Why Healthcare Reform Needs a New Focus with Dr. Martin Makary

Martin: 
People are trying to deceive us into thinking that healthcare is about pro versus anti, some peripheral issue. These issues may have merits, but don’t be fooled. Healthcare is not a debate between Obamacare and replacing Obamacare. It’s not a debate between should Medicare negotiate drug prices or not.

It is a debate between people who are lying to us, and people who are trying to tell the truth. 

Bret: 
Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a nonprofit initiative of Baszucki Group where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

Decorated Johns Hopkins surgeon, Dr. Marty Makary is saying we’ve been lied to. And the reason why our whole population is getting less and less healthy is because we’ve been lied to, but there’s something we can do about it. He took part in this round table on the Senate floor to try and bring this information to the government to say, we need to make change.

We need to prioritize our health. But unfortunately, that’s become a partisan issue, even though it was meant to be non-partisan. How can being healthy have been partisan? And why do we get so many things wrong in healthcare? Here’s my interview with Dr. Marty Makary, author of the new book, Blind Spot,

Dr. Makary, thank you so much for joining me at Metabolic Mind. 

Martin: 
Good to be with you, Bret. Thanks. 

Bret: 
I’ve got to say you’re the first hepatobiliary and pancreatic surgeon I’ve had on this channel, but there’s a reason. There’s a reason because we tend to focus on metabolic health and mental health.

So, someone would say like, why are you having a hepatobiliary surgeon? And that’s part of what I want to get from you, to start like how did you get from hepatobiliary surgery, Chief of Islet Transplant Surgery, something so specialized to then say, alright, I’m going to sort of branch out here and go against the system and talk about what’s wrong with the system? Talk about our metabolic health and talk about why we’re doing things wrong? How did that journey happen? 

Martin: 
I don’t know, to be honest with you. It’s been an amazing journey. I never thought specializing in the pancreas would land me a specialization in an organ that is so central to so many aspects of chronic diseases in the midst of a chronic disease epidemic.

So much of what we deal with is related to digestion, absorption, inflammation, insulin resistance. And so, really the pancreas is at the center of so much of that. I was always interested in the big question why. I left medical school after three years disillusioned, and I enrolled in the graduate school for public health where I got a public health degree. And eventually, I missed the bedside care and decided to come back to it and had a great career as a surgeon at Johns Hopkins now for 22 years.

But my research has really taken a turn in the last seven or eight years to focus on the big questions. We’re not asking that we should be asking the microbiome, the food supply, medical dogma, and many of these issues that live in our blind spots. 

Bret: 
Yeah, and you used the term blind spots, which is such a great title of your new book.

So, why do we have so many blind spots? You can look at the graphs, and the graphs of the amount of money spent per person, and then the health decline that goes along with that. And the obesity and diabetes and metabolic dysfunction that rises despite the increased healthcare spending.

So, why has that happened? Why do we have so many blind spots? 

Martin: 
I think a couple reasons. One, there’s a pride in the medical establishment. A small group of doctors at the top who write the guidelines, set the recommendations, decide what deserves research funding and what doesn’t. And that old guard medical establishment has lacked the humility to really pivot frequently as it should have, and as it should today to turn its attention to talk about the microbiome in our poisoned food supply and environmental exposures.

Instead, we’ve been set in our ways demonizing tobacco and demonizing saturated fat. We got one of those two correct, but we’ve also ignored so many other important issues. And there’s this psychology to it, and doing the research for blind spots where I go through the group think on many common current recommendations that a group think that has been misleading and wrongs many times.

It turns out there’s a psychology to holding onto what we hear first, not because it’s more logical than new information, but simply because we hear it first. Because it becomes comfortable in the brain. It gets nested, and the brain will psychologically and subconsciously dismiss new information, resist new ideas, and reframe them to fit what we already believe. And that is part of the human condition.

