Exposing The Flaws In Our Broken Healthcare System | Dr. Marty Makary

Coming up on this episode of the Doctor's Pharmacy.

We have yet to really understand what's going on here. The rise in colon cancer in young, healthy people. Turns out that there's an association with the microbiome being born by C-section and going on to have colon cancer before age 50 was an association just published in JAMA Surgery.

Hey everyone, it's Dr. Mark. I know there are a ton of functional medicine practitioners who listen to this podcast and I want to ask you a question. Are you tired of wasting valuable time on complex lab ordering procedures? If so, I got fantastic news for you. Rupa Health has made ordering and managing labs effortless. In just a few clicks you can access over 3,000 tests from over 35 lab companies all in one convenient portal. Plus Rupa Health ensures that you only pay one invoice for all your tests making everything simpler and more efficient. No more juggling multiple invoices or dealing with administrative headaches and the best part is completely free. That's right there are no hidden fees or complicated billing systems so don't let lab ordering hold you back anymore. Visit RupaHealth.com today and unlock the potential of hassle-free lab testing. That's R-U-P-A-H-E-A-L-T-H dot com. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store for a summary of my favorite and tested products. Welcome to Dr. Hyman's Pharmacy. I'm Dr. Mark Hyman and this is a place for conversations that matter. And if you've ever wondered if there's corruption and dysfunction in the medical system, then you have to wonder no longer, because our guest today, Marty Makary, is a professor at Johns Hopkins University School of Medicine and the author of two New York Times bestselling books that have kind of pulled the curtain back on a lot of the dark side of medicine that you're gonna hear about in this podcast. Dr. Makary served in leadership at the World Health Organization. He's a member of the National Academy of Medicine, one of the highest honors you can get in the field of science. published over 250 papers. His newest book, Blind Spots, challenges the conventional medical dogma to educate people about their health. Clinically, he's the chief of eyelet transplant surgery. That's getting something in your pancreas when your pancreas isn't working at Johns Hopkins. He's the recipient of the nobility in science award and the national from the National Pancreas Foundation. He's been a visiting professor at over 25 medical schools, and he's just a very courageous doctor because he has pushed the limits of what we should be talking about in medicine, because we are told to keep the secrets. He wrote a book called Unaccountable: what Hospitals Won't Tell youl and How Transparency Can Revolutionize Health Care. He also wrote another book, the Price We Pay: what Broke American Health Care, about the lack of transparency in pricing and how we can fix it. He's just an incredibly brilliant man who is just on a mission to tell us the truth that you have not been hearing. And today we talked about all sorts of things from the concern about vaccines and should we actually be vaccinating certain people and groups of people with a COVID vaccine or not? Why is the microbiome being ignored in medicine? Why is our medical education system completely teaching the wrong things? Why is our National Institute of Health actually have nothing to do with health and is all about disease and is not even funding the things we should be funding? How has the range of roles of GLP-1 agonists been ignored and why are we concerned about that? He's also, we also deep get into the topic of, of, of healthcare financing payments, how researchers funded the corruption of evidence-based medicine. I mean, we talk about it all. I think you're gonna love this podcast. So let's Dive Right In with Dr. Marty Makary. Welcome, Marty, to the Doctors Pharmacy podcast. It's so good to have you. I followed your work, and honestly, I'm kind of shocking because you're a Johns Hopkins professor and you're a heretic in the middle of the belly of the beast. Right. And you're kind of telling tales that we've traditionally kept in medicine. It's kind of like a guild, you know, or like, you know, it's a club and you don't, you don't tell in your neighbors or your colleagues or your friends about what's really going on in medicine and health care. And what's really struck me as I've, you know, been a doctor God for almost 40 years now is the, is the level of co-optation and capture of medicine by industry. And it's less about health care, it's more about business, whether it's private equity taking over health care practices and emergency rooms or whether it's, you know, just pharma controlling policy and influencing medical education, or whether it's lack of real accountability and transparency in healthcare and medicine. You've been really outspoken about these things that we kept quiet about for a long time as doctors. And you have quite a pedigree, and it means a lot coming from you. I mean, I'm just a heretic on the margins and a little fringe doctor, but you're on RD, a real doctor. I just play one on TV. And I think that, although I do see patients, I'm kind of kidding. Yeah, you're big time. But I really, I'm so excited about your work, about your new book, Blind Spots. It's a great book, when Medicine Gets it Wrong and what it Means for Our Health and your other books, which I think are also very compelling and touch on areas that are also quite concerning for me, which is really the lack of accountability and transparency in medicine. It's called Unaccountable, or Hospitals Won't Tell youl and How Transparency Can Revolutionize Healthcare. And another book you wrote called the Price We Pay, what Broke American Healthcare and How to Fix It. I mean, why are we spending twice as much as any other nation half the results. So I'd love to kind of hear how you went from being like a, you know, revered surgeon at Johns Hopkins, where it's sort of the birthplace of modern medicine with William Osler, to kind of calling out what's really wrong with the system.

Well, it's great to see you, Mark. You know, I think it hit me at a certain point. I went as far as you can go in academic medicine. All the regalia, all the societies and honors and promotion and tenure. And it hits you at a certain point, I don't know if it's after I wrote 200 scientific articles or 250, but you realize no one's reading these things. The system is so broke. And the problem is we have a lot of smart people in a system where they're just collecting their paycheck every two weeks, putting their head down, this shouldn't be, this isn't right. And we feel like we're cogs in the wheel, and people are afraid to get off the hamster wheel, take risks, and call things out. So in the book, the Price We Pay, my research team brought attention to this issue of price gouging and predatory billing, which is the term we called these kind of crazy bills that get thrown at people. They want a price, they're not given a price, and it ruins lives. And now we have this massive trust problem where some 62% of Americans say they have avoided care or delayed care for fear of the bill. Yeah. So you can have the cure for pancreas cancer now, but if 62 of the population, it doesn't trust you, that pill is only 38 effective, not 100 effective. No, it's true.

I mean, I, I literally had this direct experience. I had a knee issue, so I needed an MRI. And I went to Chinatown in New York City. I got one for 400 bucks. Had to get one in, in Berkshire's and where I live in the Massachusetts. And, and it was 2, 500 bucks for the same MRI, same machine. I just went and had back surgery and had hyperbaric oxygen, I went to this hospital and I said, I wanted to get it. They said, okay, but it's $5,000 a session. I'm like, geez, can I talk to the head of anything? Well, if you do it this way, not through Medicare, and you do it through an off-label use, it's $175. So, we're talking $175,000, $5,000, exactly the same procedure.

How does that happen in medicine? Yes, exactly right. So, this is the game. I call it the game in the book, the Price We Pay. And we found that The game is designed to maximize profits. It's not designed to be honest with patients. And so the book actually led to some real legislation and an executive order from the White House that was entirely bipartisan that now requires hospitals to start posting cash prices for common shoppable services. And the secret insurance discount that the insurance companies have with hospitals will all be public. All of that is going to start to happen this year. And that is because we felt firmly like we got to do something. All the doctors lobbying organizations out there are just fighting for more money for doctors. And that's the Common Trade Association thing. That's not bad. That's not saying that, you know, we're not getting cut on Medicare. But the health care system is more than just fighting for more money for your own special interest.

And yet the average consumer is kind of just at the effect of all this and has no power and the costs are escalating and we spend so much money in healthcare and we're getting less and less and the outcomes are worse and worse and we don't have aligned incentives. And so it's kind of messed up. I think you also talk about in your book Blind Spots some really interesting things that we screwed up in medicine or things that we're not looking at. And, you know, when I remember I gave a lecture at Cleveland Clinic once and it was a whole audience of, you know, doctors and scientists and it sort of gave some case presentations and I presented a case around autism that I treated where we really helped to reverse the case using very sort of aggressive lifestyle dietary changes, fixing the microbiome, which was an issue for 98% of these kids have really screwed up guts. And he says, well, you know, this is just an anecdote and where's the evidence? And I'm like, I said, look, can you help me explain how the microbiome affects almost all known health conditions, from heart disease to cancer, diabetes, to dementia, to autism, to allergies, to autoimmunity, to depression, to eczema, to asthma, and the fibromyalgia, to chronic, I mean, I literally could go on forever, right? how can you explain that with your current set of facts and theories? Like, well, it can't. Like, so when you have a set of facts that present themselves to you, when the science changes, you have to change your thinking and your practice. Yet we don't do that. It's just so evident to me that despite knowing now that so many of our diet, our disease are diet related, or that so many are related to the microbiome, which is controlled by our diet, or that so many diseases are related to environmental toxins, doctors don't learn about this. They don't put it in their practice. And it's sort of this, this kind blind spot. Can you kind of talk about you came up with this idea of blind spots and why the microbiome is such a blind spot and we'll get into.

