
Hosted by Robert Pearl and Jeremy Corr · EN

In this Diving Deep episode, Dr. Robert Pearl and Jeremy Corr explore what a breakthrough in mathematics can teach healthcare about generative AI, outdated assumptions and the future of medical practice. The conversation begins with Paul Erdős, the brilliant Hungarian mathematician whose unit-distance problem stumped experts for 80 years. Generations of mathematicians tried to prove Erdős’ conjecture using the tools and assumptions of geometry. Then OpenAI announced that one of its models had found a different path, one that challenged the assumptions of humans. For Pearl, the lesson for medicine is not about math. It is about the danger of staying trapped inside old models of thought. American healthcare faces persistent crises in quality, access and affordability, yet the proposed fixes focus on small adjustments to a system that has failed for decades. Pearl argues that generative AI will not reach its full potential if clinicians continue to use it merely for administrative tasks, documentation support or occasional diagnostic assistance. Instead, he says, medicine must be willing to abandon three longstanding fallacies. The second half of the episode shifts the discussion from assumptions to urgency. Pearl compares generative AI in medicine to the sudden invention of cars in a world where people could only travel by foot, bicycle or horseback. If faster transportation could save far more lives than it cost, society would not wait until cars were risk-free before building roads and teaching people to drive. He argues medicine should think similarly about GenAI: not as a finished product, but as a rapidly improving tool that could save lives if implemented wisely and quickly. In the episode, Pearl highlights three areas where GenAI could have immediate impact. In each case, he returns to the same point: the greatest risk is not only that AI might make mistakes, but that medicine will ignore the harms already caused by today’s failures. For more, tune into this month’s episode and check out the links below. Helpful links: What GenAI’s Math Breakthrough Means For Medicine (Forbes) GenAI Is Ready To Change Medicine. America Isn’t Prepared (Forbes) Monthly Musings on American Healthcare (RobertPearlMD.com) * * * Dr. Robert Pearl is the author of ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn. The post FHC #220: How AI is challenging old assumptions in medicine appeared first on Fixing Healthcare.

In this week’s episode of Medicine: The Truth, hosts Jeremy Corr and Dr. Robert Pearl probe the facts beneath healthcare’s biggest headlines. Today’s show opens with a scientific breakthrough that could change the future of inherited disease: a new gene-editing technique that may allow researchers to correct DNA errors in human embryos with far greater precision than earlier CRISPR approaches. Dr. Pearl explains that the advance, developed by researchers at Columbia University, uses a method called base editing. Unlike traditional CRISPR, which cuts out and replaces sections of DNA, base editing can alter individual nucleotides (the “letters” that make up genetic code). The difference, Pearl says, is comparable to moving from rewriting entire pages of text to correcting a single wrong letter inside a single word. The promise is extraordinary. For families affected by one of the thousands of rare genetic diseases caused by single DNA errors, this technology could one day make it possible to prevent devastating inherited conditions before birth. Children who otherwise might face blindness, severe disability or premature death could instead be born free of the genetic defect. But the ethical concerns are equally profound. The same technology that could prevent horrific disease could also be used to modify embryos for non-medical traits. Pearl warns that this possibility raises fears about “designer babies,” eugenics, private-sector incentives and the lack of federally funded oversight for embryo research in the United States. Here are the other major storylines from episode 108: A large study of 9 million patients found that four risk factors (high blood pressure, diabetes, high cholesterol and smoking) are associated with nearly all heart attacks and strokes. The FDA approved a new sunscreen ingredient already used in Europe for decades, highlighting both the promise of better melanoma prevention and the slow pace of U.S. sunscreen regulation. Employers are preparing for further increases in healthcare premiums, deductibles and copayments, with many companies limiting or eliminating GLP-1 coverage for obesity. Preliminary data show U.S. infant mortality has reached an all-time low, but progress remains slow. Medicaid work requirements could cause millions of eligible people to lose coverage because of paperwork errors, shifting costs to emergency rooms, hospitals and state budgets. New rules under the No Surprises Act aim to speed dispute resolution between insurers and providers, but Pearl warns that payment disputes will continue as long as healthcare costs rise faster than people’s ability to pay. Pearl outlines three requirements for real healthcare transformation: keeping people healthy by controlling chronic disease, moving more care into the home with generative AI support and shifting payment from fee-for-service to capitation. The episode closes with two examples of AI already helping clinicians see what they might otherwise miss. Tune in to hear the full discussion and subscribe to Medicine: The Truth for more fact-based analysis of the medical, scientific and policy stories shaping American healthcare. * * * Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine” about the impact of AI on the future of medicine. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn. The post MTT #108: Designer babies, chronic disease & AI-powered care appeared first on Fixing Healthcare.