It’s something we need to be actively aware of. It’s something that psychologist, Leon Festinger, described as cognitive dissonance, and you see it every day. It’s not just in medicine, it’s in politics and business. But it’s in medical science as well. 

Bret: 
Yeah, it’s a great point. How it’s not just medicine, it’s an unfortunate human trait that has taken over in so many different realms. But we can certainly see the impact within medicine.

But maybe there is a tide trying to shift the other way? So, this was one of the first times I remember this much of a concerted effort at Senator Johnson’s round table, led by RFK, Jr. with you and Dr. Chris Palmer and Dr. Casey Means and so many others, there to testify at this roundtable to say, we need a change.

We need to focus on making this country healthier because what we’re doing isn’t working. So, tell me a little bit about the atmosphere of being there at that roundtable, to have the attention of at least one senator, I wish it was so many more, but what was the atmosphere like and what do you think it accomplished?

Martin: 
it was incredibly invigorating for the first time ever to see national political leaders in a United States Senate hearing room hear the frustrations of health professionals, the advocacy of mothers, the voices of everyday Americans from both sides of the political aisle united around the topic of finally addressing chronic diseases at the root cause level.

We have been medicating these diseases forever. If you look at the track record of modern medicine in the last 50 years, sure we’re great at these sophisticated operations. I do some of them. Yeah, that’s impressive. We’re amazing at emergencies, but we have failed when it comes to the health of the population.

And the only thing we keep hearing from our medical establishment is that we need more medications, more access to the medications that we need to address health inequities and access to medications. And we’re not talking about the root causes. And so for the first time ever, we saw that energy at a very high level with enthusiasm to shake things up and finally address healthcare corruption, which is something that should not be partisan.

It’s something everyone in America actually believes in. We’ve been held back in addressing because of corporations special interests. 

Bret: 
And if you think about it, I think that part of the problem is it becomes overwhelming to think about special interest lobbyists, the food bill, the grain growing states, the big food, big pharma.

Like it all just seems like too much. Like how do we actually break this down? So, this was a very important first step, but what do you think it’s going to take to really start to chip away? Are we just going to need more of the same or are we going to need to run a whole different playbook here?

Martin: 
I think too often we look to government to fix our problems in society. If you look at what we did with tobacco, that was really a health education effort. It wasn’t government that saved us from the expanding tobacco epidemic that was costing many lives. It was educating people directly. And so that’s what we’re doing now with food.

We’re going directly to people and talking about the microbiome and food is medicine. Maybe we need to address school lunch programs instead of just putting every kid on ozempic? We should be treating more diabetes and mental illness and dermatologic conditions with changes in what people consume.

That has been in a blind spot of modern medicine. And if we can educate the public, we can move markets. We saw it a little bit with addressing the dangers of added sugar. Look at the products now in many grocery stores. They advertise that they, it has no added sugar. And so it’s not just one thing, it’s the cumulative burden of all these things that have poisoned our food supply and drinking water.

We can educate people and move markets. 

Bret: 
Yeah, and education is such an important part. But for a physician standpoint, education takes time, right? Like you only have limited time. So, the physician, it’s a lot easier to write the prescription for GLP-1s.

And let’s be honest, GLP-1s work, right? You see the weight melt off but at what cost? At what long-term potential risks versus a lifestyle intervention. So, how do you think our physician colleagues need to start to turn the tide to say, I can’t just reach for my prescription. I need to take the time to talk about lifestyle?

Martin: 
I think we’ve done a terrible thing to doctors in this country. We’ve told them, put your head down, focus on billing and coding, and we’re going to measure you by your throughput. And we haven’t given them the time or scientific body of evidence to really address the root causes. Now many of them are obvious.

It’s common sense. You’ll have a patient with chronic abdominal pain, have every test known to modern medicine and has try a million different therapies and none of them work. And then they go to Italy for the summer. They’re suddenly cured because they’re eating healthier foods. And so there’s a lot of stuff we can derive from common sense.

