Send us Fan Mail

Episode Summary 

Rachel Rosenthal, an editorial board member at Bloomberg who writes on healthcare and education, joins Anthony DiGiorgio and Anish Koka for a wide-ranging conversation about healthcare reporting, COVID-era lessons, and why Medicare’s fiscal path matters beyond policy circles. The discussion gets into the incentives behind drug pricing, the limits of simplistic villains in healthcare, and why trade-offs, not slogans, are what actually shape reform.
In this episode, Rachel shares how an accidental path from Asia and immigration policy led her into healthcare editorial writing, why the beat is both endlessly frustrating and endlessly rich, and how COVID in Singapore changed the way she thinks about public health authority, institutional trust, and policy mistakes. The conversation also turns to her Bloomberg piece on Medicare, where the hosts unpack how spending, deficits, borrowing, and bond markets connect.

Timestamps
00:00 - Intro and guest introduction
00:51 - Rachel’s accidental path from Asia to healthcare writing
03:25 - Why healthcare is a “gift that keeps on giving”
04:57 - From Medicare to digital twins, the range of the beat
06:48 - Why healthcare has no single villain
08:17 - The real work behind strong healthcare editorials
10:04 - How COVID in Singapore changed her perspective
11:40 - Lockdowns, surveillance, and zero-COVID enforcement
14:30 - What the pandemic revealed about institutions and trust
18:18 - Why Singapore’s approach was understandable, then failed to adapt
20:18 - Writing columns that forced policy change
23:46 - How school closures exposed institutional dysfunction
24:38 - Leadership failures and the need for honesty
26:47 - Why source diversity matters in journalism
29:35 - The pressure to publish fast and simplify complex stories
31:04 - Are readers, editors, and advertisers all part of the problem?
35:18 - Why Medicare is the next major fiscal crisis
36:38 - The “one dollar in, three dollars out” problem
39:34 - Why uncapped spending removes urgency
40:04 - Site-neutral payments and other low-hanging fruit
41:31 - Why wealthy seniors still receive subsidies
43:33 - How entitlement reform gets politically messy
45:41 - Why Medicare matters to bond traders
47:01 - Interest rates, mortgages, and everyday life
48:30 - Demographics, aging, and the scale of the problem
49:22 - Why Medicare for All doesn’t solve the deficit
52:06 - Medicare’s complexity and the limits of copying it
55:52 - A simple framework: government choices versus private choice
57:57 - Who decides preventive care coverage and why that is political
59:45 - Health policy as a value judgment, not pure math
62:12 - Rachel’s ideal direction: less employer-sponsored distortion, more individual choice
64:54 - Defining the real problem before designing reform
66:27 - Trade-offs, privilege, and the appeal of security
68:01 - Why innovation in delivery and payment still matters
69:14 - Why good-faith debate disappears when the frame becomes good versus evil
71:07 - Why both left and right need to give ground
72:35 - Universal catastrophic coverage as a possible compromise
73:35 - Security, coverage gaps, and the need for on-ramps between programs
74:32 - Wrap-up and final thoughts

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

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us Fan Mail

In this special add-on episode, Anish Koka and Anthony DiGiorgio welcome Dr. James O'Leary — a Mayo-trained OB-GYN with forty years of experience, former department chairman, ACO board member, and host of the Real Doc Speaks podcast — for a wide-ranging conversation on the erosion of physician-led care. The trio dissects a tragic Nashville case in which four outpatient knee-replacement patients were injected with potassium phosphate instead of bupivacaine after a multi-step, multi-person medication-verification process failed at every checkpoint, using it as a jumping-off point to discuss "kludgeocracy," alert fatigue, surgical-timeout mission creep, and how doctors who raise safety concerns get labeled disruptive. From there the conversation moves through OB-GYN malpractice and nuclear jury verdicts, Florida's no-fault birth-injury compensation fund as a possible national model, the maze of state-by-state Medicaid reimbursement and its perverse incentives, and nonprofit hospitals' use of stadium sponsorships as a possible anti-kickback violation, before closing with a rapid-fire "hot seat" round covering ACOs, private equity, scope of practice, physician unionization, and single-payer healthcare.

