Guest: Ali Mortazavi | CEO, Tangram Therapeutics (formerly E-Therapeutics), London, UK

Episode Summary:

Ali Mortazavi is not your typical biotech CEO. A computer scientist by training, former professional chess player, and veteran of financial markets, he invested in an RNAi company in 2012 — and then, by his own admission, made the crazy decision to become its CEO with zero background in biology, chemistry, or medicine.

What followed is a 14-year education in the brutal realities of drug development — and a front-row seat to the AI revolution now reshaping it. In this wide-ranging conversation, Mortazavi draws on his extraordinary personal story (fleeing revolutionary Iran as a child, arriving in London unable to speak English, rising through chess and finance) to offer a uniquely cross-disciplinary perspective on why biotech is stuck in a me-too loop, why the incentive system is the real bottleneck, and where AI is — and isn't — changing the game.

0:00 - Introduction & Ali's Background

1:07 - The Iranian Revolution at Nine Years Old

4:44 - Fleeing Iran, Arriving in London

6:38 - The Refugee Experience and Starting Over

7:49 - Computer Science in 1990

9:53 - Becoming a Professional Chess Player

11:06 - The Vishwanathan Anand Moment

13:17 - From Chess to Finance to Biotech CEO

14:44 - The Gleevec Illusion and the Reality of Drug Development

16:07 - Jay Bhattacharya, Reproducibility, and the PubMed Button

18:18 - LLMs as Scientific Compression Systems

20:15 - Why LLMs Give "The Average Answer" — The Co-Pilot Model

23:44 - Vibe Coding and the Explosion of Code

25:36 - AI Won't Replace 10x Coders — It Will Replace 90 of 100

26:16 - The GalNAC Case Study: 35 Years of Forgotten Innovation

31:10 - The Me-Too Algorithm and Biotech VC Incentives

34:40 - GLP-1s: Another 30 Years of Sitting Around

35:26 - The FDA, the XBI, and the Current Regulatory Landscape

40:43 - Can Politics Fix the Incentive System?

42:09 - Why Past Progress Happened Without AI

44:24 - Medical Ethics, Experimentation, and the Innovation Tradeoff

48:34 - Biotech Is Archaic: The Preclinical De-Risking Problem

50:05 - No Animal Model Actually Works

52:16 - Over-Regulation vs. Just Plain Hard

53:00 - The US Market as the Global Subsidy Engine

54:05 - China: Wake-Up Call, Not Innovator

56:25 - The London Market: "Don't Call It a Market"

58:52 - AI-Native Biotechs: Too Soon to Tell

59:36 - Where AI Works: Information. Where It Doesn't: Physics.

1:01:29 - Tangram Therapeutics and Libra OS

1:04:25 - The Future: SaaS Collapse, Medicine Returns to Fundamentals

1:07:36 - Closing: Hope, Broken Glass, and Early Adoption

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Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @sdixitmd | @drdigiorgio

Episode Summary

Dr. DiGiorgio returns from testifying before the House Energy and Commerce Subcommittee on Health, the third in a series of hearings on healthcare costs covering the provider landscape. The two break down the major policy levers discussed in his testimony — site-neutral payment, Stark Law reform, physician-owned hospitals, and Certificate of Need laws — and why so many obviously good solutions remain politically untouchable. They also dig into the rural access gap, the failure of the NP independence experiment to solve it, Medicare Advantage risk adjustment, and the new HHS healthcare advisory committee. As always, the diagnosis is clear; the politics are the hard part.

Chapter Markers

0:00 – Welcome back & Dr. DiGiorgio's Congressional testimony

3:16 – Site-neutral payment: why everyone knows it's right and no one acts

6:26 – You can't do site neutrality without also enabling competition

8:20 – How MedPAC's methodology actually works

11:50 – Stark Law explained — and why it creates a double standard

14:32 – Hospice fraud, Armenian gangs, and Nick Shirley

20:30 – The original sin: third-party payment and utilization control

23:52 – The case for allowing physician referral networks

25:15 – Hospitals' self-referral hypocrisy and the Federation of American Hospitals tweet

28:52 – How Section 6001 of the ACA banned physician-owned hospitals

30:13 – The new HHS healthcare advisory committee — will it matter?

37:44 – The rural access gap: how big is the problem really?

