American Thought Leaders - Dr. Marty Makary: When Medical Consensus Fails—From Low-Fat Diets to Peanut Bans to Overuse of Antibiotics

Episode Date: September 19, 2024

Sponsor special: Up to $2,500 of FREE silver AND a FREE safe on qualifying orders - Call 855-862-3377 or text “AMERICAN” to 6-5-5-3-2Dr. Marty Makary is a surgeon, professor at Johns Hopkins University, and author of “Blind Spots: What Medicine Gets Wrong, and What It Means for Our Health.”“We’ve got to recognize now the best practices are exactly opposite of what the medical establishment pounded into pediatricians for 15 years,” he says.In this episode, we explore the culture of medical groupthink and cases where health recommendations have produced disastrous results, looking at diabetes, peanut allergies, opioids, C-sections, and the low-fat diet.“The medical establishment created a dogma in 1955 that fat was bad for your health. It was based on one guy: Dr. Ancel Keys,” says Dr. Makary.How can America reverse the trend of chronic disease and poor metabolic health? Is there any hope?“The foundation of the medical profession is not to have a one-size-fits-all. It’s always to consider nuance and to consider scientific detail,” says Dr. Makary.Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

We've got to recognize now the best practices are exactly opposite of what the medical establishment pounded into pediatricians for 15 years. Dr. Marty Makary is a surgeon, a professor at Johns Hopkins University, and author of Blind Spots, What Medicine Gets Wrong and What It Means for Our Health. But the medical establishment created a dogma in 1955 that fat was bad for your health. It was based on one guy, Dr. Ancel Keys. In this episode, we explore the culture of medical groupthink in cases where health recommendations have produced disastrous results. Why are there doctors practicing today with c-section rates of 70-80% in low-risk deliveries. The foundation of the medical profession is not to have a

one-size-fits-all. It's always to consider nuance and to consider scientific detail. This is American Thought Leaders, and I'm Jan Jekielek. Before we start, I'd like to take a moment to thank the sponsor of our podcast, American Hartford Gold. As you all know, inflation is getting worse. The Fed raised rates for the fifth time this year, and Fed Chairman Jerome Powell is telling Americans to brace themselves for potentially more pain ahead. But there is one way to hedge against inflation. American Hartford Gold makes it simple and easy to diversify your savings and retirement accounts with physical gold and silver. With one short phone call, they can have physical gold and silver delivered right to

your door or inside your IRA or 401k. American Hartford Gold is one of the highest rated firms in the country, with an A-plus rating with a Better Business Bureau and thousands of satisfied clients. If you call them right now, they'll give you up to $2,500 of free silver and a free safe on qualifying orders. Call 855-862-3377, that's 855-862-3377. Or text American to 65532. Again, that's 855-862-3377. Or text American to 65532. Dr. Marty McCary, such a pleasure to have you on American Thought Leaders.

Good to be with you, Jan. Thank you. Blind Spot, you make the case that groupthink is actually one of the biggest health issues that we have. Yeah, groupthink's a huge problem. It creates bandwagon thinking. And in the field of science, it creates dogma that can take on a life of its own. And it turns out that dogma can do far more damage than some of the good that's discovered in medical science. So you come up with a huge number of examples, decades of basically bad policy developed out of initially, I guess, an erroneous finding, but then develops the common denominator is this groupthink that develops after, or orthodoxy, that develops afterwards.

I mean, I'll just use one, because this is one I've known about for quite some time, but it still seems to be an issue, peanuts. DAVID FREEMAN, JR.: Well, you're so right. When we as a medical profession use good scientific evidence to make health recommendations, we shine and we help a lot of people. But when we rule by

opinion and issue these edicts based on the opinion of a small group of oligarchs in medicine, we have a terrible track record with health recommendations. And the peanut allergy epidemic today, by and large, was ignited by a bad recommendation about 24 years ago by the American Academy of Pediatrics. Creating an illusion of consensus, they put out a recommendation that all mothers and children zero through three years of age should avoid peanuts. All mothers who are lactating, all mothers who are pregnant, and children zero through three years of age should avoid peanuts altogether. Total peanut abstinence was their idea on how to prevent a peanut allergy from developing. Turns out they got it perfectly backwards.

They forgot about a basic principle in science called immune tolerance. Mothers had known it as the dirt theory. When you're around something in infancy, your immune system learns not to see it as foreign, and you don't become sensitized and allergic to it later on. Because of this catastrophic wrong recommendation by the American Academy of Pediatrics,

putting out their gut feeling to avoid peanuts with no scientific evidence, and put it out with such absolutism that everybody needs to do this, we saw peanut allergies skyrocket. And as this happened with the new recommendation, they thought, well, we just got to get more compliance. We got to double down. If we're going to beat this epidemic, we have to get more people to comply. Mothers that fed their infants a little bit of peanut butter to develop some immune tolerance to it were seen as anti-science and spreading misinformation and uneducated. It turns out they had a lot of wisdom and a group of doctors who had disagreed with this big recommendation

were basically sidelined, they were silenced. Ultimately the science caught up with this bad recommendation into a very severe peanut allergy epidemic where we now saw a new type of allergy common, a severe anaphylactic reaction. That is, a kid is just near a peanut. They don't even consume it. They're near it. They can go into a life-threatening anaphylaxis. And so finally the study got done, a randomized controlled trial.

