Dhru Purohit Show - "How Could The Experts Have Gotten It So Wrong?" - Dr. Marty Makary On The Top Blind Spots in Big Medicine Making Us Sick

Episode Date: September 16, 2024

This episode is brought to you by Momentous, Lifeforce, and Lumebox.   We are spending more on healthcare than ever before, yet our population is sicker than ever. The healthcare system is flawed, and the focus on true health seems misplaced within the traditional system. What’s at the root of this broken system and the advice being given to the public? Today’s guest is here to share his expertise on the healthcare system and highlight its Blind Spots. Today on The Dhru Purohit Show, Dhru sits down with Dr. Marty Makary to discuss how decisions in healthcare are often made by a small, centralized group based on dogma rather than actual scientific evidence. Dr. Makary explains how this groupthink mentality has led to a reluctance to consider alternative opinions and a fear among physicians of being labeled if they criticize these decisions. He provides examples of how such decisions have resulted in poor outcomes and eroded public trust. Dr. Makary emphasizes that humility and a willingness to learn beyond what was taught in medical school are crucial for focusing on science and providing the best guidance for patients. Dr. Marty Makary is a renowned surgeon, professor, and author recognized for his contributions to public health, healthcare innovation, and patient safety. He serves as a professor of Surgery and Health Policy at Johns Hopkins University, where he has led initiatives to improve the quality of healthcare delivery. He is known for his research and advocacy on issues such as medical transparency, over-treatment, and the use of video technology to improve patient care. His newest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health, is set to release September 17th.  In this episode, Dhru and Dr. Makary dive into (audio version / Apple Subscriber version): The hijacking of our entire approach to healthcare and the consequences (00:00:20 / 00:00:20) Groupthink and fear of criticizing ideas (05:23 / 05:23) Lessons from peanut allergies (13:59 / 10:53) The motivation behind these grand opinions (20:16 / 17:10) The value of diverse opinions (26:56 / (20:50 ) The history behind the low-fat trend and cholesterol research (39:06 / 33:00) The importance of asking questions and true humility (46:06 / 41:00) Topics Dr. Makary is paying attention to (50:56 / (45:50) How do we change the process? (1:02:31 / 57:25 ) Dr. Makary’s journey (1:08:26 / 1:03:20) Top things people can do to invest in their health (01:17:06 / 01:12:00) Questions about vaccines (01:20:36 / 01:15:30) NIH funding (01:31:56 / 01:26:50 ) Changing minds/questioning decisions (01:40:08 / 01:35:02) Also mentioned in this episode: Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health  To learn more about Dr. Makary, follow him on X/Twitter, Instagram, or his Website. This episode is brought to you by Momentous, Lifeforce, and Lumebox.  Optimize your energy and mental clarity with the purest form of creatine made by and used by the best. Go to livemomentous.com and enter promo code DHRU to get 20% off any order. Right now, you can save $250 on your first diagnostic and get personalized suggestions. Optimize your longevity and track your progress; go to mylifeforce.com/dhru!  Lumebox is offering my community $260 off their FDA-registered portable Red Light device! That's over 40% off! Go to thelumebox.com/dhru and get your Red Light device. Learn more about your ad choices. Visit megaphone.fm/adchoices

Marty, welcome to the podcast. Such an honor to have you here. You know, you're here today to sound the alarm on something super important and a little bit controversial. And that's the idea that today, in this day and age of health care, especially in America with all our advances, there's actually a group of largely elite, quote unquote, experts that have completely hijacked our entire approach to health. health care. And it's us as lay people who are paying the price. We're spending more money on health

care than ever, but largely the population is sicker than ever. And that's a big problem. So I want to ask you, who are these individuals and what are the consequences of their actions? Well, great to be with you, Drew. Yeah, it's a small group of people. And increasingly, our authority in medicine is centralized. Now, I love being a doc. I love it. I love the bedside care. I love bringing all the scientific might to the bedside to help people. But right now, we're living in an era when a small group of people are making decisions and health recommendations for the broader community that is often based on dogma. It's not based on the best scientific evidence. They control the research dollars. They control the journals. They are now policing what doctors say.

and so we're living in a new era of a more centralized authority in medicine, which if you look at their track record, if you look at the track record of this priesthood, it's not very good getting so many giant health recommendations wrong. And not only that, it's just stagnant. Like, what are we doing in the world of Alzheimer's and mental health and food is medicine? We're not making progress because we don't have good studies because the NIH is controlling these research dollars. universities are saying, don't think broadly, don't be a Ben Franklin thinking scientist, focus on one tiny little area and work on an incremental discovery. Don't work on big ideas. And a group of doctors now are saying, no, I'm not doing this broken health care system. I'm not getting on the hamster wheel. I want to talk about, can we treat more diabetes with cooking classes instead of just throwing insulin up people? Can we treat more high blood pressure by talking about sleep quality and stress, not just throwing anti-hypertensives of people.

Can we treat more back pain with ice and physical therapy instead of just surgery and opioids? Can we talk about school lunch programs instead of just putting kids on Ozzypic, like a reflex? We are converting American children into a generation of patients. Where's the conversation about food as medicine and general body inflammation?

So a group of doctors are saying, we have got to think differently. They've got the big ideas. They're starting to implement it. They are challenging this stale modern medical establishment with its old guard priesthood that controls these institutions and journals. And they don't leave power. Like these medical journal editors are, they stay in power like a monarch for like a lifetime.

And so it's an exciting time in medicine. I felt compelled to tell the public about this internal struggle within the medical profession. Because doctors are not a homogeneous brand. They start off as great people, altruistic. Read these essays that guys coming into med school. I mean, a quarter of them want to do medical missions. Most want to do charity in some part in their career when they start. And we beat them down with this wrote memorization, memorizing useless stuff.

I mean, the Krebs cycle molecules, the molecular structure, this useless. And we've got phones now. You can look up stuff that's not emergent. So this medical education is broken. We beat them down. They come out, burnout. They're different people. And some people are now saying, this is not what I signed up for.

We've got the most medicated generation in human history, the most disabled, the most medicalized. In some cases, we're engaging in the medicalization of ordinary life. we're branding people unfairly creating self-fulfilling prophecies. So a generation of doctors is now saying the modern medical establishment has done some good, but they have giant blind spots that we need to address. And that's the name of your new book, Blind Spots,

and we're going to get into all of it. But this can sound for some people who are not familiar with this, this can sound like, oh, a small group of elite people in the dark. That feels like a conspiracy. Let's make it a little bit more personal. You know, one of the things that you talk on in the book is that there is this cooperation and this, you know, almost a cabala in a way between big pharma, the NIH, some of these experts that you mentioned, some who are at universities, and it's a revolving door.

And that leads to groupthink and dogma, and people are afraid to criticize. each other. Can you chat about that for a second? Yeah. I can't tell the difference sometimes. Who's making recommendations? You saw it during COVID a little bit. I know I don't talk about COVID in the book. It's a little too tribal and people are tired of it. But I couldn't tell who I was who I was hearing from when they would say, hey, we got a sixth vaccine dose for COVID for toddlers and everyone should take it. Was that a press release from the pharma company? And I, and I study? Was it independent physicians? There is this allegiance that we all get beat into us to obey and follow the NIH and what they say needs to be funded because the way it's done,

it's subtle. These are good people working in a bad system. You've got to get NIH funding. If you get NIH funding, your career will be elevated and promoted. And look at the NIH funding centers, the kidney, right, the heart, the heart disease, and they're funding old belts and suspenders ideas from the old guard professors. Are they funding research on the microbiome or inflammation or food or Alzheimer's prevention instead of just billion-dollar drugs that have incremental or no benefit? So the old guard establishment creates these. false incentives with good intentions, I must say. But sometimes we can't see the forest from the trees. And the reality is we've got to focus on health, not just billion-dollar drugs. The H and

NIH stands for health. And Line Spots is not a book about NIH reform, but it does point out that when people have good ideas and they are shot down as saying, well, this is not NIH-funded research or there's no good scientific study. It doesn't mean it's incorrect. It just means it's more unknown because we haven't prioritized it. There's this rampant practice in the United States right now of cutting the frenulum under the tongue of newborns. And sometimes of the upper lip, there's a frangulum under the inside upper lip and even the side of the tongue in newborns. Now, why on earth would you injure, traumatized, cut the mouth of a newborn? Well, there's a belief, there's an opinion that it may enable them to breastfeed better,

that it may help with speech impediments in the future or reduce sleep apnea or prevent learning disabilities. It's all theoretical. I think it's junk science. I think it's crazy. That's my opinion. They have their opinion. we should resolve differences of opinion by doing a randomized control style. Do the proper study to show that this practice in children helps the kids.

And we desperately need that study. Who's going to fund it? Pharma, fat chance, no way. There's no drug involved. NIH is not one of their clinical centers. The American Academy of Pediatrics, highly unlikely. So we're watching this practice take off an. America based on dogma. And it desperately needs a randomized control trial. Will it get one?

