The Prof G Pod with Scott Galloway - Modern Medicine and its Blind Spots — with Dr. Marty Makary

Episode Date: October 10, 2024

Dr. Marty Makary, a renowned surgeon and professor at Johns Hopkins, public health expert, and a two-time New York Times bestselling author, joins Scott to discuss his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. They go over topics including the issue of overmedication, weight loss drugs, and the food industrial complex.  Follow Marty, @MartyMakary. Scott opens with his thoughts on the film and TV industry in Los Angeles. He then gets into the future of the search industry, specifically how Google’s stranglehold on the $300 billion search ad market is starting to weaken. Algebra of Happiness™: find your tribe.  Subscribe to No Mercy / No Malice Buy "The Algebra of Wealth," out now. Follow the podcast across socials @profgpod: Instagram Threads X Reddit Learn more about your ad choices. Visit podcastchoices.com/adchoices

Support for Prop G comes from Viore. High-quality gym clothes make you look and feel good, and that bit of extra motivation can go a long way. Viore's clothes are made to be versatile and stand the test of time. Whether you're running a mile or running errands, Viore pieces will let you do it comfortably. Not only will you receive 20% off your first purchase, but enjoy free shipping on any U.S. orders over $75 and free returns. Go to viore.com slash prop g and discover the versatility of Viore clothing spelled V-U-O-R-I dot com slash prop g. Exclusions apply. Visit the website for full terms and conditions. What is the dog wearing? Is he wearing a collar? No, he's wearing Viore. I love this stuff. I love it. Constant Contact's award-winning marketing platform offers all the automation, integration, and reporting tools that get your marketing running seamlessly, all backed by their expert live customer support. It's time to get going and growing with Constant Contact today. Ready, set, grow.

Go to ConstantContact.ca and start your free trial today. Go to ConstantContact.ca for your free trial. ConstantContact.ca and start your free trial today. Go to ConstantContact.ca for your free trial. ConstantContact.ca Episode 323 shows the area code serving the state of Minnesota. 1920, Babe Ruth was sold to the New York Yankees from the Boston Red Sox, and the NFL was founded. My two favorite forms of media, the NFL and The Bachelor. I just love watching people fight over balls in a ring. Go, go, go!

Welcome to the 320th episode of The Prop G-Pod. In today's episode, we speak with Dr. Marty McCary, a renowned surgeon and Professor Johns Hopkins, public health expert and leading advocate for healthcare transparency and a two-time New York Times bestselling author. We discuss with Marty his latest book, Blind Spots, when medicine gets it wrong and what it means for our health. We get into what modern medicine gets wrong. We're going to need a bigger boat. And the issues of over-medication and his thoughts on weight loss drugs, which we talk a lot about here. Okay, what's happening?

The dog is in L.A. for a week. Hello, ladies. Angeles Los. Los Angeles. la for a week hello ladies angeles los los angeles but um i'm trying to be a little bit more healthy this week hanging out working out seeing a bunch of friends i met with two very charming netflix executives last night from the prestige group a super talented woman from amc and hbo working on my rich i don't know if you've heard, but I'm working on an original scripted series based on big tech that's been purchased by Netflix for a full season. Just something I do.

Just something I'm doing. I'm kind of that guy. I'm kind of that Hollywood guy. By the way, the best thing about me being in the industry, quote unquote, this has been seven years in the making. I wrote a book called The Four about seven years ago. It was essentially a love letter to big tech companies. It's called The Hidden DNA of Amazon, Apple, Facebook, and Google. And it started out as a love letter. I really do like these companies. I've made a lot of money from them. I think they're interesting. I think they're fascinating. I'm fascinated by their leaders. And as I was doing research for

this book, I got increasingly uncomfortable. And slowly but surely, by the end of the book, it was a cautionary tale. And I have been pitching this as an original scripted drama. I think, well, what succession is to family-controlled media or billions is to the alternative investments community, we're trying to do the same thing for big tech, a story of the companies and the personalities behind them. It's a drama, so it's inspired by some of the people in it, but it's not a biopic. It's not about or it's not a documentary. So I'm super excited about that. But the best thing about this is that I'm entering from a point of where I already have economic security. I don't know, probably being in the Marines is pretty stressful. But I can't imagine a more stressful place to try and make a living than L.A. right now in terms of the entertainment industry. It's not a structural decline.