They took 640 kids, randomized them to peanut abstinence in the first few years of life, or early exposure to peanut butter in the first several months of life and there was a markedly radical difference in peanut allergy development later in life and the scientists believe it's the same for milk and eggs and many other things that should be introduced a little bit early in infancy the study that was eventually published in the New England Journal was embarrassingly simple to do. They could have done it before they put out their recommendation with so much absolutism and when you get it so perfectly wrong, where's the humility to then issue a correction with the same

vigor by which the initial recommendation was put out, really spreading misinformation. And this dogma still lives to this day. We still suffer from a terrible peanut allergy epidemic. Schools have now banned peanuts. And it became a vicious cycle because the more you had to avoid it for those sensitive, the less immune exposure infants got for the next generation. And we created this crazy self-licking ice cream cone, which was perpetuate dogma and address it by more dogma. The science is now clear. The American public deserve an apology. And this is one little peek

into a broader medical establishment that can put out things with such absolutism as if it's based on scientific evidence when the reality is it was just an opinion yeah and you know so I guess the solution right now is you know to expose people in their infancy kids in their infancy to peanuts yeah their infancy, to peanuts. Yeah, four or five, six months of age. But we still have to watch out for the older people, some of whom have these potential anaphylactic reactions.

Yeah, kids have real peanut allergies, and they're often downplayed, but they are real. I mean, people should not mock them. They shouldn't ignore them. A kid can die from getting an ice cream serving from a scooper that was in a pistachio ice cream bin before they were served their non-nut based ice cream. And so we've gotta be sensitive, but we've gotta recognize now the best practices

are exactly opposite of what the medical establishment pounded into pediatricians for 15 years. The best practice is to introduce a little bit of peanut butter at four, five, six months of age when a child is an infant, and milk and eggs. And some pediatricians say it's good for them to be around dogs and cats in the first year or two of life. A basic concept of immune tolerance was known at the time, but it was ignored by the hubris of the medical establishment. And it's not just peanuts. Well, so this is what I was

going to say. I mean, really, we're saying like anything that's sort of prevalent in society, like any kind of item that you would expect someone to get regular exposure to, like, you know, milk, eggs, peanuts, penis so forth would be something that you would want to given small amounts early on to sort of you know get the child ready for the future yeah it's best practices it's it's good parenting and if you look back a generation or two this is what grandparents were teaching for a long time in their, they had known it's good for a kid to be around some of these exposures safely. We don't want kids to consume

whole peanuts. It's a choking risk. But do you know that they use peanuts in soups in Africa? And Africa has essentially no peanut allergies. The United States has the worst peanut allergy epidemic in the world. It is nonexistent in Africa. I've got students from Africa who've described this to me when I did the research for the book. But they said the few people in Africa that have peanut allergies are American and UK expats who are living in Africa. They grew up with that incorrect dogma, the misinformation put out by the medical establishment, parroted by everyone, and as a result the United States has the worst peanut allergy epidemic in the world. It's

expensive, a lot of emergency room visits, lives lost, tragically young healthy kids otherwise, and the expense of EpiPens in every school in America and these expensive treatments that are also very uncomfortable for kids. We just got a new drug approved for peanut allergies in the United States this year. So the story of the American peanut allergy epidemic is really a broader story of the arrogance of a medical establishment saying things with such absolutism when the truth is that the right answer when people wanted to know what causes peanut allergies was, we don't know. And you saw that during COVID and so many other different times in American modern history.

The right answer from the medical establishment should have been, we don't know. And that's just generally very hard for people to do, as we've been discovering over how many years, and not just in the medical field. But no one wants to see. If you're an expert, you're kind of expected to give an answer. Yeah. And I interviewed the people who made some of these recommendations for peanut avoidance. And I wanted to see if they had some humility, felt terrible about it and what their rationale was. And while some of them did feel bad, most of them were very arrogant about the recommendation and justified it.

And one of them even basically told me the public was asking us what causes peanut allergies. And we felt like we had to tell them something about what to do. And my thought was, no, you don't. You can say we don't know. That's okay. The public is very forgiving if you're entirely honest. If you're making stuff up, then they're going to perceive that you're lying to them. And that's why we have this epidemic of distrust in the United States of

the medical profession. Let's talk about this, you know, I guess the psychology of this. Yeah. Because a central thread, right, is the blind spot. And the blind spot. Yes. And where does that come from? Yeah, and it's not just the peanut allergy dogma that we got wrong for 15 years in modern medicine. We got the low-fat diet wrong for 60 years. We got opioids are non-addictive wrong for 30 years igniting the opioid epidemic. We got hormone replacement therapy wrong for, we're still getting it wrong for 22 years

incorrectly telling women that it causes breast cancer resulting in needless suffering in the post-menopausal population. So again, when we use opinion and just make a recommendation based on a gut feeling, we don't have a good track record. We've got to get back to the scientific process. And in order to do that, you've got to have impeccable objectivity. It's not just in science. In business, in politics, in management, in relationships. You've got to be objective.

You've got to have humility to recognize what you believe may be wrong. And no one studied this more than Dr. Leon Festinger in the 1960s. He created the term cognitive dissidence based on the idea that you were dissident or uncomfortable, dissidence essentially means discomfort, you had this internal conflict if there were two ideas that were in your brain competing for truth. If you had believed something because you had heard it prior, that belief then occupied your brain. And it was very happy because it had no competition

from other ideas. But when a new idea comes along, it then challenges the idea that's currently in your brain. And that conflict is very uncomfortable. People don't like it. Human beings resolve that conflict in a very passive subconscious way by ignoring the new

information even if it's logical by reframing the new information to make it fit what you already believe or reframing what you already believe to say yeah it's basically the same thing for example if we say that smoking can kill you and you're an avid smoker, you might say, well, that's in people who smoke their whole life. I just smoke one or two cigarettes a day and I've only done it for 10 years. You try to reconcile two opposing ideas in your mind by reframing them. And we do this all the time in society.

