Dr. 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.

00:00 Introduction — Dr. Stanley Goldfarb

01:37 The 2019 Wall Street Journal op-ed

12:57 The tweet that ended his relationship with Penn and UpToDate

17:04 What 550 FOIA requests revealed about who's driving DEI in academia

21:01 Is there a case for modernizing the medical curriculum?

27:29 How students gained control of the agenda

32:10 How admissions committees began selecting for activists

36:34 The two missions of Do No Harm

47:18 Nonprofit hospital tax exemption and ideological spending

53:44 The constitutional framework

1:07:19 Do demographic quotas ever make sense?

1:09:31 Closing — how to get involved with Do No Harm

Books

Doing Great Harm (2025) — Amazon: https://www.amazon.com/Doing-Great-Harm-Infecting-Healthcare_and/dp/B0FD3ZP9WN

Take Two Aspirin and Call Me By My Pronouns (2022) — Amazon: https://www.amazon.com/s?k=Take+Two+Aspirin+Call+Me+By+My+Pronouns+Goldfarb

Articles & Op-Eds

2019 WSJ op-ed: https://www.wsj.com/articles/take-two-aspirin-and-call-me-by-my-pronouns-11568325291

City Journal archive: https://www.city-journal.org/person/stanley-goldfarb

Do No Harm: https://donoharmmedicine.org

Follow Dr. Goldfarb

X: https://x.com/donoharm?lang=en

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod

Subscribe Links

Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658

YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Dr. 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.

00:00 Introduction: Why Dr. Høeg Is Back and What the Ron Johnson Memo Reveals

02:03 How Vaccine Myocarditis First Surfaced: Israel, the U.S. Military, and Early Warning Signs

05:36 Dr. Murthy on the Biology: Why the mRNA Vaccine Produced Cardiac Inflammation in a Different Population Than Expected

10:36 The Puntmann Paper: Statistical Problems, Confounding, and the Push to Close Schools and Cancel Sports

13:58 The Double Standard in Real Time: Subclinical MRI Findings vs. Kids Presenting With Chest Pain

16:26 Risk-Benefit Mismatch: Vaccine Myocarditis in Young Males vs. Genuine COVID Risk in That Population

21:05 Dr. Høeg's VAERS Analysis: Rates of One in Five Thousand, What the FDA's Own Data Showed, and the Paper That Almost Never Ran

24:03 Dr. Murthy Reveals: He Was a Reviewer for a Journal That Killed This Paper for Political Reasons

28:23 Inconsistency of Vaccine Skeptics: Who Was Questioning the Trials Before Election Day

35:52 Korea's Autopsy Program and Why the U.S. Has No Comparable Surveillance System

40:21 The Chikungunya Vaccine Withdrawal: One Death, One Action — and the Contrast With COVID

42:34 Inside the FDA: The OBPV Memo, the 10 Probable/Possible Deaths in Children, and What Happened Next

53:30 Senator Johnson's Subpoena and Why the Number Dropped from 10 to 7

58:20 Causal Attribution Double Standard: COVID Deaths vs. Vaccine Deaths

1:20:59 Should the COVID Vaccine Still Be Approved? Dr. Høeg on the Absence of Clinical Efficacy Evidence

1:23:31 The CDC-Blocked Study, Healthy Vaccinee Bias, and the Limits of Observational Data

1:28:08 What FDA Approval Actually Means — and What It Should Mean

Co-Host Handles

@anish_koka and @drdigiorgio
Show Handle

@drsloungepod

Subscribe Links

Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658

YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Investigative 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/0262053993

00:00 Welcome and intro: David Zweig

01:14 MidJourney enters medical imaging — hype or breakthrough?

05:35 Incidentalomas, cash-pay scanning, and who bears the cost

08:55 Ultrasound physics and why AI won't replace radiologists yet

14:00 Transition to the book: An Abundance of Caution

17:00 The Twitter Files and Zweig's COVID journalism

23:00 Political monoculture in public health and legacy media

41:43 Sweden, BLM protests, and the shifting COVID rules

43:06 The empirics on children: what the data actually showed

50:29 American media's uniquely alarmist pandemic coverage

56:31 Living in a deep blue area: why data couldn't penetrate the narrative

58:18 Anthony's ICU story and the Gellman Amnesia moment

59:50 How do we rebuild trust in public health?