Maybe in 10 years or 50 years. Maybe it'll never get one. Maybe it'll just live forever as dogma. This is a picture of what's wrong with American medicine. Best practices go take on a life of their own as dogma. And we can't keep up with the proper research because research is dominated by the Guard NIH and pharma. It lives in the Bermuda triangle of medical evidence. And that's so much of what we do in medicine, so much of what we do. We were putting in heart stents like crazy, a whole booming business in America for 25 years. And then the courage trial came out and found zero survival benefit of a heart stent outside of an acute coronary syndrome. It may alleviate the symptoms of vagina, but people thought they were going to live longer and the data showed no.

After a giant 25-year run of creating thousands of millionaires in the industry, this is the problem in medicine. We have got to put good research behind it. You look about HIV. People with AIDS were saying, hey, there's some pretty good data suggesting a cocktail of antivirals may help, we'd like to try it. And you saw the old guard say, no, we've got it. You know, you can only try this.

This is the only thing that is FDA approved. And this medical paternalism is one common thread in medicine. And as you mentioned, it has all sorts of implications. You know, looking back on history, which is part of what your book does, there's a lot that we can learn from it. And there's that old quote, you know, history doesn't repeat, but it often rhymes. Let's talk about one of the examples. is you actually start off the book with this, and it's about peanut allergies.

Let's talk about that, because whether people have kids or not, there are important lessons in here, especially at a date and time where it seems like allergies are on the rise across the board, which also plays into this topic of antibiotics that you write about as well. Let's start off with the peanuts. Many times in medicine, the right answer is, I don't know. That's what we doctors should be saying. We saw it a little bit during COVID. The right answer a lot of times was, I don't know.

So what happened in the 1980s was a rise in peanut allergies. It went through the 1990s. People started to notice it. We're talking about a small rise. Well below 1% of kids were noted to have peanut allergies. The media ran with some stories. By and large, these allergies were mild. But there was some attention.

The American Academy of Pediatrics in the year 2000, so this is 24 years ago, decided we have to say something about this concern. People want to know what to do, and we need to tell them what to do. We're the American Academy of Pediatrics. The problem was they had no freaking idea what to tell people. And so they got their little committee together, and they issued a giant recommendation. They blasted around the world, which was to, prevent peanut allergies, you should avoid peanuts, for all kids should avoid peanuts zero through three years of age, all moms who are pregnant or lactating total peanut abstinence, and that

will prevent peanut allergies. That was the belief. Now, technically, they said for kids who are at risk of peanut allergies, that wasn't defined, but this became blasted. It took on a life of its own. Pediatricians around the world started saying, well, really in the U.S., it wasn't really a worldwide phenomenon, started saying at age one, you can introduce some milk. At age two, you can introduce eggs. And at age three, peanut products, not whole peanuts because there's a choking risk, but peanut butter. And so this became the one two, three dogma, this recommendation. It was a moniker that took on a life of its own.

So this whole generation of kids started avoiding peanuts early in life. Well, guess what happened to the peanut analogy rates? they went way up immediately after that recommendation. So the public health community thinks, hmm, we got to beat this in harder. There's non-compliant parents out there. There's anti-science parents out there who are introducing peanut butter and infancy. So they beat down harder. They double down.

Peanut allergies continue to go way up, up to 1 in 18 kids, including a new type of peanut allergy, which is the ultra-severealgae, which is the ultra-severe reality. reaction type peanut allergy. They go into severe anaphylaxis. They end up in the emergency room. Their throat swells up. They can't breathe just from being near a peanut, not even from consuming it. That's a real thing. That's why peanuts were banned on airplanes and things like that. Schools. P peanuts are banned throughout school districts now. And it became this sort of self-licking ice cream cone. The more they doubled down, the worse it got. And they blamed it on the non-compliant parents. It turns out the recommendation got it perfectly backwards.

peanut introduction early in life through peanut butter and infancy at four, five, six months of age prevents peanut allergies. It doesn't cause it. It prevents it. They got it perfectly backwards. They ignored a basic concept in immunology known as immune tolerance. Mothers had been talking about the so-called dirt theory, same thing, for a long time. When you're introduced to allergens early in life, your body doesn't recognize them as foreign later on. The immunology community, knew about this. And they were, I learned in doing the research for the book, they were like, what the hell are you doing telling parents to avoid peanut products and young kids? They should be exposed to peanut butter at four or five, six months of age. And so 15 years later, we finally

got the randomized control study that showed massively higher rates of peanut allergies when kids avoided peanuts early in life. And now the recommendation is reversed. Kids should be exposed. to some peanut butter at 3, 4, 5, as early as the kid can eat months of age, a little bit, not in lieu of bread. It's not anti-breast milk breastfeeding. And so they got it perfectly backwards. And it's unbelievable. The modern, if you think about it, the modern day peanut allergy epidemic was avoidable.

It was created by a bad recommendation from the medical establishment when they didn't know the right answer. they should have done the trial in the study before issuing a broad recommendation. Have they apologized? Not really. I mean, they put out another document. If the medical establishment, if the elites, when they get things wrong, because it's okay to get things wrong sometimes, when they would recognize that they get things wrong,

if they would apologize and put out a reverse recommendation, hey, we got this wrong, terribly wrong. We heard a lot of people with the same vigor that they put out their initial, recommendation, people would trust doctors more. But distrust is at an all-time high. And I think it's because they rush to making recommendations when they don't know what the right answer is. They can't say, I don't know when that's the right answer. They don't do the scientific study first. I mean, during COVID, people were advised, teachers were advised in July 2020 to wear gloves while teaching class and goggles.

It's like six months into the pen. Do the study. If you think it spreads from your eye, do a research study, but it's this lack of humility. It's this putting something out as scientific fact when it's really just an opinion. And that distinction is at the crux

of our distrust epidemic in medicine today. Yeah, I've heard you call it a few different things, like top-down medicine or sort of hubris, or sort of, you know, there's a lot of different words that are there for it. What is the motivation? Is it control? Because as you mentioned, there's a lot of well-intentioned people out there, right? Yeah.

That want people to be healthy. But this idea that the public is not going to be compliant, we got a brute force into them, total and absolute compliance. And by the way, we're just not going to allow any debates on the conversation. We saw about it in COVID, but many other other things and topics that you write about in the book had the same approach. We're seeing it still right now with hormone replacement therapy and what women have been prevented to be able to embrace it and it being a lifesaving tool in many instances.

What's the motivation behind it? I think it's human tendency to feel like I'm the expert. I did all this school. I, heck, I sacrificed my soul to the medical establishment for 15 years. I did this brutal training. I'm the expert. Somebody asks you a question. You feel like, hey, I'm going to give them my best judgment and my best judgment is as good as anyone's.

I think it's an insular type of culture that's just part of the human condition. If you remember when Obama first ran for president, he was asked, what is his favorite book? And he said, team of rivals. and he was really talking about the idea of blind spots, that when you have a lot of power, people can just tell you what they perceive you want to hear, but you want to invite dissenting opinions and wrestle with ideas

and encourage people to speak up by creating a culture of non-intimidation. If you encourage different opinions and then you mock one of them or you make fun of someone, we talk about them behind their back, they're never going to really be forthcoming with you again. And creating, this applies to every business leader. It applies to relationships, politics, and medicine. You've got to, number one, invite dissenting opinions. Number two, create a culture of non-intimidation.

And number three, recognize that we all have biases from our experiences and actively suspend those biases as you intake new information. That was the charge and calling of Claude Bernard, the founder of modern medicine. He said that's what we have to do as scientists. Science is based on challenging deeply held assumptions. And when you start forbidding questioning, it becomes a dangerous place. So I think in medicine we've got good people, but we've inherited this broken system. And when you don't have a total meritocracy, as every human organization tends to bend towards more cronyism and dynastyism and, you know, worshiping individuals as opposed to a true meritocracy, you look at the New England Journal of Medicine. a small group of elite, like-minded doctors in New England who they not only think alike, they look alike.

There was one African-American board member at the New England Journal Medicine out of 51 editors. This is up until a couple years ago. This was all exposed in stat news. And the problem is not that these are bad people. They intend well. But there's a tendency to tap your buddy and they're going to, you and you don't want to invite that dissension, the difference of opinion. That is what I think good leaders are good at resisting is the tendency to just surround themselves with agreeable people.

Yeah, so many layers are going on. Even when there is a focus of diversity, it's, hey, let's get people who look different instead of what you're really talking about. We need diversity of opinions. That's right. That's right. Diversity of perspectives. And sometimes it comes with people who look different in different genders and we want to welcome that. But we need difference of opinions and we need to get people in the room and to talk about all the sides that are there. You know, we weren't doing that during the pandemic, especially early on. And you were one of the earliest voices that I remember that stood up and said, hey, guys, I think we got this wrong and we have to look at things differently. You don't write about COVID too much in the book, right? Right. As you mentioned, it can be tribal or it

be triggering my audience, regardless of where they fall on the political spectrum, and I have people on all sides of it, and a lot of people who like myself are independence, they were some of the earliest in their communities saying, look, something smells wrong about our approach to this pandemic. And it doesn't mean that well-intentioned people are not behind it, but some of this stuff, you're scratching your head saying, what the hell is going on? In fact, you have a pretty powerful quote that you've shared a few times. He said, one of the big, The biggest purveyors of misinformation during the most recent pandemic was the government itself. That's right.