You see it in politics. In medicine, we tend to have these belief systems, and we get afraid to challenge them. But the purpose of science is to challenge deeply held assumptions in the field. And in the field of psychology, they've described this dissonance by doing some experiments. They took college kids, Dr. Festinger and his colleagues took college kids, and had them do a very tedious task of putting pegs in a board.

It was an hour-long task. It was designed to be boring and not fun and a bit of a disappointment. And they paid people to do this. The students were paid either $20 or $1 and then they asked them, did you enjoy the task? And guess who enjoyed it more? The students who were paid $1 because they had to justify that they did this incredibly boring task somehow. So the way to reframe this experience was to say well it must have been enjoyable because it wasn't that lucrative in order to justify what I did by saying I believe that I want to do this you have

to make it enjoyable in your brain and another experiment by Aronson and Mills, they did this famous experiment where they said that there was a sex talk to attract students to come listen to. You had to take an entrance exam, and they were divided into three groups randomly. They didn't know what the other person had as a requirement. One group had a very hard exam. Another group had an easy exam, and the other group had her as a requirement. One group had a very hard exam. Another group had an easy exam. And the other group had no exam. Then they gave them the sex talk and made it as much of a disappointment as you could possibly design. They basically said, like, bees get together and multiply.

And then they asked the students, did you enjoy the talk? And guess which students enjoyed it the most? The one who had the hardest entrance exam because they had to justify that effort, what psychologists call effort justification, having done that difficult exam. And that's why they claimed that the exact same experience their colleagues had was more enjoyable to them because they had taken the exam. And then this theory of cognitive dissonance, or sometimes what's known as the founder's effect, you believe what you hear first, not what's most logical, It was very accepted in a theoretical realm, but it had no real world data. So Festinger was sitting home one day

and read in the newspaper that a cult was organizing to meet, because they believed that they were going to be picked up by aliens in a spaceship on a particular day and time and location. And so he went and traveled to this Illinois-based cult and embedded himself in the cult. And if his theory of cognitive dissidence and the founder's effect were true, when the spaceship did not come, they wouldn't abandon their views. They would dig in even deeper because they had to stick with their belief system. And new information had to be reframed or ignored or somehow changed.

And sure enough, that's exactly what happened. Somebody claimed that the clocks were wrong and maybe the aliens were still going to come and everyone got excited, they would sort of justify why the aliens were late and the prophecy was still true throughout the entire evening. And by the morning they had claimed that they got a revelation that because there was a lot of light shining from the cult, the aliens had changed their mind. You would think that this would result in people abandoning their belief system, but they didn't. They became more evangelical and more deeply rooted.

And one member of the cult who was a doctor said in very plain English directly to Festinger, I can't abandon this belief system. I have everything in it. My life, my family, my job, my career, everything is invested in this belief system. I can't possibly give up on it now. We have a human tendency to want to cling to our belief system, not because it's more logical or correct, but because we held that view first. I see it almost every day now that I'm aware of it from doing this research for the book. And what I notice is that on my research team at Johns Hopkins, people will suggest research ideas

and I'll tend to dismiss it a little more readily than I should. And I realize this is the founder's effect and I've got to be aware of it. Now, the father of modern medicine, Claude Bernard said, we have to recognize that we all have biases. It's part of the human condition, but you have to be aware of your bias. And when you receive new information as in the scientific process you have to actively and temporarily suspend your biases being aware that they're there and try to objectively assess new information as an active process and as there's probably no other more prophetic words from the modern era of hyperpolarization and deeply entrenched views than the words of Claude Bernard. And even specifically to the medical science community itself.

Absolutely fascinating. You're reminding me, I remember being told of the person who originated the ice pick lobotomy, right, which turned out to be a very bad procedure. It wasn't really helping people. But from what I understand, this person traveled later to try to, you know, sort of look at some of his patients and he couldn't, the level of this cognitive dissonance was so strong that he couldn't see the damage that had been done. He recorded his experiences with them and he believed that they had been helped.

Yeah. You're familiar with this story? Yes. A lot of damage was done. It was again, medical dogma and people hold onto it. And it's not that doctors are bad people or diabolical. Every doctor I know is trying to do the right thing or always tries to.

But we have good people working in a bad system. And this group think mentality creates a herd thinking where people are not encouraged to think independently. There's a culture of obedience to get in line. Well, every major scientific discovery has come from somebody challenging a deeply held assumption, challenging a dogma of the day. But you see this cognitive dissonance play out. I had a colleague who, when a study came out showing that you don't need to treat appendicitis with surgery 100% of the time, two-thirds of the time you can

manage the person without surgery. You follow them closely, give them a short course of antibiotics, and you don't need to do surgery. It's an amazing discovery. And there was a great study done that shows not only are you avoiding the pain and suffering and the complications, but the cost. We have a nursing staffing crisis in the United States. That helps. It decongests our operating rooms. It enables us to focus on other sick patients. It's an incredible research study and when it came out I remember asking a colleague and he said, well I don't buy it. I need to see two randomized control trials. Then a second randomized control trial came out and he said,

well, I need to see three randomized control trials. Then a third one came out. This is incredible data, long-term follow-up, top medical journals. And then I went back and showed him the third trial and he said, well, you know, I just still think it's just better to take them all out. You see this cognitive dissonance playing out right in front of my eyes. In the medical field, I want to be a little bit thoughtful about the doctors. You also don't want to inadvertently kill somebody. kind of works and you have this new method that's coming on and you're i can see being a little skeptical overly skeptical if you have something that actually works that kind of makes sense to me right yeah you've got an intervention that works just stick to it so the studies were very clear you don't get behind the eight ball where somebody gets sicker and then you're they have a

higher risk long term you follow them for the first 24 hours. And oftentimes, these are cases of mild appendicitis where there's no rupture. That's the inclusion criteria. And you see them start to improve. And we've seen this all the time in my career. We've been called to see someone with appendicitis, and they're already getting a little better by the time we see them. So this protocol said, keep going. As long as they're improving, you may never need to do surgery on someone. And when they follow them properly in a big study, they find that two-thirds of people end up never needing surgery, especially kids. Now, there's exceptions, of course, but this is a revolutionary study.

