Modern Medicine and its Blind Spots — with Dr. Marty Makary

Dr. Marty Makary, a renowned surgeon and professor at Johns Hopkins, public health expert, and a two-time New York Times bestselling author, joins Scott to discuss his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. They go over topics including the issue of overmedication, weight loss drugs, and the food industrial complex. Follow Marty, @MartyMakary. Scott opens with his thoughts on the film and TV industry in Los Angeles. He then gets into the future of the search industry, specifically how Google’s stranglehold on the $300 billion search ad market is starting to weaken. Algebra of Happiness™: find your tribe. Subscribe to No Mercy / No Malice Buy "The Algebra of Wealth," out now. Follow the podcast across socials @profgpod: Instagram Threads X Reddit Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Speaker 00

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• 1:30Scott Galloway?

  Episode 323 to 0 is the area code serving the state of Minnesota. 1920, Babe Ruth was sold to the New York Yankees from the Boston Red Sox. And the NFL was founded. My two favorite forms of media, the NFL and The Bachelor. I just love watching people fight over balls in a ring.

• 2:02Scott Galloway?

  Welcome to the 320th episode of the Prop G Pod. In today's episode, we speak with Dr. Marty McCary, a renowned surgeon and Professor Johns Hopkins, public health expert and leading advocate for healthcare transparency and a two-time New York Times bestselling author. We discuss with Marty his latest book, Blind Spots: When Medicine Gets It Wrong and What It Means For Our Health. We get into what modern medicine gets wrong. We're gonna need a bigger boat. And the issues of over-medication and his thoughts on weight loss drugs, which we talk a lot about here. Okay, what's happening? The dog is in L.A. for a week. Hello, ladies. Angeles, Los, Los Angeles. But I'm trying

• 2:45Scott Galloway?

  to be a little bit more healthy this week, hanging out, working out, seeing a bunch of friends. I met with two very charming Netflix executives last night from the Prestige Group, a super talented woman from AMC and HBO, working on my original, I don't know if you've heard, but I'm working on an original scripted series based on Big Tech that's been purchased by Netflix for a full season. Just something I do. Just something I'm doing. I'm kind of that guy. I'm kind of that Hollywood guy. By the way, the best thing about me being in the industry, quote unquote, this has been seven years in the making. I wrote a book called The Four about seven years ago. It's essentially a love letter to Big Tech companies. It's a, it's called The Hidden DNA of Amazon, Apple, Facebook and Google.

• 3:30Scott Galloway?

  And it started out as a love letter. I really do like these companies. I've made a lot of money from them. I think they're interesting. I think they're fascinating. I'm fascinated by their leaders. And as I was doing research for this book, I got increasingly uncomfortable. And slowly but surely, by the end of the book, it was a cautionary tale. And I have been pitching this as an original scripted drama. I think about what Succession is to family-controlled media or Billions is to the alternative investments community, we're trying to do the same thing for Big Tech, a story of the companies and the personalities behind them. It's a, it's a drama, so it's inspired by some of the people in it, but it's not a biopic. It's not about, or it's not a documentary. So I'm super excited about that. But the best thing about this is that I'm entering from a point of where I already have, I already have economic security. I don't need this industry.

• 4:16Scott Galloway?

  For my living, I cannot imagine a more stressful place. I don't know, probably, probably being in, you know, in the Marines is pretty stressful. But I can't imagine a more stressful place to try and make a living than LA right now in terms of the entertainment industry. It is in, it's on a structural decline. Content budgets are actually up 2% this year, which is nothing. For the first time, Netflix, kind of the 10 ton grill in the space, is spending more money on global production. For the first time, they are, more than 50% of their content budget is being allocated overseas. Why? This is a business. And the basic, the basic premise here, the basic ratio kicking the shit out of LA is that some of the most popular series relative to ROI,

• 4:59Scott Galloway?

  or the series that have had the greatest ROI, it was the movie Parasite, which was filmed, I believe in South Korea, didn't cost a lot to make, but made good money. So they've recognized that we can produce a lot more films and the hurdle rate is much lower, so we can take much greater risks in terms of artistic expression by filming things overseas. And there's this entire middle layer that soaks up a lot of margin. And essentially YouTube decided, all right, we're going to create this sort of Netflix-like competitor and you can upload a film or a television and just based on the numbers of viewers, we will promote it or not promote it. So there's essentially kind of a direct to consumer dispersion of creative, similar to what TikTok's doing, that will continue to each year.

• 5:42Scott Galloway?

  By the way, what's the most popular streamer in the world? Is it Netflix at 7% of all viewing time? No, it's YouTube at 10%. YouTube is the number one streamer and we really don't talk about it. But you have dispersion, content moving to creators all over the world. Do you want to hear a crazy stat? There's 1.7 billion people on TikTok. Half of them are creators. There's a half a million people making their money from streaming. So 850 million creators on TikTok. They are not as good as the half a million creators working in the streaming industry. But say 1% of them are as good. That's eight and a half million people. Well, still, well, it's not, it's not 1% of them. It's 0.1% of them are really outstanding talent. That's 850,000 additional creators, human capital,

• 6:27Scott Galloway?

  that the existing streaming ecosystem has to compete with. I think LA is always going to do fine because of the lifestyle is so incredible. But at some point, when so many people leave because they don't find they can make a living here because of taxation, because of the high cost of living, I wonder if it becomes a little bit like London. Might be the analogy where wealthy people have a home here, but there's not that much money being made here and it turns into sort of a hospitality city where it's about real estate and servicing people who've made their money elsewhere. I would move back to LA if it wasn't so fucking far from everything. You forget how far it is. One of the things that's really messing with me is the jet lag. I got here, I'm having trouble just sort of thinking clearly as evidenced by this rant that has nothing to do with the script.

