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Medicine Redefined
Altamash Raja, DO and Darsh Shah, DO
201 episodes
5 days ago
Medicine Redefined challenges outdated conventions by elevating conversations around what health truly means. Hosts Dr. Darsh Shah and Dr. Altamash Raja spotlight clinicians, scientists, thought leaders, and reformers who are reshaping how we think about physical, mental, metabolic, and systemic health. While the healthcare system focuses on treating disease, our guests focus on optimizing human potential. From sleep and nutrition to stress resilience and lifestyle medicine, discover how forward-thinking practitioners are putting the health back in healthcare.
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All content for Medicine Redefined is the property of Altamash Raja, DO and Darsh Shah, DO and is served directly from their servers with no modification, redirects, or rehosting. The podcast is not affiliated with or endorsed by Podjoint in any way.
Medicine Redefined challenges outdated conventions by elevating conversations around what health truly means. Hosts Dr. Darsh Shah and Dr. Altamash Raja spotlight clinicians, scientists, thought leaders, and reformers who are reshaping how we think about physical, mental, metabolic, and systemic health. While the healthcare system focuses on treating disease, our guests focus on optimizing human potential. From sleep and nutrition to stress resilience and lifestyle medicine, discover how forward-thinking practitioners are putting the health back in healthcare.
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Health & Fitness
Episodes (20/201)
Medicine Redefined
186. Stop Overpaying for Your Health Insurance: EOBs, Tiers & Avoiding Bad Bills
6 days ago

Medicine Redefined
185. The Functional Medicine Revolution That Went Wrong | Nisha Chellam, MD
3 weeks ago

Medicine Redefined
184. Fixing Credentialing and the Future of Physician Autonomy | Leah Houston, MD

Darsh and Altamash talk to Dr. Leah Houston, an emergency medicine physician turned healthcare entrepreneur, for insights on the broken physician credentialing system and how technology could restore autonomy to doctors.


TIMESTAMPS:

00:01:00 – Evercred (decentralized physician credentialing platform) evercred.com

00:04:00 – Centers for Medicare & Medicaid Services (CMS) oig.hhs.gov

00:05:00 – Relative Value Unit (RVU) definition en.wikipediaorg

00:12:00 – The Joint Commission (healthcare accreditation body) 00:14:00 – National Provider Identifier (NPI) en.wikipedia.org

00:19:00 – Interstate Medical Licensure Compact (IMLC) imlcc.com

00:28:00 – Decentralized Identity (DID) in healthcare healthdatamanagement.com

00:29:00 – Direct Primary Care (DPC) payment model https://www.healthinsurance.org/glossary/direct-primary-care/

00:39:00 – Blockchain (distributed ledger technology) explained techtarget.com


Thank you for listening!


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1 month ago
59 minutes 22 seconds

Medicine Redefined
183. Tech Tools, Living Pro-Analog, Ketones, and Finding Preventive Healthcare 

Darsh and Altamash are back, trading thoughts on what’s been capturing their attention lately - from the tech tools boosting daily efficiency to the appeal of living more “pro-analog.” They dive into the hype and science behind ketones, unpack how GLP-1s are reshaping the way we think about food and cravings, and share insights on what it really means to find preventive, proactive healthcare today. It’s a thoughtful but approachable conversation, blending current events, health trends, and practical takeaways.


TIMESTAMPS

00:00 Introduction to Medicine Redefined

00:33 Current Events and Political Landscape

02:10 Random Show Concept and Personal Updates

02:44 Writing and Creative Outlets

06:48 Tech Tools and Apps for Efficiency

10:32 Medical Innovations: Vagus Nerve and Hydrodissection

19:48 Breathwork and Meditation Techniques

23:49 Exploring Exogenous Ketones

28:31 Understanding Brain Health and Mood Disorders

29:31 Exploring Ketone Supplements

30:52 Nootropics and Cognitive Enhancers

32:48 The Future of Social Connection

40:44 The Concept of Misogi and Mental Fortitude

42:34 GLP-1 and Obesity Treatment

49:36 Navigating Healthcare and Finding the Right Provider


SOURCES

05:12 | How and Why To Try Alternate Nostril Breathing (Cleveland Clinic)

08:47 | Buteyko vs Soma Breathing: Origins, Benefits and Differences (Buteyko Clinic International)

14:33 | OU Researchers Explore Vagus Nerve Stimulation for Multiple Conditions (University of Oklahoma)

19:55 | Exogenous Ketones: Do They Work, and Are They Safe? (Medical News Today)

24:18 | Ozempic Quiets Food Noise in the Brain — But How? (Scientific American)

27:42 | “Food Noise”: Do Weight Loss Drugs Stop It? (Health.com)

33:11 | How to Find a Medicine 3.0 Doctor like Dr. Peter Attia (Vitality / AWI Longevity Clinic)

37:40 | Embracing an Analog Lifestyle: Opt Out of Overwhelm (The Tiny Life)

41:05 | “The ‘Boring Phone’ – Gen Z Ditch Smartphones for Dumbphones” (The Guardian)

45:22 | Alfred – Productivity App for macOS (Official Site)

47:36 | OpenAI Whisper (Speech Recognition AI)


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1 month ago
1 hour 6 minutes 12 seconds

Medicine Redefined
182. How The Biggest Loser Revealed the Dark Side of Weight Loss

Darsh and Altamash dive into Netflix’s Fit for TV and the wild story behind The Biggest Loser. From shocking weight loss tactics to the billion-dollar business of reality TV, tune in as they break down the science of obesity, GLP-1s, and the dark side of weight-loss entertainment.