And it's just in one little pocket of medicine. Let me tell you one little story. This is an anecdote from my mother's life that's, I think, relevant. As a child, she grew up in communist Poland. And as a child, I don't remember if it was appendicitis, but it was some sort of really serious acute pain needed ostensibly needed the operation instantly. Maybe this other way wasn't known at the time. But what was happening in this hospital where she was taken was there was an unusual number of children were dying and it wasn't actually clear. This is basically wartime or just post-wartime. There's not a lot of resources. And this one doctor came up with a theory, and the theory was that there was a problem with the

anesthesia, that that was actually what was killing them. But it was so entrenched, the idea that you have to do the anesthesia and there's no other way to do it that this continued. And she became the first one of the children that got operated without anesthetic, which of course was very tough for her. But in the end, she lived and it turned out some days later, they figured out that indeed it was the anesthesia that was defective. But you made me think they were very committed to using it even though someone was out there saying, hey, wait, guys, wait a second. I think it might be the anesthetic.

We need to check this. So I wrote the book Blindspots as essentially a guide to impeccable objectivity, where we have to recognize these biases, suspend them, and consider new information, recognizing we have this cognitive dissonance. And it turns out that we all know people like this. I have a mentor at the hospital who, when everyone piles on to some athlete who's accused of some allegation, he'll say, wait a minute, we don't have all the information. And then the room will be silent.

And you grow to admire that characteristic of people who don't rush to judgment. They don't fall in line with a narrative where they're told you have to have all these positions on one side or the other on unrelated topics. They think independently. And so that's a beautiful thing and it's what we badly need in the United States today. Civil discourse is under threat and in the medical profession too we're fighting censorship, control, a centralized authority. We got a little peak of it during COVID but this is an ongoing battle and I think

ultimately I do believe still in the independence and creativity of America's rank and file physicians who think for themselves and don't like to be told from a central authority what they must do. They like to be told what the opinions are of experts. The whole purpose of science is to have a foundation of transparency where we can discuss ideas. And the medical profession has an incredible heritage of tailoring recommendations to an individual based on their needs and wishes and personal physiology. And so we've got to retain this liberty to customize care to individuals. The foundation of the medical profession

is not to have a one size fits all, it's always to consider nuance and to consider scientific detail. You know, it's an amazing profession. I love being a doc. It's an incredible privilege to be able to enter into that relationship with somebody instantly because we embody an ancient trust that's been passed on through generations where we value individuals, we

treat people fairly, we assume the best in folks, and we customize what we think is best for them in a recommendation. Not in forcing, and we customize what we think is best for them in a recommendation, not in forcing, but in a recommendation. And that is our great heritage. America's first hospital was founded as a safe haven in Philadelphia for the sick and injured, regardless of their race, what they believe, or their ability to pay. That is our great medical heritage. And right now we're seeing price gouging, predatory billing, distrust, public health officials having lied to the public over and over again. We've got to rebuild the trust because medicine is an incredible heritage that we've got to keep upholding in every way that we can.

I want to talk about two things we discussed earlier. And I have to confess that I actually have personal biases. I have personal stakes of this. So one is the issue of fat, and the other one is eggs. With eggs, I've always, since the time I was a kid, I was a big yolk guy, the yolk enjoyment. But we were taught that eating even a modicum of eggs would be a problem. You would have heart problems later in life and these kinds of things. So that's one. And the second part is I've always liked, or maybe everybody does, I've always liked various types of fat in food.

But we were taught, no, a low-fat diet is literally what you want. And it turns out that that's not the case either. So let's dig into these. So fat has a lot of flavor, which is why people like it. The yolk has that flavor, which is why people, chefs use it in cooking certain types of foods. And that is natural. Okay, the healthy natural fats, saturated fats, we're not talking about the highly processed fats. Natural fats have an incredible health benefit. It's part of a healthy diet. It has substances that are filled with micronutrients, healthy eggs raised in a healthy way from healthy chickens. But the medical establishment created a dogma in 1955 that fat was bad for your health. It was based on one guy, Dr. Ancel Keys, who after Eisenhower had his heart attack, got out there and basically said that's because he ate too much fat. And

the fat builds up in your coronary arteries and therefore they put him on a low fat diet. Ancel Keys convinced Dr. Dudley, the president's doctor from Harvard, to reduce the president's fat intake, put him on this low cholesterol diet. The irony is dietary cholesterol is not even absorbed by the body. It goes through your system. Ninety percent of it plus is not absorbed because it's esterified. It's attached to a bulky molecule which means it does not get absorbed. So the irony is they move the country and still to this day you

see low cholesterol foods all over the place, promoted sometimes by the medical establishment. They got it perfectly backwards. There was never anything dangerous about eating some natural fats for the vast majority of people but the medical establishment stuck on this idea that fat was the demon of public health move the food industry to a low-fat diet and they started to study it with a major study called the Minnesota Heart Study in the 1960s it was supposed to be the end-all study, a randomized trial that once and for all proved that people who have a low-fat diet live longer and healthier. But what happened was they got the opposite result.

