We trust the guidance of medical professionals so much – and it can be hard for both doctor and patient when new research recommends changing course on well-established treatments. Dr. Marty Makary is a Johns Hopkins professor and member of the National Academy of Medicine. He joins guest host Courtney Collins to discuss why physicians have recommended we avoid everything from hormone replacement therapy to eggs and why it’s so hard to correct flaws in previous studies. His book is “Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health.”
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Transcript
Courtney Collins [00:00:00] There are certain things we all think we know about living a healthy life. A lot of these truths are pretty straightforward. Wear a seatbelt, get enough rest, eat some vegetables. But have you ever heard that hormone replacement therapy can cause breast cancer? Have you been told to avoid high fat or high cholesterol foods? What about that once golden rule for new parents? Don’t let a baby peanut butter. If these sound familiar, it’s because they were once preached as law by the medical establishment. But new research has turned all this guidance upside down and inside out. From KERA in Dallas, this is Think. I’m Courtney Collins in for Krys Boyd. Doctor, professor and public health researcher Dr. Marty Makary’s new book takes us on a journey through old protocols, new protocols and the decades it often takes to set things right. It’s called “Blindspots: When Medicine Gets It Wrong and What It Means for Our Health.” Marty, welcome to Think.
Dr. Marty Makary [00:00:53] Great to be with you, Courtney.
Courtney Collins [00:00:54] So this book is really a fascinating read. I’m wondering why you set out to write it. What inspired you in the first place?
Dr. Marty Makary [00:01:01] Well, medical dogma can take on a life of its own. And we have groupthink sometimes in medicine with a small group of establishment leaders that sometimes set edicts for everybody. And when they use good science, we help a lot of people as doctors, but when they sort of shoot from the hip and go with their opinion, they have a terrible track record saying opioids are not addictive for 30 years. Kids should avoid peanuts Hormone therapy. There’s so many things where the recommendations have either been reversed and you haven’t heard that they’ve been reversed because the establishment kind of quietly fades out or new research should be reversing some recommendations that are still prominent to this day.
Courtney Collins [00:01:47] So I love that you started the book with peanuts because I don’t think there is a single American out there who hasn’t heard a horror story about a kid with a severe allergy or who’s had a brush with a nut free school or an office party where peanut products were not allowed to be brought. It seems like one of those universal things everyone knows about peanut allergies and how dangerous they can be for kids.
Dr. Marty Makary [00:02:08] So it’s interesting. The United States has the worst peanut allergy epidemic in the world, and it’s not because of genetics. It’s because of a dogmatic recommendation that was pounded into parents for 15 years, up until very recently, that kids should avoid all peanut butter and peanut products in the first three years of life. It turns out they thought in the medical establishment that they were telling parents how to avoid peanut allergies later in life. But what they were doing were causing peanut allergies because they forgot about a basic principle called immune tolerance or the old dirt theory. When you’re exposed to something in infancy, your body learns it and you’re less likely to become allergic later on. So as the recommendation to avoid peanuts and peanut butter, abstinence and for the first three years of life took on this life of its own, peanut allergies began to go up very high, including a new type of allergy, which is a very severe allergy. A kid can have trouble breathing just being near a peanut. And so homes started getting rid of peanuts and peanut butter. Schools started to ban them. And then it just perpetuated the problem because the younger kids and infants did not get exposed in the homes either. So it became this self licking ice cream cone, igniting the modern day peanut allergy epidemic, which is not present in Africa, parts of Europe or Southeast Asia.
Courtney Collins [00:03:38] So let’s talk about how this happened. I mean, how do we get from basic science? You understand a little bit of exposure to something is good when you’re little and it builds tolerance. How do we get from that kind of commonsense concept that you just broke down to what we actually recommended for all those years, which was, please don’t give your children peanut butter until they’re three. What happened? How did that conclusion come about? It sounds like it was just flat out wrong.
Dr. Marty Makary [00:04:01] Well, it was wrong. And it turns out there’s a psychology to groupthink. And this psychology is true of the human condition. We all have a natural human tendency to just believe what we hear first, not because it’s more logical or more scientific than new information, but just because we heard it first. And so Dr. Leon Messenger, the psychologist who described cognitive dissonance, goes through exactly how ideas that we hear first get comfortable in our brain. And we have a sort of subconscious tendency to just keep things peaceful, just have that one original idea, and our bodies will go through acrobatics again subconsciously to reject new information or to reframe it, to make it fit what we already believe. And that’s the psychology of cognitive dissonance that I detail in the book, because most of these modern medical dogmas come from this pride of not wanting to change what we are originally put out there as a medical record recommendation or a dismissal of new information, or a dismissal of other scientific opinions that may threaten what we already believe. And this cognitive dissonance, this sort of subconscious mental laziness that makes us reject or reframe new information to hold on to what we already believe is part of the human condition. We do it all the time with politics, business relationships, and in medical science, we see it play out as well.
