Stay Off My Operating Table

Dr. Marty Makary Challenges Medicine's Blind Spots 161

• Dr. Philip Ovadia • Episode 161

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Dr. Marty Makary challenges deeply ingrained medical dogmas that have shaped healthcare for decades. From hormone replacement therapy to low-fat diets, Dr. Makary exposes how outdated assumptions can adversely affect patient care and health outcomes.

TIMESTAMPS
00:00:00 - Introduction and background
00:05:30 - Hormone Replacement Therapy controversy
00:15:45 - Low-fat diet myths
00:25:00 - Challenging medical dogma
00:35:00 - The future of medicine and AI

BIO
Dr. Marty Makary is a surgeon, public health expert, and New York Times bestselling author. He is a professor at Johns Hopkins University and has been a leading voice in medical innovation and health policy. Dr. Makary's work focuses on making healthcare safer, more transparent, and more patient-centered.

DID YOU KNOW
While discussing the dangers of medical dogma, Dr. Makary reveals an unexpected connection between C-section births and an increased risk of colon cancer in young people. This surprising link highlights the complex interplay between medical practices and long-term health outcomes, further emphasizing the need for continuous reevaluation of established medical norms.

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Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings

Any use of this intellectual property for text and data mining or computational analysis including as training material for artificial intelligence systems is strictly prohibited without express written consent from Dr. Philip Ovadia.

Speaker 1:

Welcome everyone. It's the Stay Off my Operating Table podcast. As you would know if you had just listened to the intro, my best friend hates it when we introduce the show after the show's been introduced. So, matthew, that one was for you. Our guest today is shoot, marty. I didn't even ask how to pronounce your last name, mccary. If it works, works, mccary. There we go, dr Marty McCary, and he holds a special place in the pantheon of guests that we've had because he, phil, has a special relationship to you.

Speaker 3:

Yes, this is a reunion of sorts. I'm really honored to welcome my medical school classmate. I'm really honored to welcome my medical school classmate, marty, and so we graduated Jefferson Medical College together just about 26 years ago and, kind of you know, went off on our own but in a lot of ways have had parallel career paths that we'll get into and found ourselves sort of back on the parallel track over the last few years in terms of our thinking around medicine and really looking forward to having this conversation. Marty's got a great new book that is coming out today as this gets released, and we're going to certainly talk about that during this. But before we get there, why don't you give a little bit of your background, marty? Why don't you talk about before we came together at medical school, what sort of led you into medicine, and then you know what you've been up to since we graduated.

Speaker 2:

It's great to see you, phil, and this is, and Jack, great to meet you. You know the great part about being a doctor the amazing, unexpected part that people don't appreciate is that the collegiality is one of the best parts of the job Understanding that we're all in this together, trying to do our best, working in a broken system, and then to realize you went down the same road as I did, phil, of being a surgical subspecialist, being at the top of your game and then saying wait a minute, what are we doing? Who's asking the big questions? Why are all these chronic diseases going up? Why are we making no progress? Why is research delivering a pathetic return on investment?

Speaker 2:

I grew up in Pennsylvania, actually in Danville. I don't know if you spent any time rotating through Geisingerville, but my dad is a hematologist and worked there his whole career, seven, eight years old maybe. She was driving us to the mall and I noticed a big plume of continuous smoke coming out of the ground near the highway and it was in a couple of different spots, and I said, mom, what's that smoke coming out of the ground? And she said, oh, that's the Centralia mine fire. Oh, you were in that area. Yeah, coal mine region, I've heard about that. Yes, anthracite coal burns, you know, supposedly better than the standard B-type coal. This mine fire has been going on, had been going on for a long time and is expected to go on for hundreds of years. And she said, you know? I said, are they going to put out the fire? And she said no, it's going to, they're just going to let it burn forever. And my dad, who is a hematologist and a Geisinger, would tell me about how he was amazed he was seeing all these rare types of leukemia at his hospital but none of the other hematologists in the country saw them in the proportion he did. And when I asked him why which is of course any curious person's logical question he really believed it was because of the Centralia minefire and the coal mine exposure, the toxic heavy metals in the region. So I kind of assumed somebody is going to study this, figure it out, put the pieces together pretty soon and then address the problem. And it never happened.

Speaker 2:

Went to med school, realized nobody asks those big questions. Did residency, became a surgical oncologist and trained in gastrointestinal surgery and I realized nobody asked the big questions. Because we have not because they're bad people, we have this culture of put your head down, do your job, bill and code, and you know we value throughput and we even assign units to it. And we've done a terrible thing to doctors in this country. We have put them on this war path to stomp out disease at the very end of chronic disease with a prescription pad and the surgery, the operations that we do and they're naturally bright, creative, curious people but we've told them no, don't ask those questions. Do your job, you'll be rewarded, and we don't give doctors the time or resources to get into the root causes. And it's not just cancer, it's look at autism, look at chronic diseases. In my field of pancreatic cancer, it's doubled in the last two decades. Who's asking why? And so that's what I love about what you guys are doing.

Speaker 1:

Pancreatic cancer has doubled in the last two decades.

Speaker 2:

We have the leading center in America for pancreatic cancer. My colleagues and I we have the best experts. We do more pancreatic cancer surgery than any hospital out there and at no point in our group did anyone ever stop and ask what's causing this doubling. And I asked once to the multidisciplinary clinic again. These are my friends. They're good people, they're doing their job. Does anyone know why pancreatic cancer has doubled in the last two decades? No one. No one had thought about it because we don't value those questions in our medical culture. And, as a result, all of these things are increasing as we ignore the food supply and heavy metals and pesticides and seed oils and all these exposures that poison our food supply and heavy metals and pesticides and seed oils, and all these exposures that poison our food supply and drinking water sometimes, and they're increasing the number of medications that we do in operations. And it's almost as if we're just so busy playing whack-a-mole we're not realizing that there are preventable issues that we can address.

Speaker 3:

Yeah, it's so interesting that you mentioned that, you know, in relation to pancreatic cancer, because of course I see the same thing on the heart surgery side of things. And you know I've told this story here before. You know that when I was finishing up my surgical residency and deciding, you know, what specialty to go into, you know do my fellowship in and I told my mentors that I was going to go into cardiac surgery and their response was don't go into that, you're going to have nothing to do in 10 years. You know we have figured out heart disease and here we are, you know, 20 plus years later, and not only has it not gone away but it's increasing as well, along with all these other things. And you're right, you know my colleagues, both my surgical colleagues, my cardiology colleagues they're really too busy to think about. Why are we so busy and I think you know that's a general trend that we see in medicine Doctors are too busy to think about. Why are we so busy? Why are there so many sick people?

Speaker 2:

And they want to think about these things. Right, they're smart people. But it's almost as if we're telling them don't, you know, don't? And we dismiss things in this sort of overly sweeping way, as chronic diseases were increasing, as you know, since our time in school. We were told there's more old people. That's not true. They're increasing in every age category. We have 50% of our nation's children are overweight or obese. We've got a quarter have prediabetes or some metabolic dysfunction as children. That is an indictment of our society, not of their behavior.

Speaker 2:

And do you remember, phil and Jack? I want to get your thoughts here. But Phil, do you remember first day of anatomy in med school? What was his name? Dr Schmidt, I think he. I distinctly remember we were looking at the lung in the cadaver lab and some of the lungs were sort of a normal flesh appearance and some were black and it's so appalling. I just remember I don't know if you felt this oh my God, what happened here? The lung is black. And I remember the answer oh, that's because they're a city dweller and people who live in the cities have a black covering of their lung. So it turns black. But don't worry, it's not bad for you. And I thought how dismissive right, you don't know, and this that really captured not only the lack of curiosity but the dismissive nature of the medical culture is. We're forced to just memorize all these drugs and indications and you come out with this reflex and, as a result, we have the most medicated generation in human history.

Speaker 3:

You know it's interesting. You mention that because I think one of the things I've noticed is that perhaps surgeons in general seem to be at least more vocal, if not more aware of, you know, these problems in medicine and you know it's occurred to me. It's because we actually see the pathology, right. We, you know, open the people up. We see the tumors, we see the atherosclerosis in my case. You know, we see the lungs looking like that, right, and when you're, you know, doing it from a medicine standpoint, right, it's more of an abstract thing. It's some blood work maybe looks abnormal, the scans look abnormal, but I think there's something pretty powerful about, you know, putting your hands on and directly seeing this stuff. And you know, and maybe it's just our surgical personalities that ask us that lead us to be more questioning. But you know you mentioned earlier, it's almost like this type of questioning has become discouraged in medicine and I think in many ways it has.

Speaker 3:

You know, one of the other things that strikes me so much about medicine today, versus, you know, going back 50, 60, 70 years, you know, one of the things that Jefferson is famous for is that's where the heart lung bypass machine was first used. And you read about the you know the. I mean they had to question all of the norms, right? The thinking prior to that was you know, the heart is off limits to surgeons, you cannot operate on the heart. And guys like Dr Gibbon and others, you know, were such pioneers and because they were so willing to question the norms, what was accepted as fact then. That's where we are today, that's how things advance, and it just seems more and more that type of thinking is discouraged among doctors instead of being encouraged, like it should be.

Speaker 2:

Absolutely, 100%, 100%. Yeah, doctors are good. I mean, every doctor I know is a good person who went into the field out of a sense of compassion. Every nurse, everybody in healthcare is united by a sense of wanting to do something greater, some higher purpose, to help others in a time of need. And what we've done in the medical culture is really atrocious this myopic vision, this lack of stomping out curiosity, ignoring these massive blind spots and, at the same time, just everyone's collecting their paycheck and we've created a lot of millionaires in healthcare.

Speaker 3:

So at what point in your kind of training career? You know, it sounds like at least you. You went into this with some curiosity and you know, I know you're not one to toot your own horn, but you know you literally trained at the finest institutions in this country, right, you did your surgical training at Johns Hopkins, which is the pinnacle of surgery. You got a master's at Harvard, you know, went through the public health school there. You're now a you now a professor at Hopkins. Talk to us a little bit about how this curiosity continued to sort of play into your career, and when did you really start to notice my colleagues aren't thinking the same way exactly, I think third year medical school I felt like I was supposed to consent somebody for surgery who I knew in their heart she didn't want surgery.

Speaker 2:

I knew in her heart she did not want surgery, but my job was to get her to agree to it. And so I kept coming back saying she didn't, she doesn't want it, and I kept being told tell her this, tell her she needs to tell her she's going to die, and all this and I kind of half did what I was instructed to do. I'm being graded. And when she agreed to it and then had a complication and this and it was so obvious to me the surgery was unnecessary just because she was had terminal cancer, let her be. She had goals. I basically walked out of medical school and I don't know if you knew that at the time, phil, but I basically told the dean I want to do something bigger. I want to get at to understand the whole system, the whole. I don't know what to. I didn't know what to call it. It's not holistic care, but it includes that it's not alternative. But it includes that it's not holistic care, but it includes that it's not alternative. But it includes it's not functional medicine, but it includes it it's not primary care.

Speaker 2:

I knew I loved being a surgeon but there was something deeper and so I enrolled at the Harvard School of Public Health, studied epidemiology, learned about occupational medicine, environmental exposures that cause cancer, not just the chemo to treat it, and I loved it. I absolutely loved it. But I did miss the patient care. So I went back, did my surgical, finished med school, did my surgical residency, and my dad had always reminded me write down your experiences. Remember the shock that you initially felt when you observed certain contradictions and paradoxes in the field and you know you'd be amazed how we all tend to forget those things and wrote about my experiences, as my dad encouraged me to, from residency, and I eventually put it in a book called unaccountable. I thought just my mom and a couple of friends would read it, but it hit the New York Times bestseller list and was turned into the TV show the Resident, which just finished its sixth season. And then my interest then turned into in healthcare, patient safety, the checklist, recognizing frailty in old people.

Speaker 2:

So I had a very productive surgical career at Hopkins and when people would say what is your research focus, I told them you know I don't believe in being pigeonholed Like you, can only study this one dolicol ester in the mitochondria. I said our research is focused on the big issues in healthcare that we are not talking about, that we need to talk about. So we pivoted to opioids and eventually the billing cost crisis in healthcare that alienates patients. We really put out the term price gouging of patients and predatory billing by hospitals and started an advocacy effort which I described in a book called the Price we Pay. It came out about five years ago.

Speaker 2:

Effort which I described in a book called the Price we Pay it came out about five years ago had a nice run on the New York Times list, and so this latest work is sort of the compilation of all of our work addressing the blind spots of modern medicine today, the big issues today that are not getting the attention they should be the latest scientific discoveries that affect every specialty, every aspect of health, things like the microbiome, how we prevent allergies, the side effects of antibiotics, all kinds of big topics preventing cancer, the truth about food and food as medicine, scientific studies today that when I share them with my colleagues at Hopkins, they're like whoa, that's amazing. That's amazing. Pesticides and microplastics have estrogen binding-like properties and fertility is going down, and the average age of puberty is going down. And so if my friends and colleagues at Hopkins are blown away by this new research because they didn't notice it, how much bigger of a story is there for the general public and the medical community alike. So that's basically the book Blindspots.

Speaker 1:

I want to dig into that, but I can't help but laugh, because there's one sector of the population that seems to be on top of this stuff, way ahead of almost everybody, and they practice a type of science known as bro science. It's the dudes at the gym who are always biohacking. This stuff has shown up years ago with these guys. Granted, they're not running randomized controlled trials, but most of them are experimenting on themselves. Okay, enough of this. I want to hear more about the book You're reporting the kind of thing that we've been dealing with now for the entire history of this show. In fact, not a lot of people know that I made Phil answer a whole lot of questions that I had about the medical industry before I had agreed to be his co-host, so I've heard a lot of the horror stories that I think moved him in this direction. But let's pick one of these chapters. You know I was thinking when you said food is medicine. I'd love to hear more about that, and I know our audience will as well.

Speaker 2:

Right, I think we grew up in the era of one of the biggest pieces of misinformation in modern health care, propagated by the medical establishment, the government, the industry. It was sort of your classic story of health in America, and that was that the reason we had all these problems with heart disease the number one cause of death in the US was because people were eating saturated fat. And if you could just stomp out all the fat in society and get them to stop eating their eggs and the yolk and the eggs and switch to egg white only and low fat milk and school lunch programs, then we could finally get at this, you know, remove these molecules and get people to comply. And it really had. It was laced with this paternalism that we have seen in modern medicine, which is the reason we have these chronic diseases is that people are not listening to us, they're being disobedient, but maybe we're giving them the wrong information, maybe they're obedient and we're wrong. Yeah, the most dangerous thing right now and in modern medicine has been to ask a big question, to challenge deeply held assumptions in the field that were never based on good science, and that's what you guys are doing. That's what my friend Peter Atiyah, who was with us at Hopkins, zubin, so many other physicians. Now you're seeing Casey Means out there challenging deeply held assumptions in the field.

Speaker 2:

It turns out that the guy who promoted the low-fat diet, ancel Keys, had his own shoddy study. He left out a bunch of data points. It was a study by which you could not make the conclusions he made that fat caused heart disease. Then they embarked in trying to do the ultimate randomized controlled trial in Minnesota, randomizing 9,000 individuals to a low-fat diet versus a standard diet, and they followed them to see if there was going to be more heart attacks in one of the groups. They expected the low-fat diet reduced the risk of heart disease, but it was the opposite. They got it perfectly backwards and probably because the low-fat diet has more refined carbohydrates, ultra-processed foods and pro-inflammatory mediators like added sugar. So they got it perfectly backwards. There ended up being more fatal heart attacks in the low-fat group, but they didn't publish the data for 16 years. After the results came in, they suppressed it, use me. Yes, dr Franz, who is the senior author, was asked by my friend, gary Taubes why didn't you publish this for 16 years? And he said we were just disappointed in the results.

Speaker 1:

It didn't prove our thesis, so we didn't publish it. I love it, that's right the hubris.

Speaker 2:

We have already decided this result. This did not support it.

Speaker 1:

Therefore don't put it out there. I'm sorry to interrupt, but can we explain how that is exactly not science?

Speaker 2:

You know we're laughing at it, jack, but we just saw the exact same thing happen with Pfizer and Paxlovid in people who are vaccinated. The study was done. It was just published in the New England Journal of Medicine I think it was the April issue this year and it shows that Paxlovid, the COVID antiviral, had zero benefit in people who were vaccinated, or low risk Zero. You had to be high risk. The study was originally done in the unvaccinated so we were recommending it. It was the biggest public health campaign of the last two years, coming from the White House, from industry, from the medical establishment. Everyone was drinking the Kool-Aid. You saw the same pattern. Eventually the study got done. Two studies in the April I think it was April 4th issue New England Journal of Medicine evaluating Paxlovid no benefit in the majority of Americans who took it because they were low risk and there's no benefit there. Sometimes it prolonged the illness.

Speaker 2:

The study was done a year and nine months before the data had come in. A year and nine months before the study was published. They slow rolled it as the government bought it for 10, spent $10 billion on that medication, pushed it One of the biggest public health campaigns. Overhead announcements at CVS. You have COVID commercials. You know Superbowl playoff games. You have COVID. You know packs, take packs of it. You saw the exact same thing Now. Does it take a year and nine months to put together, make it, make the results public? Didn it take a year and nine months to put together, make the results public? Didn't take a year and nine months when they said the COVID vaccine booster worked, took about two hours and they announced it with no data. Same thing with the hormone replacement.

Speaker 2:

Anyway, this is a pattern. This is a pattern and I think this is how I got interested in epidemiology, one of the lost arts in medicine. Today in society, one thing that's hurting us is we have lost the critical and objective appraisal of research and basic standards of transparency. If a study comes out that shows what you like, hey, it was an amazing study, it just came out. Studies show something inconvenient, like pesticides have estrogen-like binding properties and microplastics and may account for declining ages and onset of puberty. I don't know anything about it, we don't talk about it, it doesn't make the big journals. Anyway, the low-fat diet is really emblematic and if you think, oh, we're enlightened now, we don't make those mistakes. The low-fat diet went on to have two other major studies the Framingham study, the Nurses' Health Study and the Women's Health Initiative, which was the largest study in the history of medicine, a billion dollars in taxpayer funds. Neither showed an association between saturated fat and heart disease and we ignored.

Speaker 1:

Let's just I want to underline that the largest study in the history of medicine, a billion dollars of taxpayer money. What was it called the?

Speaker 2:

Women's Health Initiative and I was designed to look at hormone therapy, but that was one of the endpoints.

Speaker 1:

Secondary endpoint Found no correlation between saturated fat and heart disease. Yes, huh, and this is to take a take from that.

Speaker 3:

And we're now in a situation where, you know, as you mentioned in the book and I think we've mentioned here as well, right, the American Pert Association has removed mention of saturated fat from their guidelines. Now, they didn't really publicize that, but they did it. The US dietary guidelines have removed limits on saturated fat and yet the most common dietary advice that people get when they go to their doctors is to eat a low-fat diet, and this is beyond cardiology. I mean, most cardiologists would agree with that dietary recommendation. I think most internists would agree with that recommendation. And here we are. You know, like you said, every study.

Speaker 2:

that's looked at it. The dog agrees with the recommendation. Yeah, the dog agrees with the recommendation.

Speaker 3:

Yeah, the dog agrees too. Believe me, this dog does not eat a low-fat diet. You know that's the situation we find ourselves in.

Speaker 2:

Advice has been thoroughly disproven, and yet doctors keep giving and they have different stands for different sort of departments and health benefits. And one of them was a group of dietitians and I said, oh, what are you doing at the health benefit fair? They said we offer free dietetic counseling as a health benefit, as part of the health plan, and we're here to make people aware. And I said, ok, interest Great. Just out of curiosity, let's say someone comes in who's overweight, what diet do you recommend? Or what change do you recommend? They do, within eight seconds they went to the low-fat diet. It's unbelievable. Ignoring the highly addictive properties of refined carbohydrates, ignoring the fact that we don't have bread anymore, we don't have true whole foods, we have flour that's stripped of fiber and nutrients and turned into sugar. It's turned into a high glycemic load food, which is essentially sugar. It's processed into this highly addictive that sells better and you can't get full on it. You know you eat it and your hunger level seems to go up, almost like your appetite's not being suppressed the more you eat, as you are sometimes naturally, with fruits, vegetables and natural foods. So it's still medical dogma. You know the book is basically about medical dogma and the way the medical establishment, in their hubris, marched on and you didn't see them.

Speaker 2:

You mentioned, phil, that they sort of acknowledged they made a mistake or they changed their guideline. They didn't, they did it quietly, they just kind of fade out. That's what the medical establishment does. They get something perfectly backwards, they just kind of drop it from next year's guidelines. No announcement If you get something wrong.

Speaker 2:

Remember there's giant levels of mistrust out there in the medical profession. You've got to apologize with the same vigor by which you made the recommendation. People want to see humility, they're hungry for honesty. And you don't really see. You didn't see that with the peanut allergy avoidance recommendation. That was perfectly backwards. You didn't see when the randomized trial came out showing they got it wrong for 15 years. You didn't see an apology, just saw kind of a fade out.

Speaker 2:

After COVID you're seeing a little bit of a fade out. I don't know anyone who's really apologized, not for making a quick decision at the moment with the limited information, but for quick decision at the moment with the limited information, but for insisting schools stay closed in some states for nearly two years, broadly recognized to be a mistake, bipartisan. But no apology, just kind of this fade out. And that's what we saw with low fat Heck, the American Heart Association still sells a low fat, low cholesterol cookbook. Still sells a low-fat, low-cholesterol cookbook. This is how they made millions and licensing out their healthy heart seal to restaurants. The irony of taking in cholesterol is, as you know, 90-plus percent of it's not even absorbed from the diet. Cholesterol that you eat is esterified the vast majority. What?

Speaker 1:

does that mean?

Speaker 2:

It means it's bound to a bulky, large molecular side chain. It's not absorbed, and so 99% of your body's cholesterol is made by your body.

Speaker 1:

So the idea that you have to Just to be clear. Cholesterol I consume basically just goes straight through. That's right.

Speaker 2:

Basically goes straight through. That's right.

Speaker 3:

Okay, yeah, how do you think we do move forward? You know, I think back to the old clip. You know that science advances, one funeral at a time, right, and basically all of the doctors that learn this pretty much need to retire. You know, and maybe the new generation, the next generation kind of coming through, you know, maybe the new generation, the next generation kind of coming through, you know, isn't as ingrained in this way of thinking. And I know you know, in your role you interact with a lot of medical students now and you know you teach. And what do you see among the next generation of physicians that's coming up now? Do you think that they are kind of shifting back the other way and getting more curious again and starting to question some of these things? Yes, I do.

Speaker 2:

A new generation of students is joining us and asking the big questions that a prior generation dismissed. Maybe we need to treat more diabetes with cooking classes than just throwing insulin at people. Maybe we need to treat more high blood pressure by talking about sleep quality and stress, not just throwing antihypertensives at people. Maybe we need to talk about school lunch programs, not putting every 12-year-old on Ozempic that's obese. We need to talk about food as medicine and general body inflammation, environmental exposures, pesticides, heavy metals, seed oils, other things that are not naturally occurring and when they go down the GI tract, the body's immune system is responding not with an immune antibody storm, but with a low level of inflammation that's chronic, that's always there and that makes people feel sick. And that may explain why we're altering the microbiome in ways we don't understand, why we're seeing rising rates of colon cancer and other cancers in young people. A study just came out suggesting an association between people born by C-section, which we know alters the microbiome, and colon cancer in young people. There's signals in the data we have got to pursue.

Speaker 2:

Yes, the microbiome may be the central organ of health that we've been ignoring. It has no specialty, but it produces serotonin, involved in mood and mental health. It digests food. It is involved in regulating estrogen and other hormones. It trains the immune system. It is an amazing organ and when you hear about someone who eats perfectly but they can't lose weight, maybe their microbiome has been altered in ways that we know. Some of the bacteria produce GLP-1, the active ingredient in Ozempic.

Speaker 2:

There's actually some research now on the microbiome. That's unbelievable, that I go through in the book because my colleagues are blown away by it. I'll show the new research to cardiologists and primary care doctors and infectious diseases doctors and they're all blown away by this some of the research on the microbiome that applies to their specialty and when I see them blown away or in shock, I realize we're too siloed, we're too compartmentalized. We're not training physicians or allowing them to explore the sort of connectivity of every organ and cell in the body through some basic principles, the underlying issues that affect most diseases that we see in medicine. We're talking about high levels of insulin. How often do we talk about that? In every field Insulin levels are too high in America general body inflammation and other you know other aspects of health.

Speaker 1:

Isn't this just a function? And I don't mean to be fatalistic, but I look back on the last hundred years of medicine. I study it as a layman and early In early 1900s there was a pronounced effort to eliminate all allopathic medical practice. They didn't make it go away, but they did a good job of marginalizing anybody who didn't practice allopathic medicine, and I think the inevitable result, as best as I can see, has been an increasing tendency of medical practitioners to view the human being as this collection of discrete functions that are largely other than all being housed under the same roof, basically don't have anything to do with each other. That's why the only people who ever talk about insulin are people who deal with diabetes directly, even though I don't have to educate.

Speaker 2:

It affects every cell, even they get insulin wrong.

Speaker 1:

So my question, as Joe Sixpack, is what's got to happen to medical education, let alone medical practice, for you guys to start seeing the human body, the human being, as a single integrated entity where everything's connected to everything else integrated entity where everything's connected to everything else? It's not like there aren't medical practices that have developed around the world that do view the body that way. They're just largely ignored through an allopathic medicine. I don't want to go down the woo path, but the reality is these different modalities that address the body as a single integrated operating unit get results that our allopathic medicine doesn't get.

Speaker 2:

Jack, I'm optimistic and let me tell you why. In the old days you had to kiss the ring just to get any airtime in medicine to talk about a fresh new idea, a big idea to ask a big question that no one else is asking. The old guard medical establishment controlled the journals. They would only allow articles in there if it fit their deeply held assumptions. They controlled the academic towers and the research. But now medicine and the discourse in medical science is decentralized. You've got your podcast. You've got other podcasts. People are getting their. I know I can't tell you how many doctors I know that are learning what we're not taught in med school, the stuff you need to know from people like yourselves. My buddy, peter Atiyah, in his podcast has educated tens of thousands of physicians on the truth, on these dogmas in medicine that are wrong. And so in the old days they would say and you saw this a little bit during the recent COVID pandemic Medical establishment puts out a recommendation.

Speaker 2:

You know a 12-year-old needs three booster shots and we got the White House to say it. We got the journals to print it. We got the academic leaders to sign a letter. You know done. You know we've controlled everyone. You know we've taken care of the problem and then, oh my God, there are some people here out there on the internet questioning whether or not a 12-year-old girl needs three booster shots.

Speaker 2:

I'm talking about myself, by the way, because we did the largest study on natural immunity, published it in the Big JAMA, the main JAMA journal, testing the blood of people and showing the antibody profile up to two years later. It was a big study on natural immunity and, of course, the ultimate review was done in the Lancet last year. It showed that natural immunity is at least as effective as vaccinated immunity and probably less fleeting. Linkedin took down the post. No one in the medical establishment was willing to talk about whether or not the vaccine mandates should have a carve out for natural immunity or at least a dose reduction strategy, if it was a recent recovery from COVID, and so you saw this sort of anger from the medical elites, like what's going on here. We put out the statement and we put out the recommendation. By the way, they don't evolve when new data comes in. Very well, you see that with the low-fat diet and all these other recommendations.

Speaker 2:

So we are seeing now a healthy, open, civil discourse among respected medical experts, and that's good. That's good Because if you guys weren't out there, heck we might still be hearing. The low-fat diet is the only way to reduce heart disease risk.

