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The 1000 Hours Outside Podcast
1KHO 455: How to Raise Healthy Kids in a Confusing Medical World | Dr. Marty MaKary, FDA Commissioner
00:57:31
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- [00:01]
Dr. Marty Makary
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- [00:29]
Ginny Urich
Welcome to the 1000 Hours Outside podcast. My name is Ginny Urich. I'm the founder of 1000 Hours Outside and I have a three time New York best selling author, healthcare expert from John Hopkins, surgeon, incredible, incredible accomplishments. Dr. Makary, welcome.
- [00:45]
Dr. Marty Makary
Great to be with you, Jenny. Thanks so much.
- [00:48]
Ginny Urich
I have three of your four books. I have Blind Spot, which is the newest one. I have the Price We Pay, what Broke American Healthcare and How to Fix It. I also have Unaccountable what Hospitals Won't Tell Value and How Transparency Can Revolutionize Healthcare. And you have a fourth book called Mama Maggie, which I'm planning on reading. The Untold Story of One Woman's Mission to Love the Forgotten Children of Egypt's Garbage Slums, which I just think is a really a cool different type of book. I Learned so much, Dr. Makary, from these books of yours that I read. But before we hop into them, you also, you write for all sorts of publications and you had an op ed that came out in August of 2024 in the New York Post about smartphones. So can we kick it off in a little bit of a different vein? What do parents need to know about smartphones and their kids?
- [01:40]
Dr. Marty Makary
Yeah, so there's a couple things in our society that are just accepted that we shouldn't accept. There's a couple dogmas out there that antibiotics won't hurt you. That's not right. That they change the microbiome of a child's gut. There's a dogma that all things in moderation. That's not true. It's not true for cocaine and it shouldn't be true for highly processed, compacted, high fructose corn syrup and other sugars added to the food of children. And one of the dogmas is that while they have to have a cell phone, it turns out that the average teenager receives over 150 notifications a day. And when you get a notification, every emotion goes through your brain as you go to read it. Am I in trouble? Is this good? Is this going to solve all my problems? Is this notification from the girl or boy that I'm Interested in dating. And now it's going to be a wonderful bliss. And so it messes with the brain. And there's a psychology to it, which is why the companies have engineered their social media apps to be addictive. And kids are not paying attention in school. So they don't have to have a cell phone. They don't have to have a smartphone. They can have a phone without any apps or the ability to call just anybody. They can have a flip phone. They can have a phone where they can only call. Their parents are 91 1. And so we should not accept these dogmas out there because studies have shown when they ask teenagers about the smartphones, over half of the people surveyed say it makes them anxious. And there's a secondhand smoke effect in the classroom that is people get anxious watching other people checking their phones all the time. So I encourage parents to do what my sister did. No cell phone whatsoever until the mid teen years, or maybe she's going to do a little later. And then limited cell phone use and then do it, you know, search a cell phone, use some of the apps, get on the Internet with parents so they learn how to do it responsibly and what the hazards are.
- [03:55]
Ginny Urich
This just kind of goes in line with the blind spots. This is another blind spot that's going on right now in our culture. Give us your backstory. You were really influenced by your dad. You said your dad taught you that it's always okay to the price we pay. And the dedication you wrote, dedicated to my father, whose compassion in caring for cancer patients has taught me that part of being a doctor is the responsibility to advocate for those who are most vulnerable. You said he taught you how to be a good doctor.
- [04:26]
Dr. Marty Makary
My dad was an amazing guy. And every time I came back to him as a child and asked questions, he would say, hold on to that curiosity. That's what will make you successful in life. And be open minded to what you might learn, even if you're already convinced of something. And I think those are basic principles that would do us so good in today's echo chambers of strong opinions and polarization. My dad would hear me come back from med school and say things. I would tell him things that just appalled me, things that I didn't understand. I almost. I didn't want to go to the next page of the textbook until I understood, why is the age of puberty going down every year by a week and a half? And now is three years roughly sooner than it was just a century ago. And this is really a Western phenomena. They don't see the same decline in age in Europe. And so, you know, I didn't love the way we would just brush off these giant questions in medicine. And I think there's a lot of those. We would only demonize fat. We never talked about ultra processed foods. We never once talked about pesticides, gut health, the microbiome, which is central to the health of a person. So my dad really did encourage me to keep those questions alive. And that's what I've done with my research group at Johns Hopkins and it's what I've tried to do in my books.
- [05:59]
Ginny Urich
So this is a must read for parents because I'm a parent, I've got five kids, and I thought, well, every parent needs to know about these different blind spots. The subtitle is When Medicine Gets It Wrong and what it Means for Our Health. So several of the chapters, they're so imperative for parents to know about. You kicked it off with peanut allergies, which didn't exist really when I was growing up in school. You talked about the data. In 1990, 6% of kids had peanut allergies. And by 2019, 1 in every 18American children had them. So this is like a swing in 20 years. Yeah, they gave the wrong advice.
