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Published by Dr. Adam Brown and Dr. Lara Zibners
Welcome to Unstable Vitals , where healthcare experts Dr. Adam Brown and Dr. Lara Zibners navigate the ever-evolving healthcare landscape. Adam, an emergency physician, professor, and founder of ABIG Health, brings a wealth of leadership experience and expertise in healthcare strategy and DEI. Lara, a nationally recognized educator and co-founder of Calla Lily Clinical Care, combines clinical insights with business expertise to address the industry's most pressing challenges. In each episode, Adam and Lara break down complex topics, offering practical insights and clarity in the often unstable world of healthcare. From policy shifts to healthcare economics, they provide the knowledge you need to navigate today's healthcare system. Tune in for fresh perspectives, expert analysis, and a dose of reality in every episode!
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Only 6-7% of doctors feel adequately trained in menopause care, and Dr. Adam Brown and Dr. Lara Zibners argue that gap is costing the healthcare system billions. In this episode, they unpack their new white paper, "The Business Case for Integrating Menopause Education into Medical School Curriculum," making the case that teaching menopause isn't about adding new coursework, but "completing the sentence" in courses that already exist. They dig into the real stakes: how untreated genitourinary syndrome of menopause drives hip fractures and fatal urinary sepsis and why a market touching 51% of the population has been treated as a niche "women's health" cause rather than a massive business opportunity for innovators and investors. Plus, they announce the launch of closetheknowledgegap.com, a free hub with the full white paper, audio version, shareable slides, and social graphics designed to help anyone push this conversation into their own institution. #CloseTheKnowledgeGap
Dr. Adam Brown and Dr. Lara Zibners reunite from London for a deep dive into how American and British healthcare actually compare, not in theory, but from two physicians living it. Lara walks through her own visit (no insurance card, no copay, no bill) and breaks down what she's really paying for US coverage versus UK coverage. The conversation turns personal when Lara shares the story of her mother's ALS diagnosis and the weeks-long wait to see a neurologist. They also dig into why the US and New Zealand are the only two countries that allow direct-to-consumer prescription drug advertising, the downstream effects of recent Medicaid and SNAP cuts, and why NHS wait times get more attention than what's actually broken. It closes out with a British-vs-American medical vocabulary round that gets predictably out of hand.
Unstable Vitals is back, and this time Dr. Adam Brown and Dr. Lara Zibners sit down with primary care physician, Substack favorite, and Beyond the Prescription author Dr. Lucy McBride. Lucy has spent 25+ years watching medicine become transactional and impersonal, and she's written a book that isn't a "do as I say" guide, but a "here's how to think" guide. In this episode, we get into why the wellness industry is thriving on 15-minute doctor's appointments, the real difference between "health" and "wellness" (one is objective, one is a marketer's dream), how to spot a credentialed expert from a snake-oil influencer, and the "linked to" vs. "caused by" trick that turns every headline into a panic headline. We also dig into some uncomfortable truths: why 95% of U.S. healthcare spending goes to damage control while only 5% goes to primary and preventive care, the conspiracy theory that doctors are profiting off patient illness (and why it's wrong), and whether AI is going to save primary care or just make the broken system move faster. Grab Lucy's new book, Beyond the Prescription, and follow her on Substack.
Dr. Adam Brown and Dr. Lara Zibners sit down with Allison Komiyama, PhD, RAC, former FDA reviewer, founder of Bluestocking Health, and self-proclaimed "med tech hype woman", to demystify what actually happens when a medical device tries to reach patients. Allison breaks down PMA pathways, why "the FDA is the big bad hurdle" is only half the story, and why getting cleared is often just the starting line: insurers won't pay, hospitals won't adopt, and promising life-saving tech can quietly shut down within a year. They dig into AI's real (and overhyped) role in medical devices, why 8 of the last 10 drugs pulled from FDA clearance failed women specifically, and how the same inequality showing up in clinical trials shows up in art museums too. Plus: summer camp chaos, killer houseplants, and why everyone needs a "food distribution engineer."
What does it take to leave a steady hospital job and build a value-based care company for the most medically complex kids in America? In this episode, Dr. Adam Brown and Dr. Lara Zibners sit down with Alison — pediatric emergency physician, mom of 4, host of Startup Physicians , and co-founder of Imagine Pediatrics — to trace her path from clinician to telehealth pioneer to founder of a company that now takes full risk for children on Medicaid. Along the way, they get into the realities of homeschooling four kids through COVID, why complex pediatric care has been ignored by investors for so long, and the analogy that finally explains the broken math of insuring only the sickest kids (hint: it involves teenage boys and car insurance). Alison also delivers the single best piece of advice we've heard for physician founders: stop polishing the pitch deck and pre-sell the thing that doesn't exist yet. It's how Imagine Pediatrics walked into day one with thousands of patients already under contract — and it's the playbook she now teaches other doctors who want to build.