Give us a little recap of some of the earliest things that you saw. You were like, where you felt like, okay, I'm scratching my own head as to why the public is being told this when it feels like we either don't have the science to support it or in some cases we have science that contradicts that answer. Well, at the time when COVID first became a thing in China, I was the editor-in-chief of the largest trade publication read by physicians, or second-largest. I'm sorry. I felt a moral duty to understand what was happening, talk to as many experts as I could. When I say experts, I'm not talking about people who tweet the most or go on TV the most. I'm talking about the true experts in the lab. and I had a group of virologists and lab scientists that I tapped.

And it was a couple things were clear. One, this was going to be bad in the United States. There was already broad community seating and transmission, that people were blowing it off and inappropriately, that we were not being appropriately warned by our public health officials, that people should prepare and start contingency planning. And it just struck me that it was not a surface transmission virus, that COVID was not spread from touching things. The other two coronaviruses

that cause severe illness in humans, and there's only two that we know of, SARS and MERS, both were airborne. So why would this third one suddenly bucked the trend and just spread differently? It didn't make sense to me. To me, it made sense that we would recognize airborne transmission. So when I heard about four, 50 gallons of alcohol in your mail or groceries, I was like, spray your packages with chlorox or whatever. Right? It was kind of like, Now, look, I get it. In the moment, you don't know what to do, you put something out. Everyone's forgiving with that.

But we're talking four or five months in, six months in, they're telling teachers to wear goggles and gloves and gloves in class. Then I was like, you know, I don't hear different opinions, and that's not right. That is not how science is conducted. Science has founded on transparency. So I started putting out different ideas when I heard that they're bringing in old doctors in retirement to come staff the ICUs. I was like, this is a crazy idea when I heard they were closing the schools. Initially, I was like, sure, we don't, we can't, we don't know what's

going on, let's play it safe. But then it was very clear the data showed that this by and large spared healthy young children. And we were enacting the worst, the harshest restrictions on children. Now, people may have different opinions on that, but this is the discourse we were not having. And so I felt compelled to speak up. Then eventually I noticed that the obvious people who had recovered from the infection were not getting deathly ill in the subsequent time period. Several months in, we noticed no one was coming back after with reinfection deathly ill. There was some protective value to natural immunity.

And I started saying, hey, if we're going to pull in people to staff the ICU, Ulets, after people recover from COVID, they should live their lives. We need them to work. This idea of you're an essential worker, you're not essential, it's insane. Like, everyone's essential. So I felt strongly that natural immunity was a real thing. We started seeing studies overseas. I begged the NIH to do a study on natural immunity.

They wouldn't do it. Privately, I was told by public health leaders, yeah, if you talk about natural immunity, some people might want to try to get COVID. So don't talk about the benefits of it. or the other group that got COVID, they're not going to get the vaccine. That was the big concern. That's right.

It could create vaccine hesitancy. Yeah. Right. That's the ultimate evil. You could never, you know, promote that. So it's like a very backwards way of thinking scientifically. So I took it on myself at Johns Hopkins. I'm, first of all, I don't care about,

I don't care if I get fired. I don't care what people think of me. I want to do what I think is true to myself and true to the scientific process. So I was told, don't do this study. We did it anyway. We got a private funder, and we tested the blood of people who were infected with COVID and not vaccinated to look at their antibody levels and measure natural immunity. We found that there was strong evidence of natural immunity that lasted up to nearly two years. And that made sense.

We weren't seeing people in the first two years after the initial group got infected to come back in the ICU. So I started saying, yeah, if a kid recovered from COVID, I don't think they need their second dose or their, or maybe they don't need vaccinated at all. And then I got the anti-vax label. Yeah, I remember that. I shared some of that initial research that you guys put out on my Instagram stories where I was pretty vocal. You know, besides being Indian and so many of my friends are doctors. Yeah. A lot of friends in the wellness space and things.

But it was my traditional friends in medicine that were like, this is, you know, just one. thing, the FDA, Fauci, other people have already chimed in. It's inconclusive about natural immunity. And I was getting sent all this information, even though you guys had done one pivotal study that built on top of other additional research that was coming out of Israel and other places. Yes. And people were just discounting it. And you're being told that you're spreading misinformation. That's right. Our study, by the way, was published in JAMA, Journal of American Medical Association, the most widely read journal in the world. And it was published by myself and several other members of the National Academy of Medicine.

A big group of Hopkins scientists. And we put this thing out there. It ended up being, I think, the second most read study in JAMA, according to their own website for that year. And when I posted it on LinkedIn, got censored. It got taken down as misinformation. This is a scientific study from Johns Hopkins where we simply tested people, drew the blood of people who had recovered from COVID and not been vaccinated, looked at the antibody levels, presented all the data. We didn't say get vaccinated or don't get

vaccinated. We just did the science as the scientific process would merit. And this thing got censored left and right in America. And that's when I saw the intellectual dishonesty. And it went both ways. It went both ways. The, you know, this sort of claim that there was a strong statistical significance of ibupmectin or hydroxychloroquine was the same flimsy data that was used on the other side to support Paxlavid and teenagers or the six booster and toddlers or masking toddlers with cloth masks for three years. The untold story of COVID was its disproportionate effect on poor and low-income minority communities in America. who are largely because of a bunch of different reasons, metabolically unhealthy,

they're already suffering from many co-morbidities, and yes, they may not have access, and the government doesn't spend money on any true approaches to wellness, but we can't discount that aspect that they are fundamentally sicker than the rest of the population. That's right. That's right. And, you know, where was the conversation about obesity, about good health?

Average American put on, I think, eight pounds in the first year, average. Alcohol consumption went up. Substance abuse. Yeah. Yeah. I mean, looking back, I mean, I think people are so disgusted by it. People have deeply held opinions on the topic. And of course, it's now come out what happened to the two top vaccine experts at the FDA in a congressional hearing recently that they were both fired for having ethical concerns about vaccine mandates in young people, specifically with the boosters. They, from their writings publicly, made it pretty clear they didn't think the booster should have been approved for young healthy people. So it became tribal, and I think you started to see the stripes of people in the medical community.

It was very disheartening. It felt like a modern-day McCarthyism. If you got that anti-vax label, which is ironic, right? Because this is, I mean, there could not have been a more ad. I was on cable news almost daily during the vaccine rollout encouraging people at risk to get vaccinated. But you saw the tribalism and so many doctors came up to me saying, thank you for what you're saying. Thank you for your research articles and your op-eds and your studies. I would love to say something about this publicly, but I can't. My hospital will get on my back and my communications, my boss, my promotion.

People told me they had research funding from Dr. Fauci Center. They got NIH funding. They were worried about that. And you realize, like, this is not healthy for science. And COVID was one peak into our medical establishment. This elite priesthood with central authority that issues broad recommendations when they should be saying, we're not sure. And there are so many like that out there.

That was one little peak. It wasn't a one off. Yeah, it was almost this concentrated period in history where everybody got a chance in real time where traditionally before this day and age of social media and cable news and, you know, have legacy media having competition and how information got out there. Maybe 50 years ago it would have taken 10, 20 years for all the lessons and the learnings from COVID or even 50 years to shake out. But here it got shortened in this period of time where even people who largely,

felt that they were repeating the statements of the science has settled or other things. You know, they said, okay, maybe we don't exactly know what's going on. You saw this with the childhood rates of the COVID vaccine. I think less than 4% of parents across the board. They said no. Parents said no. Because they said it wasn't worth it. They were making up their own mind, even though the FDA, I think, still recommends that,

you know, kids get vaccinated for COVID. I see an alert on my electronic. health record when somebody's doesn't like a woman came in and I saw an alert automatically populated on the electronic health records. This woman is noncompliant with her sixth COVID vaccine dose. That's crazy. Still today. Still today. Well, the place that I was going with that is that it was this concentrated period where we all as society and if there was a silver silver lining from COVID, it was that. So many people and parents got a peek behind the scenes. But as you mentioned, this is going on in so many different areas. My audience cares a lot about.