Content budgets are actually up 2% this year, which is nothing. For the first time, Netflix, kind of the 10-ton grill in the space, is spending more money on global production. For the first time, more than 50% of their content budget is being allocated overseas. Why? This is a business. And the basic premise here, the basic ratio, kicking the shit out of LA, is that some of the most popular series relative to ROI, or the series that have had the greatest ROI, it was the movie Parasite, which was filmed, I believe in South Korea, didn't cost a lot to make, but made good money. So they've recognized that we can produce a lot more films and the hurdle rate is much lower. So we can take

much greater risks in terms of artistic expression by filming things overseas. And there's this entire middle layer that soaks up a lot of margin and essentially youtube decided all right we're going to create this sort of netflix-like competitor and you can upload a film or a television and just based on the numbers of viewers we will promote it or not promote it so there's essentially kind of a direct-to-consumer or dispersion of creative similar to what tiktok's doing that will continue to each share by the way what's the most popular streamer in the world? Is it Netflix at 7% of all viewing time? No, it's YouTube at 10%. YouTube is the number one streamer. We really don't talk about it. But you have dispersion, content moving to creators all over the world. You want to hear a crazy stat, there's

1.7 billion people on TikTok. Half of them are creators. There's a half a million people making their money from streaming. So 850 million creators on TikTok. They are not as good as the half a million creators working in the streaming industry. But say 1% of them are as good. That's 8.5 million people. Well, still, well, it's not 1% of them. It's 0.1% of them are really outstanding talent. That's 850,000 additional creators, human capital that the existing streaming ecosystem has to compete with. I think LA is always going to living here because of taxation, because of the high cost of living. I wonder if it becomes a little bit like London might be the analogy where wealthy

people have a home here, but there's not that much money being made here. And it turns into sort of a hospitality city where it's about real estate and servicing people who've made their money elsewhere. I would move back to LA if it wasn't so fucking far from everything. You forget how far it is. One of the things that's really messing with me is the jet lag. I got here, I'm having trouble just sort of thinking clearly as evidenced by this rant that has nothing to do with the script. Let's get back to the script. All right, what's happening? Google's stranglehold on the $300 billion search and ad market is starting to weaken. According to the research firm eMarketer, Google's share of US search ad market is expected to fall below 50% next year for the first time in over a weekend. According to the research firm eMarketer, Google's share of U.S. search ad market is expected to fall below 50% next year for the first time in over a decade. Wow. Wow, that's from

60% as recently as 2018, and it's going down. And who's taking share from them? Amazon and also AI. I don't know about you, but I have found I'm starting to type search queries into ChatGPT and Clod. I'm not sure if I generally like Clod more. I think it's actually better with writing, but I like to think of myself as alternative. I'm an edge. There's a little salsa on the dog chip. That's right. So I use Clod. Everyone's like, ChatGPT. And I'm like, I use Clod like I'm in the know. And that is eating into what is probably the most lucrative market ever. That is the $300 billion search business. The analogy I would use for search, and I've used it before, but it's worth repeating, is retail. And that is the

retailers that added the most shareholder value in the 50s, 60s, 70s, and arguably right into the 80s with big box, massive selection, everything there. You want peanut butter? No problem. We have 45 Marans, right? And it comes in big vats and it's inexpensive. Everything for less. That's Google. It gives you 7,000 search returns in 0.0055 seconds. The problem is you have to sort through all those returns. And increasingly, those returns are a lot of bullshit. And that is, it doesn't take you to the best place. It takes you to another place that it can further monetize. As its shareholder value, its shareholders continue to want 20% and 30% annual shareholder growth. Now, along came in

retail, especially retail. Actually, in the 80s, Circuit City was the number one stock performer. Remember them? Where service is state-of-the-art, and they brought together every piece of electronics. And then in the 90s and the 2000s, the greatest market capitalization in retail was created by specialty retail. Specialty retail is the following. It recognizes what is the most overlooked truth in marketing, and that is choice is not a feature, it's a bug. And that's it. Consumers want someone with better taste than them to tell them what to buy. And that's what AI is. AI is the specialty retail to traditional searches Walmart. And that is, we're's going to give you the best one answer. And if you don't like that toaster, you can say, well, what about a toaster that can do four slices? You can ask query follow-on questions, or you can ask AI follow-on questions, and it comes back with the right answer. Does that mean Google's going to go away? No. It's the Walmart. It's the Costco. It's the Best Buy. These companies will still do well, but the major shareholder growth, the major growth of market capitalization is going to be in the specialty Angeles. Amazon, get this, is expected to account

