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Child: Welcome to my Mommy’s podcast.
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Katie: Hello, and welcome to The Wellness Mama podcast. I’m Katie from wellnessmama.com, and I very much enjoyed today’s conversation about blind spots and why humans resist new ideas, including some really practical examples of blind spots that might exist in your life and be impacting your health that you might not even be aware of. And today’s guest, Dr. Martin Makary, has quite the resume. He’s a professor at the Johns Hopkins University School of Medicine and author of two New York Times bestselling books. He has served in a leadership role at the World Health Organization and is a member of the National Academy of Medicine. He’s a public policy researcher that leads John Hopkins’ initiative on the redesign of healthcare to make it more reliable, more approachable, and more affordable, especially for vulnerable populations. Like I said, he has multiple bestselling books, The Price We Pay, about the high cost of health care and the grassroots movement to improve this. His book Unaccountable, which turned into a popular TV show. And his new book, Blind Spots, which we talk a lot about today. Clinically, he’s the Chief of Islet Transplant Surgery at Johns Hopkins and is the recipient of the Nobility in Science Award from the National Pancreas Foundation. He’s been a visiting professor at over 25 medical schools, has published over 250 peer-reviewed studies, and has done so much more beyond that as well. He’s a graduate of Bucknell, Jefferson Medical College, and the Harvard School of Public Health, and has, like I said, one of the most impressive resumes I’ve seen. I love how he turns his expertise and research to human blind spots and why we resist new ideas so strongly and walks us through essentially the process of becoming more open-minded and able to accept new ideas in ways that can benefit our lives and our health very profoundly. So let’s jump in and learn from Dr. Marty. Marty, welcome. Thank you so much for being here.
Dr. Makary: Great to be with you, Katie.
Katie: I’m super excited for this conversation because this is something I have not gotten to ever dive deep on in this podcast. You have quite the resume and quite the expertise, and I just ordered your books. I’m really excited to jump into those. For this episode, I would love to go deep on the topic of blind spots and why humans resist new ideas. I feel like if we just look even a surface level glance at social media, it kind of reinforces that this is the case. But I feel like it’s something that most of us don’t understand, certainly at a deep level, but maybe even at a surface level. So to start off broad, can you walk us through kind of what’s going on? What’s the psychology behind why we as humans tend to resist new ideas so strongly?
Dr. Makary: So the idea of dogma is a major problem in every field. I write about medical dogma in the book Blind Spots, but really it’s in politics, it’s in business, relationships. We tend to resist new ideas. And that is because there’s a psychology to it. It’s been described by a famous psychologist, the late Leon Festinger. Our minds are subconsciously very comfortable and happy with one belief. And when we get new information that challenges that belief, our minds get uncomfortable. There’s an internal conflict or what he called dissidence or cognitive dissidence. And so we tend to believe what we hear first, even if it’s not more logical or true than the new information. And he did a lot of famous experiments to prove this idea.
But we see it really in so many aspects of society. We see it in ourselves. The father of modern medicine said, we all have prejudices. We have to recognize those prejudices. It’s an active process. And we have to actively work to suspend those prejudices as we hear new information. And so that really is the guide to impeccable objectivity. You know, the folks that are open-minded, truly open-minded, not folks who claim and think they’re open-minded, but are really not open-minded. The folks who are truly objective, they’re more affable. They’re more successful. They’re more light. People are more likely to share information with them because they don’t rush to judgment. They don’t come to conclusions.
We have a guy at our work, one of the doctors at the hospital, and he’s kind of known for his objectivity. If somebody says, hey, did you hear this professional athlete got in trouble for doing something, he’ll say, you know, that’s an allegation. We don’t have all the information yet. And he’s known for that. And for that reason, he’s more successful. He’s more liked. He’s more affable.
So we all have this so-called cognitive dissidence. And Dr. Festinger, the psychologist, went deep into it. And I go deep into it as well in the book Blind Spots, because we all have it. It’s part of the human condition.
