The Doctor’s Lounge Podcast
@DRsLoungePod • 3,229 subscribers
This is where scalpels meet systems and physicians say what they really think. @anish_koka @DrDiGiorgio @sdixitmd @drdanchoi
Videos
Vinay Prasad: COVID, the FDA, and Why Journalism Keeps Getting Medicine Wrong Dr. Vinay Prasad joins the Doctors Lounge in a recorded in person conversation that moves from his time at the FDA to bigger questions about evidence, incentives, and trust in medicine. The discussion focuses on how regulatory agencies actually function, why public health debates have become so politicized, and whether the current healthcare funding model rewards good care or just expensive care. Timestamps: 00:16 - Why the FDA conversation matters now 02:49 - Why Vinay accepted the DC job 04:02 - What can actually change inside the FDA 05:39 - The Exondys approval and commissioner authority 07:22 - Do appointees really steer regulatory decisions? 09:48 - Should the FDA regulate safety or efficacy? 10:31 - Safety, efficacy, and the car analogy 13:04 - Could COVID vaccines have been released earlier? 14:04 - Challenge trials versus large community trials 16:32 - Rolling out vaccines by age and risk 18:05 - Why post COVID myocarditis comparisons are flawed 22:36 - The danger of elite stamped misinformation 24:06 - When medicine became political 26:24 - Why institutions may be too captured to trust 27:24 - The measles death story and missing context 30:17 - Buchanan, Tullock, and the logic of bureaucracy 33:17 - How healthcare swallows trillions with mixed value 35:02 - Why low back surgery is hard to centralize 37:27 - ICD placement and gray zone medicine 39:07 - Who should pay for marginal cancer drugs? 41:10 - Demand subsidies and distorted prices 43:34 - Innovation before large welfare programs 46:53 - Does more money always mean more innovation? 48:48 - Why journalism misses what matters at FDA 51:21 - The No Surprises Act and who really pays 55:42 - Vinay’s broader career path and what comes next 57:34 - Why active clinical practice still matters Co-Host Handles Anish Koka, MD and Anthony DiGiorgio, DO, MHA Show Handle The Doctor’s Lounge Podcast Subscribe Links Spotify: Apple Podcasts: YouTube: Dr. DiGiorgio's project "Off Label Ideas" Dr. DiGiorgio's on Substack
The Doctor’s Lounge Podcast27,022 просмотров • 16 дней назад
"No more networks. Just — what's your price?" Rep. Tom Oliverson, MD (practicing anesthesiologist) on where he thinks healthcare is headed: "The future may very well just be direct contracting models... no more networks. It's just — what is your price? What is your cash price?" "This has been a dream of mine for over a decade."
The Doctor’s Lounge Podcast13,312 просмотров • 8 дней назад
Cardiac surgeons are trying to compete with cardiologists on convenience. They're going to lose. A smaller incision doesn't make it minimally invasive. It makes it minimal access. And a mini-AVR? It actually hurts more than a standard sternotomy because you open the sternum AND break into the rib cage. "If you think you can compete convenience-wise with a cardiologist who does stents when you do a CABG and your incision is small, you're not fooling anyone." The game surgeons should be playing isn't incision size. It's durability. Longevity. Freedom from re-intervention. That's the competition cardiologists can't win. But surgeons keep fighting on the wrong turf.
The Doctor’s Lounge Podcast99,309 просмотров • 4 месяцев назад
Academic Medicine published a study. Minority residents were underperforming across multiple top programs — Harvard, UVA, Emory. The paper offered three explanations: faculty racism, a flawed assessment tool, or an unwelcoming environment. Dr. Goldfarb tweeted a fourth: could it be a performance problem? That one sentence ended his 50-year career at Penn.
The Doctor’s Lounge Podcast60,242 просмотров • 2 месяцев назад
Medical students think being a cardiac surgeon means waking up, going to the OR, doing something incredible, and going home. That couldn't be further from the truth. And we're not correcting them. Three different pathways to become a cardiac surgeon. 5-2. 4-3. I-6. Programs change their pathway depending on the year. Depending on who came back from the lab. "There's no other field like this. If you want to become a pilot, there is a path. With cardiac surgery, there are three different paths — and programs change them depending on the year." And the work hour restrictions meant to protect residents? "I'm convinced they hurt the residents." Residency is supposed to be a simulation of the rest of your life. We're not giving them that simulation. We're giving them a highlight reel. And then sending them out to practice.
