Unstable Vitals

Dr. Resa Lewiss has spent more than two decades in emergency medicine treating what chronic disease looks like at its worst: strokes, heart attacks, wounds, diabetic complications, and patients who come back again and again because they can’t get primary care anywhere else. So she went upstream. Resa is now board-certified in lifestyle medicine, and a lot of her work is aimed at physicians themselves, who she says get the same chronic diseases as their patients.

Dr. Adam Brown and Dr. Lara Zibners talk with Resa about the mentor who told her ultrasound would never go anywhere, whether lifestyle medicine is only for people who can afford it, and the point in her late 40s when recovering from an overnight shift started to take her days. She also explains the idea behind MicroSkills, the leadership book she co-wrote. It breaks big, overwhelming goals into small, intentional steps, starting with the fact that most one-hour meetings could be 30 minutes.

Resa is an emergency physician, author, and host of The Visible Voices podcast. Find her at resaelewiss.com or connect with her on LinkedIn.

Healthcare is one of the biggest line items on any employer’s budget, yet most business leaders get almost no training in how to manage it. Dr. Adam Brown sits down with his former attending, Dr. Kristi Artz, to talk about the white paper they just co-authored, Teaching the Business of Healthspan with Lifestyle Medicine.

Dr. Artz is board-certified in emergency medicine and lifestyle medicine and serves on the board of the American College of Lifestyle Medicine. She and Adam make the case that healthcare costs aren’t just an HR problem. They’re a strategic risk that tomorrow’s leaders should learn to manage in business school.

Dr. Lara Zibners brings her own questions (and a hypothetical 55-year-old with a WHOOP), and the three get into:

• The growing gap between healthspan and lifespan, and why Americans now spend more than a decade in poor health
• How lifestyle medicine differs from functional medicine, longevity clinics, and wellness influencers
• Clinical evidence that intensive lifestyle programs can put type 2 diabetes into remission
• Why employer wellness programs often fall short, and what “dosing” lifestyle intervention actually means
• The $18,500 per employee that employers spend on health coverage every year

Read the white paper: https://www.abighealth.com/white-papers/healthspan

Every clinician has opened a new tool at work and wondered who picked it. Michelle Higginson co-founded Inlightened to get that question asked before the product ships. Her platform connects vetted healthcare professionals with the startups, pharma companies, and innovators who need their input, and pays them for it.

Michelle came to healthcare from Boston startups and tech, then led service line marketing for the transplant and heart centers at Boston Children’s Hospital. She tells Dr. Adam Brown and Dr. Lara Zibners why founders build too much before talking to the people who will use the product.

They also talk about why so many women physicians say they have no consulting experience and then describe years of it, unpaid. Michelle explains what it was like to recruit doctors in 2020, how outside work gives burned-out clinicians another option, and why AI-driven fraud has made vetting a bigger part of her job. She also describes the clinicians she recruits to help train AI models, and the mistake she sees founders make most often.

Clinicians who want to join the network can sign up at getinlightened.com.

Why does almost nobody talk about how hard it can be to get pregnant?

Dr. Lara Zibners and Dr. Adam Brown are joined by Audrey Ward, a former Sunday Times writer and editor and the author of The Waiting Room: Stories of Love, Loss, and Hope on the Path to Parenthood. Audrey went through recurrent miscarriage and failed rounds of IVF before she had her two sons. For the book, she gathered stories from people aged 28 to 68 who took every possible route: IVF, egg donation, surrogacy, adoption, and choosing a life without children.

In this episode:

• Why men rarely talk about infertility, even though a large share of fertility problems start on the male side
• How clinical language like "spontaneous abortion" and "incompetent cervix" makes a hard moment worse, and what doctors can do better
• The economics of fertility care: add-ons with little evidence behind them, prepaid IVF packages, private equity, and money as the thing that decides who gets options
• Egg freezing sold as an "insurance policy"
• What to say, and what not to say, when someone tells you they're struggling to conceive
• Audrey's view on what would stabilize the system, from fertility education in schools to investigating miscarriage sooner

Content note: This episode discusses infertility, miscarriage, and pregnancy loss.

Only 6-7% of doctors feel adequately trained in menopause care, and Dr. Adam Brown and Dr. Lara Zibners argue that gap is costing the healthcare system billions.

In this episode, they unpack their new white paper, "The Business Case for Integrating Menopause Education into Medical School Curriculum," making the case that teaching menopause isn't about adding new coursework, but "completing the sentence" in courses that already exist. They dig into the real stakes: how untreated genitourinary syndrome of menopause drives hip fractures and fatal urinary sepsis and why a market touching 51% of the population has been treated as a niche "women's health" cause rather than a massive business opportunity for innovators and investors. Plus, they announce the launch of closetheknowledgegap.com, a free hub with the full white paper, audio version, shareable slides, and social graphics designed to help anyone push this conversation into their own institution.