Sources: 
00:01 | Fit for TV (Netflix doc)

01:30 | The Biggest Loser (NBC show)

02:50 | Jillian Michaels (trainer)

03:45 | Bob Harper (trainer)

04:15 | GLP-1 drugs (Ozempic/Wegovy)

05:20 | Calories In/Out model

14:20 | Dr. Robert Huizenga

15:20 | Motivational interviewing

15:30 | Metabolic ward studies

25:20 | NYT: After The Biggest Loser

25:25 | Kevin Hall (NIH)

26:00 | Hall et al. 2016 (Obesity)

27:10 | Yo-yo dieting

27:30 | Leptin hormone

30:50 | Alan Aragon (nutritionist)

32:00 | Set point theory

32:45 | Stephan Guyenet (author)

33:20 | Sarcopenia

35:00 | Temptation challenges

35:10 | Big Brother (reality show)

35:15 | Survivor (reality show)

38:50 | Dr. Mike Varshavski

39:05 | Dr. Mike Israetel

39:10 | Aesthetic Revolution (concept/book)


Thanks for listening!

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2 months ago
51 minutes 47 seconds

Medicine Redefined
181. The Truth About Menstrual Cycle Training & Hormonal Impacts on Performance | Shawn Arent, PhD, CSCS

Dr. Darsh Shah and Dr. Altamash Raja continue their conversation with Dr. Shawn Arent on hormone physiology and performance. They dive into female physiology and menstrual cycle myths, the overlooked role of thyroid and reverse T3, catecholamines and autonomic balance, and the future of performance enhancement with GLP-1s and muscle-preserving drugs. A practical, evidence-based look at optimizing health and performance!


TIMESTAMPS

00:00 Introduction to Medicine Redefined

00:37 Deep Dive into Hormone Physiology

00:54 Female Physiology and Menstrual Cycle

01:03 Thyroid Hormone Optimization

01:12 Catecholamines and Autonomic Balance

01:23 GLP-1 Agonists and Muscle Preservation

01:58 Guest Introduction: Dr. Shawn Arent

02:21 Discussion on Female Physiology

02:29 Menstrual Cycle and Training

07:28 Hormonal Influence on Injury

07:50 Autoregulation in Training

19:03 Thyroid Hormone and Metabolism

33:55 Catecholamines and Training Response

40:55 Sympathetic vs. Parasympathetic Dominance

45:30 Tracking Trends for Better Interventions

45:53 Wearables and Recovery in Rugby

46:55 Debunking Post-Workout Downregulation

50:52 Contextualizing Fitness Advice

57:06 Balancing Training Methods

01:04:30 The Role of IGF-1 in Recovery

01:07:02 GLP-1 Agonists and Muscle Preservation

01:15:22 Myostatin Inhibitors: The Future of Muscle Growth?

01:21:25 Final Thoughts on Health and Performance


The Impact of Menstrual Cycle Phase on Athletes’ Performance: A Narrative Review MDPI

Current evidence shows no influence of women’s menstrual cycle phase on acute strength performance or adaptations to resistance exercise training Frontiers

The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis Springer

Influence of Menstrual Cycle Phases on Maximal Strength, Power and High-Intensity Interval Performance – A Systematic Review with Meta-Analysis MDPI

Evidence-Based Training Guidelines for Elite Women Football and Team Sports Human Kinetics

Hormones, Hypertrophy, and Hype: An Evidence-Guided Primer on Endogenous Endocrine Influences on Exercise-Induced Muscle Hypertrophy ESSR

Menstrual Cycle Effects on Sports Performance and Adaptations to Training: A Historical Perspective PubMed

Effect of Estrogen on Musculoskeletal Performance and Injury Risk Frontiers

Anterior Cruciate Ligament Injuries in Female Athletes: A Narrative Review of Prevention, Risk Factors, and Management Bone Jt Open

The Influence of Age on the Effectiveness of Neuromuscular Training to Reduce ACL Injury in Female Athletes: A Meta-Analysis PMC

Catecholamine and Cardiovascular Responses to Exercise: An Update Springer

Effects of Different Training Interventions on Heart Rate Variability in People with Overweight and Obesity: A Systematic Review Frontiers

Blood-Based Biomarkers for Monitoring Workload and Recovery in Athletes Sports Med Open

Changes in Lean Body Mass with the Use of Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss and Strategies to Mitigate LBM Loss Wiley

ADA Newsroom: GLP-1 Agonists and Lean Body Mass ADA News

Effects of Subjective and Objective Autoregulation Methods in Resistance Training: A Systematic Review PeerJ

Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes Springer

Exercise, Training, and the HPT/HPA/HPG Axes in Athletes CSMR

Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance PMC

Optimizing Health and Athletic Performance for Women Springer


Thank you for listening!

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2 months ago
1 hour 26 minutes 32 seconds

Medicine Redefined
180. The Truth About Cortisol, Insulin & Overtraining | Shawn Arent, PhD, CSCS

We are back with a powerhouse guest, Dr. Shawn Arent, for part 1 of a series on hormone optimization. From cortisol misconceptions to insulin fearmongering, they cut through the noise with science-backed insight into performance, recovery, and stress physiology. You’ll rethink everything you’ve seen on social media about hormones.