People that went on the low-fat diet had more heart attack deaths. So they suppressed the study for 16 years after the results were available. It was not published. When one of the main authors was asked before he had died, why didn't you publish the study? He said well we just didn't get the results we expected. We were disappointed in the results. Then they did another major study, the Women's Health Initiative study, the Framingham study. These are studies with tens of thousands of people, gigantic, federally funded studies. They looked for an association between eating natural

saturated fats and heart attacks and they did not find it. Three major studies failed to find this association that they claimed existed. But rather than apologize and show some humility, they dug in. And I interviewed one of the people who was involved in the government's food pyramid guidance and I said, are there studies that support the low-fat recommendation? She couldn't point to a single study. I then asked, how then do you put this out with so much absolutism? And she says, well, Marty, are you questioning the low-fat diet?

She says, do you mean to tell me that the American Heart Association is wrong, and the American Cardiology Group is wrong, and the Surgeon General is wrong, and all these famous scientists are wrong? She says, I don't think so. In other words, everyone believes the dogma. Therefore, it is scientific evidence. No.

That's an illusion of consensus. They got it perfectly backwards. We now recognize it's refined carbohydrates, the simple sugars, the ones added, not bound to fiber and natural fruits, and the ultra-processed foods that may be driving the inflammation that enables these certain particular lipoproteins to get deposited. And the blood tests we've been recommending are not even very precise. When we check people's cholesterol in the hospital, people should be getting a lipoprotein A and an APOB level. Those are far more better predictive tests that predict early heart disease than the standard testing. So next time someone gets a blood test,

ask to have those tests added and make sure your doctor can interpret the results. About 10% of doctors now are ordering those tests. We live in this sort of very slow culture in medicine where dogma looms large and we have an epidemic of misinformation and one of the greatest propagators of misinformation, it turns out, is the United States government, with the corrupted food pyramid, and with the peanut allergy recommendation that they got

backwards, with the opioid guidance they got backwards. Many times you see this common thread. Everyone believes it must true because these notable institutions, big academic centers, NIH, industry-funded researchers are all saying it's true and therefore people just go along with it. This was probably the number one health recommendation given to patients for 60 years. People come into the office. If you smoked, we said stop smoking. But separate from that, we would basically say eat healthy, and we would define eating healthy as avoiding fat.

My uncle had eggs every morning his whole life back in Egypt. When he immigrated to the United States, his American doctor said, stop eating eggs. And it was miserable. This was part of his livelihood. He had a routine every day. And for about 30 years, he had to avoid eggs and lived with this guilt complex until finally his son, who had done the research and is a physician, said, no, Papa, there's nothing wrong with eating a couple eggs every morning. And he is back at age 92 eating eggs every morning after he comes back from the pool and he has a routine and he lives healthy and happy.

There's a cost to this, you know, I'm thinking about this, you know, these sort of the advent of these very sweet drinks, right, soda or pop as we call it in Canada. I mean that that is actually a very real driver of obesity, as far as I understand it. Yeah, look, the low-fat diet occurred, the recommendation parallels the obesity epidemic. There's a number of factors, but we moved the food industry into a low-fat diet, which means they had to add refined carbohydrates to maintain taste. So now you had low-fat cookies and low-fat snack wells and low-fat food items where it was pounded with sugar. In schools, we would give kids milk where they take out the one healthy ingredient, natural fat. There's also protein, which is good for you, and they would add sugar. So now you're drinking like sugar water practically,

removing the fat and adding sugar. It's in everything. It's in tomato sauce, it's in all kinds of foods. Just read these labels. For a long time we couldn't, we didn't even have sugar on the nutrition labels because the industry drove the experts and funded the experts to downplay sugar and to not talk about it, as if you could have an unlimited amount. So if there's one general health recommendation I like to give my patients that are struggling with their weight, it's to drink water. There's so much added sugar in what people drink that you can look for it in everything you eat, but the drinks sometimes are loaded with sugars in ways that you can modify your life. Very high sugar diet. That's also connected to type 2 diabetes, is that right? Yeah, we have an epidemic of type 2 diabetes.

The pancreas was never meant to be pounded with sugar and surge your insulin levels as we've seen in the modern era. For most of human history, insulin produced by the pancreas happened at low levels that were undulating. But in the modern era, the insulin levels are spiking, constantly pounded with high amounts of added sugar. So it's no wonder that we're seeing this epidemic of insulin resistance, which is bad metabolic health. You know, in medicine, we have all these silos. We have 82 specialties. You finish medical school and they're like,

which specialty are you going to pick? You have to pick one. And this is our currency of academics. If you have this tiny little focus, you just only work on the choroid of the eye, which is one little part of the eye. This guy is a genius. He's celebrated.

And that's how we advance our science in our minds. Now we need subspecialists, I'm one of them, but everything is connected. Mitochondrial health, general body inflammation affects every cell in the body. Every cell in the body practically has estrogen receptors. There's a hormonal connection. There's a general way in which every cell in the body needs certain micronutrients,

which are not found in the modern food supply, because food is made with basically modern-day caffeine. It's not from good, rich soil. And so I don't even know what we're eating sometimes. It's like a piece of plastic or cardboard with sugar and it looks nice. But our food supply is not what it was. You know, it turns out that the African-American community in the United States was one of the healthiest communities in the 1950s and 60s in terms of their metabolic health.