1:08:28 Technological solutionism: why school closures were impossible before Zoom

1:10:07 1950s flu epidemics — schools stayed open with 50% of kids out sick

1:25:20 Newsroom monoculture, book publishing, and the conservative imprint problem

1:28:08 Reforming institutions vs. questioning their foundations

1:36:39 Wrap-up: the pandemic as a case study in how society functions

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod

Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658

YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode Summary

Ryan 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 Markers

00:00 Introduction — Ryan Long's 25 Years in Health Policy

02:08 Drug Pricing 101: List Price vs. Net Price and Why It Matters

06:39 GLP-1s as a Case Study: Insurance Pullback and the Price War That Followed

11:17 The Medicare Bridge Program and Government Price Setting for GLP-1s

14:11 Why Drug Companies Set List Prices High at Launch

16:10 The Inflation Reduction Act: Price Controls, Rebate Penalties, and Innovation Risk

20:57 Brand-to-Brand Competition and the FDA's Role

28:52 GLP-1s Under Medicare: Is the $50/Month Bridge Program Good Policy?

36:50 The Medicaid Drug Rebate Program and the Best Price Provision

38:08 The Origins of 340B: What the Program Was Actually Designed to Do

42:24 Qui Bono — How 340B Revenue Is Really Generated

50:17 Contract Pharmacies and the For-Profit Middlemen in 340B

56:31 The Humira Biosimilar Case and the Rebate Trap

1:02:58 The 1987 Supreme Court Case That Supercharged the Rebate Structure

1:05:26 Broad Reform Proposals: From 340B Overhaul to Consolidation

1:09:19 Closing Thoughts and Where to Find Ryan's Work

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod

Subscribe Links
Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR
Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658
YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode Summary

This week, Drs. DiGiorgio and Koka are joined by returning guest Dr. Sanat Dixit and special guest Dr. Sanjay Dhall, chief of neurosurgery at Harbor-UCLA and a leading spinal cord injury researcher. Dr. Dhall traces his path from a "commando shift" in a Houston trauma bay as a pre-med student to running solo trauma call at Grady Hospital as a young attending, then discusses the strange reality of his current institution: a major county hospital that doesn't bill professional fees or for implants, leaving millions on the table. The conversation moves through hospital alignment under for-profit versus non-profit models, the Christopher Duntsch case and what it reveals about resident training and the GME system, Dr. Dhall's controversial Wall Street Journal letter on NIH indirect costs, and a guideline fight over early surgery for spinal cord injury that got him removed from a neurosurgery executive committee. The episode closes with a wide-ranging discussion on AI and robotics in surgery — what they might realistically take off physicians' plates, and what they almost certainly can't replace.

Chapter Markers

00:00 Welcome and introducing Dr. Sanjay Dhall

01:49 From a Houston "commando shift" to a trauma bug

05:10 Running Grady's trauma service solo as the only neurosurgeon

09:25 The unsupervised resident era and its billing aftershocks

14:03 Harbor-UCLA doesn't bill for neurosurgery profies — or implants

19:44 How county hospitals account for six-figure implant write-offs

24:30 Fiduciary duty, taxpayers, and the case for billing aggressively

28:00 Drug rep economics at county hospitals

31:10 Comparing Cleveland Clinic, Mayo, and the county model

34:29 The "color-coded sticker" idea and the bureaucratic mindset

37:59 For-profit alignment vs. "non-profits functioning as for-profits"

43:24 The Devi Shetty suture story and physician-driven cost control

44:13 Physician ownership, conflicts of interest, and carve-out hospitals

46:00 Jefferson's neuro hospital and the private anesthesia advantage

48:45 The Christopher Duntsch case and a failure of training oversight

52:10 How does an incompetent surgeon make it through residency?