In this Unfiltered episode of Fixing Healthcare, Drs. Robert Pearl and Jonathan Fisher join cohost Jeremy Corr for a fascinating conversation about the physician’s mind, the promise and limits of generative AI, and what medicine risks losing when technology advances faster than humans can tolerate. In this episode, Pearl turns to a realization he had during a recent hiking trip in Portugal: his brain felt different while walking through the woods than it does while solving analytical problems. That observation leads to a deeper discussion of “left brain” and “right brain” thinking in medicine. Fisher explains that while the popular labels are oversimplified, the underlying challenge is real. Doctors must integrate structured reasoning with emotional awareness, diagnosis with relationship, and technical expertise with the human experience of illness. The discussion then moves into one of the episode’s most provocative questions: Can generative AI be taught to express empathy and relational intelligence as well as humans? Pearl points to studies showing that AI-generated responses to patient questions can be rated as highly empathetic, comprehensive and accurate. Fisher pushes back, arguing that there is a difference between perceived empathy in written answers and the embodied presence of a physician sitting with a fearful patient and family in a vulnerable moment. What follows is a thoughtful disagreement about the future of medicine. Pearl sees generative AI as a way to fill dangerous gaps in American healthcare, including lack of access after hours, rural shortages, diagnostic errors, preventable medical mistakes and poorly controlled chronic disease. Fisher worries that if AI begins taking over both analytical and relational parts of care, physicians may feel even more threatened in a profession already marked by burnout and uncertainty. This leads to the debate’s central question: Will generative AI become the enslaver of clinicians or the liberator? Pearl argues that AI could help physicians escape the growing corporatization of medicine by taking on routine work, expanding access and enabling doctors to practice with more autonomy. Fisher agrees that this future is possible but cautions that in a fee-for-service system, efficiency gains may simply become an excuse to increase volume, billing and pressure on clinicians. Finally, Jeremy brings the conversation back to everyday life by asking whether heavy reliance on technology and AI could weaken the mind the same way physical inactivity weakens the body. Fisher warns that when people offload too much thinking, emotion and relationship-building to devices, they risk losing cognitive sharpness and emotional attunement. Pearl agrees that every technology carries benefits and harms, arguing that the goal should be balance: using AI to learn, understand and solve problems without letting it flatten life’s richer, more meaningful experiences. For more unfiltered conversation, listen to the full episode and explore these related resources: ‘Just One Heart’ (Jonathan Fisher’s newest book) ‘ChatGPT, MD’ (Robert Pearl’s newest book) Monthly Musings on American Healthcare (Robert Pearl’s newsletter) * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #219: Can AI help doctors think without losing medicine’s humanity? appeared first on Fixing Healthcare.