TIMESTAMPS

00:00 Introduction to Medicine Redefined

00:36 Welcoming Dr. Sean Arent

02:11 The Importance of Cortisol

02:49 Understanding Cortisol's Role in Performance

04:59 Chronic Cortisol and Overtraining

13:51 Monitoring Stress and Performance

22:30 The Role of Nutrition in Cortisol Management

33:31 Insulin: The Anabolic Hormone

39:27 Exercise and Insulin Sensitivity

40:43 Impact of Stress and Sleep on Glucose Levels

43:02 Continuous Glucose Monitors: Pros and Cons

47:42 Athlete Nutrition and Performance

55:52 Hormonal Responses to Training

01:07:18 Sex Hormones and Athletic Performance

01:17:37 Conclusion and Future Topics


SOURCES

00:00:22 | Cortisol deficiency (Addison’s disease) is life-threatening

00:04:42 | Cortisol peaks in early morning (chronobiology) 

00:05:25 | Acute sleep deprivation significantly increases cortisol 

00:05:42 | One week of 5h/night sleep restriction lowers testosterone by \~10–15% 

00:22:11 | Cortisol stimulates gluconeogenesis (maintains blood glucose upon waking) 

00:27:38 | No single reliable biomarker for overtraining syndrome 

00:27:38 | Overtrained athletes show blunted HR, blood lactate and cortisol responses 

00:29:00 | Prolactin rises in response to stress/exercise 

00:30:00 | Dietary fat guidelines: 20–35% of calories from fat 

00:33:30 | Insulin is an anabolic hormone promoting nutrient storage 

00:33:30 | Low-fat (∼20% fat) diets reduce testosterone 10–15% vs high-fat diets 

00:39:26 | Regular exercise improves insulin sensitivity 

00:39:26 | ~38% (~98M) of U.S. adults have prediabetes 

00:40:29 | Shorter sleep duration impairs insulin sensitivity 

00:01:02:57 | Exercise above the lactate threshold elicits maximal GH release

01:04:42 | Resting lactate \~1–2 mmol/L; intense exercise >20 mmol/L 

01:08:53 | Higher testosterone levels correlate with greater lean mass in men 

01:11:51 | Winners in competition show post-event testosterone spikes 

01:12:29 | Female athlete amenorrhea leads to low bone density and stress fractures

01:12:29 | Amenorrheic female athletes have lower IGF-1 (growth factor) 

01:08:53 | Testosterone even within normal range affects strength/mass

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3 months ago
1 hour 21 minutes 22 seconds

Medicine Redefined
179. Is Medicine Worth It? Real Talk on Debt, Purpose, and The Future of Doctors

In this episode of Medicine Redefined, Darsh and Altamash dive deep into the question on every future and current physician’s mind: is medicine still worth it? What starts as a reflection on the financial and emotional toll of the profession quickly evolves into a powerful conversation about agency, reinvention, and longevity in medicine. With honesty and humor, they unpack their own journeys from burnout to building lives and careers on their own terms, sharing hard-earned insights and tactical frameworks for thriving in a changing healthcare landscape.

If you’ve ever felt disillusioned about your path in medicine or wondered how to break free from the constraints of the job, this episode will challenge and inspire you to rethink what’s possible.


TIMESTAMPS

00:00 Introduction to Medicine Redefined

00:54 Is Medicine Still Worth It?

02:24 Challenges in Modern Medicine

05:20 Financial Realities of Medical Education

10:46 Diversifying Medical Careers

17:40 The Importance of Diverse Experiences

22:20 Generational Shifts in Medical Practice

22:55 The Importance of Professional Diversification

23:21 Shared Decision Making with Patients

23:48 Challenging the Culture of Self-Destruction

24:15 Advice for Aspiring Neurosurgeons

24:32 Balancing Interests and Professional Growth

25:54 The Business of Medicine

27:59 Frameworks for Medical Students

29:33 Reframing Medical Careers

33:49 Setting Prices in Direct Pay Practice

41:18 Final Thoughts and Parting Words


SOURCES

| [00:06:45] | One Big Beautiful Bill Act (H.R.1, 119th Congress) – A 2025 budget reconciliation bill passed by the House and signed into law, containing sweeping tax and spending changes (health, taxes, etc.)

 | [00:06:51] | Medicaid coverage cuts – CBO estimated the reconciliation bill would reduce Medicaid enrollment by on the order of 10–12 million people

| [00:06:53] | Fiscal impact of the bill – Analyses (e.g. by the CRFB) show the bill adds roughly $3.4 trillion to the deficit (≈$4.1 trillion including interest)

| [00:07:30] | Student loan policy changes – H.R.1 eliminates Grad PLUS loans (effective July 1, 2026) and caps borrowing for medical/law students at $50,000/year ($200,000 total)

| [00:07:45] | AAMC medical school cost data – The AAMC reports median 4‑year cost of attendance for public med schools ~$286K (2025 cohort, i.e. ~$71–73K/year including living)

| [00:08:04] | AAMC medical school debt – AAMC data show the median debt at graduation for MD grads is about $205,000

| [00:09:39] | Primary care physician trend – Reports indicate many U.S. med students are “turning away from primary care in favor of more lucrative specialties”, leading to projected shortages.

