The Checkup with Doctor Mike - The Corruption Of Healthcare & The Poisoning Of Our Food System | Dr. Marty Makary

Episode Date: October 27, 2024

Check our Dr. Marty Makary's new book "Blind Spots" and his other best-selling books here: https://www.martymd.com Follow Dr. Makary on X/Twitter here: https://x.com/martymakary?lang=en 00:00 Intro 01:50 Why The Cost Of Healthcare Has Ballooned 14:40 School Lunches, Pesticides, Chronic Disease 39:38 Calories, Artificial Sweeteners, Condoms 48:48 Changing Guidelines / Hormone Replacement Therapy 1:01:40 Should We Follow Experts? 1:18:48 Trusting The Government / Antibiotics 1:26:16 AI / Food Assistance Programs / Ozempic 1:36:22 School Closures / Vaccinations 1:42:45 Microbiome / Supplements 1:51:38 Improv / Poker / Bad Doctors 1:59:25 Fact-Check Help us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, an exclusive discord community, and many other perks for just $10 a month. Become a Resident today: https://www.patreon.com/doctormike Let’s connect: IG: https://go.doctormikemedia.com/instagram/DMinstagram Twitter: https://go.doctormikemedia.com/twitter/DMTwitter FB: https://go.doctormikemedia.com/facebook/DMFacebook TikTok: https://go.doctormikemedia.com/tiktok/DMTikTok Reddit: https://go.doctormikemedia.com/reddit/DMReddit Executive Producer and Host: Doctor Mike Varshavski Produced by Dan Owens and Sam Bowers Art by Caroline Weigum Contact: [e-mail]

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It's a joke. Insurance is basically now an obstructionist party in health care, where they're just trying to throw as many roadblocks in utilizing care. And we haven't given doctors the time or resources to talk about root causes. And then we're giving them all this misinformation about nutrition. Heck, we were demonizing fat for 60 years, ignoring the role of refined carbohydrates and ultra-processed foods. We said opioids were not addictive for 20 years, igniting the opioid crisis.

We said peanut allergy abstinence helps reduce the risk of peanut allergies. later in life. We had it backwards. We ignited the modern-day peanut allergy up and down. So we need to talk about these root causes that nobody is talking about. Welcome to the Checkup podcast. I'm really excited for this episode's guest, Dr. Marty McCarrie. He's a distinguished cancer surgeon professor and public health advocate based at Johns Hopkins. He actually serves as a professor of surgery at the Johns Hopkins School of Medicine and is a professor of health policy and management at the Johns Hopkins Bloomberg School of public health. He's also an incredibly successful author. Dr. McCarrie has written several New York

Times bestselling titles, like Unaccountable and The Price We Pay, which shed light on the inner workings and challenges of the American health care system. His new book, Blind Spots, which is again a New York Times bestseller, focuses on ways in which modern health care has dropped the ball when it comes to helping people stay healthy. In going through some of the points he covers in his interviews surrounding the book, I found myself disagreeing on several important topics, so I thought it would be great to get them on the checkup to discuss these differences. I do recommend sticking around to the end of the episode for a more thorough fact check than usual, given the number of claims we discussed. Let's get started, and I hope you enjoy the episode.

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anti-modern health care. Then you have people who are very pro-modern health care. Don't check the establishment. We know exactly what we're doing. You're not smart enough to question us because you didn't go to the exact Ivy League school or publish X number of articles. But what I like and the approach that you've taken is no one is above scrutiny. We need to be able to be transparent, honest, skeptical, without becoming cynical. I think that's the greatest takeaway that I've gotten from your books. We even had a conversation around your book, which was a New York Times bestseller, the price we pay about how much fraud there exists in the healthcare space.

Why our health care costs are so astronomically high? Let's start with that because people oftentimes will come to me and say, Dr. Mike, doctors are paid too much? And I'm like, well, where are you getting that from? They say, well, you guys are always so wealthy, and I frequently have to bring them back and explain that the cost of health care has gone up at a rate that is enormous, but the doctor's cost of that rate has not contributed that, at least to the majority of the degree. Why do you think the cost of health care has ballooned as much as it has?

Well, great to see you, Mike. And we've got to ask these big questions, right? We're kind of told, put your head down as a doctor, focus on your. you're billing and coding. And then if the healthcare costs too much, work harder as a doctor, right? But the reality is we have a tremendous amount of waste in this system. And we can keep throwing good money after bad into this broken system. We've got the majority of adults on medications, 20% of kids are on medications. All these chronic diseases are skyrocketing. What are we doing? We've got to take a step back and ask ourselves, what can we prevent and where's the waste that we can

cut. And it turns out there's a tremendous amount of waste in the middleman industry of health care that people can bypass, with good decisions on how to buy your health insurance, how to approach a hospital or a doctor with a credit card and negotiate your bills. People don't know bills are negotiable. And it turns out that price gouging is a real problem in health care. It's a huge problem. And you talked about surprise billing in your book. I find that to be so terrible. Actually, when we did our show, our live tour, we ended on a segment where we talk about surprise billing how an individual can be insured, can be healthy, still have a negative health situation happen because not all of health is under our control, and be left with this tremendous bill that would

ruin most people's lives. And yet you did everything right. How is that happening these days? Where is the break in the health insurance space that you think we can plug to get the greatest benefit. Well, first of all, if we had honest and fair prices for medical services, why do you need insurance networks? What's this whole thing about, oh, you're out of the network or, you know, where's your network card? It's like a shakedown. You go to your doctor and it's like the receptionist is shaking you down for an insurance card. You're just like, I just want to know the price. I'll pay. My deductibles high. I'll just pay. So if we can get to honest and fair prices, then that'll clean a lot of the waste, cut out a lot of the middle. Why do we need giant armies hired by hospitals and

insurance companies to negotiate prices? Prices are not even that good sometimes that they negotiate. That's true. And we have that on the pharmacy side with pharmacy benefit managers that were initially created to create discounts for us as consumers, but instead started splitting that discount of savings with themselves and becoming billion dollar entities in the process. Yeah, they came along to say, oh, there's a lot of price gouging. We're going to fight for you and negotiate better prices. And then they started price couching the American people. And so people need to know what they can do and what their rights are. And so I think there's a lot of good stuff happening right now. We got a price transparency executive order

signed by the White House. It was bipartisan. Didn't matter who was in the White House. It was just upheld and the fines increase for noncompliance. These are American ideas, right? Transparency. They're not partisan. And so people are now starting to, third party is starting to scrape the data, make it available on apps. You can see the price. And people should ask about the price. When we told people ask if food is organic, ask if the fish are wild caught at a restaurant, guess what happened? The market moved. Restaurants supplied differently. When we started educating people about added sugar, guess what? Food companies started advertising, no added sugar. They will respond. So we want people to ask for prices.

And we want to call out the hospitals, holding them accountable for price gouging and predatory billing. Let's call a spade a spade of them are doing. Some of these hospitals are filthy rich. They're like hedge funds with hospitals on the side. And it's not coming. The money is not trickling down to the doctors and nurses. It is sort of corporate greed at its worst. Hospitals were designed to be a safe haven for the sick and injured.

That's why we went into medicine. Everyone in medicine, every nurse, physical therapist, everyone comes to the field out of a sense of compassion. They want to help somebody who's coming in earnest when they're sick or hurting for help. And we want to help them. So to ruin their life financially or give them these forms to sign their life away financially, it violates the very ethos of the profession. Yeah. Do you feel like it's contributed to this issue because doctors have slowly been pushed out of the C-suite executive role? 100%.

100%. Some of these doctors have no control over their billing. Some do, but most of them have no control. I don't have a control if I do an operation. Yeah, when a patient asks me about a cost of an MRI, I can't even give a reasonable answer. We had a math genius, this guy, Tim Shoe, as a medical student, and he did a paper on the price markups that hospitals add on to a bill.

The same IV service could cost 18-fold more. Facility fee. All the games. And he was like, hmm, how are we calculating these? How do hospitals generate these bills? Who decides we're going to mark this up 18-fold or 23-fold? So he's a genius. He did a master's in math after college before med school.

I was like, why did you do a master's in math? They're doing like calculus five in high school now. And we have calculators. Like, what are you doing? He's like, I just wanted to bone up on my math. Okay. This guy's a genius. Okay.

He goes to the billing department to figure out how they calculate the markup, and he spends hours with him, and he comes back and tells me, Marty, I can't figure it out. He's a genius. So it's like a forensic accounting he attempted to do, basically, at that point. I mean, I don't know if you need to do an autopsy on all of this, but I feel, in general, the health care industry where I'm the biggest critic of it falls under the, avenue of private equity entering the health space. I feel that uberization of health care is not compatible with health care. Right now, young folks don't have a PCP. They don't

have a primary doctor that they have a relationship with. They don't have someone that they go to when there's nothing wrong. And that's important because we can check in. We can make lifestyle recommendations. We can make guidance before a problem happens. And they're moving more to, oh, well, why would I create a relationship with a doctor when I can go to the local urgent care when I have a stomachache or a headache, a migraine, what have you. And that model responds very well from the money side. Because you can make a lot of money from a hedge fund, private equity, owning a chain of urgent care centers, which exist. But it's not good for health care. The health care outcomes are worsened. We don't have the preventive care aspect when we're

treating those visits because they're not sharing in the savings. When you have a primary care doctor talking about healthy nutrition, healthy exercise, healthy sleep, that's added value down the line. And I feel like one small change, and I'm not a policy expert by any means, that I would love to see made, and I've tried to discuss this with politicians, but because I don't have a big institution behind me that's hard at times, I wanted to institute a rule where if an insurer starts covering you, well, let's move back. Right now, I feel like the problem is when people get one insurance coverage, the

Odds that they'll have the same insurance coverage in five to 10 years is very low. Is that fair to say? Yes, so they don't want to invest in things that'll save their competitors' money in the future. Correct, because that person will switch jobs. They will go on the marketplace again. That insurer will go out of business. They'll sell it to another hedge fund and then open another one, what have you. But people will ultimately not have the same insurance.

So there's no benefit to investing in the future because you're investing in the future for someone else's savings. I would love to see a rule where if you're going to insure someone, you're insuring someone for a long period of time. And I don't think that's not a reasonable thing to ask for. It's a reasonable thing to ask for. Right now we're talking about enrolling young people into like the Obamacare world in order to generate revenue so we can take care of those who are sicker. And we understand the benefit of that because everyone, once everyone buys in, it kind of averages the risk and cost out across everyone. But young people are like, we don't want to do that. Okay, that's an individual right. But why not forced insurance companies to take on that role? And so,

say, hey, let's get everyone covered that wants to be covered, but we have to cover them for their life. Align their interests better. Yeah, yeah. The whole system is a joke. It's a joke. Insurance is basically now an obstructionist party in health care where they're just trying to throw as many roadblocks in the care, and then we're just playing whack-a-mole on the back end. And we've done a terrible thing to doctors. We've told them, focus on billing and coding and seeing patients in short visits. We're going to measure you by your through. put, and we haven't given doctors the time or resources to talk about root causes. And then we're giving them all this misinformation about nutrition. Heck, we were demonizing fat for 60 years,

ignoring the role of refined carbohydrates and ultra-processed foods. We said opioids were not addictive for 20 years, igniting the opioid crisis. We said peanut allergy abstinence helps reduce the risk of peanut allergies later in life. We had it backwards. We ignited the modern-day peanut allergy up and down. So we need to talk about these root causes that nobody is talking about. Maybe we need to talk about school lunch programs, not just putting every kid on Ozzympic when they come to the doctor. Maybe we need to talk about treating diabetes with cooking classes, not just putting everyone on

insulin. And maybe we need to talk about these environmental exposures and toxins that cause cancer, not just the chemo to treat it. Sure. Sure. We're kind of getting to the topic of your book Blind Spots. And I think that the healthcare industry as a whole has created a lot of blind spots because of the mixed-up incentives where doctors get 15 minutes with a patient. Last Thursday, I had my entire schedule, nine hours, 15-minute appointments, essentially. I think one was 30 minutes for physical.

I don't know how you do that. And my first visit, I walked in, the chief complaint or reason for illness was dizziness. And when I walked into the visit, it was a mother and a daughter. And they were talking about very sensitive things that were going on in their life from a personal standpoint, undergoing massive mental health stress. I had to ask the child to leave the room in order for me to become versed and what's the dynamic here? What's the actual mental health concern? Is there a role for medication, for therapy? Is the dizziness brought on by something that's going on with this major stress that's put on their lives versus is this neurological issues, is it a cardiac issue? In what world am I doing that in 15 minutes? It's impossible.

It's like fully set up for failure. And then we wonder why Dr. Burnout rates are at record high levels, why doctors have the highest rate. They don't want to be on the hamster wheel. They can, they're smart enough to know this is a broken system. Now, we do what we can in the short visits on the same. You know, we have to work within the system. But can we talk about what we're doing to children in America. I mean, we're forced to deal with these issues in a short visit, but we wake up kids early messing up the circadian rhythm. We tell them to sit sedentary at a desk for seven hours a day. We feed them poison for lunch and they go into a food coma. And then if they don't like it or they can't sit still, we medicate them with a diagnosis.