Some more of them? You know, maybe we need to be treating more diabetes with cooking classes instead of just throwing insulin at people. We are the most over-medicated generation in the history of the world, right? And so we can keep treating high blood pressure with first line after second line or we can start talking about sleep quality and stress management. And this is the new movement now in medicine. It's a real tension to address these giant blind spots. The microbiome is one of them. Food is medicine, general body inflammation, all the stuff that you've been teaching the public and the medical community about for a long time now. The microbiome may be this central organ to health, but it has no center at the NIH. There's a little tiny unit and I talked to the person who runs it and they're massively underfunded. But the microbiome trains the immune system, digests food, produces vitamins. It's involved in mood because some of the bacteria produce serotonin. It even regulates estrogen, it deconjugates estrogen.

Into an active form. and so you're sounding like a functional medicine doc there, Marty.

I think at heart I want to be one, but, you know, I don't have the expertise on which foods and vitamins, but what I'm interested in as almost a journalist within the medical profession is we have new, exciting research that relates to every disease process, every specialty, and it gets almost no attention.

Yeah.

And This one study by the Mayo Clinic, I think maybe the most significant study of the last 10 years, in my opinion, that got almost no attention. They looked at 14,000 kids and compared kids who got antibiotics in the first couple years of life compared to kids who did not. And the kids who got antibiotics in the first few years of life went on to have higher rates of chronic diseases. they had a 20% higher rate of obesity, a 21% higher rate of learning disabilities, a 32% higher rate of attention deficit disorder. All these things are on the rise. 90% higher rate of asthma, almost a 300% increase in celiac disease. All these diseases are going up. We're messing up the microbiome. That was the mechanism believed to the end, which how the antibiotics worked. to induce the increased risk of these diseases? And how can you look at that and say, yeah, let's ignore that. There's nothing there. We may have- 'Cause there's no pill-.

Marty, to fix it. There's no pill. There's no statin for the microbiome.

No pharma company CEO gets rich. But it's amazing now the research on the microbiome is blowing me away. And they published this study in the Mayo Clinic Proceedings, which is in our world of research, it's a little bit of a flag. that no one else would take it. I think it's probably the most important significant study in the last 10 years.

Wow, okay, tell us about it.

So, I mean, the fact that you have all these chronic diseases, I mean, all the stuff that is increasing, attention deficit disorder, learning disabilities, we scratch our heads. People come in and we diagnose them with celiac and they say, Doc, how could this possibly happen? And we come up with some non-answer like, well, it's unknown or, you know, genetic. Genetic. And no, we have, I mean, there's a study here telling us 300% increased risk when you alter the microbiome with antibiotics early in life. And it's other things, it's C-sections it's Ultra processed foods, it's high refined carbohydrates. So we have yet to really understand what's going on here. The rise in colon cancer in young, healthy people. Yeah.

Right.

Turns out that there's an association with the microbiome. There's an association with polyps and antibiotic use. There's an association with C-section delivery. Being born by C-section and going on to have colon cancer before age 50 was an association just published in JAMA Surgery. So you have this incredible body of literature emerging on this central organ system that is highly actionable. that we can talk about, that we can study. And it kind of lives in this corner because what specialty is it? And what NIH Center is it? Is it infectious diseases, GI? Is it oncology? Is it primary care? Is it functional medicine? And it has no home because we've created these silos, right?

Well, that's really the fundamental issue with medicine, right? Is the subspecialization, the specialization, the dividing the body into parts and geography and specialization based on that, but it has no scientific rationale. Like when you actually look at how the body is truly organized, it's one integrated ecosystem. And it's not a bunch of separate different parts that have no relation to one another. They're all doing- It's so connected. It's so connected. It's really connected. And the microbiome is, I would say, the best example of that. And in the functional medicine world, it's always been the place we start. When anybody comes in with almost anything, we optimize their nutrition and we fix their gut. Now, when I say fix the gut, most traditional doctors, well, I don't know what you mean. Like, take a laxative if you're constipated, take Imodium if you have diarrhea, if you have a parasite, take a drug. Like, people don't know in the medical world how to optimize the microbiome. That's why it's ignored. It's not taught. It's people don't understand how to regulate it.

And it's possible and it's doable. That's what we do every day in functional medicine. It's inherited the microbiome. So you pass on the skeleton of the microbiome to offspring. Antibiotics and C-sections save lives. We've both seen that. But they're massively overused and they're messing up the microbiome in ways we don't even appreciate. And people are being given options without really knowing what is potentially happening because of this. Now, I don't know what causes autism. Other smarter people may have ideas. But the researchers that did this study, and they're not no-name researchers, talking to Marty Blazer, who I think is the world expert on the microbiome. Missing microbes, yeah. Missing microbes, great book. told me that while they did not find an association with altering the microbiome and autism, they believe there is an association there. They think maybe they haven't sampled enough children or something. Now, I don't know if he's right, but if he's right, that is a massive signal in the data that we should be following.

Well, no, it's true. I mean, it's not surprising. You look at the data on autism, almost all the kids have some kind of gut issue. They have bloating, they have distension, they have sticky smelly poops.

Really? I did not know that.

Yeah, it's really common. I mean, it's really out there and it's in the literature. And I can tell you if you talk to parents with kids with autism, they all have gut issues. And it's not sort of a red herring finding, it's a core finding. And about 75% have altered immune systems. and inflammation. If you look at the brain of kids with autism, they're bigger on MRI. This is work done by Martha Herbert at Harvard. And there's also, if you look at kids who've died from some accident or something who had autism, their brains are all full of inflammation. Their microglia, which is the immune system of the brain, are all just on fire. And when you look at the history, and I've treated many, many, many dozens of kids with autism over the years, the stories are almost sort of universally similar. The kids, you know, have born by C-section they're not breastfed, they get lots of colic, they get antibiotics, they got eczema, they get earaches. It's like. And then they get piled on with tons of vaccines. Not saying vaccines cause autism, but, like, it's just a lot for these kids immune systems.

And then something flips. I'm chuckling a little bit. I mean, I love what you're saying, but I'm chuckling because I had this kid come in, a teenager who had the classic sort of irritable bowel, chronic abdominal pain, no one knows what it is, has had a million tests done, it doesn't show anything definitive. And I decided to take a lot of time with something we're not incentivized to do. It took a lot of time.

You mean it took more than eight minutes with the patient?

Took more than 20 minutes. I listened to the patient, I didn't look at the EHR. And it turns out that the kid had that same profile. born by C-section constant antibiotics unnecessarily, it sounded like, throughout their early childhood, especially in the first three years when the microbiome is being formed, and had eaten terrible food their whole life. And then the mom tells me this, you know, this condition, which we just give this diagnosis of irritable bowel, how could this possibly happen to my son? Well, you know, I wasn't there when you got all these choices, but you've also been feeding the kids shit for the last 12 years. And so we're shocked. And then we have this massive whacK-A-Mole medical industrial system that's gonna order millions of tests and put the kid on some kind of IVIGG or some kind of Ketruda. It's like, can we talk about root causes?