Katie: That’s so fascinating. And I can only think there’s probably examples in every area of life where this shows up. Certainly this year, I’m sure politics is an area we don’t have to delve into that one because it’s controversial. But it seems like the stakes are high if this shows up in something like medicine or health or education. There’s so many areas we could likely benefit from questioning these biases. But I’m guessing because your book is titled Blind Spots, this is a hard process to actually learn how to cultivate because we may not even be aware of where these blind spots are. So you mentioned the first step was kind of recognizing and paying attention to, becoming aware of where they are. How do we actually do that?
Dr. Makary: Yeah, so this requires work. The subconscious brain, left to its own vices, will just automatically reframe new information. So, for example, let’s say somebody smokes cigarettes and a study comes out showing that smoking cigarettes is bad for your health. The brain doesn’t like two conflicting ideas. So what it does is it reframes new information to say, well, that study wasn’t really applicable to me. Those were people who smoked more than I smoked. We don’t really know what the bad outcomes were. But we also don’t know what the good outcomes were. So it was really more non-conclusive.
The brain passively, subconsciously, will actively work hard to try to reframe new information just to make it fit what we already believe. And that is a, it requires an awareness that our brains are doing that in order to achieve that sort of open-mindedness that makes people so successful. And you see it in medicine. You see it, especially with health tips and recommendations, what we should eat. You know, it seems like there’s a lot of different ideas out there, but ultimately we kind of believe what our mothers taught us about food. You know, this food’s good, this food’s bad. How to prevent allergies. In medicine, there was a dogma that opioids were not addictive. I mean, dogma can take on a life of its own. And the group think is not only powerful, but many times in health and medicine, it’s dangerous. So people need to know the truth and they need to recognize that when they react immediately and think, whoa, well, that’s not true. Or I, you know, I thought this. That objection is really something called the founder’s effect. That is, we tend to believe what we hear first over what’s more logical or more objective or scientific. So an awareness of that is the key to sort of having that impeccable open-mindedness.
Katie: And that’s interesting that you mentioned we tend to believe more strongly what we hear first, because most of the people listening are parents. So this makes me think we probably have even more influence in our kids’ lives and their entire future than we think we do if the things they hear early in life are kind of more sticky and more likely to become their biases. So it seems like there’s kind of two paths to understanding this, one being in ourselves, how do we cultivate that impeccable objectivity that you mentioned, which I love. But also as parents, how can we be responsible in the way we sort of cement those early things for our kids and teach them to be able to question things? So maybe we can break it down first in whichever direction you want to go.
Dr. Makary: Well, you know, in the world of parenting and what’s best for children and even women’s health in particular, the new scientific information that’s coming out is unbelievable. I mean, it is really exploding in terms of the amount of knowledge out there. And much of this new scientific information has been dismissed. Not only by the medical profession because of this cognitive dissonance or the founder’s effect, but also because, also the general public can be dismissive of a lot of this information.
It turns out that we have good information about some of the best ways to raise a child to ensure they have a healthy microbiome, the garden of bacteria in their gut. It’s central to so many aspects of health. We’re seeing chronic diseases go up in the United States. We have the most medicated generation in history. Many of these assumptions that we’ve had about chronic diseases or learning disabilities, or asthma, or celiac, many of those deeply held assumptions are now being challenged with really good scientific studies. But when I would share it with some of my colleagues in medicine, I would find they would either be completely shocked and didn’t know how to react. Some would be just intellectually curious and dive deep and sort of convert over to believe the new information. And others would just find it so upheaving. It’s so challenging. The new information sounds logical. The new research makes sense, but it’s just so disruptive to what they already believe. They just can’t. They just can’t.
And Dr. Leon Festinger, the psychology who described cognitive dissonance, wrote about his experience embedding himself in a cult to see whether or not his theory was correct of cognitive dissidence. This cult expected a spaceship to show up at a certain date, at a certain time, in a certain location to pick up the cult members. And he embedded himself in that cult to see what would happen when the spaceship didn’t show up at that time and place. What he found is that if people didn’t really truly believe in the cult, they just quickly defected. But a lot of people who had so much vested in that cult, they believed even stronger after the prophecy was not true, proving his idea of cognitive dissonance in this founder’s effect.