What if there were a network of clinics quietly delivering full-suite care — primary care, dental, behavioral health, pharmacy, prenatal, mobile units — to anyone who walks in, regardless of their ability to pay? Spoiler: there is, and most Americans have no idea it exists. Adam and Lara sit down with Dr. Rui Ariyapala, Associate Chief Medical Officer at Piedmont Health Services and a public health physician trained across New Zealand, the UK, and the US, to unpack the Federally Qualified Health Center model, a 55-year-old experiment in keeping vulnerable patients out of the ED and inside coordinated, value-based care. Along the way: why a father walked out of his child's cancer diagnosis, how $4,500 of NHS coverage stacks up against $26,000 a year in US premiums and what it actually takes to move a system built on sick-care toward real prevention. Plus: Gary the Word Bird, Ginger Spice at the London Zoo, and a proposal hidden inside an escape room. A conversation about the parts of US healthcare that are working and the upstream shifts that could fix the parts that aren't.
Endometriosis affects as many women as diabetes. Diabetes research gets $1 billion a year from NIH. Endometriosis gets $28 million. That kind of gap doesn't exist because people are against women's health research, it exists because it hasn't been made a priority. In this episode, Dr. Adam Brown and Dr. Lara Zibners sit down with Kathryn Schubert, President & CEO of the Society for Women's Health Research, to unpack why the women's health funding gap persists, how policy actually gets shaped behind the scenes in Washington, and what it's going to take to close the gap for good. Kathryn shares her journey from Capitol Hill scheduler to registered lobbyist to leading one of the longest-standing organizations fighting for women's health equity. Along the way, we get into the real role lobbyists play in healthcare policy (it's not what you think), how advocates tailor their message to move lawmakers on both sides of the aisle, the history of excluding women from clinical trials — and the assumptions that made it seem reasonable at the time, navigating women's health advocacy in a politically charged environment, and why the private sector is finally waking up to women's health as a market opportunity. This conversation will change how you think about where health policy comes from and who's actually moving it forward. Follow Unstable Vitals: LinkedIn Instagram Youtube
You put on a lead apron and assume it's keeping you safe. But what if it's carrying MRSA, ringworm, and nearly 10 times the bacteria of a gas station pump handle? Even worse, what if nobody's required to clean it? Justin McKay, founder of RadCare Services, joins Dr. Adam Brown and Dr. Lara Zibners to share how a ringworm infection, a torn-up apron on his first day in the OR, and a year of quietly studying hospitals across the country led him to build something the healthcare industry didn't even know it needed: a full-service lead apron cleaning, repair, and compliance program. In this episode, we dig into the disgusting (and dangerous) reality of radiation protection garments in U.S. hospitals from blood and fecal-stained aprons going right back on the rack, to a culture study that found MRSA on the majority of aprons tested. Justin shares the moment a skeptical surgical director called his pitch "snake oil," so he tested her busiest surgeon's apron on the spot. The results were jaw-dropping. We also talk about the uphill battle of building a business around a problem no one is required to fix, why financial incentives in healthcare make or break innovation, and what gives Justin hope for the future of medicine. In this episode: Why hospital lead aprons are virtually unregulated for cleanliness in the U.S. The ATP test that proved aprons are nearly 10x dirtier than gas pump handles How a 2017 lawsuit tied defective PPE to cancer deaths among OR staff The founder's journey: quitting a VP of sales job, two years without a paycheck, and bootstrapping a new business Follow Unstable Vitals: LinkedIn Instagram Youtube
In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners are joined by a very special guest, Lara's husband, Robert Pinate, a nurse consultant with over 30 years in UK emergency medicine. Rob helps emergency departments rethink outdated workflows and improve patient flow. The conversation dives into how the NHS actually works from its funding model and workforce of to the freedom clinicians feel when billing isn't part of the equation. Rob breaks down the rapid assessment and treatment model he champions, the culture shock of implementing America's Epic EHR in a system that doesn't bill, and what it's like walking into struggling hospitals that feel like they've regressed. The trio explores the sobering parallels between the NHS's decline after years of austerity and the growing cracks in the U.S. system, from Medicare cuts to frontline burnout. But it's not all doom. Rob shares where he's seeing improvement and makes the case that sometimes all it takes is pulling the right people off the floor, handing them a blank sheet of paper, and asking: how can we do this better?