Chapters

00:00 Cold open — why isn't Medicaid money reaching physicians?

00:34 Welcoming Dr. James O'Leary (Real Doc Speaks)

02:34 Why physicians need a voice on social media

03:14 The Nashville potassium phosphate medication error

09:52 Would a physician-owned hospital have prevented this?

10:17 "Kludgeocracy" and getting labeled disruptive

14:30 The surgical timeout's mission creep

19:35 EMR alert fatigue and lost safety signals

22:50 Replacing pharmacy techs with better safeguards

24:34 Anish's shift from hospital to outpatient practice

30:19 Malpractice, nuclear verdicts, and OB-GYN

33:50 Florida's no-fault birth-injury compensation model

39:16 Medicaid reimbursement and state-by-state variation

50:33 Nonprofit hospitals, sports sponsorships, and the anti-kickback statute

55:46 Five hot-seat questions for Dr. O'Leary

1:01:51 Direct referrals vs. large health systems

1:03:23 Closing thoughts and where to find Dr. O'Leary

Co-Host Handles

@anish_koka and @drdigiorgio

Guest Handle

Dr. James O'Leary — @realdocspeaks

Show Handle

@drsloungepod

Subscribe Links: 

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

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

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

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us Fan Mail

Episode Summary
Anthony DiGiorgio and Anish Koka speak with Dr. Ashish Jha, co-founder and CEO of BioRadar, senior fellow at Harvard Belfer Center, and former White House COVID-19 response coordinator, about the future of American healthcare policy. The conversation moves from hospital pricing and insurance design to Medicaid, HSA-based models, and the political realities that shape what reform is actually possible. They also pivot into a second major topic: biothreat detection. Jha explains why he thinks biosurveillance, not just response, will be essential in an era of AI-assisted biological engineering.

Timestamps
00:00 - Intro, guest credentials, and the Boston Globe cost cure series
00:33 - Why Jha wrote a 10-part reform series instead of one op-ed
01:54 - Evidence-based ideas that should annoy someone on every side
03:42 - Why state-level health policy matters, not just Washington
04:20 - American healthcare’s core pricing problem
05:58 - Competition, monopolies, and when price regulation enters the picture
06:57 - Scope of practice, insurance design, and administrative burden
08:40 - Indiana’s Medicaid-based hospital pricing experiment
09:47 - Why provider price caps are controversial
11:42 - Site-neutral payments and the hospital lobbying problem
13:30 - Why temporary regulation can bridge a monopoly-heavy market
16:22 - Why payer competition matters before price caps can reach consumers
17:44 - Can temporary government policies ever really be reversed?
20:11 - Tackling the demand-side subsidies that fuel consolidation
22:39 - FTC enforcement and the slow pace of market change
23:53 - Why policy experts should give leaders workable alternatives
26:27 - Hospitals are not villains, but incentives matter
27:32 - Site-neutral payment and physician-owned hospitals as starting points
28:57 - Cash payments, deductibles, and value-based insurance design
29:49 - The outline of a possible deal among hospitals, insurers, and policymakers
33:34 - Medicaid work requirements and what the evidence says
35:36 - Why eligibility should be easier for people who qualify
38:02 - Medicaid as a value statement about universal coverage
40:19 - Program integrity, fraud, and long-term sustainability
43:43 - Why Jha changed his mind on pay-for-performance and EHRs
45:14 - His critique of quality metrics and the value of empirical humility
46:14 - Why HSAs are attractive but imperfect
47:23 - Living under an HSA and why behavior changes
49:47 - Why Medicare for All is politically and operationally hard
50:41 - Uwe Reinhardt, Denmark, and why systems depend on politics and people
53:18 - Why sick people often make irrational cost decisions
57:02 - Smarter copays, true emergencies, and the limits of consumerism
58:24 - Why disagreement should stay respectful and not personal
60:20 - Pivot to bioterrorism and biological weapons
61:07 - Why BioRadar was created and what problem it is solving
63:18 - AI, state actors, and the shrinking barrier to bioweapons
64:18 - Why the risk of an engineered pathogen in the next five years worries Jha
65:31 - Jha’s view that COVID was more likely a lab leak than a natural origin
66:30 - Guardrails around gain-of-function research and Fauci criticism
68:46 - The difference between a dangerous outbreak and a stealth pandemic
71:38 - How biosurveillance can avoid overreaction while still catching real threats
73:13 - Why better surveillance could have changed the COVID response
75:16 - Wrap-up, bipartisanship, and the value of trade-offs