There’s a body of literature on a lot of stuff that we can be objective. And if we’re going to be real, we can actually, if we’re going to be honest with ourselves, 83% of the studies of food additives and food ingredients, of those studies that support the harms, 83% of studies that are funded by the, that are independent show harm to these ingredients and chemicals.

But when it comes to studies funded by the food industry, 90 plus percent show no harm. So, if we’re going to be honest about healthcare corruption, we need to interpret the literature objectively, and get away from this culture in medicine where we have to have a randomized control trial around every single food ingredient and toxin in the environment in order to believe that there’s any harm.

You don’t need a 10 year randomized controlled trial to ask whether or not a chemical that causes leaky gut or cancer or problems in several studies is also dangerous for human beings. We can’t do that. We, you’ll never, there’s a thousand food ingredients that are allowed in the United States food supply that are banned in Europe and Canada.

Kellogg’s is making two versions of their cereal. One for Canada without the food chemicals, and one for the American kids. Don’t American kids deserve the healthier version of a cereal made by an American company? We have to use some common sense and get away from this idea that until we have a randomized controlled trial, we cannot make any scientific deductions.

Bret: 
Yeah, that just makes so much sense. Sure, if it’s a drug, if it’s something synthetic, we need the randomized controlled trial showing that these are safe since they’re not real food. They’re products; they’re chemicals. I think if anything, you need to turn it around, and you need to show it’s safe before you put it in.

But certainly, you don’t need a randomized controlled trial to say real food is safe and real food is healthy. That’s just, it’s so simplistic and so frustrating to hear you say how they’re making two versions of the cereal. It just doesn’t, it doesn’t make sense. And yet, so it, so much of it seems so common sense and seems so frustrating.

But then you probably saw the article by The Atlantic that sort of, I don’t know, made fun of and really put down the round table that you were part of saying it was woo science. And how do you feel when you see people react so negatively to what should be just so much common sense that we need to change things for the better?

Martin: 
I think people see through the partisanship that some are trying to insert into this effort to address chronic diseases in America and to address the corruption of our health agencies, pharma, big food and big ag. They feel like they own the FDA and the USDA and the EPA. They feel like they have captured those agencies, but they don’t belong to those companies.

They belong to the American people. And so there are all sorts of voices that are going to try to make this a partisan issue. But remember, until RFK Jr, a career Democrat, partnered with the Trump campaign to take on this topic of chronic disease management, it was a topic that was championed by liberal democrats.

And so if we can remove all the labels and get rid of the labeling and the partisanship and the echo chambers of cable news and all the back and forth name calling, and just talk about what we have in common, we will realize that we are trying to, people are trying to deceive us into thinking that healthcare is about pro versus anti, some peripheral issue.

These issues may have merits, but don’t be fooled. Healthcare is not a debate between Obamacare and replacing Obamacare. It’s not a debate between should Medicare negotiate drug prices or not. It is a debate between people who are lying to us and people who are trying to tell the truth. And the people lying to us are trying to say that this is a fringe thing.

Don’t listen to it. Food ingredients are totally safe. There’s no need to address our poisoned food supply is the fault of children for overeating, and it’s, that’s where the blame lies and ignore everything else. So, don’t be deceived. There’s tremendous consensus in the United States if we can block out all the partisan noise.

Bret: 
Yeah, such an important point to get rid of the partisan noise. And it’s just so frustrating to see how people want to make it a partisan issue. They want, it is like they thrive on the conflict and the controversy rather than coming together. And I think that’s something that really showed in the reaction to this round table, which was meant to be non-partisan but somehow turned out to not be that way.

But when we talk about conflict, I’m curious. So, you are at one of the most respected institutions at Johns Hopkins. You probably have a number of colleagues who are on committees to write guidelines, who do research for pharmaceutical companies. And here you are writing a book that sort of goes against all that or says that those things are wrong.

So, how has that been internally for you with your colleagues? You’ve really kicked a hornet’s nest a little bit, and what’s the reaction been? 