• 7:11Scott Galloway?

  Let's get back to the script. All right, what's happening? Google's stranglehold on the $300 billion search and ad market is starting to weaken. According to the research firm E-Marketer, Google's share of US search ad market is expected to fall below 50% next year for the first time in over a decade. Wow, wow, that's from 60% as recently as 2018 and it's going down. And who's taking share from them? Amazon and also AI. I don't know about you, but I have found I am starting to type search queries into ChatGPT and Claude. I'm not sure if I generally like Claude more. I think it's actually better with writing, but I like to think of myself as alternative. I'm a little, I'm an edge. There's a little, there's a little salsa on the dog chip.

• 7:56Scott Galloway?

  That's right. So I use Claude, everyone's like ChatGPT and I'm like, I use Claude like I'm in the, in the know. And that is eating into what is probably the most lucrative market ever. That is the $300 billion search business. The analogy I would use for search and I've used it before, but it's worth repeating is retail. And that is the retailers that added the most shareholder value in the 50s, 60s, 70s and arguably right into the 80s with big box, massive selection, everything there. You want peanut butter? No problem. We have 45 brands, right? And it comes in big vats and it's inexpensive, everything for less. That's Google. It gives you 7,000 search returns in point 0055 seconds. The problem is you have to sort through all those returns.

• 8:39Scott Galloway?

  And increasingly those returns are a lot of bullshit. And that is it doesn't take you to the best place. It takes you to another place that it can further monetize as its shareholder value. Its shareholders continue to want 20 and 30% annual shareholder growth. Now along came in retail, specialty retail. Actually, in the eighties, Circuit City was the number one star performer. Remember them, where service is state of the art? And they brought together every piece of electronics. And then in the nineties and the two thousands, the greatest market capitalization in retail was created by specialty retail. Specialty retail is the following. It recognizes what is the most overlooked truth in marketing. And that is, choice is not a feature, it's a bug. And that's it.

• 9:22Scott Galloway?

  Consumers want someone with better taste than them to tell them what to buy. And that's what AI is. AI is the specialty retail to traditional searches Walmart. And that is, we're not going to give you 5,000 answers and then ask you to sort through them and figure it out. We have someone who has better taste than you, essentially GPU chips, that's going to attempt to give you the best toaster. It's going to give you the best one answer. And if you don't like that toaster, you can say, well, what about a toaster that can do four slices? You can ask query follow on questions, or you can ask AI follow on questions, and it comes back with the right answer. Does that mean Google's going to go away? No, it's the Walmart, it's the Costco, it's the Best Buy.

• 10:02Scott Galloway?

  These companies will still do well, but the major shareholder growth, the major growth in market capitalization is going to be in the specialty retail component of search, and that is going to be AI. And we're already starting to see it with perplexity and OpenAI. That's a good analogy. That's a good analogy here from Los Angeles. Amazon, get this, is expected to account for 22.3% of the market this year, up 17.6% compared to Google's 50.5% share and 7.6% growth. I mean, think about Amazon, 50 cents on the dollar in e-commerce if you take out grocery and gasoline. And this blows me away, 22% of share, a quarter of the search market goes to Amazon. If people want stuff, they use Amazon as a search engine.

• 10:47Scott Galloway?

  What people also don't recognize is that Amazon is one of the five or 10 largest media companies in the world. AWS that suggests different products. If you're searching for Huggies, they go to, is it Pampers or PNG? And they say, would you like to run an ad for Pampers? And they say, yes, especially if someone's looking for diapers from a competitor. And then they start essentially being like the mob with protection money, saying that if you have the best product at the best price, that's not enough. If you want to be in the golden buy box, you want to come up, I insert, you have to use our fulfillment and our advertising. And we're basically going to starch all of the margin from your product, whereas. Brands and products on the third-party marketplace used to pay about 22 or 25% of their

• 11:30Scott Galloway?

  top line to Amazon. Now it's 45%. There's a term for this monopoly. Oh, wait, no, that's not true. Monopoly abuse. Okay, TikTok plays an interesting role in search, especially for Gen Z. Axios reported that 21% of 18 to 24-year-olds start their search journey with TikTok. The platform has started allowing brands to target ads based on search queries and move that directly challenges Google's core business. And then there's perplexity. The AI-powered search startup backed by Jeff Bezos, which is introducing ads in their AI-generated answers and letting advertisers sponsor follow-up questions. You know, it's nice to see Jeff finally starting to make some money, and I hope he finds somebody. And Jeff, don't be

• 12:11Scott Galloway?