What happens when a Canadian finance guy with zero healthcare experience decides to take on one of the most broken systems in the world? You get Alex Barrett, co-founder and CEO of Meroka, and a genuinely different perspective on why independent medicine is dying and what can actually be done about it. In this episode, Drs. Lara Zibners and Adam Brown sit down with Alex to unpack the real force behind healthcare consolidation, and it's not the "silver tsunami" you keep hearing about. CMS reimbursement rates have been essentially flat since 2002 while costs have surged, making the business model of running an independent practice quietly unsustainable for thousands of physicians across the country. Alex shares how Meroka is building a third exit path for retiring physicians, one that keeps practices out of private equity hands and transfers ownership to the staff who actually do the work. But the conversation goes deeper: Why does the only OB delivering babies in a 100-mile radius in rural West Virginia still have no negotiating power? Why are non-compete clauses one of the biggest hidden barriers to independent medicine? And is the system so broken it simply can't be fixed? Spoiler: Alex doesn't think so. Listen now.
Dr. Adam Brown and Dr. Lara Zibners are back for Season 2 of Unstable Vitals , and they're wasting no time. After catching up on life, including Laura's Arctic Circle dog sledding adventure, Adam's new London life, Calla Lily's first Big Pharma partnership, and a spirited rant about Yorkshire pudding, the duo lays out their ambitious plan for the season ahead. This episode introduces the "Five P's" framework that will guide Season 2: Politicians/Policymakers, People (patients), Providers, Payers, and Producers. They argue that fixing America's broken healthcare system requires engaging all five groups, and they plan to do exactly that through conversations with health tech founders, clinical innovators, device executives, regulators, and investors. From the cost of estrogen gel in Europe vs. the U.S. to why walking to the grocery store might be better healthcare policy than anything coming out of Washington, this season promises to be equal parts hilarious and eye-opening. Topics covered: The "Five P's" of healthcare: the season's guiding framework Public transportation, walkability, and downstream population health Lifestyle medicine and transatlantic perspectives on healthcare costs A preview of Season 2 guests and episodes What Adam and Lara have been up to since last season Follow Unstable Vitals on LinkedIn to stay connected.
In this special year-end episode of Unstable Vitals, Dr. Lara Zibners and Dr. Adam Brown reunite for their funniest, most unfiltered conversation yet. From GLP-1 mania to AI hype, from the workforce crisis to the seismic impacts of the 2025 election, Lara and Adam break down the five biggest healthcare stories of the year, with the honesty and occasional oversharing you’ve come to expect. Along the way, they revisit their favorite moments from Season 1, reflect on personal wins, and look ahead to what excites and terrifies them most about 2026. They also talk negotiations, vaccine misinformation, reproductive rights, and why you should always travel with spare underwear. Lara and Adam close out 2025 exactly the way they started it: unstable, opinionated, and determined to make healthcare a little less chaotic, one candid conversation at a time.
In this episode of Unstable Vitals , we sit down with Mac Deford, former local government attorney, community advocate, and congressional candidate from South Carolina. From his time in the Coast Guard to his work in behavioral health and affordable housing, Mac has seen firsthand how policy decisions ripple through people’s lives. We talk about what inspired him to run for Congress, the realities of healthcare and housing access in South Carolina, and why public service still matters, even when the system feels a little… unstable.
In this episode of Unstable Vitals , Dr. Lara Zibners and Dr. Adam Brown welcome Alison Fragale, organizational psychologist, professor, and author of Likeable Badass , to talk about the science of respect, influence, and why women in leadership still face steep uphill battles. From trading nail files for shoes to unpacking why “likeable” and “badass” aren’t opposites, this conversation dives into how gender bias shapes pay, leadership, and culture, and what can be done to change it. Alison breaks down the psychology behind earning respect and why bias isn’t just a “men vs. women” problem. Lara and Adam bring it home with real-world reflections on mentorship and what it means to balance warmth and authority in a system that often rewards the opposite. Smart psychology, unfiltered honesty, and a little bit of chaos the Unstable Vitals way.
In this episode of Unstable Vitals, hosts Dr. Adam Brown and Dr. Lara Zibners sit down with orthopedic surgeon, researcher, and author Dr. Jocelyn Wittstein. Together, they dig into an often-overlooked area of medicine: bone and joint health as the foundation for long-term wellness. Dr. Wittstein shares insights from her new book, The Complete Bone and Joint Health Plan , exploring why osteoporosis and arthritis are more than “aging problems” — they’re critical, preventable drivers of disability that ripple into cardiovascular health, cognitive decline, and overall quality of life. The conversation covers: Why mobility is medicine and how preventing fractures protects independence. The evidence (and myths) behind supplements like glucosamine, collagen, and more. How proactive, cross-specialty care (from hormone therapy to strength training) can reduce complications and extend healthy years. Dr. Wittstein’s journey as one of the 6% of women in orthopedics, and how her perspective shapes both her practice and her advocacy for women’s health. Blending humor, real-life stories, and evidence-based strategies, this episode shines a light on the connection between musculoskeletal health and the stability of our entire healthcare system.