So we've got to be able to talk about these underlying issues that bring people to care. And I think there's a movement now of doctors that are like, I want to get off the hamster wheel. For sure. I very much love supporting doctors who want to get off the hamster wheel and put out the accurate info to the general public. At the same time, I'm very aware of how talking about these issues, if done with too much vigor, with not enough concern for how this can easily have the pendulum swing completely the other way, how we can misguide people. So I'd love to go through those issues like one by one, if you want. the medication, not the medication, the dietary standpoint of it all. You mentioned school lunches.

Tell me what your thoughts are on what's going on in our current state of things, and we can discuss going off of that. Well, first of all, I think you're touching on a very important topic, and that is what's the right balance? Right. Because we live in a real world. We know microplastics are bad. They have hormonal disrupting.

But how do you avoid it? You can do your best. Of course, yeah. Childbirth is a good example. that we sort of swung as a profession to the over-medicalization of ordinary life, and then people are swinging back to delivering babies in the woods with nobody,

and that's dangerous. So there's a balance with all of this. And with school lunch programs, if you think about the big food, big ag in their lobbies, you might think these are evil companies trying to poison us, but I actually see the best in people.

We have good people that went into those industries, and those industries after World War II were asked to address food insecurity, to maximize food production and address hunger. And they did that. And an unintended consequence of all the GMO and pesticides and added food ingredients that the food scientists engineered to be addictive. So a kid finishes eating the school lunch. And they're kind of full, but they're kind of, it's kind of queasy full. It's not really, they don't really feel full. And so they're,

hunger level is designed to increase with the food additives. And so they want to keep eating. And we never saw this before. We don't see it with any other species in the animal kingdom. You didn't see it before just the current generation. Try overeating broccoli. It's like impossible. Yeah, exactly.

Right? And so we've got to look and say, what are some common sense things we can do? California just banned seven food chemicals that have been implicated in attention deficit disorder, hormonal disruption, genetic mutations. And so there are some things we need to do. And a lot of it's just educating people. You don't need a lot of these food ingredients that are... For sure.

I think the description of putting in processed and ultra-processed foods into kids' lunches, kids' snacks, and then marketing into them in an incredibly impactful way with the rise of social media, television programs, that is the most wild thing that I never expected to happen, especially as a young person. and how effective their marketing was in getting kids to eat these foods, parents to buy these foods for kids, and then have the kids be perpetually hungry.

Now, again, I'm trying to be as careful as possible with all these ingredients. You mentioned like GMOs, for example. I hesitate to say that putting in GMOs is like a problematic thing. Because what I've seen on social media is, again, what you're describing here is good intentions creating bad outcomes, right?

The good intention was they're trying to feed a wide group of people. of people. Bad outcomes, they created a problem where the foods became irresistible, non-satiating, and therefore led to potentially the obesity crisis. That's our suspicion. But now with this, in talking about how those food additives are a problem, good intentions, we're also scaring away people from things that may not be terrible for us, like GMOs. So how do we strive to keep that line safe without fearmongering to people? Because what I see happening, my people, patient population is they're confused. The distrust is happening because our government and our

institutions make mistakes, which can happen. I get that. But then it is also happening as a result of people labeling those institutions as failures or demonizing all ingredients. Trying to make you sick. Yeah, trying to make you sick. That sort of thing. So how do we be careful with that line? So I think it's good for people to prioritize certain changes in their food choices and behaviors. So we don't have a pile on with just demonizing one thing. Right. And it may be the cumulative burden of all of these things going down our GI system. That's increasing inflammation.

When chemicals go down the GI tract, things that do not appear in nature, like vegetable oil and seed oil derivatives. These are chemicals. They sound healthy, but they're not. Microplastics, toxins, arsenic, ultra-processed foods. It may be the cumulative burden of all those things that is causing some of this. So we want to give people good guidance. And so here's something that I think is a good way to think of it for people who are listening. You want to think about your gut health.

It may not be, say, the GMO food itself that is that toxic and poison. But why are these foods genetically modified in the first? place. Well, they found out after using Agent Orange in the war that it kills a lot of stuff, including insects. And so they started using it as a pesticide to get rid of the insects in crops, and they found it kills the crops and the pesticides. So then they thought, let's genetically modify the crops to be roundup ready so it can handle the pesticides. And then we eat these foods coated with all these pesticides. The average strawberry has been sprayed over a dozen times with 7.8 different pesticides.

One sample of school lunches in the D.C. area found that a school lunch has up to 38 detectable pesticides. It's showing up in the urine now when tested in children, shows up in the umbilical cord of moms. So these pesticides have been added, but the GI tract is not roundup ready. Humans are not round up ready. So what may be happening is the pesticide itself may not be poisoning you. It may be altering the microbiome, the lining of the GI tract of millions of different bacteria

that normally live in a balance. But when you throw all this stuff down, it's changing that balance and you get overgrowth of certain bacteria. And we know those bacteria are involved in digestion. It's a beautiful thing. It's normal. It's natural. Those millions of different bacteria train the immune system.

Some make serotonin involved in mood and mental health. some produce GLP1, the active ingredient in OZemphic and low doses. It's this incredible organ system called the microbiome. And so we've got to think about our gut health. So it may not be the GMO food itself, but think about what those pesticides are doing. Yeah. So you say a statement like the strawberry has X number of pesticides on it. What is the takeaway from that?

The takeaway is, should I not eat strawberries? Buy organic strawberries because they won't have pesticides, especially if the source well. That's not true. They still have pesticides. Organic technically means they're not produced with pesticides. But there are organic pesticides. Well, there are ways to kill bugs without chemicals. So it means technically no chemical pesticides.

According to the USDA organic label, which is not always accurate. Yeah, exactly. The organic label has a lot of flaws in it. So I always want to give the most practical advice. So if I'm saying, like just the other day, I even caught some flag for this, I did a video about black plastics in food products. And where that black plastic came from was VCRs, DVDs, wires that were made 20 years ago had an ingredient in it.

It's called Deca BDE. And this ingredient was a flame retardant. And it made sense why, good intention, so that the wire didn't burn. But then those plastics were recycled. Also good intention. We want to recycle, not cause pollution. They were recycled into some products that ended up in kitchen utensil. pencils, spatulas, takeout containers, where that ingredient actually has been linked to some

harms. And I did a video talking about it. And the takeaway was try and get rid of them out of your food products. Like can't get rid of them out of your life fully. That's ridiculous. So food products, washing your hands after you handle them so that if you have some residue in your hands, it doesn't end up in your mouth. And actually, they said dust was one of the biggest contributors of those plastics binding. So I said dust your homes. And people were mad that I'm talking about chemicals and scaring people. But I think in that instance, we're talking about chemicals

in a way where it's empowering. There's three steps you can take. I'm not selling anything. This is very reasonable advice. But when we say strawberry has scary chemicals on it, and we say buy organic, and organic is more expensive

and not available in every area, as you know, with food deserts and all, and also has potential pesticides on it. I don't know if that's worth... If it's practical. If it's practical and also worth the time spent with the patient. I feel like there's so many larger issues that we can get so much benefit from. And I see that happening with a lot of podcasts and clips from like even famous doctors

where they'll say like strawberries are now basically poison or apples not the same that it was not the same as it was, you know, a hundred years ago. And like, okay, but like you're just saying something to get a lot of viewership. But what is the practical take? remember that apple scare at one point from our friend. So here's how I think of it. We have got to try something different. All these chronic seizures are going up. We know pesticides have hormone estrogen-like binding properties.

We're watching the age of puberty go down every year by a week and a half. It's now years sooner than it was just a generation ago. And you don't think obesity can be partially related to that? I think it is. And so the truth is, if I'm being really honest, I don't know. I don't, but I'm looking epidemiologically at these massive trends. One living generation, autoimmune disease skyrocketing, infertility skyrocketing, obesity skyrocketing, diabetes skyrocketing, autism skyrocketing.

What's happening? We're altering the microbiome in ways we don't appreciate or don't recognize. Sometimes when we test individual things, you'll see these really concerning trends like pesticides have glyphosate, having a precursor to leukemia. My dad's a hematologist, he can tell you more. But one thing is where we've added all of these chemicals. So I do think if you can reduce the pesticide load, the chemical load in general in one's life,

washing things really well. And remember, it's most important when you're eating the surface of a fruit or vegetable. So it's not as important when you're eating watermelon. Sure. You know, you can waste a lot of money. But for people who say, you know, it's a little more expensive to buy the organic foods, I tell them, try insulin. That's expensive. And we're watching all these chronic diseases go up.

I think we need to take a look at these things we haven't been taking a look at. I think the idea of taking a look at it is so important. Like doing the proper research and the lack of funding that exists for it because there's nothing to sell on the pharma side of it is absolutely a real problem. I also, using your own thoughts, using the peanut situation where in year 2000, it was recommended by the American Academy of Pediatrics to say, hey, take out peanut out of a child's life early on, and that's going to decrease allergies, where in 2008 we actually saw the flip side to be true that we should be introducing highly allergenic foods, one at a time, starting at four to six months. And we changed that guidance. And you talk about how that guidance was made in the year 2000

based on just expert opinion because people were being asked, right? Is that a summary of, yeah, the claim? Now, I feel like right now, we're almost doing the same thing in this conversation by saying we don't know, which is what you said about the pesticides and chemicals and why these rates are going up. And yet we're giving advice. Are we not just doing the same thing? So people say, like, we're confused. We don't know what to believe. The research is mixed. Well, if we actually look at the research in general on food additives, that is ingredients, pesticides, chemicals in the food, 83% of studies show a harm when studied, but 93% of studies funded by the food industry show no harm. So I think we have to recognize this conflict

of interest. I personally look at studies that demonstrate that pesticides have hormone-like estrogen-like binding properties as a major flag. And although we can't do a 10-year randomized controlled trial on this. Well, we can do a cohort that test out people who have and have not. And that's not perfect. Well, maybe we have that. I mean, look at the Amish community in the United States. The Amish community that doesn't sneak in all the junk food.

The Amish community that eats whole foods from good soil and regenerative farming, lower rates of all these chronic diseases, all of them. Now, we could say they're also active. Yeah, there's a lot of differences in the Kalashvish. There's a lot, right? Absolutely. And that's also true. So activity matters. But how do we explain the fact that we have infant obesity in the modern world? How do we explain the fact that we have six-year-olds now with type 2 diabetes? You would rarely hear of a case a generation ago. A pediatrician ago,

the whole career, maybe see one case. Well, the average pregnant person is more obese than they were 20 years ago. So that's why those babies are being born in that way. At least that's my logical way of thinking about it. The idea of these pesticides and all being problematic and needing research, I think is so important. I guess the practical side of things, because I'm family medicine, right? So, like, I have the patient in front of me, what should I do? Do you think, as America as a whole, we follow the American Standard Diet, which is rich in ultra-processed foods, burgers, hot dogs, all these terrible foods that are not great in the amounts that we're consuming them, and that's saying it lately.

Is that the problem, or is that those people are eating berries with pesticides on them? I think it's all of it. I think it's a poison food supply with pesticides, ultra-processed foods, refined carbohydrates, engineered chemicals that are designed to make food addictive, microplastics, and heavy metals in the water supply. All of it is changing the microbiome. And an amazing study down at the Mayo Clinic that I go through in the book, when they gave antibiotics to young children in the first two years of life, now one thing we know

about antibiotics is they massively alter the microbiome. They shift all those, that balance of millions of different bacteria are altered when you carpet bomb the microbiome with antibiotics. Now, antibiotics save lives, you and I have seen that, but over 60% are unnecessary according to big studies, right? So they looked at kids who took antibiotics the first couple years of life, 20% higher rate of obesity, 32% higher rate of learning disabilities, ADHD. This is a Mayo Clinic study, 14,000 kids, pretty well controlled, and it had a dose-dependent relationship. The more courses of antibiotics the kid took, the greater the risk of all these chronic diseases

that we are also seeing increase in the modern era of antibiotics. So it's all of it. I think it's all of it. So we need to teach antibiotic appropriateness, avoiding C-sections when they're unnecessary, which is a fraction, maybe 40%, avoiding all this junk and poison in our food supply. And I think that includes recommending people

not eat pesticides, buying organic, or washing their food very well. But when you make this change in society to poison the food supply, and then you see all these chronic diseases skyrocket and then look at the one control group of the United States that is not seeing the skyrocketing the Amish community old bandite community and by the way other people who have lived from good soil and good foods right you want to cook and not buy sure then and in other countries you see much lower rates where they have not adopted the western diet

yeah i mean i think the western diet and like i had um marian nessel uh food policy expert on the other day, and we're talking about how why our ultra-processed food so bad? Is it one chemicals? And the reality is like it just makes us overeat. We over-consume. And when we over-consume, that throws our body off equilibrium, hormonal changes shift when we have high rates of obesity. And the biggest part that is not just changeable, but the reason for why these health

concerns happen is because of the over-consumption of food. And I look at, again, a practical takeaway from the water is poison, the food is poison, this and that. If I have a patient in front of me, I can't make 20 changes, right? That's just so not realistic because no human can undergo 10 changes in their lifestyle when they have a job, kids, multiple jobs at times. So I think of big things, the big rock. What is the one big rock that I can pick up to lift the most amount of weight, not the smallest amount that I can put on top? And the biggest ones is the processed foods, the ultra-processed foods, getting them on whole foods. So when I hear these messages, which are the loudest messages of berries having pesticides,

and scaring the person that's eating the burgers, say, why would I eat berries, they're poison? I worry about how that message lands for those people. Do you have any concern with that, or do you feel like that's, I'm overthinking it? Look, I see where you're coming from. I'm in the same situation with my patients. They come in overweight, morbidly obese, and we want them to lose, weight before surgery, because it radically reduces complication risks. So what can I do in a short visit to get them to lose weight? This is a long problem with many factors in society. Of course.