One guy who was in the cult was actually a physician. And the guy sort of confessed to him the morning after the spaceship didn’t show up. And he said, you have to understand, Dr. Festinger, I’ve got everything vested in this religion. My family, my job, my friends, everything is in this. I just can’t give it up. And Dr. Festinger sort of noticed the naked reality of this cognitive dissonance. When we feel like we’re vested in something, we hold on to ideas. So in medicine and in health and wellness, people really need to be open to new scientific research in a very objective way.
Katie: And that sounds like certainly the extreme example, someone getting to embed themselves in a cult and witness what that psychology was. But to your point, I feel like the internet shows all of us that sheer logic alone or scientific data to back up your points, certainly alone does not change someone’s mind about something. And I feel like we see this even as a mom. I see this in my kids. Never once has any of my children at age two, when I tried to present something logically gone, you know what, mother, now that you have said that logically, I understand and I will change my position on this thing, this hill that I’m willing to die on. So there’s obviously a lot deeper things at play.
And I love that your book is kind of the, you know, handbook to being more open-minded. I would love to go through maybe some of the ways we can start doing that in our daily life. Because one practice I’ve had for several years now is that every year I make a list, actually a spreadsheet, of anything I think I believe with some certainty. So a kind of a beliefs list. And then my goal throughout that year is to question each of them line by line, read at least five books or conflicting viewpoints with the idea that if I’m right, I’ve only gained hopefully empathy and understanding for people who believe something different. And if I’m wrong, I want to be aware of that. But that’s kind of a big and grueling process. I would love to hear your take on how we can become on a day-to-day basis, more open-minded and make this part of our lives.
Dr. Makary: Well, I think the key is to ask good questions. And when you find a pediatrician or a physician who shuts down questions, that’s a warning flag. If somebody says something, you don’t know whether or not it’s well-supported or not supported. But if they say, you need to believe me just because I’m the expert, that’s a warning flag.
It turns out the group think in healthcare has gotten so many things massively wrong. Opioids are not addictive. They got peanut allergies wrong. Hormone replacement in postmenopausal women. The food pyramid, so many things catastrophically wrong, sometimes igniting epidemics from the hubris of their absolutism. Some people think we saw a little peak of this during COVID. The people need to know the truth. And at the same time, you don’t want to become cynical where anything you hear from the medical establishment, you tend to reject or disbelieve.
We see a pendulum swing in so many areas of medicine, back and forth from one extreme to the other. In the 1950s, doctors ushered in the white coat era of medicine. Now we have the power to prescribe an antibiotic. We had technology in the hospital. Doctors had unquestioned authority. Before the advent of penicillin and the mass use of antibiotics in the 1940s, doctors were kind of like, they weren’t disrespected, but they were like barbers. They would have a lancet and a saw so they could do amputations. And they weren’t disrespected, but they were sort of like you might consider a barber. As a matter of fact, surgeons and barbers was the same profession.
But then when we had this control over antibiotics, it ushered in this unquestioned authority. People began to believe whatever the doctor would say without any questioning, doctors were altruistic. They tried to do the right thing. I believe many still do. But because of this unquestioned authority, doctors routinely kept healthy babies when they were born in the hospital for 10 days. And that drifted down to three days or so by the 1970s. But it turns out that this dogma took on a life of its own. You know, we now are recognizing that many of the important aspects of health are ancient practices. Having a mom hold a baby, skin-to-skin time, delayed cord clamping, the first hour colostrum and breastfeeding. Avoiding C-sections when unnecessary. There’s a lot of rediscoveries of truth.
And in the world of diet and fitness and wellness, we’re kind of rediscovering some ancient biblical principles, the value of fasting and meditation, whole foods and clean meats, introducing allergies in life so that kids become tolerant to them. So it’s amazing, you know, from a personal standpoint, how I’m watching the medical field get disrupted in many of its sort of old ways. I think there’s lessons there for everyone, not to be cynical, but to ask questions and ensure that you’ve got a healthcare partner that’s listening good, that has good listening skills and is open to your ideas.
