"Second Opinion" with Christina Farr, Ash Zenooz MD & Luba Greenwood JD

This week on Second Opinion, Christina Farr sits down with healthcare investing legend Zen Chu, who shares his framework for backing resilient entrepreneurs and insights from early investments in companies like Abridge and PillPack. — 📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess   🙏 Help shape our show by taking our quick listener survey at https://bit.ly/TurpentinePulse    — SPONSOR:  👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — LINKS:  Zen Chu (MIT): https://mitsloan.mit.edu/faculty/directory/zen-chu  MIT Hacking Medicine: https://hackingmedicine.mit.edu/  — FOLLOW: https://www.linkedin.com/in/hackmed/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/  https://www.linkedin.com/in/ashzenooz/ — HIGHLIGHTS FROM THE EPISODE: According to Zen, technology is essential to scale medicine and achieve the quadruple aim: better quality, lower cost, better access, and reduced burnout. When investing, Zen looks for entrepreneurs who have weathered crises and shown adaptability and resilience. He prefers "missionaries over mercenaries" - founders whose personal identity connects with their business mission. Zen believes in "founder-market fit" where entrepreneurs deeply understand the problems they're solving. Determined founders refuse to give up during challenging periods and find ways to pivot successfully. Zen highlights examples of his successful investments, including Abridge and PillPack. Zen recommends securing a personal "FU fund" that provides the financial security to take entrepreneurial risks. Investing in friends can be effective but may alter the dynamics of personal relationships. Zen advises investors to only put money in startups they're willing to lose entirely. Health systems make challenging customers because they often "pilot things to death." Most physicians aren't suited to be startup CEOs as they're typically trained for individual decision-making rather than collaborative leadership. The best physician entrepreneurs often come from resource-constrained healthcare settings. "Algorithmic care" enables automated, guideline-based treatment for patients who know what they need. The healthcare system frequently underestimates patients' understanding of their own health needs. In his rapid assessment, Zen considers AI in medicine appropriately hyped with incredible potential. He sees point solution care delivery businesses as likely overhyped with many failures ahead. Consumerization of healthcare is "about right" though possibly receiving too much funding. Medical devices are "under invested" with insufficient venture capital expertise in the sector. Many healthcare technology tools struggle as standalone products, pushing startups to vertically integrate and deliver care directly.

The week on Second Opinion, Christina Farr and Luba Greenwood sit down with Georgina McMillan to discuss the impact of celebrities and influencers on the healthcare and longevity sectors, exploring how their endorsements and social media presence can both promote health awareness and lead to misinformation, and the need for authentic and scientifically-backed partnerships. — 📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess   🙏 Help shape our show by taking our quick listener survey at https://bit.ly/TurpentinePulse    — SPONSOR:  👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — RECOMMENDED PODCAST: Check out Modern Relationships, where Erik Torenberg interviews tech power couples and leading thinkers to explore how ambitious people actually make partnerships work. Founders Fund's Delian Asparouhov and researcher Nadia Asparouhova kick off the series with an unfiltered conversation about their relationship evolution. Apple: https://podcasts.apple.com/us/podcast/id1786227593  Spotify: https://open.spotify.com/show/5hJzs0gDg6lRT6r10mdpVg  YouTube: https://www.youtube.com/@ModernRelationshipsPod  — LINKS:  Headline: https://headline.com/  Apple Cider Vinegar (Netflix): https://www.netflix.com/title/81637595  Subscribe to Second Opinion Newsletter: https://secondopinion.media/  — FOLLOW: https://www.linkedin.com/in/georgie-mcmillan/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/  https://www.linkedin.com/in/ashzenooz/ — HIGHLIGHTS FROM THE EPISODE: There's a distinction between celebrity doctors starting their own businesses and traditional celebrities getting involved in health companies. Social media has become crucial for healthcare distribution, allowing doctors to grow their practices by building online authority. Celebrity partnerships may solve rising customer acquisition costs by offering startups access to built-in audiences. Trust and authenticity are essential for effective celebrity involvement in healthcare. The longevity trend raises concerns, particularly when physicians promote products without clinical evidence. Social media rewards extreme content, which can lead to health misinformation. Vanity and aesthetics can positively motivate health behaviors. There's a trend shifting from artificial fillers toward natural-looking solutions based on real science. The beauty industry draws healthcare resources away from traditional care into more lucrative aesthetic practices. Celebrity motivations range from authentic interest to financial incentives. Olivia Munn's breast cancer diagnosis post demonstrates the powerful positive impact celebrities can have on public health education. Celebrity attention to rare diseases can be crucial for driving research and finding cures. Celebrities and influencers can be powerful patient advocates when connected to scientifically-backed products and services.