  so shy. Live out your midlife crisis. Really, enjoy yourself. Buy a canary yellow teatop Corvette and crash it into a hair plugs clinic. Jesus Christ, could this guy be having more of a midlife crisis right now? And I just want to say, Jeff, I'm here for it. When you're in LA, call me. We'll roll together, be totally pathetic, but we don't care. We're at the point where we recognize we're going to die soon. Let's just go for it, buddy. Let's just go for it. I'm in. Anyways, the big tech stock for 2024 during my predictions. By the way, we're reviewing my predictions for 2024. I get more right than I get wrong almost every year, and occasionally I kind of nail it. But in 2024, I would best describe my predictions, reviewing them, is what's the term? Shitting the bed. I literally got everything

• 12:54Scott Galloway?

  wrong. One of my picks was Alphabet, because I think it's going to be revenge of the nerds. I do think their AI is going to be pretty powerful. I wonder if it's too late, if ChatGPT is kind of pulling away with it. Anyways, Alphabet's performed relatively well, but Amazon has performed much better. Think about Amazon. Best cloud provider, number two in search, number one in e-commerce. I mean, these guys are just like kind of killing it. I would say other than their video, it's kind of a distant three or four. Many advertisers are cautious about shifting their budgets from Google to TikTok due to lower search volume. While TikTok has massive appeal among younger audiences, it still can match Google's

• 13:36Scott Galloway?

  overall search traffic, which handles about 2 trillion searches per year. 2 trillion.

• 13:42Scott Galloway?

  The big picture, this is happening as Google faces legal challenges, including an antitrust case it lost this summer, which heightened the tension around its search ad dominance. What's the future of search? Like I said, it's bifurcating. I do think there is plenty to go around. I do think AI you want to learn about, you want to understand it, you want to start thinking about, and it'll come naturally just playing with it, how it impacts your industry. In sum, in sum, AI is not going to take your job. Somebody who understands AI is going to take your job. We'll be right back for our conversation with Dr. Marty Makary.

• 14:22Scott Galloway?

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• 15:25Scott Galloway?

  Support for the show comes from Vanta. As AI adoption grows, so does your company's security risks and requirements. New frameworks, audits, and vendors keep piling on, but your team isn't getting any bigger. Most compliance tools promise automation, but you're really stuck doing all the work by hand, chasing screenshots, validating controls, and playing catch-up when audit season comes around again. Vanta works differently. The Regent Trust platform is built to scale with you, not slow you down. With over 1,400 automated tests across 400-plus integrations, Vanta collects evidence and monitors your controls year-round, cutting your audit prep by 82%. Plus, you can access the Vanta agent everywhere you work, whether your team is in Vanta every day or living in tools including Claude or Cursor. Want proof?

• 16:10Scott Galloway?

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• 16:32Scott Galloway?

  Support for the show comes from Vanta. As AI adoption grows, so does your company's security risks and requirements. New frameworks, audits, and vendors keep piling on, but your team isn't getting any bigger. Most compliance tools promise automation, but you're really stuck doing all the work by hand, chasing screenshots, validating controls, and playing catch-up when audit season comes around again. Vanta works differently. The Regent Trust platform is built to scale with you, not slow you down. With over 1,400 automated tests across 400-plus integrations, Vanta collects evidence and monitors your controls year-round, cutting your audit prep by 82%. Plus, you can access the Vanta agent everywhere you work, whether your team is in Vanta every day or living in tools including Claude or Cursor. Want proof?

• 17:17Scott Galloway?

  Over 16,000 fast-growing companies like Ramp, Ryder, and Harvey save time and resources while scaling fast with Vanta. Learn more at vanta.com/profg and get $1,000 off. That's spelled V-A-N-T-A dot com slash profg for $1,000 off.

• 17:48Scott Galloway?

  Welcome back. Here's our conversation with Dr. Marty Akary, a renowned surgeon and professor at Johns Hopkins, a leading advocate for healthcare transparency and a two-time New York Times bestselling author. Doctor, where does this podcast find you?

• 18:01Speaker 04

  I'm in New York today.

• 18:02Scott Galloway?

  Let's bust right into it. Your new book Blind Spots: When Medicine Gets It Wrong and What It Means for Our Health is an eye-opening book about the latest scientific research on the biggest health topics of our day, including hormone replacement therapy, peanut allergies, cholesterol, gut health, and rising levels of cancer in young people. Let's start there. What does modern medicine get wrong? What are the biggest blind spots?

• 18:28Speaker 04

  Well, modern medicine is so busy billing and coding and seeing patients in short visits that we've not been talking about the root causes of so many of these diseases that are on the rise and with cancer on the rise in young people. And so we've got to talk about our poisoned food supply and the chemical ingredients that are engineered and added to our food that are banned in Europe and Canada. And we've got to talk about environmental exposures that cause cancer, not just the chemo to treat it. And we've got to talk about school lunch programs, not just putting every kid on Ozempic when they get overweight. We've seen this massive explosion of chronic diseases in our lifetime. Didn't exist two generations ago. Doesn't exist in many parts of the Amish community

• 19:11Speaker 04

  that still use good farming and eat food from the soil. And it doesn't exist in many parts of the world. So we've got to look at what we're doing differently. Those root causes have been in our blind spots.

• 19:24Scott Galloway?