Courtney Collins [00:05:38] So was research just kind of misinterpreted, misrepresented? Did someone kind of draw a conclusion and just run with it? How do we get to peanut abstention? Because if my memory serves, I think you interviewed someone who worked on this research who said that I never said anything about not having peanuts for the first three years of life. The research didn’t really point that direction, did it? Did someone misunderstand it?
Dr. Marty Makary [00:06:01] They misinterpreted. Well, first of all, there was no good research. And you’re right, in many of these examples of modern health recommendations that were based on nothing, no science. I went back and interviewed the people and I asked them, why did you tell parents to avoid peanut butter and peanut products for young children when you really didn’t know what the right way was to approach peanut allergies? And they first of all, acknowledged that they got a terribly wrong. But I didn’t really sense a humility. They said, well, parents were asking us, what can they do to prevent a peanut allergy in their children? And we felt as experts, we needed to tell them something. And I told them, no, you didn’t. You don’t have to tell them to do something if you don’t know. Sometimes in medicine, the right answer is we don’t know. And that humility would have spared us in igniting this modern day peanut allergy epidemic.
Courtney Collins [00:07:02] So when did the pushback start to come? I mean, there were certain doctors who were saying, no, don’t avoid peanut. You found a pediatrician, for example, who had not a single kid with a peanut allergy in his whole practice group. And that’s because he hadn’t told parents to stop. Ge said, introduce it a little bit with some water when they’re babies.
Dr. Marty Makary [00:07:21] Well, a couple of doctors sort of stood up against the groupthink they were familiar with immunology and basic immunology principles, that didn’t make sense that you would tell people to abstain from peanut butter in the first couple years of life in order to prevent those allergies later. So a couple doctors tried to push back. A couple of doctors told their patients, look, I want you to introduce peanut butter early. Ignore the big recommendation you’re hearing from the American Academy of Pediatrics. Introduce a little peanut butter at five months of age, six months of age, as soon as a child takes food. And the pediatricians who did that have had some impressive practices. In one case where I interviewed one doctor, not a single kid in his practice has developed a peanut allergy. Whereas standard in America now 1 in 18 kids has a peanut allergy. So there have been people who have challenged deeply held assumptions in the field. And that’s really the purpose of science, to challenge some of the deeply held assumptions that are not based on good science or based on dogma. And one of those doctors in England finally did the big study. It just came out eight years ago in the New England Journal of Medicine. He did the proper study, randomizing 600 kids to both approaches, peanut butter exposure versus peanut butter avoidance in the first couple of years of life. And what he found was a dramatic difference in peanut allergies later in life. Kids that avoided peanut butter in the first three years of life had an eight fold plus increased risk of developing a peanut allergy, including some severe allergies. That definitive study that was done just eight years ago should have been done back when they made the recommendation.
Courtney Collins [00:09:05] And I like the last point you make is that peanuts are cheap and pretty nutrient dense, and they’re pretty important in a lot of different cultures. Like a lot of African countries incorporate them into soups. You talked about how Israeli kids get Bamba, which is kind of like a peanut butter puff snack that’s really tasty and shelf stable and nutrient dense. So it seems like of all the things to pick on, this is an especially unfortunate food to tell parents nothing for your under three crowd.
Dr. Marty Makary [00:09:33] It was quite a pile on effect and we see this in medicine. Medicine will get fixated on certain dogmatic recommendations and it will just be a massive herd mentality, sometimes a mob mentality. For example, the low fat diet leads demonized saturated fat in the diet, and you saw this massive sort of pile on effect. In the case of the peanut allergy, it is tragic that this dogma still lingers. The wake program in the United States still does not cover peanut butter for infants, which is a modern day scandal. And when world hunger programs try to use peanuts to address world hunger, some American doctors tried to stop them saying, hey, you can’t introduce peanuts early in life. It could cause peanut allergies if they get exposed to peanuts. Agian, they had it perfectly backwards. Turns out peanuts are a great source of protein and they’re cheap and they don’t require refrigeration. And they’re ideal not just for addressing world hunger, but it’s ideal to prevent peanut allergies by early introduction with peanut butter as soon as a child can eat.
Courtney Collins [00:10:45] So we’re not going to get through this next section before we take our first break, but I do want to talk to you a little bit about the start of your chapter, where you talk about hormone replacement therapy. How did the medical establishment arrive at the conclusion that hormone replacement therapy, which people call HRT for short, caused breast cancer? This is something I think everybody heard at some point in their life, no matter their age. It was definitely some belief I had filed away in the back of my mind when I was in my 20s and 30s and hadn’t heard otherwise. But how did we get to that conclusion, that hormone replacement therapy for women who had gone through or going through menopause caused breast cancer?
Dr. Marty Makary [00:11:25] It was really the biggest announcement in modern medicine. 22 years ago, a doctor from the NIH held a press conference where he declared that taking hormone replacement therapy after menopause causes breast cancer. He cited the largest study ever done in the history of medicine. A $1 billion NIH taxpayer funded study. And he said they had to end the study early because they saw that it causes breast cancer. Turns out he never released his data until a week and a half later. And when the data came out, the headlines had already run. The medical community had already been persuaded. Women had been scared. They had flushed their pills down the toilet. Doctors had called their patients to tell them, you’ve got to get off this. It’s a carcinogen. And the great tragedy is that from my investigative reporting I show and describe in this book, Blind Spots, that there was never a statistically significant increase in breast cancer from that study. They had misrepresented their data. So tragically, 50 million women since then have been denied the incredible health benefits of hormone replacement therapy after menopause, allowing women to feel better, live longer, and have better health outcomes with everything from Alzheimer’s to heart disease to bone fractures.
Courtney Collins [00:12:45] You talk a lot about longevity in this chapter because you have a lot of documented benefits of HRT. Can you just name a couple?
Dr. Marty Makary [00:12:52] Well, demonizing it was probably the biggest screw up in modern medicine because there’s probably no medication that improves the health of a population more than hormone replacement therapy for a woman after menopause. If they started within ten years of the onset of menopause, reduces Alzheimer’s by 35%, reduces cognitive decline by 50 to 60%, cuts the rate of heart attacks in half. If a woman falls, she’s far less likely to break a bone. And also for those long term health benefits. It also alleviates or helps alleviate the symptoms of menopause, which can be severe and last for sometimes 8 to 10 years.
Courtney Collins [00:13:34] So, Marty, before we took a break, we were talking about kind of the big press conference around the fact that HRT hormone replacement therapy allegedly caused breast cancer. You spoke in the last segment about how there really was no statistical proof of this. The research wasn’t released. I wonder if you can paint a picture about the meeting that this group kind of had when they were surprised with the news that this was going to be published. Now, this wasn’t like a typical process for a study that was headed to publication, am I right?
Dr. Marty Makary [00:14:07] No, it wasn’t. Not at all. The study was a massive study called the Women’s Health Initiative. And just before the press conference in 2002, where the lead investigator announced that hormone therapy causes breast cancer, he held a meeting of the 40 different investigators from around the country who were running this study at different sites, and they thought they were attending just a regular meeting for the study. And when they showed up at this room in the Chicago Sofitel, somebody got up and said, you can throw out the agenda. There’s been a new finding. We found that this hormone therapy causes breast cancer. And so we’re going to publish these findings. We went ahead and wrote the article, and it’s already been accepted at the Medical Journal. Well, as they handed out the article, some of the researchers said, what’s going on here? This is totally unconventional to write the study results up and submit it and have it accepted by a medical journal. And the coauthors had never even seen the manuscript. And so an argument erupted where some of the researchers who glanced at the data of this paper being handed out at the meeting, they said, wait a minute, there’s no statistical significance in an increased rate of breast cancer. You can’t put this out there. And they warned the lead investigator. They said if you put out fear around breast cancer with something as sensitive as breast cancer and associated with hormone replacement therapy, you may never be able to undo that fear. You may never be able to put the genie back in the bottle. And those words were prophetic. It turns out those researchers were steamrolled. The publication went ahead. The announcement went ahead despite their objections. And their words were very prophetic because to this day, 80% of doctors still believe the dogma that hormone therapy causes breast cancer. And if you ask them why, they will cite that famous 2002 to Women’s Health Initiative study.
Courtney Collins [00:16:18] Yeah, as an exercise, they did a quick Google search of that question before we sat down for this conversation today. It took about six, seven articles down on the main page to get any kind of nuance. The first six entries were like, yes, it does cause breast cancer. Yes, it does. And you had to really kind of dig in to get any kind of clarity on maybe them single only estrogen, only HRT does not actually correlate with an increase in breast cancer. And you couldn’t really get an answer to that question that backed up the research that you lay out in this book very quickly.
Dr. Marty Makary [00:16:50] And it is let’s assume it did cause breast cancer to the degree at which the claim was made, in my opinion, falsely made. The other health benefits would far eclipse that increased risk of breast cancer. First of all, there was never any suggestion that it increased deaths from breast cancer or what we call breast cancer mortality. When I interviewed the guy who made that original claim in the press conference for the purposes of this book, I asked him, has there ever been a study showing that hormone replacement therapy, yours or any study showing that it increases breast cancer mortality? And he acknowledged to me that there wasn’t. So tragically, 50 million women have been denied this incredible therapy, including my mother, who broke her hand several months ago from a fall. And she needed surgery. But it was a borderline fracture. She almost did not need surgery. But the preponderance of opinions among doctors I respect said better to do surgery to repair this fracture. I can’t help but think if this announcement had not been made, she would have been on hormone replacement therapy and had stronger bones. It prevents osteoporosis. And one of the incredible benefits is that women are less susceptible to hip fractures later in life, which is a common cause of death or disability that leads to a cascade of other events.
Courtney Collins [00:18:18] And you mentioned briefly before we took our short break that frequently menopause symptoms go on much longer than a lot of even medical professionals, professionals acknowledge we’re not talking about a year or two of mild symptoms for many women. Symptoms of menopause can include things like significant depression and can last seven, eight years.
Dr. Marty Makary [00:18:40] Yet there are many different ways in which menopause presents, and everyone’s different. It can be mood swings, hot flashes, night sweats, weight gain, difficulty sleeping, dryness, painful sexual activity. There are 50 plus different manifestations of menopause. But tragically, because of this announcement that hormone therapy causes breast cancer. Medical schools and the male dominated medical profession generally felt like there’s nothing you can do for menopause, so why teach menopause? And so this old dogma from a very paternalistic mindset continued to loom in medical school education and residency, education that some women experience menopausal symptoms, but it’s usually mild and just lasts a few years. Well, that’s never been true. The symptoms are experienced by about 80 plus percent of women and they can be very severe and the average duration is seven years.
Courtney Collins [00:19:45] So in the wake of this kind of press conference and this study being published, has anyone ever stood up and said, we really got it wrong? Is there been like amendments or mea culpas or apologies made or has this kind of just trickled out? Is more common knowledge now? What’s where do we stand?
Dr. Marty Makary [00:20:04] On the contrary, they have dug in. They have published follow up studies where they have tried to massage the data to make it look like there is a correlation there. And although it may not be statistically significant or at least wasn’t in the initial study, that follow up studies show that it was a stronger signal in the data. Well, these are very poor methodological studies when you look at the follow up studies. If you already announced to the world that people on hormone therapy have a higher rate of breast cancer, you create fear. And so when they disclose to the women in the original study, hey, you were on hormone therapy and we stopped the study because we found it causes breast cancer. Well, they’re getting more frequent mammograms. They’re more vigilant, and there may be more false positives. So tragically, you did not see any humility. You saw the opposite. And that is, in fact, a pattern. Not that it fits with Dr. Singer’s theory of cognitive dissonance. And it also sort of fits with the pride of the profession, the insistence on keeping things consistent so we don’t confuse a public that cannot understand nuance. And you saw it with the opioid epidemic. You saw with peanut allergies, you saw with the food pyramid, with overuse of antibiotics. So many of the modern health recommendations that were wrong, bad information, misinformation. You didn’t see a apology. Some argue even with Covid policies, there were missteps and you really have not seen an apology for any of that. It’s consistent with the behavior of a bigger medical establishment.
Courtney Collins [00:21:44] I want to take a second to talk about the section of the book that focuses on the microbiome, basically your gut and your gut health. Can you explain a little bit how antibiotics can disrupt gut health?
Dr. Marty Makary [00:21:56] So we don’t talk enough about gut health and the microbiome. It’s been a topic that lives in one of the giant blindspots of modern medicine. Trust me, I’m a busy academic surgeon at Johns Hopkins. I do a lot of research. No one’s talking about this stuff but the microbiome. That is the millions of different bacteria that lie in the intestinal tract are central to so many aspects of health. It integrates into every organ system in the body. These bacteria help with digestion of food. They metabolize what we eat. They train the immune system, which is closely adjacent in the wall of the intestine. Some of these bacteria produce serotonin involved in mood and mental health. Some of the bacteria produce vitamins. Others help regulate estrogen. So the central organ system we call the microbiome is so central to so many areas of health. Antibiotics, for example, carpet bomb, that garden of bacteria that normally live in an equilibrium. And when you change that equilibrium, you can have overgrowth of some pro-inflammatory bacteria or bacteria that may have effects we don’t fully appreciate. And in an amazing study by the Mayo Clinic that just came out and I describe in the book. Kids who took an antibiotic in the first couple of years of life compared to kids who did not had a 20% higher rate of obesity, a 32% higher rate of attention deficit disorder and learning disabilities, a 90% higher rate of asthma and nearly a 300% higher rate of celiac. What’s going on? Well, we’re altering the microbiome, and we understand the microbiome is integral to so many of these conditions. And farmers have noticed that for years. They’ve noticed when you give an animal antibiotics, the animal is fatter, which is why they use it for mass production of animals for food.
Courtney Collins [00:24:00] Talk to me a little bit about kind of what has the reigning thought been, you know, since antibiotics became kind of safe and widely available? I mean, you say this frequently throughout the book is doctors have been known to say things like, well, it won’t hurt. Might as well give your kid or for yourself an antibiotic. Just give it a try. It can’t hurt.
Dr. Marty Makary [00:24:21] Well, Courtney, that’s been one of the most damaging pieces of medical dogma in the modern era now. Antibiotics probably won’t help you, but they won’t hurt you. And so we have massive overuse of antibiotics. It’s been even accelerated with telemedicine. Heck, you can’t even look into a child’s ear by telemedicine. You need a good ear exam to determine if it’s bacterial or viral. But the modern day consumerist culture, fueled by the dogma that antibiotics won’t hurt you, has resulted in massive overuse. And it’s altering the microbiome. And the overuse of antibiotics is paralleling has paralleled many of the increases in chronic diseases. As a matter of fact, when the guy who discovered the first antibiotic penicillin received his Nobel Prize, he had issued a strong warning in the 1940s, warning about the unintended consequences over the overuse of antibiotics, one creating superbugs that would undo the progress in medicine from antibiotics, but also just things we don’t yet appreciate. And it turns out, altering the microbiome is one of the areas that has been in the blind spots of modern medicine. And it’s not just antibiotics, it’s C-section deliveries and other things. Now, antibiotics and C-sections save lives and sometimes they’re necessary, but 40% of C-sections are unnecessary and 60% of antibiotics are unnecessary. So we need more appropriate care. We need to use our medical interventions judiciously and address the dogma.
Courtney Collins [00:26:00] Can you explain a little bit, speaking of superbugs, can you explain kind of how bacterial resistance has accelerated? I don’t think I realized how long it used to take for, you know, resistant bacteria to appear compared to now. It’s it’s going pretty quick these days.
Dr. Marty Makary [00:26:17] Yeah, it used to take a bacteria 13 years to be able to figure out how to mutate around a new antibiotic. Before that, it took 21 years with the early introduction of antibiotics. Today, it takes one year quickly with the administration of a new antibiotic. The bacteria will genetically mutate. They’ll find a way. The surviving mutants will overpopulate and dominate the bed of infection. And so the antibiotic overuse today results in an increase in resistant bugs. That is superbugs. And this is not theoretical. 30,000 Americans die each year in the United States from these antibiotic resistant bacteria. And the W.H.O. expects this to be a pandemic, but it’s not an exponentially growing pandemic. It’s a slow growing pandemic, and it’s already set in. It’s here.
Courtney Collins [00:27:19] I want to talk about one of my favorite chapters in the book that started with your Uncle Sam and his just absolutely delicious sounding recipe for scrambled eggs. First of all, you got to tell us what the recipe was and then tell us why this egg love ended up making Uncle Sam very unhappy for a period of time in middle age.
