Episode SummaryDrs. Anish Koka and Anthony DiGiorgio sit down with independent science writer Cremieux, the pseudonymous Substack author known for auditing primary data and calling out flawed research. The conversation ranges from FDA drug approval reform (Cremieux proposes a two-pathway system separating safety approval from insurer-facing efficacy approval), the divide between well-evidenced GLP-1s and unregulated peptides like BPC-157, and the HRT black-box warning controversy, to the Columbia and NYU admissions data leaks that made national news and implicated NYC mayor Zohran Mamdani. The back half digs into research methodology: why observational studies rarely replicate RCT findings, how Cremieux debunked a widely-cited Jonathan Haidt social media/cognition study, why the "administrator growth" chart doctors love to cite is likely exaggerated, and how publication bias correction methods work.Chapter Markers00:00 Introduction and guest background02:00 Why the pseudonym "Cremieux"03:11 How he got into primary data analysis and writing04:46 FDA drug approval reform — a two-pathway proposal05:57 The peptide market: GLP-1s vs. unproven peptides like BPC-15709:39 Should drug authority come from the FDA or "bubble up" from trusted voices?11:25 Regulatory capture and ideas for FDA reform16:10 HRT, the black box warning, and communicating risk to patients21:40 Decentralizing medical decision-making22:45 DEI in medicine and the Columbia/NYU admissions data leak34:28 Proving discrimination: causal inference standards for university admissions36:42 Busting myths from observational studies with multiverse analysis40:29 Debunking the Jonathan Haidt social media/cognition study46:46 Does the US healthcare system explain lower life expectancy?49:56 Is the administrator-to-physician growth chart accurate?54:22 How publication bias correction methods workCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePodMr. Jordan Lasker X Handle / SubstackX handle: https://x.com/cremieuxrecueilSubstack: https://substack.com/@cremieux

Episode SummaryAnish Koka and Anthony DiGiorgio sit down with Scott Becker, founder of Becker's Healthcare and partner at McGuireWoods, on the business of medicine — his path from healthcare lawyer to media mogul, the real story behind physician supply shortages, why private enterprise (not government) is driving healthcare's real progress, and the debate over breaking up consolidated hospital systems.Chapter Markers00:00 Welcome and introducing Scott Becker01:22 Origin story: building Becker's Healthcare09:53 The "teach and entertain" media philosophy14:57 Law school with Barack Obama16:57 Physician supply and the ACA's coverage-without-supply gap19:48 Healthcare inflation and third-party payment24:41 Is there really a spine surgeon shortage?37:10 Physician burnout, autonomy, and leaving clinical medicine41:08 Reagan, Mamdani, and government vs. private healthcare46:00 Pushing back: is "nothing we can do" a real answer?48:30 340B reform, site-neutral payments, hospital margins53:41 Lina Khan, Mark Cuban, and health system consolidation57:18 Can private industry absorb hospital revenue losses?1:04:47 Payers as the real customer, price transparency1:06:16 Keeping Becker's Healthcare editorially independent1:13:44 Closing thoughts and the new bookCo-Host Handle@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePodResource: Dr. Scott Becker Book:Building Great Businesses: Create Momentum, Overcome Setbacks, and Scale with Confidence — Scott Becker & Molly Gamble https://www.amazon.com/Building-Great-Businesses-Momentum-Confidence/dp/1637635400Becker's Healthcare: https://www.beckershospitalreview.com/Scott Becker on X: @becker_sbeckerBecker's Healthcare Show Handle: @BeckersHR

