No Priors Podcast Summary: "A New Operating System for Physicians" with OpenEvidence Founder Daniel Nadler

Podcast: No Priors: Artificial Intelligence | Technology | Startups
Episode: A New Operating System for Physicians with OpenEvidence Founder Daniel Nadler
Hosts: Sarah Guo and Elad Gil
Guest: Daniel Nadler, Founder of OpenEvidence
Date: September 4, 2025

Episode Overview

This episode explores the rapid adoption and immense impact of OpenEvidence, an AI-driven platform positioned as the "operating system for clinical knowledge" among American physicians. Daniel Nadler, founder of OpenEvidence, explains how the company cracked the code on high-stakes clinical decision support and why treating physicians as consumers upended entrenched practices in the healthcare system. The conversation also delves into the future of medicine, the explosion of biomedical knowledge, and the implications for product builders across industries.

Key Discussion Points & Insights

1. OpenEvidence: Viral Growth and Use Among Doctors

Timestamps: 00:08 – 02:04

• Daniel Nadler describes OpenEvidence's meteoric rise in clinician adoption, noting that it's used "20 times more than the next most used platform" in its segment, which supports high-stakes clinical decision-making.
• Unlike paperwork and scribing tools, OpenEvidence tackles "the highest stakes area of medicine," where mistakes are costly and not easily reversed.

  "Most people have self-selected themselves out of the problem of high-stakes clinical decision-making, certainly through an AI lens, because they view it as ambitious." (Daniel Nadler, 01:20)

2. The Core Challenge: Semantic Search for Complex Medical Queries

Timestamps: 02:04 – 06:35

• Medical queries are fundamentally different from standard searches due to their length, complexity, and the need to incorporate emerging knowledge (e.g., new drug approvals).
• Doctors lack time to synthesize new literature on the fly, making semantic understanding crucial.
• Example scenario: Choosing therapy for a patient with concurrent psoriasis and multiple sclerosis, where the wrong choice could aggravate the condition.
• OpenEvidence's value lies in its ability to "route" physicians directly to evidence in recent randomized controlled trials, not just abstracts or guidelines.

  "All of the juice is in connecting the very complex semantic meaning of a medical scenario to the answer where the answer might be in a Phase 3 RCT in the New England Journal of Medicine and in a snippet, not even in the abstract, but in the methodology section." (Daniel Nadler, 05:45)

3. Approach to Medical Ambiguity & Evidence Gaps

Timestamps: 06:35 – 09:32

• The product is strictly for physicians to ensure context and accountability given the high stakes.
• OpenEvidence does not position itself as an "answer engine" or an AI platform, but firmly as a search engine, which fosters auditability and trust.
• The interface highlights uncertainties and provides citations, so users can evaluate the evidence themselves:

  "We did two things that were very smart. The words AI never appeared and the words answers were not used in the framing of what we provided… That created a certain social contract." (Daniel Nadler, 08:36)

4. User Behavior and Platform Design

Timestamps: 09:32 – 11:53

• Typical workflow: Doctors input complex queries, receive the three to five most relevant evidence sources, and almost always check the originals.
• OpenEvidence drives significant referral traffic to major medical journals.
• The value is amplified by respect for evidence, robust source material, and strategic partnerships with "gold standards" like NEJM and JAMA.

5. Treating Physicians as Consumers, Not Gatekept Appendages

Timestamps: 11:53 – 16:03

• Nadler wanted to build the world's first "consumer internet company for knowledge workers," not a traditional healthcare business.
• The innovation: Allowing doctors to independently download and use tools, bypassing health system gatekeepers, analogous to a "Bloomberg Terminal for doctors."
• This approach led to highly organic and widespread adoption.

  "It was just no one had ever addressed them as consumers before… Today virtually every doctor in America is walking around with a computer in their pocket that they own, called an iPhone or an Android phone." (Daniel Nadler, 15:00)

6. Overcoming Institutional Resistance

Timestamps: 16:03 – 17:57

• Attempts to block the app mostly failed due to logistics and overwhelming physician demand.
• The platform quickly hit over 60% daily active physician use in some prominent health systems.
• Now, even hospital leadership are avid users.

7. Physicians vs. Patients: Direct Access to Medical Knowledge

Timestamps: 17:57 – 21:32

• Nadler believes patients should have agency and supports physician-generated patient handouts.
• However, raw medical literature is often inaccessible without advanced training, which can create confusion and unproductive conversations.