And so I usually tell them, eat whole foods as you're recommending. Whole foods that you think are whole foods are sometimes not healthy foods. When you say the whole foods are not whole foods, which like the grains? If you just buy bread from a grocery store, you don't realize it's enriched ultra-processed flour. Right. You have to see the whole wheat. You have to see the whole wheat and not whole wheat die, but actual, actual true whole wheat, because most bread is stripped of its fiber and chopped up and functions like sugar in the body. And then I tell them to drink water instead of, you know, all the other juices and stuff with added sugar. Absolutely.

Fruit is not bad, right? These are not, it's not that fruit, fruit has fiber, and that's important. But, you know, maybe I'm a little more concerned. about the pesticides since I've been reviewing the literature on its hormone properties. But Marian Nessel, I know you had her on, I like her. I interviewed her for the book because she was involved in the food pyramid. I would say... I criticized the food pyramid to her, by the way. Good. Yeah, she... I did too in the book. Yeah. So I give a couple of these... I interviewed a couple of these people who have been around during the dogma of the food pyramid and asked them, you know, I asked

is there any evidence that natural saturated fat causes heart disease? And she basically didn't have any studies, but she said, you know, kind of everyone believed it at the time. The consumption of the eating natural fats, eating saturated fats causes heart disease. It was a theory from the 1960s. They did three major studies to try to prove that was true. All studies failed to show it causes heart disease. But we have most of the American public to this day on a low fat, try to tiptoe around cholesterol diet when cholesterol is not even absorbed by your GI tract. Dietary cholesterol. Dietary cholesterol, 90% of it goes through your system. So do you not have the belief that consuming saturated fat raises cholesterol levels that then increase your risk of having a heart

attack or stroke? So eating natural fats in high proportions can increase your LDL. But the real important lipoproteins are the sub-fractionated apo-lipoprotein B and L-P-L-P-L-A. But don't you think they correlate very well with the L-DL numbers? So L-DL has been a... And I know it's imperfect. It's an imperfect test. It's a screening test also that we use a lot of times. It's a screening test, and it's done okay, not as good as the other test that people should

be getting out. Everybody get an L-P-L-L-A and A-P-B when you get your blood work. But if you overeat anything, you can do harm. But the idea that natural fat increases your LDL, and that translates clinically into more heart attacks, was disproven with three major studies. The Minnesota heart study, they randomized 9,000 people, half got the low fat, half did not.

The low fat group had more heart attack deaths. But that's not comparing apples to apples necessarily. Because putting people on a low fat diet, doesn't necessarily mean you're putting them on a healthy diet. In fact, on a food product that says low fat, that also probably means

they added a ton of sugar to make it taste better. That's why more people died in that group. Exactly, yeah. But when we look at the longitudinal research of those who consume more saturated fat, have higher LDL figures, they have higher risks.

That's not up for debate. Is that fair to say? I would say the Women's Health Initiative, and I go through all these studies in the book, Women's Health Initiative study and the Nurses Health Study out of Harvard both failed to show a correlation between reported saturated fat intake and cardiac risk. And that's why the recommendations are being rolled back and they're focusing on the refined

carbohydrates like you're talking about. Things that stimulate your pancreas. I never thought I would be, when I became a pancreas specialist, I never thought this was going to be the central organ of society. But I kind of think it is. Like with pancreas has never been stimulated at rates that we are seeing in the modern world. It's our generation. And that drives the insulin resistance, metabolic dysfunction, and general body inflammation that are probably the three main drivers of all these chronic diseases that we're seeing. Yeah, I think it's, we always have to be careful when we're saying ingredient A is bad. Is it bad replacing what? You know, people oftentimes will have these clips go viral. Diet soda is so bad.

bad for you. It's like, well, if you're morbidly obese and you're drinking tons of regular soda, maybe switching to diet soda and decreasing the amount of caloric intake you're taking in could be helpful. And of course, I wouldn't recommend someone who drinks water to replace that with diet soda, then it's not a healthy choice. But it's always like in lieu of what. In lieu of what, yeah. And when it comes to talking about nutrition, I'm so careful of not misguiding people to have the pendulum fly the other way, where it's absolutely refined sugars are a problem. They cause you to overeat. They have all these problems from an insulin perspective, the pancreas perspective. But at the same time, I feel like the world has now

pushed so far, again, we said fats were bad, we villainized them. Now we're going to, they're completely fine, saturated fats aren't the problem. We have to like bring people back to the center that homeostasis of information, if you will. And what I've seen is that's not popular. for television, for social media, and the world that I play in so often, because it doesn't get the attention. Honestly, if this interview was done on a different health podcast,

the title of this would be, Dr. Marty says, strawberries are poison. I'm not gonna lie, that would be the headline of it. And I know that's not your main point. I know that's not even what your main goal is of changing in your patients' life, but that's what sticks in people's minds. So I'm always so careful about

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deeply held assumptions that are not based on science, they've been dogma. And there's a whole psychology to this. Of course. A matter of fact, a Harvard student, I don't know if you saw this, he just ate 720 eggs in a month. Which again is not valuable from research perspective. I'm not encouraging it. I don't want to be able to go out there and do it, but his LDL went down a tad. So, I mean, it is, he is, I'm not saying he's the new Einstein. I'm saying, we need to challenge some of the deeply held assumptions. My dad, who's a doc, grew up in an era where they just piled on and demonized two things in society, smoking and saturated fat. And that was like, that's our charge to go out there and educate the public. So it's good for

us to start asking about these chemicals that are studied in radically different ways with food industry and chemical industry studied, sponsored studies, and with independent studies. And look at this objectively. It's not part of our medical school education. I wish it would have been. I mean, how much time do we spend on nutrition? And the little nutrition we got was the old sort of Marion Nessel food pyramid calories in, calories out, which we know is not really a good model, right? Calories in. Well, why is it not a good model? Because not all calories are the same. If you take prednisone, you're going to gain weight, and it's not because the calories in the pill. And so some calories bound to fiber are slowly absorbed. Right. Are you just finding

an extreme, though? Like, it's a, it applies in most situations, no? If you overeat calories, you gave weight. Yeah, most situations. But what we did is we got people counting their calories so they could get those equivalent calories from ultra-processed foods. They switched over. The food industry said, hey, come on over. You can get your calories here.

You know, here's the number of calories in a, what are those diet plans, like your Weight Watchers, and they're serving ultra-processed frozen food in waste watchers. What's it doing? It's altering the microbiome. It's stimulating the parents. their process is not bound to fiber. When things are bound to fiber, you know, eat fiber. People should eat fiber. Of course. Fiber is enables the carbohydrates to get absorbed slowly. That's why we encourage fruits and vegetables. They've got sugar, but it's it's complex carbohydrates. It's bound

to fiber. It's not stimulating your pancreas to surge insulin. And you mentioned artificial sweeteners. Just two seconds I might take on that because I thought a lot about it. I think we're messing with the pancreas. We know that from psychology, if you think about eating food, your mouth will actually start salivating, right? Sure. This pre-dromal response. And what's happening in the pancreas with the artificial sweeteners,

I think, are the same thing. If they're very sweet, but no sugar load comes, you've kind of tricked the pancreas. And the insulin is sort of getting ready to get released. It's not released, but the pancreas is, ready for it. And when it doesn't come, your appetite can increase. And so people can eat a lot of these artificial sweeteners. And then at night, binge eat. We go out for the Ben and Jerry's or the Orioles. And because they have a craving that's been created by these sweet things that are

telling the pancreas food sugar is coming, but it doesn't come. I like Stevie. I like some of the natural sweeteners. I mean, they all taste differently. And people have their preference. But anyway, that was my take on it. When it comes to those foods, the same concerns you share about it feeding or changing the microbiome because the bacteria consume it because it's not absorbed like a traditional sugar would. I think there's truth and validity to that. Research has shown it.

When we look at randomized controlled human trials with diet sodas or artificial sweeteners, Lane Norton, who's a popular PhD that talks about this, he's been a guest. on the podcast, he's pointed out these randomized controlled studies that showed those who, if you randomized and controlled, so it's a very controlled study in dietary world is very rare. And they had people with sugar, artificial sweetener, and water, and then milk and some. And they found that people did lose weight. And it's not perfect because there are harms, just like with any risk reduction, right? So, you know, this probably wasn't in my generation of education, but there was at one point

of villainization for doctors that recommended condom use because they said, well, that's not abstinence, you're still creating risk because now people might use them wrong or they might do this. And all those risks are true. Condom use from a research article doesn't yield the same

results as real world condom use and there are still issues with it. But it doesn't mean that condoms are bad. So what is the takeaway from what you're saying with artificial sweet? Should we avoid them at all costs? Are they a valuable step-down tool off of sweeteners? What's the practical takeaway of that advice?

So the reason I'm going into some of this detail is that people can really make their own decision. Try it. If someone is on sugary sodas and juices with added sugar, and they want to switch to the artificial sweeteners, watch to see if it increases your craving at night later in the day. If you find this desire to binge eat, which is not a natural human instinct, It is a modern byproduct of what we eat. Then be aware of that. Maybe that means don't eat or drink with artificial sweeteners.

Maybe use less sweet, natural sweeteners. And sometimes it's a combination of sweeteners that can taste better. So it's not monk fruit is the best sweetener and the coconut. The newest generation. The newest generation. But sometimes it's a blend of all those. And people cook with all of those. And it creates sort of a blended flavor.

And you can titrate each. Right. I think we can talk about these extremes ad nauseum. There are so many instances where there is a relative contraindication, there's an absolute contraindication. But what I worry is where these days in scientific communication being so out in the open, we're having these inside baseball discussions over minutia of extremes and it's leading people to actually lose trust in us. So I can see how people would lose trust in the CDC see when they make a mistake or they say something inaccurate, I can get why that's happening and it's almost not preventable because ultimately we're learning, they're going to make changes,

all these things will have. There are things they could do better, but it's, mistakes will happen. But for example, do you think when someone reads blind spots and sees the instances that you've brought up with the peanut allergy, with the hormonal replacement, do you think that creates trust or hurts trust or neither? I think what's hurt what's really harmed trust in doctors and hospitals is saying that we have to have one curated message and we can't really have civil discourse in the public domain. I think that is what has been hurt public trust. Public trust in doctors and hospitals went from 71% just before COVID. And I don't talk about COVID in the book. Sure. Of course. Yeah. 71% down to 40%. A 31 point drop is.

in public trust in doctors and hospitals. I mean, that's a little offensive to us, right? Because we work hard and we're trying our best. But people saw what happens when you have sort of a central command that makes recommendations that doesn't really invite different opinions and ends up getting it perfectly backwards. And I think that's what happened with the food pyramid. I think that's what happened with opioids.

I think that's what happened with the peanut abstinence for 15 years. We were telling parents, don't allow your kids to be exposed to peanut butter. You know what the right answer, right recommendation should have been? We think peanut exposure early on may cause peanut allergies late, but we're not sure. A lot of times the right answer is we don't know. I think that's healthy to have that out there. So I'm a little bit of the school mindset that we should be having the civil discourse out there. People should hear different expert opinions.

The guy who said, look, added sugar is really the devil in reference. of carbohydrate, not saturated fat, Dr. John Yudkin was sidelined, railroaded, pushed into retirement, had his lab shot down, and it was with the same argument. We can't have the public hearing this discourse. You'll confuse them. And so I actually am on the side of discourse. Yeah, I think I'm on the side of discourse too. Obviously, that's why I'm so happy we're having this conversation. I think truth seeking is so important when it's done with the goal of truth seeking. I think if we look at the mistakes modern medicine has done as listed in the book, there's plenty of mistakes to point out.