  What you say really resonates. The first thing I noticed, we moved to the UK two years ago, and I'm not exaggerating. The first thing I noticed was that everything in a refrigerator went bad or spoiled in two or three days. And what I recognize is that's a feature, not a bug. It's because they're not putting all the preservatives and shit in it.

• 19:45Scott Galloway?

  Is that, is that part of the problem that in order to increase economics and decrease the perishability, we just put too many things in our foods that aren't healthy?

• 19:55Speaker 04

  I've got patients that have chronic pain and nothing works. We try everything in modern medicine, but then they come back and say, you know, I spent a summer in Italy and for the first time I felt healthy. And what's going on is they're eating healthy foods, foods that are designed to go bad after some time. They don't have these chemicals designed to increase the shelf life. So that's a part of it, along with pesticides that are, you know, killing insects in the crops, but they're also killing our gut microbiome, the bacteria that line our gut. So there's so many factors, but that's exactly the sort of thing right now that we need to take a hard look at.

• 20:34Scott Galloway?

  If you thought, okay, I don't have the money or I don't have the energy to totally reconfigure my diet, what are two or three things you could do right away that would take out, say, a disproportionate amount of the risk factors in your diet?

• 20:46Speaker 04

  Well, I hear that a lot. I hear organic food, which is food without pesticides, costs too much. And I tell people, try the cost of insulin because a lot of these things going on today are the direct result of our poisoned food supply. How else do you have 40% of our nation's children that are overweight or obese and just 5% in Japan? Our kids in America are not more disobedient or more addicted as a part of their personality. No, we've poisoned the food supply and created highly addictive foods that have things like food dyes. So the food dyes, for example, are mostly banned in Europe and Canada. So Kellogg's makes two types of Fruit Loops, one with the banned

• 21:29Speaker 04

  ingredients for the American kids that makes the food look all colorful and shiny. And one without the banned ingredients that they shipped to Canada. So don't American kids deserve the healthier version of food made by an American company? Uh, California just banned seven food dyes. Uh, 10 other states have some bans on these dyes. But I would say, read the ingredients. Simple messages I tell patients, drink water, avoid these sugary drinks, avoid processed food with lots of ingredients. And watch out for seed oils. They sound natural, like vegetable oil and canola and soybean oil. But they're not, they're denatured at high temperatures and then a chemical solvent is used to change the structure.

• 22:12Speaker 04

  So you, these are really chemicals. And when they hit the GI tract, guess what? Your body's immune system reacts to them. These are things that do not occur in nature and your body is reacting with an inflammation. It's not a big inflammatory storm. It's a constant low-grade inflammation and it makes people feel sick. And we need to address these root causes, not just medicate everybody that comes in with these sicknesses.

• 22:41Scott Galloway?

  I want to put forward your thesis and get your, get your response to it. I've always thought that unfortunately, in areas that are especially important to the well-being of our society, when you inject the profit element, there's some good components to it, but there's a lot of bad components. And I've always thought that essentially the industrial food complex has a profit incentive to get you addicted to terribly addictive sugary, terrible food, such that they can hand you over to the industrial diabetes complex where there's a ton of money. Your thoughts?

• 23:12Speaker 04

  Well, I think you're right. The food industry started off with a charge to address food insecurity and world hunger. And so they started creating techniques genetically modifying food, adding pesticides after it was discovered in the days after Asian orange, that it would kill insects, but it also killed the crops. So they genetically modify the crops to be so-called roundup-ready. That's where they can tolerate the pesticides. Well, that's our modern-day food supply. But the problem is, human beings are not made roundup-ready. So it's poisoning the human body as well. So, look, I see the best in people, and I think the food industry started off with this commission,

• 23:57Speaker 04

  this charge to mass-produce food. Now, we have to educate people about the unintended consequences of all these chemical ingredients in ultra-processed foods and foods laced with pesticides. For example, pesticides have hormone-like binding properties. Food dyes are hormone disruptors. Is it a surprise that the average age of puberty goes down by a week and a half every year for the last 30-plus years? It's now years sooner than it was a generation ago. That sperm count's are down 50% in the last five decades. That rates of GI cancers are increasing. So, these are things we don't talk about in medicine. I got zero of this stuff in medical school.

• 24:39Speaker 04

  But now that I've taken the effort to learn about it, research it, and summarize it for folks, I'm going directly to the public, as a bunch of doctors are now, to try to educate people about what's happened to our food supply.

• 24:54Scott Galloway?

  Describe your diet. What do you try and dial up and what do you dial down?

• 24:59Speaker 04

  Well, I think one of the biggest pieces of misinformation spread by the United States government, and they've spread a lot of it. But one of the biggest pieces has been demonizing natural fats. Saturated fats, I'm not saying everyone needs to eat it, but it's a good source of protein. And when you're eating meats that are well-sourced, that is a good source of nutrition. The government food pyramid demonized natural fats, moved the entire food industry to ultra-processed foods, and created these refined carbohydrate addictions that have drove our obesity epidemic. I like nuts. I like fruits that are not coated with pesticides. It's especially important to buy organic when you're eating the surface of a fruit

• 25:44Speaker 04

  or vegetable. Uh, strawberry, for example, has been sprayed over a dozen times with 7.8 different pesticides on average. The average school lunch program may have 38 different types of pesticides detectable. You can detect these things now in the urine of children, in the umbilical cord blood of mothers. So, um, I'd like to eat. These are almost biblical principles, right? Things that grow out of good soil, uh, clean meats. And I do a little bit of intermittent fasting when I can.