- [06:42]
Dr. Marty Makary
Yeah, it. This was one of those big questions that just hit me and I didn't want to move on until we. I really understood it. Why is it that peanut allergies were rare just a generation ago and you still don't see them in Africa and Southeast Asia and many parts of Europe, and it's not genetic. So why do we have this explosion of peanut allergies right in front of our eyes? And the reality is, if you actually take a deep dive, which I did in the opening of the book, is that the modern day peanut allergy epidemic in the United States really was ignited 24 years ago when the American Academy of Pediatrics issued bad advice to parents saying that no child should ever eat a peanut or peanut butter until they turn three years of age. Well, it turns out the abstinence of any peanut exposure in the first couple years of life made the immune system more sensitive. And the opposite is true. That if a little bit of peanut butter exposure in infancy at 5 or 6, 7 months of age is sort of a small natural vaccine, if you will, that reduces the risk of future allergies because the body learns it, it learns to tolerate it. It's called immune tolerance. But for most of the last 24 years, parents have been given the wrong advice by Doctors in the medical establishment. Now, some doctors were smart enough to know that this advice violated basic principles of immunology. But a lot of doctors just recited the catechism and just told parents to do what they were told by the small group of doctors at the top of the American Academy of Pediatrics. This illusion of consensus gave doctors their marching orders. And as they sort of stomped out peanut butter and peanuts in the homes and diets of young children, peanut allergy rates went up. And as it went up, they thought, oh my gosh, we need to get more moms to comply. Like we have non compliant mothers, anti science mothers who are not listening to our instructions. No, the problem was there was no science. It was dogma. The recommendation was dogma from the medical establishment. And to this day, we have the worst peanut allergy problem in the world. The official recommendation just got reversed just a number of years ago in 2015-17. And now we're recognizing that, you know, you should introduce a little bit of peanut butter to infants. And we created a monster.
- [09:22]
Ginny Urich
I think every parent has to read this chapter because there's so much in it. In the book Blind Spots, one of the things that you talk about is how they knew by 2004, it's just four years later. And you said that it was a surprisingly simple experiment to figure out that this is not the way to go. You said they had it backwards. So what is a parent to do? I think this is the tricky part of raising children today. There was a doctor in East Tennessee you talked about who didn't recommend it because he'd learned about the immunology, which is similar to getting kids outside. Right. We want to expose them to dirt and different things like that. It helps with their immune systems. But how does a parent navigate that? Because you told a story of this girl named Charlie who has, you know, really bad food allergies now. And the parents said, we had no way of knowing that this was made up. We had no way of knowing that we shouldn't follow the doctor. Things are in flux. So what advice do you give for parents on how cautious we should be with our kids?
- [10:25]
Dr. Marty Makary
Yeah, it's. It's tricky to navigate sometimes. Right. And this is a question that comes up a lot. Well, if they got all of these things wrong, how can I trust them or who do I trust? If the medical establishment said opioids were non addictive for 20 years, they got it wrong. Do I trust them? When they said the food pyramid was true for 70 years, they still say it sometimes. How Do I know who to trust? And so I think most doctors are trying to do the right thing. If you're in an emergency, do whatever the doctor says. But when it comes to big decisions, chronic decisions, having an elective operation, going on a medication for the first time in your life regularly, it's okay to ask about food as medicine and alternatives and different approaches or different medications, or what you can do in terms of lifestyle. Sometimes we don't even explore those options. And it's not because doctors are bad people or they want people to be sick. It's because we're busy. And we've been indoctrinated in medical school that everything is a diagnosis with a medication to treat it. Diagnosis, medication, diagnosed medication, you come out with a reflex. And when you have to see people in short visits, I mean, I think we've done a terrible thing to doctors. We've told them, put your head down, focus on billing and coding. We're going to measure you by your throughput. And we haven't given doctors the time or resources or research evidence to actually educate people about what we should be doing differently. Maybe we need to talk about school lunch programs, not just putting 6 year olds on Ozempic. Maybe we need to talk about treating diabetes with cooking classes, not just throwing insulin at people. We need to talk about sleep quality, not just antihypertensives to treat high blood pressure. We need to talk about environmental exposures that cause cancer, not just the chemo to treat it. Maybe we should treat more back pain with ice and physical therapy, not just surgery and opioids. So we have a culture in medicine that is very wired towards drugging, cutting and billing. And it's resulted in doctors having record rates of burnout. We have the highest suicide rate of any profession. And I think when people are trying to figure out who do I believe or what do I believe? My doctor seems like a nice person. Well, they are good people, but sometimes the culture has a powerful effect. And I think it's good to be educated. I don't want people to be cynical towards their doctors. The vast majority of doctors are giving great advice and doing the right thing. But. But when it comes to big questions, it's okay to be educated. And there's a bunch of us doctors now that are going directly to the public to try to educate people about food and medications and the microbiome and gut health and perimenopause and other major topics in medicine that we don't talk about as we should, that we need to talk about.
