Good Medicine

Dr. Anthony Fauci: A Lifetime of Service and Impact

What does it look like to be in the room — and sometimes at the center of the fire — for every major public health crisis of the last 50 years? Dr. Anthony Fauci, former Director of the National Institute of Allergy and Infectious Diseases and advisor to seven U.S. Presidents, joins Dr. Rohan Ramakrishna for a sweeping conversation that spans a Brooklyn pharmacy, the first AIDS wards, the Situation Room, and the front lines of COVID.Dr. Fauci traces the unlikely arc from delivering prescriptions on a Schwinn bike in Bensonhurst to architecting PEPFAR — the most successful global health program in history, credited with saving 26 million lives. He reflects candidly on his famous adversarial-turned-collaborative relationship with activist Larry Kramer, how that changed the way clinical trials are run in America, and why the scientific community needs a louder collective voice. He also addresses the Great Barrington Declaration, the vitriol of the COVID years, and what it means — as both a physician and a public servant — to tell the truth when people don't want to hear it. And he shares his deep concern about what's happening right now to the institutions he spent a lifetime building.New episodes are released every other week, wherever you get your podcasts. If you’re a US-based physician, continue the conversation with Dr. Fauci on Roon, visit: www.roon.com Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care -- (00:00) Intro (02:54) Welcome — Dr. Anthony Fauci (03:12) Growing up in Brooklyn: A family pharmacy and a calling (05:52) The Classics, the Jesuits, and a philosophy degree (07:43) Why he chose the NIH over private practice (10:38) Early career: Vasculitides and the bench-to-bedside approach (11:05) How treating rare autoimmune disease shaped his HIV work (13:41) The first AIDS patients at the NIH (1981) (15:07) Pivoting his career entirely to HIV/AIDS (18:06) Becoming director of NIAID — a job he didn't want (20:31) Advising seven presidents: The feeling of the Oval Office (21:30) The moment Bush commissioned PEPFAR (22:59) PEPFAR: 26 million lives saved (24:41) The contrast with today's global health commitments (27:06) The Godfather, Bethesda, and the secret PEPFAR meeting (31:16) PEPFAR's uncertain future under the current administration (34:12) Can other countries fill the U.S. funding gap? (36:20) Larry Kramer and the HIV activist community (39:00) Listening instead of running: The decision that changed everything (40:40) How activism permanently changed clinical trials and the FDA (44:33) Is an HIV vaccine possible? (46:30) The tools we already have to end the epidemic (48:34) COVID: How quickly mRNA became the obvious platform (50:41) Lessons from Operation Warp Speed (52:59) Buying doses before knowing if the vaccine worked (53:53) What the Great Barrington Declaration got fundamentally wrong (57:15) Handling years of personal attacks and vitriol (1:00:05) Did the broader medical community let him down? (1:01:40) The need for doctors to speak up — measles as a warning (1:02:38) An impassioned defense of the NIH (1:04:21) Quick Hits: Book recommendations (1:05:47) Most impactful mentor: Sheldon Wolff (1:06:29) Most inspiring leader: Nelson Mandela (1:07:16) Closing

Dr. Mandy Cohen on Fixing the Broken Systems of Public Health

What does it actually take to fix a broken health system — and what happens when the progress you've built starts to unravel? Dr. Mandy Cohen, former CDC Director, former Secretary of the North Carolina Department of Health and Human Services, and longtime leader at the Centers for Medicare and Medicaid Services, joins Dr. Rohan Ramakrishna for a wide-ranging conversation on what it means to lead at the intersection of medicine, policy, and operations. Dr. Cohen traces her journey from accidental operator during the HealthCare.gov crisis to architect of one of the country's most ambitious social determinants of health programs in North Carolina — and ultimately to the helm of the CDC during its most consequential rebuilding effort in decades. She speaks candidly about the promise and limits of value-based care, the systemic importance of primary care–led ACOs, and why she's deeply concerned about the current state of vaccine infrastructure. She also shares her framework for building public trust — transparency, relationships, and results — and why getting the payment models right is the only way AI will actually improve health outcomes rather than just optimize revenue. New episodes are released every other week, wherever you get your podcasts. For more from Roon, visit: ⁠https://www.roon.com/⁠ [https://www.roon.com/%E2%81%A0] Sign up for our substack: ⁠https://rohanramakrishna.substack.com/⁠ [https://rohanramakrishna.substack.com/%E2%81%A0] Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care -- (00:00) Intro (03:15) Welcome — Dr. Mandy Cohen (03:37) Why she went into public service (06:06) Discovering she was an operator: The HealthCare.gov crisis (08:30) The limits of ambition in government (10:40) Coalition building as a leadership tool (11:51) The origins of value-based care and CMMI (13:45) The case for primary care-led ACOs (16:31) Physician-led vs. hospital-led value programs (17:22) The complexity problem in programs like TEAM (19:10) Blood pressure control as a key intervention (20:25) Day one as NC Secretary of Health and Human Services (22:15) Rebuilding culture before setting priorities (23:30) Working across the aisle in North Carolina (25:11) The Healthy Opportunities Pilot: Social determinants at scale (26:53) Navigation as the highest-impact intervention (28:57) Behavior change and the limits of education programs (30:39) Coalition building for social determinants policy (33:26) Lessons that other states have learned from NC (34:13) Arriving at the CDC post-COVID (36:10) Modernizing siloed data systems (38:00) Rebuilding the CDC's lab infrastructure with private sector (40:01) Where pandemic preparedness stands today (42:55) The return of measles — and what it means (43:58) How Dr. Cohen rebuilt public trust during COVID (46:30) Trust in three parts: Transparency, relationships, results (49:05) Advising health systems on AI (51:00) Payment models and the AI trap (52:54) AI tools she's excited about (55:13) How health systems should evaluate AI vendors (58:31) Does Epic have too much power? (1:00:20) Paying for outcomes, not activity (1:03:22) Doctors building their own tools (1:04:42) Leadership philosophy for change management (1:08:30) Making hard calls that will upset people (1:10:54) Communicating under uncertainty (1:13:58) What the medical community should have done differently (1:17:17) Quick Hits: Mentors, books, and inspiring leaders (1:20:08) Guest recommendation for Good Medicine (1:20:39) Closing