Dr. Marty Makary [00:27:39] Well, my uncle Samuel, we call him Uncle Sam. He grew up in Egypt and he loved eggs every morning. It was part of his ritual. His parents had prepared eggs and it was prepared with a little bit of milk and fluffed up. And some cumin and salt and pepper. And so these eggs sort of became part of his daily ritual his entire life. And when in his 30s, when he immigrated to the United States, he started seeing an American doctor for the first time, assuming these were the best doctors in the world, and they quickly detected that he liked to eat a little bit of eggs each morning about two eggs. And they gave him the guilt trip and they made him feel terrible. And the relationship became very contentious. And they would negotiate down how many eggs he was allowed to eat. And eventually they scared the crap out of him to the point where he just gave up all eggs altogether with the dogma that saturated fat and cholesterol drive heart disease risk. So he went through the miserable patch of his life without eggs for like a couple of decades. And then his son, who became a gastrointestinal doctor, told him, Hey, Papa, the research never showed that cholesterol or eggs were bad for your health or that it causes heart disease. And so he’s back to eating his eggs. A good source of protein. A lot of research now supports eating healthy eggs. And he’s now 92 years old and every morning continues to have his eggs in Florida.
Courtney Collins [00:29:13] So we’re going to talk about this a little more after a break, which we’re just about a minute from. But I can’t think of anything in the book that was kind of more widespread than the low fat craze. Do you think that’s the most pervasive of all of the kind of medical dogmas you explored in this book?
Dr. Marty Makary [00:29:28] It was the number one health recommendations that doctors gave to patients for 60 years. And some doctors still very much believe in the low fat diet. It turns out that the idea that saturated fat causes heart disease came from one guy who had a very shoddy study he put out there. And when they did the formal, randomized controlled trial to test this hypothesis, it showed the opposite. It showed the low fat diet caused more fatal heart attacks. But they suppressed the study. It was not published. The famous Minnesota heart study was not published for six years as this doctor lobbied the American Heart Association and the surgeon general in the government in the food pyramid system to make fat the demon of Western civilization. Turns out there was never scientific support. And ironically, we moved the food supply to a refined carbohydrate diet with a lot of added sugar. And that movement of the food industry is what ignited the modern day obesity epidemic.
Courtney Collins [00:30:33] So we were starting to dig in to kind of the low fat, low cholesterol, entire heart disease craze that pervaded for decades. As you mentioned in the last segment, you started to talk a little bit about how we moved everyone to low fat, no fat. And that in turn turned into a lot of carbohydrates, refined sugars. Talk to me a little bit about how carbs and low and refined sugars tie to inflammation and what that means for heart health.
Dr. Marty Makary [00:31:02] Sure. So in a couple different by a couple of different mechanisms, these ultra processed foods and refined carbohydrates, increased general body inflammation. And that inflammation is really at the core of so much of our chronic disease epidemic. And it’s augmented by insulin resistance. The bodies can’t handle the high levels of glucose, and so they block glucose transport by resisting insulin. And many of our modern chronic disease epidemics are tied to general body inflammation, insulin resistance, mitochondrial health and gut health. That is the balance of the microbiome. When we alter that microbiome, you feel sick when we ingest all of these chemicals. We have a thousand chemicals in our food system that are banned in Europe. And when we eat these products, the immune system reacts. We have an immune system adjacent to our GI tract, and it’s responding to these chemicals. Now, with a big inflammatory storm, but with a low grade inflammatory response and it’s constant and it’s always there and it makes you feel sick and people feel sad. And so what do we do? We medicate them with everything from antidepressants to treating their chronic diseases. But we’re not dealing with the underlying root cause that is a poisoned food supply. It’s been in one of the blind spots of modern medicine, and it’s something everyone needs to be educated about. Take seed oils, for example. Seed oils are not natural as they sound when you see vegetable oil or canola or soybean oil. They are highly processed, they’re heated and denatured. They’re changed with a chemical solvent. And so these are new chemicals that are do not appear in nature. And they hit our GI tract in the body is responding. They are increasing inflammation, pesticides in our food supply. If they are killing pests and insects on crops, what do you think they’re doing to the microbiome? The bacterial lining of the of the gastrointestinal tract? All of these things in the modern era have been changing the microbiome. The overuse of antibiotics and C-sections, pesticides, ultra processed foods, seed oils, microplastics and heavy metals in the drinking water. In the cumulative effect of this has been an inflammatory response, a rejection by the immune system in the gut and a rise in sickness. We have the sickest population in the history of the world. Half of our nation’s children now are obese or overweight. In Japan, it’s 5%. Are American children just more lazy and disobedient than Japanese children? No. What we’ve done is we’ve poisoned the food supply. And so we’ve got to talk about food as medicine and school lunch programs, not just putting every overweight child on ozempic. We’ve got to talk about treating diabetes with cooking classes and educating people about healthy foods, not just throw insulin at people with diabetes. And we’ve got to talk about environmental exposures that cause cancer, not just the chemotherapy to treat it.