Martin: 
First of all, we need to kick the hornet’s nest. We have been misled. All of our chronic diseases are going up and what are we doing in medicine?

We’re busy billing and coding and medicating people. We have got to take a fresh new approach, and I think a lot of doctors know it. Burnout rates are at record high levels in the medical profession. We have the highest suicide rate of any profession. About a third of physicians feel burned out, and it’s not because they don’t like hard work. It’s because they’ve lost autonomy.

They want to talk about the bigger macro picture. And so I have found a tremendous amount of support at Johns Hopkins. I don’t think there’s any one view of doctors at the hospital. I think it’s a heterogeneous group. Some are open-minded. Some are supportive and quiet. Some are supportive in public. And some are highly partisan, and they will only stick to their party positions regardless of what the topic is.

So it’s a mixed group, but I found tremendous support at Johns Hopkins. I’ve been there 22 years. I love being a surgeon there. I spend 90% of my time doing public health research. In the last seven or eight years or so, but it’s been a great place, and I found people are hungry for this stuff. They know the system’s broken.

Our students, by the way, they don’t want to get on, they don’t want to get on the hamster wheel. They see this whole billing and coding and short visits and throwing meds at people. They’re laughing at us. They’re like, what? Stop and look up and look around you. We’re not making progress. We’re playing whack-a-mole at the back end.

And if you look at mental illness and the areas that you’re interested in, it’s the ultimate case study. We just do not deal with the root causes and instead have a medication for everything, calling it a chemical imbalance without talking about the root causes. 

Bret: 
Absolutely, it’s just so rampant in mental healthcare, and healthcare, in general. And I’m glad you brought up the students because we’ve been going through this exercise so much about how do we institute change?

And do we do it from the top down with the leaders of the AMA or the leaders who are writing the guidelines? Or do we do it from the bottom up with the medical students and the residents and the leaders of tomorrow? And it seems like maybe that’s the way to get more inroads because they’re a little more open-minded, a little more impressionable?

They haven’t had 20 or 30 years to really solidify their position and define who they are and how they practice. And they seem hungry. So, I’m curious, in your experience, have you seen the impact on medical students and residents, that they’re more open to identifying root causes? That they’re more open to focusing on metabolic health to trying to get governmental and policy change?

Martin: 
Great question, Bret. I’d like to think so. I think we’re seeing a movement. Some get so caught up in the whole, this sort of story of health inequities where we need to focus on doing more research to describe health inequities. I think that’s a misguided effort. We don’t need more efforts to describe health inequities.

We need efforts to reduce health inequities. In medicine, we have this sort of tendency to just talk to each other about the broader problems in society and not address them. And I think you’re seeing a generation of people now who want, social justice is a generational value, and they want to do something about it.

They don’t want to just talk about it. So, they see these panels and the medical conferences and they’re just like, this is boring and nothing is coming out of this. I don’t want anything to do with it. They see these short medical visits and the office and they’re like, this is ridiculous. We’re not dealing root causes.

I don’t have anything to do with it. So, we’re seeing a bunch of students and residents now think independently and creatively. And this effort to deal with root causes, they’re getting their information from podcasts and books because the textbooks and the traditional medical curricula they know is broken.

Heck, you show up and you’re just told, memorize and regurgitate for four years. They know that we’re not talking about major issues in society that we need to be talking about. And so they are now listening to Peter Attia and Mark Hyman and Casey Means, and reading books, like my book sold out on opening day and it’s still going strong.

A lot of doctors and students have been reading it. Casey Means has a book. So, a lot of people now are realizing they’re not getting the true story on healthcare in traditional medical education. The worst thing we could have in our healthcare system is people to come out perceiving that they are experts in nutrition and gut health and the microbiome and the food, and actually not being experts on it.

So not being expert, expert is one thing. If you have humility, but not having any expertise or knowledge and perceiving that you’re the expert is the worst combination. 