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

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us Fan Mail

Episode Summary 

In this episode of the Doctor's Lounge, Anthony DiGiorgio speaks with Hon. Tom Oliverson, MD, Texas State Representative for House District 130 and chair of the House Republican Caucus. Dr. Oliverson shares how he moved from medicine into public service, why practicing physicians should remain involved in policymaking, and what Texas is doing to address healthcare affordability. They also dig into 340B, prior authorization reform, and the origins of the No Surprises Act.

Chapter Markers
00:00 - Introduction to Dr. Tom Oliverson and his Texas healthcare policy role
01:24 - From Cut and Shoot to Baylor and a medical career
05:01 - Why running for office felt like a calling
08:02 - Why Texas lawmakers are expected to keep real jobs
13:30 - The healthcare affordability committee and the expert testimony it drew
16:28 - Consolidation as a major driver of healthcare cost growth
18:49 - Why direct contracting may replace traditional networks
22:49 - What the future could look like in a Singapore-style transparent market
23:53 - ERISA limits, state authority, and the frustration of federal preemption
25:17 - Medicaid payment, fraud, and what states can still influence
28:06 - Using Medicaid buying power to push back on abusive pharmacy practices
29:15 - 340B as a “Robin Hood” program with perverse incentives
36:03 - Why Texas is pushing transparency on 340B revenue and pricing
37:38 - The gold carding law and prior authorization reform
43:43 - A Capitol cardiac arrest and a real-life case with Dr. Bonnen
46:35 - What Texas can and cannot regulate in state insurance markets
48:47 - Texas roots of the No Surprises Act
51:43 - How Texas arbitration was designed to define fair market value
54:25 - Why the federal NSA lost key guardrails
61:41 - Texas opt-in for ERISA plans and why that matters
66:49 - Cash deductible credit when patients choose cheaper care
68:45 - Compounding, GLP-1 dosing, and preserving access through customization
70:09 - Peptides, prevention, food access, and the case for lifestyle-based care
72:34 - Closing thoughts on free markets, 340B, and healthy food

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

Official Texas House Select Committee on Health Care Affordability page:

https://house.texas.gov/committees/committee/059

Dr. Tom Oliverson on X:

https://x.com/TomOliverson

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us Fan Mail

The prior uploaded file had 26 seconds that was corrupted.  Restored on this version!

Episode Summary:
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 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. DiGiorgio's project "Off Label Ideas"
https://www.offlabelideas.com/

Dr. DiGiorgio's on Substack
https://substack.com/@drdigiorgio

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us Fan Mail

Episode Summary:
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 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. DiGiorgio's project "Off Label Ideas"
https://www.offlabelideas.com/

Dr. DiGiorgio's on Substack
https://substack.com/@drdigiorgio

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us Fan Mail

Episode Summary

Duke political economist and podcast host Mike Munger (The Answer is Transaction Costs) joins Anthony DiGiorgio and Anish Koka to argue that what Americans call "health insurance" isn't insurance at all — it's a social program where, as Bastiat put it, everyone tries to live at the expense of everyone else. Munger walks through why Medicare functions as a bilateral monopoly rather than a market, compares the U.S. system to Germany's competitive-insurer model and Chile's subsidized-private-account system, and lays out the four ways any society rations scarce goods — queuing, price, lottery, or authority — arguing the U.S. has mostly abandoned price in favor of blunt instruments like certificates of need. The conversation moves through Kenneth Arrow's 1963 uncertainty paper, the RAND cost-sharing experiment, insurer and provider consolidation, the tax exclusion for employer health benefits, and closes on a bleak but pointed read of federal debt, entitlement insolvency, and why Munger thinks the ship on real reform has already sailed.