Courtney Collins [00:34:21] You kind of have. And you have some interesting chapters towards the end of the book where obviously these these topics that we’ve discussed so far take up a lot of real estate at the beginning of the book because they’re kind of this advice was so expansive and how long it was kind of held. And then there’s been some movement to slowly overturn some of this so that a lot of kind of direct, in your words, like apologies or accountability. But there’s also a lot of things that we do very differently now that we used to do in a way that seems almost hard to conceive of. And one of the things that kind of caught my attention were the way that we used to treat kind of moms and newborn babies. It was very different in the 50s and even the 70s to go deliver a baby at a hospital. Can you point out some of the stark differences between how mother and baby were cared for then versus now?
Dr. Marty Makary [00:35:14] Well, for most of human history, when babies were born, they were given to their mother. Now, the infant and maternal mortality rates were high because of infection and other causes. And for most of human history, doctors were respected but not held on a pedestal. They might have been respected like you’d respect your hairdresser or your barber. As a matter of fact, surgeons were called surgeon barbers in the. And the only tools we had were a saw in a lancet and some medications that didn’t work well, like digoxin. So what happened was, with the advent of antibiotics in the 1930s and 40s, doctors now controlled a magical medication that could cure you. All of a sudden, childbirth could be safer. We could do surgical procedures. A child would not die from a scratch while playing outside because of antibiotics. And doctors controlled the antibiotic prescribing. They began to wear white coats after World War II, and this ushered in the White coat era of medicine. All of a sudden now, doctors began to have unquestioned authority. And so the pendulum swung and they took advantage of that unquestioned authority separating babies at birth from their mothers. Routinely in the 1950s, for ten days. There’s nothing wrong with the baby. They just would routinely separate the babies to keep the babies in the nursery, to poke and prod and test and evaluate. And this became sort of the paternalism of medicine. We saw it in so many areas of medicine. The doctors blocked home pregnancy tests. When they became technologically feasible because they felt women couldn’t handle this information on their own. They wouldn’t allow people to get their HIV test results without coming in for a visit. And so we saw this paternalism play out in so many ways. And even in the 1970s, my little sister was born. And we remember mom came home. My little sister was born normal, healthy at term. But I remember asking Mom, hey, what’s her little sister going to come home from the hospital? And they said, well, the doctors haven’t released her yet. You know, what were they doing? Separating babies from mothers of birth. We now know the best practices are not to cut the umbilical cord immediately upon birth. Delayed cord clamping enables the blood to continue to flow for a few minutes after the baby is delivered. And that’s good blood. It’s healthy blood with fetal hemoglobin that has a high oxygen binding stem cells, antibodies, nutrients. And the blood is warm, so it keeps the baby warm. You know, as a medical school, we used to whisk the baby off to warm the baby under some French fry light or something like that. And I remember, what are we doing? You know, the baby was getting warm blood directly in its circulatory system. And now we recognize the best practices are to let that cord continue to pulsate for a few minutes and let the mom hold the baby’s skin to skin immediately upon birth for hours. As long as the mom can safely hold the baby. The baby’s blood pressure and heart rate are more normal that way when the mom holds the baby. And even their glucose level is more normal, which is because their spike proteins are not their steroid levels. Their corticosteroid levels are not spiking. So we’re seeing these tremendous benefits now almost being rediscovered of the benefits of delayed cord clamping skin to skin time, not washing the baby in the first day to keep that bacterial lining from the vaginal tract, the bacteria that will seed the baby’s microbiome and encouraging breastfeeding in the first hour after delivery.
Courtney Collins [00:39:08] Something I thought was interesting when I read this book was how often something we’ve discovered is positive for our health and for the well-being of our loved ones. How often we learn that lesson from either the very distant past or from another culture? There are so many instances of this book someone taking a lesson they learn from nutrition or from the way parents and children interacted in another country or culture or a very long time ago. And that kind of has come back to inform today’s practices. Can you talk about that a little bit?
Dr. Marty Makary [00:39:39] Yeah. I met an amazing woman from India who really helped pioneer this new pathway at Baylor Scott and White Hospital. And what she did as she had noticed that back in India, where they didn’t have enough neonatal ICU beds, they would the moms would have to hold premature babies and they would see these incredible benefits of the nurturing and the magic of bonding that occurs between a mother and baby and the early breastfeeding rates. And so she started to implement these studies at Baylor Scott and White and produced some incredible research that really helped establish the benefits of delayed cord clamping skin to skin time and many other benefits. And so she implemented these best practices in a protocol at that hospital. Now, one doctor said, hey, are we practicing African medicine here? And she said in her feisty way, if Africa has something to teach us about childbirth, then yes, we’re going to learn from Africa. And sure enough, this protocol is pretty amazing.