Root causes, exactly. And the antibiotics are prevalent. I gave a lecture about 500 people on Aspen Institute last week. And I asked, talking about something I think similar to this, I said, how many of you in the audience have never had antibiotics and not a single person raised their hand? Right. So, and if you look at, for example, there's work done on Bifidobacterium infantis, which is a really key, important keystone species that proliferates in an infant. It's supposed to be there, but if the mother's taking antibiotics, it will, it's very sensitive, it will get wiped out. and this is important for the development of immune tolerance, for the prevention of allergy, autoimmunity, eczema, inflammation, asthma, all these conditions. And there's actually a company that's been funded, I think hundreds of millions of dollars called it. I think it's the name of the company, but the product is Vivo, E-V-I-V-O. And it's basically a baby probiotic that you can give to the baby. And the thing that's unique about it is that it colonizes because when you take any probiotics as an adult, they don't really stay. They kind of go through. They have an impact. but it's like tourists going through an economy. This is actually building a house. And it's quite amazing how it prevents a lot of these conditions.

That's what we need research on.

There's a lot. The thing is that there's a lot. If you people say, oh, we will practice evidence-based medicine. Have you looked at the evidence? There's like 10 million articles on PubMed. Have you actually read all of them and you actually know what you're talking about? Because this sort of veil of evidence-based medicine often is a sort of a smoke screen for people not knowing all the data and saying just because they don't know it, it means it's not true. And I think that's unfortunate because like you said, when you start to look at the research of the microbiome, you found so much.

I saw a trial in China where they're treating autism with combination of bacterial therapy or basically probiotics. Fecal transplants. Fecal transplants and Shepherd Pratt affiliated with my hospital, Johns Hopkins, is doing a trial with probiotics and bipolar to treat bipolar. So it's like, this is, you know, we, how much have we spent on cancer and we, what have we gotten for it? Almost nothing. The ROI is almost zero. I mean, the top paper at ASCO, the cancer meeting, was like, oh, if we use Avastin for GBM of the brain, you can get another- Couple months. Couple months, no added cure, right? So anyway, I love what you're saying, 100%.

Today's episode is brought to you by BiOptimizers, a company dedicated to enhancing your health naturally. They believe that a deficiency in magnesium, one of the body's most critical nutrients, can cause a host of health problems and that supplementing with magnesium can significantly improve health. I couldn't agree more. That's why I'm thrilled to tell you that they're offering a bottle of their top-notch supplement, Magnesium, is a master mineral that powers over 600 chemical reactions in our bodies. Everything from hormone balance and stress management to sleep quality and digestion is influenced by magnesium. Yet up to half of Americans are deficient in this nutrient without not even knowing it. Supplementing with magnesium can be an antidote to stress. It can help improve your sleep. So why wait? Start taking regular magnesium supplementation today and see the results for yourself. And right now you can get a bottle of magnesium breakthrough free. Just go to magbreakthrough.com slash hymen free and get your bottle of magnesium breakthrough for free today. That's magbreakthrough.com M-A-G-Breakthrough.com slash hymen free H-Y-M-A-N-F-R-E-E. Did you know that most Americans are deficient in not just one, but several essential nutrients? It's a big deal because nutrients drive all the biochemical processes in our body. And that's why I'm excited about bioavail multi from adapt Naturals. It's not your average multivitamin. It's created by my friend and functional medicine expert Chris Kresser, and it contains over 40 essential vitamins, minerals and phytonutrients in their most bioavailable forms. From methylated B vitamins to 3, 000 International units of vitamin D3 to full spectrum K2 blend, to chelated forms of magnesium and zinc, bioavail multi is Rich in the essential nutrients that so many of us are lacking. Plus, it has 11 different phytonutrients from sources like broccoli, blueberry and Elderberry. It's like taking a multivitamin plus Reds and greens powder in one supplement. So here's an exclusive offer for my listeners. Get a free pouch of Bioavail Organ, another nutrient powerhouse from Adapt Naturals, when you subscribe to Bioavail Multi. Visit adaptnaturals.com/pharmacy with an F and that's adaptnaturals.com/F-A-R-M-A-C-Y. So I want to go into like a kind of related but a little bit of a touchy subject, which is the subject of vaccines. And it's one of those subjects that is so confusing to me as a doctor, as a scientist, because science is about asking questions.

You can't ask questions about that.

It's about having a hypothesis and proving it negative. That's kind of the basic scientific method. And if you question anything at all about any vaccine, you're immediately able to be an anti-vaxxer, and you can't say, well, Is this vaccine safe? Is that vaccine safe? What are the risks and benefits of each one individually? What about them combined? And it's just the weirdest thing. It's like heresy. And I experienced this personally, like at Cleveland Clinic when I was there, somehow because people thought I was anti-vaxxer, the pediatric department got very upset.

I didn't get that label and so on.

And I literally had to write a letter like, no, I'm not. I've been vaccinated, my kids are vaccinated. But it's important to actually ask questions about this because if there's signal somewhere that there's an issue, we should look at it. And you wrote a very courageous paper that you co-authored in Journal of Medical Ethics. And it was talking about whether or not we should be giving vaccine boosters to young adults going back to school. And you basically said that in a survey of all the data, and I'll let you unpack it, but the punchline was that the risk of getting it was worse than the risk of not getting it. And I wonder, one, can you tell us about that study? And two, what has been the reaction? And have you been now labeling any vaccine?

Yeah, sure. I've gotten that label a little bit for questioning the booster vaccine in young healthy people, especially who have already had COVID. So the question is, with the vaccine, booster in young healthy people, is there a benefit? And there was so much controversy, and I saw how at the FDA it was pushed in with the political might of, you know, a top down order that it made me ask some questions. The two top vaccine experts at the FDA were fired, directly fired by their superior for questioning the COVID vaccine approval for young, healthy people. That is the booster, the booster, not the original. So the CDC never released the data and only the data we had was observational. The clinical trial data on the booster was basically just reamed through. They didn't go through the normal process. So then when you look at the risk of myocarditis, not to mention the other claims that are out there of people being messed up or injured or not the same, after the vaccine. Again, high-risk people, early in the pandemic, it was very clear the benefits outweigh the risks. But when you get down to young, healthy 12-year-old girl, does she really need six COVID vaccine doses in three years?

We really need to make a profit.

Well, they weren't too happy with me. Moderna constantly has people at their company trying to reach out to me. and so what is the risk of myocarditis of the COVID vaccine in a young healthy of the COVID booster in a young healthy person? I ask that every time I'm engaged on this topic with someone who's like, how dare you not support the vaccination with the COVID booster in young healthy people? What is that risk of myocarditis? It's one in 2200 to one in 2800 heart injury from myocarditis. One person in a study of about 2000 died in an ICU. Two others were admitted to an ICU in the New England Journal. This is the New England Journal. It's not like I'm making it up. So on a societal level, is there a net benefit or a net harm to giving the COVID booster to a young healthy population? It's a net harm. If we actually do the math, it's a net harm. Small harm, but to mandate it, to force, you're gonna create never vacciners by doing that. Right.

I mean, in your study, you basically looked at it over 40,000 people, young adults, and found to prevent one COVID hospitalization, you would have to trade that for 18.5 serious adverse events from the mRNA vaccines, including the myo- and pericarditis.

We don't even know if that hospitalization, that's based on data where we don't know if the hospitalization is for COVID or with an incidental COVID positive test.

Yeah, but you're talking about like you have to vaccinate you know, 40,000 people to prevent one hospitalization, but you get.

18 serious side effects.

You got to burn the village to save it. That's a problem. And so what's been the reaction to this article that you published and to this view? Because it's like you can't have this conversation. It's like you're not allowed to have this conversation in medicine. And so how have you been able to still have a position at Johns Hopkins?

They've been great, actually. Hopkins, the School of Medicine has been terrific. My dean, asked me to present to all the other department leaders, along with one or two other infectious diseases experts. And my dean said, I know you have a slightly different perspective on COVID and the vaccine booster in young healthy people. So I'd like the department leaders at Johns Hopkins to hear both perspectives. And we had a wonderful dialogue. I've been active there as a surgeon and public health researcher for over 20 years before COVID so they knew you.

Were in a nutshell.