56:04 Troubled personalities in neurosurgery training

1:00:04 Work-hour restrictions and the self-selection of old-school neurosurgery

1:02:29 Is dissent tolerated in academic medicine anymore?

1:06:31 Inside NIH indirect costs — where 40-60% of grant money goes

1:10:19 The spinal cord injury guideline fight and getting removed from committee

1:13:44 Burnout, call coverage, and the safety net argument

1:20:27 Will robots ever do neurosurgery?

1:23:11 AI for administrative burden vs. AI in the OR

1:28:34 The pilot analogy, a ruptured aneurysm story, and the limits of automation

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod

Subscribe Links

Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658

YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Dr. 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.

00:00 Introduction and Tracy's bio

02:19 Origin story: French major, med school, ophthalmology dropout

07:42 Seven years in Denmark: PhD, clinical work, ultra marathon racing

10:55 Back to the US: PM&R, interventional spine, and the start of COVID research

13:43 Funding research outside the NIH pipeline

17:18 How government funding crowds out independent science

20:59 Evidence-based medicine, spine, and the N-of-one problem

25:35 The Wisconsin school transmission study

28:32 If masks were a drug, would they pass FDA approval?

30:04 Testifying before Congress three times

32:46 The myocarditis preprint: origins, backlash, and vindication

38:34 Post-vaccine myocarditis: what the data actually showed

43:01 Regulatory failure, COVID vaccine risk-benefit, and the pediatric question

45:09 How Europe and Scandinavia got it right earlier

47:58 Cancel culture in academia and the chilling effect on scientific questions

51:18 Joining the FDA: how it happened and what she expected

53:50 What the FDA looks like from the inside vs. the outside

56:38 Where real philosophical disagreements lived within the agency

58:58 Reducing animal testing and CNPV pilot: what actually got done

1:01:45 Leaks to the media: where they came from and what they meant

1:05:17 What the FDA's role should be

1:06:23 Pharmaceutical industry influence and the Wall Street Journal editorial board

1:14:48 The firing: why she refused to resign

1:18:53 The chain of command and who is responsible

1:21:08 What the firing signals about FDA reform

1:27:42 Advice for anyone thinking about taking a leadership role in government

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod

Resource 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=web

Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658

YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode Summary

Dr. 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 Markers

00:00 Introduction — Meet Dr. Noah Kaufman

02:12 What led to leaving the ER after 20 years

04:53 Becoming the patient — the moment everything clicked

09:33 What is Cough Care and where it sits between urgent care and the ER

13:54 Why he doesn't take insurance

16:30 How ER billing actually works — the 2.6 cm laceration rule

19:49 Can urgent care be shopped? The free market argument

21:17 One month in — what he's actually seeing

41:00 Does cost-consciousness lead to undertreating?

43:39 The culture of over-treatment and the evidence behind it

45:48 Longevity, peptides, and the gray market

54:25 Patient autonomy vs. clinical responsibility

1:01:36 What happens if every burned-out ER doc does this?

1:07:33 The franchise vision — scaling direct acute care nationwide

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod

Subscribe Links

Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658

YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode Summary

Dr. 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 Markers

00:00 Introduction — Dr. Greg Katz, NYU Langone cardiologist and Beyond Journal Club co-host

01:40 What prompted the Substack: patients bringing in Nick Norwitz's content

02:51 Who is Nick Norwitz — LDL of 500, low-carb diet, and the clean CTA

05:38 Why Katz takes the question seriously but disagrees with the framing

08:01 Familial hypercholesterolemia outliers: why some FH patients never have events

10:05 The 50/50 problem — half of high-cholesterol patients have heart disease, half don't

12:27 The Jody Plute story: homozygous FH, Thomas Starzl, and the portacaval shunt experiments

17:37 Seven years of LDL 500 — is that long enough to know anything?

