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.

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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.

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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

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