Yeah, they knew I'm a reasonable guy and I work hard and I mean well and I love this country. So I didn't get that kind of anonymity based accusations you see on Twitter. Did you convince them? I don't know. You know, you have people privately come up all the time to me. I don't know if you had this happen, we're like, Marty, I love what you're saying. I love, keep going. I can't say anything, but you keep, that's perfect. Right, right. what are you afraid of? You know, too many people are afraid of speaking up.

It's still happening in so many areas of medicine. I was like, how many doctors, in an audience, how many doctors here take vitamins and almost everybody raised their hand. How many doctors recommended their patients and half their hands go down?

Exactly. All right.

The other thing you talk about, this whole idea of the GLP-1 agonists, and they've been around for a while, some of them more than others. And we're in this moment where we are in a metabolic crisis in America. 93% have poor metabolic health, which means they have some degree of insulin resistance, pre-diabetes on the spectrum, even if they're normal weight, because they ate too much crap and sugar and ultra-processed food. You know, 42% are obese. And these drugs seem like a panacea. Wow, this is a miracle drug. Give this shot once a week and like lose weight and everything's gonna be great. I'd love to hear your thoughts on this perspective of kind of widespread use, Medicare coverage they're talking about, insurers covering it, you know, there's new study after new study coming out. And I just want to give a little, little background on this, showing that, and here's my belief, and I don't really have any evidence to back it up, but it's like, I see a new study almost every day about the benefits of these GLP-1 agonists coming out in major journals. It works for heart disease, it works for depression, it works for this, it works for that. You know, it seems like everything. And now in my head, I'm like thinking, is it the GLP-1 agonist or is the weight loss? Right? And in a bariatric surgery study, they looked at, for example, what the difference was because, oh, bariatric surgery can cure diabetes in two weeks. And they basically did bariatric surgery on one group and then no bariatric surgery on the other group, but they fed them the exact same diet that the bariatric surgery group ate.

They also reversed their diabetes in two weeks. No difference. Yeah, sometimes out of the operating room.

In the recovery room, we noticed the requirements go down. Right. Right, but what I'm saying is even without the surgery. Without the surgery. So, is it the GLP-1 or is the weight loss? And there was a guy I met recently named Sammy who started a company called Virta Health which uses ketogenic diets to reverse diabetes. And he said they've actually done the study where they've actually looked at this and they found it wasn't really the GLP-1, it was just the weight loss and the improvement in metabolic health as a result of it. So, I'd love to hear your perspective on that because you know, it's hard to, to learn how to eat right, and it's hard how to do it. And, yes, everybody wants that easy fix, and it is appropriate for some patients. But, you know, I know people who want to lose 10 pounds for the bikini, and I'm, like, thinking this is not a good idea.

So can you tell us your perspective on that? Well, one thing that is a theme in blind spots and a theme in, in the research I learned was that if somebody puts something out there with such absolutism, when the scientific evidence is really inconclusive or there's a lot of opinion, we just don't know what the long-term effects of GLP-1 are, for example. They just haven't been around long enough. How can you say with such absolutism that there's no long-term downside? We may see a benefit in the short term with some of these chronic diseases, but we may be accelerating frailty, which is basically- Loss of muscle mass. Loss of muscle mass. And that is, as you know, the number one predictor of longevity is muscle mass. And that's why we want people to be active when they're older.

So.

We don't have that data and people are acting as if it doesn't matter, it'll go the way we want it to go. There are bacteria in the microbiome that produce GLP-1. Yeah. And maybe we should be talking more about- Probiotics. Having a very- There is one. Yeah, maybe we already make some. So it's like, how can we not crush that? We're on a path of having every eight-year-old in America on three or four medications. It's scary.

When they're children or when they're adults?

When they're children. I mean already half of America are taking chronic medications and the average number is four. Once you get over 65, it's like you gotta have these boxes to remember what to take. Medications save lives, you and I have seen that. that's part of the medicine we're trained in. But we're gonna convert America's children into a generation of patients. Maybe we need to talk more about school lunch programs than putting every kid on Ozempic. And that is not a conversation that we're having. We're just sort of celebrating, Hey, high five, we found a way to create a GLP-1 agonist. We'll see about these new generation GLP-1 drugs that have a blocker on the muscle receptor, supposedly. They're going to enter clinical trials soon.

Yeah. So to prevent the muscle loss.

Yeah, prevent it or reduce it. Maybe, I mean, I believe in impeccable objectivity, changing positions as the data evolves. Right now, I have serious concerns about just giving out GLP-1s like candi.

For side effects wise, or just beyond the muscle loss.

The acceleration of frailty, the muscle loss, there, some people don't do well with the profound loss of muscle. So, you know, there have been studies that have looked at weight, and it turns out that fluctuating weight all the time is worse for you than staying over. That's right. That's right. So are people going to be, I'm doing better now and I don't need it. I need, I'm going on this vacation. I'm coming back. It's like, that's not, that's not good medicine.

No. And I, and I, I don't have that many patients on these GLP-1 agonists. But, you know, I'm seeing side effects. Like one person had pancreatitis the other day.

Yeah. Known side effects.

I mean, this is a 900 increase in the risk of pain. I mean, never see pancreatitis unless you have somebody with a serious problem. And see from a drug like that, it's very concerning.

That's just.

You're a pancreas surgeon, so you get on point. The pancreas. You love the pancreas. You love the pancreas. So this is.

This is.

It's concerning to me, and I think the perverse incentives in medicine. are driving this kind of crazy trend. And in your book, you also talk about sort of the blind spot around the way we do research and the profit motive in research. And when I entered medical school, I thought science was this sort of ethereal thing which was pure and independent and completely objective and just like, you know, just had this kind of halo around it. And what I realized is that science is really friggin corrupt. And that, and I was at a Passover dinner with my, with my, one of my cousins and their husband, I was like, what do you do? And he's like, well, you know, I I I I am a contract research organization. I run contract. I'm like, oh, really? What's that? He says, well, that's where pharma companies pay us to find experts in different domains and then fund the drug studies, do the studies, write the paper, and then we pay them to put their name on it.

Like a super PAC.

Yeah, and I'm like, really? I mean, this is not right.

Corruption.

It's so corrupt. So can you speak to that in And the challenges around the sort of the peer review process, the weaknesses in that, how do we address this whole phenomena? Because it's, you know, there's so much conflict of interest in medicine and it leads to like the massive funding. So for example, if the amount of money that was now going into GLP-1 research was going into food is medicine research, Right? We would be showing phenomenal outcomes if we did the right kind of research. Right? So how do we deal with this?

I do think everyone that goes into medicine is going in it for amazing reasons. And one thing that unites everybody in medicine is everyone has a sense of compassion that drew us into this calling. So we've got good people, but we walk into a bad system. And it's not a system we designed, it's a system we inherited. But we shouldn't defend it. It's entirely broken. We have a bloated NIH that funds research worse than the government funds the Postal Service. We have silos.

That's pretty bad.

There's a small group of people making all the decisions at the very top. These are folks where we need term limits, the folks where they decide what's important or not important, and it's based on their understanding of the world. Medical school education at every school in the United States is controlled by 19 people that serve on the board of a private company that determines the curriculum of every medical school in the country. And if you want to do something creative, talk about food or inflammation, you gotta get back in line.

Is this a company that creates the.

Licensing exam or is this- AAMC, they run the USMLE. And so these, you know, I've talked to deans of medical schools that have said, Marty, I'd love to talk about this stuff. All this stuff you talk about, all these stuff that are in the blind spots of modern medicine, and they say, We can't. the students know exactly what their learning objectives are for the boards. And if we teach something else, they're gonna skip that class, and they're gonna focus on memorizing and regurgitating the 55 enzyme names they have to spit out on an exam. Why are we forcing our youngest, brightest, creative, most altruistic minds to regurgitate the names of enzymes that you can look up on a smartphone?

Right, right.

