The Preventive Medicine Podcast – Détails, épisodes et analyse

Ragav Sharma, DO In this episode, we break down the surprising and often overlooked history of how the U.S. healthcare system came to be—not through strategy or design, but through a series of accidents, policy compromises, and economic incentives that spiraled into today’s crisis.We explore the roots of employer-based insurance, the rise of fee-for-service reimbursement, the unintended consequences of Medicare and the Affordable Care Act, and how hospitals, insurers, and physicians evolved into the fragmented landscape we live with today. From the explosive growth of consolidation to the misaligned incentives driving costs, access issues, and burnout, this episode explains why American healthcare works exactly as it does—and why fixing it requires understanding its origins.Whether you’re a clinician, policymaker, administrator, or simply a curious listener trying to understand why U.S. healthcare is so complex and costly, this deep dive uncovers the structural forces that still shape the system. You’ll learn how major policy decisions, market power, and historical quirks created the misaligned incentives that fuel skyrocketing prices, consolidation, administrative waste, and persistent inequities. Ragav's Social Media: Instagram Link Show Notes Key Topics CoveredHow employer-based insurance began by accident during WWII wage freezesThe rise of fee-for-service and how early insurance models locked in volume-based paymentMedicare and Medicaid’s structural influence on cost and system designHow technology and specialization shifted the system toward high-cost acute careWhy the ACA unintentionally accelerated consolidation among insurers and hospital systemsHow misaligned incentives across hospitals, payers, physicians, and patients drive today’s dysfunctionWhy U.S. healthcare prioritizes volume, pricing power, and market share over actual health outcomesWhat You’ll LearnWhy the system behaves exactly the way it doesHow economic incentives—not clinical priorities—shaped U.S. healthcareWhy costs continue to rise regardless of reform effortsWhy consolidation amplifies prices and reduces competitionThe historical context needed to understand meaningful solutionsIdeal ForCliniciansHealth policy professionalsStudents in medicine, public health, or health economicsAnyone trying to understand why U.S. healthcare feels so broken  Join our Mailing List HERE: Mailchimp

Ragav Sharma, DO Ragav Sharma, DO is a Physical Medicine and Rehabilitation (PM&R) physician with training in interventional spine and musculoskeletal medicine. He formerly set powerlifting records and has also completed several races including ultramarathons. He is an avid proponent of resistance training and has coached others, obtaining a Certified Strength and Conditioning Specialist (CSCS) certification, for both general health and powerlifting goals. In this episode, Dr. Ragav Sharma breaks down the science and strategy behind resistance training — one of the most powerful tools for improving long-term health, performance, and longevity. We explore what the evidence says about strength training for muscle growth, fat loss, metabolic health, injury prevention, and healthy aging. If you’ve ever wondered how often to lift, what exercises actually matter, or whether resistance training is “safe,” this episode gives you the no-nonsense, research-driven answers.  Dr. Sharma's Social Media Instagram Link Show Notes What Is Resistance Training?Resistance training involves contracting skeletal muscle against external resistance to challenge strength and stimulate muscle growth. That resistance can come from:Bodyweight exercisesFree weights (dumbbells, barbells, kettlebells)Resistance bandsMachinesHousehold objects (backpacks, water jugs, cinder blocks)Strength training is not just for athletes or bodybuilders. It is one of the most potent therapeutic tools we have for improving overall function, mobility, and longevity — and it should be accessible to everyone.The Evidence-Based Benefits of Resistance Training1. Improved Body CompositionResistance training:Increases fat-free mass (muscle)Reduces overall and visceral fatHelps preserve muscle during weight loss or GLP-1/GIP therapyPredicts lower mortality independent of BMIMuscle is metabolically protective. Higher muscle mass is associated with a lower risk of chronic disease and death, even in those with a high BMI.2. Stronger Bones and Lower Fracture RiskBone density peaks around age 25–30 and declines after 40, especially in women. Walking alone does little for bone mineral density.Mechanical loading — squats, deadlifts, step-ups, weighted carries — is essential for:Increasing bone densitySlowing osteopenia and osteoporosisReducing fracture riskMaintaining physical function later in lifeOne of the strongest demonstrations is the Lift More Trial, where women 60+ with diagnosed osteoporosis safely performed heavy squats and deadlifts twice per week. They improved bone density significantly, with only one mild strain in over 2,600 sessions.3. Cardiovascular BenefitsMany people assume aerobics is the only way to protect the heart. The data tells a different story:Any resistance training → 19% lower cardiovascular mortalityImproves LDL, HDL, triglycerides, blood pressureEnhances functional capacity in heart failure patientsThe best results come from combining aerobic exercise with strength training — but strength training alone has a meaningful impact.4. Improved Metabolic HealthStrength training increases insulin sensitivity through GLUT4 upregulation and:Lowers HbA1c in both type 1 and type 2 diabetesReduces visceral fat, a major driver of insulin resistanceImproves metabolic flexibilityFor people unable to tolerate high-impact cardio, resistance training becomes even more important.5. Mental Health BenefitsThe psychological benefits are just as powerful:Significantly reduces anxiety symptomsLowers depressive symptoms in adolescents and adultsBenefits occur regardless of strength gainsSimply engaging in resistance training reliably improves mood and mental well-being.6. Reduction in Chronic PainMovement is medicine — and resistance training consistently reduces pain:Decreases chronic low back painImproves pain and function in knee osteoarthritisHelps patients with fibromyalgia reduce fatigue and tender...

The holidays is a time for getting together with family, relaxation, and celebration until it's not. There are many instances of holidays being ruined by preventive injuries and many unfortunate mortalities. In this episode, I take you through common holiday causes of morbidity and mortality for things to keep in mind during this festive time. Ragav's Social Media Instagram Twitter Link Show Notes: Toy related injuries - https://www.cpsc.gov/s3fspublic/ToyRelatedDeathsandInjuries2021.pdf Transportation related Injuries - https://injuryfacts.nsc.org/home-and-community/safety-topics/deaths-by-transportation-mode/ Red Cross Fire Safety - https://www.redcross.org/content/dam/redcross/atg/PDF_s/Preparedness___Disaster_Recovery/Disaster_Preparedness/Home_Fire/FireHolidayFactSheet.pdf Join our Mailing List HERE: Mailchimp

We know smoking is bad for us, we've been hearing it for decades at this point. Unfortunately it wasn't always this way. The use of cigarettes and smoking in general has changed dramatically within the last several decades and many still struggle with the addiction or with its chronic effects. In this episode, Dr. Baldassarri dives into smoking, cigarettes, addiction, and much more.  Dr. Baldassarri completed his residency in Internal Medicine from the Yale School of Medicine before completing a fellowship in pulmonary and critical care medicine also from Yale. He is also board certified in addiction/preventive medicine and currently serves as an assistant professor of medicine at the Yale School of Medicine. He has appeared on other podcasts and is well-published on topics relating to smoking, addiction, and sleep. Show Outline How did you get interested in smoking cessation and addiction medicine with your pulmonary/crit care background? What does preventive medicine mean to you? How has the use of cigarettes changed in the last several years? Has the gap been filled by other devices such as vapes or by marijuana? What interventions have helped bring the use of cigarettes down? How do you approach the conversation? For those who have quit but have a significant smoking history, what can be done to reduce their risk of chronic lung disease? Marijuana has gained a lot of popularity as an alternative medicine, what are the risks associated with marijuana use either through vape or smoking it? If you’re at a coffee shop and someone asks you “how do I get healthy?” what do you tell them in the 2 minutes you’re waiting for your coffee? Join our Mailing List HERE: Mailchimp

There is a lot more to health to health than what happens in an examination room. The decisions that are made at the municipal, state, and national levels make incredible impacts that often times can either make or break the health of a population at large. In fact, preventive medicine at the highest level has more to do with politics and policy than the supplement being touted on your feed as a miracle.  In this episode, I talk with Dr. Abdul El-Sayed who has had many roles throughout his career; so many that he has a wikipedia page! Dr. El-Sayed trained as a physician with a gap to complete his PhD at Oxford in Public Health after which he became an assistant professor at Columbia University within the Department of Epidemiology. He then went on to become the youngest Health Director and Executive Director of the Detroit Health Department at just 30 years old before running for governor of Michigan in 2018. Unfortunately, he did not win that race but has continued writing and speaking about the relationship between politics and health through his two published books, podcast, and newsletter. He is a political commentator on television and continued to be active in improving the landscape for public health. Dr. El-Sayed's Links: Abdul's Website The America Dissected Podcast The Incision Newsletter Abdul's Books Instagram Twitter Show Outline You have held a lot of roles and do many things, why do you do what you do? What does preventive medicine mean to you? What responsibilities does a top official of a health department have compared to a practicing physician? How much of an impact on the day to day lives of people does this role have? Why did you decide to run for governor of Michigan and how much impact can someone in this role have in the health of their constituents? What does the landscape for healthcare reform look like on the political level? Do politicians realize the issues that regular people face? If someone asks you how to get healthy while you are waiting for your coffee at starbucks, what do you tell them in 2 minutes? Join our Mailing List HERE: Mailchimp

Hospitals do a lot for their patients, but what about others in the community? The Boston Medical Center has made it it's mission to provide healthcare to everyone despite ability to pay; furthermore, the Health Equity Accelerator to transform the landscape of health equity within the Boston community. Led by Dr. Elena Mendez-Escobar and Dr. Thea James, the Health Equity Accelerator focuses its resources on maternal and child health, infectious diseases, behavioral health, chronic conditions, oncology, and end-stage renal disease through reaching those who otherwise would not receive as equitable care. In this episode, learn more about what the program is, what hospitals can do to help their communities, and a lot more about health equity!  The Health Equity Accelerator Links: Click here Click here Show Notes What are your roles within BMC? What do you do on a day to day basis? What does preventive medicine mean to you? How did the health equity accelerator come about? What does it do? Do you believe that hospitals have an obligation to their communities in reaching “hard to reach” patients? Given some of the deep origins of health inequities, how can hospitals and hospital initiatives make quantitative change within the community such that the stats actually change? Where does the money come for programs such as the health equity accelerator given the capitalistic and profit-driven nature of many hospitals? How can the health equity accelerator be replicated in other cities? What are the barriers to more widespread adoption? For those from a lower socioeconomic status - if someone were to ask you “How do I get healthy” while you were waiting for your coffee, what do you tell them in 2 minutes? Join our Mailing List HERE: Mailchimp

Climate change has been happening for some time and, while we may not actively notice it, has been harming the health of millions across the globe for some time now. Dr. Kristie Ebi is a professor of Global Health and Environmental & Occupational Health Sciences at the University of Washington and a globally renowned expert in the effect of heat on our health.  In this episode we dive into how climate change impacts our health, why the heat is so dangerous, who and where the majority of the effects take effect. We also talk about how to prepare from the individual level all the way to the global level. This episode is like none other that we have on the podcast! Episode Outline Can you briefly describe what you do and areas you are actively researching? What does prevention mean to you? Can you explain what kind of climate change we are seeing and what we expect to see within the next 50 years? Why is excess heat so dangerous to our health? Who is going to suffer the effects of climate change the most and what kinds of health issues/outcomes will they be facing? What can we do to prepare and prevent excess morbidity and mortality related to climate change on a personal level? How do communities and countries prepare for and prevent the excess morbidity and mortality related to climate change? What does the forecast look like for health outcomes? How bad is it going to get? There are those who are very apocalyptic about our future and those who have unrivaled optimism. What’s your take? If you’re waiting for your coffee at Starbucks and someone asks you “how do I prepare for climate change?” What do you tell them in 2 minutes? Join our Mailing List HERE: Mailchimp

Most of us are very privileged when it comes to healthcare. We expect not only to get better from whatever ails us, but that we have easily accessible care equipped with all the necessary medicines, diagnostic tools, and staff. Unfortunately, many parts of the world have much less in the way of healthcare!  Dr. James Sanders is a global health expert having practiced in setting such as Zambia, The Republic of Georgia, and Southeast Asia among other locations. In this episode, Dr. Sanders shares his insights on what preventive care, or just medical care in general, looks like in various parts of the world and the lessons he applied from his travels to his care as a local physician. This episode is fully of many stories so make sure to listen to the whole thing! Dr. Sander's doesn't have social media! Show Notes Can you tell us a little bit about your career and why you were interested in global health at a time it wasn’t really popular? What does preventive medicine mean to you? What is the MPH degree, why did you get it on top of the MD, and how did you utilize it during your career? Given the vast differences in resources, what are the biggest differences in care when it comes to the wealthy and the poor? Many people say that those who are poor have worse health because of personal choices, is this the case? What does healthcare look like in a country like Zambia which did not have a family medicine training program until your arrival? Many of our listeners might not even know what that looks like! In the united states we talk about preventive medicine from a very privileged position largely with nutrition, exercise, yearly checkups, etc. What does preventive medicine look like in a country with lesser resources such as The Republic of Georgia? How do impoverished populations differ in other parts of the world than in the united states? What lessons have you learned during your career as a clinician that are guiding your decisions now on the insurance side of things? If someone asked you how to get healthy while you were waiting for your coffee at starbucks, what would you tell them in 2 minutes? Join our Mailing List HERE: Mailchimp

Science has gone under attack and many silly or harmful ideas have taken hold in society under the guise of "science." The thing is, there's a lot more to science than just claiming something to be scientific. In this episode, you'll hear all about what it means to follow the scientific method, what it means to be scientific, and what to do about those who erroneously claim science.  Dr. Grimes earned his PhD in ultraviolet radiation physics followed by a post doctoral fellowship in medical physics and oncology but now largely operates as a science communicator. He is the author of the book "Good Thinking - why flawed logic puts us all at risk and how critical thinking can save the world." He is also often seen as a panelist and contributor on news stations such as BBC world news, CBS, CNN, and also in written mediums such as the New York Times, Guardian, and Washington Post among others.  Dr. Grimes' Social Media: Instagram Twitter Link Show Outline How did you go from being a cancer researcher to broad science communicator? Tell us a little bit about why you are so passionate about what you do? What does preventive medicine mean to you? Can you talk about the history of the scientific method and why “scientific” people would believe in things like the 4 humors of the body or leeches? How did we go from there to where we are now? What does it mean to follow the scientific method? Why do even prolific scientists like Dr. Linus Pauling who you write about in your book, fall into certain dogmas Misinformation seems to condense into a very vocal minority that has outsized effects on public discourse - can you speak to why this seemingly always ends up being the case? What do we do about misinformation? It seems exhausting to be constantly combatting it and relies on the “good” scientists to work 10x as hard. How can science literacy be increased - for those in applied science (doctors etc.), and the lay person? How do you find good information? How do you sift through the garbage? If someone asks you how to get healthy, what do you tell them in 2 minutes? Join our Mailing List HERE: Mailchimp

The last episode released was on May 22nd, 2022 and a lot has happened since then! Since then I have gotten married, finished my intern year of residency, moved to a different state, and started training within my specialty of choice. In all this the podcast fell by the wayside but it is back!  In this episode, you'll be re-introduced to me, the podcast, hear about the major life events in the way of the podcast, my reflections on intern year, what my specialty - Physical Medicine and Rehabilitation - is all about, and where the podcast is headed! I'm excited to bring the podcast back and if you want to help it grow make sure to rate and review the show!  Show Outline 1. Major life events and updates since the last episode released on May 22nd, 2022 2. My reflections after completing intern year 3. All about Physical Medicine and Rehabilitation 4. Future plans for the podcast! Join our Mailing List HERE: Mailchimp