Katie: Well, this is music to my ears. And you guys stay tuned. We’re going to get to do a second episode all about kind of some of these related to kids and the myths that have affected our kids, especially in the medical community. But what you’re saying right now is music to my ears because I so often say on here that at the end of the day, we are each our own primary healthcare provider. And amazing results can happen when we work with practitioners who can be a partner on that journey. But I feel like somewhere along the way, we put those authority figures in the driver’s seat instead of being in our own driver’s seat when it comes to our health. And I think a mindset shift there is really important and powerful, especially if you’re trying to work through some kind of health condition, because when we take ownership of it, we also then get agency and power to affect change. And then we can benefit from the expertise of practitioners who know more than we do in specific areas, but while maintaining the active role in our own health. So I love that you have delved into that in the research side.
You also mentioned a couple of words that I would love to get a little bit deeper explanation on. You said this showed up especially related to things like the food pyramid and to hormone replacement. And I feel like both of those are very applicable to our listeners today. And I would love if you could expound a little bit more on them.
Dr. Makary: Yeah, so hormone replacement therapy at the time of menopause, that is taking estrogen or estrogen plus progesterone when a woman starts menopause or within 10 years of the beginning of menopause is amazing. Women live on average three and a half years longer. Their rate of heart attacks is cut in half. They have less cognitive decline. The cognitive decline goes down by 50 to 60%. In one study, the risk of Alzheimer’s goes down by 35%. And if a woman falls or is in an accident, they’re far less likely to break a bone or have a hip fracture. Their bones are stronger. It also, in addition to all these long-term health benefits, can alleviate the symptoms of menopause, of which we as a medical profession are not very good at diagnosing them. Tragically, a woman is more likely to get prescribed an antidepressant for menopause than hormone therapy.
And so there is probably no medication in the history of medicine that has improved or can improve the outcomes of a population more than hormone therapy for postmenopausal women, arguably with the exception of antibiotics. But tragically, many women are not offered this treatment or the option because a dogma formed in the medical field 22 years ago with a scientist who declared that hormone therapy causes breast cancer. He didn’t release the data. And there’s an incredible backstory that I write about in the book Blind Spots.
When the data came out a year later, it turns out there was no statistically significant increased risk of breast cancer among women who took hormone therapy compared to placebo. None. And so he misrepresented his data. The head researchers did. I found out other researchers in the paper got into a shouting match behind the scenes. They were saying, how dare you put something out there with a topic as sensitive as breast cancer? If you start dangling fear around that quote-unquote, you’ll never be able to put the genie back in the bottle. And that was prophetic to this day maybe 70, 80, 90% of some medical specialties refuse or are concerned about the risk of breast cancer. And they will tell people, I don’t prescribe it because of that risk. The risk was never established to be statistically significant in the study that people cite.
Katie: Wow. Yeah, that’s dramatic. And I know that from hearing from listeners and readers, that myth certainly persists because I’ve heard from many of them who went to their doctors and were told, nope, this will give you cancer. I will not prescribe this for you. And they had to kind of go on their own journey of finding a practitioner who would work with them or even listen to them. And also many women who were sort of dismissed and told their symptoms were just normal and associated with perimenopause or menopause and essentially to get over it or take antidepressants. So I love that you’re confronting that sort of misinformation that’s floating around.
Dr. Makary: Because, Katie, the medical profession concluded when this study came out 22 years ago that there’s nothing you can do for menopause. That was essentially how the message was received when the idea came out that it may cause breast cancer. For that reason, menopause was blown off because there was a feeling in the medical profession, there’s nothing we can do for it. Why are we diagnosing it or looking for it? It was downplayed, a male-dominated medical profession suggested, yeah, some women experience it, and it might last a couple years and the symptoms are mild.
Well, in reality, the average woman may experience eight years of menopausal symptoms. Many of the symptoms can be severe. We’re talking about weight gain, brain fog, dryness, pain, cholesterol can go up all I mean like 80 different manifestations of menopause. And it’s most women who experience these symptoms, 80%. So the idea that it was just some women and it was mild and was short really was not true. And that was driven by this sort of blowing off of menopause because of the dogma that there was nothing you could do for it.
