A Closer Look at Health Care
With Dr. Marty Makary, MPH
Season 4, Episode 13 | December 7, 2021
Our health-care industry can be confusing and difficult to navigate — and it presents challenges when the lifestyle changes that can help manage or prevent illnesses aren’t considered. Marty Makary, MPH, offers a transparent look at the industry and underscores why lifestyle changes are such important factors in the quality of our health.
Marty Makary, MPH, is a practitioner and professor at the Johns Hopkins University School of Medicine and Johns Hopkins Carey School. His current research focuses on health-care transparency, and he has published more than 250 scientific articles on the redesign of health care, medical innovation, and health equity.
He has been elected to the National Academy of Medicine, is the recipient of the Nobility in Science Award from the National Pancreas Foundation, is the chairman of the African Mission Healthcare medical advisory board, and leads several health-care collaboratives. He’s the author of The Price We Pay and Unaccountable.
In this episode, Makary discusses the opportunities he sees to make improvements in our health-care industry, including addressing what he believes are three primary problem areas:
- Financial toxicity. “Billing quality is medical quality and financial toxicity is a medical complication,” says Makary. “We didn’t take an oath to treat illness and cure disease and then ruin a person’s life financially. Hospitals were built for communities. They were funded by philanthropists and churches. They were there as a safe haven for people who are sick and injured. That’s our great medical heritage. And that is being threatened now by this business of price gouging and predatory billing.”
- Appropriateness of care. “Disease did not double in the last 10 years — medications doubled,” says Makary. “We have the most medicated, the most disabled, and the most obese generation in the history of the world.” He encourages new types of conversations, such as looking at treating diabetes with cooking classes, talking about school lunches instead of bariatric surgery, and thinking about sleep quality, stress management, and yoga classes rather than hypertension pills.
- Care coordination. “The hard part about managing illness and disease is not telling people what to do, it’s helping them do it,” says Makary. “The No.1 factor that predicts whether or not somebody gets a meaningful workout isn’t the equipment they’re using — it’s the presence of a workout partner.” He says he’s starting to see medicine adopt that same model where you have a partner in achieving your health goals.
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Transcript: A Closer Look at Health Care
Season 4, Episode 13 | December 7, 2021
Welcome to Life Time Talks, the healthy-living podcast that’s aimed at helping you achieve your health, fitness, and life goals. I’m Jamie Martin, editor-in-chief of Experience Life, Life Time’s whole-life health and fitness magazine.
And I’m David Freeman, Life Time’s national digital performer brand leader. We’re all in different places along our health and fitness journey, but no matter what we are working toward, there are some essential things we can do to keep moving in the direction of a healthy, purpose-driven life.
In each episode, we’ll break down the various elements of healthy living, including fitness and nutrition, mindset and community, and health issues. We’ll also share real inspiring stories of transformation.
And we’ll be talking to experts from Life Time and beyond, who’ll share their insights and knowledge, so you’ll have the tools and information you need to take charge of your next steps. Here we go.
Hey, everyone, we’re back with another episode of Life Time Talks. I’m Jamie Martin. I’m here with my cohost David Freeman, and also a special guest host. David, do you want to introduce our friend here?
Special indeed. I’d say superstar, but let’s just go ahead and say mega-star at this point, we got Paul Kriegler, did a episode around healthcare transparency with Dr. Marty. Paul’s background within, being a registered dietician, nutrition, our product development when it comes to the supplements that many people who are probably listening right now actually take, just an all-around jack of all trades. Paul, how are you doing today?
Thanks, David, I’m doing great. I appreciate you guys having me back on to do a guest host episode.
With so many great talking points throughout this episode around healthcare transparency, what were some of the biggest take-aways that you had with Dr. Makary?
You know, Dr. Makary, he’s got such a breadth of knowledge and experience in multiple realms of healthcare, from Master’s of Public Health, so he’s got epidemiology training and experience, he’s got healthcare policy experience, and he’s still to this day a practitioner and professor at Johns Hopkins University. So, he sees the entire spectrum of how healthcare gets delivered, decided on, funded. You know, it’s really quite eye-opening to see how confusing our healthcare industry can be, and how many areas of opportunity for mistakes or missteps there are.