diet, nutrition, longevity. So I'd love to pivot into one of those areas that you write about in the book. And that's on the topic of cholesterol, how we have this sort of expert group think that's going on. And there might be more to the story or at least more research that's needed. Can you talk about that? Well, first of all, Drew, you couldn't be more correct in the way you described it. If we got some things wrong during COVID, look at our track run. record. We got opioids wrong for 35 years. We got hormone replacement wrong for 24 years. We're still

getting it wrong. And people are ignoring the evidence. We got peanut allergies wrong for 17 years. We're still getting it wrong. We got the low fat diet wrong for 60 years. I mean, putting, and there's probably the number one health recommendation we as doctors told patients in the office in the primary care setting was, well, it's time to lose weight. You got to lose weight. are you avoiding fat avoid this try low fat i mean this is like the number one thing we were doing we now recognize it was perfectly backwards the industry got got this bandwagon effect and i interviewed one of the people involved in the food pyramid at the government and she basically tells me she still believes it like the low fat is the way to go and she says marty you mean to

tell me that the american heart association is wrong and the American College of Cardiology and the Surgeon General's report and all these experts, you mean to tell me they're all wrong? And I'm like, oh, well, heck, if all these people are saying it, then it must be true. That alone becomes scientific evidence. No, we have got to challenge deeply held assumptions. And the low-fat bandwagon was started by a one-man show, a guy who was politically savvy. And he put out there, after Eisenhower had his heart attack, that this was caused by fat in the diet, and we got to put him on president on a low-fat diet. And it became dogma, became gospel. And there was a lot of industry and financial profit incentive aligned,

because the American Heart Association put a healthy heart seal for sale, that if you as a little mom and pop family-owned Italian restaurant, wanted to promote healthy foods in the name of public health, you would pay the American Heart Association, a licensing fee to put their little healthy heart by certain low-fat items on the menu. Never mind, they're coated in sugar and refined carbohydrates and ultra-processed. But we're going to sell you our little heart. And it took on a life of its own. They're making millions from selling low-fat cookbooks, low cholesterol cookbooks. is not even absorbed. You know, the idea that dietary cholesterol

jacks up your body's cholesterol level, it's like, it's hysterified. It's too bulky. It's not digested. 90 plus percent of the cholesterol you and just goes right through your system. It's not even absorbed. And 99% of your body's cholesterol is made by your body. So this idea that we just got to beat more people into compliance

with avoiding cholesterol in their diet is the same thing we saw with this peanut allergy. story, beat more moms to avoid total peanut avoidance, peanut avoidance in young kids. And if we get more people compliant, we saw it during COVID. I hate to make the connection. If we could only get every last toddler in America to get their fifth vaccine booster and wear a cloth mask, we could finally end this epidemic. And you saw this bandwagon thinking. And the reality was that it is now pretty clear, the doctors who sounded the alarm, and I mentioned them in the book Blind Spots, who said, wait a minute, the data on low fat preventing heart disease is not there.

And it's not for lack of trying. Three major studies, three massive studies, the Minnesota Heart Study, the Women's Health Initiative study, and the Framingham study all tried to show with the hypothesis that saturated fat causes heart disease, all three. failed to show it. And they were gigantic studies. Minnesota Heart Study actually found low-fat diet group had higher rates of fatal heart attacks. And they suppressed the study. The guy was asked, hey, why didn't you publish this for 17 years after you got the results? Would have made a big difference. This was the study started in the 1970s. He said, oh, you know, we were just disappointed

in how the results turned out, Dr. France. I mean, and you realize who is advocating for the everyday American for the patient, for the American worker that's funding this giant system. So the story of the low-fat diet is really, and it still lingers today. I mean, heck, this morning, I was at a coffee shop and I saw egg white only, you know, avocado toast. I'm like, egg white only, okay, because we got to reduce natural saturated fats, right? And it's just like the nutritionist community, dietitian community got corrupted. by the food industry.

You see a lot of young dietitians today coming out of school. And they're like, yeah, what I was taught was wrong. I mean, they're listening to podcasters like yourself who are trying to be very judicious and honest with the scientific data talking to the real experts. And they know that a lot of this stuff was made up. Breakfast is the most important meal of the day, made up by Kellogg for a marketing campaign.

And so people are now getting smart. and that's why I'm so optimistic about the future of medicine. People are smart and they're realizing, and it's not just in medicine, people are realizing they've been lied to, they've been lied to by corporate media and governments and corporations. And so the idea that I'm just going to believe whatever I'm told, you know, hey, you know, we heard it on CBS Evening News and I read it in the New York Times and therefore it must be true.

People are now like, no, there's something I'm not hearing about this. Weapons of mass destruction in Iraq. Is there possibly a reason why no other country in the world is supporting our invasion of Iraq? And I think people are now asking questions they realize they've been lied to. You know, there's a super popular mug. I don't know if you've seen it. You know, a lot of doctors have it. not all doctors, which is good.

And the mug, I'm paraphrasing here, says a quote on there, and it says, my medical degree outweighs your Google Internet search. Right? And I remember a doctor friend of mine, you know, seeing that and kind of joking in a group text, he said, if your doctor has this in his office, you know, run and go the other way. Because it essentially is saying, I am science. I know. and by the way, having so many doctors in my family, my brother-in-law, cousins, etc., doctors

Google all the time. They Google all the time stuff. They're using Google all the time to research things or ask questions with normal stuff. Many of them are not trained in actually how to break down the peer review and break down a study. I'm not training that either. I don't know how to do it, but I'm just saying many of them are not trained in that. and it goes counter to what one of your central recommendations are in the book, which is that even though it's tough, even though people will accuse you and label you with all sorts of names,

you have to, to protect you and your family, you have to be willing to ask questions. Yes. That's one of the only ways to make sure we can protect ourselves in this modern day industrial medical complex. Can you talk about that? societies are defined by the speech they do not allow. And in the medical establishment, we had sort of an open freedom to ask questions. And recently it's been like, no, why are you studying that? You know, if you talk about natural immunity, that could create hesitancy.

We've never seen this before. But I love the rank and file doctor that thinks independently. And there's a lot of them. And they're good folks. And they mean well. The vast majority of doctors, by and large, do the right thing or always try to. but there is a group when I talk to them, there are individuals that when I say, what are your thoughts on the arrived trial of it? So there's this trial in, say, in OB, not to get too much in the weeds that concluded, I think the study was flawed methodologically, concluded that all healthy women that are pregnant at term when they get to, when that when, when, when, when, when, when, when, when, when, when, when, when,

they come in should be induced or you should bring them in to induce them, 100% of them. There is this other view, which has been dominant in the world forever, and that is expectant. Let's see if they go into labor on their own, 39 to 42 weeks. And once they go into labor, then we will bring them in and deliver the baby. But there's this study that said, no, no, every woman that hits 39, 40 weeks, bring them in and induce them, 100% of them. And so when I talk to a doctor and I say, what are your thoughts in the arrived trial? If they say, well, according to the American Academy of whatever, we are supposed to do this, I'm like, I'm not asking you to recite some catechism of what you're told to obey.

I'm asking you what your independent mind. You went to school for a long time. You're smart, obviously. What do you think of that study? Did you read the study? Other doctors will say, and this is a mark of a good doctor. Well, Marty, I know that study concluded this, but my experience is this. And I know some doctors are pointing to these other studies that would suggest that

study wasn't, didn't arrive at the right result. And there were methodologic concerns. I may not know what they are, but I'm a little skeptical and I'm open to what you think. Those are the docs you want, right? The doctors that have humility. What makes a doctor a great doctor is not how many things they've read? or how fast they can regurgitate the Krebs cycle. It is knowing their limits.

It's humility. It's what we cannot teach in medical school. And you can spot the students that have humility as a trait. They have awareness, self-awareness, and they're aware of how scared somebody is when they come and ask them a question or you're recommending surgery to them. Those are the folks, the students and residents

that I know we're going to excel. They're going to crush it. and you see it in practice. You see people say, you know, I've seen this once before. What do you think, Marty? Knowing your limits. I had a resident beat himself up once over something trivial. And I was like, what are you doing?

He was like, well, I need to get this right. I said, sure, yeah, that's you're correct. But what's going to make you a great doctor is knowing your limits, when to call for help, when to say, I don't know, when to say, hey, that's interesting. I've never heard of this diet as a way to manage a cancer. I'm going to go and read up on it and then come back and say, you know, I wasn't too impressed with the results or I don't know. But that level of dialogue is what's healthy in medicine.

We've always had it up until the white coat era of medicine. You know, part of what you are asking inside of this book, just to jump ahead and then we'll jump back into some of the content of the book. And I want to know a little bit more about your story, is you're asking, if we can understand with humility that there's well-intentioned people that are out there that are doing their best, there is this group think at the very top that is partly, you know, absolute power corrupts absolutely, as well as the emperor has no clothes, as well as surrounding yourself with people who don't question you.

Yeah, they don't have a good track record. They don't have a good track record. Right. And you've listed out many of those areas. then we can also ask what else are we wrong about? What are some of the top areas that you don't know the answer on, but you hear whether it's your patience, the community or people you respect asking questions and saying,

hey, I don't know if this is true or also and or. We need more research in this area to know definitively. Give us a few of those areas that you are paying attention to, even if you didn't get a chance to write about them in the book. We don't talk about alcohol abuse. We talk about fentanyl. We talk about opioids. We talk about every drug out there.

Nobody talks about alcohol abuse. It turns out it claims the lives of more people than any other drug out there. And we glorify it on college campuses. And we, I'm not talking about abstinence versus drinking alcohol. We're talking about the glorification and promotion of binge drinking. and that has consequences in society. It's something no one will talk about. Fluoride in the drinking water.

That was very controversial and still is. Yeah. I think there was a study that was published in JAMA, and this was two years ago, a researcher out of Canada who did a natural experiment where there was two counties in Ontario, one that fluorinated their water and the other group that,

the other county that didn't fluorinate their water. And this experiment, again, natural experiment, it's already happening on its own. This researcher looked at babies, and in particular, both boys and girls, and babies don't have teeth. They don't need fluoride, right? They don't need fluoride to protect their teeth, right?