Our system is so flawed, I could point out a mistake every two seconds if I want to. But if we're trying to create goodwill with the public and we're trying to explain that for every mistake that's been done here, because of the scientific method, we are actually catching these mistakes. Like, why did the 2000 recommendation from peanut allergies change in 2008? Because we did a study.

science auto-corrected. And sometimes it's slow, and I agree with you, because of medical inertia. We carry things sometimes for too long. We have egos. Those things absolutely do happen. But at the same time, I think that when it happens,

it could be the right move. So sometimes we have a lot of evidence pointing in one direction. Then something new comes out. We don't automatically change to that. Otherwise, we'd be flip-flopping so aggressively like the media headlines about coffee, causes cancer, saves cancer, causes cancer, useless, right?

Going back and forth. So I think that there is some value to medical inertia of not just constantly flip-flopping when you see a new study come out, but absorbing it into the general field and seeing where it lands and seeing how the consensus changes over time. Do you not think that this is how modern medicine works?

It feels like you're saying medicine is this antiquated notion that is never changing, that is constantly holding on to its beliefs. But I actually view it as a young doctor where it is apt to change and it is open to making new recommendations. And when it does, it's villainized even more. Do you see how that cycle, vicious cycle, can keep happening?

So we don't want to create cynicism. We want to educate people about truth. And I think sometimes the way to educate people about their health is to give them the backstory of where the recommendation came from, where it went wrong, and where it should be today. That's what I'm trying to do in blind spots. So the worst thing you can do in medicine, the worst thing we can do is doctors,

is to make a recommendation absolute and suggest that it's scientific. When it's not, it's just a gut feeling. And that's what they did with the peanut allergy thing. Women who slipped peanut butter into their kids because they believed in the old dirt theory, which actually has some truth of it, they were seen as anti-science. And when the medical establishment saw peanut allergies surge after their recommendation in the year 2000s, They thought, gosh, what's going on?

We told them to avoid peanuts, and now we're seeing peanut allergies go up. We've got to double down and get more peanut abstinence in the first few years of life. 15 years later, 2015, the ultimate randomized trial was published in the New England Journal, showing that the 15-year dogma was wrong. Now, in the absence of science, I think it's good to have a healthy debate. A bunch of pediatricians said, I know immunology, I studied immunology. this violates basic principles of immunology, I'm going to encourage my moms to introduce a little bit of peanut butter when the kid's five or six months of age. Now, some of these dogmas

in modern medicine are still, and by the way, I'm proud to be a doctor. The operations we're doing at Johns Hopkins are a tour to force. They're incredible. A lot of the major achievements in medicine are to be, you know, to be highly respected. But when you look at, say, hormone replacement, therapy for women in the perimenopausal period. We have had a dogma that it will cause breast cancer and increase the risk of breast cancer mortality, scaring away 50 million women over the last 20 years since that dogma was announced. So in the book, because people still believe it will increase your risk of breast cancer mortality, I explained 20 years ago how they made that announcement, how the study they pointed to never showed a statistically significant increase

in breast cancer mortality, and why there are tremendous benefits for women, because I want women to know about that option. I want the vast majority of women are candidates. You live longer, feel better, heart attack rates go down, Alzheimer's risk goes down, cognitive decline goes down, 50 to 60 percent, and it alleviates the symptoms of menopause. This has a where I get worried. We're selling hormonal therapy right now. Don't you think that's a conversation should be spoken with with their doctor? Because you know how the commercial enterprise of health care works. After hearing you say that, as respected as you are in your field, all the work that you've done, how many women that will see this interview and say, Jesus, I haven't been

offered this? Screw the health care system. I'm going to go get this. And they're going to go to a doctor that has a hormonal clinic that will not do the proper counseling and will prescribe the hormone don't you agree that that would happen that's a very jaded cynical sort of interpretation i'm trying to educate people you you live in the world of uh johns hopkins very educational academic center i'm in new york city do you know how many people here are as you said overmedicated on stimulants on anti-anxiolytic medications sleep medications when they don't have any one of those diagnoses, or if they do, they could be treated

but with some lifestyle changes. And the reason why is the doctor wants to please the patient and give them exactly what they want. Consumerous culture. Consumerist culture, totally. So don't you think that that is going on? At least I've witnessed this. Maybe it's just not happening across the United States

as much as it's happening in the L.A.s or New Yorks of the world. So are you suggesting, I shouldn't be educating women about the benefits of hormone replacement therapy? Because I talk about the risks and the lack of, you know, the contraindications in the chapter on that. Well, I don't think we just did right now. I think right now we just said that it makes you live longer, positive, positive, but we didn't say what are the contraindications and why it might not be right for everyone.

Yeah, it's in the book. Right. But I'm saying the clips and the way that it's communicated makes it so problematic because then people say, well, doctor, you're not giving this to me. You're withholding valuable information. that doctor-patient relationship. So I'm just trying to figure out the best way to communicate a meaningful message.

And I'm not a women's hormonal expert. I don't pretend to be so. I don't know the exact nuances of the research on it. But I just venture to say that when, imagine for me I would say, Advil controls this so well. And I never say that there's a risk of kidney issues or this on this podcast.

People are going to go home and take Advil like crazy. So I have to like always be mindful of the impact. especially of someone of your fortitude. Like you have so much knowledge and people will listen to you. So I get worried about that. So let's say I'm going to sort of talk openly here. So let's say you're in my situation. Right.

You see tremendous long-term health benefits of a medication. And we're talking about replacing your body's natural estrogen with estrogen when your body can't produce it plus or minus progesterone, what we call hormone replacement therapy. You see tremendous long-term benefits to the point where second to antibiotics, there may be no other medication in the modern world that improves the health outcomes of a population more than hormone replacement therapy and perimenopausal women. But you see that the vast majority of doctors and the public perceive that it causes breast cancer based on a press conference that I think was a fraudulent press conference, the people there misrepresented data. Now, kind of as a journalist, I want to tell people the real story in a journalistic way without telling them take it or don't take it.

That's what I did in chapter two of the book. So if you feel that there is something out there that needs to be said, that is not being said, I think it's okay for doctors to be talking about this. Why do you think the Endocrine Society, ACOG, American College of Obstetrics and Gynecology, are not talking about it, but you are? So a bunch of them are. And so I'll cite them, for example, the osteoporosis conference, the biggest group of osteoporosis experts met, and they created a list of things to prevent osteoporosis. At the top of that list was the importance of hormone replacement therapy and

perimenopausal women. Well, that's a disease organization. What about a major organization for that special? Because neither of us are women's health experts. Yeah, I'm... Hormonally. Right. So this affects every organ in the body. Every organ of the body has an estrogen receptor, and so it affects cardiac, neuron, everything. So there are a lot of people writing about this, talking about it. The OB group, probably more than any other specialty, was the first to recognize that the original announcement 22 years ago that it increases breast cancer mortality was not

legit. And so most of the OB community, because they have a lot of experience with estrogen, with birth control, you didn't see a surge in breast cancer with girls that take young women that take birth control. Women who are pregnant have high levels of estrogen. You didn't see higher rates of breast cancer. So they were, I think, quick to call out this. Now, I've talked to doctors who believe this is one of the greatest frauds of modern medicine. So I believe in civil discourse. To answer your question directly, though, you're asking why we can be slow in medicine to adapt to new scientific evidence. And that's really one of the themes of the book is group think is a powerful thing. And there's a psychology to the founder's effect. You hold on

to what you believe first, not because it's the most scientific or logical, but just because you were told about it first. You see it in politics. It's confirmation by it said it's finest. That's exactly what it is. Founders effect. Leon Festinger was the famous psychologist who described this. And I get into his sort of rationale in the book of why you just you'll have a comfort in just holding on to a belief, whatever you hold first. It's in your brain that's happy. It's nested. And a new information comes along that conflicts with it. You want to dismiss the new information. Reframe it to fit what you already believe. So let's say you smoke cigarettes. A study comes out showing that cigarettes are bad for you. You say, well, that didn't apply to me. I work out too, and that may counterbalance the effects. They probably smoked more cigarettes in the study. I don't smoke that many.

And the mind will subconsciously go through acrobatics to reframe new information or instantly dismiss it just to hold on to what we believe first. Yeah, there's ways to overdo it, absolutely. The scientific method, though, is constantly asking those questions. and probing, I think you've probably been in way more journal club visits than I have in discussing flaws of research or ways it could have been done better. And part of the scientific method is even for the authors to say where there's limitations

in their own research. So you don't feel like that's being done? Because when I'm in a journal club, we're constantly asking, is there a confirmation bias in the study? What possible biases could be here? You don't feel like that's happening? You're saying, is there evaluation of new research by experts? Yeah, like that new expert, new research is presented and trying to be balanced against

existing research, not just what an expert believes. Yeah, so we have, we have that. We've done, gosh, I don't know how many critiques of the study you cited that coffee causes pancreas cancer, you know, in our world of pancreas, that created a lot of problems for us. And ultimately, it was a very clear control group problem. It was a very clear methodological flaw. So this is the discourse we need to have.

In the world of hormone replacement therapy, and maybe you're sick of this topic, we can move on. I just wish I was more well-versed in that specific topic, but we can get into one about GLP-1s or something else where I'm more well-versed. Okay. Well, in that world of hormone replacement, there has been intense discourse in the profession. But what there hasn't been up until the time I wrote this book

was investigative journalism on the background of the announcement that said it increases breast cancer more. That I want for sure. Yeah, good. There we go. I mean, no one is, I hesitate to think even from a partisan standpoint that people wouldn't want to see the investigation on any kind of potential fraud in our health care research. Because we put so much weight on the value of taking care of our health.

And I'm under no guise that I'm sure fraud happens and needs to be sought out. There was one point you mentioned about. you kind of gave credit to the mom that heard the pediatrician society's stance of removing peanut butter and the one mom who's secretly giving it. In general, do you think it's wise for parents to not follow the American Academy of Pediatrics advice? Based on gut, because I'm sure that mom wasn't a microbiologist or immunologist deciding that in the example. Right. So I know where you're going with this. So let me put this out there. If there's no scientific support for a recommendation, I think it's okay for people to have their own educated judgment on it. And it's, it's, you know, I understand there's hazards with that. But you look at some of the stuff today that's being put out there. Putting six-year-olds on Ozzypick, that is a massive push right now by the same organization. I personally, think, not against it, but I just think we're not talking about the right topics of the

food. Right. I'm more so in the back of individuals going against guidelines. Yeah, I don't want people to just be a rebel. Well, because that's what I feel like we're telling them to do right now. That we're like, look at these organizations. They make guidelines based on expert opinion, which actually in the health care community, we know expert opinion is the lowest form of evidence, right? In our little hierarchy of, you know, meta-analyses being up there of randomized controlled studies, cohorts, and then moving down, expert opinion is the lowest form. So we kind of know that. But the general public probably is not very well versed in that. I hope that they would be at some point, but that's not general education. And then when they hear

a recommendation being made, they're like, well, look, they made mistakes in the past. So why would I listen to them on this? And I worry about where it takes sense. There's extremes. There's definitely extremes but if somebody says hey the experts say opioids are not addictive and i just i don't you know there are people out there you met them i just if i can get by without the medication i'm gonna avoid the opioid i'm okay with that i'm okay with that for sure in that specific example and the examples that you cite with the peanut and the opioids you've highlighted the heroes of people who've disagreed but how many people well the mom was not an expert well that's not really the what i do in the as I show how these leading experts challenge the American Academy Pediatrics

recommendations showing that there was no science, it was dogma. And then they did the studies proving it wrong. And that's a healthy exercise. But what's the difference between dogma and expert opinion in your mind? Dogma takes on a life of its own. It has a couple common properties. One, industry is often funding it. Number two, it's sort of taught to younger people as if it's scientific truth. And they sort of silence dissenting opinions when it's really just an opinion that they're propagating.

What industry was funding the peanut ban or recommendation for avoiding peanuts? So in that example, it was not industry funded. That was not an industry funded thing. I have a lot of thoughts of the peanut allergy epidemic, but we're still reeling in from it. We have the worst peanut allergy epidemic in the world.

For sure. And logically, didn't make sense a lot to me either. And even when I was learning it in medical school, I'm like, well, this kind of goes against everything I've learned. And I think there were a lot of doctors that were questioning it. And sometimes I feel these organizations are a little bit too quick to point out or a little overconfident. And I think that the point that they should take from your book and your stance is so valid. And they should be more aware of being transparent and saying, here's what we know now. There you go. Here's where our limitations are. And not patronizing the general public and saying,

saying, this is the Bible, and you have to follow this if you don't. You're a bad person. But if what ends up happening, and again, I'm watching the pendulum swing the other way, and it's contributing to the loss of trust, is that they say, well, look, the American Academy Pediatrics did this thing with peanuts. Why would I trust them on anything? If there's no science, I don't think you have to blindly trust them. But when we use the word science, that means something different to you and I.