And if patients or people aren’t aware of kind of how confusing or how convoluted it can be, it can be really difficult for them to navigate. But what really stands out is, even though he’s got all this experience with every aspect of healthcare, he still is firmly grounded in the fact that people should take every step possible to take personal responsibility to move their health in the direction they want it to go. In other words, don’t leave it up to the system to take care of your concerns. Do everything in your power to manage and manipulate and optimize your own health.
It sounds like there’s really an element of preventive and proactive care around your own health and well-being within all of this, and sounds like he offers some really tangible steps that we can all take within our own daily lives to do just that.
Absolutely, and it’s pretty incredible to hear somebody who, you know, has seen and witnessed and administered some of the miracles of modern medicine. You know, he operates on patients regularly still. You know, one of the most technical surgeries, I think, that still exists, he does islet cell transplant surgeries. So, he takes certain cells from the pancreas of one patient and implants them into another, to help them manage their endocrine system.
So, one of the most complicated, almost miracle-type surgeries that he’s had his hands on for a very long time, but then, he can still kind of step back and take this 50,000-foot view, and say, like, no, listen, you got to take a walk after dinner. You got to manage your stress, you got to set a bedtime, you got to laugh with your family. You got to…you know, all those things still matter, even though modern medicine has these miracle surgeries and procedures that he’s had personal experience with.
Yeah, Paul, there was two major ones, major talking points that stood out to me. The first one is how he was able to call out the area of opportunity within our healthcare to empower our society around food being medicine, and the focus of healing versus treating. So, this is something that we need to be talking about more. So, taking this episode and sharing it to the masses, I would hope, sparks a movement so we can change the way we think when it comes to eating these foods.
So, was that something that stood out to you? I know you’re always aware of it in the health and fitness industry when it comes to food and nutrition, but as far as food being medicine, like, what stood out to you about that?
Yeah, it reinforces what we see all the time, David, you and I, you know, working with people in the clubs. Nothing can quite match the power of someone’s moment-to-moment decision-making, or meal-to-meal decision-making, I like to call it. We have way more power in the decisions we can make as individuals than modern medicine will ever be able to address. You know, and to hear it from somebody like Dr. Marty, it just reinforces all of our experience, in that as wonderful as modern medicine is, it pales in comparison to the power that we have at the end of our fork.
Well, let’s not have our listeners wait any longer. Let’s dive into this episode of healthcare transparency, so we can have a clear understanding of how to take back control of our lives, with Dr. Makary. Paul, take it away.
I’ve got the pleasure of speaking with Dr. Marty Makary here today. He’s a physician and professor of public health at Johns Hopkins University. He’s a New York Times bestselling author of, I think, two books now, the most recent of which is The Price We Pay, which is an excellent read, I encourage everyone who has any level of interest in healthcare, pick up a copy of that book.
It’s now out in paperback as well, but it’s an outstanding journey through, you know, some of the most nauseating elements of our healthcare industry, but also some of the most hopeful elements of our healthcare industry. And as a dietician, I’m super-interested in the topic of what people can do to educate themselves on and act on the things that are going to make the biggest difference in their health journey throughout their lifespan. So, Dr. Makary, pleasure to have you on.
Dr. Marty Makary
Great to be with you, Paul.
So, for our listeners, give us a little background on where your professional journey has taken you over the years of medical school, and research, and health advocacy.
Dr. Marty Makary
Well, thanks, Paul, because we do try to work in advocacy into all of our research, and what I’ve sort of found to be futile is doing research just for research’s sake. That’s kind of the scientific world, right? You just increase knowledge, and increase knowledge, and then force all the young people to memorize and regurgitate it on exams, and it’s like, hey, there are these major social injustices, there are these major blind spots in medicine.
