A condition, known commonly as "black urine disease" or Alkaptonuria is a rare genetic disorder involving protein metabolism, and it has its root in the mutation of the homogentisate 1,2-dioxygenase gene, which in turn causes homogentisic acid accumulation in the body. The appearance of dark urine after exposure to air is due to this kind of accumulation; however, a variety of symptoms can be expected, such as joint stiffness, changes in pigmentation, and other long-term health complications. Although the prevalence has been estimated to be between 1 in 250,000 and 1 in 1 million people in the United States, its effects are indeed high on those affected.

Alkaptonuria is an autosomal recessive disease, meaning that the child must inherit a defective copy of the HGD gene from both parents. If both parents are carriers, their offspring have a 25% chance of inheriting two faulty genes and developing alkaptonuria. The condition is genetic but is often not diagnosed for years because it progresses slowly and its early symptoms appear to be harmless.

Symptoms of Alkaptonuria

The most characteristic and common initial symptom of alkaptonuria is dark urine. The reason for this is due to the fact that excess HGA is excreted in the urine and upon oxidation in the presence of air, it gives the urine a brown or black color. Though it is often considered cosmetic, the long-term accumulation of HGA within the connective tissues produces more complicated health problems.

Progressive joint pain and stiffness: The accumulation of HGA in cartilage leads to early-onset osteoarthritis, making movement increasingly difficult over time.

Skin and eye pigmentation changes: Affected individuals may develop bluish or grayish discoloration of the sclera (white part of the eye) and the skin, particularly in areas exposed to friction.

Cardiovascular and respiratory problems: With age, HGA accumulation can lead to valve calcifications in the heart and stiffening of connective tissues in the respiratory tract, which can cause problems in middle and old age.

Decreased mobility and spinal problems: The spine may become stiff and painful due to chronic cartilage degeneration.

These symptoms usually begin to manifest during adulthood, leading to severe complications in a person's 40s or 50s and significantly affecting the quality of their life.

How is Alkaptonuria Diagnosed?

Because of its rarity, alkaptonuria is often mistaken or overlooked early in life. However, there are several ways to confirm the condition:

Urine Testing: The gold standard in the diagnosis is the testing of urine samples for high levels of homogentisic acid via gas chromatography. In case of oxidation, which changes the color of urine to black, it is indicative of alkaptonuria.

Genetic Testing: Confirmatory genetic testing reveals mutations of the HGD gene to diagnose the condition conclusively.

Blood Tests: High levels of HGA in the blood can be used as further evidence.

Imaging Studies: X-rays and MRIs will expose cartilage and joint damage characteristic of alkaptonuria.

Management of Alkaptonuria: Is There A Cure?

At present, there is no cure for alkaptonuria; however, various treatment approaches can reduce its symptoms and slow the disease's progress:

Nitisinone Therapy: Nitisinone is a drug that inhibits the production of HGA. It has been shown to reduce HGA levels and slow tissue damage. However, it needs to be taken under close medical supervision because of potential side effects.

Low-Protein Diet: Since HGA is a byproduct of protein metabolism, reducing protein intake—especially foods rich in tyrosine and phenylalanine—may help decrease HGA production.

Pain Management: OTC pain relievers and anti-inflammatory medications can be used to relieve joint pain and stiffness.

Physical Therapy: Exercise regularly, as it may improve mobility and strengthen muscles, thus reducing strain on affected joints.

Surgical Interventions: Most people with alkaptonuria develop severe osteoarthritis necessitating joint replacement in their old age. Also, some may require heart valve replacement surgery if cardiovascular complications develop.

Life with Alkaptonuria

Although alkaptonuria is not fatal, it severely affects the quality of life. The progressive deterioration of the joints and associated symptoms can make everyday activities difficult, requiring lifestyle changes and medical interventions. The disease may cause premature aging of the joints, requiring walking aids and mobility assistance earlier than expected.

Ongoing research will continue to work on improving the treatment options by focusing on gene therapy and alternative enzyme replacement therapies. However, because of its rarity, the clinical trials and research remain sparse.

As genetic research advances, more hope for better management and possible curative approaches for alkaptonuria exists. Scientists are searching extensively for enzyme replacement therapies and innovative drugs that can target the root cause of the disorder. Being aware and being diagnosed early helps individuals better their condition and ultimately have better long-term health outcomes.

Alkaptonuria is a striking example of how one gene mutation can have widespread effects on the body. Though still a rare and often misunderstood condition, growing awareness and advances in treatment are paving the way for better care. If you or a loved one suspect symptoms of alkaptonuria, it is essential to seek early diagnosis and medical guidance to manage the disease effectively and preserve quality of life.

Often, we underestimate the way our brain works and daydreaming has long been seen as a major sign of creativity. Many artists have used their imagination to bring their work to life. However, science offers a different perspective.

Coined in 2002 Dr. Eliezer Somer, those who experience “maladaptive daydreaming” often fantasize about celebrities, historical figures or idealized versions of themselves. Their imaginations are more elaborate, diverse, and complex as compared to other daydreamers.