Episode SummaryAnish Koka and Anthony DiGiorgio sit down with Martin Shkreli — the former hedge fund manager and pharma executive best known for the 2015 Daraprim price increase and his subsequent prison sentence — for a wide-ranging conversation on drug pricing, patent law, and the state of the pharmaceutical industry. Shkreli walks through his path from a teenage hedge fund intern to founding Retrophin and Turing Pharmaceuticals, defends orphan drug economics and the Orphan Drug Act's seven-year exclusivity window, and argues that patent terms haven't kept pace with the realities of modern drug development. The conversation turns to the Chemocentrics/Amgen scandal — in which trial data for a rare vasculitis drug was allegedly unblinded, manipulated, and relocked to manufacture statistical significance — which Shkreli calls one of the worst frauds in the history of medicine. The episode closes with discussion of the Sarepta/DMD approval controversy, the limits of randomized trials in surgery and rare disease, AI's parallels to neuroscience, and the state of media coverage of the FDA.Chapter Markers00:00 Intro and Martin Shkreli's backstory02:40 Origin story: from hedge fund to founding drug companies07:58 The Daraprim price increase and Shkreli's pricing philosophy17:14 What it actually takes to bring a drug to market35:25 The case for the pharmaceutical industry38:00 The Orphan Drug Act and patent exclusivity57:31 The Chemocentrics scandal: manipulated trial data at Amgen1:22:09 Vinay Prasad, Sarepta, and the DMD approval fights1:34:35 Neurosurgery, clinical trials, and the limits of RCTs1:37:30 AI, neural networks, and the future of psychiatric drugs1:40:40 Cardiovascular disease and LDL lowering1:42:28 Media coverage of the FDA and closing thoughtsCo-Host Handles@anish_koka and @drdigiorgioShow Handles@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode SummaryDr. Stanley Goldfarb — nephrologist, former Associate Dean for Curriculum at Penn's Perelman School of Medicine, and founder of Do No Harm — joins Drs. Koka and DiGiorgio to trace how medical education drifted from clinical science toward social activism. Goldfarb recounts the battles at Penn that led to his 2019 WSJ op-ed, the professional fallout that followed, and why he built Do No Harm into a 54,000-member organization with an active litigation strategy. The conversation covers DEI in admissions, implicit bias training, gender-affirming care in minors, nonprofit hospital tax exemption, and what it actually takes to change entrenched institutions through legislation and the courts.Chapter Markers00:00 Introduction — Dr. Stanley Goldfarb01:37 The 2019 Wall Street Journal op-ed12:57 The tweet that ended his relationship with Penn and UpToDate17:04 What 550 FOIA requests revealed about who's driving DEI in academia21:01 Is there a case for modernizing the medical curriculum?27:29 How students gained control of the agenda32:10 How admissions committees began selecting for activists36:34 The two missions of Do No Harm47:18 Nonprofit hospital tax exemption and ideological spending53:44 The constitutional framework1:07:19 Do demographic quotas ever make sense?1:09:31 Closing — how to get involved with Do No HarmResourcesBooksDoing Great Harm (2025) — Amazon: https://www.amazon.com/Doing-Great-Harm-Infecting-Healthcare_and/dp/B0FD3ZP9WNTake Two Aspirin and Call Me By My Pronouns (2022) — Amazon: https://www.amazon.com/s?k=Take+Two+Aspirin+Call+Me+By+My+Pronouns+GoldfarbArticles & Op-Eds2019 WSJ op-ed: https://www.wsj.com/articles/take-two-aspirin-and-call-me-by-my-pronouns-11568325291City Journal archive: https://www.city-journal.org/person/stanley-goldfarbDo No Harm: https://donoharmmedicine.orgFollow Dr. GoldfarbX: https://x.com/donoharm?lang=enCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode SummaryDr. Tracy Beth Høeg returns alongside Dr. Venkatesh Murthy, NIH-funded cardiologist at the University of Michigan, to dissect the Senator Ron Johnson congressional memo detailing pediatric deaths following COVID-19 vaccination — deaths the FDA's own pharmacovigilance team flagged internally but never disclosed publicly. The conversation covers the well-documented double standard applied to COVID myocarditis versus vaccine myocarditis, how journal editors killed papers not for scientific flaws but out of fear of social media backlash, why Korea's autopsy data revealed fatal cases that would never have been identified otherwise, the post-marketing commitment failures by Pfizer and Moderna, and what it means that we are still annually approving a vaccine with no randomized controlled trial evidence of clinical benefit