In this episode of Second Opinion, Christina Farr and Luba Greenwood discuss men's health with Saad Alam, co-founder and CEO of Hone Health. They cover the rapid cultural shift in attitudes toward men's wellness, Alam's personal journey with hormone imbalances, and the emerging trends in health treatments for men, including testosterone therapy and lifestyle changes. — 📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess   🙏 Help shape our show by taking our quick listener survey at https://bit.ly/TurpentinePulse    — SPONSOR:  👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — RECOMMENDED PODCAST: Check out Modern Relationships, where Erik Torenberg interviews tech power couples and leading thinkers to explore how ambitious people actually make partnerships work. Founders Fund's Delian Asparouhov and researcher Nadia Asparouhova kick off the series with an unfiltered conversation about their relationship evolution. Apple: https://podcasts.apple.com/us/podcast/id1786227593  Spotify: https://open.spotify.com/show/5hJzs0gDg6lRT6r10mdpVg  YouTube: https://www.youtube.com/@ModernRelationshipsPod  — LINKS:  Hone Health: https://honehealth.com/  Subscribe to Second Opinion Newsletter: https://secondopinion.media/  — FOLLOW: https://www.linkedin.com/in/saad-alam-a146b311/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — HIGHLIGHTS FROM THE EPISODE: Saad Alam started Hone Health after personally experiencing dismissive medical care when seeking help for his hormone-related health issues at age 35. Modern men have 26% less testosterone and 50% fewer sperm compared to men 30 years ago. Hone's treatment approach starts with lifestyle fundamentals (sleep, hydration, stress, movement) before considering medication. The company performs comprehensive testing of 50 biomarkers and requires double testing before prescribing treatment. Men's health stigma has decreased significantly in the past 4-5 years, partly due to influencers normalizing hormone discussions. Men are increasingly open to wellness treatments like contrast therapy and Botox, with male Botox being the fastest-growing category. The average Hone patient is 39 years old, significantly younger than the national average testosterone user age of 52. Men strongly prefer testosterone treatment over weight loss medications, with 80% rejecting weight loss prescriptions. Urban living is associated with a 30-40% higher likelihood of hormone imbalance due to environmental contaminants. Hone conducts 45-minute consultations to create a safe space for men to discuss their health concerns openly. Treatment monitoring includes regular checks for estrogen-related side effects and red blood cell counts. Environmental factors like plastics, phthalates, and PCBs can significantly disturb hormone production. The top concerns for male patients are energy, muscles, and libido, while women prioritize brain fog, night sweats, and mood. The standard starting dose for testosterone treatment is 50-75mg per week, far lower than the 1000-2000mg used by bodybuilders.

Ash Zenooz and Luba Greenwood interview Dr. Dean Ornish, a cardiologist, researcher, and advocate for lifestyle medicine who notably treated Bill Clinton. They discuss his journey into preventative medicine, the development of the Ornish Diet, and his data showing reversal of chronic diseases and improving overall health and longevity. — 📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess   🙏 Help shape our show by taking our quick listener survey at https://bit.ly/TurpentinePulse    — SPONSOR:  👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — LINKS:  Ornish Lifestyle Medicine: https://ornish.com/  Michael E. DeBakey, M.D.: https://www.bcm.edu/about-us/our-campus/debakey-museum/legacy-of-excellence Books by Dr. Ornish (mentioned): Love and Survival: https://www.amazon.com/Love-Survival-Scientific-Healing-Intimacy/dp/0060172134 Undo It: https://www.amazon.com/Undo-Lifestyle-Changes-Reverse-Diseases/dp/052547997X  The Spectrum: https://www.amazon.com/Spectrum-Scientifically-Proven-Program-Better/dp/0345496310  Eat More, Weigh Less: https://www.amazon.com/Eat-More-Weigh-Less-Abundantly/dp/006109627X    Subscribe to Second Opinion Newsletter: https://secondopinion.media/  — FOLLOW: https://www.linkedin.com/in/dean-ornish-m-d-1057167/  https://www.linkedin.com/company/preventive-medicine-research-institute/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — HIGHLIGHTS FROM THE EPISODE: Dr. Ornish took a year off medical school to conduct a pilot study, finding that 8 out of 10 patients showed improved blood flow to their hearts through lifestyle changes alone. The landmark Lifestyle Heart Trial proved that arteries could become less clogged through lifestyle changes. The program crystallized into four key elements: whole foods plant-based diet, moderate exercise, stress management through meditation/yoga, and social support groups. It took 16 years of effort to get Medicare to cover the program, demonstrating that changing medical practice required changing reimbursement structures. The program achieved a remarkable 93% completion rate because participants felt better quickly, compared to only one-third of people staying on statins after a few months. Research with Nobel laureate Elizabeth Blackburn showed these lifestyle changes could lengthen telomeres, potentially reversing aging at a cellular level. Recent studies demonstrated the same program could stop or reverse early-stage Alzheimer's progression in 71% of participants within 20 weeks. Data from health insurers showed significant cost savings: 80% of cardiac patients avoided surgery, saving $30,000 per patient in the first year. Studies of over 20,000 participants revealed a nearly 50% reduction in depression scores through the program. President Clinton's adoption of the program helped demonstrate its effectiveness to a broader audience and influenced healthcare policy. The program's core philosophy emphasizes joy and immediate benefits over fear of future consequences, making the changes more sustainable. For disease reversal (versus prevention), patients need 80-100% adherence to the program's principles.

Luba Greenwood and Ash Zenooz interview Jonathan Bush. Jonathan is the CEO of a16z-backed Zus Health, Executive Chairman of Firefly Health and a co-founder of Athena Health. They discuss how the real opportunity lies in using AI to tackle healthcare's mundane "shit work" - like automating administrative tasks and streamlining data entry - rather than pursuing moonshot goals like curing cancer.  — 📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess   🙏 Help shape our show by taking our quick listener survey at https://bit.ly/TurpentinePulse    — SPONSOR:  👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — RECOMMENDED PODCAST: Check out Modern Relationships, where Erik Torenberg interviews tech power couples and leading thinkers to explore how ambitious people actually make partnerships work. Founders Fund's Delian Asparouhov and researcher Nadia Asparouhova kick off the series with an unfiltered conversation about their relationship evolution. Apple: https://podcasts.apple.com/us/podcast/id1786227593  Spotify: https://open.spotify.com/show/5hJzs0gDg6lRT6r10mdpVg  YouTube: https://www.youtube.com/@ModernRelationshipsPod  — LINKS:  Zus Health: https://zushealth.com/  Firefly Health: https://www.firefly.health/  Athena Health: https://www.athenahealth.com/  Subscribe to Second Opinion Newsletter: https://secondopinion.media/  — FOLLOW: https://www.linkedin.com/in/jonathanbushjr/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — HIGHLIGHTS FROM THE EPISODE: Jonathan Bush cuts through the AI hype with characteristic candor. He argues that everyone's getting healthcare AI wrong: The industry is chasing moonshots when the real opportunity lies in automating the mundane administrative work plaguing the system. The problem is painfully basic: patients still write their name and birthday hundreds of times because health data remains trapped in silos. Jonathan sees platforms like Zus, which can consolidate patient records in minutes, as the unglamorous but essential future of healthcare tech. Following the digital health funding frenzy of 2021, Jonathan notes we're now in the "post-beach party" phase – companies are sobering up, focusing on gross margins, and accepting that those sky-high valuations weren't sustainable. Healthcare's obsession with "A students" is stifling innovation. The industry needs both methodical executors and risk-taking "C students" who aren't afraid to push boundaries and hear "no" repeatedly. To founders in the trenches, Jonathan offers sobering advice: get comfortable being "lonely and afraid for a very long time." Healthcare transformation isn't for the faint of heart – but for those willing to tackle unsexy problems, the opportunity remains massive. As healthcare tech enters its next phase, Jonathan’s pragmatic approach to innovation feels particularly timely. Sometimes the biggest breakthroughs come not from chasing the next shiny object, but from solving the basic problems that have frustrated the industry for decades.

In this episode of Second Opinion, Christina Farr is joined by John Zutter, CEO of Lantern, and Matt Harmon,  a long time benefits executive who's worked at fortune 100 companies to discuss the rising costs of healthcare, focusing on how large employers are addressing the financial impacts of treatments like cell and gene therapies and medications such as GLP-1s while exploring the challenges, strategies, and ethical implications of providing affordable healthcare. — 📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess  🙏 Help shape our show by taking our quick listener survey at https://bit.ly/TurpentinePulse  — SPONSOR:  👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — RECOMMENDED PODCAST: Check out Modern Relationships, where Erik Torenberg interviews tech power couples and leading thinkers to explore how ambitious people actually make partnerships work. Founders Fund's Delian Asparouhov and researcher Nadia Asparouhova kick off the series with an unfiltered conversation about their relationship evolution. Apple: https://podcasts.apple.com/us/podcast/id1786227593 Spotify: https://open.spotify.com/show/5hJzs0gDg6lRT6r10mdpVg YouTube: https://www.youtube.com/@ModernRelationshipsPod — LINKS:  Lantern: https://lanterncare.com Subscribe to Second Opinion Newsletter: https://secondopinion.media/  — FOLLOW: https://www.linkedin.com/in/john-zutter-687000a/ https://www.linkedin.com/in/mattharmon/ https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — HIGHLIGHTS FROM THE EPISODE: Healthcare costs for employers are rising dramatically, with some Fortune 100 companies seeing 18% increases in a single year, amounting to hundreds of millions in additional spending. Million-dollar claims, once rare, are now common due to advanced cell and gene therapies (costing up to tens of millions per patient), new expensive medications like GLP-1s, complex surgeries and treatments, and rising rates of cancer and chronic conditions. Smaller employers often can't afford high-cost treatments and may exclude coverage while large employers have more resources to implement specialized programs and networks. About 60% of Americans get healthcare through employers. High employee turnover at some companies (35% annually) makes long-term health investments difficult. GLP-1 Medications Emerging Challenges: High member demand driven by marketing and physician recommendations, long-term ROI unclear due to medication newness, employers implementing prior authorization and step therapy requirements, and alternative access through compounding pharmacies and direct programs.

In this episode of Second Opinion, Christina Farr and Luba Greenwood chat with Mike Desjadon, CEO of Anomaly Health, about the state of American healthcare heading into 2025. Mike breaks down how health insurance companies actually make money and explains why we spend $500 billion just processing medical bills. They discuss the security concerns around J.P. Morgan Healthcare Conference after a tumultuous 2024, explore why pharma companies really aren't making money from vaccines, and unpack how Ozempic transformed endocrinology from an overlooked specialty to the most coveted medical fellowship in the country. The conversation wraps with realistic predictions for healthcare in 2025. Thanks to our sponsor, Midi Health. — 📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess  🙏 Help shape our show by taking our quick listener survey at https://bit.ly/TurpentinePulse  — SPONSOR:  👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — RECOMMENDED PODCAST: Check out Modern Relationships, where Erik Torenberg interviews tech power couples and leading thinkers to explore how ambitious people actually make partnerships work. Founders Fund's Delian Asparouhov and researcher Nadia Asparouhova kick off the series with an unfiltered conversation about their relationship evolution. Apple: https://podcasts.apple.com/us/podcast/id1786227593 Spotify: https://open.spotify.com/show/5hJzs0gDg6lRT6r10mdpVg YouTube: https://www.youtube.com/@ModernRelationshipsPod — LINKS:  Anomaly: https://www.findanomaly.com/ Subscribe to Second Opinion Newsletter: https://secondopinion.media/  — FOLLOW: https://www.linkedin.com/in/mike-desjadon-4a0a21a/ https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — HIGHLIGHTS FROM THE EPISODE: 2024 was marked by several major healthcare events including a massive Change Healthcare cybersecurity breach, increased PBM scrutiny, Trump's election, and the tragic shooting of UnitedHealthcare CEO Brian Thompson. While security concerns exist for the upcoming JP Morgan Healthcare Conference, high hotel costs remain the primary deterrent for attendees, with many companies opting for nearby meetings instead of conference attendance. The Change Healthcare hack exposed a critical transparency issue when Americans learned that a single company had access to half of the nation's health data. The U.S. healthcare system spends $4 trillion annually, with $500 billion going to administrative costs in a complex third-party payment system where insurance companies operate on 4-6% margins and health systems on 0-4% margins. While the U.S. healthcare system is more expensive and less efficient than other countries', it offers advantages like shorter wait times and fewer age-based restrictions on procedures. The pharmaceutical industry faces significant challenges in drug development, with high failure rates and complex manufacturing processes for modern drugs, while vaccines typically don't generate major profits. For 2025, industry experts predict an increase in biotech IPOs, expansion of Medicare Advantage, potential separation of PBMs from vertically integrated entities, and greater scrutiny of PBM relationships by employers. The healthcare industry needs better transparency in pricing and in insurance plan coverage. The system incentivizes volume-based care rather than preventive care, which is evident in both payment structures and professional specialization trends. The rise of GLP-1 drugs has transformed endocrinology from one of the least desired medical specialties to the most coveted fellowship program.

Ash Zenooz and Luba Greenwood interview Andrea Ippolito about her extensive career in healthcare spanning academia, government, and the private sector, as well as her current role as founder and CEO of SimpliFed. They discuss the intricacies of government roles, the importance of women's health, and the evolving landscape of maternal health care and entrepreneurship. For full show notes, visit: https://highlightai.com/share/2c96255c-b8e5-4469-855f-dc5c22f6a339 — 📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess  🙏 Help shape our show by taking our quick listener survey at https://bit.ly/TurpentinePulse  — RECOMMENDED PODCAST: Check out Modern Relationships, where Erik Torenberg interviews tech power couples and leading thinkers to explore how ambitious people actually make partnerships work. Founders Fund's Delian Asparouhov and researcher Nadia Asparouhova kick off the series with an unfiltered conversation about their relationship evolution. Apple: https://podcasts.apple.com/us/podcast/id1786227593 Spotify: https://open.spotify.com/show/5hJzs0gDg6lRT6r10mdpVg YouTube: https://www.youtube.com/@ModernRelationshipsPod — SPONSORS: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — LINKS:  SimpliFed: https://www.simplifed.com/ Subscribe to Second Opinion Newsletter: https://secondopinion.media/  — FOLLOW: https://www.linkedin.com/in/andreakippolito  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — TIMESTAMPS: (00:00) Intro (02:04) Andrea's government experience (02:41) Impact of political transitions (03:25) Challenges and opportunities in women's health (10:52) SimpliFed: A journey in women's health (14:12) Scaling SimpliFed (16:43) Fundraising in women's health (20:55) The future of women's health (23:09) Impact of abortion regulations on valuations (23:56) Trends in fertility and IVF (24:22) High-risk conditions in maternal health (25:14) Veterans' healthcare benefits (26:20) Advocating for change through Congress (29:53) Drug pricing and international policies (39:37) Encouraging innovation in women's health (41:11) The Debrief

Luba Greenwood and Ash Zenooz discuss the evolving biotech landscape, the impact of AI on drug discovery, the importance of using real-world evidence in drug development, and personal motivations for continuing efforts in the biotech field. For full show notes, visit: https://highlightai.com/share/f4d42739-65df-42d9-a6b4-6c1327705d7a  — 📰Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess   — RECOMMENDED PODCAST: Check out Modern Relationships, where Erik Torenberg interviews tech power couples and leading thinkers to explore how ambitious people actually make partnerships work. Founders Fund's Delian Asparouhov and researcher Nadia Asparouhova kick off the series with an unfiltered conversation about their relationship evolution. Apple: https://podcasts.apple.com/us/podcast/id1786227593 Spotify: https://open.spotify.com/show/5hJzs0gDg6lRT6r10mdpVg YouTube: https://www.youtube.com/@ModernRelationshipsPod — SPONSORS: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. 📝 Notion offers powerful workflow and automation templates, perfect for streamlining processes and laying the groundwork for AI-driven automation. With Notion AI, you can search across thousands of documents from various platforms, generating highly relevant analysis and content tailored just for you - try it for free at notion.com/upstreampod 🕵️‍♂️ Take your personal data back with Incogni! Use code ECON102 at the link below and get 60% off an annual plan: https://incogni.com/econ102 — LINKS: Gallup Oncology: https://www.galloponcology.com/ PureTech Health: https://www.puretechhealth.com/  — FOLLOW: https://www.linkedin.com/in/christinafarr/  https://www.linkedin.com/in/lubagreenwood/  https://www.linkedin.com/in/ashzenooz/

Christina Farr, Ash Zenooz, and Luba Greenwood are joined by Zeke Emanuel, a prominent oncologist, bioethicist, and influential voice in healthcare to discuss the impact of GLP-1 drugs, healthcare affordability, Trump's appointments, and AI in medicine. The second half of the episode was recorded a week after Trump's election victory. For full show notes, visit: https://highlightai.com/share/dd71470c-2a01-4cfa-a011-5597a86efdf5 — 🙏 Help shape our show by taking our quick listener survey at https://bit.ly/TurpentinePulse. — RECOMMENDED PODCAST: Unpack Pricing Dive into the dark arts of SaaS pricing with Metronome CEO Scott Woody and tech leaders. Learn how strategic pricing drives explosive revenue growth in today's biggest companies like Snowflake, Cockroach Labs, Dropbox and more. Apple: https://podcasts.apple.com/us/podcast/id1765716600 Spotify: https://open.spotify.com/show/38DK3W1Fq1xxQalhDSueFg — SPONSORS: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. 📝Notion offers powerful workflow and automation templates, perfect for streamlining processes and laying the groundwork for AI-driven automation. With Notion AI, you can search across thousands of documents from various platforms, generating highly relevant analysis and content tailored just for you - try it for free at notion.com/upstreampod — FOLLOW: https://www.linkedin.com/in/zeke-emanuel-6ab78a1b0/ https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/

Christina Farr and Ash Zenooz discuss the recent departures of prominent female CEOs from major healthcare companies and explore why progress in female leadership representation has been challenging in the healthcare industry. For full show notes, visit: https://highlightai.com/share/f0e550de-d7d5-49bd-96ea-700dde222ccc  — 📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess   — RECOMMENDED PODCAST: 🎙️ Unpack Pricing - Dive into the dark arts of SaaS pricing with Metronome CEO Scott Woody and tech leaders. Learn how strategic pricing drives explosive revenue growth in today's biggest companies like Snowflake, Cockroach Labs, Dropbox and more. Apple: https://podcasts.apple.com/us/podcast/id1765716600 Spotify: https://open.spotify.com/show/38DK3W1Fq1xxQalhDSueFg — SPONSORS: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. __ LINKS: HLTH: https://www.hlth.com/  — FOLLOW: https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/

In this episode of Second Opinion, hosts Christina Farr, Ash Zenooz, and Luba Greenwood interview Rob Perez, founder of Life Science Cares, about his work bridging the biotech industry with poverty alleviation efforts. For full show notes, visit: https://highlightai.com/share/f3eb77b0-b71c-40fe-817e-bd3c1b4dc5b4  — RECOMMENDED PODCAST: 🎙️ Unpack Pricing - Dive into the dark arts of SaaS pricing with Metronome CEO Scott Woody and tech leaders. Learn how strategic pricing drives explosive revenue growth in today's biggest companies like Snowflake, Cockroach Labs, Dropbox and more. Apple: https://podcasts.apple.com/us/podcast/id1765716600 Spotify: https://open.spotify.com/show/38DK3W1Fq1xxQalhDSueFg __ SPONSOR: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. __ LINKS: Life Science Cares: https://lifesciencecares.org/ Project OnRamp: https://lifesciencecares.org/project-onramp/ Subscribe to Second Opinion Newsletter: https://secondopinion.media/  — FOLLOW: https://www.linkedin.com/in/rob-perez-93707916/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/

Dr. Lloyd Minor, Dean of Stanford School of Medicine joins Christina Farr, Ash Zenooz, and Luba Greenwood to discuss the various transformative advancements and challenges in healthcare, focusing on the equitable use of AI and technology to enhance patient care, improve medical training, and address labor shortages. They dive into AI’s role in imaging, pathology, and electronic health records, as well as innovative approaches in medical education.  — SPONSOR: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — LINKS:  Stanford Medicine: https://med.stanford.edu/ RAISE Health: https://med.stanford.edu/raisehealth  Subscribe to Second Opinion Newsletter: https://secondopinion.media/   — FOLLOW https://www.linkedin.com/in/lloydminor/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — TIMESTAMPS: (00:00) Intro (03:50) Challenges in healthcare and potential solutions (06:49) AI in medical practice (11:01) The future of medical education (19:33) Encouraging careers in medicine (28:56) Preventative care and health policy (31:46) Advances in cancer treatment (32:48) Innovations in early diagnosis and preventative strategies (33:18) Challenges in the US healthcare system (34:17) Reflections on academic leadership during Covid-19 (35:50) Stanford's response to the Covid-19 crisis (38:49) Balancing academic freedom and public health (40:37) Practical solutions during the pandemic (41:20) Innovations in healthcare (42:37) The future of ai and digital health (49:11) The debrief

In this episode of Second Opinion, Christina Farr, Ash Zenooz, and Luba Greenwood discuss the integration and evaluation of digital tools in healthcare with guest Caroline Pearson from the Peterson Health Technology Institute. They explore the challenges in demonstrating clinical effectiveness and affordability of digital health solutions, using diabetes management tools as a case example. They address the role of evidence in the healthcare system, potential biases in standard evaluation practices, and the need for improved data sharing between digital health companies and traditional healthcare providers. — SPONSOR:  👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — LINKS:  Peterson Health Technology Institute: https://phti.org/ Peterson Center on Healthcare: https://petersonhealthcare.org/  Nonlinear dynamics of multi-omics profiles during human aging: https://www.nature.com/articles/s43587-024-00692-2  New Report Finds That Digital Diabetes Management Tools Fail to Deliver Meaningful Health Benefits to Patients While Increasing Spending: https://phti.org/announcement/new-report-finds-that-digital-diabetes-management-tools-fail-to-deliver-meaningful-health-benefits-to-patients-while-increasing-spending/  Subscribe to Second Opinion Newsletter: https://secondopinion.media/   — FOLLOW: https://www.linkedin.com/in/pearsoncaroline/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — TIMESTAMPS: (00:00) Intro (01:39) Discussion about super aging (02:54) Introducing Caroline Pearson (04:16) Challenges in digital health solutions (05:58) The role of evidence in digital health (16:41) Employer-sponsored health insurance concerns (20:05) Collaboration and data sharing in health tech (32:05) The future of health tech and patient outcomes (33:30) Conclusion and final thoughts (34:37) The debrief

In this episode of Second Opinion, Christina Farr, Ash Zenooz, and Luba Greenwood discuss the evolving landscape of healthcare leadership with Oxeon CEO Sonia Millsom. They explore what makes a great healthcare CEO, covering current talent market trends, qualities of successful leaders, and the valuable roles of executive chairs in a company. Sonia offers invaluable insights into the art of relationship-building, the importance of rigorous candidate evaluation, and the strategic decision-making that fuels successful hiring and partnerships — RECOMMENDED PODCAST:  🎙️Turpentine VC Investor Erik Torenberg interviews partners at the top VCs in the world to learn their approach to the art and science of building a successful venture firm. Apple: https://podcasts.apple.com/us/podcast/id1701006772 Spotify: https://open.spotify.com/show/3Yb8ErLRnyoAqn4Y6NegTx — SPONSOR: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. — LINKS:  Oxeon: https://www.oxeon.com/ Subscribe to Second Opinion Newsletter: https://secondopinion.media/   — FOLLOW: https://www.linkedin.com/in/sonia-millsom-a1b993a/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — TIMESTAMPS: (00:00) Intro (03:28) Current market dynamics and talent trends (06:04) Challenges and changes in the C-suite (12:38) The reality of being a first-time CEO (15:53) Hot and cold: trends in healthtech (19:40) Negotiating offers and equity (23:06) Understanding company valuations (24:52) Breaking into the tech industry (26:17) Advisory work and board positions (27:14) Challenges and importance of board chairs (28:37) Effective interviewing and hiring practices (30:59) The human element in recruitment (38:05) The debrief

In this episode of the Second Opinion Podcast, Christina Farr, Ash Zenooz, and Luba Greenwood engage in a candid conversation with Dr. Isaac (Zak) Kohane, a renowned AI expert and chair at Harvard Medical School's Department of Biomedical Informatics.  Zak expresses his optimism about AI in healthcare, sharing personal anecdotes to illustrate how tools like ChatGPT can enhance patient care by providing detailed and understandable information, and highlights AI's potential to address healthcare system gaps by complementing human doctors. They explored regulatory issues, data privacy concerns, and the importance of patient control over their health data, while emphasizing the need for a balanced approach that prioritizes patient care and ethical guidelines. — SPONSORS: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. 🩺 AWELL: Transform your healthcare operations with Awell! Say goodbye to manual work and Excel hell. Awell's CareOps orchestration platform helps design, implement, and improve care flows in days. Trusted by Astrana Health, Commons Clinic, and Better Health, Awell automates processes for faster care model improvements in 2 days or less. Visit awellhealth.com and mention Second Opinion for a free bootcamp. — LINKS:  Department of Biomedical Informatics at Harvard Medical School: https://dbmi.hms.harvard.edu/  NEJM AI, a journal from the publishers of the New England Journal of Medicine: https://www.nejm.org/  The AI Revolution in Medicine: GPT-4 and Beyond: https://www.amazon.com/AI-Revolution-Medicine-GPT-4-Beyond-ebook/dp/B0BXNVM6FC AMIE: A research AI system for diagnostic medical reasoning and conversations: https://research.google/blog/amie-a-research-ai-system-for-diagnostic-medical-reasoning-and-conversations/  Medical Artificial Intelligence and Human Values: https://www.nejm.org/doi/full/10.1056/NEJMra2214183  Transformer: A Novel Neural Network Architecture for Language Understanding: https://research.google/blog/transformer-a-novel-neural-network-architecture-for-language-understanding/  Subscribe to Second Opinion Newsletter: https://secondopinion.media/   — FOLLOW: https://www.linkedin.com/in/isaac-kohane-729b03  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — TIMESTAMPS: (00:00) Intro (02:24) Skepticism in advanced technology (04:56) AI in Medicine: Personal Anecdotes (07:29) Challenges in healthcare access (08:26) The role of ai in patient empowerment (11:26) Human clinicians vs. AI (19:45) Sponsor: Awell (20:57) Privacy concerns with AI (25:13) HIPAA compliance and medical data (26:19) Bias and alignment in AI models (29:00) The role of AI in medical decision making (33:13) Challenges in AI regulation (38:21) The future of AI in healthcare (43:56) Wrap (45:05) The Debrief

In this episode of Second Opinion, Christina Farr is joined by Carine Carmy, CEO of Origin to discuss the overlooked aspects of women's healthcare, a case for a physical clinic, and funding stigmatized fields within the complex healthcare landscape. Carine shares valuable insights on scaling the business, the importance of evidence-based care, and the future of pelvic health, including the potential impact of AI and digital health. — RECOMMENDED PODCAST: 🎙️This Won't Last Eavesdrop on Keith Rabois, Kevin Ryan, Logan Bartlett, and Zach Weinberg's monthly backchannel. They unpack their hottest takes on the future of tech, business, venture, investing, and politics. Apple Podcasts: https://podcasts.apple.com/us/podcast/this-wont-last-with-keith-rabois-kevin-ryan-logan/id1765665937 Spotify: https://open.spotify.com/show/2HwSNeVLL1MXy0RjFPyOSz YouTube: https://www.youtube.com/@ThisWontLastpodcast  — SPONSORS: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. 🩺 AWELL. Transform your healthcare operations with Awell! Say goodbye to manual work and Excel hell. Awell's CareOps orchestration platform helps design, implement, and improve care flows in days. Trusted by Astrana Health, Commons Clinic, and Better Health, Awell automates processes for faster care model improvements in 2 days or less. Visit awellhealth.com and mention Second Opinion for a free bootcamp. — LINKS: Subscribe to Second Opinion Newsletter: https://secondopinion.media/  Origin: https://www.theoriginway.com/  — FOLLOW: https://www.linkedin.com/in/carinecarmy/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — TIMESTAMPS: (00:00) Intro (01:43) The origin story of Origin (03:31) Challenges in women's health (04:02) Understanding pelvic floor therapy (05:10) Pain and gaslighting in healthcare (07:39) Building a business in women's health (10:16) Navigating health plan coverage (13:51) Sponsor: Awell (15:02) Scaling and fundraising challenges (17:42) Clinic setup and expansion (25:36) The importance of evidence-based care (29:05) Wrap

In this episode of Second Opinion, hosts Christina Farr, Ash Zenooz, and Luba Greenwood dive into the intricacies of the behavioral health industry with Alex Katz, CEO of Two Chairs. They discuss the misconceptions and challenges within the mental health system, the importance of finding the right therapeutic fit, and the impact of venture capital in driving both quality and accessibility in mental health services. Alex highlights the need for personalized care, the evolving perception of therapy thanks to platforms like TikTok, and the potential and limitations of AI in therapy, emphasizing the irreplaceable value of human therapists. — RECOMMENDED PODCASTS: 🎙️This Won't Last Eavesdrop on Keith Rabois, Kevin Ryan, Logan Bartlett, and Zach Weinberg's monthly backchannel. They unpack their hottest takes on the future of tech, business, venture, investing, and politics. Apple Podcasts: https://podcasts.apple.com/id1765665937 Spotify: https://open.spotify.com/show/2HwSNeVLL1MXy0RjFPyOSz YouTube: https://www.youtube.com/@ThisWontLastpodcast 🎙️Turpentine VC Investor Erik Torenberg interviews partners at the top VCs in the world to learn their approach to the art and science of building a successful venture firm. Apple: https://podcasts.apple.com/us/podcast/id1701006772 Spotify: https://open.spotify.com/show/3Yb8ErLRnyoAqn4Y6NegTx — SPONSORS: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. 🩺 AWELL. Transform your healthcare operations with Awell! Say goodbye to manual work and Excel hell. Awell's CareOps orchestration platform helps design, implement, and improve care flows in days. Trusted by Astrana Health, Commons Clinic, and Better Health, Awell automates processes for faster care model improvements in 2 days or less. Visit awellhealth.com and mention Second Opinion for a free bootcamp. — LINKS: Subscribe to Second Opinion Newsletter: https://secondopinion.media/  Two Chairs: http://www.twochairs.com/  — FOLLOW: https://www.linkedin.com/in/alexjkatz/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — TIMESTAMPS: 00:00 Intro 01:14 Behavioral health industry insights 02:04 Alex Katz's journey with Two Chairs 05:02 Navigating the mental health landscape 08:22 Business models in mental health 14:04 Barriers to mental health access 16:08 Sponsor: Awell 19:56 Behavioral health companies and cost reduction 22:00 The crisis in therapy retention 23:41 Youth mental health challenges 25:40 Gen Z and therapy culture 29:14 The importance of hybrid care models 31:31 Skepticism around ai therapists 36:00 The Debrief

In this episode of Second Opinion, Leslie Schrock, author of Bumpin' and Fertility Rules, joins Christina Farr, Ash Zenooz, and Luba Greenwood to discuss women's health, men's health, and fertility. They dive into why men need to be more involved in fertility and pregnancy conversations (it's not just a women's issue!). They address the gaps in women's health research, including the lack of understanding about how drugs and diets (like intermittent fasting) affect women differently than men. Leslie emphasizes the need for more honest, comprehensive information about pregnancy and women's health. They also discuss the potential future of women's health companies and the need for a more holistic approach to addressing health concerns beyond reproductive issues. — RECOMMENDED PODCAST: 🎙️ This Won't Last - Eavesdrop on Keith Rabois, Kevin Ryan, Logan Bartlett, and Zach Weinberg's monthly backchannel. They unpack their hottest takes on the future of tech, business, venture, investing, and politics. Apple Podcasts: https://podcasts.apple.com/us/podcast/id1765665937 Spotify: https://open.spotify.com/show/2HwSNeVLL1MXy0RjFPyOSz YouTube: https://www.youtube.com/@ThisWontLastpodcast — SPONSORS: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. 🩺 AWELL. Transform your healthcare operations with Awell! Say goodbye to manual work and Excel hell. Awell's CareOps orchestration platform helps design, implement, and improve care flows in days. Trusted by Astrana Health, Commons Clinic, and Better Health, Awell automates processes for faster care model improvements in 2 days or less. Visit awellhealth.com and mention Second Opinion for a free bootcamp. — LINKS: Subscribe to Second Opinion Newsletter: https://secondopinion.media/  Bumpin: https://www.amazon.com/Bumpin-Pregnancy-Navigating-Wonderful-Conception/dp/198213044X  Fertility Rules: https://www.amazon.com/Fertility-Rules-Definitive-Female-Reproductive-ebook/dp/B0BHTLCWZ7  — FOLLOW: Leslie: https://www.linkedin.com/in/leslieschrock/  Christina: https://www.linkedin.com/in/christinafarr/ Luba: https://www.linkedin.com/in/lubagreenwood/ Ash: https://www.linkedin.com/in/ashzenooz/ — TIMESTAMPS: (00:00) Intro (01:37) Leslie Schrock's personal journey (02:57) The reality of pregnancy (06:55) Understanding fertility and ovulation (08:47) Challenges in women's health education (13:50) Sponsor: Awell (15:00) Investing in women's health (25:54) Understanding drug metabolism in women (26:09) Men's role in women's health (26:38) The importance of inclusive pregnancy literature (28:45) Heart health: gender differences and misconceptions (30:50) Birth control and stroke risks (31:46) Challenges in women's health research (37:11) The impact of nutrition and fasting on women's health (39:19) Future of women's health companies (41:09) Suggestions on future books and research in women's health (43:55) Wrap (46:07) The debrief

In this episode of Second Opinion, hosts Christina Farr, Ash Zenooz, and Luba Greenwood sit down with Owen Tripp, the CEO of Included Health. They discuss digital health models, the challenges and opportunities in selling directly to employers, growing digital health companies, and the potential return to a more personalized, concierge-style primary care model to actually make a difference in people's health. — RECOMMENDED PODCAST: 🎙️ This Won't Last - Eavesdrop on Keith Rabois, Kevin Ryan, Logan Bartlett, and Zach Weinberg's monthly backchannel. They unpack their hottest takes on the future of tech, business, venture, investing, and politics. Apple Podcasts: https://podcasts.apple.com/us/podcast/id1765665937 Spotify: https://open.spotify.com/show/2HwSNeVLL1MXy0RjFPyOSz YouTube: https://www.youtube.com/@ThisWontLastpodcast — SPONSORS: 👩‍⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit joinmidi.com to book your virtual visit today. 🩺 AWELL. Transform your healthcare operations with Awell! Say goodbye to manual work and Excel hell. Awell's CareOps orchestration platform helps design, implement, and improve care flows in days. Trusted by Astrana Health, Commons Clinic, and Better Health, Awell automates processes for faster care model improvements in 2 days or less. Visit https://awellhealth.com and mention Second Opinion for a free bootcamp. — LINKS:  Subscribe to Second Opinion Newsletter: https://secondopinion.media/  Thinking of selling into the employer? You probably shouldn't: https://secondopinion.media/p/thinking-of-selling-into-the-employer  The thing that is breaking digital health is marketing: https://secondopinion.media/p/the-thing-that-is-breaking-digital — FOLLOW: https://www.linkedin.com/in/owenwtripp/  https://www.linkedin.com/in/christinafarr/ https://www.linkedin.com/in/lubagreenwood/ https://www.linkedin.com/in/ashzenooz/ — TIMESTAMPS: (00:00) Intro (01:16) Owen Tripp's journey in digital health (02:04) Challenges in healthcare vs. other sectors (03:29) Building a business model in healthcare (05:07) Grand Rounds: from concept to success (08:07) The role of AI in healthcare (13:48) Sponsor: Awell (14:50) Growth strategies in digital health (17:33) Selling digital health solutions to employers (19:10) Cancer care and digital health (22:22) Navigating employer sales (26:12) Utilization and awareness of digital health services (35:01) The future of digital health and primary care (38:57) The Debrief