for 22.3% of the market this year, up 17.6% compared to Google's 50.5% share and 7.6% growth. I mean, think about Amazon, 50 cents on the dollar in e-commerce if you take out grocery and gasoline. And this blows me away, 22% of share, a quarter of the search market goes to Amazon. If people want stuff, they use Amazon as a search engine. What people also don't recognize is that Amazon is one of the five or 10 largest media companies in the world. AWS, it suggests different products. If you're searching for Huggies, they go to, is it Pampers or P&G? And they say, would you like to run an ad for Pampers? And I say,

yes, especially if someone's looking for diapers from a competitor. And then they start essentially being like the mob with protection money saying that if you have the best product at the best price, that's not enough. If you want to be in the golden buy box, you want to come up high in search, you have to use our fulfillment and our advertising. And we're basically going to starch all of the margin from your product. Whereas brands and products on the third-party marketplace used to pay about 22 or 25% of their top line to Amazon. Now it's 45%. Now there's a term for this, monopoly. Oh, wait, no, that's not true. Monopoly abuse. Okay. TikTok plays an interesting role in search, especially for Gen Z. Axios reported that 21% of 18 to 24-year-olds start their search journey with TikTok. You know, it's nice to see Jeff finally starting to make some money,

and I hope he finds somebody. And Jeff, don't be so shy. Live out your midlife crisis. Really enjoy yourself. Buy a canary yellow T-top Corvette and crash it into a hair plugs clinic. Jesus Christ, could this guy be having more of a midlife crisis right now? And I just want to say, Jeff, I'm here for it. When you're in LA, call me. We'll roll together. Be totally pathetic, but we don't care. We're at the point where we recognize we're going to die soon. Let's just go for it, buddy. Let's just go for it. I'm in. Anyways, the big tech stock for 2024, doing my predictions. By the way, we were reviewing my predictions for 2024. I get more right than I get wrong almost every year

and occasionally I kind of nail it. But in 2024, I would best describe my predictions, reviewing them as, what's the term? Shitting the bed. I literally got everything wrong. One of my picks was Alphabet because I think it's going to be revenge of the nerds. I do think their AI is going to be pretty powerful.

I wonder if it's too late. If Chat chat GPT is kind of pulling away with it. Anyways, Alphabet's performed relatively well, but Amazon has performed much better. Think about Amazon, best cloud provider, number two in search, number one in e-commerce. I mean, these guys are just like kind of killing it. I would say other than their video, it's kind of a distant three or four. Many advertisers are cautious about shifting their budgets from Google to TikTok due to lower search volume. While TikTok has massive appeal among younger audiences, it still can't match Google's overall search traffic, which handles about

2 trillion searches per year. 2 trillion. Wow. The big picture, this is happening as Google faces legal challenges, including an antitrust case it lost this summer, which heightened the tension around its search ad dominance. What's the future of search? Like I said, it's bifurcating. I do think there is plenty to go around. I do think AI, you want to learn about, you understand it, you want to start thinking about, and it'll come naturally just playing with it, how it impacts your industry. In sum, in sum, AI is not going to take your job. Somebody who understands AI is going to take your job. We'll be right back for our conversation with Dr. Marty Akari. Marty, I carry. Support for PropG comes from Grammarly. No one knows how much time you spend doing busy work more than you do.

Your time is valuable and you don't want to spend nearly half your working hours on emails and written communication. But finding a way to offload some of those redundant tasks, you might want to try Grammarly. Grammarly is your AI writing partner. With Grammarly, you can stay focused and spend more time getting through your higher level to-do list and less time sending the same emails over and over again. Grammarly can give you real-time relevant suggestions for whatever you write. And it's not just for emails. Grammarly works across more than 500,000 apps and websites and can help you brainstorm ideas or suggest edits that will make you sound more confident and persuasive at work.

We use Grammarly here at PropG, and simply put, it makes us more productive. For 15 years, Grammarly has helped professionals do more with their writing. Get more done with Grammarly. Download Grammarly for free at grammarly.com slash podcast. That's grammarly.com slash podcast. Podcast. Welcome back. Here's our conversation with Dr. Marty McCary, a renowned surgeon and professor at Johns Hopkins, a leading advocate for healthcare transparency and a two-time New York Times bestselling author. Doctor, where does this podcast find you? I'm in New York today. Let's bust right into it. Your new book, Blind Spots, When Medicine Gets It Wrong and What It