in the current immune landscape.Chapter Markers00:00 Introduction: Why Dr. Høeg Is Back and What the Ron Johnson Memo Reveals02:03 How Vaccine Myocarditis First Surfaced: Israel, the U.S. Military, and Early Warning Signs05:36 Dr. Murthy on the Biology: Why the mRNA Vaccine Produced Cardiac Inflammation in a Different Population Than Expected10:36 The Puntmann Paper: Statistical Problems, Confounding, and the Push to Close Schools and Cancel Sports13:58 The Double Standard in Real Time: Subclinical MRI Findings vs. Kids Presenting With Chest Pain16:26 Risk-Benefit Mismatch: Vaccine Myocarditis in Young Males vs. Genuine COVID Risk in That Population21:05 Dr. Høeg's VAERS Analysis: Rates of One in Five Thousand, What the FDA's Own Data Showed, and the Paper That Almost Never Ran24:03 Dr. Murthy Reveals: He Was a Reviewer for a Journal That Killed This Paper for Political Reasons28:23 Inconsistency of Vaccine Skeptics: Who Was Questioning the Trials Before Election Day35:52 Korea's Autopsy Program and Why the U.S. Has No Comparable Surveillance System40:21 The Chikungunya Vaccine Withdrawal: One Death, One Action — and the Contrast With COVID42:34 Inside the FDA: The OBPV Memo, the 10 Probable/Possible Deaths in Children, and What Happened Next53:30 Senator Johnson's Subpoena and Why the Number Dropped from 10 to 758:20 Causal Attribution Double Standard: COVID Deaths vs. Vaccine Deaths1:20:59 Should the COVID Vaccine Still Be Approved? Dr. Høeg on the Absence of Clinical Efficacy Evidence1:23:31 The CDC-Blocked Study, Healthy Vaccinee Bias, and the Limits of Observational Data1:28:08 What FDA Approval Actually Means — and What It Should MeanCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode SummaryInvestigative journalist David Zweig joins Anish Koka and Anthony DiGiorgio to discuss his book An Abundance of Caution: American Schools, The Virus, and a Story of Bad Decisions — a heavily cited account of how public health authorities, the media, and a politically homogenous expert class got COVID policy badly wrong, especially for children. The conversation covers why U.S. media coverage was uniquely alarmist compared to the rest of the world, how Americans overestimated child COVID mortality by as much as 40 times, the role of "technological solutionism" in making school closures possible when they never would have been before, and what it would actually take to rebuild public trust in institutions that squandered it. The episode opens with a discussion of MidJourney's foray into medical imaging and what it reveals about AI hype cycles in medicine.Resource:David's Book: https://www.amazon.com/Abundance-Caution-American-Schools-Decisions/dp/0262053993Chapter Markers00:00 Welcome and intro: David Zweig01:14 MidJourney enters medical imaging — hype or breakthrough?05:35 Incidentalomas, cash-pay scanning, and who bears the cost08:55 Ultrasound physics and why AI won't replace radiologists yet14:00 Transition to the book: An Abundance of Caution17:00 The Twitter Files and Zweig's COVID journalism23:00 Political monoculture in public health and legacy media41:43 Sweden, BLM protests, and the shifting COVID rules43:06 The empirics on children: what the data actually showed50:29 American media's uniquely alarmist pandemic coverage56:31 Living in a deep blue area: why data couldn't penetrate the narrative58:18 Anthony's ICU story and the Gellman Amnesia moment59:50 How do we rebuild trust in public health?1:08:28 Technological solutionism: why school closures were impossible before Zoom1:10:07 1950s flu epidemics — schools stayed open with 50% of kids out sick1:25:20 Newsroom monoculture, book publishing, and the conservative imprint problem1:28:08 Reforming institutions vs. questioning their foundations1:36:39 Wrap-up: the pandemic as a case study in how society functionsCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode SummaryRyan Long — former senior policy advisor to Speaker Kevin McCarthy and current non-resident senior scholar at the USC Schaefer Institute — joins Drs. Koka and DiGiorgio for a deep dive into the structural failures driving American drug pricing. The conversation covers the list-to-net price bubble and why