 | [00:09:39] | Primary care shortage (projected)

| [00:09:39] | Overall physician shortage – AAMC projects an all‑specialty physician shortage up to ~86,000 doctors by 2036

 | [00:09:49] | Healthcare spending share (physicians) – U.S. health expenditure data: hospitals ~31% and physicians/clinics ~20% of total spending in 2023 (so physician pay is a fraction of total cost)

 | [00:10:00] | Private equity in healthcare – Deal activity surged in 2024

| [00:10:05] | PE healthcare deals (2024) – A recent analysis counted ~1,069 private‑equity healthcare deals in the U.S. in 2024.

| [00:17:15] | Peter Attia – Physician who left surgical residency

[00:21:09] | Emphasizing diversity of thought and experience in healthcare teams can broaden insight and drive innovation

[00:21:34] | The notion of a physician “martyr complex”

[00:32:20] | Nearly 39% of U.S. doctors now have side “gigs”

[00:33:23] | A 2023 randomized trial (knee bursitis) found local corticosteroid injections relieved pain significantly more than extracorporeal shockwave therapy (ESWT)

[00:34:16] | Concierge medicine and Direct Primary Care (DPC) are growing trends

[00:39:58] | Patients paying concierge/DPC fees gain perks (shorter wait times, direct doctor access)


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3 months ago
44 minutes 2 seconds

Medicine Redefined
178. The Cost of Secrecy in Insurance: Why Transparency Matters | Dr. Vincent Marchese, DO

In this episode of Medicine Redefined, Dr. Darsh and Dr. Altamash sit down with Dr. Vince Marchese, sports medicine physician and founder of Apex Medicine, to explore how transparency and direct pay models are transforming healthcare.

We break down why traditional insurance creates confusion and barriers, how clear pricing empowers patients, and what happens when physicians reclaim time to focus on care - not paperwork.


TIMESTAMPS

00:00 Introduction to Medicine Redefined00:35 Meet Dr. Vince Marchese01:13 Journey to Sports Medicine01:37 Breaking Away from Insurance02:06 Life as a Direct Pay Practitioner09:33 Understanding Insurance Complexities10:27 The History of Insurance11:56 Navigating the Insurance Maze15:37 The Case for Direct Pay17:31 Empowering Patients with Knowledge41:39 The Insurance Dilemma42:00 State Mandates and Penalties42:58 Self-Insurance and Cost-Saving Strategies44:40 Catastrophic Insurance and HSAs52:04 The Benefits of Direct Pay Models55:02 Building a Patient-Centric Practice01:04:31 Scaling and Future of Direct Pay Medicine01:11:44 Support Systems and Taking the Leap01:16:03 Closing Thoughts and Resources


SOURCES

Healthcare Spending & Insurance Costs

[00:16:01] “51 cents of every healthcare dollar goes to insurance” – In fact, CMS and KFF data show [1, 2] private insurers cover ~30% of U.S. health spending, and federal/state programs ~51%. Administrative overhead is only about 7.4% of spending [1]. 

[00:10:00] Average premium costs – Kaiser Family Foundation reports that in 2024 the average annual employer health insurance premium is ~$8,951 for single coverage and ~$25,572 for family coverage [4], illustrating why monthly premiums can seem “crazy high.”

Policy & Regulations

[00:31:54] Balance billing protections (No Surprises Act) – Effective Jan 1, 2022, federal law bans surprise/“balance” bills for most emergency and certain other out-of-network services [5, 6]. For example, CFPB explains that patients generally will no longer face balance bills for emergency care [5, 6] under the No Surprises Act.

Health Savings Accounts (HSAs)

[00:43:30] Triple tax advantage of HSAs – HSAs are truly tax-advantaged. According to IRS rules and financial guides, HSA contributions are tax-deductible, earnings grow tax-free, and qualified withdrawals are tax-free [7, 8]. Bank of America and IRS publications both highlight this “triple-tax” benefit.

[00:44:17] HSA contribution limits – For 2024, IRS rules allow $4,150 annual HSA contributions for self-only HDHP coverage and $8,300 for family coverage [7] (The podcast guest’s “~$4,000” estimate for solo coverage aligns with the $4,150 limit for 2024 [7]).

Price Transparency & Cash Payments

[00:21:30] MRI cash prices – Pricing guides show that uninsured (cash) MRI costs vary widely. For example, a 2025 SingleCare review finds a national average MRI cost of ~$1,325 (range ~$400–$12,000) without insurance [9]. A cash-pay platform (MDsave) reports a $1,335 average for an MRI, with their cash price as low as ~$805 [10]. These sources confirm that self-pay MRI prices can be far below billed/insurance prices.

[00:21:30] Cash vs. negotiated prices – Studies show many hospitals set their cash (self-pay) rates lower than insurer-negotiated rates. For example, one analysis found 60% of insurer-negotiated hospital rates exceed the hospital’s cash price for the same service [11], and a JAMA-published study reports that cash prices are often below the commercial prices insurers pay [12]. In short, paying cash (or high-deductible plans) can sometimes cost less than the “discounted” insurance rate.