Speaker 3:

But, on the other hand, we see many of our colleagues that are scared to talk about these types of things, for good reason, right?

Speaker 3:

You see a guy like Peter McCullough, one of the most respected you know clinician scientists ever, you know, having his board certification threatened because you know he's out there talking about these things. So I think a lot of our colleagues are, you know, scared, and maybe rightfully. You know, if this is your livelihood, if you're employed by a large health system, as many are, you know, or employed directly by an insurance company, as many are, and they're basically dictating, you know the guidelines that you have to follow, and they can, you know. You know the guidelines that you have to follow, and they can. You know they can come after you if you're not following those guidelines. So how do you talk to your colleagues about, you know, getting more vocal about this, about trying to take back control of medicine, you know, which is, I think, ultimately what doctors, what physicians, need to do. We need to get back to our Hippocratic oath right the patient comes first and unfortunately, the environment around us is, in many cases, very antagonistic against that.

Speaker 2:

Yes, We've got to get back to the civility of disagreeing politely with another opinion. It's okay to disagree. It's okay to say I have a different opinion on that. I think we live in a modern era where some of the old guard medical elites are saying that's, you know, no one can disagree with us and if you do, you need to be silenced. We saw all kinds of efforts to censor some respected physicians. Jay Bhattacharya made a strong call for schools to reopen in the fall of 2020, as they had been throughout Europe, with no added risk to the children, and the medical guard had made up its mind and really silenced that. And the medical guard had made up its mind and really silenced that.

Speaker 2:

And the problem when you silence opinions different from your own, where there's a void of scientific evidence, is that you can get it wrong. So if you have a central authority and you're silencing opinions different from yours and your opinions are not based on any randomized, controlled trial data, you run the risk of spreading misinformation yourself. And, ironically, one of the greatest propagators of misinformation during the pandemic was the United States government, as it had been with the low-fat diet, moving the food industry to a refined carbohydrates, as it had been with saying opioids were non-addictive for 30 years, igniting the opioid epidemic as it had been. By incorrectly telling mothers to avoid all peanut butter for kids zero through three years of age to prevent peanut allergies, they got it backwards. The study had not been done 15 years into the recommendation. Just about seven and a half years ago the study was published in New England Journal. They got it perfectly backwards and that's saying something.

Speaker 1:

They weren't just a little bit wrong, right, they were perfectly backwards.

Speaker 2:

Eightfold difference in peanut allergy rates if you adopted the peanut avoidance guidance of the American Academy of Pediatrics and the National Institute of Allergy and Infectious Diseases.

Speaker 1:

The experts, the experts who were the ones we were told to believe, trust, the science.

Speaker 2:

We were told to worship them. But it turns out they were going on a gut feeling. And when peanut allergies went up in the years and I go through this in the book as peanut allergy rates started to skyrocket after their recommendation for peanut butter avoidance, they thought and by the way, a new type of peanut allergy, that sort of ultra severe anaphylactic reaction that someone can experience just from being near a peanut butter, that's a real thing. We shouldn't mock those people. They're near Kid can die from being close to.

Speaker 2:

That's how severe the sensitivities were, in large part from that recommendation for total peanut abstinence. They forgot about immune tolerance. They forgot about what parents had called the dirt theory for a long time. They got it perfectly backwards and so when the rates were going up a couple of years into their new recommendation, they thought we've got to get these anti-science parents out there just to comply. People are not complying. We got to double down. And that's the risk you run when you block out all other opinions and when you make recommendations based on opinion. We have a lousy track record as a medical profession. When we make recommendations based on good scientific studies, we shine and help a lot of people.

Speaker 1:

What does a schmo like me do? I know I want to say this. I haven't read the whole book, but I've jumped around and looking at various things that immediately caught my attention and got me excited. You talk about hormone replacement therapy and the nuttiness wrapped around that. The peanut allergy thing is astonishing. So you've got some very specific subjects that are addressed in the book, but what I'm hearing is and I don't think I'm unique in this what I'm hearing is that the medical establishment that we were raised to trust is it very trustworthy? That's what I hear. What do I do? What do people like me do? How do we? How did just a guy with a music degree that's me Sift the wheat from the chaff?

Speaker 2:

First of all, I think we're good at emergency and urgent care 100% agree.

Speaker 2:

Amazing and I would say wholeheartedly, trust whatever care is recommended in an urgent or acute situation. When it comes to chronic ailments and chronic diseases, beware of the over-medication approach. When it comes to a child's behavior, beware of the over-diagnosis of ordinary life. With mental illness diagnoses there is true extreme attention deficit disorder, bipolar and certainly a change in brain chemistry that results in schizophrenia. But when a kid disagrees with their parent it doesn't mean they have oppositional defiant disorder, which is a true ICD diagnosis, one of the most bogus in the entire DSM manual. So we have to beware of an industry that's been dominated by pharma and as a pill for every ailment in society and as a result, we're just getting sicker and we're not addressing the underlying problem.

Speaker 2:

I would say find a doctor who listens, who thinks independently, who's willing to consider what they know and don't know, who's willing to look into questions that you might have, what they know and don't know. I was willing to look into questions that you might have. What makes a great doctor is their humility, it's knowing their limits, it's being open-minded, and that's most doctors. But the medical establishment, I would say, has gotten a lot of things wrong. So we don't want to create cynicism, but we do want people to ask questions because we've kind of been told asking questions is not allowed. But asking questions is the very way we've dug ourselves out of the dogma of the low-fat diet, the peanut allergy. Science has always been based on challenging, deeply held assumptions. The hormone replacement therapy one you mentioned I don't know if we have a minute to talk about that. That was the most amazing.