Food as medicine is one of them. The inflammatory state is another one. We don’t talk at all about those things, but yet, they’re actually very integral to what we do. So, you know, when you go to medical school, and this is true of a lot of medical fields, you’re kind of forced to choose one organ that you love, right? Are you going to be a heart doctor, or a brain doctor, or a pancreas doctor, and I happen to be a pancreas doctor, by the way, but it’s like, why do you have to pick one organ system, like the skin?
Why can’t we actually encourage people to understand the way that we deliver care, and how can we can redesign that? So, over the years, I’ve pivoted my research to be really research/advocacy on these issues that we study, like price gouging and predatory billing in healthcare, or the lack of research on the important issues involving food as medicine. And then, the other piece of it is, we actually say, let’s focus on the redesign of healthcare, complete start-over of healthcare. So, that’s what all of my work has been on.
That’s outstanding, and as I’ve explored, you know, your most recent book, and a lot of the op-eds that you’ve written in recent months, and it’s fascinating to see how obvious some of these patterns, these broken patterns are, but how little is done about it at the regulatory level or at the consumer-transparency level. So, I’d like you to talk a little bit more about, what are the problems with price transparency that the average consumer ought to know about when it comes to healthcare?
Dr. Marty Makary
Yeah, sure, Paul. Well, look, I loved your point that you just made now, and that is, we’ve had this entire, gigantic healthcare system, which in January of 2018 was officially the largest business in America, the largest industry by dollar amounts, 3.5 trillion. So, we have this enormous system, and here comes the viral pandemic, and it’s entirely unable to pivot quickly. The research systems were unable to pivot.
Americans had really good questions about how does it spread, and when are you most contagious, and do masks work, for months, and they were unanswered by this gigantic healthcare system. It just couldn’t pivot. So, we’ve become, our team, a sort of rapid-response team, if you will, to move quickly, and we’re able to do that through the fortune of having good funding from philanthropists and foundations. And so, we did that with COVID. We did that with opioids, and we’ve got to be able to do that more in healthcare.
Why don’t we have an mRNA vaccine for HIV right now? We should. We should’ve had it. mRna technology was developed in the ‘90s, OK? We still, I just talked to a buddy of mine, [INAUDIBLE], who’s in medical school, he’s part of my team, and he said that, and he’s not at Johns Hopkins Medical School, he’s at another one, he said, Marty, we’ve spent a total of two hours on nutrition in the entire medical education. And I said, well, you know what’s interesting, Will, is I bet you those two hours, it was probably wrong information in those two hours.
And sure enough, it was outdated stuff. You know, the old-school, food industry-driven narrative. Now, we’re trying to address what we consider to be one of the greatest social injustices, and that is price gouging and predatory billing in medicine, when well-meaning people in the public come to us as doctors for help when they’re vulnerable, and the business side of medicine takes advantage of them financially. Billing quality is medical quality, and financial toxicity is a medical complication, and we didn’t take an oath to treat illness and cure disease, and then ruin a person’s life financially. That’s what’s happening right now.
So, we have been creating transparency for US hospitals, calling them out on their price gouging, creating a national dashboard, increasing accountability, calling donors of a hospital and board members, urging them to stop suing patients when they can’t afford to pay, to garnish their paycheck, which is a practice we exposed, and all these sort of adventures really ended up, for the most part, having a really good outcome once we, as a team, dispatched and tried to create some accountability around this stuff, and that was basically the journeys of the book The Price We Pay.
I loved that journey. I loved and hated it, actually. I hated the fact that, you know, what you describe in the book as some stories of patients being billed exorbitant amounts of money for, like, a Life Flight or a transfer on an air ambulance, and they’re actually billed a price that’s higher than the aircraft that’s flying them from point A to point B. And you know, I would like to believe, listening or reading through that material in the book, that those are outliers.
But what you uncovered is these are actually patterns that are present, and there’s specific hospitals or healthcare systems that are known to do this, but the doctors providing care in those systems don’t necessarily know that’s the pattern that they’re operating under.