In this episode of Unstable Vitals , Dr. Adam Brown and Dr. Lara Zibners welcome Dr. Steven Farmer, former senior leader at the Center for Medicare and Medicaid Innovation (and Adam’s husband). Between playful banter and sharp commentary, the trio dives into the serious business of healthcare regulation: why the U.S. system remains unaffordable, how payment models shape medical practice, and what it really takes to shift toward value-based care. From international adventures to bundled payments, Dr. Farmer shares his unique journey through medicine, policy, and innovation—sprinkled with equal parts humor and frustration. If you’ve ever wondered how regulation, incentives, and a little bit of “gaming the system” affect the care you receive, this is the episode for you.
Trigger warning : This episode contains discussion of physician mental health and suicide. If this topic is distressing, please consider listening with support nearby or using local mental health resources. In this episode of Unstable Vitals, hosts Dr. Adam Brown and Dr. Lara Zibners sit down with Dr. Stefanie Simmons, Chief Medical Officer of the Dr. Lorna Breen Heroes' Foundation, for an urgent, unfiltered conversation about the mental health crisis in medicine. Timed for National Physician Suicide Awareness Day (September 17), the episode explores why clinicians—especially emergency and critical care providers—face elevated rates of burnout, depression, and suicide; the systemic barriers that keep clinicians from seeking help; and concrete policy and operational changes that can begin to “heal the healers.” Dr. Simmons explains the Foundation’s work that’s shifting culture and protections for clinicians. The hosts bring personal stories from residency and frontline care to highlight how stigma, intrusive application questions, and unsafe workplace systems drive clinicians away from care. This episode is essential listening for physicians, nurses, hospital leaders, policy makers, and anyone who cares about the future of the healthcare workforce. Subscribe to Unstable Vitals, share this episode to raise awareness, and consider supporting clinician wellbeing efforts in your organization.
In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners dive into one of the biggest challenges in healthcare today: misaligned incentives. Should our system prioritize profit or patients? How do payment models, public policy, and personal responsibility collide to shape health outcomes? From fee-for-service vs. value-based care to the impact of public transportation, food policy, and behavioral nudges, Adam and Lara unpack the hidden forces driving both innovation and inequity in modern medicine. Along the way, they share personal stories, debate policy trade-offs, and explore how we can make healthy choices easier, care more accessible, and incentives better aligned, without sacrificing innovation. If you’ve ever wondered why our healthcare system feels broken (and what it would take to fix it) this episode is for you. 🎧 Listen now to hear: Why profit-driven incentives often work against patient health How public health policies intersect with economic growth The promise and pitfalls of value-based care Behavioral nudges and making healthy choices easier Why doctors need to understand the business of healthcare Listen to Part 1 before diving into Part 2.
Why is the U.S. healthcare system so expensive, yet so ineffective? In this episode of Unstable Vitals , Dr. Adam Brown and Dr. Lara Zibners dive deep into the tangled web of patients, profits, and misaligned incentives driving instability in American healthcare. From skyrocketing medical school debt and low primary care reimbursements to insurance company profits and hospital billing practices, Adam and Lara expose the financial forces shaping how (and if) patients receive care. They compare the U.S. system to models in the U.K. and Europe, exploring why Americans pay more but live shorter, less healthy lives. This episode tackles big questions, like: Why do we prioritize treating illness over preventing it? How do insurance companies profit while patients struggle with medical bills? What does “health” actually mean and who gets to decide? Can we fix a system where profit often outweighs patient care? If you’ve ever wondered why navigating healthcare feels so complicated, or why the U.S. spends more per person on healthcare than any other developed nation but ranks lower in life expectancy, this conversation is a must-listen.
Residency: the rite of passage every doctor must survive before practicing on their own. But is the system built to train (or to break) young physicians? In this episode of Unstable Vitals , Dr. Laura Zibners and Dr. Adam Brown sit down with Dr. Jared Dashevsky, a resident physician at Mount Sinai and founder of Healthcare Huddle, to unpack the realities of residency and what it reveals about the larger instability in U.S. healthcare. From 80-hour work weeks and six-figure medical school debt to the high-stakes “Match” process and the infamous July 1st turnover, we dive into the pressures that shape doctors before they even become attendings. Jared shares his perspective as a third-year resident, new father, and healthcare communicator, offering an unfiltered look at the sacrifices, frustrations, and occasional absurdities of residency life. Along the way, we ask: Is the residency system outdated? How do pay disparities and debt burden destabilize medicine? What changes could make training more sustainable for doctors and the patients they serve? Whether you’re in medicine, thinking about it, or just want to understand what’s behind the curtain, this conversation exposes the cracks in the system and why they matter for all of us.
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Observed September 14, 2026. Cached outside the daily freshness window; the positions keep the date they were taken on.
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