Bret: 
And there’s that old quote that it’s not what you don’t know that’s the problem. It’s what you don’t know, but think you know, that is truly the problem.

So, exactly what you said. But I want to go back to the health inequities, which is such a big topic and rightly, but I think the problem comes when we say what we need is more equitable access to these expensive medications as opposed to saying what we need is more equitable access to healthy food and healthy lifestyle.

But from a medical standpoint, okay, it’s the doctor and the pharmaceutical company. So, that’s really all we need to talk about access to medications. But it’s the doctor and it’s the farmer and the rancher and the big food company and the food policy and the government, all those intermediaries come to saying, how do we have more equitable access to healthy food?

So what role can you play? Can a physician play? Can a healthcare advocate play to get healthy food access for everyone? 

Martin: 
I think there’s a couple areas of low hanging fruit. Number one, we need to educate parents about how to raise kids in a healthy environment. Number two, we need to address school lunch programs.

is it really logical that we would wake up kids very early in the day messing up their circadian rhythm, not because it’s good for their health, but because it’s convenient for parents to drop them off at school? And then we feed them these giant, ultra-processed loads for breakfast, and then hit them again at lunch with refined carbohydrates.

They have a food coma. They can’t pay attention. They can’t sit sedentary for seven hours. Then, we diagnose them and medicate them. At what point are we going to say, this is insane? No one’s addressing communities. No one’s addressing circadian rhythms and loneliness. No one’s addressing bullying online.

Social media apps that are designed to capture their attention and make them anxious. The average teen is checking their phone with 200 and 273 notifications in a day. Why do we even allow phones in the classroom? Some states now, Kathy Hochul in New York and Governor Youngkin in Virginia have said, hey, this makes no sense to allow them to be on their phones during class.

And so I think you’re starting to see some bipartisan efforts to address some of these things, but we’ve got to talk about them. And if people don’t know what’s going on, if they’re told, hey, this is a chemical imbalanced disease, they need a medication. That’s the solution, and they’re not being told about the underlying root causes.

We’ve done a terrible thing to the public, if that’s how we approach it. 

Bret: 
Yeah, and such an important point about what we’re feeding our kids at school lunches. And I used to be of the opinion like, ah, the, dietary guidelines don’t really matter because we can make choices for ourselves how we eat.

But the institutions can’t. Like a school cannot go outside of the dietary guidelines in terms of what they want to offer. And because of that, our kids are getting, just like you said, over overprocessed, refined high carb. Really, like malnutritious kind of lunches. And we’ve seen groups like the Nutrition Coalition try to make the dietary guidelines more scientific to demand more rigor and to try and make change.

And it’s, the results have unfortunately been more of the same old, you look at the conflicts of interest of the people on the dietary guideline board, and where they’re getting money from and the big food hand in there. And it’s really disheartening. So, again, like what is it going to take to chip away at the dietary guidelines so that we can make changes to school lunches and that we can make changes to how we feed our kids?

Martin: 
Yeah, so we need fresh, new leadership. We need to get rid of these conflicts of interest that come up with our nutrition guidelines. 95% of people who have written these misinformation, food pyramid-related nutrition guidelines, they have been conflicted with the food industry. My head of nutrition at the Harvard School of Public Health, where I did my graduate degree, he was being paid off by big food, big sugar, all these companies.

And so it’s a corrupted science. So, I think we need to educate people about the truth. I think we need to address corruption ,and I think we need to talk about these root causes. Otherwise, we’re going to be going down a very dark path, and we’re on it right now.

And then we’re just going to be arguing in politics about how we pay for our broken healthcare system. The real issue is not how we fund and finance our broken healthcare system. It’s how we fix it. And in order to do that, we have to talk about root causes. We’re seeing enthusiasm to do that now. I hope that enthusiasm keeps going so we can get people the truth about what’s going on.