- [13:18]
Ginny Urich
I think One of the things that's maddening as a parent, and you feel it as you read the book, is there seems to be no repercussions for. You use the word vigorous. And I thought that was such a great word. It's like there is this, you know, you say it came out with a big splash. The 1, 2, 3, you know, no milk until one age. Two is eggs, H3 is peanuts. You know, it's very vigorous. It's really pushed. And then when it changes, and it changes way too late, there isn't the vigorous campaign to say, oh, we got this wrong. And so what you talk about is some of these things, they're still out there. You talked about how the fact that moms, low risk mothers who can't eat or drink during labor, that's still out there. WIC still does not cover peanut butter for infants. And on the other hand, the pharmaceutical companies are making a lot of money off of EpiPens. So I mean, should there be accountability there? I think that's one of the craziest things in my mind that's going on when someone steers you wrong, but then they're making, they're jacking up the price of EpiPens from a hundred to six hundred dollars and they have to be restocked each year. So it's like some people are really losing and some people are really gaining.
- [14:35]
Dr. Marty Makary
Yeah, I think people are hungry for honesty in healthcare. And when you get something wrong, people want an apology and they deserve it. You know, I've made mistakes in the hospital, and when you make a mistake and you tell somebody, when you're transparent, when you're honest, when you feel bad, when you apologize, people can be very forgiving. But we haven't seen that from our medical establishment. And you're right, we have not corrected the record on our bad recommendations with the same vigor by which we put them out. Initially, when we told parents to avoid peanut butter for young kids, it was a very strong recommendation. And when it was reversed, they didn't really broadcast it that much. They just kind of faded out and then started giving different recommendations. The food pyramid that was so catastrophic you didn't see an apology, hey, we feel bad. Obesity rates skyrocketed as we ignored the role of sugar refined carbohydrates. You didn't hear that from anyone, the American Heart association, the Surgeon General's office, any of those many institutions that forced the food pyramid on us. And I think people are hungry for that, especially coming out of COVID Many people feel that there Were mistakes made with prolonged school closures and cloth masks on toddlers, not allowing people to visit their dying loved ones for nearly two years or more in many hospitals. In my opinion, that was a human rights violation. We should never say, no, you're not allowed to go be with your dying mother in the icu. So I think people are hungry for honesty and humility.
- [16:22]
Ginny Urich
I mean, you bring up Covid, it's like, this is just such a real and recent issue. We struggled. I've got five kids. I mean, that was a really hard season for us. And so when you talk about the vigor, I mean, the vigor of the masks was wild. And then even the food pyramid, I didn't know the food pyramid changed. I heard little things about how later on the masks, now they're saying it wasn't as effective or the 6ft distancing. It kind of came out of thin air. But even still, I'm like, is that true? I don't. You know, you hear like just little whispers of it. And that's all. We live in Michigan, Dr. Makary. And there's this really cool river near Ann Arbor. It's in Ann Arbor that the Army Corps of Engineers took these two set sides of the river, and they took one side and they funneled it down to these little waterfall drops. And you can ride it in a tube or ride it on a kayak. And our governor actually shut it down for a while. So she shut down the river. But additionally, when it wasn't shut down, people were kayaking down the river, a single kayak, wearing a mask. So that's the vigor. They are alone in a kayak outside on a river near no one.
- [17:34]
Dr. Marty Makary
Yes.
- [17:35]
Ginny Urich
Wearing a mask.
- [17:36]
Dr. Marty Makary
So, Jay, I think you're onto something really important here. And that's a broader message. The most dangerous thing you can do to lose credibility is to put out a recommendation with such absolutism, suggesting it's based on science, when it's just a gut feeling, it's just an opinion of a doctor. And so what we had was a small group of doctors at the top issuing these broad, strong, absolutist recommendations. And then they just kind of faded out when they realized there's really nuance to it. So Both yes and N95. High quality mask that's tight fitting does reduce the transmission of respiratory viruses. Yes, that. That is correct. But I see nurses who can barely wear those things in a tight fitting way in a shift. And we want a child to wear that for two and a half years. And so the Idea that, well, it doesn't matter what kind of mask, just wear anything. Well, we learned the cloth masks were so porous, they basically did nothing. And people didn't comply. They were wearing them below their nose. You're still breathing. It's just the air comes in and out of the side. And so this incredible culture war that erupted over the mask just shows how many times we didn't listen to good scientific data. We wouldn't have nuance. And it really captures, in my opinion, a broader theme that I write about in the book Blind Spots because I didn't want to talk about COVID in the book. People are sick of it and it's very tribal. You know, people kind of already made up their minds. But the paternalism of medicine came out in full force. The paternalism that's been around that said women should not have home pregnancy tests. They can't handle this information on their own. HIV patients can't get their test results on their own. It has to go to the doctor. And then they can only get the result by making an appointment to come in to see the doctor. We can't call them. We can't tell them you saw it with COVID testing in the beginning of the pandemic. We can't let people do their own home Covid tests. They won't. They can't handle this on their own. And you saw this medical paternalism that's actually very strong in the modern history of medicine. It's done a lot of damage. There's been a very male dominance to a lot of those recommendations. Historically, in the last 50 years, you see it with so many different areas of medicine. So, you know, I think it was an opportunity for us to see how a broader medical elite priesthood can work. And again, not a knock on doctors. Every doctor I know is trying to do the right thing and giving it their best. But it's a knock on a small group of elite doctors at the top who make edicts for everybody. And that I think can be dangerous when they do it with such absolutism and no real good science.
