Medicine Redefined

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.TIMESTAMPS00:00 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 ResourcesSOURCESHealthcare 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

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.TIMESTAMPS00:00 Introduction to Medicine Redefined00:36 Meet Dr. Patrick Sullivan01:46 The Evolution of Ketamine Therapy03:18 Rocky's Journey into Psychiatry07:57 Understanding Ketamine's Mechanism08:49 Off-Label Uses and Research11:12 Ketamine in Emergency and Pain Management14:14 The Importance of Set and Setting15:29 From Anesthetic to Antidepressant17:15 Mainstream Depression Treatments23:02 Navigating Treatment Options26:45 Screening and Safety Protocols37:29 Ketamine Assisted Psychotherapy41:42 Telehealth and Ketamine Delivery42:16 The Importance of Provider Interaction43:11 Case Studies: Depression and OCD43:55 Case Studies: Pain and Trauma44:24 Case Studies: Alcohol Use Disorder46:12 The Role of Therapy in Ketamine Treatment47:54 Ketamine's Mechanism and Benefits52:09 Maintenance and Dosage Variability01:05:13 Challenges in Ketamine Research and Regulation01:16:14 Conclusion and Contact InformationSOURCES04:13: Ketamine suicidal ideation meta-analysis; Ketamine depression meta-analysis05:09: What is ketamine?06:01: History of ketamine07:36: Off-label prescriptions07:44: Research referenced on alcoholism and ketamine:1997 study1998 study2001 study2018 study07:44: 2000 study done on depression and ketamine07:44: 2006 study repeated09:30: Ketamine dose-dependent responses10:13: Ketamine on respiratory drive10:58: Ketamine for asthma13:47: Psychedelic therapy15:21: Treatment-resistant depression16:18: SSRIs and other antidepressant drugs17:36: ECT and Ketamine therapy studies:Study 1Study 2Study 3 (70% statistic)18:48: TMS18:48: Spravato study18:48: IV Infusion ketamine study22:19: Treatment resistance depression prevalance25:20: Mathew Perry story28:05: Studies on how Ketamine works in the brain:Study 1Study 229:30: Adjustment disorders32:21: Studies on BDNF and ketamine:Study 1Study 2Study 3Study 432:37: Exercise and BDNF 32:39: HIIT and BDNF35:08: Ketamine assisted psychotherapy research38:08: Ketamine for PTSD44:27: EMDR44:46: How to change your mind:DocumentaryBook01:04:25: Ketamine is top-studied drug in depression01:05:40: Low-dose naltrexone01:06:00: FDA approval for naltrexone01:07:23: American Society of Ketamine Physicians, Psychotherapists & Practitioners01:14:02: Rocky’s website!

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!TIMESTAMPS00:00 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 InformationSOURCES00:19: Price We Pay Book01:35: Pharmacy Benefit Management History03:24: Medical Modernization Act03:53: Affordable Care Act04:13: Vertical Integration04:33: Big Three Control 80% of Prescriptions04:56: 20% of Smaller Companies05:40: Tyson Foods RightWay06:01: Smaller PBMs Gaining Traction07:42: Antitrust enforcement in healthcare08:22: Affordable Care Act and High Deductible Plans09:24: Gag clauses09:58: Trump’s Law to Eliminate Gag Clauses10:39: Elizabeth Warren and Josh Hawley's Bill on PBMs13:25: Clawbacks14:32: Clawback disclosure law14:52: Losing money on drugs15:00: GLP-1 drugs16:27: Info on drug pricing17:05: Insurance companies set drug prices22:01: Article on rebates22:30: Net prices have gone down22:39: List prices have gone up24:21: Deep dive into drug prices in US24:45: US VS Europe drug pricing26:49: US subsidizes the world’s drug prices27:32: History of Ozempic28:31: Current status of Ozempic shortage29:11: Compounding drugs law32:21: Compounding pharmacy creditation34:42: Alliance for pharmacy compounding35:35: Cost plus36:16: NADAC39:27: Number of people on employer health insurance41:35: Bottle of lies56:55: Mako RXDr. Vinay Patel’s contacts:Email:  vinay.patel@makorx.com.LinkedIn: https://www.linkedin.com/in/vinaypharmd/