And here again, we see dogma in the medical field and then disseminated to the public. Took on a life of its own. The study was misrepresented by the scientists, and I go through all of it in the book Blind Spots, the media ran with it, and they just instilled fear in women. And so that was the first thing that people remember about hormone replacement therapy. And it’s still difficult to sort of undo a lot of the damage of that misrepresentation.
Katie: I will, of course, link to your book in the show notes for you guys listening on the go. And of course, it’s available anywhere books are sold. But I know what you mean, because my original background was actually in journalism. And we were sort of taught that if it bleeds, it leads and fear sells. So I can see how these fear-based messages can kind of take off and then get deeply rooted in our psyche because we’re sort of wired to pay attention to those kind of things. It’s one of the reasons I also advise people don’t get your health information from the news because that’s always going to be their angle is the fear side of it.
I would love to delve a little into the nutrition side and maybe just a few key areas where you would encourage people to question their biases and perhaps ask better questions and get better answers. Because I know from my own process of doing that, I was really surprised when I looked into things like the recommendations around fats and how much and what type we should eat. The same with salt. We were told salt was bad for so long. And I think we’re seeing evidence to the contrary there. And even basic things like sunlight. I feel like we’ve avoided sunlight for the last few decades out of fear of skin cancer. And it seems like the data might indicate there could be a better approach there. But what were the ones that came up the most for you in researching this?
Dr. Makary: Well, I think that the dogma that formed back in the 1960s, that natural fats are bad for your health or maybe the driver of obesity and heart disease, that dogma has never been proven to be correct. And it’s not for a lack of trying. The original guy who was really a politician, who happened to be a physiologist at the University of Minnesota, a guy named Ansel Keys, he lobbied the medical field and the American Heart Association to get behind his hypothesis that natural fat was sort of the dangerous ingredient in food. And we needed to sort of purge the food supply of it or reduce natural fat. And so his campaign was very successful. The American Heart Association had a little healthy heart seal that they licensed out to restaurants to put on their menu. And also this dogma.
And so they did three major studies, massive studies. One of them was the most expensive study ever done. All three failed to show an association between eating natural fats and heart disease. But you didn’t hear any humility. There was no apology. There was no, ah, we got this tragically wrong. This dogma still lingers to this day. You go to a restaurant or a breakfast place, you’ll find egg whites only and low-fat this and yogurt. And it’s amazing. These are the remnants of the medical dogma of Dr. Ansel Keys. And then the pile-on effect, the bandwagon mentality of the medical establishment that just, the reality was they didn’t know. That should have been the correct answer when people said what causes heart disease.
We now believe it’s refined carbohydrates, ultra-processed foods, alterations in the microbiome, the garden of bacteria that live in the gut. And we can talk about that. It’s an amazing organ system that we’re learning about. That microbiome, the balance of different bacteria in the gut can be altered from different things, from an unnecessary C-section, from antibiotics as a kid, from bad foods, ultra-processed foods, a lot of refined carbohydrates. And it may explain why some people eat perfectly and they can’t lose weight, or they may work out like crazy and they can’t lose weight. The microbiome has been altered and new research is trying to understand how to restore some of that balance.
So we have to ask important questions. And one important question for the medical establishment is, where’s the data to suggest that natural fats are bad for your health? Where’s the study? I asked in doing my own investigative journalism for the book. I asked one of the authors of the government’s food pyramid that very question. Can you point me to one study that clearly shows that eating natural fats causes heart disease? And she replied to me, and again, think of this cognitive dissonance of Dr. Festinger. She said, well, I can’t give you one study, but do you mean to suggest that everyone’s wrong, that the Surgeon General’s wrong, that the American Heart Association’s wrong? That all these academic leaders are wrong. And I’m thinking, yeah, I do mean to suggest that if there’s no definitive studies.