And so we have this, System now where a small group of people are controlling medical education, a small group of people control where the NIH dollars go, and who are funding the big questions central to health? For example, there's a new practice that's taking off of cutting the tongue under- Frenulum, yeah. the frenulum under the tongue. Sometimes they'll even do the side of the tongue or the frenulum under the inside of the upper lip. It's crazy to me. I have ENT docs that say there's a subset of kids that may benefit from this.

Well, if you've got your tongue tied, fully tongue-tied.

If it's truly a foreshortened tongue, they believe there could be a benefit. It's never been proven, but they do believe there's clinical benefit. But then they say going to the upper lip and the side is crazy. They also say we need a good study on it. Well, there's a group of people out there that are calling every kid tongue-tied doing it routinely. Who's gonna... this desperately needs a randomized controlled trial. Who's gonna fund it? Pharma? No way. NIH, not in one of their silos, American Academy of Pediatrics, unlikely.

And so this practice will- Moms against fenulum cutting.

Maybe, sometimes it is the advocacy groups, the philanthropists that fund research. Most of our research at Johns Hopkins on my team, which is, we call it the redesign of healthcare, it's on all the major topics in medicine that we are not talking about that we should be talking about. and we are a rapid response team. When the opioid epidemic hits, we go to work in days. When COVID hits, we go to work in days. The old NIH, you know, take a couple years, work on formatting a grant. They're funding these tiny incremental little, I don't even call them discoveries, like findings.

Yeah.

Like, is it interesting what the average size of stones are on the street? No. Is it research? I guess.

Yeah.

But we're funding these little dumb things and then the big questions go unfunded. So we think the solution is philanthropic funding, reorganizing the NIH, term limits at the NIH, and a small- For the.

Director of the NIH?

For all people who are in decision making leadership power over grants at the NIH. And grants, in my opinion, when I say we, these are my opinions. The grant should be funded when one reviewer loves the idea, then it goes into a pool and you could give out the grants randomly to when one person thinks that's a big idea that could be interesting, why do you have to have a consensus among the old guard establishment that yes, we're going to fund another study on stents?

And there's unconscious bias. I was talking to Francis Collins who's a wonderful man, really kind, good hearted man, brilliant guy, you know, who was the director of NIH. And I said to him, and I think I've talked about this on the podcast before, I said, France, why didn't you use COVID to educate the American public about the importance of nutrition in optimizing your health to prevent COVID? Because 63% of the hospitalizations and deaths from COVID were because of poor diet. And we know that we are 4% of the population in the world and 16% of the cases in death. He's like, oh, well, we couldn't do that because it would basically blame the victim and we don't want to do that. and in another meeting, I was like, no, it's not their fault. It's because we have a toxic food system. Talk about that. And then at another meeting, he got up and said, well, we don't really know that much about nutrition, and there's no National Institute of Nutrition at the NIH, and many other countries have this. And nutrition is the biggest cause of all the diseases we see today, period. No argument. All the science says this. and he got up and said, we don't really know much and there's not much data. And at the same meeting, Dr. Darius Mozafariyan was there who was the dean of the Tufts School of Nutrition, Science and Policy, is now the head of the Food is Medicine Institute there. He said, well, for instance, Dr. Collins, I beg to differ with you. And then he went into this long kind of scientific unpacking of the literature.

That we do know.

I was like, wow, you know, it's not necessarily malevolence. Sometimes there's just, oh, ignorance. Never. I'm like, wow. And also in terms of the medical school stuff, you're right about the licensing exam. And I think it's one of the things we're working on in Washington, my nonprofit called the Food Fix Campaign, is to change the licensing exams because that's what determines the curriculum. And my daughter's in med school now, and I'm like, have you learned about this? No, have you learned about the microbiome? No, have you learned about inflammation? Like all the things that matter.

She'S not learning about.

And she says, all you know is dad, I have to pass the test and I just have to study what's up for the test. And that's it. And I have the practice test, I have the questions, and it's like if there was five percent of the questions on nutrition and chronic disease, that would force the change in the curriculum. If there was five percent of the questions on the microbiome or on inflammation and health or like any of these things, on mitochondrial function and how to treat mitochondria, that's another black hole, right? I don't know a blind spot.

I don't know if you're talking about mitochondria. Yeah, it's a big blind spot, energy and mitochondria. I mean, it's essential, connected, you know, sort of universal theory behind health is that there are these basic principles of mitochondrial health, inflammation, nutrients, we have such a nutrient-poor diet, all the stuff you've been working on.

But next time you see Francis Collins, you can remind him that the H in NIH stands for health.

I know.

And that's why I say we don't have National Institutes of Health, we have National Institutes of Diseases. That's right. It's amazing. so how do you think that we can kind of reform the system besides just changing the term limits and besides, do we get pharma money out? Do we try to sort of have special barriers that prevent them from manipulating the science in the papers? I mean, it's like half the time what it says in the abstract isn't actually what it says in the data. Most people just read the abstract. There's all kinds of monkey business going on.

Yes, right? It's a monkey business, yes. Well, first of all, I think we insist on rules of transparency for clinical trials. Number two, if you're gonna opine about a topic, do a clinical trial. The amount of opining around topics that the NIH throws out there, oh, we don't have good data on this. Well, you control the $80 billion budget over there at NIH. We saw this all during COVID All the COVID controversies could have been settled immediately by them doing the proper clinical or randomized control trial on that question. All those questions, masking toddlers, natural immunity, The booster six feet. Do the trial. Isn't spread airborne from touching surfaces? In the summer of 2020, six months into COVID, the NIAID and Dr. Fauci, sorry I said something I shouldn't have said there, I mentioned his name. He was telling teachers. Is that okay? I know he's very, some people love.

Him, some people hate him.

I hate Dr. Fauci. I try to be objective, but so he was telling teachers to wear gloves and goggles in class. Do the freaking study. If you think it's spread by surface transmission and you don't believe it's airborne, do the study. You got the $80 billion budget at the NIH.

So one is increasing- He actually admitted that. He says, I just made this stuff up. I just made up the six feet thing. I just made up the mask thing.

I just made this stuff up. I'm like, wow, okay, well, thanks for telling us. I think one of the biggest propagators of misinformation during the pandemic was the.

United States government itself.

And it's not new, the food pyramid.

And- and it wasn't just Trump saying put bleach in your veins.

It was more than that.

Yeah, it was the actual NIH.

It was the actual CDC. And it's not new. Peanut allergy is the same thing. We give people the wrong guidance. There's so many recommendations that people should be able to ask questions. I'm not saying be cynical. I'm not saying don't trust your doctor, but people should be able to ask questions. So if Pharma does a study, regardless if that study goes their way or not, we should get the results immediately. Okay, that is a basic new principle of transparency we need to adopt in the United States. When Paxlovid, just as an example, the antiviral used made by Pfizer to treat COVID, when that came out, the government recommended that for everyone. They promoted it. It was one of the biggest public health campaigns of the last year and a half of the pandemic. A study came out in the New England Journal of Medicine just a number of months ago that showed zero benefit in people under 65, none. Zilch. The study, now studies go different ways and that's the way science is, but the study ended nearly two years prior. If you look at the actual tables, the results were, the study was done. Why did the public not see it for nearly two years? Because it didn't go their way. COVID vaccine booster goes their way, they tell you before anything's even published. Just a press release and it's a CDC recommendation.

They got a full page ad in the New York Times. Yes.

So this is the type of trial level transparency we need. And we got to do it now because otherwise we need better funding in academics, we need more civil discourse in medicine, we need less cancel culture. Yeah.

And so, yeah, it's so true. It's so true. You know, just like we totally agree on everything here. One of the things that shocked me that I found out, you know, because as a doctor you think, okay, well the literature is published, they're publishing all the data on a particular drug or a particular intervention that they're studying. And it turns out that pharma has to present all their data to the FDA, but they don't have to publish all the data. And typically they only publish the positive data. They don't publish any of the negative trial data.

That's right.

And so the public has no clue that there's all these other studies that contradict the one study that showed that it was positive. And the FDA is a captured agency because it's like a revolving door for pharma and pharma leadership. And so it was sort of shocking to me as I sort of, even as a doctor that I found this out, I'm like, what do you mean? They don't publish all the data? They just hide all the negative data.