A 2012 Consciousness and Cognition study found that maladaptive daydreamers spend, on average, 57 percent of their waking hours daydreaming far more than their counterparts.

Dr Somer explains: "The greatest difference is the maladaptive daydreamers reported that the activity interfered with their daily life. They also reported higher rates of attention-deficit and obsessive compulsive symptoms, and more than 80% used kinesthetic activity or movement when daydreaming, such as rocking, pacing or spinning"

He further noted that while everyone experiences moments of mind-wandering, it usually does not interfere with daily life. But maladaptive daydreaming does interfere in regular life. The condition has not been classified as a mental illness and there is no treatment for it yet.

What Do People Say?

Many Reddit users have shared their experiences with maladaptive daydreaming, often asking questions such as: “Is it normal to daydream for such long hours?”

While some responses described daydreaming as a form of dissociation when bored, others relied on music or movies to fuel fantasies of being a “better version” of themselves, often struggling to return to reality.

Common Symptoms Of Maladaptive Daydreaming

Here are some early signs of maladaptive daydreaming to keep an eye out for:

• Compulsive need to daydream
• Avoiding social interaction and activities
• An inability to perform work or other daily tasks
• Extreme feelings of shame or guilt
• Feeling a compulsive need to daydream that you can't control
• Making a conscious effort to stop or lessen daydreaming episodes.
• Intense and extremely vivid daydreams
• Complex and elaborate daydreams, often with many people involved
• Daydreams accompanied by repetitive movements such as pacing
• Prolonged daydreams that may last hours at a time
• A feeling of disconnect or dissociation from people and reality during the episode.

What Does Science Say?

Rachel Bennett, a member of Dr. Somer’s online community, shared she usually dreams up new episodes of her favorite Japanese animé characters and TV shows. She’s also created four families of fictional characters which have grown with her over the years.

“I’d much rather stay home and daydream than go out,” she said.

What Causes Maladaptive Daydreaming?

Dr. Somer noted that about one-quarter of maladaptive daydreamers are trauma survivors who use daydreaming as an escape. Many report family members with similar tendencies, as well as being shy or socially isolated.

Meanwhile, a Harvard Medical study found that 80 percent of maladaptive daydreamers have ADHD, followed by anxiety disorders, depression, and OCD. Researchers believe daydreaming often acts as a coping mechanism for pent-up emotions that cannot be expressed in real life, so they are released through imagination instead.

How Do You Cope With Maladaptive Daydreaming?

Experts emphasize that maladaptive daydreaming is not an extreme condition requiring formal diagnosis, but many people have shared strategies that help:

• Exercise: One forum user reported swimming daily, gradually reaching 2,000 meters, which acted as meditation and grounded them in reality.
• Remove triggers: Avoid activities that spark daydreaming episodes.
• Practice mindfulness: Stay present and aware of thoughts.
• Limit music use: Music is a common trigger.
• Scheduled daydreaming: Set aside specific times with a timer, then consciously exit the session.
• Seek professional help: Therapies such as CBT, DBT, and mindfulness-based stress reduction have shown benefits.
• Stay busy: Engage in tasks to prevent wandering thoughts.
• Improve sleep quality.
• Make daydreams less appealing: Reduce instant gratification.
• Self-development and creativity: Channel imagination into productive outlets.
• Journaling: Record thoughts daily or weekly.
• Practice self-acceptance.
• Find group support.

In January 2026, a Guardian investigation uncovered something deeply unsettling. Google’s AI summaries, designed to quickly answer search queries, were giving users inaccurate health information. Some of the advice was not just misleading but potentially dangerous.

One striking example involved liver function tests. The AI presented incorrect “normal ranges,” which could make someone with a serious liver infection believe their reports were fine. Following the investigation, Google quietly removed AI Overviews for certain queries such as “normal range for liver function tests” and similar searches.

Soon after, another finding raised further alarm. Researchers discovered that Google’s AI Overviews frequently relied on YouTube rather than established medical websites when responding to health questions. Considering nearly two billion people use Google search every month, the implications were hard to ignore.

Is AI Replacing Medical Advice

For years, doctors have warned about “Dr Google” and self diagnosis. But the situation has now moved beyond search results. People are increasingly asking AI tools directly for answers to complex medical problems.

The search optimization platform SE Ranking analyzed more than 50,000 health searches in Germany. The most cited source in AI responses was YouTube, which accounted for 4.43 percent of citations. That is about 3.5 times more than netdoktor.de, one of the country’s biggest consumer health portals. It was also cited more than twice as often as the well known medical reference MSD Manuals.

Only 34.45 percent of citations in AI Overviews came from reliable medical sources. Government health institutions and academic journals together contributed roughly one percent. No hospital network, university, or medical association came close to YouTube’s citation numbers.

Read: ChatGPT Health Explained: Will This New OpenAI Feature Replace Doctors?

Why Experts Are Concerned

The concern is simple. YouTube is a video platform, not a medical publisher. While qualified doctors upload educational videos, the platform also hosts wellness influencers, life coaches, and creators without medical training.