And what you saw are these food deserts, foods poor in micronutrients, potato chips and other foods becoming popular in these areas where there wasn't good education, there wasn't good access to healthy foods, the government put out misinformation on what people should be eating. And now you have this total reversal where the African American community has epidemic levels, disproportionately higher than other communities

of poor metabolic health. And you've got to ask, should we just be beating people up, making them feel guilty, or should we actually look at the information we've been giving people and the access to the food and what types of food we've been giving people? Maybe we need to treat more obesity in young people by talking about school lunch programs,

not just putting every kid on Ozempic. Maybe we need to talk about treating more high blood pressure by addressing sleep quality and stress management, not just putting everybody on an antihypertensive. Maybe we need to treat more loneliness by addressing communities, not just putting everybody on an antidepressant. Maybe we need to treat more loneliness by addressing communities, not just putting everybody on an antidepressant. Maybe we need to study food as medicine and look at the environmental exposures that cause

cancer, not just the chemotherapy to treat it. We've got to look at general body inflammation as an incredible phenomena that affects all of human health that is modifiable by our activities and our actions and our exposures. We've got to look at toxins. So we can keep going down this whack-a-mole healthcare system of just beating disease in the last final stages with medications. We've got the most medicated generation in the history of the world. Or we can actually look at the root causes and address healthy food, healthy living, mitochondrial health, nutrients, behaviors, choices, and give people the right information instead of the disinformation they've been given.

I remember I've seen a number of studies right now that suggest that a lot of these, you know, for example, antidepressant drugs don't actually work particularly well. So, you know, not to make any blanket statements either, right? But that's, is this right? We don't even know the mechanism by which some of these drugs are actually helping some people. And because they help some people doesn't mean everybody needs to go on it. We are converting America's children into a generation of patients. We're going to have every six-year-old in America on three medications soon. And in some cases, it's the medicalization of ordinary life. If you're nervous before an exam as a kid, you're nervous before an exam.

Why do we tell the kid, you have anxiety, assigning a chronic disease to a child? Some of this stuff is the healthy, normal development of children. And we do this in so many ways. We do it when they have the normal confusion around their identity. We do it when they're down and out. Now, there are extremes where people need focused attention and medication. I believe that.

But when you talk to the real experts, not the people who are just giving out pills like a pill mill, but the people who really know this field, they will tell you that in many cases, we're engaging in the medicalization of ordinary life. We've seen it in childbirth and the treatment of children. For centuries, when children were born, they were given in the arms of their mother and held for hours. It was a natural incubator.

They stayed warm. The umbilical cord would continue to pulsate for minutes, sending healthy fetal hemoglobin and oxygen and stem cells and nutrients and antibodies to the baby after the baby is born for a minute or two during that transition. But something happened in the 1940s. We had the mass production of an antibiotic called penicillin. For the first time in history, doctors now controlled a substance that could cure you. There's probably no greater discovery in the history of modern medicine than that of antibiotics. It's converted childbirth to a safe procedure. It's enabled us to do surgery. And now people who are young don't die from a small cut that gets infected or a minor ear infection. Antibiotics are a miracle. After their discovery in 1922 by Alexander Fleming, within a few decades, it was being mass-produced and

doctors controlled the ability to prescribe an antibiotic. It ushered in the white coat era of medicine. Doctors now had an unquestioned authority. Technology was booming in hospitals. They had iron lung machines for polio victims. They had incubators for babies. And the culture of paternalism began to dominate. Babies were separated immediately from birth from their mothers and kept in the hospital routinely in the 50s and 60s for 10 days, even though there was nothing wrong with the baby. Every baby was detained for 10 days. It drifted down to about three days by the 1970s. But doctors would probe and pry and feed their infant formula to the baby with the sort of paternalism that,

well, this is controlled, this is better, this is under our care as doctors. No, the best thing for a baby in nearly all circumstances is to be held by the mother upon birth, to not immediately cut the umbilical cord, which is pulsating warm blood. I remember as a medical student, they immediately cut the cord and then take, you know, I was assigned to cut the cord. I'd have the scissors, you know, there it is, cut it. And then they whisk the baby off to this incubator in the back. And I'm like, what are we doing? Is there anything wrong with the baby? No, we just have to, this is our routine, we have to rewarm the baby. And they go back and put the baby under some French fry light,

and they're poking and prodding and putting a temperature probe in the baby's rectum, and the baby's crying. I don't know what's going on. I just assume I'm a medical student. I don't understand. It turns out this is the medicalization of ordinary life. The baby's crying. I don't know what's going on. I just assume I'm a medical student. I don't understand. Turns out this is the medicalization of ordinary life. That baby should have been rewarmed in the arms of the mother safely with some coaching or help because a mother is often exhausted.

Skin to skin for hours upon birth have more normal heart rates, blood pressure, less NICU utilization, neonatal ICU utilization. And when the cord is cut in a delayed fashion, so it can continue to pulsate for the first few minutes, babies have different myelination of the brain when studied on MRI. And so something magical is happening with that bonding. And when you take a step back at our modern day medical culture of doing things, sometimes with this strong threat of paternalism, what we're discovering in our medical research now is that we had things correct in ancient times. Almost the biblical principles of eating whole foods, things grown in good soil, eating clean meats, meditating, fasting.

It's as if we're discovering this for the first time. These are basic principles that many people had wisdom on for a long time. You know, a couple of quick thoughts. One of them is you mentioned this, you know, the advent of antibiotics and that it was a miracle. It enabled all sorts of, you know, medicine, frankly. But one of the consequences, and this is another thing you cover, and actually, you know, one thing that I really like about your books, not just this one, is you go to the people who are at the source of these things, and you have these conversations, as we've been discussing, not just the people who might be at fault, but the people who are doing really interesting work that might, you know, point

in another direction and see how they think. And I think you have an example, we have one example where, you know, I think the original researcher, what is it, on the peanut study, he said, no, I didn't want anyone to come to that conclusion from my study. That's totally the wrong thing. Ah, yes. Right? Yes, giddy and lack. Yeah, I mean, you get it from the horse's mouth, which I really appreciate.