Referenced Book
[00:21:24] The Price We Pay – Dr. Marty Makary

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3 months ago
1 hour 17 minutes 5 seconds

Medicine Redefined
177. Ketamine, Trauma, and the Future of Psychiatry | Rocky Sullivan, DO

In this episode of Medicine Redefined, Darsh and Altamash sit down with Dr. Patrick “Rocky” Sullivan, an emergency physician turned ketamine therapy pioneer, to explore how this powerful molecule is quietly transforming mental health care. Drawing from years of ER experience and clinical innovation, Dr. Sullivan breaks down the science, stigma, and promise behind ketamine treatment for depression, PTSD, addiction, and chronic pain.

We unpack the nuances of off-label prescribing, why most depression treatments miss the mark, and how ketamine-assisted psychotherapy (KAP) is helping patients rewire trauma in real time.

If you’ve ever wondered how ketamine really works, who it's for (and who it’s not), or what a responsible treatment plan should look like, this conversation will change your perspective. It's an eye-opening look into the future of mental health care.

TIMESTAMPS

00:00 Introduction to Medicine Redefined

00:36 Meet Dr. Patrick Sullivan

01:46 The Evolution of Ketamine Therapy

03:18 Rocky's Journey into Psychiatry

07:57 Understanding Ketamine's Mechanism

08:49 Off-Label Uses and Research

11:12 Ketamine in Emergency and Pain Management

14:14 The Importance of Set and Setting

15:29 From Anesthetic to Antidepressant

17:15 Mainstream Depression Treatments

23:02 Navigating Treatment Options

26:45 Screening and Safety Protocols

37:29 Ketamine Assisted Psychotherapy

41:42 Telehealth and Ketamine Delivery

42:16 The Importance of Provider Interaction

43:11 Case Studies: Depression and OCD

43:55 Case Studies: Pain and Trauma

44:24 Case Studies: Alcohol Use Disorder

46:12 The Role of Therapy in Ketamine Treatment

47:54 Ketamine's Mechanism and Benefits

52:09 Maintenance and Dosage Variability

01:05:13 Challenges in Ketamine Research and Regulation

01:16:14 Conclusion and Contact Information

SOURCES

04:13: Ketamine suicidal ideation meta-analysis; Ketamine depression meta-analysis

05:09: What is ketamine?

06:01: History of ketamine

07:36: Off-label prescriptions

07:44: Research referenced on alcoholism and ketamine:

  • 1997 study

  • 1998 study

  • 2001 study

  • 2018 study

07:44: 2000 study done on depression and ketamine

07:44: 2006 study repeated

09:30: Ketamine dose-dependent responses

10:13: Ketamine on respiratory drive

10:58: Ketamine for asthma

13:47: Psychedelic therapy

15:21: Treatment-resistant depression

16:18: SSRIs and other antidepressant drugs

17:36: ECT and Ketamine therapy studies:

  • Study 1

  • Study 2

  • Study 3 (70% statistic)

18:48: TMS

18:48: Spravato study

18:48: IV Infusion ketamine study

22:19: Treatment resistance depression prevalance

25:20: Mathew Perry story

28:05: Studies on how Ketamine works in the brain:

  • Study 1

  • Study 2

29:30: Adjustment disorders

32:21: Studies on BDNF and ketamine:

  • Study 1

  • Study 2

  • Study 3

  • Study 4

32:37: Exercise and BDNF 

32:39: HIIT and BDNF

35:08: Ketamine assisted psychotherapy research

38:08: Ketamine for PTSD

44:27: EMDR

44:46: How to change your mind:

  • Documentary

  • Book

01:04:25: Ketamine is top-studied drug in depression

01:05:40: Low-dose naltrexone

01:06:00: FDA approval for naltrexone

01:07:23: American Society of Ketamine Physicians, Psychotherapists & Practitioners

01:14:02: Rocky’s website!

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4 months ago
1 hour 18 minutes 29 seconds

Medicine Redefined
176. Pills, Profits, and Power: The Fight to Reform Big Pharma | Vinay Patel, PharmD

In this episode of Medicine Redefined, Darsh and Altamash take a deep dive into the complex world of medications with Dr. Vinay Patel, pharmacist and founder of MakoRx. Dr. Patel exposes the hidden realities behind Big Pharma, explaining why generic drugs can be so confusing and revealing the true factors driving skyrocketing pharmacy prices. We also explore how cutting-edge AI technology is revolutionizing drug discovery and development.

This conversation will fundamentally change how you understand the medications you rely on every day. Whether you’re a healthcare professional or simply curious, this episode delivers powerful knowledge and a fresh perspective. Tune in!


TIMESTAMPS

00:00 Introduction to Medicine Redefined00:36 Meet Vinay Patel: Healthcare Innovator01:04 Understanding PBMs: The Hidden Middlemen02:47 The Evolution of PBMs05:29 Vertical Integration and Its Impact15:52 The Complexities of Drug Pricing26:30 Compounding Pharmacies and GLP-1 Medications34:15 Mark Cuban's Cost Plus Solution37:39 The Dominance of Employer-Based Health Insurance39:46 The Generic vs. Brand Medication Debate40:52 Challenges in Generic Drug Manufacturing45:05 The Role of Pharmacists in Medication Management50:50 Solutions for a Broken Healthcare System53:54 Introduction to Make O Rx58:29 Overcoming Barriers in the Healthcare Market01:01:31 The Future of Pharmaceuticals and AI01:05:54 Key Takeaways for Healthcare Providers01:08:04 Final Thoughts and Contact Information

