The Doctor's Lounge
Where scalpels meet systems — and physicians say what they really think.
Co-hosted by Dutch Rojas & Anthony DiGiorgio, DO, with Anish Koka, MD, Dan Choi, MD, & Sanat Dixit, MD — candid talks on healthcare policy, reform, physician autonomy & patient care.
The Doctor's Lounge
Hope vs. Power: Gene Therapy, FDA Shake-Up, and Truth in Medicine
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Rojas Media
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Season 1
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Episode 9
Original Substack Release: Aug 23, 2025
🎯 Why Listen
When hope collides with billion-dollar incentives, who protects patients? We unpack Vinay Prasad’s FDA resignation, Sarepta’s $3.2M Duchenne gene therapy, and how accelerated approvals can leave families without the long-term data they deserve.
👥 Co-Hosts
- Dutch Rojas – Founder, Bliksem Health
- Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
- Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
- Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
- Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur
📌 Episode Overview
- Vinay Prasad’s exit from FDA/CBER and what it signals about evidence, safety, and politics.
- Duchenne muscular dystrophy, Sarepta’s one-shot gene therapy, and deaths linked to vector toxicity.
- The promise and peril of accelerated approvals—and why confirmatory trials so often stall.
- Left vs. right myths about healthcare; markets, incentives, and why “healthcare is a right” can fail in practice.
- Quick hits: public-good economics in medicine, decentralization vs. central control, and where AI may actually help (RCM, workflow).
💬 Notable Quotes
- “These trials are never gonna get done. It’s a game—with patients as pawns.”
- “The FDA is the Midas touch: approval turns hope into revenue—fast.”
- “You don’t want a world where healthcare is non-excludable and non-rivalrous.”
- “If healthcare is ‘first, do no harm,’ who decides what harm looks like—and who pays the price?”
📚 What You’ll Learn
- How accelerated approval works—and where it breaks.
- Why safety signals (e.g., vector-related liver failure) matter more than press releases.
- The difference between hope, evidence, and incentives in rare disease.
- How political tribes systematically misunderstand healthcare mechanics.
- Practical places AI can improve care operations today.
⏱ The Episode (Timestamps)
- 00:00–01:10 Welcome back & cadence update (new Sunday drops)
- 01:10–07:40 Vinay Prasad resigns from FDA/CBER—context and stakes
- 07:40–13:30 Duchenne 101, dystrophin biology, trial endpoints vs. real outcomes
- 13:30–17:30 Accelerated approval promises vs. missing confirmatory trials
- 17:30–22:30 Safety signals: vector immunogenicity, reported deaths, what pulls look like
- 22:30–28:30 Media/influencer pressure and the politics of “right to try”
- 28:30–41:30 Is healthcare a public good? Scarcity, incentives, and economic reality
- 41:30–50:30 Government, morality, and why central planning fails patients
- 50:30–59:30 AI, agents, and near-term wins in physician workflows
- 59:30–End What we need next from policymakers—and from clinicians
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