Anthony DiGiorgio and Anish Koka sit down with Dr. Dan Donoho, an NIH-funded neurosurgeon-scientist at Children's National Hospital and George Washington University, and founder of the Surgical Data Science Collective and the Foundation for Digital Neurosurgery, for a wide-ranging conversation on AI in medicine. Donoho explains why surgeons get almost no structured feedback after a case, walks through a randomized controlled trial showing AI-coached medical students outperformed those coached by humans on simulated tumor resections, and argues that most regulatory "barriers" to deploying AI in healthcare are cultural rather than statutory. The conversation moves through the limits of tactile sensation in surgical AI, why he expects innovation to come from small agile practices rather than large insurance-pay hospitals, his family's data science lineage, humanoid robots performing laparoscopic surgery, the anti-data-center backlash, and ongoing surgical AI trials in Ethiopia and Tanzania.

00:16 Introduction and guest background

01:16 The Surgical Data Science Collective and the problem of lost surgical knowledge

03:26 How AI could replace the mentor's voice in a surgeon's head

06:50 Tactile feedback and the limits of video-based AI in surgery

08:47 The RCT: AI coaching vs. human coaching in medical students

11:48 What's the gold standard for grading surgical performance

14:42 Who validates the AI — the EKG problem and patient outcomes as the real judge

17:19 Humanoid robots, self-driving cars, and low-hanging AI fruit in clinics

20:27 Regulatory barriers to AI in EHRs — culture vs. statute

22:09 Doctronic, AI prescribing, and licensure

25:12 Where Dan's interest in data science started

26:39 His father, statistician David Donoho, and the rise of empiricism

28:09 The "don't go into medicine" narrative and why it's wrong

30:26 COVID as a case study in bureaucratic drag on technology adoption

33:27 Should the FDA regulate surgical AI products

35:50 Andromeda Surgical, humanoid robots in the OR, and the cost gap

38:27 The anti-data-center movement and the history of sabotage

39:54 Global AI competition and China's Kimi K3 model

42:41 How to measure whether an AI model is actually better

44:34 Model size vs. training — why prompting changes performance

45:46 What the surgical community currently measures, and why it's the wrong thing

47:23 The Tanzania surgical AI trial and other real-world deployments

49:03 What actually scares Dan about AI

51:21 Will AI democratize power or concentrate it

52:15 Closing questions — what's next, including the Ethiopia partnership

Co-Host Handle

@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

Dr. Daniel Donoho Website & X

Website: https://www.surgicalvideo.io/

X: https://x.com/ddonoho

Episode Summary

Cardiothoracic surgeon Dr. George Tolis, chief of cardiothoracic surgery in Boston, returns to The Doctors Lounge with hosts Dr. Anish Koka and Dr. Anthony DiGiorgio for a wide-ranging conversation that opens with the newly proposed 2027 Medicare physician fee schedule and the budget-neutrality rule dating back to 1989 that forces cuts to one specialty to fund raises to another. The conversation moves into why true independent private practice has effectively disappeared, how hospital systems control physician hiring, firing, and pay regardless of what Medicare reimburses, and how locum tenens pay and device pricing expose the arbitrariness of professional fees. The back half of the episode turns to a widely discussed case of a cardiac valve implanted upside down in a young patient, with Tolis walking through how tunnel vision and ECMO can mask a never event for days, why he holds the surgeon fully accountable while condemning the social media pile-on that followed, and how palliative care should never be initiated without physician involvement. The episode closes on innovation in cardiac surgery — minimally invasive and robotic mitral repair, the Ross procedure, bilateral mammary artery use, valve selection, and how thirty-day outcome metrics quietly discourage surgeons from doing what's best for patients long-term — along with a candid discussion of industry money and conflicts of interest in medicine.