SOURCES

  • 00:19: Price We Pay Book

  • 01:35: Pharmacy Benefit Management History

  • 03:24: Medical Modernization Act

  • 03:53: Affordable Care Act

  • 04:13: Vertical Integration

  • 04:33: Big Three Control 80% of Prescriptions

  • 04:56: 20% of Smaller Companies

  • 05:40: Tyson Foods RightWay

  • 06:01: Smaller PBMs Gaining Traction

  • 07:42: Antitrust enforcement in healthcare

  • 08:22: Affordable Care Act and High Deductible Plans

  • 09:24: Gag clauses

  • 09:58: Trump’s Law to Eliminate Gag Clauses

  • 10:39: Elizabeth Warren and Josh Hawley's Bill on PBMs

  • 13:25: Clawbacks

  • 14:32: Clawback disclosure law

  • 14:52: Losing money on drugs

  • 15:00: GLP-1 drugs

  • 16:27: Info on drug pricing

  • 17:05: Insurance companies set drug prices

  • 22:01: Article on rebates

  • 22:30: Net prices have gone down

  • 22:39: List prices have gone up

  • 24:21: Deep dive into drug prices in US

  • 24:45: US VS Europe drug pricing

  • 26:49: US subsidizes the world’s drug prices

  • 27:32: History of Ozempic

  • 28:31: Current status of Ozempic shortage

  • 29:11: Compounding drugs law

  • 32:21: Compounding pharmacy creditation

  • 34:42: Alliance for pharmacy compounding

  • 35:35: Cost plus

  • 36:16: NADAC

  • 39:27: Number of people on employer health insurance

  • 41:35: Bottle of lies

  • 56:55: Mako RX


Dr. Vinay Patel’s contacts:

  • Email:  vinay.patel@makorx.com.

  • LinkedIn: https://www.linkedin.com/in/vinaypharmd/


Show more...
4 months ago
1 hour 11 minutes 18 seconds

Medicine Redefined
175. Cynicism in Healthcare: New Surgeon General, Critiquing Viral Health Experts & Getting on Board with AI

In this episode, Darsh and Altamash talk about why so many people feel let down by the healthcare system. They break down where trust has gone wrong, how rising costs and confusing policies leave both patients and doctors frustrated, and why it feels like "no one is coming to save you". They also get into AI’s growing role in medicine, the recent Surgeon General pick, and what it means to get on board with AI.


00:00 Introduction (Dr. Darsh hates on LeBron)

00:49 Setting the Stage: Healthcare System Frustrations

01:58 Theme 1: Erosion of Trust in Healthcare

15:12 Theme 2: Financial Burden and Affordability Crisis

23:32 Theme 3: Systemic Pressures and Burnout

31:28 The Future of Medical Education

31:48 AI in Medical Decision Making

33:15 The Rapid Advancement of AI

33:46 AI's Impact on Jobs and Society

37:24 Healthcare System Challenges and Layoffs

39:43 Controversial Surgeon General Nomination

47:22 Functional Health and Longevity Market

55:49 Accountability in Health and Society


Resources mentioned in the show:

  • 03:30 Public Trust fell after COVID

  • 04:09 UHC Medicare Fraud case

  • 04:38 21st Century Cures Act

  • 14:24 The Price We Pay book

  • 29:30 Simon Sinek ranting about soft skills

  • 30:14 People referenced:

    • Vanessa Van Edwards

    • Vin Giang

    • Jefferson Fisher

  • 33:03 Chat GPT study

  • 34:41 Sergey Brin interview

  • 35:02 AI Singularity

  • 36:16 Morgan Housel podcast

  • 39:30 Nobel Prize study

  • 47:32 Healthcare huddle

  • 47:41 Function health acquiring Ezra

  • 47: 57 Function health

  • 50:53 Dr. Mike Episode with Prenuvo

  • 50:50 Dr. Mike Episode with Eric Topol

  • 56:28 David Wiss Episode

  • 57:27: Young people can’t pass military test

  • 57:47: I, Robot movie

  • 59:38: Indistractable book


DEEP DIVE:

  • 04:17 Distrust in pharmaceutical companies

  • 15:45 Medical debt bankruptcies

  • 15:57 Exponential growth of healthcare costs

  • 16:12 35% of Americans cannot afford quality healthcare

  • 17:10 Law that stops emergency rooms from refusing care:

  • 18:04: Healthcare premiums have been increasing over time

  • 18:27 Laws and regulations for price transparency: 

    • Link 1

    • Link 2

    • Link 3

    • Issues with compliance

  • 18:49 Drug pricing transparency

  • 23:46 Healthcare burnout at all time high 

    • COVID and the impact on burnout

  • 24:12 Average medical school debt accrued

  • 24: 17 Average doctor salary

  • 26:10 Generational divide between new and old doctors

  • 37:23 Tech Layoffs

  • 37: 43 Stand up for science

  • 37:52 Schools losing funding

  • 41:49 Red 3 ban

    • 42:21 Surgeon general completed med school but not residency
    • 46:47 RFK don’t listen to me on vaccines

  • Thank you for listening, let us know your thoughts!

    Show more...
    4 months ago
    1 hour 3 minutes 11 seconds

    Medicine Redefined
    174. The Torn ACL Dilemma: Should Every Athlete Get Surgery? | Jeremy Boyd, PT, DPT

    We welcome back Dr. Jeremy Boyd for a deep dive into one of the most debated injuries in sports medicine: the ACL tear. Building on our previous conversation around philosophy and mindset in rehab, this one gets tactical—real tactics, real strategies, and real challenges.