Dr. Marty Makary
That’s right. That’s right, and when we share with them what’s happening, they’re pretty livid about it. I don’t think I was ever told how air ambulance or even ground ambulance transport works in terms of billing. Turns out, you can get a bill for a little, short hop for the equivalent of flying private to Beijing, China and back five times. I mean, that’s the equivalent of what you’re paying for these short, little hops. And so, what we got to do is recognize that when hospitals were built, they were built for communities.
They were funded by philanthropists and churches. Look at their names, and they were there to serve the community as a safe haven for people who are sick and injured. That’s our great medical heritage. It’s an incredible heritage. I’m proud to be a part of it. I mean, the guy who invented the polio vaccine, Jonas Salk, he refused to get a patent. He said, this will be the property of humanity, a gift to mankind, so as many kids in the world can get it as possible.
Look at that incredible medical heritage. Those are our ancestors, and for centuries, doctors and nurses have won the respect of the public, and that is being threatened now by this business of price gouging and predatory billing which is being quickly adopted at a lot of hospitals as a common business practice. So, that’s what we’re standing up against, and we’re winning. We go to court on behalf of patients that are sued, and we win a hundred percent of the time.
That’s one of the most hopeful pieces of your book that I pulled away, is you’re actually on the ground, not only uncovering these patterns with your team, but going to the courtroom to advocate for these patients who, you know, most cases, they’re receiving care that they needed, regardless of what they know the cost might do to their financial fitness, and then find out later that they’re being sued into bankruptcy, or their wages are being garnished, just to cover the cost of their care above what their insurance might’ve covered.
And you’re actually winning these cases or getting them thrown out. So, what have you seen happen as you’ve implemented those practices of patient advocation, pattern recognition, and disrupting what’s going on?
Dr. Marty Makary
I find that when you appeal to the best in people, like hospital leaders, they’re good people, if you appeal to the best in them, point out what’s happening, they’re often embarrassed by what’s happening. It sort of spun out of control through a series of errors. This is not a broken system anyone today designed. This is a system we inherited, and we’ve got to get rid of it. We’ve got to start over. It’s the wrong system. What we’ve got to do is get back to some basic principles.
One of the fundamental problems in healthcare is we have non-competitive markets, and you’re seeing mass consolidation for monopoly pricing. Let’s just call a spade a spade. That’s the sort of thing where everyday Americans can have a say. I mean, most hospital board members are comprised of community members, and I think a lot of it is just the basic recognition that the world does not like those of us who are calling the shots and making the policy, but most of America does not live like us.
Most of America lives paycheck to paycheck, and we often forget about that half of America, and we do it all the time in policy, right? People forget that for a lot of people, there’s a lot of financial uncertainty, and for them, when they get a 1500-dollar medical bill that was supposed to be covered by their insurance, it can be catastrophic. That’s what we’re trying to remind people of in our movement called Restoring Medicine, trying to remind people why we went into the medical profession.
And it’s a movement, really, that goes far beyond the medical profession, and raising awareness about billing practices, and also what we call the appropriateness of care, which gets into food as medicine and the other issues that we touched on. And so, at RestoringMedicine.org, we’ve got our advocacy platform for some of the work we have around billing practices.
That’s outstanding. The appropriateness of care is something that I’ve always been interested in as well, and you’ve got a few specific examples in your book. One is a personal example that I’m going to bring up and put you on the spot with. You know, it relates to prescription medications. In the last ten years, I think the figure that I’ve heard you say is, there’s been a doubling of the number of prescription medications that Americans are using.
Dr. Marty Makary
And there’s no good programs, really, that I’m aware of for de-prescribing, or getting people to transition to minimal medication for chronic conditions. But you had an instance where you had some heartburn, and you went to your doctor and asked for something to take care of your heartburn, and walk us through that experience, and what it taught you, and how you translated that into other work that you’re doing.