Means for Our Health, is an eye-opening book about the latest scientific research on the biggest health topics of our day, including hormone replacement therapy, peanut allergies, cholesterol, gut health, and rising levels of cancer in young people. Let's start there. What does modern medicine get wrong? What are the biggest blind spots? Well, modern medicine is so busy billing and coding and seeing patients in short visits that we've not been talking about the root causes of so many of these diseases that are on the rise, and with cancer on the rise in young people. And so we've got to talk about our poison food supply and the chemical ingredients that are engineered and added to our food that are banned in Europe and Canada. And we've got

to talk about environmental exposures that cause cancer, not just the chemo to treat it. And we've got to talk about school lunch programs, not just putting every kid on Ozempic when they get overweight. We've seen this massive explosion of chronic diseases in our lifetime. Didn't exist two generations ago. Doesn't exist in many parts of the Amish community that still use good farming and eat food from the soil. And it doesn't exist in many parts of the world. So we've got to look at what we're doing differently. Those root causes have been in our blind spots. What you say really resonates. The first thing I noticed, we moved to the UK two years ago, and I'm not exaggerating. The first thing I noticed was that everything in a refrigerator went bad or spoiled in two or three days. And what I recognize is that's a feature, not a bug. It's

because they're not putting all the preservatives and shit in it. Is that part of the problem, that in order to increase economics and decrease the perishability, we just put too many things in our foods that aren't healthy? I've got patients that have chronic pain, and nothing works. We try everything in modern medicine, but then they come back and say, you know, I spent a summer in Italy and for the first time I felt healthy. And what's going on is they're eating healthy foods, foods that are designed to go bad after some time. They don't have these chemicals designed to increase the shelf life. So that's a part of it, along with pesticides that are, you know, killing insects in the crops, but they're also killing our gut microbiome, the bacteria that line our gut. So there's so many factors, but that's exactly the sort of I don't have the energy to totally reconfigure my diet, what are two or three things you could do right away that would take out, say, a disproportionate amount of the risk factors in your diet?

Well, I hear that a lot. I hear organic food, which is food without pesticides, costs too much. And I tell people, try the cost of insulin, because a lot of these things going on today are the direct result of our poisoned food supply. How else do you have 40% of our nation's children that are overweight or obese and just 5% in Japan? Our kids in America are not more disobedient or more addicted as a part of their personality. Now, we've poisoned the food supply and created highly addictive foods that have things like food dyes. So the food dyes, for example, are mostly banned in Europe and Canada. So Kellogg's makes two types of Froot Loops, one with the banned ingredients for the American kids that makes the food look all colorful and shiny, and one without the banned ingredients that they ship to Canada.

So don't American kids deserve the healthier version of food made by an American company? California just banned seven food dyes. Ten other states have some bans on these dyes. But I would say read the ingredients. Simple messages I tell patients. Drink water. Avoid these sugary drinks. Avoid processed food with lots of ingredients.

And watch out for seed oils. They sound natural, like vegetable oil and canola and soybean oil, but they're not. They're denatured at high temperatures, and then a chemical solvent is used to change the structure. So these are really chemicals. And when they hit the GI tract, guess what? Your body's immune system reacts to them. These are things that do not occur in nature, and your body is reacting with an inflammation. It's not a big inflammatory storm. It's a constant low-grade inflammation, and it makes people feel sick. And we need to address these root causes, not just medicate everybody that comes in with these sicknesses. I want to put forward a thesis and get your response to it.

I've always thought that, unfortunately, in areas that are especially important to the well-being of our society, when you inject the profit element, there's some good components to it, but there's a lot of bad components. And I've always thought that essentially the industrial food complex has a profit incentive to get you addicted to terribly addictive, sugary, terrible food, such that they can hand you over to the industrial diabetes complex where there's a ton of money. Your thoughts? Well, I think you're right. The food industry started off with a charge to address food insecurity and world hunger. And so they started creating techniques, genetically modifying food, adding pesticides after it was discovered in the days after Asian orange that it would kill insects. But it also killed the crops. So they genetically modified the crops to be so-called roundup ready.

That's where they genetically modify the crops to be so-called roundup ready. That's where they can tolerate the pesticides. Well, that's our modern day food supply. But the problem is human beings are not made roundup ready. So it's poisoning the human body as well. So look, I see the best in people. And I think the food industry started off with this commission, this charge to mass produce food. Now we have to educate people about the unintended consequences of all these chemical ingredients in ultra-processed foods and foods laced with pesticides. For example, pesticides have hormone-like binding properties. Food dyes are hormone disruptors. Is it a surprise that the average age of puberty goes down by a week and a half every year for the last 30 plus years? It's now years sooner than it was a generation ago.