The Doctor’s Lounge Podcast91,039 просмотров • 4 месяцев назад
George Tolis: TAVR, Broken Training, and What's Really Wrong With Cardiac Surgery. Dr. George Tolis, section chief of coronary and general cardiac surgery at Brigham and Women's Hospital, joins Drs. Koka and DiGiorgio for a wide-ranging conversation on the state of cardiac surgery. He makes the case that TAVR — while genuinely transformative for the right patient — is being systematically applied too broadly, driven by industry incentive and the erosion of meaningful surgical consent. He discusses his collaboration with John Ioannidis that found no statistically significant mortality benefit for any new cardiac surgery technique introduced over the past 35 years, the paper's rejection by every major surgical journal, and what he paid out of pocket to make it open access. The conversation moves to the collapse of surgical training — fragmented pathways, work hour restrictions that leave residents unprepared for attending life, an academic promotion system that ignores teaching, and a culture that routes incompetent trainees around rather than out — and closes with a brief on Vasily Kolesov, the Soviet surgeon from Leningrad who performed the world's first documented coronary bypass years before Favaloro, and whose work was buried by the Cold War. Chapter Markers 00:00 Introduction 01:02 Air-cooled VWs, concert piano, and how Dr. Tolis got here 02:40 TAVR: genuine breakthrough or being abused? 08:02 Finding the TAVR threshold — and why informed consent is the real problem 11:46 Collaborating with John Ioannidis: no mortality benefit for 35 years of new techniques 20:02 Why the major surgical journals wouldn't touch the paper 21:52 Minimally invasive surgery: minimal access vs. minimally invasive 26:24 When do CABG survival curves diverge — and what does it mean? 30:05 Surgeons signing off on TAVRs in young patients 33:51 Health system economics and the heart team dynamic 37:50 How to actually pick a good surgeon (ask the scrub nurses) 40:36 Cardiac surgery training: the three pathways problem 44:04 Work hour restrictions and the residency simulation gap 51:16 General surgery is like MTV — they don't operate anymore 53:21 A resident who finished training without ever applying a cross-clamp 56:34 How to evaluate if a program actually trains 59:27 Academic promotion has nothing to do with teaching 01:01:33 Dr. Tolis's resident outcomes database and three papers nobody cared about 01:05:32 The training timeline: finishing at 49, no runway left 01:07:08 One-size-fits-all RRC rules for cardiac surgery and psychiatry 01:09:16 Cardiac surgery as a disposition, not a therapy 01:12:24 When ECMO becomes the final common path 01:13:38 How you become nationally recognized without being a good surgeon 01:17:16 Vasily Kolesov: the Soviet surgeon who did the first bypass Co-Host Handles Anish Koka, MD and Anthony DiGiorgio, DO, MHA Show Handle The Doctor’s Lounge Podcast Subscribe Links Spotify: Apple Podcasts: YouTube:
The Doctor’s Lounge Podcast69,129 просмотров • 4 месяцев назад
Every major study comparing myocarditis risk after the vaccine vs. after COVID has the same flaw, says Dr. Vinay Prasad. The denominator problem: For the vaccine, the denominator is everyone who got the shot. For COVID, it should be everyone who got infected. Instead, it's everyone who got infected AND called a doctor AND went to clinic AND got a PCR test. "So I think all these papers are flawed."
The Doctor’s Lounge Podcast11,467 просмотров • 14 дней назад
"Old cranky guy who walked to school in the snow barefoot." That's the pushback he expects. But here's the evidence: More and more cardiac surgery graduates are doing "extra training" after they finish. Not because they want to specialize further. Because they never got the basics. One resident. Reputable program. Finished their entire training. Never applied a cross-clamp. Not once. "That's what the attending does from the other side of the table." So they finished. Got their certificate. And left unprepared to operate independently. "That is not training. That is complete insanity." This isn't an anecdote about one bad program. It's what happens when you protect residents so much that you forget to actually train them.
The Doctor’s Lounge Podcast65,816 просмотров • 4 месяцев назад
Safety and efficacy aren't the same thing. And the FDA still struggles with the harder of the two. Dr. Vinay Prasad, breaking down drug safety like a car: "When you turn the ignition and the car starts... that's a type of safety. The car didn't detonate." Efficacy is driving it a few miles down the road. But real safety — knowing a new heartburn medicine doesn't raise heart attack risk by 4% over the old one — that takes massive, unbiased data. "That is actually something that the FDA, to this day, struggles with."