Courtney Collins [00:40:47] And that brings me perfectly to kind of the last couple of questions I wanted to ask you today. You made that point really well. And what that doctor from Baylor said, the whole point of being a physician or a medical researcher, the idea is really to stay open and to kind of push the boundaries of known truths. Right. Isn’t that idea that the idea for every kind of branch of science and of mathematics to see if you can find the counterexample or the exception or the new or the more innovative?
Dr. Marty Makary [00:41:13] Yeah, we need big ideas right now more than ever in health care. We need to think big. We need fresh ideas. We need to challenge deeply held assumptions in the field. And the reason for that Courtney is that we’re not making progress. We are going backwards in American health care. If you look at the performance of the American health care system over the last 50 years, we’ve done great at emergencies and operations and acute care. But when it comes to chronic diseases and the root causes of what’s driving them, the American health care system has failed over the last 50 years. Rates of autism have gone up 14% each year for the last 23 consecutive years. And the low fat diet has ignited an obesity epidemic. Half of our nation’s kids are suffering now. It used to be rare that a child would have type two diabetes. Now a quarter of kids will have type two diabetes or pre-diabetes or fatty infiltration of their liver in childhood. We’ve seen fertility rates go down. Sperm counts have gone down 50% over the last five decades. In my field of pancreatic cancer, cancer rates have doubled in the last 20 years. And no one is asking the big questions. We need to think differently. We need to change how we fund our research. We need to encourage Ben Franklin thinkers, people who think cross-disciplinary people who are willing to challenge deeply held assumptions. We need to address our blindspots in modern medicine. The poisoned food supply, the toxic exposures and pesticides and so many other chemicals that now go down our GI tract and ask what are we doing differently now than just 1 or 2 generations ago when we did not see this massive expansion in chronic diseases? Why is it that the Amish, who sparingly use modern medicine have lower rates of cancer, lower rates of chronic diseases, lower rates of obesity and lower rates of autoimmune diseases? We’ve got to look at our own blind spots and ask big questions. Things we’re not talking about right now that we need to be talking about.
Courtney Collins [00:43:29] Do you think it’s hard for doctors to address blind spots?
Dr. Marty Makary [00:43:32] I think it is, and I think it’s not their fault. I think we’ve done a terrible thing to doctors in the United States. We’ve told them to put your head down, focus on billing and coding and seeing patients in short visits. And we’re going to measure you as doctors by your throughput. That has been the effect of our modern medical culture of obedience. It’s driven by corporate medicine. It starts in medical school where you are kind of conditioned to dismiss the big questions and just focus on memorizing and regurgitating the names of all these medications and. Steps of the Krebs cycle. Maybe we need to be talking about the bigger questions, the topics and the blind spots of modern medicine. Nutrition, for example, gets about two hours of formal education in most medical school curricula, and most of that two hours is misinformation. It’s based on the old textbooks that used the food pyramid, Even the new NIH replacement of the food pyramid, which I’m convinced had a big hand from the food industry, is called the Food Compas. And last year the NIH from their research funding announced the new Food Compas. Well, the Food Compas concludes that Lucky Charms cereal is healthier than a steak. And what’s happening here is we’ve got a lot of bad nutritional studies, a lot funded by the industry or done by people conflicted by with the industry. And then we summarize them all to sort of update the guidance. And we start with bad studies and we get bad studies and bad conclusions from those studies. So we need fresh new ideas. Right now, 90 plus percent of people writing our national nutrition guidelines are conflicted with the food industry. We need fresh new ideas.
Courtney Collins [00:45:22] My guest this hour is Dr. Marty Makary, Johns Hopkins professor and member of the National Academy of Medicine. His new book is called “Blindspots: When Medicine Gets It Wrong and What It Means for Our Health.” Marty, thank you so much for your time. What a great conversation.
Dr. Marty Makary [00:45:37] Really enjoyed it. Thanks so much, Courtney.
Courtney Collins [00:45:39] Think, is distributed by PRX, the Public Radio Exchange. Once again. I’m Courtney Collins, in for Krys Boyd. Thanks so much for listening and have a great day.