Chapter Markers

00:00 Introduction and welcome

00:58 Why Medicare isn't really insurance

05:40 Comparing the German, English, and Singaporean models

08:38 Medicare for All as a bilateral monopoly

12:25 Demand-side subsidies and the Learjet story

15:03 Value vs. demand — the Medicaid bariatric surgery example

17:56 Certificates of need and rationing without price signals

21:55 The four ways to ration scarce goods

26:41 The RAND experiment and the cost-sharing debate

28:41 Kenneth Arrow's uncertainty paper and market failure

34:16 How Germany decides what to pay doctors

36:05 Mandatory insurance and adverse selection

38:41 Federalism and state-level insurance regulation

41:04 Provider consolidation and the competition problem

45:18 The employer health benefit tax exclusion

46:27 Federal bureaucracy, DOGE, and cutting government

50:13 Medicare and Social Security insolvency

52:24 "Medicare for All" — the punchline

54:59 Closing thoughts: fee-for-service experiments at the margins

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. Michael Munger on X:

@mungowitz

Dr. Michael Munger: The Answer Is Transaction Costs podcast links

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-answer-is-transaction-costs/id1687215430

Buzzsprout: https://taitc.buzzsprout.com

Spotify: https://open.spotify.com/show/05V1tglrMa3ANs0r89OXXg

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us Fan Mail

Episode Summary

With scheduled guest Dr. Geoff Manley pulled away by a medical emergency, hosts Anish Koka and Anthony DiGiorgio turn the episode into a news roundtable. They open on a JAMA op-ed by Neil Khosla and Ezekiel Emanuel arguing AI will replace physicians outright, and push back on both the regulatory timeline and the incentive structure behind it — including why hospitals are slow to adopt AI tools that already exist, like AI scribes and pre-charting. From there they dig into Medicaid: Michigan's $350 million in new staffing costs tied to One Big Beautiful Bill work requirements, the distortions created by the 90% FMAP for expansion populations, Medicaid fraud recovery data, and Anthony's "food stamps for healthcare" pitch for a cash-equivalent alternative. They close by dismantling the widely cited claim that Medicare for All would save 155,000 lives a year, walking through the underlying studies and what randomized data actually shows about insurance and mortality.

Chapter Markers

00:16 Introduction and the JAMA op-ed on AI replacing physicians

07:04 Regulatory hurdles to replacing physicians with AI, and billing codes for AI-assisted care

10:08 Why hospitals aren't adopting AI tools that already exist — scribes and pre-charting

17:01 Healthcare's unlimited demand at zero price

18:53 Michigan Medicaid's $350 million work-requirement staffing costs

22:09 How administratively complex Medicare really is

27:27 Medicaid expansion, the 90% FMAP, and state incentives

31:51 The case for "food stamps for healthcare" — a cash-equivalent Medicaid alternative

37:05 Medicaid fraud control units and state-level innovation

40:41 Debunking the 155,000-lives Medicare for All claim

52:21 Medicare for All and the future of private practice

55:34 Wrap-up and next week's guest preview

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 

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us Fan Mail

Episode Summary

In a special Tuesday episode, Anish Koka and Anthony DiGiorgio sit down with Heather Tereshko, a Principal at Post & Schell in Philadelphia and a 25-year veteran of medical malpractice defense, to break down the largest medical malpractice verdict in Pennsylvania history — a $207 million judgment against the University of Pennsylvania stemming from a delayed C-section and resulting anoxic brain injury. Using the case as a launching pad, the three walk through how verdict slips are constructed, why Pennsylvania's "increased risk of harm" standard makes cases easier for plaintiffs to win, how EMR documentation gets weaponized against physicians on the stand, how life-care-plan and non-economic damages get inflated (including "anchoring" tactics like invoking Jalen Hurts's salary), and why juries so often disregard clinical guidelines in favor of narrative and sympathy. The conversation closes with a practical, if sobering, discussion of what physicians could realistically lobby for — tighter expert witness standards, damage caps, and organized legislative pressure — and why none of it is coming easily.