The Doctor’s Lounge Podcast12,222 просмотров • 16 дней назад
If you have a billion dollars, you cannot buy good medicine. Because good doctoring has three components — and none of them are visible from the outside. Technical skill: Can your surgeon actually operate? Other surgeons barely know. You don't. Relational skill: Does your doctor listen? Patients are actually the best judges of this one. Cognitive skill: Can they appraise evidence and apply it correctly to you — not to the average trial patient? No market signal identifies all three. — Dr. Anil Makam, UCSF
The Doctor’s Lounge Podcast30,430 просмотров • 3 месяцев назад
Subspecialists write guidelines for diseases they've never really seen. Not the full disease — just the tip of the iceberg. The sickest. The most complicated. The referral cases. The hospitalist sees the whole denominator. Every COPD admit. Every run-of-the-mill heart failure. The frail, the comorbid, the ones who will never make it into a trial. "You're seeing the sickest of the sickest — which don't represent the monolith of the disease your recommendations are now applying to." A subspecialist's clinical credentialism is real. So is their selection bias. — Dr. Anil Makam, UCSF
The Doctor’s Lounge Podcast27,018 просмотров • 3 месяцев назад
Korea built a no-fault vaccine compensation program that requires autopsy data to attribute cause of death. So they actually did the autopsies. What they found: multiple deaths that were only linked to the vaccine at autopsy. Without the autopsy, the connection would never have been made. The United States has no equivalent system. No autopsies. No attribution. No data. — Dr. Anish Koka
The Doctor’s Lounge Podcast17,002 просмотров • 2 месяцев назад
Every neurosurgeon in America must know what Section 6001 is. Almost none do. Hidden deep within the Affordable Care Act, this one section quietly banned physicians from owning new health systems, cutting off one of the last pathways for independent medicine to compete with billion-dollar hospital monopolies. In this week’s episode of The Doctor’s Lounge, recorded live at PHA Santa Fe, Dr. Lou Tumialan, Chair of the Council of State Neurosurgical Societies, explains how Section 6001 erased physician ownership, created the conditions for mass consolidation, and pushed young doctors into permanent employment. We talk about what independence really means, why the law exists, and how the next generation can take it back. Because the ban wasn’t just legislative... PHA Anthony DiGiorgio, DO, MHA Dutch Rojas Sanat Dixit MD FACS Dan Choi, MD, FAAOS CSNS
The Doctor’s Lounge Podcast47,696 просмотров • 10 месяцев назад
There's a pattern playing out in academic medical centers. Cardiac surgery isn't being called as a therapy. It's being called as a last resort. A patient comes in with endocarditis. DNR. DNI. Medical service admits them. A week goes by. They throw an embolus. The toe turns blue. The infection isn't clearing. And then someone says: "If you don't have an operation, you're going to die." And now the patient says yes. "You've been in the hospital for 10 days, you were DNR DNI, and now you're going to have a double valve with a reconstruction of the aortomitral curtain." Wait a second. This isn't a heart team decision. This is what happens when surgery is treated as a disposition for the sickest, most terminal patients — instead of a viable therapy offered early enough to actually matter.
The Doctor’s Lounge Podcast21,072 просмотров • 4 месяцев назад
The AAMC predicts a shortfall of 86,000 physicians by 2036. Sounds alarming. But who's doing the predicting? "The AAMC is an organization that exists to advocate for the interests of medical schools, which are businesses that are gainfully involved in producing more doctors." You're the carpenter with a hammer. Every problem is gonna be a nail. Yes, population is growing. Yes, the training pipeline has limits. But what doctors do, how they practice, where they practice — none of that is answered by those numbers. Medicine changes. Technology changes. What patients actually need changes. So before accepting the shortage narrative, Carmody says ask a better question: "What are the data that make you think there is a physician shortage?" Not just a number from the AAMC. The actual data.
The Doctor’s Lounge Podcast19,081 просмотров • 3 месяцев назад
We keep applying cancer trial data to the wrong patients. RCTs enroll ECOG 1-2 patients. Functional. Ambulatory. Prognosis of months to years. Then we prescribe those same drugs to patients living between the hospital and a nursing facility. Haven't been out of a wheelchair in months. Prognosis of weeks. "Even if you believe the six-week difference in mortality — when you apply it to a prognosis of weeks to months, the absolute difference is non-existent. And we have that research." That's not subjectivity. That's indication creep. — Dr. Anil Makam, UCSF
The Doctor’s Lounge Podcast17,435 просмотров • 3 месяцев назад
"I did my first unsupervised craniotomy for an epidural hematoma as a PGY three. No one said a word." Dr. Sanjay Dhall on training in the Wild West days of residency — no attending in the room, no one checking, just expected to do the case.
The Doctor’s Lounge Podcast14,893 просмотров • 3 месяцев назад
The first coronary bypass wasn't Favaloro. It wasn't DeBakey. It was Vasily Kolesov. A Soviet surgeon from Leningrad who performed a LIMA-to-LAD at least seven years before anyone the West recognizes. Off pump. No bypass machine. The same surgeon who ran the hospital through the Nazi siege of Leningrad. Through famine. Through the worst conditions imaginable. "He unfortunately died in relative obscurity because the West wanted this to be a Western thing." From 1964 to 1967, the only place in the world you could get a coronary bypass was with Kolesov. And almost no one knows his name. Not because the science wasn't there. Because it was the Cold War. And we decided whose discoveries counted.
The Doctor’s Lounge Podcast13,618 просмотров • 4 месяцев назад
AI will tell you that surgeon is the best thing since sliced bread. The scrub nurses won't. "There are some surgeons that I know — I wouldn't send the neighbor's dog that wakes me up at night to them." AI has a long way to go before it can tell you if someone is actually good in the OR. The people who can? Anesthesiologists. Scrub nurses. Circulating nurses. They're in the room. Every single time.
The Doctor’s Lounge Podcast12,692 просмотров • 4 месяцев назад