The Doctor’s Lounge Podcast

Dr. Sanjay Dhall on Trauma, Medical Training, and the County Hospital That Doesn’t Bill This week, Drs. DiGiorgio and Koka are joined by returning guest Dr. Sanat Dixit and special guest Dr. Sanjay Dhall, chief of neurosurgery at Harbor-UCLA and a leading spinal cord injury researcher. Dr. Dhall traces his path from a "commando shift" in a Houston trauma bay as a pre-med student to running solo trauma call at Grady Hospital as a young attending, then discusses the strange reality of his current institution: a major county hospital that doesn't bill professional fees or for implants, leaving millions on the table. The conversation moves through hospital alignment under for-profit versus non-profit models, the Christopher Duntsch case and what it reveals about resident training and the GME system, Dr. Dhall controversial Wall Street Journal letter on NIH indirect costs, and a guideline fight over early surgery for spinal cord injury that got him removed from a neurosurgery executive committee. The episode closes with a wide-ranging discussion on AI and robotics in surgery — what they might realistically take off physicians' plates, and what they almost certainly can't replace. Chapter Markers 00:00 Welcome and introducing Dr. Sanjay Dhall 01:49 From a Houston "commando shift" to a trauma bug 05:10 Running Grady's trauma service solo as the only neurosurgeon 09:25 The unsupervised resident era and its billing aftershocks 14:03 Harbor-UCLA doesn't bill for neurosurgery profies — or implants 19:44 How county hospitals account for six-figure implant write-offs 24:30 Fiduciary duty, taxpayers, and the case for billing aggressively 28:00 Drug rep economics at county hospitals 31:10 Comparing Cleveland Clinic, Mayo, and the county model 34:29 The "color-coded sticker" idea and the bureaucratic mindset 37:59 For-profit alignment vs. "non-profits functioning as for-profits" 43:24 The Devi Shetty suture story and physician-driven cost control 44:13 Physician ownership, conflicts of interest, and carve-out hospitals 46:00 Jefferson's neuro hospital and the private anesthesia advantage 48:45 The Christopher Duntsch case and a failure of training oversight 52:10 How does an incompetent surgeon make it through residency? 56:04 Troubled personalities in neurosurgery training 1:00:04 Work-hour restrictions and the self-selection of old-school neurosurgery 1:02:29 Is dissent tolerated in academic medicine anymore? 1:06:31 Inside NIH indirect costs — where 40-60% of grant money goes 1:10:19 The spinal cord injury guideline fight and getting removed from committee 1:13:44 Burnout, call coverage, and the safety net argument 1:20:27 Will robots ever do neurosurgery? 1:23:11 AI for administrative burden vs. AI in the OR 1:28:34 The pilot analogy, a ruptured aneurysm story, and the limits of automation Co-Host Handles @anish_koka and @drdigiorgio Show Handle @drsloungepod Subscribe Links Spotify: open.spotify.com/show/44vw8eirs… Apple Podcasts: podcasts.apple.com/us/podcast/the… YouTube: @TheDoctorsLoungePod" target="_blank" rel="nofollow noopener">youtube.com/@TheDoctorsLou…

We hold vaccines to a lower evidentiary bar than drugs — backwards, since we give them to healthy people to prevent disease, where the bar should be higher. Høeg's VAERS estimate: ~1 in 6,200 myocarditis in adolescent boys after dose 2. Hong Kong's prospective data: 1 in 2,680. VAERS didn't overcount. It undercounted.

She had a near-perfect performance review. She got fired anyway. Here's what she'd tell anyone thinking about a leadership role in government. "You're gonna get fired no matter what. So at least when you go down, you go down with honor."

There's an asymmetry that doesn't get talked about enough. If you keep a patient's LDL at 290 for five years and they have a heart attack You get that call from the hospital. And the first thing you think is: What did I do wrong? Those are the nights you don't sleep. That's what closing the door means. When you post something on YouTube, you don't have that. You may believe it with your whole heart. But you don't have to answer to a human across the room from you.

Critics said Høeg's (@TracyBethHoeg) VAERS myocarditis numbers were inflated. Then Hong Kong followed adolescent boys prospectively and hospitalized them: 1 in 2,680 after dose 2 — roughly double her VAERS estimate of 1 in 6,200. Passive surveillance didn't overcount. It undercounted.

Statins lower GLP-1 levels. That study exists. It's real. So why isn't it breaking news? Because it was a handful of people. It measured a protein in the blood. The history of medicine is full of mechanisms that should have worked — and didn't when tested in a real trial. Because biology is complicated. Nobody cares what their LDL is. They care: Am I going to have a heart attack? Mechanisms don't answer that question. Outcomes data does.

No lies detected.

In 2021, Dr. Tracy Høeg flagged a vaccine side effect in adolescent boys. The tweet got censored within 12 hours. She looked at the data again this week. "It has withstood the test of time."

The conflict of interest argument gets thrown at cardiologists who prescribe statins. A $4 generic. Let me ask the obvious question: Isn't it more lucrative to skip the conversation, bill a level four visit, and move on to the next patient? Conflicts of interest exist in medicine. Nobody's naive enough to think otherwise. But there's also a conflict of interest in: "Your doctor is hiding something from you. Subscribe to get behind my paywall." The interesting question isn't who has a conflict. It's where does the burden of proof lie.