18:21 Limitations of coronary CTA: what it can and can't see

21:00 Why LDL gets put on a pedestal — and the cognitive dissonance of a diet that works

22:05 The conflict of interest argument — and why it cuts both ways

25:43 Burden of proof: mechanisms vs. outcomes data

27:16 Statins and GLP-1 levels — why a mechanistic claim isn't the same as a clinical outcome

31:38 Physician accountability vs. content creator accountability

35:24 The Keto CTA study: what it found, what it didn't, and why the blinding controversy matters

44:40 The new lipid guidelines: where they overcomplicate, where they overprescribe

49:38 GLP-1 deficiency framing and the over-medicalization of well people

55:54 Longevity medicine as "over-medicalization of well people"

57:35 What a well-designed trial would actually look like

1:00:01 Why the debate needs real research, not conjecture

1:02:37 How Katz talks to statin-hesitant patients in clinic

1:07:06 Wrap

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod

Subscribe Links

Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658

YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode Summary

Dr. Anil Makam — hospitalist, health services researcher at UCSF, and faculty at Zuckerberg San Francisco General — joins Drs. Koka and DiGiorgio for a wide-ranging conversation on the hidden mechanics of American healthcare. Makam breaks down long-term acute care hospitals (LTACHs): what they're for, how regional variation and perverse payment incentives have distorted their use, and what the 2016 site-neutral payment reforms actually did to the market. The conversation then shifts to Makam's research on clinical practice guidelines — specifically his 2018 study showing that the majority of ATS recommendations were grounded in low-quality evidence, many carrying strong designations anyway — and what that means for how clinicians should read and apply guidelines at the bedside. The episode closes on the FDA, indication creep, the limits of central planning in quality measurement, and what it actually means to be a good doctor in a system where you can't buy your way to better medicine.

Chapter Markers

00:00 Introduction — Dr. Anil Makam, UCSF hospitalist and health services researcher

02:09 What is an LTACH? Origins, optimal use cases, and the vent-weaning niche

08:09 How clinical practice led Makam to study LTACH utilization

10:08 Geographic variation in LTACH use — decomposing what drives it

14:16 Post-acute care economics: DRGs, payment systems, and perverse incentives

19:11 Medicare Advantage denial rates and the two-tier access problem

23:06 Market access vs. total closures: what the 100 LTACH closures actually mean

24:04 Short-stay outlier rules and the "magical recovery" at the payment threshold

26:07 Site-neutral payment reform and its effects on the LTACH market

31:51 Moving to guidelines: evidence vs. recommendations

33:38 The ATS guidelines study — what they found and the Twitter fallout

39:34 How to practice when most of what we do lacks strong evidence

43:38 Why guidelines are getting more confident on less evidence

47:10 The generalist vs. specialist lens on evidence appraisal

53:47 How do you measure what makes a doctor good?

56:41 Three buckets of physician quality: technical, relational, cognitive

01:00:06 Running a trial vs. appraising a trial — two different skills

01:05:16 Indication creep and applying trial evidence to the wrong patients

01:09:24 The FDA, Vinay Prasad, Marty McCary, and why reform failed

01:13:45 Wrap-up and where to find Makam

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod

Subscribe Links

Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658

YouTube: https://www.youtube.com/@TheDoctorsLoungePod

Episode Summary

Anish sits down with Adu, a med student and biotech investor, to work through the FDA's contested handling of Unicure's AMT-130 — a gene therapy for Huntington's disease delivered via stereotactic brain injection. They debate whether the underlying data justifies approval, why the agency's mid-course reversal has rattled the investor community, and what the Sarepta precedent should have taught everyone involved. The conversation broadens into a bigger question: given that desperate patient populations will always demand access to anything showing a signal, who is actually best positioned to make the call on whether a drug works — the FDA, the clinician, or the market?

Chapter Markers

00:00 FDA approval of AMT-130 and investor reaction

01:16 Unmet need and the case for regulatory flexibility

02:37 Sarepta, Duchenne's, and the cost of approving under pressure

05:09 Accelerated approval done right: the Amylyx example

09:14 Debating the AMT-130 data and the historical control problem

13:53 Why stock price matters for trial funding

17:20 How Prasad could have changed FDA culture differently

19:37 The FDA's role from Kefauver-Harris to today

22:26 Competing Huntington's therapies in the pipeline

25:39 Prasad's tenure: what worked, what didn't

28:27 Media coverage of the FDA and science journalism

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod