Modern Medicine and its Blind Spots — with Dr. Marty Makary

23:57I'm not saying everyone needs to eat it, but it's a good source of protein. And when you're eating meats that are well-sourced, that is a good source of nutrition. The government food pyramid demonized natural fats, moved the entire food industry to ultra-processed foods, and created these refined carbohydrate addictions that drove our obesity epidemic. I like nuts. I like fruits that are not coated with pesticides. It's especially important to buy organic when you're eating the surface of a fruit or vegetable. Strawberry, for example, has been sprayed over a dozen times with 7.8 different pesticides on average.

24:40The average school lunch program may have 38 different types of pesticides detectable. You can detect these things now in the urine of children, in the umbilical cord blood of mothers. So I'd like to eat. These are almost biblical principles, right? Things that grow out of good soil, clean meats, and I do a little bit of intermittent fasting when I can. Talk about intermittent fasting. Why is that helpful? Well, I think in general, people are not getting enough protein. So I'd warn people about just starting to skip meals because you really want to get a good amount of protein in your meal, in your day.

25:21But I just try it because I think it helps manage through a bit of willpower some of the appetite urges that I sense. I'll tell you what had a big impact is when I got rid of artificial sweeteners. The debate about artificial sweeteners got really hijacked by the do or do they not cause cancer argument. But I don't think they do. They've been around for a long time. But what they do is they trick your pancreas into thinking that a big sugar load is coming and it doesn't come. So the pancreas is waiting for that sugar load and it creates a craving and often results in binge eating of carbohydrates later in the day.

26:02So by getting rid of those artificial sweeteners, I think it helped manage my appetite. So which of these topics do you think the public is most informed about? What are the biggest myths in healthcare? Well, I think for perimenopausal women, there's a myth that hormone replacement therapy, that is taking estrogen or estrogen plus progesterone when your body doesn't produce it anymore around the time of menopause, causes cancer. It's one of the greatest dogmas that's still alive and well, both in the medical establishment. And it turns out the study that was cited where people say, aha, here's the study where we show it caused cancer, did not show a statistically significant increase in cancer.

26:45But the announcement was so magnificent and so broad by researchers at the NIH, the media ran with the story before they ever looked at the data. The data were released later, over a week later. And by that time, the world had already been convinced of this dogma. Now, the reason I'm mentioning hormone replacement therapy when you asked what's one of the biggest misconceptions, here's a medication that not only alleviates the symptoms of menopause, the hot flashes, mood swings, weight gain, night sweats, but also has long-term health benefits because the blood vessels are healthier. Nitric oxide levels are higher.

27:27And so heart attack rates in some studies are half, or they're cut in half because women who start hormone therapy within 10 years of the onset of menopause, the rate of cognitive decline goes down by 50 to 60 percent. The rate of Alzheimer's goes down by 35 percent. And a woman has stronger bones and is far less likely to break a bone or have a hip fracture. So the overall long-term health benefits are overwhelming. Women live longer and feel better. But tragically, 50 million women have been denied hormone therapy since the time of this dogma announcement that it causes breast cancer. Do you feel the same way about testosterone replacement therapy?

28:08I don't. It's very different with men and testosterone. Both men and women have testosterone and estrogen. Now, some of the dogma is parallel. For example, the dogma that testosterone therapy causes prostate cancer. Another dogma, like the dogma that hormone therapy in women causes breast cancer, is not supported by the data. Now, there are benefits, and I do recommend people who are symptomatic get tested for their testosterone levels. And I do see people who benefit, men who benefit from testosterone replacement. But the long-term health benefits are not as dramatic as we see with hormone therapy in women.

28:47But if you go on testosterone replacement therapy at 57 and you find you're stronger, Your skin's a little more youthful. Your sex is a little, your erections are a little bit longer. Do the benefits outweigh the drawbacks? Asking for a friend. Look, yes, most of the time the benefits outweigh any potential downsides. People just need to recognize that if you're still making some pet testosterone on your own, you're probably going to shut that down by taking it exogenously. You're not at the rest of your life. That's what they told me, yeah. And you talk a little bit about the chronic disease problem.

29:27What do you mean by that? And how serious is it for society? Autism has increased 14 % every year for the last 23 years. What's going on? Like, who's looking into this, right? We just keep medicating kids when they come in. It's now 1 in 22 kids in California born today will be diagnosed with autism. I mean, it barely existed. It was rare just two generations ago. It's still rare in the Amish community, in other parts of the world that have not adopted the Western diet. And I think the autism cause discussion has also been hijacked by the is it or is it not vaccines after a fraudulent study suggested it was due to vaccines.

30:10But we got to put that aside and talk about the microbiome, the lining of the GI tract, the garden of bacteria that normally live in harmony, millions of different bacteria that we alter, we throw it off, we carpet bomb it with ultra-processed foods, antibiotics, even C-sections. Antibiotics and C-sections can save lives, but they're massively overused, especially antibiotics. And a study just found that kids who take antibiotics in the first couple of years compared to kids who do not have higher rates of learning disabilities and obesity and celiac and asthma. And you may wonder, how could altering the microbiome affect mental illness?

30:56Well, some of those bacteria make serotonin. And if you look at the diets of people in Europe, it's very different. They have far less chemicals. They have lower rates of mental illness, of autism, of obesity, of autoimmune diseases. Autoimmune diseases now affect one in five women. What's going on here? You know, my field is pancreatic cancer. As a surgeon at Johns Hopkins that specializes in the pancreas, pancreatic cancer rates are going up and no one is asking why. We do more pancreatic cancer work than any hospital, more pancreatic cancer research than any center in the country. Nobody is asking why.

31:39We've got to ask these big questions and talk about root causes. It's interesting because I think of pancreatic cancer as a death sentence. I just think it's game over. Is that not true? So of those who get to surgery, which is a subgroup, maybe 20 to 30 percent of people can have the option of having surgery. The five-year survival rate's about 20%. So it's pretty bleak, and we have not made a lot of progress in the last 30 to 40 years. So I think that we've got to talk about root causes. Same thing with Alzheimer's. Alzheimer's is skyrocketing, and we spend billions of dollars on these expensive new medications that get a lot of excitement that, honestly, they barely work, and they have high side effects.

32:29And we're not talking about the study that the Mediterranean diet was found to reduce Alzheimer's significantly. Hormone therapy in perimesopausal women reduced Alzheimer's by 35%. And Alzheimer's is associated with poor quality sleep on a chronic basis. So we could do a better job talking about these underlying root issues. I mean, it sounds like, and common sense is obviously where the inside is. I've had doctors Atia and Huberman on my podcasts. I'm always amazed how much shit they get because what they say to me feels pretty common sense. Get good sleep, eat better, eat out less, eat at home more, more grains, more vegetables, less processed food, and make sure you get some exercise.

33:18I mean, I'm not saying these things are easy, but aren't they pretty basic? And what you're talking about is preventive, offensive health care as opposed to defensive health care after something's gone wrong. Is that accurate? Look, I can tell you Peter Attia was with us at Johns Hopkins, and he is as superb as they get, evidence-driven, science-based, logical, common sense, and lives what he says. And so a bunch of us now are going directly to the public to try to educate them about these issues. So yes, it is common sense, but you'd be amazed. 90 plus percent of our food supply is sprayed by pesticides and multiple times.

33:56You just saw the court case now open up the window to removing fluoride from drinking water, or at least not adding it. This was a dogma for decades that we had to have fluoride in drinking water because it supposedly reduced risks of cavities. Well, how about stop drinking sugary drinks if we want to reduce cavities. And if the fluoride is killing the bacteria in the mouth, reducing cavities, what do you think it's doing to the microbiome bacteria in the gut? So these are the big questions we've not been asking that we need to ask. We'll be right back.

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36:32and they've replaced it with drugs, ketamine, MDMA, edibles. Give me your thoughts on the health impacts of alcohol versus psilocybin versus some of these designer drugs, for lack of a better reason. And I recognize that ideally you don't do any of these things. Well, and I'll cut to the chase. I drink way too much. It's where my health falls down. Imagine you're someone who is always probably going to have a certain level of substances in their life, because correctly or incorrectly, they've identified it enhances their life. What substances would you stay away from, and how do you feel about the impacts of some of these more trendy designer drugs?

37:18Well, I can tell you about alcohol. So as a doctor who has dealt with liver and pancreatic issues for a long time, if there ever were any tiny benefits to the heart from drinking a glass or two of wine a day, they are far eclipsed by the damage done to the liver. So people are, look, I understand people have their rituals and if they want to drink a glass of alcohol, I think it's safer than cocaine. But more people die of alcohol abuse than opioids and fentanyl. And so I think we don't talk enough about the abuse potential as people need just to be mindful of that because it's one of these things that it's in our blind spots in medicine.

38:05We just sort of ignore the fact that we have up to 170 ,000 deaths a year from alcohol. We don't need to be celebrating and glorifying abuse of alcohol and can promote more responsible drinking. And for those who choose not to drink or drink rarely, which is what I do, you're going to probably sleep a little better and sometimes have a healthier liver. What do you think of like ketamine, MDMA? I was shocked how many young people would either not drink, nurse a drink, but they were on ketamine or MDMA. Well, it's a mixed story because, sure, while we don't see the same deaths as we do from heroin with some of those external exogenous drugs, there is the potential for abuse.

38:59You just saw the Star of Friends suffer with ketamine overdosing. It can be addictive. In the past, we used to use lower doses. Now that it's more available and people are trying it, there's an abuse potential people may not be aware of when they first try it. So, I mean, I'm probably not the best expert to answer those questions, but certainly we see an abuse potential pretty broad. Marijuana is one that I know more about. I wrote about in the book Blind Spots. There's a dogma that it's totally safe. And I try to dispel some of that because, sure, it's safer than cocaine. But the idea that, oh, it's not a gateway drug, we may want to believe that, but that's not really what's supported by the data.

39:49Say you use it once or twice a week to help sleep and wind down instead of alcohol, and it hasn't been a gateway drug. Again, asking for a friend. What are your thoughts on edibles? Marijuana today is not the marijuana of Woodstock. It's about 10 to 20 times more potent, so you want to watch those doses. You want to be aware of the fact that it acts differently in an adult than it does in an adolescent, where a developing mind may be more susceptible to the risks of future psychoses. In one study, 25 % of people who use it regularly as a teenager will go on to have some psychosis-related diagnosis in the future.

40:27So it may be more dangerous in the developing mind in adolescence. You said in an interview with PragerU that there's no reason anyone should ever sign a financial document in an emergency. You suggest to write, did not read, or this is not a contract instead. What did you mean by that? Yeah. So by law, hospitals are required to take care of you for any urgent or emergent situation. And what hospitals increasingly have been doing is putting this financial contract telling you, almost manipulating you to sign your life, home, mortgage, retirement, savings away under penalty of law just to be treated.

41:06And that is, if it doesn't violate the letter of the law, it violates the spirit of the law. You don't have to sign your forms away. My team has done a lot of work on hospital price gouging and predatory billing. And we found that hospitals sometimes sue patients in court to garnish their wages. This violates everything sacred in our profession. Hospitals are there as a safe haven to take care of somebody and manipulate them to sign their life away financially, I think is predatory. I don't think anyone should ever sign a financial document in an emergency room. So I'll put forward another thesis, and I want to get your response.

41:45The majority of advanced nations have nationalized health care, spend about$6 ,500 per citizen on health care. We spend$12 ,000 to$13 ,000, yet we have worse outcomes, higher infant mortality, lower age expectancy. And yet the insurance industry, who has inserted themselves in the middle here, 45 cents on the dollar goes to administration and profits, which as far as I can tell in terms of math, is responsible for the difference between what other nations spend on health care and what we spend. Hasn't basically the industrial health complex weaponized government inserted profit institutions to the expense of American citizens?

42:22I think there's a lot of truth in what you're saying. The question is, what's the solution? And I've spent a lot of time in my tenure as sort of as a health policy expert at Johns Hopkins talking about different health care systems. And I'm convinced there's a better model than what we have now. At the same time, while there's an attractiveness to moving to a single payer system, you cut a lot of the waste in the short term. A lot of the middlemen and the people profiteering off of, say, our billing and coding system. And ultimately, governments cannot resist 10, 20 years down the road doing across the board tightenings of the belt.

43:06And what it ends up doing is resulting in an underfunding of the health care system. And we've seen that even with our own government system, Medicare. It's massively underfunded and it just becomes a declining priority after the initial enthusiasm to have some government. So it's a mixed picture. I tend to focus on what's feasible. And right now, my concern is we can have the most gold-plated health insurance for every American. We can fix our broken health care financing. But if we are still recommending bad practices and not addressing our poison food supply, we're going to keep watching these chronic diseases extend.

43:46So it feels as if many of these roads lead back to preventive health care, specifically around our food supply system. How do we fix that? Is it taxing these foods to their, I mean, my understanding is if you just, if you just priced water at its real cost, beef would be 20 or$30 a pound. If you, you know, Bloomberg wanted to tax big gulps, is it taxing these companies? How do you, how do you address the externalities and fix, is it more regulation, more pricing that reflects the damage of the externalities here? How do we create a healthier food supply system? So, Scott, you're talking to a guy who's studied a lot of the unintended consequences of well-intended government policies.

44:29So I'm a little leery of things like strong government interventions. And so what I would suggest is the government needs to stop spreading misinformation about food and nutrition. They need to stop purchasing with U.S. tax dollars dangerous foods. We do this in almost every school lunch program in the United States. Heck, we strip the fiber out of the food and feed it to kids like sugar and call it bread, even though it's really not bread. And we've got to sometimes help support these school lunch programs with subsidies to buy healthier foods. Curious to get your thoughts on GLP-1 drugs. We're clearly seeing a reduction in short-term health complications when people lose weight.

45:13But just like you're losing excess body fat, you're also losing muscle mass. So everyone who prescribes these drugs is supposed to technically be saying that you're supposed to exercise like crazy and eat a high-protein diet. But in the real world, people are not necessarily doing that. And we don't know what the long-term consequences are of losing all that excess muscle mass. Here's one little fact people may not be aware of. The number one predictor of how long you live is your muscle mass. So we may be accelerating frailty and even shortening lifespan despite the reduction in health complications in the short term.

45:52God, that's wild. So everything I read about Ozempic, every year I do a prediction seminar on technologies. And I said that in 2024, the most seminal technology breakthrough was GLP-1 drugs. The stuff I've read reduces alcohol consumption, biting nails. They're talking about giving it to people with gambling and social media addictions. Am I overestimating the impact this might have on our society? I'm a little cautious about the premature celebration that we may now have a drug to treat addiction. And it may be a secondary effect, because you probably feel better about yourself when you lose weight and may just have a more positive outlook and better willpower.

46:37So I'm a little cautious when pharma says we have a solution for everything. But I will tell you this, Scott, we are seeing now a new generation of GLP-1 drugs like Ozempic that are about to come to market. There's estimated to be 29 that are going to come to market in the next 20 years or so. And some of these now are designed to block that receptor on the muscle. So it may not reduce muscle mass, as is our concern with Ozempic and Magovia and some of the others. So we'll have to see. But here's a question I pose to most doctors when I talk to them about this topic. Have you seen anybody come off of Ozempic and keep the weight off just from diet and exercise.

47:20I'd like to see that be a nice population of people before I recommend it too broadly. And final question, just something personal. Someone in a high-pressure job, you're obviously very ambitious. Any thoughts on being a good partner when you're trying to have the kind of impact you have and the demands of places on your professional life? Yeah. I think what we've seen is that the happiest communities in America are those with strong social networks. And when you look at the Maslach work at Berkeley on workplace satisfaction, one of the greatest drivers of happiness at the workplace is the amount of positive feedback you get directly as a result of your time and services.

48:06And we're learning now in an amazing study that blew me away as a doctor, that when you energetically and enthusiastically compliment someone else, then you actually increase your own endorphin levels at a level higher than that of an antidepressant. Love that. Be generous. That's the best medicine. Dr. Marty McCary is a renowned surgeon and professor at Johns Hopkins, public health expert and leading advocate for healthcare transparency and a two-time New York Times bestselling author. His latest book, Blind Spots, When Medicine Gets It Wrong and What It Means for Our Health, is out now. He joins us from New York City.

48:47Doctor, I really enjoyed this conversation. Thanks for your good work. I think it's having a real impact. Thanks so much, Scott. Good talking with you. I appreciate it.

49:02Algebra of happiness. You need to find your tribe. I went to this birthday party this weekend for some friends from college. About eight of us met when we pledged ZBT fraternity Alpha Road chapter at UCLA. And I think if you're a young person or even an older person that wakes up and realizes you're one of the men that, one of the one in seven men that doesn't have a single friend or one in the four men that can't name a best friend, you have to find your posse. And I don't care if it's a church group, a sports league, a nonprofit, whatever it is, temple, a fraternity, a sorority, a club at work that gets together on a regular basis.

49:44Seek out a group of virtuous men who are intelligent and express friendship. Try and get together with them. I don't care. It's poker and start finding your tribe. Because here's the thing. By the time you get to my age, all you have literally is love and camaraderie for these people. And I went to this party Saturday night and I met all of their kids and all of their wives. And it's literally this tide pool, this epicenter, this volcano of achievement, prosperity, love, and friendship. and all the bullshit just sort of melts away. And you feel loved and you get so much reward from these friendships.

50:30And we've done a really good job. We go every year to Las Vegas for the last, or every other year, I should say, for the last 40 years. We know each other all so well. And there's something about investing in relationships when you're young. It's like compound interest. And that is you wake up one day and you just have a mess of great friends that bring you enormous reward, enormous comfort. But it starts with the tribe. And especially young men, I worry that we're developing into a different species where we're comfortable being alone, sequestering from society, becoming much more prone to nationalist or misogynist content.

51:08We start blaming immigrants, start blaming women, start getting angry, start being susceptible to the manosphere, which is nothing but thinly veiled weirdness. It's effort, it's work. Find that group. Lean into it. Be generous. Be open to friendships. You are part of a tribe. Start building yours. This episode was produced by Jennifer Sanchez and Caroline Shagrin, and Drew Burrows is our technical director. Thank you for listening to the Prof G Pod from the Vox Media Podcast Network. We will catch you on Saturday for No Mercy, No Malice, as read by George Hahn. And please follow our Prof G Markets Pod wherever you get your pods for new episodes every Monday and Thursday.

51:53Daddy was here early. Daddy's on time, despite the fact that, oh, fucking dark hundred hours here, he found a way to be on time. But not the millennials. They were walking their dogs and doing ketamine.