- [20:29]
C
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- [24:23]
Ginny Urich
So a very real problem then is if you're on the downstream of that you're a mom, you're not a doctor. Yeah, maybe you have no further education beyond high school. Maybe you don't even have that. But you have a little bit of common sense, right. And you read your reader and when you challenge or, or don't even publicly challenge, you just make a slightly different decision or a different decision altogether. You wrote parents out of compliance with the AAP guideline. So this is talking about the peanuts, but I feel like it's really with everything. Parents out of compliance with these guidelines are viewed as idiots who arrogantly deny science. So I'm like, I'm a mom, I'm not a doctor. I don't have like this incredible education. I actually am like, fairly insecure in just even the way that I go about life. Like, I have a hard time keeping up with a meal plan of all things. But I think to me, the cloth masks don't make sense or, you know, the different types of decisions that have come in the past. Like you talked in the book about separating the mother from the baby.
- [25:30]
Dr. Marty Makary
Yeah.
- [25:31]
Ginny Urich
When we say something or even don't say anything, we just do something different. We're called arrogant, a science denier, an idiot. And I think that the majority of people have a hard time with those labels.
- [25:46]
Dr. Marty Makary
Yes, this is a major problem in the medical culture and we can fix it a couple ways. One, those of us inside the medical culture need to work to change it. And number two, people need to demand change. Because look, when mom said they didn't want added sugar in their products, the food industry started making products that said on it, this has no added sugar. They responded to that market demand. There's a couple things that really bother me about the current sort of absolutism and dogma that that's out there today. For example, four in 10 women who should be getting a mammogram according to the guidelines, that is low risk. Women beginning at the. At age 40 have said no. 40% of women said no. They don't want to do it. They don't. For whatever reason, they've basically, they're not going to do it. Now, if you actually listen to patients, they will tell you, and this, these are different things I've heard. The common things I've heard. It's very uncomfortable. It's a little humiliating. It's radiation from an X ray that goes into my body, and I'm not comfortable with the radiation. Now, if we actually listen to these concerns, one, we can address them individually or two, we can recognize that they may not want to get a mammogram or will not get a mammogram for those reasons, and maybe we can recommend an ultrasound instead of a mammogram. Now, what I just said is considered heresy and malpractice. How dare you suggest that ultrasounds could be used for mammographic screening of breast cancer? Well, an ultrasound will pick up 90% of what a mammogram will pick up in terms of concerning cancer or precancerous findings. 90%. Now, for 40% of women who don't feel comfortable with a mammogram, can we offer them something and just let them know this is not as good as American, but it's almost 90% or so as good. And yet that is not offered out there? It's just the dogma, the absolutism is doing tremendous damage to health. And I think there's a lot of these examples, right, where we just need to listen to people to understand them and to, you know, meet them where they're at.
- [28:06]
Ginny Urich
It's all these blind spots. It's such a great title for the book. I'd like to talk about antibiotics because this is another thing that is very relevant for parents. And I want to talk about. So people have. You have to read the book. This is talking about carpet bombing the microbiome. So this is a big deal. And you also talk about how C sections, fluoride in the drinking water, microplastics, which. There was some. Oh, one study suggests that the average person may consume up to a credit card's worth of microplastics every week. Oh, my goodness. Glyphosate. So all of these things are affecting the microbiome. But the other thing you talk about with the antibiotics is that. Well, there's a couple things I didn't know. Antibiotics make animals fatter. And there was a study, if someone had taken like five or more rounds of antibiotics, they were 53% more likely to develop diabetes, which you said was a dose dependent relationship that suggests a close association. So I didn't know any of that. Also, antibiotic resistance. Listen to this. It used to take 21 years on average for bacteria to become resistant to a new antibiotic. Now it takes an average of one year. There are so many things in this antibiotics chapter, the microbiome, I mean that's a whole issue in and of itself. But the fact that someone's Achilles heel ruptured, that there's other side effects that we don't know of, it's maybe contributing to obesity and also the antibiotic. That's a lot of things. Do you want to cover any of them? Yeah, is any. Do any of them rise to the top?