    Topics Covered in the Episode:

    • The 4 main pathways for ACL injury management: reconstruction, repair, non-operative rehab, and cross-bracing for regeneration/recovery

    • What makes someone a coper—and how to identify them safely

    • ACL rehab with a unique blend of manual therapy, neurocognitive testing, and performance training

    • Why rehab isn’t just physical—it’s psychological and personal

    • Risks and benefits of surgery vs. non-op management (and shared decision-making)

    • ACL self-healing and of course, the use of orthobiologics in ACL healing

    • What every patient recovering from an ACL tear should know.

    Resources Mentioned in the show:

    ⁠Cross Bracing Protocol⁠

    ⁠ACL Self-healing study⁠

    ⁠KANON trial for non-op ACL healing⁠

    ⁠PRP for ACL injuries

    Show more...
    5 months ago
    1 hour 31 minutes 32 seconds

    Medicine Redefined
    173. Why Rehab Fails—And What Truly Heals | Jeremy Boyd, PT, DPT

    Dr. Jeremy Boyd, founder of Trifecta Therapeutics, a sports rehabilitation and performance practice with three locations in Southern NJ/Greater Philadelphia, is residency and fellowship trained and board-certified in Orthopaedic and Sports Physical Therapy. As a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), he demonstrates advanced skills in diagnosing and treating complex neuromusculoskeletal conditions, utilizing a comprehensive approach that integrates advanced manual therapy and psychological considerations. Dr. Boyd's expertise is trusted by elite athletes from the NFL, NBA, MLB, and the Olympics, and he has a particular interest and focus on ACL injuries and rehabilitation within his practice.


    Topics covered in this episode:

    • Why manual therapy remains so polarizing — and what the research actually says
    • How to tease out whether patient “failed” rehab or the rehab actually failed the patient
    • The critical role of therapeutic alliance in patient outcomes
    • The downsides of social media misinformation in rehab and healthcare
    • How to properly dose both exercise and rest for high performers
    • Practical advice for physicians and clinicians to evaluate the quality of a rehab program


    Resources mentioned in the show:

    • Adam Meakins — The Sports Physio

    • Adriaan Louw — Pain Neuroscience Education

    • Change Maker by John Berardi

    • Range by David Epstein

    • Mastery by Robert Greene


    Connect with Jeremy Boyd

    • Trifecta Therapeutics

    • Jeremy Boyd — @thedecentdoctor


    Show more...
    5 months ago
    1 hour 13 minutes 58 seconds

    Medicine Redefined
    172. Ultra-Processed Minds: Trauma, Addiction & the Food We Eat | David Wiss, PhD

    Dr. David Wiss, a registered dietitian with a PhD in Public Health from UCLA and a minor in Health Psychology. David is the founder of Nutrition in Recovery and the creator of the Wise Mind Nutrition app, which blends nutritional psychology, behavioral change, and trauma-informed care. His work sits at the cutting edge of nutritional psychiatry, functional medicine, and public health—and today’s conversation will leave you thinking deeply about how food shapes not just our bodies, but our minds, behaviors, and even our societal structures.


    In this episode, we cover:

    • The spectrum between disordered eating and full-blown eating disorders like ARFID
    • How ultra-processed foods hijack our brain’s reward system and mimic addiction
    • The emerging connection between gut health, inflammation, and mental health
    • Why early life trauma shapes long-term food behaviors and emotional regulation
    • How Dr. Wiss’s personal recovery journey inspired the Wise Mind Nutrition app and his unique clinical approach


    Mentioned in show:

    David's Website

    Wise Mind Nutrition App

    Nutrition in Recovery

    ARFID

    Nova Institute Think Tank

    Food Politics - Dr. Mike Podcast

    Recommended Article -Nutritional Criminology


    Social Media

    Instagram


    Show more...
    6 months ago
    1 hour 21 minutes 42 seconds

    Medicine Redefined
    171. Microplastics Are Everywhere But Should You Care?

    In this unscripted deep dive, Altamash and Darsh tackle the overlooked but increasingly relevant topic of microplastics—what they are, how they affect our bodies, and what practical steps we can take to reduce exposure. From water filtration and air quality to household hacks and consumer habits, they explore the intersection of environmental toxins, chronic disease, and health optimization. Plus, the conversation veers into everything from sauna myths and visceral fat to book abandonment and the art of communication. A curious, wide-ranging discussion grounded in evidence and everyday life.


    Podcasts mentioned in the show

    Toxins on Medicine Redefined

    Rhonda Patrick on Modern Wisdom

    Peter Attia on Microplastics


    Studies

    Abdominal fat causing pain?

    Show more...
    7 months ago
    42 minutes 12 seconds

    Medicine Redefined
    170. Owning Your Practice and Your Future with The Rise of Direct Specialty Care | Sarah Weinstein, DO

    Dr. Sarah “Sassy” Weinstein—triple board-certified in family medicine, sports medicine, and lifestyle medicine. After finishing her family medicine residency, Dr. Weinstein headed to Colorado for a sports medicine fellowship, then expanded her expertise by becoming board-certified in lifestyle medicine. Now practicing in Princeton, New Jersey, she blends advanced sports medicine techniques with holistic, lifestyle-focused care—all within a direct specialty care model that cuts out needless insurance barriers.