Everyone assumes the FDA's problem is the career scientists. Dr. Tracy Høeg went inside expecting the same. What she found was the opposite. "I absolutely loved it. It was a dream job." Former Acting Director of CDER on what the agency actually looks like from the inside.

Here's the real psychological problem with diet-induced LDL elevation: The diet is working. Joints feel better. Blood sugar controlled. Weight down. Energy up. Clothes fit. And then the LDL comes back at 400 and the cardiologist says we need to talk. That cognitive dissonance — this thing is helping me and might also be hurting me — is a real clinical challenge. I see it in my office constantly.

The Doctor's Lounge - Sanjay Dhall x.com/i/broadcasts/1…

Heartbreaking. I was genuinely hopeful this administration would deliver real systemic change to American healthcare and finally rebuild trust after COVID. But the credible voices who actually stood apart during the pandemic @DrMakaryFDA @VPrasadMDMPH @TracyBethHoeg are now gone. A rare opportunity… lost. Why? What agendas and forces are really at work here? @RobertKennedyJr @DrOz @realDonaldTrump #MAHA #FDAReform

This was an absolute 🔥 of an episode. The origin story for Dr. Tracy Hoeg, (@TracyBethHoeg ) COVID times, the route to the FDA, accomplishments at the fda, and the exit :/ Read the following for context on the FDA: open.substack.com/pub/anishkokam…

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The FDA saga is an embarrassing failure that represents a deep lack of understanding in the current administration of what’s actually happening at the FDA. My read: with midterms approaching, bad actors manipulated the White House into a move designed to take care of the daily torrent of “fda in chaos” headlines. The press that politically hates this administration were gleeful stenographers lubricating the whole process. Shameful.

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She was handed a resignation letter. She handed it back. "If you don't want me to be here, then you should fire me. Because I certainly don't want to leave." Dr. Tracy Høeg on her last hour at the FDA.

Seven years. LDL of 500. No plaque on coronary CTA. Here's what coronary CTA doesn't show you: Fatty streaks. Sub-millimeter plaque. Anything in the aorta. The carotids. The vertebral arteries. The renal arteries. The cerebral vasculature. Atherosclerosis is a systemic disease. A coronary CTA looks at one part of one vascular bed. That's limited data. And we should be humble about what limited data tells us.

The Atom Bomb Speaks: Tracy Høeg on COVID, Myocarditis, and the FDA From the Inside Dr. Tracy Høeg — physician, epidemiologist, and former Acting Director of the FDA's Center for Drug Evaluation and Research — joins Drs. Koka and DiGiorgio for her first interview since being fired from the agency in May 2025. She traces her unusual path from ophthalmology dropout to professional ultramarathoner to one of the most consequential and contested researchers of the COVID era, walking through her school transmission studies, the myocarditis preprint that detonated on social media, and what she actually found when she got inside the FDA: career scientists who were sharp, collegial, and largely aligned with her — not the entrenched bureaucratic resistance she expected. She also gives the most detailed account yet of how her firing went down, why she refused to resign, and what she thinks it signals about pharmaceutical industry influence over the agency. Chapter Markers 00:00 Introduction and Tracy's bio 02:19 Origin story: French major, med school, ophthalmology dropout 07:42 Seven years in Denmark: PhD, clinical work, ultra marathon racing 10:55 Back to the US: PM&R, interventional spine, and the start of COVID research 13:43 Funding research outside the NIH pipeline 17:18 How government funding crowds out independent science 20:59 Evidence-based medicine, spine, and the N-of-one problem 25:35 The Wisconsin school transmission study 28:32 If masks were a drug, would they pass FDA approval? 30:04 Testifying before Congress three times 32:46 The myocarditis preprint: origins, backlash, and vindication 38:34 Post-vaccine myocarditis: what the data actually showed 43:01 Regulatory failure, COVID vaccine risk-benefit, and the pediatric question 45:09 How Europe and Scandinavia got it right earlier 47:58 Cancel culture in academia and the chilling effect on scientific questions 51:18 Joining the FDA: how it happened and what she expected 53:50 What the FDA looks like from the inside vs. the outside 56:38 Where real philosophical disagreements lived within the agency 58:58 Reducing animal testing and CNPV pilot: what actually got done 1:01:45 Leaks to the media: where they came from and what they meant 1:05:17 What the FDA's role should be 1:06:23 Pharmaceutical industry influence and the Wall Street Journal editorial board 1:14:48 The firing: why she refused to resign 1:18:53 The chain of command and who is responsible 1:21:08 What the firing signals about FDA reform 1:27:42 Advice for anyone thinking about taking a leadership role in government Co-Host Handles @anish_koka and @drdigiorgio Show Handle @drsloungepod Subscribe Links Spotify: open.spotify.com/show/44vw8eirs… Apple Podcasts: podcasts.apple.com/us/podcast/the… YouTube: @TheDoctorsLoungePod" target="_blank" rel="nofollow noopener">youtube.com/@TheDoctorsLou…