42:52 – Why NP independence didn't solve rural shortages

47:58 – International medical graduates and the rural fiction

50:06 – Let prices rise: the market solution to rural primary care

55:25 – Medicaid federal matching rates and state competitiveness

56:38 – How Democrats and Republicans engaged at the hearing

58:57 – The politics of why nothing gets done

Links:

YouTube Dr. Digiorgio Congressional Testimony: https://www.youtube.com/watch?v=sjPr3fK9jjc

Written Testimony

@anish_koka | @drdigiorgio

@drsloungepod

🎧 Spotify | Apple Podcasts | YouTube

Kevin Bass, PhD, joins Anish and Dr. DiGiorgio to tell the story of how a viral Newsweek op-ed apologizing for his support of COVID lockdowns and mandates set off a chain of events that ended in his dismissal from Texas Tech's MD/PhD program. Kevin walks through the internal emails, sham professionalism hearings, and rigged dismissal process he uncovered through FERPA records requests — and his ongoing federal and state lawsuits alleging First Amendment retaliation. The conversation then shifts to what Kevin has been building since: using AI pipelines to do large-scale investigative data analysis, from parsing the Epstein files to probing Medicaid fraud — work he argues would have taken a newsroom months, done now in days by one person.

YouTube Chapters:

00:00 - Introduction and Kevin Bass background

01:16 - Kevin's COVID arc: from establishment supporter to dissenter

03:14 - The Newsweek op-ed and Tucker Carlson appearance

08:00 - Internal emails and the professionalism complaint campaign

13:44 - Sham hearings, appeals, and eventual dismissal

19:19 - The rigged consolidated hearing and Darren Gibson

27:34 - Dr. DiGiorgio on the medical training dismissal system

29:51 - Why Kevin still believes in the broader legal system

33:00 - What Kevin has been building since dismissal

36:00 - Using AI to analyze the Epstein files

40:10 - The messiness of large health data sets

46:00 - Immigration policy data analysis

49:06 - Medicaid fraud and the limits of legal definitions

56:20 - Advice to physicians on AI

01:03:10 - The future of health policy research in the AI era

@anish_koka and @drdigiorgio

@drsloungepod

🎧 Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1489323962

🎧 Spotify: https://open.spotify.com/show/7vE4aCMpVHnSGwuOHiGVLp

▶️ YouTube: https://www.youtube.com/@TheDoctorsLounge

Resources:

Kevin Bass's case documentation site: https://case.kevinnbass.com

Kevin Bass on Substack: https://www.kevinnbass.com

Kevin Bass on X: @kevinnbass

Kevin's original Newsweek op-ed (Jan. 2023): https://www.newsweek.com/its-time-scientific-community-admit-we-were-wrong-about-coivd-it-cost-lives-opinion-1776630

Kevin's Epoch Times essay on his dismissal: https://www.theepochtimes.com/opinion/how-my-medical-school-scandalously-dismissed-me-5580841

Dr. Anish Koka and Dr. Anthony DiGiorgio open with the little-known medical story behind the death of the Shah of Iran — how Mohammed Reza Pahlavi came to be operated on in Cairo in 1980 by legendary cardiovascular surgeon Michael DeBakey, and how the "comforting explanation" bias may have contributed to his death from a post-operative abscess rather than his underlying cancer. The case, drawn from a piece by Dr. Li Zhao (NYU Langone), launches a broader conversation about anchoring bias in medicine and the cognitive traps all clinicians face. From there, the hosts turn to the quality metric industrial complex — MIPS, the new low back pain ambulatory model threatening a 12% Medicare penalty for spine surgeons, the hospital readmission program's documented mortality spike, and how 2,266 CMS metrics are costing billions while failing patients. They close with a NEJM perspectives piece from Harvard Business School's Leemore Daphne on health insurance consolidation and her surprisingly free-market prescriptions for reform.

Chapters

00:00 Introduction

02:00 The Shah of Iran — Political Background

03:45 The Shah's Leukemia and Michael DeBakey's 1980 Surgery

06:30 A Spleen the Size of a Football

08:00 The Decision Not to Drain — And Its Consequences

10:00 The Comforting Explanation Bias

12:30 Subspecialization Matters — The Most Famous Surgeon Isn't Always the Right One

14:45 Anchoring Bias in Clinical Medicine

17:00 Modern Imaging and Residents as Checks on Bias

18:30 Surgeons, Complications, and the M&M Conference

21:00 Segue: Judging Doctors by Stats

22:30 The Origins of Quality Metrics — Donabedian 1966

24:00 MIPS and How It Actually Works

26:00 The New Back Pain Ambulatory Specialty Model — A 12% Penalty

28:00 Evidence That Metrics Harm Patients: Hospital Readmission Reduction Program