Dr. Anthony “Mazz” Mazzarelli brings a rare combination of perspectives to American healthcare: physician, executive, lawyer, bioethicist, author and media voice. As co-president and CEO of Cooper University Health Care and associate dean of clinical affairs at Cooper Medical School, Mazzarelli leads a major safety-net health system while continuing to see patients himself. He is also co-author of Compassionomics, a book that makes the evidence-based case that compassion in medicine improves outcomes, lowers costs and reduces clinician burnout. That combination makes him an ideal guest for Fixing Healthcare with cohosts Dr. Robert Pearl and Jeremy Corr. This season’s guests are being asked what they are hearing from patients, clinicians and the public right now. For Mazzarelli, three themes rise to the top: Growing concern over Medicaid cuts and rising uninsurance Excitement about generative AI and other new technologies Awe at the speed of change healthcare leaders will need to manage Key episode highlights include: Medicaid cuts will hit safety-net patients hardest. At Cooper, roughly one-third of patients are covered by Medicaid or are self-pay. Mazzarelli explains that many of these patients live paycheck to paycheck or depend on coverage to manage chronic disease. When they lose access, prevention disappears and patients often delay care until they show up sicker in emergency departments and hospitals. Generative AI is a promising tool for rethinking how care is delivered. Ambient listening and automated notes are helpful, he says, but the larger opportunity lies in decision support, preventive outreach, chronic disease management, medication adherence and giving clinicians more time to connect with patients. Fraud prevention should not become a barrier to legitimate care. Mazzarelli supports catching fraud and abuse in Medicaid and Medicare, but argues that AI should be used to identify bad actors more precisely so the system can reduce unnecessary checkboxes. Employer-based healthcare has hidden the true cost crisis. Employers and government programs have absorbed much of the rising cost of care, preventing individuals from feeling the full impact. That delay has reduced pressure for major reform, even as the system becomes increasingly unaffordable. Payment reform remains the real lever for change. While Mazzarelli supports incremental improvements, he says the biggest changes will require addressing the way care is paid for, including the misaligned incentives that shape nearly every part of American healthcare. AI can help clinicians reconnect with patients. Compassion is not a soft concept. Stronger patient connection has been linked to better outcomes, lower costs, fewer unnecessary tests and less burnout among clinicians. Technology should redesign care, not automate bad workflows. Mazzarelli cautions that healthcare does not simply need better AI models. It needs leaders willing to redesign workflows in an “AI-native” way rather than layering technology on top of broken processes. Convenience must be balanced with human connection. Jeremy raises concerns about the broader health consequences of modern convenience, including loneliness and isolation. Mazzarelli agrees, noting that loneliness is a major public health risk and that healthcare organizations have a responsibility to address it. Burnout requires more than wellness programs. Mazzarelli argues that yoga, walks and wellness initiatives are not enough if clinicians feel disconnected from the work itself. The real antidote, he says, is restoring meaning at the point of care by helping clinicians connect with patients and see the difference they make. There’s much more in this conversation, including Cooper’s co-president model, the impact of private equity on physician practice, the future of 24/7 access and how policymakers should think about AI safety without slowing progress. Tune in to hear what one of healthcare’s most thoughtful physician-executives believes patients, clinicians and leaders should expect from the next era of medicine. * * * Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.” Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn. The post FHC #218: Dr. Anthony Mazzarelli on healthcare’s next burning platform appeared first on Fixing Healthcare.

In this Diving Deep episode, Dr. Robert Pearl and Jeremy Corr examine the rapid advance of generative AI, along with the growing conflict between medicine’s mission to heal and doctors’ need for financial security. The conversation begins with a question now echoing across every profession: Will AI replace highly trained workers? In medicine, Dr. Pearl argues, the answer is less about replacement than redefinition. Drawing on recent changes in software development, he explains how “vibe coding” has allowed programmers to stop writing much of the code themselves and instead use generative AI to build, test and refine applications from plain-language instructions. Rather than feeling diminished, many coders report greater satisfaction because AI has taken over the repetitive, error-prone work and left them more time for problem-solving. Pearl sees a similar possibility in healthcare. Like coding, medicine relies on years of training, structured reasoning and repeatable processes. Chronic disease management offers the clearest example. Hypertension, diabetes and high cholesterol are leading causes of heart attacks, strokes and kidney failure, yet proven treatments often fail because doctors lack the time to monitor patients continuously and adjust medications quickly. With home devices, physician-set targets and generative AI support, care could shift from occasional office visits to ongoing management, helping more patients achieve control while freeing physicians to focus on complex cases. The second half of the episode turns from technology to mission. Using Tim Cook’s legacy at Apple as a case study, Pearl examines what happens when values and financial incentives collide. Cook’s tenure produced extraordinary business results, but critics have questioned whether some of his choices conflicted with his own values and Apple’s public statements around privacy, dignity and human-centered technology. Pearl uses that as background for a similar question about medicine: What happens when doctors, who train to help and heal others above all else, feel increasingly forced to make career decisions shaped by money? For generations, medicine was understood as a calling. Today, most physicians no longer own their practices. Many now work for hospitals, health systems, insurers or private equity-backed groups, while others have moved into concierge or direct primary care models. Pearl stresses that these choices are rational. But the financial upside comes with psychological and moral consequences that are rarely discussed — and that may shape the future of physician fulfillment. For more, tune into this month’s episode and check out the links below. Helpful links The AI Revolution In Coding Offers A Preview Of Medicine’s Future (Forbes) What Tim Cook’s Legacy Teaches Doctors About Money And Mission (Forbes) Monthly Musings on American Healthcare (RobertPearlMD.com) * * * Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.” Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn. The post FHC #217: GenAI, physician fulfillment & the future of medical practice appeared first on Fixing Healthcare.