Even if some people argue that fluoride is not actually protecting teeth or the number to treat is actually a lot higher. The question is, is this a potential neurotoxin? And one of the conclusions that was there, again, one study, but looking at a natural study that was there, is that the county that didn't fluorinate their water, that the baby boys in that county had higher IQ and the counties that fluoridated their water, in particular young boys, we don't know why. It didn't affect young girls as much. The boys had much lower IQ that was there statistically significant. And it was super

controversial that it was even published in Jam in the first place. They had to issue a letter from the editor saying, we think this is important research. We know that a lot of you feel that the science is settled on fluoride. I love that. But we have to be able to have that conversation. It was kind of crazy that they had to defend publishing a study questioning something. Isn't that the goal of a journal? Yeah. Isn't that the scientific process? Yeah, you're just presenting data. How dare you challenge these deeply held assumptions in medicine? Look, we got a myopic view on fluoride a long time ago because dentists noticed that there were lower cavity rates and that may be because it's antibacterial. It's bacterial cytop fluoride.

But if it's killing the bacteria on the teeth, what's it doing to the microbiome? Is it altering that balance of the bacteria that lie in the gut? and it was noted, as you pointed out, that fluoride may be accumulating in one of the learning centers in the brain. And that was the controversy. That was the rationale put forth supporting that JAMA pediatric study you mentioned. We florida, the vast majority of our water in the United States, Canada, about a third of their water in Europe, 3%. Now, do they have an epidemic of root canals that we don't have? No, this is one of those areas where the hubris of the medical establishment and the lack of

questioning, we're talking about how to have impeccable objectivity. This book Blindspots is a bit of a guide on impeccable objectivity. Where was the inviting of different opinions? Where was the creating of a safe space? Where was the team of rivals concept? Instead, we put out there, the CDC on their website to this day, has the fluoridation of drinking water as one of the top 10 public health achievements in human history. That is the hubris of the medical establishment right there.

What is it doing to the microbiome separate from the learning center of the brain? The microbiome is the biggest frontier right now in medicine. Freaking incredible new research on the microbiome that has not only blown me away, as a physician and public health researcher. But it may very well redefine health in every specialty of medicine, from mental health and learning disabilities to dementia, to the estrogen cycle, to food, the immune system. It's interacting with everything.

These millions of different bacteria, not millions total cumulative, millions of different types of bacteria, live in a certain harmony. And when you put fluoride down there, it may be killing some, enabling overgrowth of others, and maybe those that are increasing in the number from the overgrowth are more pro-inflammatory. I don't know. It's the theory. But what we do know is that there's a Mayo Clinic study, and this was the study that blew me away the most, a Mayo Clinic study just came out a couple years ago. And they compared kids that grew up in Olmstead County, Minnesota, where the Mayo Clinic is located. So these kids were matched kids who took antibiotics

in childhood versus kids who did not. And so they were matched to be roughly similar type of kids. It's not like one group was divergent in how they sought medical care. They found that children who took 14,000 kids, okay, the kids who took antibiotics in early in childhood were more likely, to be obese, have learning disabilities, have celiac disease. Siliac was almost 300% more common in kids who took an antibiotic in childhood. And a host of other conditions, asthma right on down the line. The group that did this research, one of the senior authors told me they didn't find an increase in autism among the kids who took an antibiotic, but he believes there is an association there, and they're doing another broader study to look at that.

We know some bacteria produce serotonin involved in mood. We know some adults work out and exercise like crazy, and they can't lose weight. They change what they eat. What is going on? Now, you might say if you're an objective scientist that we cannot conclude a cause and effect. If the kid didn't take an antibiotic, maybe it was the illness that they did not get. kids who took an antibiotic had a certain infection, maybe they needed an antibiotic. You could make

criticism of the studies, but here's an incredible kicker. The more courses of antibiotics the child took, the greater the likelihood of obesity and diabetes and celiac and learning disabilities. And certain antibiotics like septriaxones had an even higher incidence. And more and more studies are now showing this connection, even a connection with the rise in colon cancer. in young people, which if you've been following the media on this, this is like a new thing. This is something we're trying to understand. And so the average 10-year-old has already taken almost a dozen courses of antibiotics in their life in America today. Now, antibiotics save lives.

That's important for us to say. But they're also massively overused, even more so with telemedicine. I mean, how can you even look in the ear in telemedicine sometimes? They're just, this is a consumerist culture driving a lot of this. It's sloppy medicine. It's a number of different reasons, but it's antibiotics given to food. So antibiotics are routinely given to a lot of farm animals raised for generating food because it makes them fatter. And the researcher I studied, who's kind of the world expert in the microbiome, Marty Blazer,

I interviewed him for the book Blind Spots, and he said, it's just kind of, to struck them once, hey, if they're giving antibiotics to farm animals to make them fatter, what's it doing the humans? And he actually did the research, and sure enough, there was an association there. And C-sections was the other thing, C-sections. So you're born sterile. You're born with no bacteria in your gut, right? When you're in utero, there's no bacteria in your gut. And the microbiome, this garden of millions of different bacteria, is seeded by the bacteria in the vaginal canal on delivery, and it's augmented by bacteria from breast milk and the colostrum and the mother's kisses and grandparents kissing the baby and so forth, touching the baby.

That's how the microbiome is formed. But when you're born by a C-section, a baby with a sterile gut is extracted from a sterile operative field. And instead of the vaginal bacteria having ceded the microbiome, it may be the bacteria that normally live in the hospital. And those are not good bacteria. And so what are we doing? What are we doing to children?

What are we doing the microbiome? We've given out antibiotics like candy. There's this dogma that there's no downsides to them. A study just found in association between colon cancer and young people and being born by C-section. And there's other studies that have shown these connections. So we will spend billions of dollars on chemotherapy drugs for colon cancer. And the medical establishment, my field, I'm a surgeon, will do big operations, resecting lesions in the liver and doing studies of how to stage it and what types of lesions

to resell somebody has got to say stop what is actually causing cancer we need to study the environmental exposures that cause cancer not just the chemo to treat it and this is one of the giant frontiers can we look at our own field the overuse of C-sections the overuse of antibiotics can we look at what we're doing with food as medicine can we look at the impact of fluoride and ultra-processed foods and refined carbohydrates. The new research now on the microbiome is just unbelievable. It's amazing. And I was so blown away reading these studies, talking to the experts, then taking them to, say, the colon cancer community and the C-section community, hey, have you seen this? Have you guys seen this? I would do this at my own institution at Johns Hopkins.

And they would be like, wow, this is interesting. And then the reason to write a book is not, oh, I, you know, I want to be a published author again. I want to, no, the reason you should write a book is that you feel there's a compelling story out there that needs to be told, needs to be shared broadly, that is not being shared broadly. And even within the medical community, this research on the microbiome is not widely known. It's mind-blowing because anybody listening to you, all of our listeners, all our viewers, they're all nodding their head.

And it feels like total common sense. what you're talking about. And yet our actual world, the medical industrial complex, which is different than the day-to-day doctors who are fighting so hard to keep their patients and families healthy, right? They're largely doing their best, and they want people to be healthy. But the medical industrial complex, the system that we're in,

is pulling us in a completely different direction. do you feel that the answer, you know, there's the things that we can do. We already talked about one of them. We all have to ask questions, even if we're being afraid of being mislabeled as being just simply by asking a question, a purveyor of misinformation or whatever it is that's there. We have to ask questions if we want to look out for our family. But in terms of the system, because it's a top-down approach system is the answer we have

to change the leadership at the top, and society has to sort of vote with their dollars, vote at the polls, and that's the only way? Or do you feel that innovation is going to somehow supersede this top-down medicine? Yeah, what is going to change this? There is this big struggle, and I'm not just talking philosophically and intellectually, but in the market. Market forces right now are pulling at the medical establishment, and they're saying people are asking, Hey, do you know a functional medicine doctor that specializes in endocrinology? I can't find one. There's one in Maryland that, you know, somebody may know.

Hey, I want to learn more about the microbiome. You see probiotics coming to market faster than anyone can study them. There's this hunger and thirst to talk about what actually matters, not this old gar establishment doctrine that comes from the medical establishment. And so you see this play out in the medical field. young people who are listening to your podcast and are learning about health and reading Mary Claire Haver, they're reading her book before they come to med school and they're saying, hey, wait a minute, why are we not talking about menopause? Why do you believe a hormone replacement therapy cause of breast cancer?

And they are challenging this old guard establishment from within. We're seeing philanthropy dollars come in that with our research say, you don't have to study what the NIH tells you. you to study, you can actually study what you believe is important. What if the NIH, instead of giving a research or a million dollars, putting them through the ringer with tons of red tape, telling them they can only do this little research project that is approved by the old guard establishment, what if we took a medical, a research genius, like an Elon Musk in medicine? We've got these very creative thinkers. And we said, here's $10 million, go study whatever you want. You get seven years.