30:30 Obstetrics and the C-Section Penalty

31:30 Press Ganey and the Cafeteria Problem

33:00 Risk Adjustment Gaming — 40% Margin Increase from Coder Rounding

38:00 2,266 Metrics and 108,000 Person-Hours at Johns Hopkins

40:00 Why Doctors Leave Medicare

42:00 What Good Metrics Could Look Like — Dr. DiGiorgio's JAMA Proposal

44:00 Health Insurance Consolidation — NEJM Perspectives

50:30 FDA, Vinay Prasad, and the WSJ Retraction

55:00 Next Week: Kevin Bass

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In this conversation, Dr. Mary Talley Bowden shares her experiences as an independent physician during the COVID-19 pandemic, detailing her courageous battle against health systems and the Texas Medical Board. She discusses the challenges faced by healthcare professionals, the impact of politics on medical practices, and the importance of patient care and medical freedom. Dr. Bowden emphasizes the need for changes in healthcare policies, including the repeal of mandates and the promotion of alternative treatments like ivermectin. Her personal philosophy and motivation to fight for her patients shine through as she navigates the complexities of the healthcare system.

Chapters

00:00 Introduction to Dr. Mary Talley Bowden

02:17 Dr. Bowden's Courageous Battle Against Health Systems

06:01 The Role of Telemedicine and Ivermectin in COVID Treatment

11:37 Legal Battles and Hospital Privileges

17:03 The Texas Medical Board and Its Controversies

22:21 Political Dynamics in Texas Healthcare

27:22 The Future of Independent Medicine

32:19 The Impact of COVID Vaccines on Patients

37:26 Ethical Concerns and Medical Mandates

40:40 Critique of Public Health Figures

46:03 The Role of Independent Physicians

50:58 Future of Healthcare and Patient Empowerment

About Dr. Mary Talley Bowden:

Dr. Mary Talley Bowden is a Stanford-trained ENT physician running a solo, third-party-free practice in Houston, Texas. She became nationally known during COVID for continuing to see patients, offering early treatment, and publicly opposing vaccine mandates. She is currently in ongoing litigation with both Houston Methodist and the Texas Medical Board.

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Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @sdixitmd |

Episode Title: The Medicaid Data Dump: $1.7 Billion in Billing From Shell Companies and Why Nobody Stopped It

Guest: Samir Unni | Biomedical Engineer, former Palantir healthcare data lead, currently working on federal data modernization efforts

Chapters

00:00 Introduction and Technical Difficulties

02:47 Reflections on Jay Bhattacharya's Insights

06:04 Navigating Polarization in Science

08:50 Moderna's Flu Vaccine Controversy

11:56 Understanding the FDA's Refusal to File

14:58 The Medicaid Data Dump and Its Implications

17:50 Duplicate Payments in Medicaid

20:59 The Role of Transparency in Healthcare

24:01 Home Health Services and Fraud Risks

42:57 Understanding Fraud in Government Billing

46:51 Political Ramifications of Home Health Agencies

50:53 Analyzing Data for Fraud Detection

56:30 Incentives and Accountability in Healthcare

01:01:52 The Role of Technology in Fraud Prevention

01:12:32 Legislative Solutions to Healthcare Fraud

Resources Mentioned:

• Samir Unni's viral Medicaid data thread (@SamirUnni on X)
• CMS TMSIS Medicaid provider-level data release
• Anish Koka's deep dive on Fluarix clinical efficacy
• HHS Office of Inspector General excluded individuals/entities list
• Dr. Mandrola's posts on the Moderna/FDA controversy
• Alex Berenson's report on autism behavioral therapy billing trends

About Samir Unni:

Samir Unni is a biomedical engineer who has spent over a decade working at the intersection of healthcare and data analytics. He previously served as a lead at Palantir working with government and healthcare organizations, and is now focused on modernizing how the federal government leverages AI and data tools to identify waste and fraud in public health programs.

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Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @sdixitmd | @DrDiGiorgio

In this engaging conversation, Dr. Jay Bhattacharya discusses his unique perspective as a health economist and the impact of his training on his approach to public health, particularly during the COVID-19 pandemic. He reflects on the Great Barrington Declaration, the importance of dissent in science, and the need for reform within the NIH to foster innovation and address the replication crisis in research. Dr. Bhattacharya emphasizes the necessity of a culture shift in science, advocating for transparency and rigorous inquiry into public health issues, including vaccines and chronic diseases.

Takeaways

Dr. Bhattacharya's background in economics shapes his approach to health policy.

The COVID-19 pandemic highlighted the importance of considering trade-offs in public health decisions.

Dissent in science is crucial for progress and innovation.

The Great Barrington Declaration challenged the prevailing public health narrative during the pandemic.

The NIH must adapt to foster a culture of questioning and innovation.