• 26:18Scott Galloway?

  Talk about intermittent fasting. Why is that? Why is that helpful?

• 26:23Speaker 04

  Well, I think in general, people are not getting enough protein. So I'd, um, warn people about just starting to skip meals because you really want to get a good amount of protein in your, in your meal, in your, uh, day. But I just try it because it, I think it helps manage through a bit of willpower, some of the appetite, uh, urges that I sense. I'll tell you what had a big impact is when I got rid of artificial sweeteners. The debate about artificial sweeteners got really hijacked by the do or do they not cause cancer argument? But I don't think they do. They've been around for a long time, but what they do is they trick your pancreas into thinking that a big sugar load is coming and it doesn't come.

• 27:07Speaker 04

  So the pancreas is waiting for that sugar load and it creates a craving and often results in binge eating of carbohydrates later in the day. So by getting rid of those artificial sweeteners, I think it helped manage my appetite.

• 27:21Scott Galloway?

  So which of these topics do you think the public is most informed about? What are the biggest myths in healthcare?

• 27:27Speaker 04

  Well, I think for perimenopausal women, there's a, a myth that hormone replacement therapy, that is taking estrogen or estrogen plus progesterone. When your body doesn't produce it anymore around the time of menopause, causes cancer. It's one of the greatest dogmas that's still alive and well, both in the medical establishment. And it turns out the study that was cited where people say, aha, here's the study where we show it caused cancer, did not show a statistically significant increase in cancer. But the announcement was so magnificent and so broad by researchers at the NIH. The media ran with the story before they ever looked at the data.

• 28:09Speaker 04

  The data were released later, over a week later. And by that time, The world had already been convinced of this dogma. Now, the reason I'm mentioning hormone replacement therapy, when you asked, what is, you know, what's one of the biggest misconceptions? Here's a medication that not only alleviates the symptoms of menopause, the hot flashes, mood swings, weight gain, night sweats, but also has long-term health benefits because the blood vessels are healthier, nitric oxide levels are higher. And so, heart attack rates in some studies are half, or they're cut in half because women who start hormone therapy within 10 years of the onset of menopause.

• 28:51Speaker 04

  The rate of cognitive decline goes down by 50 to 60%. The rate of Alzheimer's goes down by 35%. And a woman has stronger bones and is far less likely to break a bone or have a hip fracture. So, the overall long-term health benefits are overwhelming. Women live longer and feel better. But tragically, 50 million women have been denied hormone therapy since the time of this dogma announcement that it causes breast cancer.

• 29:19Scott Galloway?

  Do you feel the same way about testosterone replacement therapy?

• 29:22Speaker 04

  I don't. It's very different with men and testosterone. Both men and women have testosterone and estrogen. Now, some of the dogma is parallel. For example, the dogma that testosterone therapy causes prostate cancer. Another dogma, like the dogma that hormone therapy in women causes breast cancer, is not supported by the data. Now, there are benefits and I do recommend people who are symptomatic get tested for their testosterone levels. And I do see people who benefit, men who benefit from testosterone replacement. But the long-term health benefits are not as dramatic as we see with hormone therapy in women.

• 30:01Scott Galloway?

  But if you go on testosterone replacement therapy at 57 and you find you're stronger, your skin's a little more youthful, your sex is a little, your erections are a little bit longer. Do the benefits outweigh the drawbacks? Asking for a friend.

• 30:19Speaker 04

  Look, yes, the most of the time, the benefits outweigh any potential downsides. People just need to recognize that if you're still making some testosterone on your own, you're probably going to shut that down by taking it exogenous.

• 30:34Scott Galloway?

  You're out of the rest of your life. That's what they told me. Yeah. And you talk a little bit about the chronic disease problem. What do you mean by that? And how serious is it for society?

• 30:45Speaker 04

  Autism has increased 14% every year for the last 23 years. What's going on? Like, who's looking into this? Right? We just keep medicating kids when they come in. It's now one in 22 kids in California born today will be diagnosed with autism. I mean, it barely existed. It was rare just two generations ago. It's still rare in the Amish community, in other parts of the world that have not adopted the Western diet. And I think the autism cause discussion has also been hijacked by the is it or is it not vaccines? After a fraudulent study suggested it was due to vaccines.

• 31:25Speaker 04

  But we got to put that aside and talk about the microbiome, the lining of the GI tract, the garden of bacteria that normally live in harmony, millions of different bacteria that we we alter, we throw it off, we carpet bomb it with ultra-processed foods, antibiotics, even C-sections. Antibiotics and C-sections can save lives, but they're massively overused, especially antibiotics. And a study just found that kids who take antibiotics in the first couple of years compared to kids who do not have have higher rates of learning disabilities and obesity and celiac and asthma. And you may wonder, how could altering the microbiome affect mental illness?