That's sperm counts are down 50% in the last five decades. That rates of GI cancers are increasing. So these are things we don't talk about in medicine. I got zero of this stuff in medical school. But now that I've taken the effort to learn about it, research it, and summarize it for folks, I'm going directly to the public, as a bunch of doctors are now, to try to educate people about what's happened to our food supply. Describe your diet. What do you try and dial up, and what do you dial down? Well, I think one of the biggest pieces of misinformation spread by the United States government, and they've spread a lot of it, but one of the biggest pieces has been demonizing natural fats, saturated fats. I'm not saying everyone needs to eat it, but it's a good source

of protein. And when you're eating meats that are well-sourced, that is a good source of nutrition. The government food pyramid demonized natural fats, moved the entire food industry to ultra-processed foods, and created these refined carbohydrate addictions that drove our obesity epidemic. I like nuts. I like fruits that are not coated with pesticides. It's especially important to buy organic when you're eating the surface of a fruit or vegetable. Strawberry, for example, has been sprayed over a dozen times with 7. types of pesticides detectable. You can detect these things now in the urine of children, in the umbilical cord blood of mothers. So I'd like to eat, these are almost biblical principles, right? Things that grow out of good soil, clean meats, and I do a little bit of intermittent fasting when I can.

Talk about intermittent fasting. Why is that helpful? Well, I think in general, people are not getting enough protein. So I'd warn people about just starting to skip meals because you really want to get a good amount of protein in your meal, in your day. But I just try it because I think it helps manage through a bit of willpower some of the appetite urges that I sense. I'll tell you what had a big impact is when I got rid of artificial sweeteners. The debate about artificial sweeteners got really hijacked by the do or do they not cause cancer argument. But I don't think they do. They've been around for a long time. But what they do is they trick your pancreas into thinking that a big sugar load is coming and it doesn't come. So the pancreas is waiting for that sugar load and it creates a craving and often results in binge eating of carbohydrates later in the day. So by getting rid of those artificial sweeteners,

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

ran with the story before they ever looked at the data. The data were released later, over a week later. And by that time, the world had already been convinced of this dogma. Now, the reason I'm mentioning hormone replacement therapy when you asked what's one of the biggest misconceptions, here's a medication that not only alleviates the symptoms of menopause, the hot flashes, mood swings, weight gain, night sweats, but also has long-term health benefits because the blood vessels are healthier. Nitric oxide levels are higher. And so heart attack rates in some studies are half, or they're cut in half because women who

start hormone therapy within 10 years of the onset of menopause, the rate of cognitive decline goes down by 50 to 60%. The rate of Alzheimer's goes down by 35%, and a woman has stronger bones and is far less likely to break a bone or have a hip fracture. So the overall long-term health benefits are overwhelming. Women live longer and feel better, but tragically, 50 million women have been denied hormone therapy since the time of this dog announcement that it causes breast cancer. Do you feel the same way about testosterone replacement therapy? I don't. It's very different with men and testosterone. Both men and women have testosterone and estrogen. Now, some of the dogma is parallel. For example, the dogma that testosterone therapy causes prostate cancer. Another dogma, like the dogma that hormone therapy in women causes breast cancer, is not supported by the data. Now, there are benefits, and I do recommend people who are symptomatic get tested for their testosterone levels. And I do see people who benefit, men who

benefit from testosterone replacement, but the long-term health benefits are not as dramatic as we see with hormone therapy in women. But if you go on testosterone replacement therapy at 57 and you find you're stronger, your skin's a little more youthful, your sex is a little, your erections are a little bit longer, do the benefits outweigh the drawbacks? Asking for a friend. Look, yes, most of the time the benefits outweigh any potential downsides. People just need to recognize that if you're still making some testosterone on your own, you're probably going to shut that down by taking it exogenously. You're not the rest of your life. That's what they told me, yeah. And you talk a little bit

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

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

at the diets of people in Europe, it's very different. They have far less chemicals. They have lower rates of mental illness, of autism, of obesity, of autoimmune diseases. Autoimmune diseases now affect one in five women. What's going on here? You know, my field is pancreatic cancer. As a surgeon at Johns Hopkins, it specializes in the pancreas, pancreatic cancer rates are going up, and no one is asking why. We do more pancreatic cancer work than any hospital, more pancreatic cancer research than any center in the country. Nobody is asking why. We've got to ask these big questions and talk about root causes. It's interesting because I think of pancreatic cancer as a death sentence. I just think it's game over. Is that not true?

So of those who get to surgery, which is a subgroup, maybe 20 to 30% of people can have the option of having surgery, the five-year survival rate's about 20%. So it's pretty bleak, and we have not made a lot of progress in the last 30 to 40 years. So I think that we've got to talk about root causes. Same thing with Alzheimer's. Alzheimer's is skyrocketing, and we spend billions of dollars on these expensive new medications that get a lot of excitement that honestly, they barely work and they have high side effects. And we're not talking about the study that the Mediterranean diet was found to reduce Alzheimer's significantly.