- [29:43]
Dr. Marty Makary
Thank you for your interest in this topic, Ginny, because it's so important, and this is, you know, a very practical thing for parents out there to know about. Antibiotics save lives. They can prevent hearing loss when early bacterial infections are treated appropriately with antibiotics. They've done a miracle in modern medicine. It's defined the white coat era of medicine over the last 80 years, making childbirth much safer, allowing doctors to do surgery, preventing a child from dying from a scratch, that in a previous era, before antibiotics could result in an infection and death. Antibiotics are amazing, but they're massively overused. 60% of antibiotics are unnecessary in many studies. And I think it's higher, I think it's 80%. And I can tell you that because I've been forced to give them when I have not wanted to give them because there are hospital protocols around just giving them blindly in certain situations. And so what are the antibiotics doing? They are carpet bombing the microbiome. That is the millions of bacteria that normally live in the gut. They live in a balance. These bacteria are not just sitting there. They are a very busy garden of active bacteria that are involved in digestion and absorption. They produce vitamins, the bacteria make vitamins. Some of them even make a little ozempic in low levels. They regulate estrogen to some degree. They make most of your body serotonin, which is involved in mood. In mental health, they train the immune system. This is really the central organ of health. And sometimes when those bacteria are out of balance, you can get a lot of inflammation. Sometimes it is involved in leaky gut. So there are so many roles of the microbiome and when we get take an antibiotic thinking, oh, there's no downsides, well, it's reshaping Some of that microbiome, it's changing the balance, it's killing some, allowing other bacteria to over grow. And these studies are very compelling. And I can tell you, many of my colleagues at Johns Hopkins, most of them had no idea about these studies that kids who took antibiotics in the first three years of life, I think it was two or yeah, first two years of life, had a 20% higher rate of obesity later in childhood compared to kids who did not. And we've seen this in animals, as you said, farmers have noticed you give antibiotics to poultry and animals that are fatter. Well, it's probably because it's changing the microbiome. And so the world expert in the microbiome who I interviewed noticed that for years farmers were giving antibiotics to animals to make them fatter. And he wondered, well, what's it doing to humans, what's it doing to children? And so he did these studies that are amazing showing that antibiotic use was also associated with a higher rate of attention deficit disorder. Asthma CELIAC was nearly 300% higher among kids who took antibiotics in the first couple years compared to kids who didn't. So there's something major going on here. This is an organ system we should respect, not ignore. Medical establishment has ignored the microbiome. Throughout my entire training as a medical student, as a surgical resident, as a gastrointestinal surgery specialist doing gastrointestinal surgery, sub fellowship fellowship training at Johns Hopkins, never once did we talk about the micro. It's unbelievable. We're looking at it, we're working with it, we're redoing the plumbing in the GI system, we're treating all these complications and we never talk about it. There's now a mature body of medical literature that I try to summarize for people in the book so they can understand what to do, what to eat, what to not eat. For example, seed oils are pro inflammatory. The vegetable oils, canola, corn, soybean, these are often the oils on processed foods. If you read the labels and they're, they sound natural, but they're not. They're changed with a high temperature that denatures the chemical, the molecules and then a chemical solvent is added. So it's good for shelf life, but it's not good for the body. And there are so many of these things where if we understand the microbiome, we now see a plausible mechanism by which certain things affect our health. For example, pesticides, they're not directly toxic to most of the cells of the body, but if they're killing pests, what do you think they're doing to the bacteria in the microbiome? Well, they're probably killing bacteria in the microbiome and altering the microbiome, especially when you're eating them all the time. So we have a mechanism now by which things that are toxic in the environment may be affecting our health by altering the microbiome and killing some bacteria. Fluoride, too, has been implicated. Fluoride kills bacteria. That's why it's added to the drinking water in the United States to kill the bacteria on teeth and reduce cavity rates, which it does. But if it kills bacteria on teeth, what do you think it's doing to the microbiome and our gut health, which is lined with millions of bacteria? That's why Europe does not add fluoride to drinking water. And that's why fluoride now has been implicated in some chronic diseases. These are questions we can ask, we can educate the public, and we can all be up to speed on some of this latest research as it's developing.
- [35:25]
Ginny Urich
What about the antibiotic resistance bacteria? Oh, yeah, resistant bacteria, C. Diff. And I was like, oh, there's a doctor on. I want to give this one a go. Carpepinem resistant Enterobactera Psi. I don't know. I was like, that's quite the name.
- [35:45]
Dr. Marty Makary
Good job.
- [35:45]
Ginny Urich
I don't know if I came anywhere near it.
- [35:47]
Dr. Marty Makary
Yeah, I mean, we're seeing now these superbugs develop because of the overuse of antibiotics. So when you give antibiotics so liberally, the bacteria that are always dividing, every now and then we'll have a random mutation that enables them to survive the antibiotic. And so the more antibiotics you give, the more you drive resistant bacteria where the antibiotics don't work. You can't just keep giving antibiotics liberally forever. The bacteria will mutate to develop a resistance to the antibiotic over time. Well, that time to develop resistance is shortening every decade now. And now we have bacteria that will develop. Resistance used to take 15 to 20 years, now it takes one year sometimes. And one of those resistant bacteria, he mentioned a couple. Well, C. Diff is now a common hospital infection that you get after taking antibiotics most frequently. And so we'll have patients in our hospital where they get a basic amoxicillin type antibiotic, and then a week later they can be deathly sick with the overgrowth of C. Diff bacteria that normally it's in the colon. But because the amoxicillin kills some bacteria, it allows the C. Diff to overgrow and dominate. And that drives inflammation. It can even drive severe sickness and we've seen deaths from it. There's an estimated 30,000 deaths from these resistant bacteria every year and many people are saying this is the next pandemic. It's just slow growing. It's interesting. The guy who discovered penicillin, the first antibiotic, warned in the 1940s after he got the Nobel Prize, about the overuse of antibiotics and these unintended consequences. So we need to heed that warning today, including the overuse of antibiotics in food. That's why I buy food where there's not the routine use of antibiotics.