    In this episode, you’ll discover:

    • How she built a fulfilling practice by leaving draining environments behind and embracing direct specialty care.
    • Smart strategies for marketing and community outreach, helping her connect authentically with patients who need her most.
    • A blueprint for handling logistics in a cash-based model, from price transparency to collaboration with imaging centers.
    • Practical lifestyle medicine tips to address inflammation, enhance recovery, and boost overall wellness.
    • Advice for medical trainees and early-career physicians on finding autonomy and renewed passion in the evolving healthcare landscape.

    Core Sports Medicine

    Show more...
    7 months ago
    1 hour 8 minutes 40 seconds

    Medicine Redefined
    169. Feeling Stressed is Optional: Redefining Burnout, Identity & Purpose | Robyn Tiger, MD

    Dr. Robyn Tiger is a board-certified physician and founder of StressFreeMD, a platform dedicated to helping healthcare professionals navigate burnout and reclaim a sense of calm in their daily lives. After overcoming her own high-pressure struggles as an interventional radiologist, Dr. Tiger dove deeply into lifestyle medicine, mind-body techniques, and cognitive behavioral tools—eventually developing a holistic approach to sustainable stress management. She is the author of Feeling Stressed Is Optional and a sought-after speaker who educates medical trainees, institutions, and practitioners on evidence-based strategies for improving mental well-being. Through her coaching and online programs, Dr. Tiger empowers others to prioritize self-care, rediscover their “why,” and cultivate resilience in the face of modern healthcare’s most pressing challenges.

    In this episode:

    - Revisiting Dr. Tiger’s JourneyHow her initial struggles with burnout shaped her holistic, mind-body approach to stress relief.

    - Labels & IdentitiesWhy identifying solely as a “doctor,” “mom,” or “Type A” may keep you stuck—and how to break free.

    -Stress: Good vs. BadUnderstanding healthy stress (eustress) and how to prevent chronic distress from impacting your health.

    - Practical Self-Care ToolsBusy-physician strategies to eat well, move mindfully, sleep better, and support mental health.

    - Aligning with Your PurposeReconnecting with your deeper “why,” so you can show up better for your patients, colleagues, and loved ones.


    Social media:

    Website

    Instagram

    Linkedin


    Show more...
    8 months ago
    1 hour 1 minute 7 seconds

    Medicine Redefined
    168. Rewiring the Brain: Unlocking the Secrets to Neurodegenerative Disease Prevention | Leonaura Rhodes, MBChB

    Today, we are honored to welcome Dr. Leonaura Rhodes, a physician, public health expert, neurotherapist, and certified brain health coach. With over three decades of experience, she has dedicated her career to helping individuals optimize brain function, manage stress, and design fulfilling lives. Dr. Rhodes combines her expertise in medicine, coaching, and neuroscience to empower people with actionable strategies for peak health and longevity.

    In this episode, we explore neurodegenerative diseases, the lifestyle factors that influence brain health, and practical steps to protect cognitive function as we age.


    Topics include:

    • Understanding neurodegenerative diseases: causes, progression, and common types like Alzheimer’s, Parkinson’s, and vascular dementia.

    • The role of genetics vs. lifestyle—can we prevent cognitive decline?

    • The 11 key factors that influence brain aging and cognitive function.

    • The power of exercise, sleep, and diet in maintaining long-term brain health.

    • How stress, inflammation, and gut health contribute to neurodegeneration.

    • The latest insights on supplements like creatine and their impact on brain performance.

    • How to build a resilient mind and optimize mental well-being through mindfulness and stress management.

    Show more...
    8 months ago
    1 hour 28 minutes 55 seconds

    Medicine Redefined
    167. Hype vs. Reality: The Biggest Health Trends of 2025

    In this episode, we revisit our 2024 health predictions to see what we got right—and what we completely missed. Then, we dive into the biggest winners and losers of 2025, the most overhyped health trends, and the breakthrough technologies that will actually make an impact.

  • Plus, Altamash shares his personal experience with surgery and recovery, revealing the critical lessons he learned about muscle loss, nutrition, and what most people (and even doctors) overlook when it comes to post-surgical healing.


    Tune in to hear:

    • The 2025 health trends that are here to stay—and the ones that need to go.
    • AI’s growing role in healthcare and how it’s changing the game.
    • The truth about wearables, biohacking, and ultra-optimized living.
    • Why traditional insurance models are on the decline.
    • A deep dive into surgical recovery: what helps, what hurts, and how to bounce back faster

    Resources mentioned in the show:

    • ESPEN practical guideline: Clinical nutrition in surgery
    • Study on Sleep Regularity & All-Cause Mortality
    • Study on Muscle Atrophy Post-Surgery & Nutritional Strategies
    • JAMA Open Access Paper on Nutrition Competencies for Medical Trainees



  • Show more...
    9 months ago
    55 minutes 33 seconds

    Medicine Redefined
    Medicine Redefined challenges outdated conventions by elevating conversations around what health truly means. Hosts Dr. Darsh Shah and Dr. Altamash Raja spotlight clinicians, scientists, thought leaders, and reformers who are reshaping how we think about physical, mental, metabolic, and systemic health. While the healthcare system focuses on treating disease, our guests focus on optimizing human potential. From sleep and nutrition to stress resilience and lifestyle medicine, discover how forward-thinking practitioners are putting the health back in healthcare.