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

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

the window to removing fluoride from drinking water, or at least not adding it. This was a dogma for decades that we had to have fluoride in drinking water because it supposedly reduced risks of cavities. Well, how about stop drinking sugary drinks if we want to reduce cavities? And if the fluoride is killing the bacteria in the mouth reducing cavities, what do you think it's doing to the microbiome bacteria in the gut? So these are the big questions we've not been asking that we need to ask. We'll be right back. Support for Prop G comes from NerdWallet. If you're a listener of the show, you know business, and if you're looking for a resource to find financial products that can help you make smart financial decisions, turn to the nerds at NerdWallet.

Not only have they spent thousands of hours researching and reviewing over 1,300 financial products, but they have the tools you need to make smarter decisions. Looking for a credit card? At NerdWallet, you can go beyond the basic comparisons, filter for the features that matter to you, and read in-depth reviews. Ready to choose a high-y yield savings account? Get access to exclusive deals and compare rates, bonuses, and more. House hunting? View today's top mortgage rates for your home sweet home. Make the Nerds your go-to resource for smart financial decisions. Head to nerdwallet.com slash learn more. NerdWallet, finance smarter. NerdWallet Compare Incorporated nmls 1617539 support for the show comes from mercury it's time banking did more now it can your bank account is

no longer just a place to hold your money with mercury your account powers all your critical financial operations giving you greater control precision speed. Pay bills the moment you need to maximize your cash flow. Close the books faster by categorizing and syncing transactions effortlessly. Send invoices and track what you're owed. Share the spending power while keeping spend in check with corporate cards and get complete and accurate visibility into it all, all from one powerful account. Apply in minutes at mercury.com to experience how Mercury is transforming banking. Mercury is a financial technology company, not a bank. Banking services provided by Choice Financial Group and Evolve Bank & Trust, members FDIC. Support for PropG comes from Anthropic. If you're not using AI to

help your business run more efficiently, you might be falling behind. Still, it's a lot easier to talk about incorporating AI into your workflow than it is to actually get started. The landscape is cluttered and technical, and a lot of us are fatigued by the options. If you're looking for a place to get started, Claude from Anthropic may be the answer. Claude is a next-generation AI assistant built to help you work more efficiently without sacrificing safety or reliability. Anthropic's latest model, Cloud 3.5 Sonnet,

can help you organize thoughts, solve tricky problems, analyze data, and more, whether you're brainstorming alone or working on a team with thousands of people, all at a price that works for just about any use case.

If you're trying to crack a problem involving advanced reasoning, need to distill the essence of complex images or graphs, or generate heaps of secure code, Claude is a great way to save time and money. Plus, the Anthropic leadership team was founded in AI research and built Claude with an emphasis on safety. To learn more, visit anthropic.com slash Claude. That's anthropic.com slash Claude. And he always takes me to these kind of fabulous parties with a lot of very young, very fabulous, very attractive L.A. people. And the thing I've noticed that's changed among a younger generation is they have substantially reduced the amount of alcohol intake and they've replaced it with drugs.

Ketamine, MDMA, edibles. Give me your thoughts on the health impacts of alcohol versus psilocybin versus some of these designer drugs, for lack of a better reason. And I recognize that ideally you don't do any of these things. Well, and I'll cut to the chase. I drink way too much. It's where my health falls down. Imagine you're someone who is always probably going to have a certain level of substances in their life, because correctly or incorrectly, they've identified it enhances their life. What substances would you stay away from? And how do you feel about the impacts of some of these more trendy designer drugs. Well, I can tell you about alcohol. So as a doctor who has dealt with liver and pancreatic issues for a long time, if there ever were any tiny benefits to the heart from drinking a glass or two of wine a day, they are far eclipsed by the damage done to the liver. So people are, look, I understand people have their rituals and they, if they want to drink a glass of alcohol, I think it's safer than cocaine. But more people die of alcohol abuse than opioids and fentanyl. And so I think we don't talk enough about the abuse

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

with some of those external exogenous drugs, there is the potential for abuse. You just saw the star of Friends suffer with ketamine overdosing. It can be addictive. In the past, we used to use lower doses. Now that it's more available and people are trying it, there's an abuse potential people may not be aware of when they first try it. So, I mean, I'm probably not the best expert to answer those questions, but certainly we see an abuse potential pretty broad. Marijuana is one that I know more about. I wrote about in the book Blind Spots. There's a dogma that it's totally safe, and I try to dispel some of that because, sure, it's safer than cocaine, but the idea that, oh, it's not a gateway drug, we may want to believe that, but that's not really what's supported by the data. Say you use it once or twice a week to help sleep and wind down instead of alcohol, and it has them in a gateway drug.