In this week’s episode of Medicine: The Truth, hosts Jeremy Corr and Dr. Robert Pearl probe the facts beneath healthcare’s biggest headlines. Today’s show examines the accelerating progress of generative AI, the political turmoil inside America’s leading health agencies and the infectious disease threats testing the nation’s public health readiness. The conversation opens with a listener question about how close generative AI is to matching clinicians. Dr. Pearl explains that the technology is advancing faster than he predicted in ChatGPT, MD, with recent research showing an OpenAI model outperforming experienced physicians on emergency room triage and management in text-based clinical cases. He cautions that medicine is more complicated than written scenarios but argues that the trajectory is clear: before today’s incoming medical students finish training, generative AI tools are likely to be used in emergency rooms across the country From there, the episode turns to the resignation of former FDA commissioner and Dr. Marty Makary, a two-time Fixing Healthcare guest. Pearl describes Makary as a respected clinician and patient-safety expert who found himself caught between scientific rigor, political pressure, industry opposition and public health critics. His departure, along with other leadership upheaval at FDA, CDC, NIH and HHS, raises a larger concern about whether America’s once-trusted scientific agencies can regain their independence and credibility. Here are the other major storylines from episode 107: RFK Jr. removes preventive-care leaders. Pearl criticizes the firing of two respected co-chairs of the U.S. Preventive Services Task Force, warning that prevention policy may be pushed away from scientific evidence. The surgeon general nomination moving toward confirmation. Nicole Safier appears more confirmable than Dr. Casey Means because her vaccine views are closer to the scientific mainstream. A hantavirus outbreak raises public health concerns. A cruise ship outbreak involving the Andes virus appears to have spread person-to-person, causing at least 13 cases, several severe illnesses and three deaths. The U.S. remains vulnerable to fast-moving outbreaks. Pearl says the slow federal response to hantavirus shows how weakened public health capacity could become dangerous if a highly lethal virus were also easily transmissible. Tick bites are rising sharply. ER visits related to tick bites have climbed well above typical levels, driven in part by warmer temperatures and the spread of deer ticks into the Midwest and South. Ebola exposes the cost of global health cuts. A new Ebola strain in the Democratic Republic of Congo has no vaccine or effective treatment, and the outbreak was recognized only after spreading for weeks. USAID and WHO cuts increase risk to Americans. Pearl argues that reducing global public health support does not put “America first” because viruses ignore national borders. Patients should be more concerned when doctors avoid AI entirely. Pearl says he would worry more about clinicians who refuse to use reliable generative AI tools than those who consult them regularly. Opioid overdose deaths are falling but remain devastating. New CDC data show overdose deaths down for the third straight year, but annual fatalities still total roughly 70,000, with overdoses remaining the leading cause of death among adults ages 18 to 44. Vaccine safety data are being suppressed. Pearl closes by describing blocked FDA and CDC research showing COVID and shingles vaccines to be safe and effective, warning that political censorship undermines trust and harms patients. Tune in for more fact-based analysis and practical perspective on the healthcare policies, technologies and trends shaping medicine today. * * * Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine” about the impact of AI on the future of medicine. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn. The post MTT #107: How politics is weakening America’s public health defenses appeared first on Fixing Healthcare.