patients pay cost-sharing on a fictitious number, how the IRA's price-setting mechanism disincentivizes both new drug development and subsequent indications, and why the 340B program — sold politically as a lifeline for safety net hospitals — systematically funnels the most money to wealthy health systems with high commercial payer mixes. Long argues the fix isn't tweaking the formula; it's scrapping the drug arbitrage mechanism entirely and replacing it with a direct, transparent grant program that actually reaches the hospitals that need it.Chapter Markers00:00 Introduction — Ryan Long's 25 Years in Health Policy02:08 Drug Pricing 101: List Price vs. Net Price and Why It Matters06:39 GLP-1s as a Case Study: Insurance Pullback and the Price War That Followed11:17 The Medicare Bridge Program and Government Price Setting for GLP-1s14:11 Why Drug Companies Set List Prices High at Launch16:10 The Inflation Reduction Act: Price Controls, Rebate Penalties, and Innovation Risk20:57 Brand-to-Brand Competition and the FDA's Role28:52 GLP-1s Under Medicare: Is the $50/Month Bridge Program Good Policy?36:50 The Medicaid Drug Rebate Program and the Best Price Provision38:08 The Origins of 340B: What the Program Was Actually Designed to Do42:24 Qui Bono — How 340B Revenue Is Really Generated50:17 Contract Pharmacies and the For-Profit Middlemen in 340B56:31 The Humira Biosimilar Case and the Rebate Trap1:02:58 The 1987 Supreme Court Case That Supercharged the Rebate Structure1:05:26 Broad Reform Proposals: From 340B Overhaul to Consolidation1:09:19 Closing Thoughts and Where to Find Ryan's WorkCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode SummaryDr. Tracy Høeg — physician, epidemiologist, and former Acting Director of the FDA's Center for Drug Evaluation and Research — joins Drs. Koka and DiGiorgio for her first interview since being fired from the agency in May 2025. She traces her unusual path from ophthalmology dropout to professional ultramarathoner to one of the most consequential and contested researchers of the COVID era, walking through her school transmission studies, the myocarditis preprint that detonated on social media, and what she actually found when she got inside the FDA: career scientists who were sharp, collegial, and largely aligned with her — not the entrenched bureaucratic resistance she expected. She also gives the most detailed account yet of how her firing went down, why she refused to resign, and what she thinks it signals about pharmaceutical industry influence over the agency.Chapter Markers00:00 Introduction and Tracy's bio02:19 Origin story: French major, med school, ophthalmology dropout07:42 Seven years in Denmark: PhD, clinical work, ultra marathon racing10:55 Back to the US: PM&R, interventional spine, and the start of COVID research13:43 Funding research outside the NIH pipeline17:18 How government funding crowds out independent science20:59 Evidence-based medicine, spine, and the N-of-one problem25:35 The Wisconsin school transmission study28:32 If masks were a drug, would they pass FDA approval?30:04 Testifying before Congress three times32:46 The myocarditis preprint: origins, backlash, and vindication38:34 Post-vaccine myocarditis: what the data actually showed43:01 Regulatory failure, COVID vaccine risk-benefit, and the pediatric question45:09 How Europe and Scandinavia got it right earlier47:58 Cancel culture in academia and the chilling effect on scientific questions51:18 Joining the FDA: how it happened and what she expected53:50 What the FDA looks like from the inside vs. the outside56:38 Where real philosophical disagreements lived within the agency58:58 Reducing animal testing and CNPV pilot: what actually got done1:01:45 Leaks to the media: where they came from and what they meant1:05:17 What the FDA's role should be1:06:23 Pharmaceutical industry influence and the Wall Street Journal editorial board1:14:48 The firing: why she refused to resign1:18:53 The chain of command and who is responsible1:21:08 What the firing signals about FDA reform1:27:42 Advice for anyone thinking about taking a leadership role in governmentCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodResource link: Anish's substack: https://open.substack.com/pub/anishkokamd/p/they-were-fixing-the-fda-then-they?r=6chj5&utm_campaign=post-expanded-share&utm_medium=webSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode SummaryDr. Noah Kaufman - board-certified emergency physician with 20 years in the ER, seven seasons on American Ninja Warrior, and a new direct acute care practice in Denver - joins Drs. Koka and DiGiorgio to talk about why he walked away from the employed medicine model and built Cough Care, a cash-pay, fully transparent urgent care. The conversation covers the broken economics of emergency billing, why most urgent care is a race to the bottom, how price signals change both patient and physician behavior, and what a parallel direct care system could look like at scale -including the franchise model Kaufman is already planning.Chapter Markers00:00 Introduction — Meet Dr. Noah Kaufman02:12 What led to leaving the ER after 20 years04:53 Becoming the patient — the moment everything clicked09:33 What is Cough Care and where it sits between urgent care and the ER13:54 Why he doesn't take insurance16:30 How ER billing actually works — the 2.6 cm laceration rule19:49 Can urgent care be shopped? The free market argument21:17 One month in — what he's actually seeing41:00 Does cost-consciousness lead to undertreating?43:39 The culture of over-treatment and the evidence behind it45:48 Longevity, peptides, and the gray market54:25 Patient autonomy vs. clinical responsibility1:01:36 What happens if every burned-out ER doc does this?1:07:33 The franchise vision — scaling direct acute care nationwideCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode SummaryDr. Greg Katz, preventive cardiologist at NYU Langone and co-host of Beyond Journal Club, joins Anish to dissect the online cholesterol debate — specifically the claims made by science communicator Nick Norwitz, who has maintained an LDL over 500 mg/dL on a low-carb diet for seven years with no coronary plaque on CTA. Katz takes the data point seriously, walks through the limitations of coronary CTA and the flawed Keto CTA study, and explains why he still believes the burden of proof lies with those arguing diet-induced hypercholesterolemia is safe — while acknowledging where the cardiology establishment, including the new lipid guidelines, overcorrects. The conversation covers the accountability gap between clinicians and content creators, the failure of risk calculators in young patients, and what a well-designed trial to actually answer this question would look like.Chapter Markers00:00 Introduction — Dr. Greg Katz, NYU Langone cardiologist and Beyond Journal Club co-host01:40 What prompted the Substack: patients bringing in Nick Norwitz's content02:51 Who is Nick Norwitz — LDL of 500, low-carb diet, and the clean CTA05:38 Why Katz takes the question seriously but disagrees with the framing08:01 Familial hypercholesterolemia outliers: why some FH patients never have events10:05 The 50/50 problem — half of high-cholesterol patients have heart disease, half don't12:27 The Jody Plute story: homozygous FH, Thomas Starzl, and the portacaval shunt experiments17:37 Seven years of LDL 500 — is that long enough to know anything?18:21 Limitations of coronary CTA: what it can and can't see21:00 Why LDL gets put on a pedestal — and the cognitive dissonance of a diet that works22:05 The conflict of interest argument — and why it cuts both ways25:43 Burden of proof: mechanisms vs. outcomes data27:16 Statins and GLP-1 levels — why a mechanistic claim isn't the same as a clinical outcome31:38 Physician accountability vs. content creator accountability35:24 The Keto CTA study: what it found, what it didn't, and why the blinding controversy matters44:40 The new lipid guidelines: where they overcomplicate, where they overprescribe49:38 GLP-1 deficiency framing and the over-medicalization of well people55:54 Longevity medicine as "over-medicalization of well people"57:35 What a well-designed trial would actually look like1:00:01 Why the debate needs real research, not conjecture1:02:37 How Katz talks to statin-hesitant patients in clinic1:07:06 WrapCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod