Dr. Marty Makary is a New York Times bestselling author and health care expert at Johns
Hopkins University. He writes for The Wall Street Journal and served in leadership at the World Health Organization. Marty is the recipient of the 2020 Business Book of the Year Award for his book, “The Price We Pay,” which has been described by Steve Forbes as “A
must-read for every American.”
A public health researcher, Dr. Makary leads efforts to improve the health of communities and focuses on the “redesign of healthcare” to make healthcare more reliable, holistic, and coordinated, especially for vulnerable populations. He leads national efforts to increase medical transparency and lower health care costs for everyday businesses and consumers.
Clinically, Dr. Makary is the chief of Islet Transplant Surgery at Johns Hopkins and is the
recipient of the Nobility in Science Award from the National Pancreas Foundation. He has been
a visiting professor at over 25 medical schools, has published over 250 peer-reviewed scientific
articles, and has been elected to the National Academy of Medicine. A graduate of Bucknell,
Thomas Jefferson, and Harvard Universities, he completed his surgical residency at
Georgetown University and his specialty training at Johns Hopkins Hospital.
Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author. Gabe is also the host of the “Inside Bipolar” podcast with Dr. Nicole Washington.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To book Gabe for your next event or learn more about him, please visit gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.
Gabe Howard: Hey everybody, welcome to the podcast. I’m your host Gabe Howard. Calling into the show today, we have Dr. Marty Makary. Dr. Makary is a New York Times best-selling author and health care expert at Johns Hopkins University. He served in leadership at the World Health Organization and is the author of the new book, “Blind Spots: When Medicine Gets It Wrong and What It Means for Our Health,” which is available now. Dr. Makary, welcome to the podcast.
Marty Makary, MD: Yeah. Good to be with you, Gabe. Call me Marty.
Gabe Howard: Oh, Marty, thank you so much for being here. Now today we’re going to be discussing how people tend not to notice their own biases and limitations. Now, often even after the blind spot has been pointed out to somebody, people just double down and they reject the idea that they could ever be wrong. Now, we may think that this is just as simple as, oh well, they’re just stubborn. But your research has indicated that it goes further than that.
Marty Makary, MD: Yeah. If you look at a lot of the groupthink in medicine, we’ve made a lot of giant mistakes and still do. And really, what’s behind a lot of the groupthink is a part of the human condition that the psychologist Leon Festinger first described, where he basically suggested that we subconsciously cling to whatever we believe first, not because it’s more logical or more scientific than new information, but simply because we heard it first. And so the brain likes to nest a novel idea, and we subconsciously will go through acrobatics to try to dismiss new information or reframe it to fit what we already believe, just so we can have the comfort of holding on to that original view. And when a new idea conflicts with what we believe. It creates this sort of discomfort or this internal conflict, what he called dissonance or cognitive dissonance. And so it really gets at so much of the groupthink that has resulted in catastrophic health recommendations, the food pyramid, demonizing saturated fat, the bad advice on peanut allergy prevention, cancer prevention, antibiotics aren’t bad for you. So many of the bad medical dogma that we still live with today, it’s still rampant within the medical field.
Gabe Howard: You’ve really framed this as doctors are doing it. And the reason that this is fascinating to me is because in our society, doctors are held up as the logical ones, the intelligent ones, the respected ones. And they would never fall prey to something as simple as getting it wrong. That’s for stubborn people. That’s for blue collar workers. That’s for your angry uncle at Thanksgiving. Right? So how did this happen? That this research has exposed that some of the most intelligent people in our society are falling into a trap, that the average listener probably really feels that the stupidest members of our society only fall into.
Marty Makary, MD: Well, if you look back before World War II, before the advent of modern technology, doctors were for most of human history, respected but not held up on a on a pedestal with this sort of unquestioned authority. Kind of like you’d respect your hairdresser or your barber. As a matter of fact, barbers and surgeons, it was the same person. They had the title surgeon barber in Europe. And we didn’t have a lot of tools. We had a saw. We had a lancet to make you bleed. And we had 1 or 2 medications that really didn’t work well. And so doctors weren’t disrespected, but they might have been respected like some other professions. But then came the advent of antibiotics. A magical pill that the medical community, doctors, controlled. We could now prescribe it. We now had some technology in the hospital, like an iron lung machine, and we had the ability to do surgical procedures because antibiotics now enabled them to be safer. We had anesthetics. And so you saw after the after World War II, the rise of the White Coat era, doctors began to wear a white coat. They had unquestioned authority. Well, some believe that the modern white coat era of medicine with the unquestioned authority of physicians has really ended. It has really taken a turn. And I think people started seeing through this sort of groupthink of medicine and how they got so many things wrong in the last ten years.
Marty Makary, MD: You know, many times in medicine, the right answer is I don’t know. And we’re not good at that sometimes. And smart people can develop giant blind spots. The microbiome. Food is medicine. What’s going on with our food supply? We’ve watched all of these chronic diseases, including mental health illness, skyrocket in just our lifetime. Gabe, this is one living generation. I mean, obesity or type two diabetes in a child was so rare, a pediatrician might see a single case in their entire career. Now, 1 in 5 children has diabetes or pre-diabetes. Half of America’s children are obese or overweight. What’s going on here? Autoimmune diseases are surging, GI cancers are surging. And so we have a health care system that’s been so busy billing and coding and short visits that nobody has had the time or the resources to stop and look at what’s in our blind spots. What are we missing here?
Gabe Howard: I have several questions. I my my mind is kind of blown, but I think I would be remiss if I didn’t stop just for a moment and ask, you know, you’ve mentioned that the food pyramid, something that many of us learned in school and honestly, I thought was still taught in schools is largely based on misinformation. And you’ve talked about our food supply having I’m going to go with issues. I’ll just say issues because I’m not a doctor. I want to take a moment, because I think some of our listeners are like, well, wait a minute, isn’t the food pyramid settled science? Aren’t fruits and vegetables good and proteins good? And high fat is bad. I, I know that a lot of people are raising their children on this, and you’ve sort of put it into a little bit of, huh, what’s going on there?
Marty Makary, MD: Sure. So in the 1960s, a guy named Dr. Ancel Keys decided to demonize saturated fat and the American Heart Association and everybody he lobbied sort of joined the bandwagon thinking, this was sort of the classic groupthink. And by the time the government issued the food pyramid, the Surgeon General was on board, the American Heart Association. Doctors were sort of sidelined or railroaded if they had alternate theories of what was driving heart disease. We inherited this dogma that saturated fat was the villain. Matter of fact, just to give you a sense as to how big of a recommendation this was, this was the number one thing we, as doctors told patients they’d come in to see us for their checkup. We’d say, eat healthier. If they’d ask what that meant, we would say, well, the first thing we’d say is avoid fat. Try to eat low fat. Well, what we did is a terrible thing. We demonized something with no evidence that it was bad for your health. We moved the entire food supply to a highly ultra processed food supply of refined carbohydrates. All of a sudden food designed for mass production was stripping wheat of its fiber. Chopping it up into essentially sugar. Now, where refined flour was functioning like sugar, stimulating the pancreas. And we saw all of these chronic diseases surge around the same time. Obesity.
Marty Makary, MD: And we also ignored the role of pesticides. We were so busy demonizing fat, we ignored the fact that 80 to 90% of our fruits and vegetables that we have been promoting are covered with pesticides. The pesticides kill the insects by creating a leaky gut in the insect. What do you think it’s doing to humans? Right. They started using pesticides. They’d kill the crops, and then they engineered the crops genetically to be so-called Roundup Ready. Well, humans are not Roundup Ready. We’re not genetically modified. If they kill insects, what are they doing to the bacterial lining of the gut? What is it doing to our microbiome? That is, the millions of bacteria that live in a balance. Well, we’re certainly we’re carpet bombing the microbiome. The overprescribing of antibiotics, antibiotics save lives, but they’re massively overprescribed and they’re altering the microbiome. So gut health, the microbiome, food has been in a giant blind spot of modern medicine. We have not really focused on it, even though it’s central to health. This is the root cause of so many of our modern-day problems in medicine, but we have not focused on it because we’ve been so busy demonizing saturated fat in the food pyramid.
Gabe Howard: So I’m interested in how we got here. If there’s research, is there just a disagreement on the research? Is there competing research or is it literally just. Well, this is what I learned. This is what I do. And it’s easier to stay the course.