Addressing the replication crisis is essential for restoring trust in scientific research.

Public health responses must be transparent and trustworthy to gain public confidence.

Raising the evidentiary bar for vaccines is necessary to ensure safety and efficacy.

The NIH's role in funding research should focus on improving health outcomes.

A second scientific revolution is needed to shift the power dynamics in research.

Titles

Navigating Public Health: Insights from Dr. Jay Bhattacharya

The Economics of Health Policy: A Conversation with Dr. Bhattacharya

Chapters

00:00 Introduction to Dr. Jay Bhattacharya

03:18 The Influence of Economics on Health Policy

06:23 Unique Perspectives During the COVID-19 Pandemic

10:12 The Role of Authority in Public Health Decisions

13:08 The Great Barrington Declaration and Its Impact

16:27 Challenges to Scientific Consensus

19:08 Leading the NIH: An Economic Perspective

22:33 Addressing the Replication Crisis in Science

36:56 Addressing Scientific Stagnation and Replication Crisis

43:42 Fostering a Culture of Dissent in Science

52:56 Setting Research Priorities for Public Health

59:58 Navigating Vaccine Safety and Public Trust

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Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @sdixitmd | @DrDiGiorgio

Benjamin Ryan was the only journalist in the courtroom for every day of the first detransition lawsuit to reach a jury verdict. In January 2025, a White Plains jury awarded $2 million to Fox Varian, who received a double mastectomy at age 16 after being diagnosed with gender dysphoria. Years later, she detransitioned and sued her psychologist and plastic surgeon.

What happened in that courtroom tells a bigger story about how American medicine got here, why Europe is walking it back, and what happens when "affirmation" becomes the only acceptable path. Ben breaks down the testimony, the expert witnesses, the coerced mother, and why one of WPATH's own leaders sank the defense.

This conversation covers the case details, the prefrontal lobotomy parallel, why the American Academy of Pediatrics can't back down, insurance incentives gone wrong, and what it's like to be the only journalist willing to cover the story everyone's afraid to touch.

Chapter List

• 1:00 - Introduction: Benjamin Ryan, The Only Reporter in the Room
• 4:00 - How Ben Got Into Trans Medicine Reporting
• 7:00 - The Case Overview: Fox Varian vs Her Medical Team
• 10:00 - Body Dysmorphia vs Gender Dysphoria: The Fatal Error
• 13:00 - Ken Einhorn and the Philosophy of Affirmation
• 17:00 - The Pride Center Records He Never Requested
• 19:00 - Dr. Loren Schechter: WPATH's President-Elect Testifies for Plaintiff
• 22:00 - Coercing the Mother: "You're Not in Reality, Mom"
• 25:00 - Why Was the Plastic Surgeon Liable?
• 29:00 - The Lobotomy Parallel: When Medicine Gets It Wrong
• 33:00 - The Ethics of Taking Functioning Organs
• 37:00 - Why the Plastic Surgeons Released a Statement
• 39:00 - Expert Witness Testimony: The Game-Changer
• 42:00 - Johanna Olson-Kennedy: "Live Son or Dead Daughter"
• 44:00 - The Nose Job Fallacy: Breasts Have Function
• 46:00 - How Did We Get Here? Internet, Social Media, Civil Rights
• 50:00 - Why Europe Walked It Back and America Didn't
• 54:00 - The Insurance Problem: Perverse Incentives
• 59:00 - Why Medical Societies Can't Say "We Don't Know"
• 1:02:00 - The Media Blackout: "No Institutional Bandwidth"
• 1:05:00 - Closing: Follow Ben's Substack for Case Files

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Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @sdixitmd | @DrDiGiorgio

Guest: Benjamin Ryan on Substack: Hazard Ratio (benryan.substack.com)

Ben's Free Press Article : A Legal First That Could Change Gender Medicine

Guest: Ed Gaines, JD, CPC Vice President of Regulatory Affairs, Zotec Partners Honorary Member, American College of Emergency Physicians

Episode Summary:

If you're a hospital-based physician and you don't understand the No Surprises Act, you're missing the biggest shift in payment leverage in decades. Insurance companies estimated there would be 17,000 disputes. The actual number? Over 2.5 million. And physicians are winning 85-90% of them.

Ed Gaines has been fighting for physician payment for 32 years—from the 1990s battle over 1099 independent contractors to today's war over Independent Dispute Resolution. He explains how California's "neutral" stance cost physicians dearly, why Trump's price transparency rule changed everything, and what Anthem's threat to cut hospital payments really means.

0:00 - Introduction & Opening

1:05 - Who is Ed Gaines?