Dr. Marty Makary
Yeah, sure. So, you know, some of the operations that I’ve done in surgery are long, I mean, day-long procedures. One of them’s called a pancreas auto-transplant procedure, and when you don’t eat, and you, you know, take a quick swipe of juice in the morning or something, you’re normally going to get a little bit of heartburn when you’re standing, doing manual work for eight hours. Well, I, you know, went to my GI doctor, and just thought, OK, I’m going to take this medication, it’s going to get rid of it, and it did, perfectly.
And then I saw on the news that this particular, very common medication for heartburn out there can be associated with long-term renal failure and stroke, and I thought, oh my gosh. This study just came out, ironically from researchers at Johns Hopkins, my own institution. And I called them, and I was like, is this real? And they’re like, yeah, this is a real signal, but…and then I went back to my doctor, and I said, OK, I need a different medication, and he’s like, OK, well, how about this?
How about lifestyle changes? And I was like, yeah, you’re right, I forgot about that. OK, remind me again, avoid chocolate, eating between meals, avoid processed food, and sure enough, just making a couple simple changes to what I eat cured the heartburn. Well, most illnesses in the United States, most of the stuff we pay for, can be managed through simple changes like that, and we’ve got to start talking about it. We’re not, and you can’t in these ten-minute visits with your doctor.
Doctors can’t do it, patients, you know, are frustrated. We’re frustrated. This throughput billing model of primary care is so broken, why are we doing it? We all hate it, OK? Look at it. We’ve got to change the conversation. We’ve got to start treating more diabetes with cooking classes instead of just throwing insulin at people. We have the most medicated generation in the history of the Earth right now. Disease did not double in the last ten years.
Medications doubled, but we have the most medicated, the most disabled, the most obese generation in the history of the world, and we’ve got to start talking about it. How about we talk about school lunches, instead of just talking about bariatric surgery, with gastric bypass on kids? How about we start talking about sleep quality, and stress management, and yoga classes, instead of just anti-hypertension pills? We’ve got to change this conversation, and it’s starting to happen.
And this is not a theoretical, it’s not an academic philosophy, it’s happening, and that’s one of the reasons I wrote the book The Price We Pay, is to usher in the disruptors, and say, hey, guys, healthcare is being fixed in different parts of America. Let’s just put our attention on those areas, and learn from them, and one of those areas is, you know, health and wellness and fitness. And if you think about COVID, one of the biggest stories about COVID, we did not hear about till the very end of the pandemic, was a little study that the CDC put out, that 78 percent of COVID hospitalizations were in people overweight or obese. You see that study?
Dr. Marty Makary
I mean, whoa, hey, this would’ve been nice to have a year ago, and it may explain why the US has one of the higher case fatality rates in the world.
Yeah, I saw those signals coming out of the data early on, and I’m sure you did, too, but it wasn’t until it was formalized in that official CDC release that, you know, people really wrapped their head around it, like, we went into this thing with a problem, and we can’t afford to come out of it not addressing that problem of underlying metabolic health, and fitness, and just general resilience, non-medicated resilience, or minimally-medicated resilience.
Dr. Marty Makary
I like that.
I love that, so, you have strong opinions about that, you have strong thoughts and feelings about what is broken, and that sort of thing, and how we can go about fixing a lot of these issues with our healthcare model, and just general health in our population. What does the data show us? You know, your group and your colleagues do research on finding, of all the possible solutions, what are the most probable to be part of the real solution?
Is it cooking classes? Is it nutrition education? Is it fixing school lunches? What are the most likely things that are going to help us emerge from this crisis, and enter the next one in a better situation?
Dr. Marty Makary
Well, if you look at the sub-prime mortgage crisis in the United States, what helped us there in reforming that industry was mass education, and the idea was that, you know, we were told early on, hey, if the financial industry is so complicated, leave it to the experts. And guess what, it turns out that you can break down all the jargon, and explain that a credit default swap is really just a predatory loan. And so, really, if you think about the equivalent in healthcare, what we need to do is explain things in very simple terms, and engage the public.