  "It took me personally taking my first graduate level statistics course at Harvard to really understand these clinical trials." (Daniel Nadler, 19:23)

• The balance: Empower patients with clear, consensus-based information while maintaining necessary interpretive context.

8. The Acceleration of Medical Knowledge & Future of Physician Training

Timestamps: 21:32 – 29:13

• Medical knowledge now doubles every few years; even in a physician’s hyper-specialized niche, keeping up would require hours of daily reading.
• Medical education is set to be "radically inverted": post-graduate continuous learning will vastly outweigh initial education.

  "The majority of what they practice today they learned in the last two years. And I’ve had a 70-year-old physician tell me that." (Daniel Nadler, 27:13)

• Leading institutions are piloting avant-garde models emphasizing evidence-based, interdisciplinary collaboration ("curbside consults") and distributed decision-making.
• However, this is costly and highlights equity issues—AI tools like OpenEvidence help level the field for underresourced areas.

9. Patient Agency, Societal Health, and Cultural Lessons

Timestamps: 32:44 – 36:50

• Nadler draws from Japanese culture, highlighting societal habits—walking, purposeful work, portion control—that lead to better health outcomes.
• He notes doctors have long known these truths, but social and political factors have stifled open dialogue.

  "An idle life cannot, in Japanese culture, be a good life. Those are incompatible notions, idleness and fulfillment." (Daniel Nadler, 34:50)

10. AI Adoption: Psychological Lessons for Other Industries

Timestamps: 38:06 – 39:32

• Approach people as people, not just as workers or abstractions.

  "If you address people as people and as consumers and if you speak to them in a way they've never spoken to before, and if you sort of hit them different… that at minimum will be very refreshing and different and will lead to them considering the thing with an open mind." (Daniel Nadler, 38:37)

• The surprising velocity of "consumer-like" growth in medicine suggests psychological universals that product builders can leverage elsewhere.

11. On Motivation, Will, and Company Recruiting

Timestamps: 39:49 – 46:30

• Nadler is skeptical of the trope "if you build it, they will come." Success is more about founder will and drive than ideas alone.
• OpenEvidence's big insight wasn’t unique, but relentless execution mattered.
• For hiring, Nadler values intrinsic drive and self-motivation over traditional management levers:

  "There's only a moderate correlation… between freakishly smart and output.… I seek out in recruiting are the people for whom all of that [motivation] is just entirely redundant because… they're driven on their own war path." (Daniel Nadler, 44:52)

Notable Quotes & Memorable Moments

• "The golden age of biotechnology is sort of the dark ages of physician burnout because it’s just impossible to keep up with all the new drugs and all the new mechanisms of action and so on."
  —Daniel Nadler [05:08]

• "OpenEvidence is a consumer internet company masquerading as a healthcare company."
  —Daniel Nadler quoting Sequoia [12:17]

• "I would say almost the default behavior is, then they go out. I think we're one of the largest sources of referral traffic to the New England Journal of Medicine after Google…"
  —Daniel Nadler [10:14]

• "There are very few things people can agree about in America—they can agree Congress is dysfunctional and they agree American healthcare is dysfunctional."
  —Daniel Nadler [13:23]

• "You need to find this sort of perfect storm of things. And it has very little to do with ideas. The idea for OpenEvidence is the most obvious idea in the world."
  —Daniel Nadler [42:42]

Structured Timestamps for Key Segments

• 00:08: OpenEvidence’s adoption and focus on high-stakes clinical decisions
• 02:04: Example scenario—semantic search challenges in medicine
• 06:35: Navigating ambiguity and conflicting evidence
• 09:32: User workflows and partnerships with journals
• 11:53: Treating physicians as app store consumers
• 16:03: Health system resistance and organic viral spread
• 17:57: Patient access, handouts, and the interpretive issue
• 21:32: Impact of knowledge doubling, medical education’s future
• 29:13: New residency models and distributed decision-making
• 32:44: Sociocultural dimensions of preventative health (Japan)
• 38:06: AI adoption principles for other verticals
• 39:49: On 'if you build it, they will come,' founder motivation
• 44:52: Recruiting for drive and output, not just intelligence

Closing Thoughts

Nadler's story demonstrates the transformative power of treating elite professionals as everyday consumers, the necessity of radical approaches to evidence in an era of accelerating knowledge, and the primacy of intrinsic motivation in driving both company success and personal achievement. OpenEvidence is arguably a harbinger for AI’s impact not just in healthcare, but in all high-stakes, knowledge-driven industries.