In one particularly worrying example, Google’s AI advised pancreatic cancer patients to avoid high fat foods. Medical experts say this recommendation is the opposite of what many patients actually need and could increase mortality risk.

AI Overviews also gave incorrect information about women’s cancer screening tests. Experts warned this could lead people to dismiss serious symptoms and delay diagnosis.

The Rise of Chatbot Medicine

The shift is not limited to search engines. Chatbots are rapidly becoming everyday health advisers. OpenAI estimates about 40 million people globally use ChatGPT for healthcare guidance each day.

A 2026 Health and Media Tracking Survey by the Canadian Medical Association found roughly half of Canadians consult Google AI summaries or ChatGPT for medical concerns.

Read: AI Therapy Gone Wrong: Psychiatrist Reveals How Chatbots Are Failing Vulnerable Teens

The outcome has not been reassuring. People who followed AI advice for self diagnosis and treatment were five times more likely to experience negative health effects than those who did not.

Studies help explain why. A 2025 University of Waterloo study found GPT 4 answered open ended medical questions incorrectly about two thirds of the time. Another 2025 Harvard study showed chatbots often agreed with flawed assumptions instead of correcting users, such as confusion between acetaminophen and Tylenol.

Researchers say AI systems tend to be overly agreeable and confident, prioritizing helpful responses rather than critical reasoning.

Confidence Versus Care

Despite knowing AI can be wrong, many people still rely on it. Long waits for specialists, lack of family doctors, and limited access to healthcare make instant answers appealing.

The real concern is not curiosity but unquestioned trust. Looking up symptoms is one thing. Acting on AI advice without verification is another.

The technology is powerful and useful, but when confident sounding answers replace medical judgement, the consequences can affect real lives.

A new review published in The Lancet highlights how close this shift may be. The study underscores a hard truth: despite having effective medicines for years, global blood pressure control remains disappointingly poor. The real challenge, experts say, is not the absence of drugs—but problems with adherence, health systems, and long-term patient engagement.

The Unrelenting Burden of a Silent Killer

Hypertension continues to be the leading cause of heart attacks, strokes and premature deaths worldwide. The World Health Organization (WHO) defines high blood pressure as readings at or above 140 mm Hg systolic and/or 90 mm Hg diastolic. A normal reading is below 120/80 mm Hg.

The numbers are staggering. Between 2024 and 2025, an estimated 1.4 billion adults aged 30 to 79—roughly one in three people in this age group—are living with hypertension globally. Nearly 44 percent do not even know they have it. Among those diagnosed, fewer than one in four have their blood pressure adequately controlled.

India reflects this alarming trend. The ICMR-INDIAB study (2023) estimated that about 315 million Indians—35.5 percent of the population—have hypertension. Data from NFHS-5 further showed that nearly half of hypertensive men and more than a third of hypertensive women in India do not have their condition under control.

Why Daily Pills Are Falling Short

For decades, hypertension treatment has relied on daily oral medications—often combinations of two or more drugs. These may include ACE inhibitors, angiotensin receptor blockers paired with calcium channel blockers, and thiazide diuretics.

On paper, these regimens are effective. In reality, adherence is the weak link.

Many patients with hypertension also manage diabetes, obesity or high cholesterol. The result is polypharmacy—multiple pills, multiple times a day. Over time, missed doses, side effects and simple “treatment fatigue” erode consistency. Therapeutic inertia—where doctors do not intensify treatment despite poor control—further worsens outcomes.

The Rise of Long-Acting Injectables

This is where long-acting injectable therapies come in. According to Dr Mohit Gupta, cardiologist at G B Pant Hospital and UCMS, the field is now moving toward therapies that may be administered just twice a year.

Unlike traditional medicines that work downstream to reduce blood pressure numbers, these new drugs target upstream molecular pathways that drive hypertension.

One promising approach involves small interfering RNA (siRNA) therapies that inhibit angiotensinogen production in the liver. By silencing this protein, they dampen the renin–angiotensin system—central to blood pressure regulation. Zilebesiran, developed by Roche and Alnylam, is currently in global phase 3 trials.

Another candidate, ziltivekimab by Novo Nordisk, targets inflammatory pathways increasingly linked to cardiovascular risk. There are also newer strategies aimed at selectively modulating aldosterone, a hormone that increases blood volume and pressure.

The appeal is simple: durability. A twice-yearly injection could eliminate the daily burden of pill-taking, improve adherence and provide more stable blood pressure control over time.

Promise, But With Caution

However, excitement is tempered by concern. Cost remains a major question. The recent introduction of inclisiran, an injectable cholesterol-lowering therapy priced between Rs 1.8 and 2.4 lakh annually in India, highlights affordability challenges.

Long-term safety is another critical issue. Hypertension is lifelong. Patients may require these treatments for decades. Experts stress the need for robust long-term data across diverse populations before widespread adoption.

The promise is undeniable. A twice-yearly injection that reliably controls blood pressure could transform preventive cardiology. But its true impact will depend not only on scientific success—but on accessibility, affordability and sustained safety.