You know, the medical profession really failed us when it came to health, OK? They’re really good with sickness, but when it comes to health, you know, good luck, OK? Now, if you’re going to get shot in the chest or in the left atrium of the heart, you want to be in the United States. You want to be a mile from Grady, or LA County Hospital, or Johns Hopkins, or…you want to be at one of our great American hospitals. We will fix that bullet hole faster than any place in the world.
But you come in with chronic abdominal pain, we don’t know what to do with you, and that is because we have ignored this giant body of information. We’ve spent no money researching it, and instead, we deal with the uncertainty of not understanding it by discounting everything out there, and it’s really not fair to people, because it turns out that probably one of the greatest indicators of health status is your general body inflammation.
And when we talk about health in 50 years, Paul, we’re going to be talking about how’s your inflammatory state. Is it high, medium, or low? Turns out, there’s now some crude measures of that, you can measure it with a lab test called highly selective C-reactive protein. And it turns out, general body inflammation affects heart disease, that’s probably what a heart attack is, it’s inflammation of the heart blood vessel lining, where cholesterol, certain types sit in there and dwell inside the lining. That’s the genesis of plaque.
Heart disease is an inflammatory condition. We believe inflammatory states contribute to cancer. It turns out that there’s a lot of new diseases now that we didn’t have a hundred years ago. Crohn’s disease, ulcerative colitis, irritable bowel, IBS, these are inflammatory conditions that can only be explained by changes in the microbiome and the new pro-inflammatory instigators that we’ve introduced into the human diet, that we don’t talk about, that we don’t study, and that have a big part of so many illnesses.
I mean, the microbiome has been shown to produce serotonin, which is responsible for your mood. Who would’ve ever thought that microbiome, when it’s thrown out of whack and disequilibrium, could actually affect your mind? It affects so many different things, and we’ve ignored it. Instead, we’ve actually abused it in medicine. A baby is born, what do we do? We say, C-section and vaginal delivery is no different. Turns out, it’s very different in shaping the microbiome.
It so-called colonizes, and when a baby is born, we wash the baby immediately. Why? That bacteria on the baby colonizes the microbiome. Turns out, the baby is born, we separate the baby from the mom instantly, this, historically we’ve done it this way. Now, we’re recognizing skin-to-skin time reduces the stress hormones in the baby. As soon as the baby is born with the umbilical cord pulsating, the second we see it, we clamp it. Why? Turns out, in premature deliveries now, the evidence is out, that when the baby’s preemie, if you delay that cord-clamping until the pulsation stops so you can safely do it, the baby requires less blood transfusions in the NICU.
We’re learning more and more about this stuff. Antibiotics, that’s like throwing TNT in the microbiome and blowing up parts of the microbiome. You get bacterial overgrowth. Now, antibiotics save lives, and sometimes you got to do it, but most of the time, it doesn’t. Most of the time, the antibiotics are overkill for a viral infection which the doctor doesn’t even want to treat, and a parent’s demanding it. The food we eat, of course, is the biggest, and processed food and added sugar are all factors shaping the microbiome.
We don’t talk about it. We’ve got to start talking about it. That’s the movement we’re trying to push right now in healthcare, to not only change the conversation, but change our research infrastructure in the academic disciplines to get deep into these issues.
And that’s exciting for me as a dietitian. I started my career in clinical dietetics, and inpatient and long-term care, and quickly realized, you know, the place to make the biggest impact is up the food chain a little bit further, get into prevention. Get into engaging the people who are at least somewhat interested in changing the course of their health future, and that’s where you get, you know, a bigger impact, at least in my experience, in terms of increasing the quality of life-years, not just increasing life-years.
So, that’s exciting to me, to hear that, you know, even you as a highly-specialized pancreas surgeon, you have an incredible interest in a lot of good work in these areas of changing the tune of the conversation completely, where maybe we should fund studies that try to tell us what actually creates health, not just what’s a good way to manage a disease, or manage illness, right?