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 Frustrations01:58 Theme 1: Erosion of Trust in Healthcare15:12 Theme 2: Financial Burden and Affordability Crisis23:32 Theme 3: Systemic Pressures and Burnout31:28 The Future of Medical Education31:48 AI in Medical Decision Making33:15 The Rapid Advancement of AI33:46 AI's Impact on Jobs and Society37:24 Healthcare System Challenges and Layoffs39:43 Controversial Surgeon General Nomination47:22 Functional Health and Longevity Market55:49 Accountability in Health and SocietyResources mentioned in the show:03:30 Public Trust fell after COVID04:09 UHC Medicare Fraud case04:38 21st Century Cures Act14:24 The Price We Pay book29:30 Simon Sinek ranting about soft skills30:14 People referenced:Vanessa Van EdwardsVin GiangJefferson Fisher33:03 Chat GPT study34:41 Sergey Brin interview35:02 AI Singularity36:16 Morgan Housel podcast39:30 Nobel Prize study47:32 Healthcare huddle47:41 Function health acquiring Ezra47: 57 Function health50:53 Dr. Mike Episode with Prenuvo50:50 Dr. Mike Episode with Eric Topol56:28 David Wiss Episode57:27: Young people can’t pass military test57:47: I, Robot movie59:38: Indistractable bookDEEP DIVE:04:17 Distrust in pharmaceutical companies15:45 Medical debt bankruptcies15:57 Exponential growth of healthcare costs16:12 35% of Americans cannot afford quality healthcare17:10 Law that stops emergency rooms from refusing care:18:04: Healthcare premiums have been increasing over time18:27 Laws and regulations for price transparency: Link 1Link 2Link 3Issues with compliance18:49 Drug pricing transparency23:46 Healthcare burnout at all time high COVID and the impact on burnout24:12 Average medical school debt accrued24: 17 Average doctor salary26:10 Generational divide between new and old doctors37:23 Tech Layoffs37: 43 Stand up for science37:52 Schools losing funding41:49 Red 3 ban42:21 Surgeon general completed med school but not residency 46:47 RFK don’t listen to me on vaccinesThank you for listening, let us know your thoughts!

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 Protocol⁠⁠ACL Self-healing study⁠⁠KANON trial for non-op ACL healing⁠⁠PRP for ACL injuries

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 saysHow to tease out whether patient “failed” rehab or the rehab actually failed the patient The critical role of therapeutic alliance in patient outcomesThe downsides of social media misinformation in rehab and healthcareHow to properly dose both exercise and rest for high performersPractical advice for physicians and clinicians to evaluate the quality of a rehab programResources mentioned in the show:Adam Meakins — The Sports PhysioAdriaan Louw — Pain Neuroscience EducationChange Maker by John BerardiRange by David EpsteinMastery by Robert GreeneConnect with Jeremy BoydTrifecta TherapeuticsJeremy Boyd — @thedecentdoctor

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 ARFIDHow ultra-processed foods hijack our brain’s reward system and mimic addictionThe emerging connection between gut health, inflammation, and mental healthWhy early life trauma shapes long-term food behaviors and emotional regulationHow Dr. Wiss’s personal recovery journey inspired the Wise Mind Nutrition app and his unique clinical approachMentioned in show:David's WebsiteWise Mind Nutrition AppNutrition in RecoveryARFIDNova Institute Think TankFood Politics - Dr. Mike PodcastRecommended Article -Nutritional CriminologySocial MediaInstagram

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 showToxins on Medicine RedefinedRhonda Patrick on Modern WisdomPeter Attia on MicroplasticsStudiesAbdominal fat causing pain?

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

Dr. Robyn Tiger, a board-certified physician and founder of StressFreeMD, shares her transformative journey from burnout to well-being. She discusses the importance of identifying beyond labels like 'doctor' to enhance personal growth. Dr. Tiger explores the dual nature of stress, emphasizing healthy, motivating stress over chronic distress. She provides practical self-care strategies for busy professionals and advocates for a deeper connection to purpose, encouraging healthcare workers to prioritize mental health and resilience.