Yeah, you can do that.

Yeah. yeah, and that's how it is. So for people listening, you've got to be smart on your own, and you've got to be your own advocate, and you've got to be proactive about your health, and you've got to not just take things at face value, and you got to do a little digging. And now with AI, it's going to be easier and easier with Dr. Chad GPT, it should be Dr. Google, but not always right, but it's at least a good start. One of the things you also talk about in your book was this whole idea of blood tests that are not being ordered that everybody needs. And I thought that was really intriguing because I just co-founded a company called Function Health, to which is a health platform allows you access to your own health data and lab testing without having to go through a doctor or insurance company. And you get, you know, for 4.99, you get over 110 biomarkers would be fifteen thousand dollars retail. And there's been huge consumer interest. We're like 60, 000 members in the first year. And we had 10 million biomarkers. Fascinating. And, and it's, and we're doing a lot of tests practically. Now, you and I know, went to med school, we're like, only test to confirm. a diagnosis that you've already made through history, right? Diagnosis, history, history, history. And yet you're saying maybe we should be reconsidering this because there may be things that we can do proactively and practice more proactive, preventive, predictive medicine than reactive medicine. Can you tell us about what you're thinking there and what these tests are?

Yeah, so a buddy of mine, Will Bruin, just graduated from medical school at I don't know if I should say that school, but it's in the South. And he basically said he got two hours of teaching on all of nutrition and cholesterol and lipoproteins, basically. And in those two hours, and he got eight hours on a bunch of nonsense that he can't, you know, the disparity is unbelievable. The two hours on nutrition, he said it would have been better not to have those two hours because there was so much misinformation in him. All that was HDL is good, yeah, exactly. Go forth, preach to the world, check their total triglycerides. Turns out lipoprotein A and apoprotein B are very good predictors, at least better than the current old crude predictors of people that have early heart disease looking for general body inflammation. The tests aren't great, but I get a highly selective C-reactive protein, said rate, not very good, but something. So trying to measure general body inflammation, the deposition of the types of lipoproteins that result in that plaque buildup.

And when you put that together- And then lipoprotein fractionation?

Yeah, lipoprotein fractionation, the high density particles, LP.

So looking at the quality and number of the particles, not just the weight, which is what you get on a regular cholesterol test, which in my view should be banned.

It should, it's such little useful information. It's misleading.

It is, yeah.

And when somebody has an early heart attack in their 40s or early 50s, and it shocks everybody. Sometimes we'll go back and get that test, and it turns out their LP was up or their apo protein was up, even though the other numbers showed that things were okay.

Yeah.

So next time somebody gets a set of lab tests, I usually tell them, make sure that you've got that tested for at least once. LP, at least once. It's a lot. Genetically driven. 99 of cholesterol is made by your own body. and so these are some basic things that people can test for. And then I'm really fascinated with the micronutrients and allergy testing and that's something where you've got more expertise than I do.

Yeah, yeah, right, true. You mean true allergy IgE or you mean more food sensitivity testing?

Food sensitivity because.

And nutritional testing.

Nutritional testing because we've had this dogma from the American Academy of Pediatrics starting 24 years ago. that don't feed young kids any peanut butter related stuff, milk, eggs. There was this one, two, three saying, have you heard of this? Your kids should get milk at age one, you can introduce a little bit of eggs at age two, and then peanut butter at age three. Well, yeah, it's so backwards. Peanut butter should get introduced a little bit, not in place of breast milk, but a little bit at age at four months, five months, six months, as soon as the kid can eat. The studies have even shown that five months prevents peanut allergies more than introducing it at six months, four more than five. And so there's a strong association with what we call oral tolerance. And that's what the American Academy of Pediatrics got perfectly backwards when they told lactating and pregnant mothers, Total peanut abstinence for you and kids zero through three, they didn't prevent peanut allergies with that recommendation. They caused them.

So we have evidence-based medicine for the things we want to say we prove, and we, for the things we have no evidence on, we say them with such authority that they act like they have evidence, but they don't.

Well, that's the thing. If you're gonna put out a strong recommendation, either say, you know, this is based on just me shooting from the hip here, I don't know. or reverse it once the study comes out showing that it was wrong with the same vigor that you put it out. When the study came out in the New England Journal, 2015, what's that, nine years ago, showing peanut avoidance causes an eightfold increase in peanut allergies. Say, gosh, we got this so wrong as an academy. We need to tell the world. Instead they kind of fade out. You get the low-fat diet wrong for 60 years, they kind of fade out, you know? get hormone replacement therapy wrong, just kind of fade out.

Where's the humility? Yeah, yeah, right. Oh, sure, we got it wrong. Like, let's, let's, may I help, like, let's, let's set direct. Right. It's crazy. And, you know, the test you mentioned, the, the Apo B, which is a, really a measure of, of small, dense particles and all the bad particles that cause heart disease and LPA, which is a, a marker that's genetic, but also increases your risk, the particle size and the number of lipoprotein fractionation, the sense high sensitive CRP. these are all tests that are just part of the standard function health profile. And we also test all the nutritional stuff. We're finding that 51% have abnormal ApoB. We find that 89% have abnormal lipoprotein particle size and number. We find that 46% have elevated CRP. This isn't a health board population. And 67% have a deficiency in one or more nutrients. and this is not at the level that would be optimum for health, but the minimum to prevent a deficiency disease. So a ferritin of 16, not an optimal ferritin of 45, for example, or a vitamin D of 20, not an optimal vitamin D of 50. And so we've been fighting this in the population and so I'm a big advocate of test don't guess and of knowing your numbers and of actually being proactive about optimizing them because they may not that cause an immediate issue. But there was a brilliant scientist, Robert Heaney, who was now dead, who was a vitamin D researcher. And he wrote an article a long time ago called long latency deficiency diseases. And it was fascinating because he talked about, well, if you have, like, you know, acute, you know, folate deficiency, you'll get megaloblastic anemia, which is a certain type of anemia. But if you have, like, low grade, like low folate, you might get dementia. Or if you have like, you know, a little bit low on optimal vitamin D, very low, you'll get rickets if it's acute deficiency. But if it's a little over your lifetime, you'll get osteoporosis, long latency deficiency disease. And he goes over nutrient like this. And it was fascinating to me. It really changed my thinking about being more proactive because you're optimizing the body systems and they all have to be functioning. And it's amazing to me how many doctors don't even think about this, don't know about it or aren't educated about it. and I mean, you've been asking my daughter, you learn about lipoprotein fractionation in medical school, which is like, should be the gold standard. I mean, I shouldn't be telling these tales, but I was at Cleveland Clinic and there's a doctor there who, wonderful man, but he's older and he developed the executive health program. I don't think he's there anymore, but I met with him and I said, listen, you should update the executive health program to include the lipoprotein fractionation. Yes. Because it's a much better representation of cardiovascular. You have someone with a normal, perfectly normal cholesterol under 200, their LDL under 100, 100, they're triglycerides normal, HDL looking like 45-50, everything looks great, but they could have the worst particle size and density that you could imagine and be at very high risk. And he's like, well, you know, we only like to introduce things after we have a lot of research. I said, well, this has been around for 40 years. I've been doing this test personally for 30 years. Ronald Krauss developed this. It's been around, yeah. And he's one of the most brilliant lipidologists in the world. I'm like, you know, this is so slow to adopt actually the science into what we know. And people are suffering because of it. And that's kind of why I think, you know, some of these things can be solved from the inside, but like you said, some of this has to be solved from the outside. We need, you know, we need philanthropy, we need, you know, better policy regulations, we need better, you know, reimbursement around medicine that pays for the things that actually work, like food is medicine. You know, we need to have companies from the outside changing things from the inside. So it's pretty, it's kind of an exciting moment, but like you're like, you know, like, you know, the Wizard of Oz when the curtain gets pulled back, you're that guy. You're like, you're the guy pulling back.

The curtain and there's like this little.

Old guy back there with no pants on. Emperor has no clothes. Yeah.

And it's quite amazing what you've done. Well, you know, I go around, I talk to so many experts and I ask them, is there dogma in your field that is wrong or has been proven wrong or you believe is wrong, but it's still so heralded out there as science when it's really just the way we. It's been done. It's just sort of custom. And they start unloading and they start telling you things. And actually, the lipidology Community has evolved entirely independent of the cardiology Community. So the cardiologists kind of claimed lipid science at a certain point, but the lipidology community is like, hey, wait a minute. We've been studying this for a long time with hyperlipidemia. and they have very different views on things. So for example, Lp(a) testing was recognized in the lipidology community as saving lives, as you mentioned, but not in the cardiology community because all their tests just use the crude LDL. So I went to the head of the cardiology lipid center at Hopkins and I asked him, I said, I've been reading about Lp(a), seems like it should be this subject of a massive universal public health campaign to get everyone to get it done. It'd be a lot better than trying to get a defibrillator in every bathroom in the mall, which is actually a real campaign, Hopkins champion. Saves lives for sure. Saves lives, but here's something that's so-- that heart disease is the number one cause of death. So he acknowledged, yeah, there's some new research and we did put it in our new guidelines. I'm like, you know what? I read those guidelines, American College of Cardiology, It was a footnote. Where's the enthusiasm? Where's the vigor? It's just like molasses sometimes.

Yeah, well, because there's no good drug for it, right? I mean, there's plasma pheresis, there's certain supplements at work, sometimes the PCSK9 inhibitors lowered a little bit. But it's a harder to treat problem. And we're very, very excited about testing things for which we have great drugs because the pharmaceutical companies make it easy for us. They do all these studies, they have their drug racks come, they have great commercials that tell the patients what to ask for.

There is a drug in phase three clinical trial that targets lipoprotein little A. So we'll see what the results of that show. But I wonder if those are the people you want to just be more aggressive on maybe and track. Maybe you get the cardiac CT angiography on them instead of just a calcium score. Those are the ones well, with functional.

Health, we had a young 35 year old who did the test and he had high ApoB, he had high LPA, he had really horrible lipid particles, the rest of his cholesterol, normal cholesterol profile looked pretty good. And, you know, he was 35 and we sent him for a CCTA, but coronary angiogram with a CT scan, but we added the AI interpretation with a test called Clearly. I don't know if you've heard of this test, have you? No. It's really amazing because you actually can see soft plaque inflamed plaque, not just calcified plaque, and you get a much better read on every artery. Found a plaque?

You found a plaque?

Yeah, and this guy's 35 and he's heading for a heart attack and he had no clue because he was thin, he's healthy, he's fit, he exercises, he eats great. It's like some genetic thing going on. And so, we're often kind of walking into our futures without any idea of what we're heading into because we're not taking advantage of the latest science. and, and, I mean, I wrote a book, like, more than 20 years ago, where I was talking about Apo B and LPA and CRP and testing insulin. I mean, insulin's another one of those tests. You know, thank God, Quest now has a test. It's called the insulin resistance score, which uses mass spec to measure insulin C-peptide, which is a. I mean, you're a pancreas guy. I don't tell you, but it's. Yeah. And telling the audience, it's, it's the precursor of the insulin molecule. And, and when you get this ratio, so it's as good as what we call euglycemic clamp test, which is the gold standard, it's very invasive test that you do in the hospital for insulin resistance, but it's as good as that test and it's cheap and it's something everybody should get because it is the biggest driver of cancer, heart disease, diabetes, dementia, and even linked to depression and fertility, acne and a bunch of other stuff. Even low sex drive and erectile dysfunction and I mean, you name it. And yet, nobody's doing that test. I mean, I asked Quest, I asked Quest, like how many people are getting lipoprotein fractionation? like less than 1%. How many people are testing insulin when they were doctors order insulin has less than 1% of our tests.

I'm like, tell them we don't need AI. We just need I. We just need some.

Oh, my God.

Basic.

Well, actually, I actually talked about this. I don't know if it's not right. Maybe in your wheelhouse, you can tell me, but I've kind of come up with this new concept, what I call am I? And not am I like heart attack, but am I like medical intelligence, which is something we don't have. We have a single doctor that you rely on for his own experience, however smart they are, whatever they've learned, whatever course they went to, whatever school they went to, whatever residency they went to. Like, that's what you're getting. And, and they haven't certainly read all 10 million papers on PubMed. They certainly haven't read every textbook and article about every disease. And, and you're, and you're kind of relying on their Goodwill and intelligence and kindness to figure out what's going on. And, and, you know, we do a pretty good job most of the time, I would But, you know, it feels like we're entering this moment in healthcare where we're going to be able to draw through technology all the world's scientific literature that it consumed, every single textbook, you know, up to date, all the latest medical knowledge, patient reported data, all their lab data, all their omics, all their imaging, all their biosensors and wearables, all their medical history to track it over time, you know, what Lee R. Berthold calls dense dynamic data clouds of information. that give you personalized predictive models of where you're headed and what to do about it. To me, you know, having that, being able to sort of inquire to that, that your own data set about what what's really going on and see those patterns and correlations that, you know, the average doctor is going to miss. I mean, would you rather have your dermatology exam by, you know, an AI computer or by a dermatologist? Like I went to a dermatologist and I'm a doctor. I know I had a pre-cancerous lesion. and he completely missed it. And he was like the head of, you know, I don't know, dermatology at a major academic, you know, medical school. And I was like, I'm gonna go.

To the top guy and get him.

A Dow Professor. Anybody. And you know, he looked at me, like, turned me around, looked with his eyeballs. I'm like, no magnifying glass, no lights. I'm like, God damn, I know better than this. And I was like, just walked out, so disappointed. And I'm like, you know, so what do you think of this idea? And could this really change things? Because then, all of a sudden all the things you're talking about will bubble up. The pharma and medical industrial complex won't be in charge anymore because you've got free access to data and information that's been locked away.

I tell all our Johns Hopkins students and residents that what will make you a great doctor is knowing your limits. It's your humility. It's saying, I don't know when that's the right answer. And that was the right answer during COVID a lot of times we didn't hear it. so when I talk to a pediatrician and ask them about peanut allergies, you'll have somebody who will just recite a catechism. Well, according to the guideline of the American Academy, you know, somebody else will think independently and creatively, and they'll say, you know, there's a guideline out there, but there's this study, and I've heard doctors suggest this, and my, this has been my experience, and I'm not sure. Or this is what one Mentor thinks. This that is a creative, that's a doctor you want, doctor who thinks independently and isn't just, you know, falling in line with some dictum that says everyone obey and, and, and get in place. When we as a medical profession have used good scientific studies to make broad health recommendations, we shine. We help a lot of people. But when we wing it, when there's broad health recommendations made by a small group of people, people who are just ruling on it on an opinion and making it sound absolute like it's scientific data. We have a terrible track record. We ignite epidemics. We ignited the opioid epidemic saying opioids were not addictive. Pain is the fifth vital sign. Pain is the fifth vital sign. These are manufactured. The peanut allergy epidemic, you go down.

The line, even you could argue the low fat contributed to obesity rates.

The low fat.

I don't think you can argue that. I think it's pretty much a fact. You don't need AI, just die for that. Yeah, no, it's true. And then we get stuck and don't want to say that we made a mistake either.

That's the key. That's the key. And patients are very forgiving if you're honest in real time.

Yeah, I was talking to a friend of my dad about that. If you're a doctor and you tell the patient the truth and you say, I don't know or I up, they're less likely to sue you than if you're just trying to hide what's going on. And we're kind of trained to kind of circle ranks and hide not telling each other. And I'm so impressed by you. You're actually out there saying stuff that I've been saying forever, but I'm like kind of, you know, on the fringe. You're in the center of the belly of the beast.

I've ushered so many people to the afterlife in the ICU and, you know, I've done a lot of cancer care that I'm constantly reminded how life is short. And these folks that are just afraid of what somebody's gonna think if you just speak your honest opinion. I don't think that's healthy and that's what we need more of.

