the 2026 Stanford AI4MH Symposium
Annotated field notes from Stanford’s first AI for Mental Health gathering
Jun 14•Adam D. Borecky, MD
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The Most Replicated Biomarker in Psychiatry You Cannot Order

The Most Replicated Biomarker in Psychiatry You Cannot Order
IL-6 and depression have one of the most credible associations in biological psychiatry. That doesn't mean you should order the test.
Apr 26•Adam D. Borecky, MD
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