Chapter Markers

00:00 Welcome back, Dr. George Tolis

01:09 The proposed 2027 physician fee schedule

05:20 Budget neutrality since 1989 and the flat physician bucket

10:09 Tolis: physicians are compensated less, not necessarily paid less

16:41 Barriers to going private and the PSA model

21:03 The painful transition to an independent physician ecosystem

25:25 Locum tenens pay, valve pricing, and "it's all by design"

33:51 The case: a valve placed upside down

40:01 Tunnel vision, distraction, and 110% concentration in the OR

50:45 Palliative care involvement and the organ-harvesting narrative

55:50 Reader comments: minimally invasive mitral surgery pushback

1:03:02 Competition, capitalism, and information asymmetry in medicine

1:13:02 Bio AVR vs. mechanical valve in a 57-year-old

1:15:28 Bilateral mammary arteries and the 30-day outcomes problem

1:17:46 Prospective payment, DRGs, and device cost incentives

1:25:08 Industry relationships and physician disclosures

1:29:05 GLP-1s, honoraria, and what counts as conflict of interest

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. George Tolis's Previous Appearance on The Doctor's Lounge

Dr. Tolis first joined The Doctor's Lounge about two months ago. Watch that episode here:

https://x.com/DRsLoungePod/status/2055619280855515141?s=20

Dr. George Tolis on X

@georgetolisjr

Drs. 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.

00:00 Introduction and guest background

02:00 Why the pseudonym "Cremieux"

03:11 How he got into primary data analysis and writing

04:46 FDA drug approval reform — a two-pathway proposal

05:57 The peptide market: GLP-1s vs. unproven peptides like BPC-157

09:39 Should drug authority come from the FDA or "bubble up" from trusted voices?

11:25 Regulatory capture and ideas for FDA reform

16:10 HRT, the black box warning, and communicating risk to patients

21:40 Decentralizing medical decision-making

22:45 DEI in medicine and the Columbia/NYU admissions data leak

34:28 Proving discrimination: causal inference standards for university admissions

36:42 Busting myths from observational studies with multiverse analysis

40:29 Debunking the Jonathan Haidt social media/cognition study

46:46 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 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

Mr. Jordan Lasker X Handle / Substack

X handle: https://x.com/cremieuxrecueil

Substack: https://substack.com/@cremieux

Anish 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.

00:00 Welcome and introducing Scott Becker

01:22 Origin story: building Becker's Healthcare

09:53 The "teach and entertain" media philosophy

14:57 Law school with Barack Obama

16:57 Physician supply and the ACA's coverage-without-supply gap

19:48 Healthcare inflation and third-party payment

24:41 Is there really a spine surgeon shortage?

37:10 Physician burnout, autonomy, and leaving clinical medicine

41:08 Reagan, Mamdani, and government vs. private healthcare

46:00 Pushing back: is "nothing we can do" a real answer?

48:30 340B reform, site-neutral payments, hospital margins

53:41 Lina Khan, Mark Cuban, and health system consolidation

57:18 Can private industry absorb hospital revenue losses?

1:04:47 Payers as the real customer, price transparency

1:06:16 Keeping Becker's Healthcare editorially independent

1:13:44 Closing thoughts and the new book

Co-Host Handle

@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

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/1637635400

Becker's Healthcare: https://www.beckershospitalreview.com/

Scott Becker on X: @becker_sbecker

Becker's Healthcare Show Handle: @BeckersHR

Anish 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.

00:00 Intro and Martin Shkreli's backstory

02:40 Origin story: from hedge fund to founding drug companies

07:58 The Daraprim price increase and Shkreli's pricing philosophy

17:14 What it actually takes to bring a drug to market

35:25 The case for the pharmaceutical industry

38:00 The Orphan Drug Act and patent exclusivity

57:31 The Chemocentrics scandal: manipulated trial data at Amgen

1:22:09 Vinay Prasad, Sarepta, and the DMD approval fights

1:34:35 Neurosurgery, clinical trials, and the limits of RCTs

1:37:30 AI, neural networks, and the future of psychiatric drugs

1:40:40 Cardiovascular disease and LDL lowering

1:42:28 Media coverage of the FDA and closing thoughts

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handles

@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

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