And so in the policy realm, because you mentioned how your book really helped shift some policy around cost transparency. What are the other big levers besides fixing the NIH and putting it in national instant nutrition and funding the right research and getting rid of all the old cronies in there that just don't want to get the new science out there? What actually can we do on a policy level? Because I'm curious, I have a nonprofit that works on food policy. actually going to be doing a hearing in front of the Ways and Means Committee on September 18th in front of the health subcommittee that's in charge of all Medicare and reimbursement. You know, and like you were talking about, like, for example, about diabetes, and I had spent the afternoon with Sammy who started Virta Health, and they really deeply studied that they could save $6,000 per patient after costs by putting them on the program to reverse diabetes, and they reverse diabetes. which is not something the ADA even basically recognizes as something you can do. And if Medicare implemented this, overnight it would save $100 billion. It was like that, boom, because there's 16 and a half million people on Medicare who have diabetes.

So- Sami's the endocrinologist that started Virta?

No, Sami is an entrepreneur who is an elite athlete who found that he had metabolic syndrome because he using all these sports goos that are full of sugar to fuel his endurance athletes performances. And so he was like, what's going on here? And then he basically trained and did a cross the ocean row from California to Hawaii doing a keto diet and showed that you could do it.

He rowed from California.

Rowed like rowboat with his wife.

Wow.

Like rowboat guys hardcore. I mean, I don't think it's that safe. But it was hardcore. He said like 20-foot seas. It was pretty rough. But the point is I'm having this hearing and I imagine it's going to be very tough to get Medicare reimbursement for a program like that, even though the data is so clear, even though they've shown that it proves all the lipid parameters, it's sort of the opposite of what you'd think by eating only fat, right?

The policy world is tricky because there are so many things we can do without the government that we're not doing. For example, the Virta company that you mentioned, and I had met with the endocrinologist who was one of the, I think, co-founders or something and he showed me that data.

It was super impressive.

I think that was him. Yeah, super impressive data. Just like you said, this is clearly something we should be doing and it fits the whole, what we've known and seen on the ground as doctors for many years, and that is the hard part of treating chronic disease is not telling people what to do, it's helping them do it.

Behavior change.

It's behavior change. It's checking in with them, it's being their friend, it's going along the walk with them. If I tell, I see somebody smokes on their chart, I don't do what I used to do and tell you, yeah, you should stop smoking, you're gonna die. Now I ask them, you know, some.

People- Let's go outside and have a cigarette.

I'll tell you, we'll talk. Almost, I almost do that. I say, some people really don't want to quit, they don't want to talk about it, and other people really want to. Where do you stand? And whatever answer you say is okay with me. Most people say, I don't want to talk about it, and you're not gonna affect them no matter what. But then you meet somebody that says, I just had a granddaughter. I'm dying to quit. We should put all of our energy in to help them with medication, behavior, and that's what Virta is doing. It's saying if you want someone to help and go down this walk with you and help pick foods and manage your diabetes instead of just pumping insulin in, we're gonna be there for you. And those are the solutions that in the private sector, employers that pay for healthcare, what we call ERISA plans, employer-sponsored health care plans. They're saying, you know, I'm going to make Virta available to my employees at this company. I'm going to make Teladoc. I'm going to make, and they're piecing together what we call these point solutions. So now you can be creative and come up with a food is medicine program. You don't need to wait for Medicare and their 50 bureaucratic red tape steps. And you can go to work right away. And that's the exciting thing. That's why I'm so optimistic. about some ray of hope in this broken healthcare system because employers are standing up and they're saying yes to the challenges.

So their financial incentives are online. The privately insured large corporations who are footing the bill.

They are, but at the same time, they see the demand for this. And if there's demand, they want to make those employees happy because they want to attract employees. fertility services. Is there a ROI on it? No, but they know there's demand for those fertility services. So that is now enabling smart people to say, hey, this makes sense medically in terms of improving health. Let's do it. Let's try it. Let's do a pilot. And it's happening fast. We don't have to wait, you know, these diabetes alternative, these companies now, they're not anti-dialysis. sorry, I meant dialysis. So in dialysis, we have a system where we just kind of let people go into renal failure, then we put them on the machine. Well, what about actively getting them to avoid dialysis before they become dependent on it? So there's a couple companies now, they're not the big ones, and they are actively working with people in that pre-dialysis phase of their life. and if they can avert one patient becoming dependent, it pays for itself. So this is the exciting stuff right now in medicine. Yeah, it's true.

I mean, I, I, I, you know, with aggressive lifestyle intervention, you can reverse renal insufficiency. You can. And I, and I had a patient was like, you know, typical insulin resistance and cardiovascular disease and hypertension and kidneys starting to fail as GFR, which is the measure of kidney function, was going down and kidney level. all tests were going up. And, you know, I put him on a program, and he lost weight. He did amazing. Got the inflammation down, and his kidneys normalized. The protein went out of his urine, and his nephrologist was like, what the hell did you do? I've never seen this before. This doesn't happen. It's not possible. Like, what's going on? Like, and we don't see it because we don't know to tell people what to do. Like, we just don't have the knowledge or education. And it goes back to licensing exam. That's one of the things we're working on is also changing the licensing exams, getting ACCME to change those requirements. Graduate medical education, we spend $17 billion a year from the federal government paying for these residency programs and fellowship programs. And we have no strings attached about how that money is used or what they're teaching or anything. And so we can put some guardrails on that. It is amazing. Your work is tremendous. I'm super excited about it. Marty Makary from Johns Hopkins written so many books. His latest one is Blind Spots: When Medicine Gets It Wrong and what it Means for Our Health. You will not be sorry you read these books. You will educate yourself. You become empowered. And I think what you're doing is speaking out, telling the truth, speaking truth to power, and actually empowering patients to learn how to become agent, have agency over their own health and do what's right for themselves and not be just at the whims of a paternalistic system that immense financial perverse incentives and immense corruption, and it's not giving us what we need to know. So thank you for speaking out. Thank God you're there and doing this work. I love to have you on the podcast. Any final words or thoughts and advice for listeners about how to navigate all this?

It's great to see you, Mark. Keep up the great work. So, you know, I felt like there's so much new research that is directly speaking to these blind spots in medicine that people should know about it, not just in the medical community, But if my colleagues are fascinated by some new research that I'm presenting to them in a lecture, some of that research has direct implications for everyday folks out there. And so that's why I put this book together. So I hope people enjoy it.

Well, thank you. You can find it everywhere you get books. It's out there now. And you can go to Marty Macri and just check out his work. His website is macrimd.com Marty Macri, yep. Oh, Marty Macri, okay, Marty Macri.com, sorry I should let you say, what, you have social media?

I'm on Twitter. It's a bit of a nasty place, but I try to encourage people on it and LinkedIn a little bit. But great to be with you. So thanks so much, Marty. Okay, I can't wait to have you.

Back for your next book. And I think there were like 4,000 topics we didn't cover, so get the book, check it out, and push the field. Yeah, let's go.

Thanks so much, Marty.

Great, thanks. Thanks for listening today. If you love this podcast, please share it with your friends and family. family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at Dr. Mark Hyman. And we'll see you next time on the Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com/markspicks. I promise I'll only email you once a week on Fridays and I'll never share your email address or send you anything else besides my recommendations. These are the things that have helped me on my health journey and I hope they'll help you too. Again, that's drhyman.com/markspicks.

Thank you again and we'll see you.

Next time on the Doctor's Pharmacy. This podcast is separate from my clinical practice at the UltraWellness Center and my work at Cleveland Clinic and Function Health where the Chief Medical Officer. This podcast represents my opinions and my guest's opinions, and neither myself nor the podcast endorse the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for your help in your journey, seek out a qualified medical practitioner you can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com if you're looking for a functional medicine practitioner near you, you can visit ifm.org and search find a practitioner database. It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public.

In keeping with that theme, I'd like.

To express gratitude to the sponsors that made today's podcast possible. Don't forget, there's a way to listen completely ad free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap try free to start your seven-day free trial.