- [37:46]
Ginny Urich
A couple of the things you wrote in here, New antibiotic development cannot keep pace with the rate of bacterial resistance. The warning from Fleming, I wrote it down. The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin resistant organism. Yes, back to that responsibility piece as a big warning from 1945. This is a thing like some of these things have been out there for decades and yet there are still some problems. So definitely an important thing for families to know about. Like you said, the antibiotics do great things certain times, but they are over prescribed, so that's something to read about in blind spots.
- [38:29]
C
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- [42:33]
Ginny Urich
There's a lot in there about birth C sections. Dr. Dinner. You have the statement, if you have unnecessary surgery with no complications, that's not a great outcome. So you're talking blind spots. And also the price we pay about C sections is maybe slightly different or maybe very different, I guess, but, like, we're pushing people toward unnecessary things, sometimes for a lot of different reasons. So what should a parent be aware of in terms of. Because you were talking about, like, these screenings at these churches, they do these health fairs, and you're like, that's an unnecessary screening. That's pushing someone toward a medical procedure that they didn't really need. And then it's costing them and exorbitant amount of money. It's like bankrupting their family, you know, and now they're. They have no money. We're causing all these other problems. And then sometimes unnecessary C sections, it goes up 80% on a Friday. What should parents be aware of?
- [43:27]
Dr. Marty Makary
So if you are going to deliver a baby or have a baby as a couple, I really encourage people to read that chapter in the book because there are best practices now for baby delivery that are not known. Now. It's not a textbook, and it's not telling you what to do, but it tells parents about these best practices that have not been widely adopted. And they should be moms. Holding the baby skin to skin for hours after the baby is born, that's the best place for a baby. The studies have shown now that when a mom can safely hold a baby for hours after the baby's born, immediately upon the birth of the baby, the baby has a more normal heart rate and blood pressure. And they've even found that the baby's glucose is more likely to be normal. Now you might say, well, how does holding a baby result in a more normal glucose level in the baby's blood? Well, the baby is not having stress hormones spike when the baby is not held by the mother. And so when you have all those corticosteroids spiking when the babies are separated, that affects the blood glucose level. So we don't see that to the same degree when a mom holds a baby. So there's. And there's something magical about bonding. We don't fully understand it. We now know that when there's delayed cord clamping, that is, they don't cut the cord the second they see it. You know, it was kind of all. I always thought that was absurd. You know, like, there it is. Got it. You know why it's pulsating? It's we're watching the, you know, blood flow to the baby that's warm right into the baby's system. So it keeps the baby warm. That blood has stem cells and it's got something called fetal hemoglobin, which is a very high binding oxygen type of molecule. They've done studies. Now when there's delayed cord clamping, say a minute or two after the baby is born, then the babies have a different brain development. There's something about the myelination of the brain that has only been suggested in one study that I mentioned in the book. But it's really interesting. And if there's something really there, it would, you know, suggest that delayed cord clamping has more benefits than just the short term benefits. And then breastfeeding is good for the baby. Now, it's not politically correct to say that in the modern world, but it's a scientific truth. Women cannot breastfeed. Sometimes they're physiologically unable, or they're unable for other reasons to breastfeed. We shouldn't shame those women. But let's not fool ourselves. Breast milk is the best form of feeding for the microbiome in its development. C sections save lives, and they're necessary sometimes. But it's C sections are bad for the microbiome. Why? Because the gut of a baby in utero is sterile. And so where does that microbiome come from? You've got millions of different bacteria that normally live in your gut, you know, in life. So where do those bacteria come from? Well, when a baby is born through a vaginal delivery, the bacteria in the birth canal will seed the microbiome of that baby. But when you're born by C section, a sterile baby is extracted from a sterile operative field. And what may seed their microbiome are not the bacteria from the birth canal. It may be the bacteria that normally live in the hospital, which some of those are not good bacteria. And so they've noticed an association recently between babies born by C section and asthma, irritable bowel syndrome, inflammatory conditions, and even a recent study showing an association with the colon cancer in young people. If you remember, there's a rise in colon cancer in young people under age 50. One study found an association between people born by C section. Now, who knows if that's a true cause and effect, but it may be all of these things cumulatively that affect the microbiome. People ask me what causes obesity, what causes autism, what causes a lot of these chronic diseases that are surging in our lifetime that we rarely saw in Prior generations. And I always come back to the microbiome. We have altered the microbiome in ways we have not fully studied. And the more we look at it, the more we're finding these associations. It all starts at the time of childbirth. And that's why. And you know, some hospitals now are recognizing if they have to do a C section, maybe it's good to take vaginal fluid and swab it on the baby's face. That's a protocol at Mount Sinai Hospital in New York. We're going to learn more about the microbiome. But it all starts the time of birth.