• 32:10Speaker 04

  Well, some of those bacteria make serotonin. And if you look at the diets of people in Europe, it's very different. They have far less chemicals. They I have lower rates of mental illness, of autism, of obesity, of autoimmune diseases. Autoimmune diseases now affect one in five women. What's going on here? You know, my field is pancreatic cancer. As a surgeon at Johns Hopkins, it specializes in the pancreas. Pancreatic cancer rates are going up and no one is asking why. We do more pancreatic cancer work than any hospital, more pancreatic cancer research than any center in the country. Nobody is asking why.

• 32:53Speaker 04

  We've got to ask these big questions and talk about root causes.

• 32:56Scott Galloway?

  It's interesting because I think of pancreatic cancer as a death sentence. I just think it's game over. Is that not true?

• 33:05Speaker 04

  Um, so of those who get to surgery, which is a subgroup, maybe 20 to 30% of people can have the option of having surgery, the five-year survival rate's about 20%. So it's, it's pretty bleak and we have not made a lot of progress in the last 30 to 40 years. So I think that we've got to talk about root causes. Same thing with Alzheimer's. Alzheimer's is skyrocketing and we spend billions of dollars on these expensive new medications that get a lot of excitement that honestly, they barely work and they have high side effects. And we're not talking about the study that the Mediterranean diet was found to reduce

• 33:49Speaker 04

  Alzheimer's significantly. Hormone therapy in perimenopausal women reduced Alzheimer's by 35%. And Alzheimer's is associated with poor quality sleep on a chronic basis. So we could do a lot, a better job talking about these underlying root issues.

• 34:06Scott Galloway?

  But I mean, it sounds like, and common sense is obviously where the insight is. I've had doctors, Atiya and Huberman on my podcasts. I'm always amazed how much shit they get because what they say to me feels pretty common sense. Get good sleep. Eat better, eat out less, eat at home more, more grains, more vegetables, less processed food, and make sure you get some exercise. I mean, I'm not saying these things are easy, but aren't they pretty basic? And what you're talking about is preventive offensive healthcare as opposed to defensive healthcare after something's gone wrong. Is that accurate?

• 34:45Speaker 04

  Look, I can tell you, Peter Attia was with us at Johns Hopkins, and he is as superb as they get. Evidence driven, science based, logical, common sense, and lives what he, what he says. And so a bunch of us now are going directly to the public to try to educate them about these issues. To say, yes, it is common sense, but you'd be amazed. Ninety plus percent of our food supply is sprayed by pesticides and multiple times. You just saw the court case now open up the window to removing fluoride from drinking water, or at least not adding it. This was a dogma for decades that we had to have fluoride in drinking water because it supposedly reduced risks of cavities.

• 35:28Speaker 04

  Well, how about stop drinking sugary drinks if we want to reduce cavities? And if the fluoride is killing the bacteria in the mouth, reducing cavities, what do you think it's doing to the microbiome bacteria in the gut? So these are the big questions we've not been asking that we need to ask.

• 35:46Scott Galloway?

  We'll be right back.

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• 36:20Speaker 06

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• 36:51Scott Galloway?

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• 38:00Scott Galloway?

  Curious where you think I'm. I'm in LA and whenever I'm in LA, I have a buddy here who's what I'll call going through a midlife crisis that he's going to grow out of in about 30 or 40 years. And he always takes me to these kind of fabulous parties with a lot of very young, very fabulous, very attractive LA people.

• 38:18Scott Galloway?

  And the thing I've noticed it's changed among a younger generation is they have substantially reduced the amount of alcohol intake and they've replaced it with drugs, ketamine, MDMA, edibles. Give me your thoughts on the health impacts of alcohol versus psilocybin versus some of these designer drugs, for lack of a better reason. And I recognize that ideally you don't do any of these things. Well, and I'll cut to the chase. I drink way too much. It's where my health falls down. Imagine you're someone who is always probably going to have a certain level of substances in their life, because correctly or incorrectly,

• 39:00Scott Galloway?

  they've identified it enhances their life. What substances would you stay away from? And how do you feel about the impacts of some of these more trendy designer drugs?

• 39:12Speaker 04

  Well, I can tell you about alcohol. So as a doctor who has dealt with liver and pancreatic issues for a long time, there, if there ever were any tiny benefits to the heart from drinking a glass or two of wine a day, they are far eclipsed by the damage done to the liver. So people are, look, I understand people have their rituals and they, if they want to drink a glass of alcohol, I think it's safer than cocaine. But more people die of alcohol abuse than opioids and fentanyl. And so I think we don't talk enough about the abuse potential as people need just to be mindful of that because it's one of these

• 39:56Speaker 04

  things that it's in our blind spots in medicine. We just sort of ignore the fact that we have

• 40:03Speaker 04

  up to 170,000 deaths a year from alcohol. We don't need to be celebrating and glorifying abuse of alcohol and can promote more responsible drinking. And for those who choose not to drink or drink rarely, which is what I do, you're going to probably sleep a little better and sometimes have a healthier liver.

• 40:25Scott Galloway?

  What do you think of like ketamine, MDMA? I was shocked how many young people would either not drink, nurse a drink, but they were on ketamine or MDMA?