It probably means something different to me and you because you're more well-versed on the research side of things with 200 plus publications. But for the general public, to them, science means reading a Facebook article. Right? Like from a practical standpoint? If people are in an emergency, do whatever the doctor says. Don't ask any questions, okay? But when it comes to like how to manage your, how to eat healthy,

there's probably a lot of wisdom from old school farmers. And sometimes we, it's not the doctor's, are giving deliberately diabolical recommendations. It's just, it's not been our, in our domain or purview to understand sometimes the aspects of regenerative farming and healthy foods and nutrients and all that stuff. Yeah, so like in your book, you talk about not changing, like changing the obesity epidemic

by approaching it from a food standpoint. Yeah. I think that is the correct way of going about it. I think if there is a perfect world, we would all be doing that. And I hear names in the industry. think you've been on his podcast, Peter Atia, talks about how medicine 1.0 was moving away from the gods causing our health

problems. And it said, no, it's not the gods. And that was a great win for medicine 1.0. Peter Atia says we're now in medicine 2.0, where we're just catching up and treating conditions as they are. And then he brings up this topic of what he deems medicine 3.0, which is getting ahead of issues. So not waiting for diabetes to happen and instead acting with some proactivity. I don't think this is a novel idea. I think that we are doing this. I think our health care system

in the way that the timing is, the way that we don't have investment in primary care physicians these days. We move towards a private equity model of just solving the problem with an urgent care center. I think that we want to do the right thing. And when it comes to food and nutrition,

I might not be 100% well-versed in the nutrition space to know every up-to-date article, but most of us work in these centers, a lot of us work in these centers, where we have a nutritionist, where we have a dietitian who can help us with a patient who's struggling.

Nowadays, in our office, I don't think I have a single patient, and this is a community health center, we're not some fancy concierge, $100,000 a year thing. Every patient of mine that is a newly diagnosed with diabetes gets conversation about the medications they should be on, and that could mean diabetic medications

or cholesterol medications, blood pressure medications, which are also helpful for them, a visit with a nutritionist, a visit with our nurse practitioner, diabetic educator, conversation about their mental health, lifestyle habits, sleep, how that contributes to it. So the idea that this isn't happening, and this is only happening in books and people are recommending, feels not said with honesty. So I work with a lot of diabetes educators, obviously, as a pancreas specialist. look, some of the dietitians out there are still teaching the food pyramid and remnants of it. No, come on, no one's teaching the food pyramid.

If you go, so I went to our benefits fair at Johns Hopkins, and there was a dietician booth, and I said, oh, you know, what are you doing here? And they said, well, you have free dietitian services as a part of your health benefits. And I said, okay, let me just ask you a test question. Let's say, I come in obese, what are you going to recommend? Just a couple things right off the top. within a second they went to the low-fat diet. Okay, that is a remnant of a corrupted food industry

where we know now the sugar industry was funding Walter Willett, my professor and chief of nutrition at the Harvard School of Public Health, who wrote the textbook on nutrition. This is one of the most corrupted of all signs. I'm not saying they're bad people. They're good people. We don't practice that anymore. Well, they just told me this at the health benefits.

Right. So you're finding an example of someone who's using outdated science and using that as an example to critique all of us. No, no, we are good people intending well. I'm not, this isn't the character thing. This is just about the system. We're not teaching that. I teach residents.

I've taught dozens of them over the last seven years. No one's teaching that. And just because someone is using some outdated knowledge doesn't mean that we need to drastically change it or down talk what our current methods are, don't you think? So let's say you have somebody comes in with rosacea. Okay. We have creams and medications.

There's IV infusions. They're running non-stop ads on commercials where they're all dancing in fields. Of course. And there's, I just had a patient come in who was put up for periorial dermatitis 90 days of doxycycline. Where I'm like, well, that's a little aggressive. And we needed to talk about other ways, but go ahead. You're going to talk about carpet bombing the microbiome. Yeah.

So it's not in our education and it's not part of our conversation. and it's not part of our conversation. It's not part of our business model to talk about food as medicine, as a treatment for a rosacea. Oh, for rosacea. Okay, that's very specific. Yeah, specifically. In other words, it takes more time. Honestly.

Why did you choose rosacea? So there's a great podcast on rosacea and dermatologic conditions on the Mark Hyman podcast, where they go through a bunch of these. And the docs who spend a lot of time really coaching people on the food sort of root causes of some of these dermatologic conditions, they say it's not taught in med schools, not part of their residency. It takes a lot of time. It doesn't fit well. It's easier to put them on the IV Skyrizi or whatever other medication out there. So this is where, you know, I think we've got some blind spots in medicine we can improve on.

specifically tied to rosacea or dermatologic conditions? I think all of it. I think all of it. But do you think if the average patient walks into Atlantic health system where I work or any Hackensack, Robert Wood Johnson, anywhere here, walks into an office with a new diagnosis of hypertension or diabetes? You don't think we're talking about nutrition with them? I don't think we're talking about sleep quality,

and that is a major driver. You really don't think we're talking about them. Are we talking about the pillow and matching? the ventilation, the light contamination, the noise. Sleep hygiene. It's the number one thing discussed with residents. Well, you're a good, look, you are an outstanding doctor, so you're talking about it. But it was never part.

Why am I learning about it for the first time five years ago after med school and residency and a regularist training? I think what happened and what's happening is that largely the system is broken in that doctors don't have enough time with their patients. And another thing has happened with the consumerism of. health care. There's a lot of patients that come in that don't want to talk about that. How many patients do I have that either me or my resident come in and start talking about sleep hygiene? And they go, why are you talking about sleep hygiene? I don't care. I need to wake up

for my job. This is my life. I don't want to make those changes. And give me the pill. Hostile patients. I mean, the consumerism is real. People give me a pill so I don't have to put in the effort. Or, and I will criticize Mark Hyman for this, there's a supplement to fix what is going on with you. And a lot of these supplements are not proven. A lot of the, especially the probiotic stuff, carries a lot of false promise where it's an evolving field and it's so interesting and we have so much to do and we're probably going to learn millions of things that we're doing wrong right now that will change. Right? Like what's that saying 50% of the things we're doing 50 years from now are going to be proven untrue? That's true. But it doesn't mean what we're doing now is

wrong. Yeah, I've got no supplements by the way. I know. But don't you think that that's a problem in that world because like I've heard you speak with people who are in the functional medical space, functional medicine space. I hate the term. What's your take on it? I don't know what to call all of this. Everything we're talking about. We're talking about getting at the real drivers of health. Good medicine. It was really just good medicine, right? Which is what good doctors do and there's bad doctors. Well, that's right. Well, why are we calling them functional medicine and say that they get down to the root as if family medicine doctors don't? Well, I think like they, they, they, They did a deep dive on Nafel D or fatty liver disease, metabolic dysphal.

There's like five names now because you can't call it non-alcoholic. Yeah, non-alcoholic. People still think it's alcohol. Sure. And they basically said traditional medicine, they throw some type of vitamin E at you maybe. It's usually the wrong type. And if you're really, really sick, they put you on some drug trial. When actually there's all kinds of stuff that we can be educating people about that increase

insulin levels that move those carbohydrates into fat storage in the liver. And generally it's not a part of the conversation. 20% of the public has NAFLED or metabolic associated fatty liver disease. And the tests people are throwing at it, like ultrasounds, don't even pick it up. There are certain blood tests that do. Generally, they're not ordered. I mean, you look at heart disease prevention. How many people are getting a lipoprotein A and APOB, a small subset of people getting cholesterol lipoprotein testing. But not even all cardiologists from the American Academy of Preventive Cardiology would recommend that everyone gets this.

Yes, I remember having this conversation with the cardiologist at Johns Hopkins at my hospital. Why is it, the question was, isn't it true that lipoprotein A testing is an incredible predictive screening tool for heart disease? And he said, yes. And I said, well, then shouldn't we be recommending it for every person? everybody. And he said, it's kind of thought about it. And he said, well, yeah, but it, we, and that's why we put it into our guidelines. And I said, well, your guidelines, the ones I read, have it in the footnote.

Like, shouldn't this be a major public health campaign? And he basically said, you know, I think that's a good idea. And it's something we're going to discuss. And it may be soon. So I'm like, okay, you guys are moving at molasses speed. But I feel like over recommending testing, as a person who works to choosing wisely campaign. There's a balance, yeah. It's so easy to get into this space of over-ordering. I just had one of my patients end up with a functional medicine doctor.

They ordered, I'm not exaggerating, 47 blood tests. In addition to all of the autoimmune things that I order, the ESR, CRPs, things that I've already checked. In addition, 47, things that are so ridiculous that have nothing to do with the patient's symptoms. That's not also the answer for this. Yes, I see it also as a subspecialist in my world of pancreas, people come in with a bolt, the kitchen sink of tests,

and I only need one. I only need one. It's like, what were you guys thinking? Just ask me or how can I educate you guys before you send these patients over. I'll do a webinar. I'll come to speak to you about the workup of a pancreatic mass. And this is part of the waste in health care that we can rein in. I think when we were training or in a prior generation, there was a sense of let's get all

the information. Yeah, more is better. More is better. But we're sometimes creating, we're allowing false positives to send people down these anxious roads of follow-up testing that is trauma in and of itself. And it could lead to downstream interventions, prostate biopsies with PSAs in the past. That's why, you know, I'm going to love your take. And that's why it was controversial to take the age of mammography down from 50 to 40 in low-risk women. It also depends which organization you look at because the United States Preventive Service Task Force

gives different recommendations than ACOC, let's say. So it's really dependent and not clear. Now you're sounding like a blind spots author. Well, no, this is why I think there's an interesting distinction. Yes. I think that in, like right now, you're actively talking about functional medicine being a waste. No, no, not a waste.

But there's waste in functional medicine. Yes, that's what I mean. Yeah, yeah. And there's a lot of that. But on the other hand, a lot of the messages that the functional medicine doctors have are there's pesticides everywhere, there's chemicals everywhere.

The only way you can get the answer is for me. And when they go see those functional medicine doctors, they give the same advice. Whole foods, eat your fruits and vegetables, exercise, sleep. You didn't need to pay $100,000 a year for that program. All the other stuff is just upselling and over-screening and over-testing.

So I just don't know how to get behind any of that. That's my struggle with it. Yeah. Are they the ones who triggered you about pesticides? No, I just think, again, pesticides become a buzzword for this community on social media that is anti-the-medical establishment. Oh, this is it the day you finally ask for that big promotion. You're in front of your mirror with your Starbucks coffee. Be confident.

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Tron Aries is a must-see movie event, filmed for IMAX and made for the big screen. experience it only in theaters October 10 get tickets now and believe me I'm the first person to call out the medical establishment when they're doing something else when I had my doctor Fauci interview I texted you and I said hey what triggering or difficult question can I give him that we need to ask that's good because I'm not afraid to ask these questions and what I found is for all the mistakes that Dr. Fauci made as he's not a public health communicator who was ready to take on this level of pandemic, because generally who was, he was honest. He answered every question I had. They didn't ask to see my questions beforehand. They didn't ask to see the video afterwards.

But yet there's a lot of people who are saying the government's a liar. They're hiding the information. And it starts with the entry of, well, our vaccine's good for us. Are these medications good for us? Are they just bought by pharma? It's a truth wrapped in a lie. There's a lot of corruption within the farmer world. There's a lot of things where money moves the needle. But it doesn't mean that everything we're saying in health care's lie. In fact, the majority of it is not. Is that your take two or do you feel differently than I? No, I think we're saying the same thing. And I think there is also another element to this, and that is we are living in an era of the hyper-polarization of driving people to extremes. Both extremes are, in my opinion, wrong.

Pharma is not diabolically trying to make people sick to sell products. No, it's just they're doing their job, and their job is to do these... Make the stakeholder their money, raise a share price. Yes, I mean, I wish they didn't have disproportionate influence in the research enterprise of medicine. I wish the NIH would fill the gaps with good studies on a lot of these issues we're talking about, so we're not shooting by that from the hip. But I think we've got overall good people working in a bad system.

It's just nowadays people are being affirmed in their views from the information sources that will pull them into extremes. And so you're left now with a community that is either deliver a baby 100% how they did in the 1960s and 70s, do whatever they want, separate the babies for 10 days for normal or deliver babies with no medical profession anywhere in sight, which is dangerous, right? So you get these, you get this. Extreme camps, yeah, and tribes. But that's a, that's a huge problem because then it creates disinformation both ways.

Like even in the example that I mentioned earlier when I talked about the black plastic thing on my social media, there's people who are the all natural route who are like all chemicals are bad. The word chemical means bad. And I'm like, that's not true. There's plenty of chemicals that are totally benign. Water technically is a chemical. There is all sorts of issues with that logic. Then there's also the people who are like, all chemicals are fun. fine. They're in small doses. It doesn't add up. Unless you do a randomized controlled study,

I don't believe it. That's also not true. If we can make small meaningful changes where it doesn't cost money and it doesn't take up a whole lot of time, why not make those small changes? So I don't feel like being in any of these camps is necessarily valuable. Is this how black plastic in it? I'm sure it has some sort of. I mean, plastic water bottles in general, probably not great, but what do I know about? Like I was on an interview the other day and someone's like, is there microplastics in our testicles. And I'm like, I have no, probably. There was a study. Yes, I'm sure it showed it. But what do I know about that? Do you see that brain study on microplastics? So they've measured microplastics by weight in the brain in, you know, cadavers. And it was

0.4% of the weight of the brain, almost half the 1% is microplastics. I believe it. And I mean, look, how much of that, again, I think about the risk balance for anything, because I'm such a clinician when it comes to family medicine. And when I think about that, I'm like, look, that was definitely a tradeoff that we have all these plastics in. But think about how many more people are fed, how much more sanitation we have, how many medications that we have where people don't lose their lives instantly from a raging infection. That was the cost.