Dr. Marty Makary
And we saw this during COVID, right? As COVID hits, the second, the very first thing we do, as a reflex, is go to the laboratory and try to drum up a vaccine. Now, we needed to do that, but could we also talk about the fact that obesity was the leading risk factor? Could we also talk about the fact that when we told people to stay at home, they gained 15 pounds, and they increased their risk? I mean, it’s got to be both, right, and this idea right now is that it’s all the molecular pathway of the laboratory science.
We’ve got to change that, and by the way, it’s not just changing. It’s looking at the same, using the same scientific principles on a macro level. Why do we not study the environmental exposures that cause cancer, and instead we only study the chemotherapy to treat cancer? We’ve got to start talking about the environmental exposures. There are synthetic molecules that are in our body forever. We’ll never excrete them. We’ll never metabolize them.
There’s about 200 of them. One of the most popular and well-known ones is C8, which is the ingredient used to make Teflon. It’s in every person in the United States. It’s in every, every baby that’s born is born with that in their blood system. You’ll never get rid of it. That was the only one out of the 200 that was studied with a large public health study. Great movie about it called Dark Waters, documentary called The Devil We Know, if you like documentaries.
So, we’ve only studied one of the 200 forever, synthetic molecules that is stuck in our blood system forever, and guess what? It was found to be associated with cancer, neurological disorders, and not one type, a whole range of them. So, when people are scratching their heads, why is autism up, why is this, it’s such a mystery, you know what? It’s not that much of a mystery. You’ve got all of this stuff out here that’s a potential cause, that we have not studied, that we need to study, and I think that’s where we’ve got to move to in medicine.
It’s almost overwhelming, what you’re painting a picture of, is modern lifestyle has put us in this really precarious position, where it’s actually uncommon to be healthy. It’s biologically normal to be healthy, and you know, try to, your body wants to be lean, and energetic, and healthy, and fit, and strong, but a lot of our modern pressures shift us into a different state, and that’s difficult. It’s almost overwhelming.
What, in your experience, and your data, and your research, what are the patterns that most Americans should focus on, not get over-engineered with how to live a perfect lifestyle, but what are the daily lifestyle patterns that, if every American adopted even 50 percent of them, puts us in a completely different scenario with regard to our health and how much we spend on our health?
Dr. Marty Makary
I mean, I can tell you, Paul, as a physician, you want to set modest goals in people who are unlikely to meet extreme goals. And so, that means breaking things down into a couple simple principles. Cook instead of buy things that are processed. Drink water, or water that’s flavored with some natural sweeteners lightly, instead of the traditional soda drinks. These are things where, look, a lot of the folks listening are already on board with this, right?
We are actually seeing a movement now in a sector of the United States, people 16 to 35, really start making consumer choices based on health, which is awesome, which is incredible, right? But a lot of Americans are not there right now. So, this is what I tell folks. Look, the dopamine center in the brain gets stimulated with something, and most of the time it’s some form of addiction, could be mild or severe. Now, addiction, we think of it as a bad word, but you can be addicted to work.
You can be addicted to working out. You can be addicted to healthy foods. And so, it’s best to make that dopamine center respond to healthy patterns, have healthy addictions rather than things like, you know, buying Oreo cookies, and you’re keeping them in your refrigerator for a special occasion, and then dipping into it every night. So, one of the things we have to educate people on is that some of these artificial sweeteners have had the wrong conversation around them, for example.
The conversation has been, do they cause cancer or not? That’s not the right question. And by the way, they’ve been around for over 50 years. If they would’ve caused cancer, we would’ve seen that. That’s not the right question. The question is, do they trick your pancreas into thinking that a sugar load, some high glycemic load is about to come down the pipes, but it never comes. So, what does the pancreas do? It’s already revved up the insulin. It’s ready to release it.