Chapter Markers

00:19 Special Tuesday episode and guest introduction: Heather Tereshko

03:22 Heather's background in malpractice defense

05:40 The $207M Penn verdict: how the case started

09:20 Why this is a typical "bad baby" case

11:49 EMR drop-downs and documentation gaps at the center of the case

14:45 The cord blood dispute and the mechanism-of-injury fight

16:01 Judge excludes key testimony on the blood draw

18:33 Inside the verdict slip: factual cause vs. increased risk of harm

25:50 Why "increased risk of harm" doesn't fit this case

27:20 The "team theory" of liability and how the verdict sheet was structured

31:39 Breaking down the $207M damages award

33:06 The life expectancy fight: 29 years vs. 70 years

36:20 Anchoring tactics and the Jalen Hurts salary comparison

39:21 How contingency fees work in Pennsylvania

42:04 "There's no winning": defensive medicine and no-win scenarios

45:14 When health system interests diverge from the individual physician's

46:25 Downstream effects: why community hospitals drop OB services

47:39 No-fault alternatives: New Zealand and Florida's birth injury fund

51:57 Expert witness accountability — or the lack of it

55:58 Venue selection and how it reshaped Philadelphia verdicts

59:04 Damage caps and why economic damages remain unbounded

1:01:54 What physicians can realistically lobby for

1:06:06 Closing thoughts

Substack References (Dr. Anish Koka)

Referenced during the episode — Anish's Substack posts on the Pennsylvania medical malpractice market and on the Penn ($207M) verdict:

PA malpractice market / NAIC data post: https://anishkokamd.substack.com/p/pennsylvania-had-a-functioning-medical

Penn verdict case breakdown post: https://anishkokamd.substack.com/p/twelve-people-three-hours-a-207-million

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

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us Fan Mail

Episode Summary

Anish Koka and Anthony DiGiorgio sit down with Niklas Anzinger, a venture capitalist and founder of Infinita VC, to unpack Montana SB535 — a new law that lets doctors administer treatments to patients that have only cleared FDA phase one trials, through licensed "experimental treatment centers" overseen by independent review boards. The conversation covers why Eroom's Law has made drug development slower and more expensive despite scientific advances, how the Montana model differs from existing right-to-try and expanded access programs, the thorny question of who pays when a treatment sits outside FDA approval and insurance coverage, the risks of messy observational data replacing randomized controlled trials, and how Anzinger's work connects to special economic zones like Prospera in Honduras, where he's speaking to the hosts from.

Chapter Markers

00:22 Introducing Niklas Anzinger and his path from economics and VC to biotech policy

03:05 Montana SB535 explained — right-to-try, but with a for-profit pathway

06:01 Phase 1 vs phase 2 vs phase 3, and why bypass the later stages

11:37 Does SB535 cover devices as well as drugs

14:15 The semaglutide timeline as a case study in regulatory delay

18:36 Federal right-to-try, the baby KJ case, and why it isn't enough

23:25 The payment problem — how a non-FDA-approved treatment actually gets paid for

33:11 What "smart regulation" would look like with carte blanche over the FDA

48:31 Why Montana's biggest need right now is clinicians, not biotechs

49:57 The practical burden on a private practice running these treatments

53:32 Observational data vs. randomized trials — the risk of junk data

59:15 Is this a domestic answer to China's faster phase one pathway

1:04:22 Roatan, Prospera, and the case for special economic zones in medicine

1:09:18 Closing thoughts and where to find Anzinger's Stranded Technologies podcast

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. Niklas Anzinger on X: 

@NiklasAnzinger

Mr. Niklas Anzinger Podcast:
Stranded Technologies podcast

🔗 Connect with the Hosts:

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X