Again, asking for a friend, what are your thoughts on edibles? Marijuana today is not the marijuana of Woodstock. It's about 10 to 20 times more potent, so you want to watch those doses. You want to be aware of the fact that it acts differently in an adult than it does in an adolescent, where a developing mind may be more susceptible to the risks of future psychoses. In one study, 25% of people who use it regularly as a teenager will go on to have some psychosis-related diagnosis in the future. So it may be more dangerous in the developing mind in adolescence. You said in an interview with PragerU that there's

no reason anyone should ever sign a financial document in an emergency. You suggest or write, did not read, or this is not a contract instead. What did you mean by that? Yeah, so by law, hospitals are required to take care of you for any urgent or emergent situation. And what hospitals increasingly have been doing is putting this financial contract telling you, almost manipulating you to sign your life, home, mortgage, retirement, savings away under penalty of law just to be treated. And that is, if it doesn't violate the letter of the law, it violates the spirit of the law. You don't have to sign your forms away. My team has done a lot of work on hospital price gouging and predatory billing, and we found that

hospitals sometimes sue patients in court to garnish their wages. This violates everything sacred in our profession. Hospitals are there as a safe haven. To take care of somebody and manipulate them to sign their life away financially, I think, is predatory. I don't think anyone should ever sign a financial document in an emergency room. So I'll put forward another thesis and I want to get your response. The majority of advanced nations have nationalized healthcare, spend about $6,500 per citizen on healthcare. We spend $12,000 to $13,000, yet we have worse outcomes. Our infant mortality, lower age expectancy, and yet the insurance industry, who has inserted themselves in the middle here, 45 cents on the dollar goes to administration and profits, which as far as I

can tell in terms of math, is responsible for the difference between what other nations spend on healthcare and what we spend. Hasn't basically the industrial health complex weaponized government, inserted profit institutions to the expense of American citizens? I think there's a lot of truth in what you're saying. The question is, what's the solution? And I've spent a lot of time in my tenure as a health policy expert at Johns Hopkins talking about different healthcare systems. And I'm convinced there's a better model than what we have now. At the same time, while there's an attractiveness to moving to a single-payer system, you cut a lot of the waste in the short term, a lot of the middlemen and the people profiteering off of, say, our billing and coding system. Ultimately, governments cannot resist 10, 20 years down the road doing across-the-board tightenings of the belt. And what it ends up doing is resulting in an underfunding of the

healthcare system. And we've seen that even with our own government system, Medicare. It's massively underfunded, and it just becomes a declining priority after the initial enthusiasm to have some government. So it's a mixed picture. I tend to focus on what's feasible. And right now, my concern is we can have the most gold-plated health insurance for every American. We can fix our broken health care financing.

But if we are still recommending bad practices and not addressing our poison food supply, we're going to keep watching these chronic diseases extend. So it feels as if many of these roads lead back to preventive health care, specifically around our food supply system. How do we fix that? Is it taxing these foods to their... I mean, my understanding is if you just priced water at its real cost, beef would be $20 or $30 a pound. If you, you know, Bloomberg wanted to tax big gulps, is it taxing these companies? How do you address the externalities and fix? Is it more regulation, more pricing that reflects the damage of the externalities here? How do we create a healthier food supply system? So, Scott, you're talking to a guy who's studied a lot of the unintended consequences of well-intended

government policies. So I'm a little leery of things like strong government interventions. And so what I would suggest is the government needs to stop spreading misinformation about food and nutrition. They need to stop purchasing, with U.S. tax dollars, dangerous foods. We do this in almost every school lunch program in the United States. Heck, we strip the fiber out of the food and feed it to kids like sugar and call it bread, even though it's really not bread. And we've got to sometimes help support these school lunch programs with subsidies to buy healthier foods.