Dr. Anupam Jena on on What Economics Can Teach Doctors

What if some of the most important forces in medicine have nothing to do with science? Dr. Anupam "Bapu" Jena—Harvard Medical School professor, practicing internist at Massachusetts General Hospital, and co-author of the bestseller Random Acts of Medicine—joins Dr. Rohan Ramakrishna to explore the hidden variables quietly shaping patient outcomes every day. Bapu is a physician-economist in the truest sense: someone who uses the tools of economic thinking—natural experiments, probabilistic reasoning, incentive structures—to expose what medicine often misses. In this conversation, they dig into why August-born children are 30% more likely to be diagnosed with ADHD, what a Jerusalem doctors' strike revealed about overtreatment, and why experienced medical doctors may actually produce worse outcomes than their younger peers. They also unpack the stubborn gap between what patients value—hope, dignity, time—and what payers are equipped to measure, and explore how AI is beginning to reshape clinical decision-making. Smart, surprising, and deeply grounded, this episode will change the way you see everyday medicine. New episodes are released every other week, wherever you get your podcasts. For more from Roon, visit: ⁠https://www.roon.com/⁠ [https://www.roon.com/%E2%81%A0] Sign up for our substack: ⁠https://rohanramakrishna.substack.com/⁠ [https://rohanramakrishna.substack.com/%E2%81%A0] Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care. -- (00:00) Intro and guest welcome (01:00) Why Bapu Jena is a unicorn in medicine (02:45) Preview: natural experiments, ADHD, value-based care (04:24) Meet Dr. Anupam Jena: physician, economist, author (05:09) Economics or medicine first? The origin story (06:46) The University of Chicago, a snowy day, and a fateful meeting (09:37) The counterfactual: what if Bapu had become a cancer biologist? (09:47) How economics changes the way Bapu practices medicine (11:13) Fever thresholds and probabilistic clinical thinking (12:45) Anchoring bias and cognitive forcing in diagnosis (15:11) Two economics lessons every physician should know (17:35) What is a natural experiment—and why does it matter? (19:38) Why observational data misleads us (21:52) Steve Levitt, Freakonomics, and the origins of quirky research (23:56) The flu shot timing experiment: does when you get it matter? (27:36) Morning vs. afternoon immunotherapy: separating mechanism from causation (31:01) ADHD and August birthdays: the school cutoff effect (33:48) Has the birth-month finding changed clinical practice? (35:21) Redshirting, school readiness, and professional athletes (37:26) The Jerusalem doctors' strike and the paradox of less care (40:26) Non-STEMI patients and the risk of doing too much (42:12) Does physician experience predict better outcomes? (45:50) Defining value in value-based care (48:19) The limits of what payers can measure (52:16) The track record of value-based care programs (56:05) How Bapu uses AI in research and clinical practice (59:49) Automation bias and the risks of clinical decision support (01:02:47) What's next: Spotify releases and fatal car crashes (01:04:34) Quick hits: mentors, podcasts, and student wisdom (01:06:10) Closing thoughts and farewell

