Perspectives

Thinking out loud.

Long-form writing on the science, history, and clinical context of metabolic medicine. Pieces here go deeper than announcements — they are the company thinking out loud about the field we are working in.

A short history

June 12, 1979. The morning a feeding tube became something a patient could live with.

On the morning of June 12, 1979, in the pediatric operating room of University Hospitals of Cleveland, a four-and-one-half-month-old infant was the first human being to receive a percutaneous endoscopic gastrostomy. The procedure took less than fifteen minutes.

Nicholas G. Demetriades · May 2026 · 9 min read
A short history

The Nasoenteric Tube. A history.

Among the devices in routine use at every hospital bedside, the nasoenteric feeding tube is among the oldest in concept and the least altered in form. Well over a million such tubes are placed in the United States every year — and by repeated measurement, it is the most painful procedure routinely performed in the emergency department.

Nicholas G. Demetriades · May 2026 · 10 min read
An argument

The Route Is the Platform.

On September 12, 1985, a surgeon in Böblingen removed a gallbladder through a scope he had partly built himself — and was nearly run out of the profession for it. Within a decade it was the standard of care. In medicine, the unit of real progress is rarely the instrument or the molecule. It is the route.

Nicholas G. Demetriades · July 2026 · 9 min read