• 40:37Speaker 04

  Well, it's a, it's, it's a mixed story because sure, while we don't see the same deaths as we do from heroin with some of those external exogenous drugs, there is the potential for abuse. You just saw the star of Friends suffer with ketamine overdosing. It can be addictive. In the past, we used to use lower doses. Now that it's more available and people are trying it, there's an abuse potential people may not be aware of when they first try it. So, I mean, I'm probably not the best expert to answer those questions, but

• 41:18Speaker 04

  certainly we see an abuse potential pretty broad. Marijuana is one that I know more about. I wrote about in the book Blind Spots. There's a dogma that it's totally safe. And I try to dispel some of that because sure, it's safer than cocaine, but the idea that, oh, it's not a gateway drug. We may want to believe that, but that's not really what's supported by the data.

• 41:41Scott Galloway?

  Say it's, say you use it once or twice a week to help sleep and wind down instead of alcohol, and it hasn't been a gateway drug. And then asking for a friend, what are your thoughts on edibles?

• 41:52Speaker 04

  Marijuana today is not the marijuana of Woodstock. It's about 10 to 20 times more potent. So you want to watch those doses. You want to be aware of the fact that there, it acts differently in an adult than it does in an adolescent, where a developing mind may be more susceptible to the risks of future psychoses. In one study, 25% people who use it regularly as a teenager will go on to have some psychosis related diagnosis in the future. So it may be more dangerous in the developing mind in adolescents.

• 42:27Scott Galloway?

  You said in an interview with PragerU that there's no reason anyone should ever sign a financial document in an emergency. You suggest, right, did not read, or this is not a contract instead. What did you mean by that?

• 42:40Speaker 04

  Yeah, so by law, hospitals are required to take care of you for any urgent or emergent situation. And what hospitals increasingly have been doing is putting this financial contract telling you, almost manipulating you to sign your life, home, mortgage, retirement, savings away under penalty of law, just to be treated. And that is, if it doesn't violate the, the letter of the law, it violates the spirit of the law. You don't have to sign your forms away. My team has done a lot of work on hospital price gouging and predatory billing. And we found that hospitals sometimes sue patients in court to garnish their wages. This violates everything sacred in our profession. Hospitals are there as a safe haven. To take

• 43:25Speaker 04

  care of somebody and manipulate them to sign their life away financially, I think is predatory. I don't think anyone should ever sign a financial document in an emergency room.

• 43:35Scott Galloway?

  So I'll put forward another thesis and I'm gonna want to get your response. The majority of advanced nations have nationalized healthcare, spend about $6,500 per citizen on healthcare. We spend 12 to 13,000, yet we have worse outcomes. Higher infant mortality, lower, uh, lower age expectancy. And yet, the insurance industry, who has inserted themselves in the middle here, 45 cents on the dollar goes to administration and profits, which as far as I can tell, in terms of math, is responsible for the difference between what other nations spend on healthcare and what we spend. Hasn't basically the industrial health complex weaponized government, inserted profit institutions to the expense of American citizens?

• 44:16Speaker 04

  I think there's a lot of truth in what you're saying. The question is, what's the solution? And I've spent a lot of time in my tenure as sort of as a health policy expert in our Johns Hopkins, talking about different healthcare systems. And I'm convinced there's a better model than what we have now. At the same time, while there's an attractiveness to moving to a single payer system, you cut a lot of the waste in the short term, a lot of the middlemen and the, um, the people profiteering off of, say, our billing and coding system. Ultimately,

• 44:53Speaker 04

  Governments cannot resist 10, 20 years down the road, doing across the board tightenings of the belt. And what it ends up doing is resulting in an underfunding of the healthcare system. And we've seen that even with our own government system, Medicare. It's massively underfunded and it just becomes a declining priority after the initial enthusiasm to have some government. So it's a mixed picture. I tend to focus on what's feasible. And right now, my concern is we can have the most gold plated health insurance for every American. We can fix our broken healthcare financing. But if we are still recommending bad practices and not addressing our poisoned food supply, we're going to keep watching these chronic diseases extend.

• 45:39Scott Galloway?

  So it feels as if many of these roads lead back to preventive healthcare, specifically around our food supply system. How do we fix that? Is it taxing these foods to their? I mean, my understanding is if you just, if you just priced water at its real cost, beef would be $20 or $30 a pound. If you, you know, Bloomberg wanted to tax Big Gulps, is it taxing these companies? How do you? How do you address the externalities and fix? Is it more regulation, more pricing? It reflects the damage of the externalities here? How do we create a healthier food supply system?

• 46:16Speaker 04

  So Scott, you're talking to a guy who's studied a lot of the unintended consequences of well-intended government policies. So I'm a little leery of things like a strong government interventions. And so what I would suggest is the government needs to stop spreading misinformation about food and nutrition. They need to stop purchasing with US tax dollars dangerous foods. We do this in almost every school lunch program in the United States. Heck, we strip the fiber out of the food and feed it to kids like sugar and call it bread, even though it's really not bread. And we've got to sometimes help support these school lunch programs with subsidies to buy healthier foods.

• 46:59Scott Galloway?

  Curious to get your thoughts on GLP-1 drugs.

• 47:02Speaker 04

  We're clearly seeing a reduction in short-term health complications when people lose weight. But just like you're losing excess body fat, you're also losing muscle mass. So everyone who prescribes these drugs is supposed to technically be saying that you're supposed to exercise like crazy and eat a high protein diet. But in the real world, people are not necessarily doing that. And we don't know what the long-term consequences are of losing all that excess muscle mass. Here's one little fact people may not be aware of. The number one predictor of how long you live is your muscle mass. So we may be accelerating frailty and even shortening lifespan despite the reduction in health complications in the short term.