- [48:20]
Ginny Urich
You had this. You talked about this earlier. Instead of asking, do these things cause cancer? We should ask, do they alter the microbiome? So really important things for parents to notice. You also talk about solutions. So I want to throw that out there. And you talk about disruptors, people who are coming in and doing different things and creating wellness centers and working on the loneliness piece and the food classes. And so I thought, that's a really amazing part of your books. You don't just talk about the problems. You throw out. Practical solutions. You said at one hospital, if they put up, let's say, what are everyone's C section rates, that the amount of overall C sections dropped by 50%. That's so much. So I just. I love that you have the practical solutions. The book is witty, the books, like, there was one where it was like, you know, we do race for breast cancer, but we don't do race for the microbiome. It's harder to raise the funds. And one of the things I thought was really witty but also very sobering in the price we pay. So this is a book about. I mean, I'll tell you our story. This is just a very small one. But our youngest daughter, when she was one, had a thing called Nursemaid's Elbow.
- [49:30]
Dr. Marty Makary
Yeah.
- [49:31]
Ginny Urich
Never had heard of it. But the ligament, when they're little, the ligaments are stretchier. It came out of place. We'd never heard of it, but she had, you know, sort of fallen down to the ground and started screaming. And so we thought, well, did she break her wrist? You know, she was really little. So we took her. We were out of town, and she wouldn't calm down. So we took her to the hospital. And it was traumatic because we have four kids at the time, five kids. So four other kids in the waiting room. My husband's not allowed to go back. It's late at night, and they're doing all these X rays, and they can't figure it out. And they keep twisting her arm and she's so upset. And they gave us Tylenol and sent us home. And while my husband was in the waiting room with the other four kids, he's like, I think I found on YouTube what it is. I think it's this thing called nursemaid's elbow. And then he fixed it. My husband fixed it.
- [50:23]
Dr. Marty Makary
Wow.
- [50:24]
Ginny Urich
So then they charged us twelve hundred dollars. And I was like, well, you didn't even fix the problem. It would be like having someone to come in and fix your fridge and they don't fix it and then they still charge you or. And it was a pretty common thing, like nursemaid's elbow. We ended up reading about it, and it turned out it's like kind of something that other people have. It's somewhat common. So you talked about with the healthcare. That's why I'm saying it's witty. You had all these really, really good comparisons. So you were like, it's like if someone came to mow your lawn for 30 minutes and then they billed you $8,000 and you had no option but to pay it. Or if you wanted to get an orange at the grocery store because you're hungry and you're like, how much does it cost? And they say you have to buy it to find out. And then you buy it and they charge you 500 bucks and there's no returns. So it's witty. It's just such a great way of illustrating what's going on. People can pick the book up. It's fantastic. The Price We Pay. What should parents know about the cost of medical care and how they should be approaching that when different things come up.
- [51:30]
Dr. Marty Makary
Yeah. So from the book, the Price We Pay, which was really designed to educate people about medical bills and how to manage that whole world and just what your rights are and the importance of negotiating. People don't know. You can negotiate a lot of these bills. You can negotiate them on the front end during and after the medical care. And the bills need to be, you know, hospitals have to live up to their responsibility to serve the community, not price gouge and engage in predatory billing. And so there are ways to hold hospitals accountable. If you get an outrageous bill, I think the most important thing is don't pay the bill until you have a chance to talk to somebody about it. If you think there's a mistake, if you think it's too much, you can look up the price and shop before a lot of elective care. Right now, there are great websites out There I'm involved in a company called Sesame Care, allows people to shop for a lot of medical services. There are many shoppable type of platforms now. And so I wanted people to know what their rights are because. And if you just tell people, hey, these are your rights, then it's a boring textbook, nobody's interested. But if you tell the amazing stories of the disruptors who are coming up with new businesses, who are changing things, if you can use humor and identify heroes and villains in the system, I actually think they're all good people in healthcare. They're just working in a bad system. It's a system we inherited and it's a terrible system. So those are some thoughts on the whole medical billing side.
- [53:08]
Ginny Urich
The book is fantastic. You talk in there about nudging, which I'd never heard about, that patients make decisions based on how we present the options to them. And doctors know the trigger words depending on their specialty, so it might be safer for the baby. Or your knee is bone on bone, or this is a widowmaker. So that's a good thing to know about. You say one in five procedures are unnecessary, and also one in five Americans currently has medical debt. You talk about, we use Samaritans, which is like a health share, sharing. It's fantastic. You talk about that in the book as a disruptor. I mean, these are fantastic books. I like to wrap it up with humility, because you talk about this in both books. The most important characteristic of a good doctor is humility. And I'd like to tie that in a little bit with the vigor that we talked about at the very beginning, the push for conformity, that this is really a battle for freedom of speech and silencing doctors who disagree. You wrote silencing doctors who disagree removes an important check on the scientific community. We need more debate, not more dismissals. The public health ruling class does not tolerate dissenting opinions. You talked about this conference about bullying, where some lady got bullied out of it because she didn't agree. I was like, that was ironic and funny, but not funny. So the books are fantastic and interesting. How would humility help to lighten this environment that we're in, where if you say anything different, you're really shunned for that.