Dr. Kedar Mate on AI & Scaling Life-Saving Interventions Across the Globe

What does it take to cure drug-resistant tuberculosis in a Lima resource-limited community, help reshape global HIV treatment policy, and then pivot to harnessing enterprise AI for the world's largest health systems? Dr. Kedar Mate has done all three. As the former president and CEO of the Institute for Healthcare Improvement and a co-founder of Qualified Health, Dr. Mate has spent his career proving that the biology of a wealthy patient and a poor patient are identical—and that the systems surrounding them don't have to be so different. In this conversation with Dr. Rohan Ramakrishna, Dr. Mate traces his formative work with Paul Farmer and Partners in Health, the pooled purchasing strategy that slashed the cost of life-saving TB and HIV medicines by up to 90%, and his role in expanding the Triple Aim into the Quintuple Aim by adding workforce well-being and health equity. He also makes the case that AI represents the most transformational force in healthcare since the internet—and explains why getting governance right is the difference between a breakthrough and a disaster. New episodes are released every other week, wherever you get your podcasts. For more from Roon, visit: https://www.roon.com/ [https://www.roon.com/] Sign up for our substack: ⁠https://rohanramakrishna.substack.com/⁠ [https://rohanramakrishna.substack.com/%E2%81%A0] Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care Timestamps: (00:00) Intro and guest overview (02:15) Meet Dr. Kedar Mate (04:00) Growing up between New Jersey and Mumbai (07:30) Brown University: a history thesis on Haitians and HIV (11:00) How Paul Farmer changed everything (15:30) Defining health equity in plain language (19:00) Partners in Health in Peru: treating MDR-TB (24:00) The pooled purchasing strategy that broke the price of TB drugs (29:30) Replicating the model for HIV: the birth of PEPFAR (33:00) What is PEPFAR, and why its funding cuts are catastrophic (37:00) Health equity success stories in the United States (41:00) The Iron Triangle: why quality, cost, and access were seen as enemies (44:00) Don Berwick and the Triple Aim (47:30) Adding workforce experience to make it the Quadruple Aim (50:00) Kedar adds health equity: the Quintuple Aim is born (53:30) Age-Friendly Health Systems: a Quintuple Aim in practice (57:00) Taking over IHI in the spring of COVID (61:00) What COVID taught us about collaborative learning at scale (64:30) There is no quality without equity (68:00) Targeted universalism: a framework for convincing skeptics (72:00) Why Kedar left IHI to co-found Qualified Health (75:30) AI as healthcare's hyperscaler (78:30) What Qualified Health is building for enterprise AI adoption (82:00) Lessons from the EHR era (84:30) Ethical AI and proportional risk governance (88:00) Quick hits: magic wands, mentors, and vaccines in Florida (92:00) Closing thoughts

Dr. Monica Bertagnolli on building a Learning Health System

What if the greatest risk in modern medicine isn't AI—but the fact that nobody is tracking whether our treatments actually work? Dr. Monica Bertagnolli, former Director of the National Institutes of Health and the National Cancer Institute, and newly elected member of the National Academy of Medicine, joins Dr. Rohan Ramakrishna to make the case for a true learning health system—one where every patient interaction generates knowledge that makes the next patient's care better. Dr. Bertagnolli reframes AI not as a threat to physician judgment, but as a diagnostic tool that finally makes personalized, evidence-based medicine possible at scale. She draws a compelling analogy between health data and credit cards: we accept the risk because the utility is real. And she issues a quiet challenge to the entire field—millions of Americans are being treated according to guidelines today, and almost no one is systematically following their outcomes to see if those guidelines actually worked. This is a conversation about trust, infrastructure, and what it means to truly learn from the patients we serve. New episodes are released every other week, wherever you get your podcasts. For more from Roon, visit: ⁠www.roon.com/⁠ [https://www.roon.com/%E2%81%A0] Sign up for our substack: ⁠https://rohanramakrishna.substack.com/⁠ [https://rohanramakrishna.substack.com/%E2%81%A0] Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care. (00:00) Intro & Guest Background (00:42) Who Is Dr. Monica Bertagnolli? (02:53) Defining the Learning Health System (04:43) How AI Makes Learning Health Systems Possible (06:15) Why We Need Data from Millions of Patients (07:26) Data Safety, Trust, and the Sacred Patient Relationship (09:10) How Clinicians Can Rebuild Trust One Patient at a Time (10:35) The Courage It Takes to Trust an Institution (12:08) Infrastructure & EHR Networks: Where We Stand Today (13:44) Is the Technical Capability Already There? (14:52) AI Applications in Cancer Care Dr. Bertagnolli Is Most Excited About (16:17) Breast Cancer Guidelines and the Learning Health System in Action (18:03) Tracking Outcomes to Make AI and Guidelines Better (19:15) Risks and Unintended Consequences of AI in Medicine (20:25) The Cardinal Rule: Always Put the Patient First (21:29) Data Stewardship: Who Really Owns Health Data? (22:51) The Credit Card Analogy for Health Data Risk (24:52) Will AI Weaken Physician Creativity and Individualized Care? (26:17) The Scary Truth: Nobody Is Watching the Outcomes Today (27:26) Lightning Round (27:45) Most Impactful Mentor: Dr. Eugene Braunwald (29:20) Most Memorable Experience with a Politician (30:33) Book Recommendation: Ron Chernow's Mark Twain (31:01) Who Should Dr. Ramakrishna Interview Next? (31:35) Closing Remarks