Speaker 1:

Yeah, I think our listeners will really be interested in that one.

Speaker 2:

That was the most amazing thing I've ever written in terms of my experience as an author. I was blown away, like I've never been blown away before, by this dogma that taking. When a woman goes through menopause and their estrogen and progesterone levels naturally decline that is, their natural production goes down in most cases, causing symptoms of menopause there is a well-known therapy to replace a woman's natural hormones with what we call hormone replacement therapy. It is unbelievable. There's probably no medication in modern medicine, with the exception of antibiotics, that has improved the health of a population more than hormone replacement therapy. Long term, they live roughly three and a half years longer. Their rate of heart disease goes down by 50 to 60 percent. The estrogen oxidizes, increasing nitric oxide, keeping the blood vessels soft and dilated. Increasing nitric oxide, keeping the blood vessels soft and dilated, perhaps improving blood flow. There's something that interacts with the estrogen interacts with neurons and that's why the rate of cognitive decline goes down, we believe, by 50 to 60%. In different studies, the risk of Alzheimer's goes down by 35%. The risk of Alzheimer's goes down by 35% and if a woman falls or is in a car accident, they're far less likely to need an operation or break a bone because their bones are stronger, overwhelming, and the short-term health benefits are dramatic, alleviating the 50-plus symptoms, different symptoms that a woman could experience with menopause weight gain, mood swings, brain fog, hot flashes, not sleeping well, dryness. There is no medication that has been more dramatic in its long-term and short-term effect. Women feel better and live longer.

Speaker 2:

But in 2002, a doctor from the NIH held a press conference to tell the world that he just completed the largest study ever done and that it found that hormone therapy increases the risk of breast cancer. He didn't release his data. A week later, when it was published in the journal, some doctors noticed hey, wait a minute. There's no statistically significant increase in breast cancer among the women who took hormone therapy versus those who didn't. Plus, they took the wrong type of hormone therapy and they started it too late in life, and so the study was deeply flawed and the results were misrepresented to the public.

Speaker 2:

But when doctors heard that an NIH scientist had completed the largest NIH trial ever done, they believed it. Based on the headline, most Americans and women around the world flush their hormone therapy pills down the toilet. They were scared. They were just told through the media that hormone therapy causes breast cancer. Turns out that study never showed that to be true and I interviewed for this book, blind Spots, the guy who made the announcement. I found him in retirement and talked to him and he admitted to me that there was no increased risk of dying of breast cancer because we had a long, hard conversation on the actual numbers and the statistical tests. Statistical tests. And to this day, a woman, when medical schools had this information that they thought hormone therapy caused breast cancer, all of a sudden they would just stop talking about menopause because now there was nothing you could do for it anyway, so why even teach it or talk about it?

Speaker 2:

And to this day, a woman is more likely to be prescribed an antidepressant for menopause than they are estrogen and to this day 22 years later 22 years later, yeah, and to this day, 80% roughly of doctors out there refuse to prescribe hormone therapy because of that dogma that's been out there, and my mom is one of them I just want to make sure I'm clear on this been out there and my mom is one of them.

Speaker 1:

I just want to make sure I'm clear on this. We had what? 20, 30, 40 years of history of successfully doing HRT? Lots of benefit, very little downside. One study from the NIH just explodes the whole thing.

Speaker 2:

That's right. And in the backstory, when I talked to the other researchers who were on that paper, they basically said they were bullied, they were boondoggled, why they were called. I think the guy believed this to be true and it didn't matter what the study was going to show. He had gone on record years prior writing a medical journal that we have to stop the hormone therapy bandwagon. Okay, he had already made up his mind. It didn't matter what the data. That's my opinion. But the other investigators told him they warned him before he held the press conference you can't put this out there, they told him.

Speaker 2:

If you put something out there as scary as breast cancer in the public domain and associated with this medication, you will never be able to undo that there is so much fear around breast cancer. And one guy specifically said if you do this, you will never be able to put that genie back in the bottle and to this day ask a doctor hey, do you prescribe hormone therapy when a woman approaches you with menopause? Nice, worry about that breast cancer thing out there. Where do you get that from the 2002 Women's Health Initiative study. Let me show you the table in the paper. Here you go. No statistically significant difference, really, but I thought it's unbelievable.

Speaker 2:

Medical dogma can take on a life of its own, and in this case I mean what reduces the risk of heart disease by up to 50 to 60%. Nothing that I know of Maybe eating better, but 50 million American women, including my mom, have been denied hormone therapy over the last two decades because of this medical dogma. And when my mom fell recently she broke some bones and I remember showing it to one of my friends who's a surgeon and he said that's a real borderline fracture as to whether or not it needs surgery. I mean you could almost go either way, but we got in a consensus and the doctors I trust said better to have it operated on. She had the surgery. She was immobile for a while because of it. I couldn't help but think had that dogma not loomed large? Has she been on hormone therapy? We know that it improves bone strength. Incredibly, it prevents osteoporosis. She probably would not have gone through that major saga later in life where immobility can lead to other problems.

Speaker 3:

Wow I want to bring into the conversation and we're going to go a little long with this episode and I don't think our audience is going to mind but we have a tool that's kind of starting to make its way into the medical world. That could make this problem a lot better. Just can't see that those needles in the haystack. But AI needs to be trained on something right. It needs to be trained on data sets. It gets trained on the existing literature and therefore this dogma you know, could find its way into the AI's analysis, find its way into the AI's analysis. And I'm curious about how you're looking at that, how you're looking at AI and what you think is going to happen as AI becomes more prominent in medicine, because it's going to, and then it's just a matter of how it gets utilized.

Speaker 2:

Well, I think there's a role for AI. We're going to see it probably expand first in areas where there's skin lesions. You're going to see that AI trained pretty well and you'll start to see an introduction there. I think you're going to see it with transcribing notes. I think you're going to see it with sort of being an assistant, maybe helping us get instruments in the operating room. I think you're going to see roles that are not directly at the bedside, but there's going to be a role for it.

Speaker 2:

But ultimately, we have been sold shiny objects before and told, hey, once we get a defibrillator in every bathroom mall in America, then we're going to finally address heart disease. That actually was a big project of our former chair of medicine at Hopkins and we get this myopic sort of small set of fixes that are really things around the periphery, and what we are ignoring is the fact that we have a poison food supply and environmental exposures that are driving up chronic disease as we over-medicate the population. And so I think we need AI, but we also need just plain eye.

Speaker 1:

Oh, boy Sorry.

Speaker 2:

We do. I mean, people ask me all the time is ai gonna revolutionize you? Know the way you do surgery. I'm like. Every time I walk into the operating room, they ask me what my glove size is. Again, every single time oh, dr mccary, are you seven or is it seven and a half? I'm seven and a half. Oh, we'll run out and grab that for you now, okay. Yeah, we need AI, but we also just need I.

Speaker 1:

Very well said. Let me roll something past you and see what you think about it. As best as I can see it remember I represent Joe Sixpack here what it looks like to me is about 90% of the primary care physicians out there don't do anything other than practice what I would call algorithmic medicine. They've got a list of symptoms, they've got some sort of table, they match the symptoms to the table and it spits out a pharmaceutical or two, and that seems to be how medicine is getting practiced at the primary care level. We've had plenty of PCPs on this show who have confirmed that that's how the HMOs are driving them to perform and if in fact that is true, those guys have no future because AI could do that better than they do. I realize that's kind of an apocalyptic viewpoint, but that's what it looks like for the cheap seats. Now getting into the specialties, I don't know, but that's what it looks like here.

Speaker 2:

You know, we were told that AI was going to fly planes, jumbo jets, yep and in one of the test flights it crashed, I think in Japan, and we're still not there. And that is far more algorithmic than listening to somebody talk about their ailments and trying to understand the appropriateness of care, not just the reflex to match a medication with a disease or an illness. My practice was very difficult when all the patients and I had to wear a mask. I couldn't see their reaction. I need to read their facial expressions and visual cues when I'd say you know, we could do surgery. This is what it would involve, or we can wait a little bit.

Speaker 2:

I need to read the patient. I need to see if they are the sort of person that's just, let's just get over with, let's do it now, I'm fine with it, or I really don't want to have surgery. I think it's a last resort option only type of thing. There's a human connection side of this I'm not sure the AI is going to capture. And if the AI is based on our current system of prescribing that has given us the most over-medicated population in the history of the world, I'm not sure I want a computer taking over that task. Oh I 100% agree.

Speaker 1:

But it appears to me that the way the system's structured right now and I realize I'm asking you to speculate and Phil correct me here the doctors aren't in control. The guy sitting in front of the patient is not in control of this. In front of the patient is not in control of this. They're being manipulated from above by a system that is designed to generate profit, maximum profit, and it appears to me that the people in the office the doctor and the patient they have to resist, yeah, yeah, if they don't resist this system, that's what the system's driving toward. It's it's not about matching the giftings and the callings of these healers to the needs of sick people. It's about using those two inputs to generate profit. And if it needs fewer one, if it doesn't need the physicians sitting there with a license to crank out pharmaceutical prescriptions, it'll get rid of them. And that's where AI is driving it right now. Now, I hope I'm crazy. Maybe I am, but that's what it looks like.

Speaker 3:

Yeah, I mean, ultimately, I hope doctors, you know, are kind of empowered, re-empowered, to realize our role here and that's, you know, first and foremost to serve our patients, to guide our patients, to educate our patients.

Speaker 3:

You know, again, doctor, the Latin derivative is educator, is teacher, and I just hope, you know, more and more our colleagues start to wake up to this reality that Jack is talking about, that we've, you know, been forced into serving the system first as opposed to serving the patient first, first as opposed to serving the patient first. And the more that we combine together, the more that we can support each other in doing that. And, you know, having great leaders like Marty to show us the way to do that is really what gives me hope about the future of medicine as well. You know, it's interesting because you know we talk so much about these problems on the podcast and one might get the sort of impression that we physicians should be pessimistic about the future. But, marty said earlier, I'm very optimistic about the future. I do see changes starting to occur and I just hope that we can continue along that path and, like I said, really re-empowering doctors to take back control of medicine, yeah, Amen.

Speaker 1:

Yes, please take back control doctors.

Speaker 3:

Awesome. I took you know again Marty's new book Blind Spots when medicine gets it wrong and what it Means for Our Health. As of when this episode is released, it is widely available all the usual places and I really encourage both doctors and patients to read this book. I think it's very applicable for both. Marty, if people want to connect with you, where can they do Great?

Speaker 2:

First of all, thank you, jack and Phil, for the conversation. Really enjoyed it. I'm on social media and LinkedIn and Twitter and other places, so hope people enjoy the book and please let me know what you think after you read it.

Speaker 1:

I've been reading it. I got to say this aside from the fact that, oh my God, some of this stuff, it's well written I just don't have a lot. My life is too short, I don't have time to read bad writing. However good the information is, I don't have time to read bad writing. And I was reading through this and I was going this is really well-written, it's a pleasure to read. So kudos. Thank you, jack. All right, the book is Blind Spots. Dr Marty McCary, thanks for being with us. This has been the Stay Off my Operating Table podcast. We look forward to talking to you again next time. Thanks for joining us.

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Dr. Philip Ovadia

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Jack Heald

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