You can pivot 15 times if you need to. We would have far more discoveries. There are many forces right now that are challenging this conventional way of doing business and medicine. The young folks, residents and students, our students, 50% do not want to practice medicine full time. They want to do something else. They want to get a second degree. They want to do some entrepreneurial thing. They want to do, we have these point solutions now where we're recognizing the hard part about treating chronic disease is not telling people what to do.

It's helping them do it. And if we just keep telling them, you know, this old model of, you know, you come in to see me every six months and, you know, you're, you know, eat better and exercise more and avoid fat and whatever other misinformation they're being told. and come back and see me in six months, and they come back and you know, you still weigh the same amount. You're a bad, bad, non-compliant patient. You lack willpower. You lack willpower, right?

This is the old model. They're looking at the young people are looking at this saying, I don't want anybody to do with this. This is insane. So here's a better model. What if somebody comes in who smokes cigarettes and I ask them, I see here that you smoke cigarettes.

Some of my patients tell me, you know what, I'm fine with it, I don't want to stop. And other people tell me I would love to stop. How do you feel about it? And this is what I do in my office. Some people say, yeah, I'm fine. I don't want to talk about it. And I say, okay, I'm not going to, you know, loom over them and make them feel guilty. And it's just because it's ineffective.

It'll backfire. It'll backfire. And they're not going to trust me with other surgical recommendations I've got to make. And then you meet somebody who says, you know, I just had a granddaughter. I would love to stop smoking. Those are the people we want to spend all our time. Okay, here is a person that's going to give you some medication to help you stop, and they're going to walk with you and check in with you and call you.

And here are you going to meet them? That is a point solution. and the data are compelling. With diabetes, there's point solutions. And employers are saying, hey, we want to offer this as a benefit. We want to offer benefits now on fertility and point solutions, obesity. And they're seeing an ROI as the funders of their self-funded health plans. And so this is the exciting thing.

And there's a lot of stuff that's depressing about the old Guard medical establishment. you know, they hold on to power with a tight grip and they just, they're not going anywhere. We're seeing doctors come up now and they're being told, hey, great job in residency. We're going to offer you a job at the university to be on the professorial tract, a tender track. And they're saying, no, thank you. I'm going to work in this clinic where I'm going to spend time and practice like Peter Atia. And so it's an exciting time in medicine. And I think it's driven a lot by your listeners.

driven by public demand, market forces. And so it's a cool, it's a cool time. I want to understand while we have a little bit more time here before we wrap up, just give us an insight into how you became one of those individuals in the face of everybody telling you out there, minus the diverse group of ideas and different thinkers you surround yourself with. How did you get to a place where you said, especially during the pandemic, which is how I first found out about your work that, hey, we have to be willing to question things and say, actually, we don't know if this is true. And people saying you're anti-vax, they're saying you're spreading misinformation, you're

killing kids. I mean, it was brutal on Twitter. Now called X, where largely, you know, you were very vocal. How did that thinking come to be? What do you credit that to in your medical training or your upbringing? Well, my dad was a doc, and I remember going home telling him stories of my medical school training and later residency and things that would blow me away, things that made no sense, but we were told to do them anyway. And I remember he said, write them down because you would be amazed at how many

people feel the same way now and will forget or will succumb to this cycle of abuse, this effort justification that Leon Fesensure describes when he talks about cognitive dissonance. And I did. I wrote them down. Some of the stories I put in this book called Unaccountable that was turned into the TV series, The Resident. And I just remember thinking differently about so many different things. And then my third year in med school, I remember trying to voice a concern a patient had to the team.

And they were like, doesn't matter. You know, she's send her for this. She needs this. She needs that. And I'm basically trying to tell the docs, she doesn't want it. She wants to go home and she wants to die. And there are things worse than dying and you're about to do it to her. And I kind of, you know, never, I've always felt a little unfiltered and would speak my mind.

And I, they were nice about it. They didn't eat me alive. But then I felt disillusioned by the profession. I felt like intellectually I can conquer this material. Ethically, I feel disillusioned. I quit medical school and I went to graduate school for public health at Harvard and I felt like this is my community. Now we're talking about broad, big stuff.

And so I got a master's public health. Eventually I missed the bedside care and went back to residency and did a surgical residency and then got a job at Johns Hopkins in fellowship training and surgical oncology in gastrointestinal surgery. But I remember my dad telling me the whole time, because we kept this great dialogue, we still do. And he said, remember all of these feelings so you can teach them to your students.

And after I got a chance to write this book that did very well, I thought, well, you know what, I've got other things I feel like I want to say about the medical field, ways that we can perform better. The prior book to Blind Spots was about predatory billing and price gouging patients in medicine. On my research team at Hopkins focuses on the big topics of medicine we're not talking about

that we need to talk about. There's no NIH funding center, but it's clearly affecting the health of the public. Health disparities, 62% of the public doesn't trust us. And so you can have a pill that cures pancreatic cancer, and now that pill because of the distrust, is only 38% effective because 62% people are not going to come in and take it. They don't trust us. And so if you ignore this giant blind spot and blame it on them or people spreading misinformation about microchips and vaccines or whatever else this idea is, then you're not connecting with the population that you've taken an oath to serve. And it really gets back to interpersonal skills,

awareness, self-awareness. So I wanted to speak to so many of the people. these topics. And our work on price transparency and the prior book, the price we paid, led to the executive order on price transparency, signed at the White House, supported bipartisan by both administrations. And it now is requiring hospitals to post cash prices for commonly shoppable services. It's banning secret discounts insurance companies get. And so there are ways to do good things. I think by talking about the big areas in medicine that we're not talking about that we should be talking about. And I think we all feel this sort of objection when we first see things in medicine that make no sense. When we see a patient waking up at two in the morning because we have to draw your blood because we have to have it for rounds,

because we round at 5 a.m., because we have conference at 6. People say, what are we doing? You know, like, sleep is important. This person's recovering. They're in the hospital. what are we doing? Like, stop, like what? And we all have these objections, but then over time you get this sort of survival mechanism. Then you get that there's almost this hazing culture of what we have to keep the cycle going and keep the profession and the tradition strong. And people, it's not that they don't have these thoughts, it's that they surrender them too early. And that's why I'm so encouraged because I've decided I'm going to speak my mind no matter what. I don't care if I lose my job. By the way, there's nowhere else for me to go in academics. There's no higher job. There's no, you get tenure at Johns Hopkins in medicine. I mean, what else you,

you know, there's nothing else to do. So who am I trying to appease? So we just focus on high impact research. We're not interested in studies that tell us that there's health disparities in a particular area. We know that. That's not interesting. We want to know what reduces health disparity. What's effective? Food as medicine. Is food as medicine sending a frozen meal to someone's house? Is that effective? Or does that just make us feel good? Is the person eating it? Is it actually healthy or is it just processed and has the appearance of healthy? What's it doing to the microbiome? Are they still eating potato chips five times a day and eating that frozen meal? What is the impact of what we do? And we do so many.

things in medicine that make us feel good, like, oh, we're championing, you know, we're promoting this, and what are we really doing on the ground? The Department of Health and Human Services issued a requirement for hospitals to demonstrate that they are engaging in activities to reduce health inequities. So hospitals sometimes are spending millions of dollars saying that we're doing these things, bringing panels of people, holding a little conference, And at the same time, they're not accepting Medicaid. And it's like these are the blind spots where we need people to speak up and challenge corporate medicine and talk about redefining health and focusing on the issues and research that matter to patients,

not just because we have the most over-medicated generation in human history. We can keep throwing good money after bad into this broken system, or we can invite fresh new ideas. and just because those ideas are not homegrown within the towers of academic medicine doesn't mean they're not good ideas. And so that's the dialogue that I love having. And that's why I love being here talking to you. No, I so appreciate it.

Again, I've been such a fan of your work. And I know that it takes so much courage to speak up when the entire world is going in a different direction, you know, to speak up early and to get all the backlash that you and a lot of the peers that you surround yourself with. you know, people who are listening today, they're largely just trying to live healthier lives. And you are connected to so many incredible thinkers in the space, some who have been on this podcast before, you know, people like Peter Ortea, who hasn't been on this podcast, but I'd love to have them on one day.

What would you say for a public that is largely, you know, pretty healthy, comparatively to the general population who's listening to this podcast, but they're paying attention to some of these topics that you're talking about? They're paying attention to the microbiome. You know, my audience largely, they're not smoking. They're not, you know, as a whole, dealing with alcohol use disorder. They're trying to eat healthy and they're maybe shopping at Trader Joe's or at least like the organic section at Walmart and they're trying to reduce their environmental toxins.

What do you want to say to them if there was one or two, three things that you would suggest that they could be doing or thinking about to invest in their health? What would it be? Well, I think we're rediscovering things in medicine that have been around from biblical times, the benefits of fasting, meditation, whole foods, eating clean meats. I mean, it's almost as if we feel that we discovered it when it's really been around there since ancient times. I think what we're learning about the microbiome would suggest that because the microbiome is passed on generation to generation. That is, if a woman has their microbiome messed up with tons of antibiotics they didn't need and all kinds of environmental exposures and bad foods, that microbiome is the default microbiome with a baby.