Curious to get your thoughts on GLP-1 drugs. We're clearly seeing a reduction in short-term health complications when people lose weight. But just like you're losing excess body fat, you're also losing muscle mass. So everyone who prescribes these drugs is supposed to technically be saying that you're supposed losing muscle mass. So everyone who prescribes these drugs is supposed to technically be saying that you're supposed to exercise like crazy and eat a high-protein diet. But in the real world, people are not necessarily doing that. And we don't know what the long-term consequences are of losing all that excess muscle mass. Here's one little fact people may not be aware of. The number one predictor of how long you live is your muscle mass. So's one little fact people may not be aware of. The number one predictor of how

long you live is your muscle mass. So we may be accelerating frailty and even shortening lifespan despite the reduction in health complications in the short term. God, that's wild. So everything I read about Ozempic, every year I do a prediction seminar on technologies. And I said that in 2024, the most seminal technology breakthrough was GLP-1 drugs. The stuff I've read reduces alcohol consumption, biting nails. They're talking about giving it to people with gambling and social media addictions. Am I overestimating the impact this might have on our society? I'm a little cautious about the premature celebration that we may now have a drug to treat addiction.

And it may be a secondary effect because you probably feel better about yourself when you lose weight and may just have a more positive outlook and better willpower. So I'm a little cautious when pharma says we have a solution for everything. But I will tell you this, Scott, we are seeing now a new generation of GLP-1 drugs like Ozempic that are about to come to market. There's estimated to be 29 that are going to come to market in the next 20 years or so. And some of these now are designed to block that receptor on the muscle. So it may not reduce muscle mass,

as is our concern with Ozempic and Magovia and some of the others. So we'll have to see. But here's a question I pose to most doctors when I talk to them about this topic. Have you seen anybody come off of Ozempic and keep the weight off just from diet and exercise. I'd like to see that be a nice population of people before I recommend it too broadly. And final question, just something personal. Someone in a high-pressure job, you're obviously very ambitious. Any thoughts on being a good partner

when you're trying to have the kind of impact you have and the demands it places on your professional life? Yeah, I think what we've seen is that the happiest communities in America are those with strong social networks. And when you look at the Maslach work at Berkeley on workplace satisfaction, one of the greatest drivers of happiness at the workplace is the amount of positive feedback you get directly as a result of your time and services. And we're learning now in an amazing study that blew me away as a doctor, that when you energetically and enthusiastically compliment someone else, then you actually increase your own endorphin levels at a level higher than that of an antidepressant. New Time, New York Times bestselling author. His latest book, Blind Spots, When Medicine Gets It Wrong and What It Means for Our Health is out now. He joins us from New York City. Doctor, I really enjoyed this conversation. Thanks for your good work. I think it's having a real impact.

Thanks so much, Scott. Good talking with you. I appreciate it. algebra of happiness you need to find your tribe i went to this birthday party this weekend for some friends from college um about eight of us met when we pledged zbt fraternity alpha road chapter at ucla and i think if you're a young person or even an older person that wakes up and realizes you're one of the men that one of the one in seven men that doesn't have a single friend or one of the four men that can't name a best friend, you have to find your posse, and I don't care if it's a church group, a sports league, a non-profit, whatever it is, temple, a fraternity, a sorority a club at work that gets together on a regular basis seek out a group of virtuous men who are intelligent and express friendship try and get together with them i don't care it's poker and start finding your tribe because here's the

thing by the time you get to my age, all you have literally is love and camaraderie for these people. And I went to this party Saturday night and I met all of their kids and all of their wives. And it's literally this tide pool, this epicenter, this volcano of achievement, prosperity, love, and friendship. And all the bullshit just sort of melts away and you feel loved and you get so much reward from these friendships. And we've done a really good job. We go every year to Las Vegas for the last, or every other year, I should say, for the last 40 years. We know each other all so well. And there's something about investing in relationships when you're young. It's like compound interest. And that is you wake up one day and you just have

a mess of great friends that bring you enormous reward, enormous comfort. But it starts with the tribe. And especially young men, I worry that we're developing into a different species where we're comfortable being alone, sequestering from society, becoming much more prone to nationalist or misogynist content. We start blaming immigrants, start blaming women, start getting angry, start being susceptible to the manosphere, which is nothing but thinly veiled weirdness. It's effort. It's work. Find that group. Lean into it. Be generous. Be open to friendships. You are part of a tribe. Start building yours. This episode was produced by Jennifer Sanchez and Caroline Shagrin, and Drew Burrows is our technical director. Thank you for listening to the PropG Pod from the Vox Media Podcast Network.

We will catch you on Saturday for No Mercy, No Malice, as read by George Hahn. And please follow our PropG Markets Pod wherever you get your pods for new episodes every Monday and Thursday. Daddy was here early. Daddy's on time despite the fact that, oh, fucking dark hundred hours here, he found a way to be on time despite the fact that oh fucking dark hundred hours here he found a way to be on time. But not the millennials, they were walking their dogs and doing ketamine.