By the way, there’s a lot of interest in seed oils right now. Seed oils are not natural. If you look at some of these vegetable oils, canola oils, these cheap oils that denature at low temperatures, and you may want to look up the temperature by which some of these oils denature or change. So you know what your cooking temperature is and what oils are better than other oils. There’s a couple oils that tend to be better at higher temperatures, but they all have a slightly different taste. So there’s a lot of interest in seed oils right now. The science really has not kept up to point us to what to do, but a lot of folks are saying these are byproducts that are not occurring in nature of some of these seed oils when they’re heated up. You look at linoleic acid, one of the common ingredients when we buy a candy bar or any product with a barcode, it probably has linoleic acid. I mean, it may be 20% of the calories of some Americans. And this is a substance that does not appear in nature. So a lot of folks are saying, what are we doing? And what is it doing to our microbiome?
Katie: On the side of the microbiome, you’ve mentioned that a couple times. And it seems like this could be a much bigger piece in the puzzle of health than a lot of people realize. I would love to hear just some key takeaways that you found in your research on what we’re doing wrong when it comes to the microbiome and maybe what to research in better ways to approach the microbiome and our health.
Dr. Makary: Well, one of the biggest things people can do to ensure their kids have a healthy microbiome is to avoid unnecessary antibiotics. Most antibiotics that are prescribed are unnecessary. Now, antibiotics save lives, and it’s important to treat early ear infections so a kid doesn’t have hearing loss. But once a kid has a viral infection of any kind, or the doctor suggests, you know, antibiotics are probably not going to help. But they won’t hurt you. That’s not true. That’s medical dogma. Antibiotics can do damage, especially in the first few years of life.
A big study at the Mayo Clinic that I consider to be one of the most significant studies in the modern era, and it lives in one of the blind spots of modern medicine. It didn’t get a lot of attention, but it’s significant. The study looked at 14,000 kids and compared kids who got an antibiotic in the first couple years of life to kids who did not. And they roughly matched the kids, so they were doing a fair comparison. And they found that kids who got antibiotics in the first couple years of life had a 20% higher rate of obesity and a 21% higher rate of learning disabilities, and a 32% higher rate of attention deficit disorder, all conditions that are on the rise in the modern era of antibiotic overuse, a 90% higher rate of asthma, and a nearly 300% higher rate of celiac. And the kicker is, the more courses of antibiotic a child took in the first few years of life, the increased risk of each of those chronic conditions.
And farmers have noticed this in animals for a long time. They’ve noticed if they give an animal antibiotics, a healthy animal antibiotics, the animal is bigger, they’re fatter. And that’s why antibiotics are unfortunately used routinely in some agriculture. And so people need to know these antibiotics, when they’re not necessary, are altering the microbiome in ways we don’t understand. Similar with C-sections, an unnecessary C-section means a baby is not having their sterile gut in utero. A baby has no bacteria in the gut. The microbiome is seeded from passing through the birth canal and then augmented by breast milk and bacteria from skin and kissing from grandparents. But when a kid is born by C-section, they’re extracted from a sterile operative field. And what may seed the kid’s bacteria, microbiome, are bacteria that normally live in the hospital.
So these are some important things people need to know about how the microbiome is shaped. And many of us think that ultra-processed foods and perhaps even some of the pesticides that are routinely sprayed on average, about a dozen times in the average conventional strawberry, for example, that if these chemicals are killing some of the pests, what are they doing to the microbiome as they run through our system?
Katie: That’s so fascinating. And I know there are so many more examples and so much more you get into in the book. So like I said, I will make sure that’s linked in the show notes. But where can people find you and follow your work and keep learning from you?
Dr. Makary: So I put a lot of this new research in a way so people can understand it in the book Blind Spots. I’m on LinkedIn and Twitter and some other social media, Instagram. I just opened a TikTok account, although I’m still trying to understand it. And so and then I have a website, martymd.com. So I encourage people to use this information to ask good questions and hopefully live a healthier life and have their kids raised in a way that has more natural wellness and good, healthy living as a part of it.
Katie: Well, thank you so much for the time in this episode. This has been a fascinating conversation. And you guys listening, stay tuned for our next episode, which will be all about this related to our children’s health in particular. But Marty, for today, thank you so much for your time.
Dr. Makary: Great. Thanks so much, Katie.
Katie: And as always, thank you for listening. And I hope you will join me again on the next episode of the Wellness Mama podcast.
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.
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