Yeah. So do I think it's a problem that we should act on? Yes. But it was a small cost for a big win, or at least a bigger win. Yeah, we use a lot of them in the operating room. I mean, plastics are a big part of surgery, right? I'm saying, like, look at paper straws. People wanted those and now look how angry they are about. Well, what you're saying really, I think, describes one of the major problems in modern

day society, which is overuse of antibiotics. They save lives. And when the guy who, there's probably nothing that has revolutionized modern medicine and cured diseases, allowed us to do surgery that was never possible before, because now we could treat the infections. Childbirth went from dangerous to safe. It's unbelievable. In 1922, when Alexander Fleming discovered penicillin, he went on to get the Nobel Prize in the 1940s. After World War II, they started mass production. And he described watching one of these mass production facilities and feeling this pit in a stomach that if they were overused and abused, it could create resistance. What great foresight. Forsy, right? And it's unintended side effects. And here we're,

we are today in that consumerist culture people coming in shaking their doctor down for antibiotics and now what we're learning about its impact on the microbiome there's a good example of sort of the pendulum swinging and it's we never want to suggest don't take an antibiotic heck i mean kids will have lifelong learning loss if they have an untreated bacterial ear infection that causes some hearing loss so it's like one it's a classic example i think of what you're talking about Yeah, I think the antibiotic thing is so interesting to me because it's such a part of my day-to-day where you're between a rock and a hard place when you're trying to decide whether or not to prescribe an antibiotic. If a patient requests and you don't give, you can get a bad review.

Bad review, bad for your hospital, for yourself, all of that. Maybe patients upset. Maybe they don't believe why you're not giving it. Then if you say, well, let's be a little more considerable, let's not give it. And you get worried because, oh my God, what if this infection gets bad and now it's your fault that you didn't give an antibiotic. So you end up practicing C.Y.A. Cover your butt medicine. And you're saying, oh my God, now I need to give more people antibiotics so I don't get this recurrent infection. How many doctors will send to me a patient saying patient needs a urine culture before a procedure? And I'm like, why? They have zero symptoms. There's no need for, well, I don't want that to reflect on my statistics if they come

in with a UTI. And I could see that pendulum swinging back and forth. And I would love to see more research in that from a perspective of like right now with strep throat as an example we routinely treat strep throat with antibiotics and that's the sole bacteria unless the patient's very sick that we treat with antibiotics for sore throat and the reason we do that is because we want to prevent rheumatic fever most people think it's if they don't take antibiotics they're going to be sicker for much longer that's not even really true on average it's like a day maybe even less than a day that you have symptoms whether you take or don't take antibiotics and And then what's happened is rheumatic fever has essentially become a thing of the past.

But how many cases of rheumatic fever are we preventing versus how many new problems with the microbiome with allergies or whatever possible problem are we now creating by overmedicate? That's right. And where I see AI actually have value where I feel it's tangible and practical could happen is overviewing massive number of cases to give us better data. And I know pharma is going to be against me prescribing less medications in general, but how much better would it be if a patient comes in and I say, well, actually, you will be the one to benefit from this cholesterol-lowering medication

as opposed to like, what do I need to treat? Like 80, the number needed to treat before I actually save someone's life or prevent a heart attack. The number needed to treat is quite high, which means that the majority of my patients that are on a medicine get no benefit from it. But I would love to see AI narrow that number down by finding who the medicine is right for. Are you excited about the AI future on this? Yeah, I am. I mean, sometimes I feel like we don't need AI.

We just need I. Yeah. You know, like in the military, they're still routinely injecting every military recruit that goes to basic training with a antibiotic shot. They are? Everybody. No. Yeah, you know, just in case. No, this is still happening?

This is still happening today. Come on. No, absolutely. I just talked to staffer in Congress about this. I got to look at this. this is wild. It's so wild, right? And there's actually, there's some papers I pulled, I can send you. But it's like, at some point, we have to use some common sense. I mean, that's a common science at this point. Yeah. I mean, yeah, I believe so. Yeah. I mean, I don't know, like I think if I would bring

any doctor in the room in my organization, they would say that sounds fishy or weird or wrong. It's very fishy. Yeah. That's crazy. Oh, there was something I wanted to point out. You mentioned in one of your interviews surrounding peanut butter and how medical inertia can hold up and that you saw that, I think this was an interview you did last week, or maybe two weeks ago, that WIC, which is a program for infants, children, mothers, in order to get them food assistance, that they don't allow peanut products. I frequently write the WIC forms because family medicine is the one that fills them out. Yeah. They allow peanut butter. Yeah, not for infants. So over age one, it does, but underage one, it does not. Oh, I see. Yeah. And that's the time

when it's most important for people, for kids to get it. And Gideon Lack, who's the world expert in peanut allergies in London, has actually done, and he's the one who did the big research proving the dogma incorrect. He's challenged it early. He did that 2008 study you cited. Then he published that big trial in 2018. A trial that was embarrassingly simple. It could have been done prior.

It should have been. It should have been done, right? So he actually found that it's so important to introduce some of these allergens early, like peanut butter, that introduce. introducing it at five months is more effective than introducing it at six months in preventing peanut allergies later in childhood. And four months was more effective than five months. Now, you don't want to give them peanut butter until they can obviously eat some food, you know, and they never want to get peanuts to a young kid because of the choking risk.

But that's how powerful. Bamba snacks. Yeah, the bamba snacks. Those are delicious, by the way. I've never had them, to be honest. Tell me about your stance on the GLP-1 medications. You started to go into that and I interrupted you. I'm really torn because on one hand I see these short-term benefits, the health complications.

And for those who aren't aware, that's like the Ozympics, Ragovis of the world. Yeah. And so I see the short-term benefits. You see, and it's no surprise when you're losing all that excess body fat, you're going to see short-term benefits. And we're going to see a flurry of studies that are going to find more short-term benefits. and year one, year two, maybe even in the first five years, what are we doing long term? That's where I just, I don't know. What do you mean what we're doing long term?

So it's reducing excess body fat. It's also reducing muscle mass because there are receptors on both. Reducing muscle mass is a concern because the number one predictor of longevity generally is muscle mass. And when you reduce muscle mass, you may be accelerating frailty. And so are we going to shorten people's lifespan and will that be counterbalanced by getting rid of some of these chronic diseases. That's where I just think it's an unknown. Now, there's a new generation. There's going to be about 25 new GLP1, OZempic-like drugs that are going to come out

in the market between now and 2029. And OZempic's going to come off patent. And so we're going to see the landscape change a lot. Some of the new drugs in development that have passed now, phase one and two clinical trials have selective binding to the excess fat and do not reduce muscle mass in theory. Once you are confident that we're not reducing your muscle mass, maybe there's a whole different profile of benefit and safety and benefits that way potential harms. Got it. Yeah, that would be interesting. The idea of the muscle loss has been raised as an important issue. And I think it is because, as you said, it's an important predictor of longevity, maintaining independence. In fact, those who carry extra weight into their elderly lives sometimes live

longer and it's a part of longevity later in life. Earlier creates all sorts of issues. When paired with resistance, the right way of taking Ozempic, pairing with resistance training, working with the nutritionist to make sure you're consuming protein, doesn't that risk drop and then the benefit of losing the excess fat go up? Absolutely. I just, I don't know a lot of people who are able to do that, work out intensely and eat a high protein diet. If they did, they might not have been obese in the first place. Now, you're touching on a really important thing. If we can use Ozempic to put people on a new plan, a new program, where they're going to get a fresh new start with a boost, with help, that's when we're talking about meaningful changes, is actually now changing

lifestyle, changing what they eat, which is the underlying root cause of a lot of this, and also bridging them with some kind of therapy. Yeah, I think that's, to me, When I sit down with an endocrinologist who's very passionate about OZemphic, it seems like that's their goal, the bridge. I become a little bit of a skeptic when I ask how many patients have you gotten off Ozempic and they say zero. Then I get worried about how long is this going to take or is this actually happening? Because, for example, for me, when I prescribe an SSRI as an antidepressant or an anti-anxiety

medication, I always inform my patients that I'm not prescribing this necessarily for life. We're going to have check-ins where we plan to gradually get you off. And if you're not ready, we don't have to. But the point is to bridge you to therapy, to allow you to make some practical changes in your life. So they're not meant to be for the rest of your life. In this situation, are we going to be able to bridge all these patients off into a healthy lifestyle off of those medicines?

I'd like to see where that goes because I'm not sure of that answer. I'd love to see some data on how many people get off of it and then are able to keep the weight off without the drug. I'd like what you're saying because, and this is really important, it gets back to some of the earlier principles we're saying, it's got to be managed with a health professional. It's not a, people want one-stop shopping. It's same thing with fatty liver disease. Same thing with hormone replacement therapy.

It's not just here, give it to me. This is something where you've got to track some labs, see the body's response, how are they doing, redose appropriately. So all of this stuff really needs to be managed. And I worry in the modern world of sort of impulsive consumerism that we're losing that. And I don't, I have not heard of anybody coming off these drugs keeping the weight off. I've heard of, you know, case studies here and there. But I wouldn't say that's the general pattern that I've seen.

Again, anecdotally speaking, so I'm looking forward to seeing the research. I'm also acutely aware of the fact that there exists a lot of judgment in those who take the medications and improve their metabolic state. you know there's people say oh you took the easy way out this is lazy but that's also unfair they're doing something to improve their health if i put a cast on someone that broke their leg i'm not they're not lazy for non-way bearing for a period of time so at the same time i'm acutely aware both sides of that equation and understanding how much nuance we need to bring to the conversation whereas whenever i see a health podcast talk about it they take a stance and they say it's either

all bad and i'm really worried and it's going to be really bad or this is a miracle Everyone should take this. I think everyone in America ultimately will be on it. And I'm like, well, that also feels inaccurate. I think you're capturing there a lot of the... This is not just a problem in medical science. This is a problem in society. This kind of everything is all good or all bad.

Nuance is lost. You can't be... You can't have different views on different issues. You kind of got to be in a camp. And this is doing tremendous damage to our society. I mean, people aren't speaking to each. other in the hospital now after COVID sometimes. Has that happened to you?

Not to me, but I've seen it. I've seen it sort of almost like a political apartheid, if you will, among medical experts. And I get it. You know, people are deeply passionate about some of these issues. I saw it with some of the biggest issues that I was vocal about. School should be open after the fall of 2020. We fought, said till we're blue in the face, again, I don't write about this in the book, but until I was blue in the face, that schools should be open.

should be open. And we were told, oh, there's not going to be any harm with prolonged school closures. So anyway, there's still some of those sores. I actually had a pediatric ICU physician, and we talked about the need to get kids back in school. And it wasn't a popular video. People were angry about it. But at the same time, they were open to the nuance of the conversation. So I think people are excited for it. I just think it's very easy to say, government dropped the ball with school. They don't know anything. They're not checking anything, but there are those debates happening. We are having those conversations. And sometimes it's the wrong party at the head or the wrong decision maker that's making the decision. But in general, I think those conversations are

happening. Like even what we talked about earlier before on camera about COVID vaccinations and how Dr. Paul Offutt, who was here not too long ago, mentioned that there might not be a benefit for everyone to get a booster. It's harder. I think his quote was, it's hard, if not impossible, to boost our way out of this because it's a recurring virus that is almost endemic now, and boosting it is going to have little impact. And I was excited to hear someone who's on the advisory committee to say that openly and honestly. But at the same time, I've seen some fear tactics of individuals taking some aspect about a vaccine, a side effect of vaccine, and basically hinting, I think dog whistling is the word, to the general public that, oh, doctors aren't checking your vaccines. They don't know what they're

doing. And it created so much fear where now young mothers are coming in and they don't know what to do for their kids or they're very angry about vaccines. Have you seen that? Or what's your take on that whole situation? I like what Paul Offett was saying. Generally, I like what Dr. Offett says. And I like how he was very open about, because it's hard to challenge the sort of narrative that's the prevailing narrative. it was hard for it. At least he represented a minority opinion in academics that I think ultimately the data supported. But he was very open that he didn't recommend the COVID vaccine for his 20-some-year-old son, I think it was. And I don't think he took it at one point, or maybe it was the second booster. I think the civil discourse is good. And there's going to be

people that misinterpret. I don't read comment boxes. You know, those things can do a lot of damage. Oh, yeah. Oh, my gosh, this person said this. Well, when you look at the actual experts in a civil dialogue, it's a beautiful thing. Oh, yeah. It's a beautiful thing. And it's good and it's healthy. Now, I feel like we lost fighting for schools to reopen. We felt like there was strong data from Europe that the American journalism community

did not report on. The schools were open free and clear after a brief and understandable closure in the spring of 2020. The data were pretty compelling that it did not propose an increase. risk to the children. And there was unintended harm from the closures. So I feel like we fought till we're blue in the face for the year and nine months that schools were closed in many parts of the country. And I feel like we lost that battle. To this day, when I go around the country and speak, I get often mothers who come up to me and just say thank you for fighting for our kids and for the school. You're never going to get 100% of things correct. But I think sometimes

when there's important data that people are not looking at that we should be looking at, that's a time to voice an opinion. Yeah, and I agree with your opinion about schools and how late they opened and how many issues we had with that. Again, we talked about it openly on the channel. I think also foresight is 2020 or hindsight is 2020. It's easy to look back and say, here's the mistakes we made and dump on the government. And I think that my theory is and why they went the route that they did, they almost

practice CYA medicine on their own. They were worried that if they did open and something bad happened, it would be on them. So they were probably more conservative than they needed to be by doing that. And I can't necessarily fault groups, government groups, for doing it this way because it was an unprecedented moment. There was research showing from Europe that it could be safe. Someone else would show research from a different study saying that it wouldn't be safe. And it was hard for especially legislative people who are not medical people to gauge what the reality was. So ultimately they ended up doing their thing of expert opinion and saying, here's what I think after reading these things. And it wasn't perfect.