• 47:46Scott Galloway?

  God, that's wild. Yeah, so everything I read about Ozempic, I've, I'm, every year I do a prediction seminar on technologies. And I said that in 2024, the most seminal technology breakthrough is GLP-1 drugs. The stuff I've read reduces alcohol consumption, biting nails. Then my, they're talking about giving it to people with gambling and social media addictions. Am I overestimating the impact this might have on our society?

• 48:15Speaker 04

  I'm a little cautious about the premature celebration that we may now have a drug to treat addiction. And it may be a secondary effect because you probably feel better about yourself when you lose weight and may just have a more positive outlook and better willpower. So I'm a little cautious when pharma says we have a solution for everything. But I will tell you this, Scott. We are seeing now a new generation of GLP-1 drugs like Ozempic that are about to come to market. There's estimated to be 29 that are going to come to market in the next 20 years or so. And some of these now are designed to block that receptor on the muscle. So it may not reduce muscle mass, as is our concern with Ozempic and Wegovy and some of the others.

• 49:00Speaker 04

  So we'll have to see. But here's a question I posed to most doctors when I talk to them about this topic. Have you seen anybody come off of Ozempic and keep the weight off just from diet and exercise? I'd like to see that be a nice population of people before I recommend it too broadly.

• 49:20Scott Galloway?

  And final question, just something personal. Someone in a high-pressure job, you're obviously very ambitious. Any thoughts on being a good partner when you're trying to have the kind of impact you're having, the demands it places on your professional life?

• 49:34Speaker 04

  Yeah, I think what we've seen is that the happiest communities in America are those with strong social networks. And when you look at the Maslach work at Berkeley on workplace satisfaction, one of the greatest drivers of happiness at the workplace is the amount of positive feedback you get directly as a result of your time and services. And we're learning now in an amazing study that blew me away as a doctor, that when you energetically and enthusiastically compliment someone else, then you actually increase your own endorphin levels at a level higher than that of an antidepressant.

• 50:19Scott Galloway?

  Love that. Be generous. That's, that's the best medicine. Dr. Marty Makary is a renowned surgeon and professor at Johns Hopkins, public health expert and leading advocate for healthcare transparency, and a two-time New York Times bestselling author. His latest book, Blind Spots: When Medicine Gets It Wrong and What It Means for Our Health, is out now. He joins us from New York City. Doc, I really enjoyed this conversation. Thanks, Tru. Good work. I think it's having a real impact.

• 50:45Speaker 04

  Thanks so much, Scott. Good talking with you. I appreciate it.

• 50:56Scott Galloway?

  As for happiness, you need to find your tribe. I went to this birthday party this weekend for some friends from college. About eight of us met when we pledged ZBT fraternity, Alpha Road chapter at UCLA. And I think if you're a young person, or even an older person that wakes up and realizes you're one of the men that, one of the one in seven men that doesn't have a single friend, or one of the four men that can't name a best friend, you have to find your posse. And I don't care if it's a church group, a sports league, a nonprofit, whatever it is, temple, a fraternity, a sorority, a club at work that gets together on a regular basis, seek out a group of virtuous men who are intelligent.

• 51:44Scott Galloway?

  And express friendship, try and get together with them. I don't care. It's poker and start finding your tribe. Because here's the thing, by the time you get to my age, all you have literally is love and camaraderie for these people. And I went to this party Saturday night and I met all other kids and all other wives. And it's literally this tide pool, this epicenter, this volcano of achievement, prosperity, love, and it is in friendship. And all the bullshit just sort of melts away. And you feel loved and you get so much reward from these friendships. And we've done a really good job. We go every year to Las Vegas for the last, or every other

• 52:29Scott Galloway?

  year, I should say, for the last 40 years. We know each other all so well. And there's something about investing in relationships when you're young. It's like compound interest. And that is, you wake up one day and you just have a mess of great friends that bring you enormous reward, enormous comfort. But it starts with a tribe. And especially young men, I worry that we're developing into a different species where we're comfortable being alone, sequestering from society, becoming much more prone to nationalist or misogynist content. We start blaming immigrants, start blaming women, start getting angry, start being susceptible to the manosphere, which is nothing but thinly veiled weirdness. It's

• 53:10Scott Galloway?

  effort, it's work. Find that group, lean into it, be generous, be open to friendships. You are part of a tribe. Start building yours.

• 53:21Scott Galloway?

  This episode was produced by Jennifer Sanchez and Caroline Shageran. Andrew Burrows is our technical director. Thank you for listening to the Prop G Pod from the Vox Media Podcast Network. We will catch you on Saturday for No Mercy, No Malice, as read by George Hawn. And please follow our Prop G Markets Pod wherever you get your pods for new episodes every Monday and Thursday.

• 53:47Scott Galloway?

  Daddy was here early. Daddy's on time despite the fact it's oh fucking dark hundred hours here. He found a way to be on time. But not the millennials, they were walking their dogs and doing ketamine.

• 54:02Speaker 08

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