I've known for years, and I don't know when I realized this, it's possible, you know, I had a pretty serious autoimmune disorder once in my life. And I remember, or maybe because I was working in Africa, I can't remember right now in Madagascar, but I became very aware that taking too much antibiotics would actually kind of destroy your gut fauna. And that would actually cause severe problems, give you severe problems and I would have to be very careful because you would always you would travel when you're traveling to these remote places you'd always have you know very strong antibiotics on hand in case something bad really did happen like Cipro or or

something like this you didn't want it and you knew like this is a bad idea you can't just kind of take this like candy this is going to have a profound impact on your body right so tell me a little bit about that what do we know today because i think that's very important i think they're perhaps i think they're overused right really yes antibiotics save lives but they also carpet bomb the microbiome the microbiome by of background, is the garden of billions of different bacteria, not cumulative, but different bacteria that live in a harmony in the gut. And they line the gut from mouth to rectum, and what they do is they're involved in digesting food, they're involved in transport of micronutrients, they

produce some vitamins, they are training the immune system in ways that we have yet to fully understand, they produce serotonin, which is involved in mood, they are involved in estrogen regulation, they do so much that we have yet to fully understand. There's been a discovery that some bacteria produce GLP-1, the active ingredient in Ozempic, at low levels. So there's this incredible organ system called the microbiome that lines the gut. And when people take an antibiotic unnecessarily, which is the majority of antibiotics used in the outpatient setting, they are carpet bombing their microbiome. They're killing a bunch of bacteria and you get overgrowth by other bacteria. And sometimes the bacteria overgrowing are the more resistant, antibiotic resistant bacteria.

They're not good bacteria. They can be more pro-inflammatory, increasing your body's general inflammatory state. And sometimes they can even kill you. A bacteria called C. diff is known to overgrow, and we see it in the hospital all the time. Almost at any time, there's at least somebody in the hospital with an active C. diff infection from their own gut, what happens is they took a little antibiotic for something and then the C. diff bacteria overgrow and it has been known to kill people. There's been about 30,000 deaths a year in the United States just from C. diff bacteria overgrowing. So people need to know when they're

taking a little antibiotic, hey, you know, probably won't help you. You got a little viral infection, but you know, you can take it anyway. It won't hurt you. That is misinformation. There's incredible research that I discovered in the book Blind Spots on the microbiome. It turns out that a study at a Mayo Clinic just came out that I think is one of the most significant studies the last 10 years. It was ignored. It lives in this blind spot of modern medicine where they looked at kids who had taken an antibiotic in the first couple years of life and compared them to matched children who did not take an antibiotic in the first few years of life. Now we know in the first few years of life, your microbiome is being formed. This was done by the Mayo Clinic, published in the first few years of life, your microbiome is being formed. This was done by the Mayo Clinic,

published in the Mayo Clinic Proceedings, which is a little clue in our research world that no other medical journal was interested in this study. But it was amazing. And 14,000 children, they found kids who took an antibiotic in the first couple years of life had higher rates of obesity, asthma, chronic diseases, learning disabilities, attention deficit disorder. Again, remember that connection between gut bacteria and the brain through serotonin. Celiac was nearly 300% more common. Now, a good objective scientist would say,

we don't know if there's a cause and effect there. It's hard to say. But here's the kicker the more courses of antibiotic a child took the greater the risk of obesity and asthma and learning disabilities which is one of the fact things you would that indicate possible causality that's right it's a dose dependent relationship yeah and farmers have been noticing this for a long time if they give antibiotics to animals, they're fatter. And so the world expert in the microbiome, who I interviewed for the book, said,

hey, if antibiotics are making animals fatter, what are they doing to humans? And sure enough, in model after model of the microbiome, he identified how taking antibiotics alters the microbiome. Certain antibiotics do it more than others, and people are more likely to be obese. We have people who do everything to lose weight. They eat right. They exercise like crazy. They can't lose weight. What's going on? Maybe their microbiome has been altered. Maybe some of it can't just be altered back by taking a probiotic that goes through your system. Maybe other probiotics could help. There's an ongoing study at Shepard Pratt Hospital giving probiotics to people with bipolar disorder to see if it helps.

They've tried now to do what they call bacteriotherapy, which is essentially giving a pill of bacteria that normally live in the microbiome to people who are obese to see if they would then lose weight. There was a study out of Harvard that did not show that it did result in weight loss, but they're trying again to change the bacteria. There's this exploding research on this organ system called the microbiome that has lived in a blind spot of modern medicine. And it's not just antibiotics that alter it. It's altered processed foods, refined carbohydrates,

things we don't even know about that are altering the microbiome. We put fluoride in the drinking water in the United States. It's only a third of the drinking water in Canada and 3% of the drinking water in Europe. But most of the drinking water in the United States has fluoride. Why?

Because we think it kills bacteria in the mouth and reduces cavities. Well, if it kills water in the United States has fluoride. Why? Because we think it kills bacteria in the mouth and reduces cavities. Well, if it kills bacteria in the mouth, what's it doing to the bacteria in the microbiome? And we've seen all these chronic diseases go up in the modern era of antibiotics, C-sections, ultra-processed foods. I don't know if fluoride is a part of that but these are the questions we have to ask if we're going to challenge the deeply held assumptions in medicine. When you're born by vaginal delivery, remember that the gut is sterile in the body. When you're in utero as a baby in the