- [54:36]
Dr. Marty Makary
Yeah. I think we need a more civil discourse in America, not just in medicine, but in society, to reduce the shouting, to reduce the affirmation of what we already believe, which is what our social media and news operations are doing now. The psychology of why we resist new ideas is fascinating. And I took a Deep dive in one chapter around this concept of why we tend to cling to what we heard first. Not because it's more logical or more scientific, but just because we heard it first. It's called the Founders Effect. Then it turns out that the, the body, the brain naturally likes the comfort of just one idea. And so the first idea that settles in gives the brain peace. And when another idea challenges that, it creates discomfort or what Dr. Festinger described as cognitive dissonance. And so what he said was we subconsciously go through acrobatics not even realizing it. To dismiss new information just to hold on to what we heard first, or to reframe new information just to hold on to what we heard first. Imagine you smoke cigarettes and there's a study that was announced that smoking is bad for your health. Well, your brain subconsciously will try to reframe it. Well, I probably don't smoke as many cigarettes as the guys in the study did. Or I use filtered cigarettes so I'm probably okay. Or I work out and that counteracts the downsides of the cigarettes, so I should be fine. It's amazing. The body will go through these incredible acrobatics to try to just hold on to what we want to believe. And the father of modern medicine, Claude Bernard, implored doctors in particular to suspend their biases to be objective as possible when we hear new information. He said, we all have biases. Let's not fool ourselves. 100% of closed minded people perceive that they are open minded. We all have our biases. We just have to be aware of those biases and then actively suspend them so we can be as objective as possible. And that is a lesson for society today. We see people clinging to views in politics, in business and management and relationship in terms of their philosophy and science as well. And we need to recognize these biases, turn off the echo chambers of affirming information and listen to one another. And I think that is probably the most powerful way that we can rebuild public trust in the medical profession because it's very low right now. A study just came out showing trust in doctors and hospitals went from 71% to four years ago to 40% today. That's a 31 point drop in trust in my profession. That's embarrassing. And we can fix that. We can be honest with people, we can show humility and we can listen to each other. And I think that's a lesson for all of us.
- [57:50]
Ginny Urich
You wrote people who actively work to be open and objective are impressive. They are also easy to spot. They surprise people with their positions on different issues. Dr. Makary, what an honor. These books are phenomenal. I learned so much, so much. Way more than we've even touched on in this episode. Thank you. Thank you for coming on. Thank you for writing these phenomenal bestsellers. And I can't wait to read the Mama one. We always end our show real quick with with the same question. What's a favorite memory from your childhood that was outside?
- [58:22]
Dr. Marty Makary
Well, it's funny. It's about Mama Maggie. The. The fourth book. Mama Maggie is my aunt. And so that that's why I wrote a book about her with Ellen Vaughn. She does amazing work in Egypt with poor children, amazing stories, and it's inspired me through my childhood. So great to get to know you, Jenny. So awesome to talk to you. Thanks for having me. And thank you, Jenny, for promoting the books and being interested in all these topics. It's so great to get to know you.
- [58:52]
Ginny Urich
I really appreciate it. Yes, thank you. Thank you. Have a great rest of the day.
- [58:55]
Dr. Marty Makary
All right, you too. Thanks. So much. Shitty.
- [58:58]
D
You know, over time, life can get you down. Discouragement starts to creep in and eventually we just stop letting ourselves hope for more. We say things like, I'll believe it when I see it and don't get your hopes up. Sounds like good grown up advice, right? Actually, it's not. Hey, I'm Christy Wright, number one national best selling author, speaker, business coach, and mom of three. Oh, and I have a podcast called get yout Hopes up, which is what I want to tell you about. Romans 15:13 says, May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by power of the Holy Spirit. And that is exactly what my show is about. Whether I'm telling one of my latest crazy God stories or giving you practical advice to live out your faith. I love hanging out with you every Monday to help you get to know God, get closer to him, and get your hopes up again. Listen to get yout Hopes up wherever you get your podcasts and you can learn more at getyourhopes Up. That's get your hopes up dot com.
- [60:00]
C
Let's be real.
- [60:01]
Ginny Urich
Talking about intimacy can be awkward, even with your spouse. But it doesn't have to be.
- [60:06]
Dr. Marty Makary
We are Alanna, Kyle and Tira, hosts.
- [60:08]
Ginny Urich
Of the Kingdom Sexuality Podcast, and we're.
- [60:10]
C
All about keeping it real and helping.
- [60:11]
Ginny Urich
You add some spice and deeper connection into your marriage. Specifically, when it comes to what happens.
- [60:16]
Dr. Marty Makary
In the bedroom, we don't shy away from the tough conversations that often get missed in Christian circles circles with us. You'll get laughs, tips, fresh ideas and challenges to strengthen your relationship and bring it to the next level.
- [60:28]
C
Because, let's face it, navigating intimacy as.
- [60:30]
D
A Christian can be confusing, and finding.
- [60:32]
C
Safe, wholesome resources can be tough.
- [60:34]
D
So subscribe now on Apple, Spotify, or wherever you get your podcasts, and join.
- [60:38]
C
Us each week on the Kingdom Sexuality Podcast.