Marty Makary, MD: Well, I think doctors are good people, but they’re working in a bad system. And I personally think, Gabe, we’ve done a terrible thing to doctors in the United States. We take these bright, altruistic medical students. We beat them with the memorization of the names of enzymes that they can look up on a phone. You don’t need to need to memorize all every intermediate name of the Krebs cycle. And then we force them to memorize thousands of drugs. They come out with a reflex where they just learn what the indication is. And here’s the drug for it. We don’t teach them about root causes. And then when they come out in practice, we we tell doctors, put your head down, focus on billing and coding and seeing patients in short visits. And we’re going to measure you by your throughput. Well, heck, you can’t do anything to address root causes in this crazy system. And so we have this bloated $4.5 trillion health care system where everybody’s getting rich except for the American citizen, the patient, and they are just getting medications thrown at them. And it’s not to say anyone’s ill intended, it’s that we have to stop and recognize we have huge blind spots.
Marty Makary, MD: I remember my first day of med school going through the anatomy book, and one of the professors looks over my shoulder and he basically says which organ, you know, do you like? Which, which organ are you going to specialize in? And I’m like, what is this? I’m interested in the whole body. What? You know, what is this like pick an organ like, oh, I’m going to be a spleen guy. And this is part of the culture we glamorize people who have who are sub sub sub specialized. And look, I’m one of those people. I’m telling you, I’m just, you know, I’m a pancreas surgeon at Johns Hopkins. We do more pancreas surgery than any hospital in the country. But at no point in the last 20 years that I’ve been there has anyone stopped and asked, why has pancreatic cancer increased in the United States? Or why is colon cancer going up in young people? Why are rates of rectal cancer going up? Why is it that? Is it the GI cancers are the ones on the rise. Could it be that they’re interfacing with our poisoned food supply? So it’s just not been there’s no NIH funding to look at this. There’s no pharma is not going to fund this stuff. Right. So we left. We’re left with this kind of Bermuda Triangle where we have some good research, amazing preliminary research, but it doesn’t fit a specialty. And it’s not a research priority for the sort of pharma agenda.
Gabe Howard: So what is the solution? Do we need the government to step up and fix it? Because I got to tell you, when it comes to groupthink, the government has to be worse than doctors. But how do we get out of this situation? What’s the solution to move forward?
Marty Makary, MD: Well, first of all, I couldn’t agree with you more. The NIH just came up with a replacement for the food pyramid. They call it the food compass, and it’s a total disaster. It shows that Lucky Charms cereal is healthier than a steak. I mean, we need some NIH reform, but we can’t rely on the government. We are seeing now the private sector explode. When people ask about these things, the markets move. When the public got educated about the dangers of added sugar, food companies started advertising. Hey, we have no added sugar in these products and we see markets move. So a bunch of us are going directly to the public and trying to educate folks about health. There are so many things people need to know about food. For example, do you know that yellow number five dye that you see in all of these foods for children is tartrazine, which is a chemical that was discovered as a byproduct of coal tar. And when they noticed it made things yellow, they started using it for fabric. And then they thought, hey, why not just put it in the food? And there was never any.
Marty Makary, MD: To you know, evaluation of this at the FDA. It turns out that in the studies that have been done, it’s been associated with tumors, genetic mutations, with anxiety and depression. Plus, there’s something called common sense. What are we what is going on here? If we’re seeing all of these mental illnesses on the rise, we’re seeing all of these chronic diseases going up. And we have this uncontrolled experiment in the United States with our current living generation watching all, everything go up in every area of American society. What does that tell us? So we need a fresh new approach to this stuff. I don’t think we can keep going down this path, because just throwing medications at people is not the solution. We have the most overmedicated population in the history of the world. 20% of children are on medications. What are we doing?
Gabe Howard: We’ve talked a lot about groupthink in doctors, but now we have to think about groupthink in parents. You know, parents, they tend to behave the same way as well. They’re they’re all feeding their kids what they believe are a healthy diet. So how can a parent stand up and say, you know what, I don’t want to be involved in their groupthink. I don’t want to be involved in my groupthink. So I’m going to risk my child by going with a guy I heard on the podcast. You understand what I’m saying? I know, I know, the question doesn’t have a solid ending because it just gets to this part where I believe you. I’ve seen the research. I had you on the show for a reason. You pass medical review if people are hearing this, you know what I mean. But
Gabe Howard: At the same time, I mean,
Marty Makary, MD: Look, I love this question, Gabe. And I get it. People are flying blind. And who do you believe? And for parents, I would say, first of all, look at our outcomes as a modern healthcare system. The last 50 years of modern medicine. We’re great at emergency care. We are great at doing sophisticated, big operations. But when it comes to chronic diseases, modern medicine has been a 50-year failure. We have the sickest population, the most medicated population, the most obese population, most disabled population, the most medicalized population in the history of the world. Here are things I think parents should know. You don’t have to do what every other parent is doing. You don’t have to give your kid a smartphone when they turn 10 or 12 just because they turn 10 or 12. You don’t have to do that. These are highly addictive substances. You don’t have to feed your kid added sugar. You can find foods your kid will love, that are healthy foods that don’t have chemical ingredients in them. People have this myth in parenting. Oh, all things in moderation. Well, you wouldn’t say that about cocaine, but yet a lot of the screen time, a lot of the added sugar it is giving dopamine surges.