And I think there's a lot of things negative that came of it. But I think anytime there's something novel, we're going to make mistakes and hard to hold people reliable and say, yeah, you're liable for this. Do you feel like we're dumping a little bit on the government at that point? Well, maybe I know too much. I know that the CDC guidance on schools being open or closed was sent to the teachers' unions before it was released. They edited the documents. Some of those edits appeared in the final.

And internal people now, I think, including your health commissioner in New York City, had acknowledged that this was really about keeping the teachers' unions happy. And so we see this throughout history, right? Kids pay the price for fights among adults. It's the, they're the line in the sand. For sure. And ultimately, it was poor in minority communities that bore the greatest burden of penalties from all these COVID policies. For sure.

Baltimore City, number one. Yeah, local to you. I think that those situations are very true in the sense of those people getting harmed were the highest levels. I think that when I look at the teachers' union having a say in it, I view that as problematic for obvious reasons. I'm a doctor, and I didn't feel like they should. But at the end of the day, I think it's a good thing that we have a teacher's union arguing on their behalf.

Does that slow things down and make us less efficient to react to certain crises unlike an authoritative nation? Yeah. But in general, where would I prefer to live? I think I would want to live in a place where the teachers' union have a say. then an authoritative nation that says, we don't care what you say.

Do you agree with that? I agree. Look, I just wish I could have had a set. I wouldn't mind editing that document as well. Sure. We're a big country, though. We're a big country, but we're also, and I think we have legal corruption

in the United States. You can buy politicians. With lobbying, absolutely. Lobbying. And so that's a very bizarre, in a lot of countries it happens when it's illegal. Here, it's like legal corruption. Yeah, it's very weird.

The one thing that I like about it being legal corruption is that at least we can look it up. where in other countries it's like you know it's happening but you're not sure you don't know who's doing what at least here there's some kind of trace where you have to write down

what donations you've given there's some rules in place Oh they are tracing it here in New York tracing the ground crumbs back to the source and a lot of things here. For sure. This episode is brought to you by Square.

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Visit square.ca to get started. Hit pause on whatever you're listening to and hit play on your next adventure. This fall get double points on every qualified stay. Life's the trip. Make the most of it at best. West Western. Visit bestwestern.com for complete terms and conditions. When I found out my friend got a great deal on a wool coat from winners, I started wondering. Is every fabulous item I see from winners? Like that woman over there with the designer jeans.

Are those from winners? Ooh, are those beautiful gold earrings? Did she pay full price? Or that leather tote? Or that cashmere sweater? Or those knee-high boots? That dress, that jacket, those shoes. Is anyone paying full price for anything? Stop Wondering. Start winning. Winners, find fabulous for less. To wrap up, I want to talk about the microbiome a little bit. You mention it quite often. This is my sort of stance on the microbiome. Really exciting. A lot of avenues of impacting mental health, immunity, obesity, cancer rates,

a lot of foundational research remains to be done. There's a lot of companies jumping on the bandwagon offering to pay me six and six and seven figure sums to promote their products, these probiotics, with claims that aren't true. In our evidence-based system, there's a very small subset of instances where we use the medications. Do you feel whenever we hear about the microbiome, it is too preliminary to have practical benefit, or do you think that there is some value to doing probiotics where we're not thinking about it yet? Yes, I think of it in two ways. I think of, there are things we do to damage.

of the microbiome that people are not aware of and they need to be aware of. And then the second part of it is how do you restore the microbiome? And we know there's some general things like eating healthy whole foods and fiber, all the good stuff that we've known about, the good habits. The question is, what's the role of probiotics? And I do agree. I do believe that it is too early for most of the probiotics for us to really say this is going to do this.

And again, the worst thing you can do in medicine is to suggest something is scientifically based when it's not. Thank you. Or put it out there with absolutism. So right now the probiotics, and some people find benefits from taking probiotics. We're not taking out individuals on this. This is... That's right.

And go ahead and try them. But they can cost a lot of money, and sometimes the ones that are most popular are the ones with the biggest marketing budgets, not the ones that are most efficacious. And some have harm. Yeah, I haven't heard of harm, but everything has harm. Everything we do has harm. I think if you label something as perfectly. safe, I think it just automatically means it does nothing. Nothing safe, yeah. Well, no,

because if it has some positive effect, it has to have some negative impact. Can you name one medical treatment, medication, therapy, physical therapy, anything that has a benefit that has no negative side effect that we need to be aware of? Not even the hepatitis be shot at birth. That's what I'm saying. So everything has some potential tradeoff. So when they say, oh, this supplement or this thing is all safe, I'm like, well, then you're just telling me it doesn't do anything. That's right. Yeah, and I agree. And so. I mean, I'm thinking about what do we know about probiotics? At Shepard Pratt Medical Center, they gave a type of probiotic to people with bipolar

and described a reduction in re-hospitalization rates. There's probably a big microbiome mental health connection that we're just starting to understand, and we're just observing one signal when we see that some of those bacteria produce serotonin. So I wish I could come in here and say, I don't take money from anything. of these companies, which I don't, but here are some that I think are good for you, but I think it's too far in its infancy. I want to help people. I want people to eat good foods. Believe me, if I knew that there was a probiotic on the market, that I could help my patients have less anxiety, less depression, better sleep, immunity, whatever on the labels that exist, I would be so happy.

It would shorten the time of my visits. I wouldn't have to prescribe medications and all these things. But unfortunately, I think you're right. It's in its infancy. And I think even going past the probiotics of it all, there's microbiome testing kits that folks are selling and then check your microbiome. And then you get your results and they tell you to eat fibrous foods. It's like you didn't need the kit. Yeah. They're collecting your data. Yeah, exactly. Not as much helping you, but they are trying. And then you've got to answer all these questions and then they're going to follow up. And then they're going to sell that. And then they'll say it's a research study and they made a lot of money. And I'm glad they're doing research, but tell people it's research, right? Yeah, exactly.

We need research. And hopefully the NIH does more. For sure. I think I'm really excited about that because I think we've started doing the research, but because the people who are very good at marketing it are the loudest voices, like before we used to have this mechanism where there would be a promise of something, there would be the initial stage one trial, stage two trials, and then stage three. And then there would be some press release about them, and then we'd learn about them. Now it's like the concept is there, it's on a YouTube video.

And it cures cancer. And it cures cancer. You don't see that happening? I see it happening so often. Yeah, I mean, if we don't have good scientific standards, snake oil cures cancer and vaccines cause autism and all this. So we've got to use these same basic principles. Now, I did talk to the world expert of the,

well, the leading microbiome expert running the microbiome unit at the NIH. She's a wonderful doctor. I interviewed her. She's in the book, Blind Spots. And she was telling me about some of the preliminary work that they're doing. It's unbelievable how it's connected. And things like Pepto-Bismol, she told me,

are altering the microbiome significantly. So what they'll do is they'll take common things that we all take, other meds or things in our food supply, and see what disrupts the microbiome the most. And then you get this interesting list of, right, You thought this was totally safe and benign, but it's doing something to the microbiome. And we know that people have tried eating well, and they can't lose weight. They switch and they, you know, what's going on there?

Maybe their microbiome has been altered so much, right? Yeah, very possible. And again, I don't want people to get so scared that just because we see a change in the microbiome or we see a marker change in our blood, that doesn't necessarily yield clinical outcomes, practical things that are changing in your life. because I've seen it, the jump happened so early, so often, even with medicine. Like, if we look at the history of what medicine is, I mean, bloodletting, all these things that we've done, where we jump the gun on things, that I'm always like, let's be a little

patient and not jump the gun. But with this book, you're like, we're being a little too patient. We need to swing the pendulum a little back. Yeah, the pendulum. That's really the theme is that there's a balance. And if you look at the history of medicine, for most of human history, we didn't really have any tools. We had a saw to do amputations, a lancid to draw your blood. We had dejoxin that barely worked for heart disease. And that was kind of it. And doctors were respected in

society, but they weren't like held up. A matter of fact, surgeons were respected like a barber. You know, you might respect your doctor back in the day, like your hairdresser. And the matter of surgeons of barbers was the same profession. They called them surgeon barbers in the UK. Isn't that why they have like the little pole outside with the red? That's what I was always told. Yeah, I've heard that too. So the surgeon bar, so we, you know, we were doing our best, but we didn't have a lot of tools. But then came the advent of penicillin.

And for the first time, we had a magical pill in the 1940s that we controlled. And we would choose to prescribe or not. You couldn't get it through other means. Doctors began wearing white coats. And this unquestioned authority began. we had now technology in the hospital that was doing amazing things, iron lung machines, incubators for newborns. And doctors, the pendulum swung where now we had this intense unquestioned authority,

and we would take the liberty of keeping babies in the hospital's normal babies at birth for 10 days just to poke and prod them, right? The moms can't have the babies. We were reacting to an era of high infant mortality. By like, okay, well, let's sort of capture these babies like aliens and, You know, let's study them. Sure. And it took a long time for that to wear down.

Even in the 1970s, my little sister was, remember, she was in the hospital for three days. Totally normal birth, right? Mom came home and it's like, when's her sister coming home? Oh, the doctor's having released her. And this unquestionate authority swung where we would order too many tests and sometimes do stuff. Now, again, good people working in a system where the culture kept shifting. And so now we're trying to figure out what is that right balance. what's the humility that we need to say we don't know and we don't know here's where we got it wrong

here's where there's good science to support what you should do and everyone needs to go out there and let people know so that's kind of the history of modern medicine in a nutshell it's very true and it's cool to see its evolution of where we are now especially with the advent of technology and how things are shifting for me my general mantra has been to my patients if you need medical care for a specific condition, you should probably get it. If the doctor thinks maybe you should get it, ask more questions or get a second opinion. Because so many times we overdo it. But there are some instances where you absolutely need a medication, and I don't want to lose

that trust with the patient. And I think doctors need more education on how to have those conversations. Because nowadays, if you're in private practice and a patient comes in and says, well, you're saying that I need this maybe, why? Why? And the doctor doesn't have time so they get angry and they think that no one should be questioning them because they've never been trained to answer those questions. And I too, like you, think that we should change medical education. But in a very specific, almost silly way, I think we should get improv classes in school. To be able to handle conversations in the moment to take the information that we're getting like an improv, they teach yes and where you take whatever the person is giving you, treat it as reality and buy in. So if a patient's telling you they disagree or they're afraid of something, you've got to treat it like a reality. respond. Not say, the data doesn't support a leave me alone. Who wants to have a doctor that's a robot? That's right. You want a doctor, I mean, I'm just speaking as a citizen. You want a doctor who is going to listen, who's willing to say, you know, I haven't heard of that, but I'll take a look

at it for you. Or doesn't seem, doesn't feel right to me, doesn't make a lot of sense. I'm happy to ask someone who may know more about. That's the sort of healthy conversation. We're not taught the non-technical skills of being a good doctor, communication, teamwork, knowing your limits, humility, doing research on things that may not be in the textbooks. We focus on the technical skills. And I'm not speaking on behalf of Johns Hopkins, but at Johns Hopkins, our medical students come in, and they come in bright, altruistic, and creative, ready to do exciting things. And we beat them down with this, wrote, memorized, all these drugs, regurgitate them on the exam.