Bret: 
Yeah, I think I saw a post that you did about it. It’s not about trying to make drugs cheaper, it’s just trying to make it so people don’t need the drugs because they’re taking care of the root causes. I remember you posted something like that, which I totally agree with. 

Martin: 
Yeah. Medicare can now negotiate the prices of 10 commercial, generic drugs.

Great. Congratulations. 

Bret: 
Yeah. 

Martin: 
The ultimate way to lower drug costs is stop taking drugs we don’t need. 

Bret: 
Yeah, now I know I might get myself into trouble by even asking this next question, but we’re saying this is a nonpartisan issue. But from what you saw when you were in DC and what you’ve seen from the reaction, do you think it’s going to actually be a partisan issue? In that if you know the Republicans win and RFK, Jr. has a seat at the table, that we’re going to see a much different approach than if the Democrats win and they don’t have the same emphasis? Or do you think they now have taken note of the importance and that we will get a concerted effort to make an impact no matter who wins?

Martin: 
I think we’ve seen a willingness to address corporate capture on one side. On the other side, on the D side, there has been some good efforts. But when you look at say, Michelle Obama’s efforts where she said all the right things when the Obama administration first came into power in their first term. All the right things about addressing our food supply and improving the health of children. But something suddenly changed just before the second presidential election in that era ,where suddenly she never talked about it again.

And 100% of her efforts were then focused on the Let’s Move campaign of activity and exercise. I don’t know what happened. I don’t know if big food, big ag threatened them or made a deal with them.

But that’s the sort of level of corporate capture that I think we would not see right now with this incredible enthusiasm on the our side of the ticket to address corruption of corporations by corporations of our health recommendations and health agencies. 

Bret: 
Yeah, I think that’s the, I think that kind of sums it up pretty well. That it has nothing to do with what party you are a part of, it has to but it does have to do with how willing you are to take on the entrenched big organizations and what’s been entrenched in government for decades and decades. You have to be willing to do that to change things. And I would just hope that no matter who’s in office, that they would be willing to do that for the health of our kids, of our country, of everyone. 

Martin: 
So, yes, and Corey Booker, by the way, in the Senate has been a huge advocate on this stuff. Obviously RFK, a career Democrat, so I think there are signs that we can do this as a country. This is one thing we can agree on. For example, PEPFAR, the program to provide assistance in Africa, was generally recognized to be a success that both parties would acknowledge, was a good thing that the other party did that they wanted to keep going.

It was bipartisan. I think we’re seeing that now with chronic diseases. But I guarantee you, Bret, we’re going to see a series of hit pieces come out in the Washington Post and the Wall Street Journal and the New York Times about this effort because they’re going to find a way to try to divide us over this issue. And they will make stuff up or misconstrue quotes. Whatever it takes.

And this is what they do. And so this is why people dislike the media more than they dislike their member of Congress. 

Bret: 
Well said. And as those smear campaigns come out, as the disinformation comes out, we’re going to need places to turn to have this pointed out to us and to learn about it. So, if people want to follow you, and see your reactions to all these things, and read your book and learn more, where would you direct them to go?

Martin: 
Great, thank you, Bret. I’m on social media and Twitter, at MartyMakary, and the book is called Blind Spots. It’s available wherever books are sold. And so that’s where I get into a lot of the research on these topics. Some people in the medical establishment don’t like the book, but no one has taken issue with any specifics in the book because it’s supported with nearly 500 references in the back.

So, I’m trying to present people to the general public and to the medical community alike, the important scientific research we are ignoring that we need to pay attention to things that have lived in the blind spots of modern medicine. 

Bret: 
I really appreciate you taking the steps to bring this to light. And really, I guess you could say, going against the common narrative to help open people’s eyes and see things differently and advocate for change and for health. What it comes down to is you’re advocating for health, which shouldn’t be so controversial. But I really appreciate you taking the time, and thank you for joining me today.

Martin: 
Great to see you, Bret. Thanks so much. 

Bret: 
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