Marty Makary, MD: Social media apps are designed to grab the attention of kids and hold on to it as long as possible. In studies, kids say that these notifications and apps make them anxious. The average kid gets 273 smartphone notifications in a day. They’re not paying attention in school. They’re anxious. We’re making them anxious. And then we tell them, you have anxiety. Here’s a medication. We’ve got to promote children growing up with a good environment. My sister raised her kids, it wasn’t until they were six years of age that they saw their first screen and the screen. What they did is they had a family movie night with not a lot of fast images, but like a boring Mr. Rogers type movie. So they had the experience of a movie. They didn’t feel left out, but she wasn’t going to create this addiction. She raised her kids with no added sugar, they had alternate foods. So, basic principles avoid unnecessary antibiotics. Antibiotics should be reserved for when they’re necessary. Healthy cooking with healthy oils. Extra virgin olive oil. Avocado oil. Coconut oil. Avoid the seed oils. The vegetable oil. These are. They’re not healthy. They sound healthy. They’re. They’re chemicalized. Eat whole foods. Avoid the highly processed foods. Look for the food dyes. Do not allow your kids to eat food dyes. Introduce a little peanut butter when a kid is 5 or 6 months of age. A little bit and also a little milk and little eggs. The medical establishment gave a bad recommendation. False dogma telling parents to avoid peanut butter until the kid turned three. That ignited the modern-day peanut allergy epidemic. They thought it would prevent peanut allergies. It caused them okay. They got it backwards. But these are some basic things parents can do. And go against the grain. Go against the groupthink.
Gabe Howard: Marty has been absolutely fascinating to talk to you. What advice do you have for other doctors to get out of this groupthink, because it really does sound like we need to move forward and advance in medicine, especially since we’re using things that are provably false.
Marty Makary, MD: So in medicine, we need big thinkers. We need folks to ask the giant questions. We’re not asking that. We should be asking. And a lot of folks now are interested in these topics, the topics that have been in the blind spots of modern medicine but are central to health. So there’s a bit of a movement. There’s a tribe now of doctors that are saying, I don’t want to be on this hamster wheel of billing and coding. I want to spend time, and I want to get into the root causes of so many of the chronic diseases, and I want to be siloed. I see how everything in the body is connected. The common causes of almost everything that we see in the hospital general body inflammation, the food supply. And so we’re seeing a lot of doctors now get educated from doctors with podcasts who are talking about this stuff. Mark Hyman, Peter Attia, Vinay Prasad, Casey Means. I’ve got this book out now, “Blind Spots.” So a bunch of us have decided to go directly to the public, share this new research. And what we found is that we’re educating doctors and the public alike at the same time about a lot of these important issues.
Gabe Howard: Marty, thank you so much for being here. Where can people find you and your book online?
Marty Makary, MD: Great. Thanks, Gabe. Enjoyed our conversation. So the book is available wherever books are sold. It’s called “Blind Spots,” and I’m on social media too, @MartyMakary.
Gabe: All right. To all of our listeners, that is the end of our show. If you have any feedback, good, bad or ugly, hit us up at show at PsychCentral.com. While you’re in the favor doing mood, here are a few more that we need from you. First, recommend this show to everyone you know. Share your favorite episodes on social media. Send somebody a text message. Send somebody an email. Bring it up in Facebook groups. Bring it up it up in support groups. Sharing the show with the people you know is how we’re going to grow next. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. My name is Gabe Howard and I’m an award-winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon, but you’re not going to want to. You’re going to want to go over to my website and get a signed copy with some free swag. That website is gabehoward.com. You can also follow me on Instagram and TikTok @AskABipolar. I will see everybody next time on Inside Mental Health.
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