And when they ask big questions, they're basically nudged to, well, remember, you got this exam, you got to pass. And it's written by one private company. Every exam and every medical school in the country, the USMLE, the boards are written by one private company. So every school is teaching to that. Right. So it's not like college where different curricula are used to introduce more food as medicine or nutrition or envisaged. environmental toxins or whatever communication skills, it's really kind of every medical school gets in line and we do the same thing. We beat them down. We put them in this financial trap of all this

debt. And then they come out, burned out, and on this treadmill of billing and coding. And it's like, stop. We've got to stop, look up, look around us and see what's happening. The public is getting sicker or they're on more medications. The more we prescribe antidepressants, the more people are depressed. Not because of the antidepressant, but because of underlying root causes, no, we don't talk about. The more ozempic we prescribe, the more obese population is. The more pain pills we prescribe, the more pain there is in society. And again, it's not causal. It's that we have developed these blind spots of big topics that we want to talk about medicine that are just not part of that formal traditional education and billing and coding system.

I remember in med school, in anatomy class, one of the first days of med school, I noticed the, I don't know if you experienced this, the lung on some cadavers is black. Yeah. And then they say, oh,

that's from, you know, your first reaction is like, holy smoke, what, you know. And they say, oh, that's city dwellers.

Yeah. And so I'm like, okay, I'm naive, you know. And I'm just like, that's, but it's all black. And they said,

don't worry Marty it's not bad for you yeah and it's like okay how I mean whether or not it is or isn't I don't know but how dismissive that is of these big questions the age of puberty is going down sperm counts are down 50% in the last 50 years you want to ask these big questions we need these big questions to be asked but our current system just kind of has this you know put your head down to your job kind of mindset but I think good things are happening people are starting to to say no, we need to address these big questions. Yeah, I think the big change that needs to happen is on the research side of things to answer some of those foundational questions as opposed to reactive answers. From the clinician side of things, we need to create more time with our patients

and really invest in primary care. I think those are valuable avenues. Something funny that I think has made me a better clinician is learning how to play poker at a young age. Because what makes someone good at poker is making decisions with limited information and being okay with it. because you never know what the person has but you can get a sense based on bettering patterns what they've done in the past how they've acted in different situations what their face is like

and medicine is a lot like that not that you're gambling with someone's life but because we never have a hundred percent certainty in health care it's impossible like a patient will say how do you know I'm not having a heart attack right now I can say well you don't have the symptoms of a heart attack your EKG looks normal your blood tests or troponins are negative

which are enzymes that we look for in a heart attack, but that doesn't mean it with a hundred percent certainty. You're not having one now, or you won't have one one one minute from now. So we're always in the error of uncertainty. That way patients can learn to understand that we don't have all the answers. We're playing on the margins, and we're trying our best.

So when people come in and act like ICA experts where I know all and here's what's missing and I have the answer, I'm like, blow off. You don't have the answer. We can't have that answer. And the more you act like you have that answer, the more it hurts the field, because then patients just distrust all of us. Yeah.

I think we see a lot of eye to eye on this. Dealing with uncertainty. That is a skill set. Yeah. And it's probably one of the most important skillsets in medicine. For sure. And in general, in life. And the people who are impeccably open-minded are more affable, they're more successful.

In science, they are more likely to discover new ways of doing things. and so 100% of people who are close-minded perceive that they are open-minded. I believe that to be true. I saw some research saying that those who are optimistic are less accurate but are healthier, and those who are pessimistic are probably more accurate but less healthy. So it's like you've got to find that balance on the spectrum. I will say my most freeing moment that I've ever had an exam room with the patient is when a patient said, but doctor, like, how do I know it's not this?

How do you know it's not this? And I just said, I don't know and didn't say anything else. And they were like, oh, okay. They like it. They like it. They're like, whoa, you don't know. Why don't you know?

Well, because this test only checks for this, this test tests for this. And we don't have a test for the thing you're looking for. Wow. Because everyone else before said it's definitely this, and they were wrong. And now I'm losing trust. So we've got to be more comfortable

with saying, I don't know. And for patients, not writing off doctors who say, I don't know. as non-knowledgeable. In fact, if your doctor says, I don't know, you should hold that doctor up with some respect. Yeah, exactly.

That's a good doc. Well, thank you so much. Yeah, good to see you. That was awesome. Great conversation. Very much appreciate it. And I think there's definitely room for part two, or if you have another book coming out,

by the way, congratulations on the New York Times bestseller. Thanks. That's a great title. And where can people go to learn more about the work you're doing? Where do you want to send folks? Great. Well, the book Blind Spots is available wherever books are sold. It's sold out on opening day a couple weeks ago, so it...

Clearly it resonates. I think it's nice to see the demand. So it's taken time for them to restock it, but you can buy it on those websites. And then I'm on social media and on... What are your social media handles? At Marty McCarrie on Twitter. I'm on LinkedIn, Marty McCarrie, and I'm on Insta. It's a Marty McCarrie everywhere.

Yeah, Marty McCarrie everywhere. Great to see you, Mike. Awesome. Great to say. Thank you so much. Thanks. All right. After a long podcast, it's time for a little fact check. You know, Dr. Marty and I really got into a thorough conversation, but I feel like we still left some loose ends. And I think it's important that I set the record straight as to where the science is right now on a lot of these topics. When it comes to his book Blind Spots, I think it's great to call out mistakes we made. I just hope that in calling out these mistakes, we don't harp too much on the system being a failure when it comes to making recommendations. Because we've already lost so much trust from everyone. everyone, we need to focus on the fact that we're making changes and we are getting better. And I think that is a good place to start.

So in talking about poisoning our children or the fact that our food supply is poison, I think it's a bit of an overstatement because while the foods that we're eating are certainly not great in the sense that we're eating a lot of processed foods, fear mongering around pesticides, GMOs, things like that, doesn't actually yield benefit. those who follow the American standard diet are unhealthy, not because of pesticides. They're not unhealthy because of chemicals, largely. It's all multifactorial. But they're largely unhealthy because of the types of foods they're consuming their processed foods,

rich in added sugar, not eating whole foods, that sort of thing. So when we want people to eat more fruits and vegetables, fear mongering around pesticides will ultimately lead them to eat less fruits and vegetables. I think for the average person worrying about pesticides isn't valuable because, first of all, there hasn't been a proven risk. When the USDA has done trials of thousands of food ingredients, they found 99% of them were lower than the EPA levels. And some people say those levels should be more strict.

And that's for the scientists. We're figuring that out. We're gauging that. But for the general public right now, the most important thing you should do is wash your fruits and vegetables, wash your produce, cold water, using your hands. Simple things, but it doesn't mean eat less berries. It doesn't mean buy organic because when we use the term organic, we don't really know what we're talking about.

Just like in this interview when we thought organic means no pesticides, that's not true. Organic can have pesticides. They're just naturally derived, but they're still pesticides. So when we look at real science, and when I say real science, we look at outcomes, we see that organic fruits and vegetables don't have better nutritional content. this Stanford study, and at the same time, they don't get better health outcomes. So if that's the case, why are we paying more,

why are we fear mongering around them, don't see the benefit of that. So when it comes to fruits and vegetables, just eat them, organic or not, and when it comes to GMOs, don't let anyone fear monger about that. There's been no proven risk when it comes to GMOs at this time. And GMOs help feed millions of people across the globe. And in the day and age where we want to reduce hunger,

that's an important thing for us to have and potentially a way for us to use less pesticides if we can get those foods to be bug resistant or disease resistant. Another topic that I thought is valuable to talk about is saturated fat. Throughout this interview, Dr. Marty says things about saturated fat that don't quite add up to current scientific consensus. he says that saturated fat does not cause an increased risk of CVD, which is cardiovascular disease. And what the evidence pretty clearly shows is that when you overconsume saturated fat, you end up having a higher LDL, which we call bad cholesterol, and APOB, if we check that.

And when you have those higher levels, you also get higher levels of cardiovascular disease. Now that being said, a lot of the studies that we have surrounding saturated fat are not perfect and some of them even disagree with one another because it depends on the population we're studying, the age of the population, what types of saturated fats are people consuming. But as a general rule, there's pretty good consensus across all organizations that cutting down your saturated fats to about less than 10% of your total capital. calorie intake for a certain meal is a general healthy thing to do. So if you're getting your calories from all the macronutrients,

going less than 10% of calories from saturated fat is wise. The American Heart Association pushed that even further and says less than 6, 7% of calories should come from saturated fat. And this is because good quality research has shown when you substitute saturated fat for polyunsaturated fat or mono-unsaturated fat, you get improvements in your health in terms of reduced cardiovascular risk. And ultimately, that's what's important.

And the same holds true when you replace saturated fat with whole grains. And the thing that I think Dr. Marty conflates in this is back in the day, we used to preach a low-fat diet. And low-fat didn't just mean low-saturated fat diet. It meant low-fat in general, and we villainized fats in general, where we've now come to realize that there are differences between fats. So as I'm saying in this part right here, switching off from saturated fats to polyunsaturator or mono-unsaturated fats is good.

So it's not that we're saying low-fat, it's about lower-saturated fat. And I feel like he kind of mixes that up several times where he says he goes to a presentation and someone in the nutritional space tells them that he should have a low-fat diet. I don't think they meant the low-fat diet. I think they meant lower-saturated fat diet. and that is something we recommend to those who have high LDL cholesterol in order to help decrease that cholesterol. In fact, the two biggest things that I tell my patients in order to reduce their LDL cholesterol

would be to lower saturated fat and increase fiber. And I think Dr. Marty would probably agree with both of those points. But at the same time, we don't want to villainize it fully because there are some references to saturated fat, especially when it comes to dairy consumption. there's a lot to be said in this nutritional space. But when he says statements like there is no proof that overconsuming saturated fat creates heart disease risk, that's not exactly true, and we need to be careful with that. He also recommends APOB testing for everyone and LP little A testing, which is lipoprotein A.

Lipoprotein A is recommended a one-time in-your-life check as a screen and not necessarily following it. and what you do with that number is a little bit complex and really should be managed by a cardiologist. APOB, 95% of the time is the same as LDL, as I pointed out during the interview. When we talk about hormone replacement therapy for women, Dr. Marty and myself are not hormonal experts when it comes to hormone replacement therapy for women. And I think when we talk about the failures of science from the women's health initiative study where it overstated some risk for hormone replacement therapy for women because of the age of participants in that study,

because of the comorbidities of people in that study, he labels it as fraud. And I hesitate to say that it's fraud. I instead take that evidence. I look into what new evidence has come about, and I try and make a complete picture. And what the complete picture says right now is for menopausal symptoms,

specifically vasomotor symptoms, there are organizations that recommend treatment for hormone replacement therapy. And the important point, which I think was missed when Dr. McCarrey talks about these issues, is the nuance here. And the nuance is that ACOG, which is the American College of obstetrics and gynecologists, say that the indication is for menopause symptoms, and there's no prevention of coronary heart disease, not recommended for it. The North American men's Menopause Society says the same. Clinical endocrinology and American College of Endocrinology says the same. And the Endocrine Society says the same as well.

They have special considerations depending on the time when you started from when menopause begins versus when you begin hormone replacement therapy. They have differences in how long you should be on the treatment. And all of that needs to be made in a shared decision-making format. The Endocrine Society did a really good job with an image showing a scale with some potential benefits as well as some risks and it's on a scale where the benefits are slightly outweighing the risks but the way he was talked about in this interview as it's all good everyone should be on it this will save your life and the research is just not clear from the standpoint of hormone

replacement therapy for women just yet as time goes on things might change but right now we don't have all the evidence for that i think in general there was a big push in highlighting how the american academy pediatrics mistakenly put out our expert recommendation saying that we should avoid peanuts in order to decrease allergies to peanuts, and it ended up actually fueling more allergies being developed to peanuts. And while that was certainly a mistake and it's been corrected since, I think Dr. Marty highlights some parents that went against the American Academy of Pediatric Advice and gave their kids peanuts and it worked out for them.

I don't routinely recommend doing this. In fact, I think that's a bad standard to put out there because while the American Academy of Pediatrics or the American Academy of Family Physicians, an organization that represents doctors like me, make mistakes because evidence changes, expert guidance can change. Generally, we're doing the right thing based on the available evidence on hand. So when parents go and do their own thing based on a gut feeling, that's not a precedent I want to recommend or set because that could potentially cause trouble for children. is unnecessary. So I think, again, highlighting issues from the major health organizations is

valid, pointing out where we can do better moving forward is valid. There's a lot of things Dr. Marty and I agree on, especially when it comes to over-ordering tests, waste in our health care system, corruption from the insurance companies. All of that is so valid. But I'm glad Dr. Marty was fair game in talking about all of this. In fact, after our interview, he looked I mean, he said, I'm glad this was a tougher interview. I'm glad you asked questions in this way because I think it makes both of us better. I completely agree with that notion. And speaking of tough interviews, I had a great one with Dr. Mike Isertel,

where we talked about steroids, deadlift, even AI. Really great conversation. Definitely recommend you check out that podcast. And as always, stay happy and healthy.