2:25 - The Origin Story: From Healthcare Fascination to Capitol Hill

6:31 - The 1099 Battle: A Five-Year Fight (1997-2002)

14:19 - What is the No Surprises Act?

17:26 - State Laws vs. Federal Action

23:48 - California's Mistake: When the CMA Was "Neutral"

26:44 - The Consolidation Paradox

28:36 - The Legislative Battle: Ways and Means vs. Energy and Commerce

31:43 - Becerra's Sabotage: Four Lawsuits, Four Victories

37:39 - The Current Battle: Insurance Companies Strike Back

40:43 - The Trump Transparency Game-Changer

42:55 - Who's Really Using IDR?

43:50 - Anthem's New Tactic: Going After Hospitals

46:18 - The Antitrust Argument

47:40 - Closing Thoughts

In This Episode:

• The 1099 battle (1997-2002): How persistence won a 5-year legislative fight
• Why the California Medical Association regrets being "neutral" on AB 72
• The $50 billion that health plans tried to extract from physicians
• How HHS tried to sabotage the NSA—and lost in federal court four times
• Why CMS was off by 147X in predicting IDR case volume
• Trump's transparency rule: The data that's winning cases for physicians
• Anthem's new strategy: Threatening 10% payment cuts to hospitals
• The antitrust case against insurance company boycotts
• Why 70% of IDR users are independent physicians, not just PE groups

Key Quotes:

"CMS estimated 17,000 cases. The actual number was over 2.5 million. They missed by just a touch."

"The judge literally said the agency tried to put their thumb on the scales of justice in favor of health plans."

"The California Medical Association was neutral on benchmarking to 125% of Medicare. To their credit, they realized they'd made a mistake."

"They're losing 85-90% of cases at 6, 7, 8X of Medicare. They didn't see this coming."

"For years they got to unilaterally decide what out-of-network payment would be, then just blame doctors for balance billing."

About Ed Gaines: Ed has worked in physician revenue cycle management for 32 years, supporting over 22,000 physicians across all 50 states. He specializes in emergency medicine, radiology, anesthesia, and orthopedics advocacy. The American College of Emergency Physicians made him an honorary member in 2010—rare recognition for a non-physician.

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What happens when a spine surgeon who's been in private practice since the Obamacare era sits down with doctors across the political spectrum? You get one of the most honest conversations about healthcare reform we've had.

Brian Gantwerker doesn't fit neatly into anyone's box. He's a private practice capitalist who thinks breaking up insurance companies is essential. He believes in "just pricing" for craniotomies (hint: it's more than $2,000). He thinks Medicare was actually a great payer—until Medicare Advantage ruined it. And he has strong opinions about why physicians spend so much time fighting each other on Twitter instead of finding common ground.

This conversation covers the Medicare Advantage meltdown (UnitedHealthcare shares tanking), vertical integration nightmares, why the FTC needs to break up both insurers AND hospitals, and what it's like when your congressman literally saves your practice. Plus: the real reason healthcare policy debates get so toxic on social media, and why quote-tweeting might be making everything worse.

0:00 - Introduction: Doctors in the Lounge 0:33 - Who is Brian Gantwerker? 2:08 - Starting Private Practice in the Obamacare Era 5:34 - UnitedHealthcare: The Pontine Glioma of Healthcare 7:43 - Medicare Advantage vs Traditional Medicare 10:26 - The Medicare Advantage Denial Story 14:35 - Who Gets the Value in Value-Based Care? 16:07 - The Free Market That Doesn't Exist Yet 19:16 - What Should a Craniotomy Cost? 21:47 - Breaking Up the Monopolies: Insurers AND Hospitals 27:09 - The Labor Theory of Value Debate 30:21 - CPT Codes and Central Planning 32:20 - The "Just Price" vs Free Market 35:42 - HSAs for Medicaid Recipients 38:47 - Price Transparency: Why Can't Healthcare Be Like Amazon? 40:03 - The Workout Period Problem 43:52 - FTC and Vertical Integration 46:04 - Lobbying, Congress, and Changing Minds 48:07 - Why Twitter Makes Physicians Fight Each Other 51:24 - Political Rancor and Taking Sides 55:14 - The Dr. Asghar Tweet Controversy 59:24 - Quote-Tweeting: The Death of Dialogue 1:03:03 - X as Thunderdome vs Real Conversation 1:04:35 - The Ted Lieu Saves: When Congress Actually Helps 1:07:32 - Closing: Shah Rukh Khan Hair and Finding Common Ground

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Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @drdigiorgio | @sdixitmd

Guest: @cscla