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
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