In this Unfiltered episode of Fixing Healthcare, Drs. Robert Pearl and Jonathan Fisher explore three questions that reach across medicine, leadership and life itself: What legacy do physicians leave behind? How does mindset shape health and longevity? And can doctors still find fulfillment as medical practice shifts from independence to employment? The conversation begins with Tim Cook’s legacy at Apple, using his tenure as CEO to ask a larger question about values, mission and compromise. Pearl and Fisher examine whether legacy is something others assign after a career ends or something professionals create daily through their choices, actions and alignment with their deepest values. For physicians, the question becomes especially personal when financial, organizational or career decisions collide with the promise to put patients first. Midway through, the discussion turns to longevity and the science of mindset. Drawing on research from Yale and Fisher’s work in Just One Heart, the two physicians explore how beliefs about aging can influence physical function, cognitive health, inflammation and long-term well-being. Fisher explains why optimism is not merely a pleasant attitude but a physiologic force that can shape stress hormones, inflammatory pathways and the daily behaviors that determine health. Finally, Pearl and Fisher examine one of the biggest structural shifts in modern medicine: the movement from physician-owned practices to employment by hospitals, health systems and insurers. Fisher notes that independent doctors may report lower burnout, but autonomy is no longer guaranteed when administrative burdens, call schedules and financial pressures consume the practice of medicine. Employment offers support and stability, but often at the cost of control. By the end, the episode connects all three themes: legacy, health and professional fulfillment are rooted in purpose. Whether through family, patient care, mission trips, mentoring or the daily work of medicine, Pearl and Fisher suggest that doctors may live longer, healthier and more meaningful lives when they preserve the mission that brought them to medicine in the first place. For listeners who connected with Fisher’s reflections on burnout, autonomy and the search for renewed purpose in medicine, his upcoming ASPIRE physician retreat offers a deeper opportunity for reflection and recovery. Co-facilitated with Dr. Robyn Tiger, ASPIRE is a CME-accredited retreat designed exclusively for healthcare professionals, taking place June 12-14 at the Art of Living Retreat Center in Boone, North Carolina. Use code ASPIRE15 for 15% off registration. For more unfiltered conversation, listen to the full episode and explore these related resources: ‘Just One Heart’ (Jonathan Fisher’s newest book) ‘ChatGPT, MD’ (Robert Pearl’s newest book) Monthly Musings on American Healthcare (Robert Pearl’s newsletter) * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn. The post FHC #216: An unfiltered look at what legacy means in medicine appeared first on Fixing Healthcare.

Fixing Healthcare hosts Jeremy Corr and Dr. Robert Pearl are revisiting a past episode of Diving Deep while Dr. Pearl travels and keynotes events around the world. And like last week’s replay, this conversation was selected for a reason. Originally recorded more than three years ago, this episode explores two issues that remain central to the future of American medicine: how healthcare leaders respond to technological change and whether the nation can finally move beyond fee-for-service reimbursement. Looking back now, the discussion feels strikingly current. Many of the opportunities Dr. Pearl identified at the time still exist today. Generative AI has advanced dramatically. Remote monitoring tools are more powerful and accessible than ever. And healthcare leaders continue to acknowledge the need for better chronic disease management, prevention and lower-cost care delivery. Yet despite these advances, many of the nation’s biggest healthcare problems remain unresolved. U.S. quality outcomes still lag peer nations. Life expectancy remains years shorter than in comparable countries. And healthcare costs continue rising at rates that far exceed inflation, wage growth and GDP. Throughout the episode, Dr. Pearl argues that these failures are not primarily technological. The tools to improve care already existed — and continue to improve rapidly today. The greater challenge is leadership itself: helping clinicians embrace change, aligning incentives around patient outcomes and building the operational systems required to make better care possible at scale. The conversation also revisits capitation and value-based care, themes that have resurfaced repeatedly in recent Fixing Healthcare episodes. Dr. Pearl explains why fee-for-service reimbursement continues to reward volume over outcomes and why meaningful progress in affordability will require shifting financial incentives toward prevention, chronic disease control and long-term patient health. Revisiting this episode now offers a useful perspective on the past several years of healthcare transformation: technology has accelerated, but the deeper structural changes required to improve affordability and outcomes have moved far more slowly. Helpful links The Anatomy Of Healthcare Leadership: A Mind For Technology (Forbes) Healthcare Leadership: Following The Money Can Lead To Positive Change (Forbes) Monthly Musings on American Healthcare (RobertPearlMD.com) * * * Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.” Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #215: Revisiting healthcare leadership, technology & capitation appeared first on Fixing Healthcare.