mother's womb there's no bacteria in the baby's gut. You get the bacteria in the microbiome when you pass through the birth canal and the baby's gut is then seeded with bacteria from the vaginal canal, augmented with bacteria from breast milk in the colostrum, and touching in the skin and grandparents kissing the baby. That's normally how a microbiome forms. But when you're born by C-section, a baby is extracted out of a sterile operating field. And what may seed the baby's microbiome is the bacteria that live in the hospital. And those are not good bacteria many times. So we're altering the microbiome in ways that we don't understand. We have dogma that C-sections have no downsides, that it's the same as a vaginal delivery. We have people choosing them just not because they need them for safety,

but just because they want to make it easy or the doctor wants to make it easy for the doctor. C-sections save lives and they're necessary sometimes. Antibiotics save lives and they're necessary at times. But they're both massively overused in the modern medical establishment and they are altering the microbiome in ways that we need to study. Early research is telling us there's an association there. It may be tied to chronic diseases and there may be other actions that we can take now once it's formed through food and what we ingest, to try to restore that microbiome. You know, you're just reminding me, I remember seeing some kind of study, and I can't remember where right now,

but it showed that the prevalence of C-sections varies significantly by hospital. The hospitals themselves are the biggest factor. So if there's just a concept of that's how it's done here, those hospitals will do that much more often than others where that's not the case. Yeah, my research team at Johns Hopkins has put out some information on that actually. So we have a consortium that does individual physician profiling on their appropriateness of care, not their complication rate, but the appropriateness of care and choosing to do back surgery and prescribing opioids in ordering CAT scans and MRIs. Are they inappropriately extreme outliers in ways that a consensus of doctors would say

that's an indefensibly high rate of doing something. And with C-sections, we have a metric called your C-section rate as an individual doctor in low-risk deliveries. So we exclude all the high-risk stuff. And in those low-risk deliveries, if your C-section rate is over 25% or 30%, that's a flag okay why are there doctors practicing today with c-section rates of 70 80 percent in low-risk deliveries so this is where it's good for the consumer to be informed it's why I write my books and I want people to know what about you know kind of approaches to sort of correct some of this? How to tackle

this group thing in a meaningful way to, you know, have a healthier, happier society? Because there is a kind of crisis in this over-medicalization. Well, it's good for people to be educated. And I don't want folks to be cynical about their doctors, but they should be educated, the general public should be educated on how medical group think affects the culture of medicine in the absence of evidence. When there's no evidence, it's okay to have an opinion, but it should be put out there as an opinion, not as scientific evidence where you must comply with incredible absolutism. And I think as a profession, we need to fight bad ideas about health with more ideas. And that civil

discourse has a way of, over time, being fueled by research and data and clinical wisdom where we learn what the truth is. So the one flag that somebody should have is that if someone says you should do something simply because I'm the expert, that's when you probably should be skeptical. When it comes to decision making, there are emergencies where I think you should just follow whatever the medical guidance is. And when you have a choice and there's nothing urgent and you can consider alternatives, it's good to ask about all those alternatives. I've got two types of patients that come to see me. One that when I start explaining things, they cut me off and say, no, doc, you just tell me whatever to do and I'll do it. And then I have a type of patient that says, thank you for your thoughts. Now I have

some questions and I did some research and can we discuss it? You want to find somebody who has good listening skills, who can know their limits. What makes a good doctor is the humility of knowing when to call for help or to go back and research something and come back to somebody. And when I see our medical culture in the medical establishment today, I think that is the greatest value that we can give to the next generation of students and doctors is humility. Because it's not the rote memorization that enables the medical community to be so good. It's their ability to learn from the patient and to learn as we go. And I think it's good for people to not become cynical or jaded or hysterical about some of the problems in

modern medicine. We've got good people working in a bad system and this is not a system we designed, it's a system we inherited and it has a medical culture. But at the same time a generation of students and doctors are now rejecting the use of medical dogma and instead asking good questions and demonstrating that humility in their everyday practice. So I'm a big fan of the rank-and-file American doctor who considers the evidence, considers the recommendations, and considers the individual needs of a patient and puts it together with some good sound advice.

So ultimately, I'm optimistic on our health care system. I'm optimistic on the future of medicine because we are seeing now people reject the current model of seeing people in five and 10 minute visits and then just billing and coding. Doctors are burning out. Patients don't like it. We've been doing this for a long time. Eat better and exercise more. We give people the wrong information. Come back in six months with these medications.

They come back and we say, you're a bad, bad, noncompliant patient. Patients hate it. Doctors hate it. Burnout rates are high. A generation of doctors are saying, we're not doing this. We're starting over. We're going to spend an hour, whatever time it takes. We're going to talk about food

and activity and evidence and wisdom and new stuff that we don't understand. We're going to be open-minded and we're going to develop a relationship where we have good rapport. And so I am a big believer in this great heritage of the medical profession, and I hope we can see it continue to make improvements in the coming years. So how do people find these doctors with this generation that you're describing, a new or perhaps old attitude. Yeah, they don't have a real name or title

or official boundary of the specialty. They are doctors with great listening skills and humility. There is a group of us that are interested in the redesign of medicine. We don't know what to call it. Is it functional medicine? It includes that. Is it holistic medicine?

Not officially, but it is holistic. Is it alternative? Not really, but it includes alternative ideas. And so this group of doctors now are emerging in direct primary care. That way, the employer is paying the bill, and anyone can access it. Concierge medicine.

We're seeing new clinics emerge for Medicare beneficiaries that are at no cost to the beneficiary. And I've written a lot about these clinics in the book, The Price We Pay. But there is this opportunity now to connect with this new generation of doctors who are thinking about the redesign of medicine instead of just being on the hamster wheel, which nobody's enjoying at this point. Well, Dr. Marty McCary, such a pleasure to have had you on. Thanks so much, Jan. Great to be with you. Thank you all for joining Dr. Marty McCary and me on this episode of American Thought Leaders. I'm your host, Jan Jekielek.