And so how we restore. So generation to generation, these microbiomes are evolving. And you see it when you travel overseas, you get sick the first couple days you're in India, Egypt, my family's from Egypt. and then you realize your microbiome is adapting. And microbiome health is something we're now learning more about. Now, there's a lot of gimmicks and a lot of ways to waste your money on things that claim to help your microbiome. But you know what?

I tell patients who really want to get healthier, tell them to try different things. See what works. See what makes you. You've got five microbiome products that you see out there and you're asking me which one's the best. Do your own clinical trial. Things are different for different people.

Maybe that's why some people do better with different diets. Almost any diet is going to be better than the standard American diet, what we call sad. So it's not that maybe this diet is ultimately superior for everybody. It may be that watching what you eat and the portion control piece of all diets is a commonality that's resulting in better health. It took me a long time to realize that I had still a sugar coma, a food coma. during the day, and there are ways to reduce that, right? I don't think cavemen woke up in the morning and had a buffet breakfast. You know, they went out and hunted and gathered, and they ate in the evening.

So there's basic principles now that we're recognizing can translate into good health, and I encourage people to try different things. I want to go through a few areas that are questions that my audience has. And it's not that people have made up their mind, but there are things that they're like, I actually don't know. and a lot of them, like myself, are people who understand that science has contributed so much, like that antibiotics are actually like a major transformation in human health. And at the same time, I can hold the other idea, which is we've overprescribed them,

as you mentioned earlier, and we need to reel some of that in. You're not against or you're not for, you're just like a lot of topics, you're nuanced around it. And I want to see if you have any commentary about at least, you know, are these questions that you have or what could we do as a society to pursue some of the answers that are there? So after everything that happened with COVID and some of the questions that came up about the efficacy of vaccines, that encouraged in both directions a lot of mistrust for public health, but a lot of parents asking genuine questions of, hey, I believe that there's a

role for vaccines, but I'm also concerned compared to when I'm, I grew up, my children are getting so many more vaccines and they're getting them in this shortened window, I have questions about that. So let's call that the standard sort of, you know, NIH vaccine schedule. Have you heard about this? I'm sure you have. And what would you propose as one way that we could step in the right direction of at least answering some of these questions that families and communities have. It's amazing. This is a subject so taboo in medicine, you cannot question a single one of the dozens of different vaccines on the schedule. You immediately get a label. Some of these vaccines, I think, could use better research to

identify the necessity and the ideal dosing schedule. Look, if you found out how some of these schedules were developed. I'm just going to use the COVID vaccine as an example. The first two doses three and four weeks apart, I was insane. Okay. The company said, yeah, we put it, we jammed it so close together to get the study done faster because of the pandemic. No one's thought, what's the ideal dosing schedule, three or four weeks? They did a study in England that you'll never hear about in the U.S. where they actually compared those first two COVID doses being three or four weeks apart versus three months apart. When it was three months apart, it was better immunity and lower side effects. What does that tell us? In general, with almost any multi-dose vaccine, the more you spread

them out, the better the immunity and the lower the complication rates. When people come in now and they're asked a question about vaccines, it's a tribal conversation. And it should be nuanced because the evidence to support different vaccines and different dosing schedules varies. It's not every single childhood vaccine has the same level of importance and scientific evidence to support. No, it's varied. Of course, it's a heterogeneous compilation of efficacy and benefits and the risk. I have talked to vaccine experts that have told me that the meningococcal vaccine of all the vaccines is one where if you look at the net benefit, net harm on a public health level,

it shouldn't be put out there with the same vigor and absolutism as the MMR vaccine. I don't know. I'm not in that field. But I think that's where people are appropriately a little skeptical, because when you're told absolute, with such absolutism, the hepatitis C, HPB vaccine in childhood has the same level of life-saving efficacy and evidence to support it at that time, at that dose, with this frequency as the MMR, I think people are appropriately saying, well, you know what, this guy over here has got a modified vaccine schedule.

I might subscribe to that. I wish I knew more about this topic, but it does tie into this broader theme. of putting something out there with absolutism when the evidence might be flimsy and treating something as scientific evidence when it's sort of based on clinical wisdom. I don't know if you saw this on TwitterX.com, but Bill Ackman posted out a tweet and said, hey, listen, I want to fund more research in this space. There's a lot of vaccines that we think are actually really beneficial. And there's ones that there might be concerns on. And he actually put a little pot of money, a big pot of money together and asked for clinicians to write in. And one of the

things that he mentioned, we'll link to the tweet below, is that even getting very accredited university researchers to even explore this topic was extremely difficult. Oh, yeah. So many of them were even just worried about taking this on with private money funding it. That's right. Because they felt like, hey, I'm going to be labeled as something or another when I too might have some these same questions that are there. So I can imagine, and my heart goes out to anybody in that position, but I feel like slowly the tide is turning. There are people that are raising their hand, often young people, as you mentioned. I don't know if you know this Max Planck quote. He was a German physicist who was a Nobel Prize winner. And when he accepted his Nobel Prize,

he said that advances in science, and obviously you could say with medicine too, advances in science, unfortunately, don't happen when the old guard wakes up one day and says, oh, you know what, I guess we got it wrong. They unfortunately happen one funeral at a time. Yes. The old guard lives, you know, their life, thinking one way, you know, retires, passes away. And a new guard comes in and they start questioning things that are a little bit different. and that's unfortunate, but sometimes that's the way that it is.

Yeah. Yeah, my dad believes in the low-fat diet with such absolutism. And I love my dad. I probably love nobody more. And he basically has been beat into him for 60 years. He's been a doctor's whole life. They've been beating it into him. And he just cannot abandon that view.

And here's a guy who's reasonable who I love, who I've shared the data with. this is what we're up against in modern medicine. So it is hard to do these research studies. I can imagine. I mean, heck, if we said, hey, we're going to do a study to actually look at the efficacy of an intracoccal vaccine and its dosing schedule, I would be getting calls and pushed around and bullied. Now, I'm in a position where I can say, screw you guys, we're doing this anyway. But I saw it during our natural immunity study. I mean, the journals can then in the final, in the end, they can say, now, luckily, I had great rapport with the medical journals, and they said, yes, we're going to publish your study on natural immunity to COVID. But we've published other studies

that are very provocative, and the journals just say, no, thank you. And it's like, do you have a reason why you're not accepting it? You always give a reason. We've chosen not to publish it, and you're like, this is very interesting. This is very interesting. The old guard in the medical establishment will turn over eventually. We're going to be getting people in there that think, you know, differently. Well, it feels like a big part of that is having platforms that individuals like yourself could speak to. If I can state and you can correct me if I'm wrong, but largely the way that you were getting out the word about all sorts of ideas that you had was using things like Twitter, X.com, and being able to speak to people directly and not feeling,

even though you were really good about going on TV and, you know, a lot of different stations and legacy media would have you on. Having other tools, you know, people like Andrew Huberman, being able to educate the population. Last year, the number one podcast downloaded across the board, I think Spotify and Apple, was his episode that he did on alcohol. Oh, really? Yeah.

Talking about how there's, you know, the research is super flimsy on the health benefits of alcohol that are out there. and I know you and I know that and maybe some of our audience but a lot of people actually didn't know they still believe the red wine risveratrol conversation you know these things they they die hard that are out there so people like Andrew Heberman being able to go directly to the public have that conversation have controversial figures on his podcast or peter t on his podcast it's shifting because how people are getting information is shifting yes and that's one of the best things that's come. Social media gets so much flack for how polarizing it is or this,

but I believe that it's allowed a whole host of conversations to happen that previously wouldn't have happened. Yes, I'm in HPBs. The world is surgical oncology and hypersalization. One of my areas is pancreatic, biliary liver disease. And if there ever was a hair of a benefit of alcohol in the heart, it is. far eclipsed by the damage to the liver and the bad outcomes of the alcohol in liver disease. I mean, not even close. So net harm undoubtedly clear cut. But so liver, by the way, is the only food I cannot eat.

I go to a restaurant. I say, do you have any foods that you can eat? I say, yeah, liver, it's just too close to work. Well, just on that topic. Yeah. You know, there's, I believe, a colleague of yours, or at least I believe that you guys are friendly with each other, Dr. Vanay Prasad. Yeah.

And he wrote a really fantastic piece in YouTube video that he put out there in his substack and then consequently on YouTube where he said that, okay, there's all this backlash against alcohol. But also we want to say that, yes, we know that ethanol is a toxin, but we actually don't have any large, randomized controlled trials to talk. talk about is there not some benefit about the social aspect that might come with sharing a glass of wine with somebody? And so, yes, we know that it's not the risverital thing and all this hype about how, you know, hey, your doctor recommends a little bit of alcohol here and there. But by the way, if you're not drinking alcohol, don't start, which always was so confusing for

the public. So you're saying this thing is beneficial, but don't start if you aren't drinking. So he came out and said, we actually need to fund more of these studies if we're definitively going to say that the social aspect that's there at a moderate level of consumption, which is where most people are at, doesn't provide some sort of net benefit that was out there. And I appreciated his rationale and thinking that he was bringing in. And this goes, regardless of how people feel about alcohol, this goes back to a larger idea that you talk about in the book, which is we can actually fund these studies. and we need to, and we need to do them more rapidly, instead of more money going to these very specific disease centers where we're looking at the tiniest little advancements. And in many cases, those things haven't panned out like adjuvant and other Alzheimer's interventions that we've tried to do.