For the next two weeks, Fixing Healthcare hosts Jeremy Corr and Dr. Robert Pearl will be replaying past episodes of Diving Deep while Dr. Pearl travels and keynotes events around the world. But these aren’t random reruns. They were selected for a reason: to highlight just how quickly technology is advancing and how slowly healthcare is adapting. This week’s flashback revisits a July 2024 conversation recorded shortly after OpenAI released GPT-4o, a major leap forward in generative AI at the time. Less than two years later, the pace of change is striking. Capabilities that once felt groundbreaking now seem primitive compared to what today’s AI tools can accomplish for patients, physicians and healthcare organizations. At the same time, the episode’s broader themes remain remarkably current. Dr. Pearl and Jeremy discuss the future role of generative AI in medicine, how these tools could improve diagnosis and patient monitoring and why healthcare institutions often struggle to embrace transformative technology quickly. The episode also examines another issue that remains unresolved today: the high cost of GLP-1 medications like Wegovy and Ozempic. Dr. Pearl explains why these highly effective obesity treatments remain financially out of reach for many Americans despite growing demand and expanding clinical use. Revisiting this conversation now offers a useful reminder: technology can advance extraordinarily fast, but healthcare systems, incentives and policies often lag far behind. Helpful links: OpenAI’s Rule-Shattering GPT-4o Update Will Be Lifesaving, Too (Forbes) Wegovy And Ozempic Are Overpriced By 400-500% — Here’s A Quick Solution (Forbes) Monthly Musings on American Healthcare (Robert Pearl’s newsletter) * * * Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.” Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn. The post FHC #214: Revisiting GLP-1 prices and ChatGPT’s early leap forward appeared first on Fixing Healthcare.

In this Diving Deep episode, Dr. Robert Pearl and Jeremy Corr dissect two issues that are often discussed separately but are deeply intertwined: how Americans can live longer, healthier lives and how the nation can make healthcare more affordable. The conversation begins with longevity. As interest in lifespan and “healthspan” grows, Dr. Pearl challenges three widely held beliefs that, in his view, are holding Americans back. First, the idea that physical and cognitive decline is inevitable with age. New research suggests that nearly half of older adults improve over time, particularly when they maintain a positive outlook and stay physically and mentally active. Second, the belief that longevity can be “hacked” through supplements, peptides and other quick fixes. Despite a $50 billion market and widespread adoption, Pearl explains that most of these interventions lack strong clinical evidence in humans. And third, the assumption that prevention can wait until middle age. Updated cardiovascular guidelines show that earlier screening and intervention, particularly around LDL cholesterol, can dramatically reduce long-term risk. From there, the discussion shifts to the financial side of healthcare. Pearl argues that improving population health is the most effective way to reduce costs, but that meaningful change will also require a fundamental redesign of how care is delivered. Drawing on behavioral research, he introduces a central concept: healthcare leaders tend to solve problems by adding more resources (staff, beds, technology) when better outcomes often require subtraction first. The second half of the episode applies this “subtraction before addition” framework across the healthcare system. In outpatient care, Pearl describes how the traditional small physician office has become increasingly inefficient in an era dominated by chronic disease and administrative complexity. He proposes larger, integrated models that share staff, leverage generative AI and shift from calendar-based visits to continuous, need-based care. In emergency departments, he outlines how segmenting patients by clinical severity could reduce wait times, improve outcomes and lower costs by treating low-risk cases through primary care pathways. And in inpatient settings, he points to hospital-at-home programs as a way to safely care for a significant share of patients at lower cost and with better outcomes. Taken together, this episode teaches that Americans can extend both lifespan and healthspan by rejecting outdated assumptions and focusing on proven behaviors. At the same time, healthcare affordability will not improve by continuing to add more of the same. It will require eliminating inefficiencies, redesigning care delivery and replacing outdated models with ones better suited to modern medicine. For more, tune into this month’s episode and check out the links below. Helpful links New Studies Show Americans Are Thinking About Longevity All Wrong (Forbes) The More We Add To U.S. Healthcare, The Worse It Gets (Forbes) Monthly Musings on American Healthcare (RobertPearlMD.com) * * * Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.” Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn. The post FHC #213: Longevity myths, healthcare costs & why medicine must subtract to improve appeared first on Fixing Healthcare.