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• Prescribe systemic immunosuppressants.
• Respond to acute flares.
• Rotate therapies when efficacy wanes.

But the next generation of biologics requires a different
mindset:

• Understanding tolerogenic mechanisms.
• Knowing how to monitor regulatory T-cell
engagement.
• Advising patients on edible biologic dosing, gut
microbiome interactions, and mucosal immunology.

This is not “de-skilling” medicine.
It’s re-skilling for a biologic era defined not by escalation,
but by prevention.

Decentralized Delivery, Recentralized Trust

When the drug leaves the clinic, trust becomes the most
powerful clinical tool.

If the physician isn’t administering the therapy directly,
then their influence comes through education and sustained
guidance. That means:

• Rebuilding trust with patients who’ve cycled
through failed biologics.
• Helping patients interpret their body’s feedback, not
just their bloodwork.
• Acting as a partner in long-term care, not a
technician of short-term protocols.

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