#CloseTheKnowledgeGap

Dr. Adam Brown and Dr. Lara Zibners reunite from London for a deep dive into how American and British healthcare actually compare, not in theory, but from two physicians living it. Lara walks through her own visit (no insurance card, no copay, no bill) and breaks down what she's really paying for US coverage versus UK coverage. The conversation turns personal when Lara shares the story of her mother's ALS diagnosis and the weeks-long wait to see a neurologist. They also dig into why the US and New Zealand are the only two countries that allow direct-to-consumer prescription drug advertising, the downstream effects of recent Medicaid and SNAP cuts, and why NHS wait times get more attention than what's actually broken. It closes out with a British-vs-American medical vocabulary round that gets predictably out of hand.

Unstable Vitals is back, and this time Dr. Adam Brown and Dr. Lara Zibners sit down with primary care physician, Substack favorite, and Beyond the Prescription author Dr. Lucy McBride.

Lucy has spent 25+ years watching medicine become transactional and impersonal, and she's written a book that isn't a "do as I say" guide, but a "here's how to think" guide. In this episode, we get into why the wellness industry is thriving on 15-minute doctor's appointments, the real difference between "health" and "wellness" (one is objective, one is a marketer's dream), how to spot a credentialed expert from a snake-oil influencer, and the "linked to" vs. "caused by" trick that turns every headline into a panic headline.

We also dig into some uncomfortable truths: why 95% of U.S. healthcare spending goes to damage control while only 5% goes to primary and preventive care, the conspiracy theory that doctors are profiting off patient illness (and why it's wrong), and whether AI is going to save primary care or just make the broken system move faster.

Grab Lucy's new book, Beyond the Prescription, and follow her on Substack.

Dr. Adam Brown and Dr. Lara Zibners sit down with Allison Komiyama, PhD, RAC, former FDA reviewer, founder of Bluestocking Health, and self-proclaimed "med tech hype woman", to demystify what actually happens when a medical device tries to reach patients.

Allison breaks down PMA pathways, why "the FDA is the big bad hurdle" is only half the story, and why getting cleared is often just the starting line: insurers won't pay, hospitals won't adopt, and promising life-saving tech can quietly shut down within a year.

They dig into AI's real (and overhyped) role in medical devices, why 8 of the last 10 drugs pulled from FDA clearance failed women specifically, and how the same inequality showing up in clinical trials shows up in art museums too.

Plus: summer camp chaos, killer houseplants, and why everyone needs a "food distribution engineer."

What does it take to leave a steady hospital job and build a value-based care company for the most medically complex kids in America?

In this episode, Dr. Adam Brown and Dr. Lara Zibners sit down with Alison — pediatric emergency physician, mom of 4, host of Startup Physicians, and co-founder of Imagine Pediatrics — to trace her path from clinician to telehealth pioneer to founder of a company that now takes full risk for children on Medicaid.

Along the way, they get into the realities of homeschooling four kids through COVID, why complex pediatric care has been ignored by investors for so long, and the analogy that finally explains the broken math of insuring only the sickest kids (hint: it involves teenage boys and car insurance).

Alison also delivers the single best piece of advice we've heard for physician founders: stop polishing the pitch deck and pre-sell the thing that doesn't exist yet. It's how Imagine Pediatrics walked into day one with thousands of patients already under contract — and it's the playbook she now teaches other doctors who want to build.

What if there were a network of clinics quietly delivering full-suite care — primary care, dental, behavioral health, pharmacy, prenatal, mobile units — to anyone who walks in, regardless of their ability to pay? Spoiler: there is, and most Americans have no idea it exists.

Adam and Lara sit down with Dr. Rui Ariyapala, Associate Chief Medical Officer at Piedmont Health Services and a public health physician trained across New Zealand, the UK, and the US, to unpack the Federally Qualified Health Center model, a 55-year-old experiment in keeping vulnerable patients out of the ED and inside coordinated, value-based care.

Along the way: why a father walked out of his child's cancer diagnosis, how $4,500 of NHS coverage stacks up against $26,000 a year in US premiums and what it actually takes to move a system built on sick-care toward real prevention.

Plus: Gary the Word Bird, Ginger Spice at the London Zoo, and a proposal hidden inside an escape room.

A conversation about the parts of US healthcare that are working and the upstream shifts that could fix the parts that aren't.