And there could be a different way. We know that most of what people are dealing with is chronic disease. and chronic disease can be greatly influenced by lifestyle. So let's fund more of that. Is the only option that that has to come from the NIH? So leadership has to change in the NIH if we're going to get more of those funded? We're seeing a lot of businesses now say, hey, we're interested in this topic for whatever reason. Like Silicon Valley type entrepreneurs, venture capital, they have a close relationship

with the universities in California. we have not been historically that great with working with industry at Johns Hopkins, for whatever reason, they don't love to invest in Johns Hopkins researchers. But this is a new trend right now. And it's creating, it's supporting Ben Franklin thinkers in medicine. We've got Ben Franklin thinkers outside of medicine like yourself, outside of the formal regalia of academia. and we've got Ben Franklin thinkers in medicine like Peter Atia and Vinay Prasad.

And they are addressing these giant blind spots in modern medicine. Vinay Prasad, you know, and by the way, I'm blessed to have research funding that enables me to do whatever I want. It's unrestricted. That's how you push the field. That's how we address predatory billing and price gouging in medicine. That's how we address so many of these other topics nobody else was talking about. That's how Vinay Prasad does a big study looking at, hey, out of all the cancer drugs approved in nearly 20 years at the FDA, like more than half did not have any overall survival benefit in the studies at the time of the approval.

And you might argue that's okay, get them out there, let people try them, if you believe in that right to try concept. But then where are the follow-up studies? And he looked at the follow-up studies, and most of them never had a follow-up study or that showed a survival benefit. some did. And so these are giant ideas. Who's going to fund that? NIH, no way. So we are seeing a revolution now driven by the decentralization of media, of podcasts, like the number of doctors learning from Peter Attie's podcast, the Nyproside's podcast, Beniperside's podcast, Beniperside is talking like a Ben Franklin thinker, medical education is broken, why are we making our students memorize, wrote BS that you can look up on a phone? People,

come out of med school, literate in the fluent in the language of medicine, but non-fluent in health care in the business of medicine. And even worse, the worst combination is you perceive that you're an expert in the business of medicine, and you're not. And so that's how we've gotten into this issue where doctors now come out of training and the professional trade groups sign them up and they say, okay, we're going to fight for health reform and policy. We're going to get you involved. Here's our issue. Fight for more money. with insurance companies and the government, we need more money, we need to pay more money. That is not health reform.

Okay, maybe an important topic. It is not health reform. So we have not enabled people to think globally on the health care system. And but there's this generation, the Vinay Prasas, Peter Atiyahs, they are talking now globally. Ben Franklin invented bifocals in the world of ophthalmology. That was a major milestone. lightning rods. He did so many discoveries in different areas of science. He was encouraged, enabled, and empowered to think big. In medicine, that's what we need. People to think

multidisciplinary. If you think big right now, you're told, no, no, you've got to get an NIH grant. This is you pick a tiny little area. And we beat the creativity out of these very creative creative people that go into medicine. Matter of fact, the first year in med school, they're given the Netter text, you know, Atlas of Anatomy. And they're basically told in many different subtle ways, pick an organ for your career.

And you're like, well, what if I'm interested in the whole person? Is that holistic medicine? It doesn't capture it because they're, you can actually, like, this is our research team, we're interested in everything. Is it alternative medicine? No, but that's not the right word, but it encompasses alternative medicine. Is it public policy reform?

Is it FDA, NIH reform? That doesn't capture it, but it includes that. Is it a different way of looking at health care? Yes, we're talking about the redesign of the entire delivery of health care, starting from scratch, challenging deeply held assumptions. Why is a woman more likely to get an anti-depripping? when they go in with menopausal symptoms than estrogen, which there's probably no drug that has helped the population of a entire, that has improved the health outcomes of a population than estrogen. I know this topic you've covered. There's no drug. If I've said, hey, there's a new

medication. Women on average live three and a half years longer. The risk of dementia goes down by 50 to 60%, 35% reduction in Alzheimer's, half the rate of heart attacks. If they fall or in a car accident, they're half is less likely to break a bone and be immobile, which later in life can lead to a cascade of events that results in demise or a disability. If I said, hey, there is this medication out there,

it's 30 bucks a month, you can wear it as a patch, there's many different forms. People would say, oh my God, this should be the number one public health campaign in all of public health. I mean, short of maybe antibiotics, there's no intervention that has helped a population's health outcomes more than this. And it's not prescribed to 90% of women who could because of a dogma that some NIH guy

came up with 24 years ago or 22 years ago when he claimed to cause breast cancer when it didn't. I interviewed him for the book. I tracked him down in his retirement. and he acknowledged to me when he tried to talk over me with statistics. I speak statistics, and I told him, here's your data. There's no statistically significant increase risk in breast cancer. And basically at the end, he kind of suggested, yeah, the data didn't show it, but I kind of feel in my gut, I believe.

Anyway, we need Ben Franklin thinkers that are not afraid. We're doing a study now to look at the 10 most. influential studies in American modern medicine. And some of them have been very misleading. And what was the design flaw? These are the conversations we need to have. Vinay persides of the world will tell you that the skill set that is now tragically missing in American medicine that has impaired us so much is the critical appraisal of research.

Sometimes people without a medical degree can tell. That's not how you do a study. or you're just doing an observational study, or how do you know what people are really eating in their diet when you say it reduces the risk of Alzheimer's? Is it the fact that people eating a Mediterranean diet are also healthier people or are also more active or have better communities?

So sometimes people have a lens to be able to interpret studies or recognize flaws. But at the same time, I think we can learn something from everybody. You can learn something from everyone. And when somebody has a study that challenges your deeply held assumptions, maybe there's something in there that's worth looking into. But I love Vinay Prasad, Peter Atia. You would not believe the number of doctors who come out of med school. And they're basically like, okay, I learned the lingo, but Peter Atia has it right.

Most of what I taught was wrong or outdated. Yeah, I'm supposed to study this one project here at the university. But look at Vinay Prasad. he's talking about all these areas of modern medicine, every aspect of modern medicine. And that's what we try to do in our own group. And we're all very collaborative. We're talking ideas all the time. So good stuff is happening.

It's an exciting time. Well, I would 100% put you in that bucket of these Benjamin Franklin thinkers. And it's one thing to attain the highest degree of influence in your career. but it's another thing to use that influence when the entire world is saying, you know, we got to go in this direction and you're saying, hey, actually, I know this is going to piss some people off, but this is why we got to go in this other direction, at least talk about it. And you've done that. You did that many times in your career.

And I want to acknowledge you for it because you've changed the mind of a lot of people. And I think that when people, it's actually becoming. cool to talk about how you've changed your mind, right? Yeah. The vast majority, especially groups, they don't change their mind. They don't apologize. But individuals are speaking up and saying, I used to look at it this way and I've changed my mind. That's good. Because you're hearing from different sources. I know I like to talk about changing my mind with my audience, but it takes individuals like you who are actually have a good lay of the land to bring a new way of thinking to things that present different evidence. And so on behalf of

everybody that you changed their mind or at least got them to question things. I want to thank you for that. And I want to acknowledge you for your book. It's called Blind Spots When Medicine Gets It Wrong and What It Means for Our Health. It's a fantastic read. Your team sent me the PDF copy, which I got a chance to devour in preparation this episode. And I was so excited that so many of the themes you talk about there, we've touched on

in somewhere or not on this podcast, which you've brought them all together in a way that is so digestible. So we'll link to that in the show notes below. And also, if people want to follow you on social media, you're extremely active on X.com. Anywhere else you want to send our audience or any asks of them. Well, just thanks for having me. I love these conversations.

We need more of them. And it's thanks to people like you that we can have them and educate the public on things that are still tough to advance within the medical profession sometimes. I'm on LinkedIn, Twitter could be a nasty place, but I'm still there and I like to use it to encourage people. I've been fascinated with this new body of research that encouraging other people and affirming them is like four times the value of an antidepressant for yourself. and I just love, I feel better when I'm out there encouraging students and docs and the public and meeting people and a lot of people reach out in different forms, LinkedIn, sometimes Twitter.

But for some young docs and folks who are doing good work, I like to use my platform to encourage them. So thanks for mentioning that. Yeah, absolutely. That's the best use of any platform for sure. Marty, thank you so much for coming on the podcast. And shout out to our mutual friend Denise for introducing us and making this happen. I hope the book gets out there far and wide. If you're listening today, please pick up a copy.

You're going to love it. Marty, thank you so much for being here. Thanks so much, Drew. Great to be with you. Hi, everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean,

the world to me, and it's the number one thing that you can do to support this podcast is share with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter, and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more.

If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole-body health and optimization, click the link in the show notes that's called Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-H-I-T dot com and click on the tab that says, try this.