It creates a craving. So, you ever wonder how people drinking Diet Coke six times a day are massively obese, you know? Well, guess what’s happening? Every time they’re getting those artificial sweeteners, their cravings are getting ramped up, and then they go home and binge-eat or drink late in the day, and that’s very common. So, when we see people who are overweight, let’s stop shaming them. Let’s recognize there’s an addiction.
Oftentimes, it’s based on bad information, like my dad’s generation of doctors. They told everyone, avoid fat, and then moved them into a high-sugar, added-sugar diet. And so, we can set modest goals, and make improvements, and I think that’s starting to happen. And by the way, the food industry is starting to get into line, finally, after deceiving people, because addictive foods sell better, right? So, we were told when we pushed for nutrition labels back in the day, this is terrible for the food industry.
Right, the food industry, the lobby was arguing to members of Congress as we were fighting for this. They were saying, well, food prices are going to spike if we have to put nutrition labels. Nobody will understand what’s on them anyway, and we’re going to have world hunger, because prices will be so high. None of that happened. Instead, we have a healthy marketplace competing on ingredients, and now we’ve got to educate people on the right things.
I want to transition into getting your thoughts on, you know, reimagining a healthcare model, or healthcare society. What does that look like, and what’s being done? Who’s doing it the best already?
Dr. Marty Makary
Yeah, so, I think a big question like that, and I appreciate the question, Paul, it’s a great question, and I think everyone has thought about it. Every American, right, there’s got to be a better way, what is the better way? Well, the conversation has been hijacked into, people at a high level, let’s call them politicians, have told us basically the message that the solution to healthcare is a legislative solution, right? It’s one piece of legislation over another piece of legislation, or there’s two competing pieces of legislation.
And they’ve really tricked the American folks into thinking that it’s going to be a legislative solution. Really, the government talks about different ways to finance the broken healthcare system. We need to talk about how to fix the broken healthcare system. Two entirely different things. Now, there’s a better way to finance the healthcare system, and there’s better legislation that can help us get there. Let’s not fool ourselves, they’re just funding the broken system. They’re not fixing it.
What is actually happening in healthcare today in America, Paul, is that without the government, entrepreneurs, local doctors, clinics, forward-thinking entrepreneurs are fixing healthcare on a micro level all across America, and they’re doing it in really creative ways. It’s relationship-based care. It’s the integration of food, fitness, education, and medical care consolidated. Imagine what it would look like if you could design the perfect way to receive medical care for routine care.
Imagine you had somebody who could give you guidance on the best way to work out, the best way to eat, the best way to live, and the best way to screen and prevent certain illnesses. You would actually create a relationship there, and it doesn’t have to be a doctor. It could be with a doctor and a medical team, right, where you’ve got a team of dietitians, and nurses, and physician assistants, and a physician, and kinesiology majors from college.
And together, they’d rally around a sort of curriculum, if you will, sort of a goal-setting of, we want folks to have low-inflammatory foods, have regularity with workouts, and have good medical guidance and availability of care when they need it on demand. That is being done right now. We are building that in so many different ways. Sesame Care is one platform I’m involved in, but there’s so many out there, and we’re trying to improve it, integrate it, expand it, and I think you’re seeing some incredible stuff.
I just talked to a group called Sidecar Health. Instead of giving you a health insurance card when you buy their health insurance, they give you a Visa card, and they’re like, just tell them you want to pay the cash price everywhere you go, and use this Visa card. Well, guess what? Everybody wins. Everybody’s winning. The doctors like it because they don’t have to go through the stupid claims appeal and the pre-authorizations.
Patients like it because it’s simple, and they can see any doctor in the world they want, and use the same card. Insurance company likes it because cash prices are below the negotiated insurance prices, because cash prices don’t deal with the middle man. So, we’re seeing care redesigned, and it’s beautiful, and for right now, I would tell people, we need you to be a part of this revolution to redesign care. And if we can help people with their health goals instead of just tell them what to do, then we’ve completely reinvented healthcare.
Look, I can tell you as a doctor, a final point here, as a doctor. The hard part about managing illness and disease is not telling people what to do. It’s helping them do it. The number-one factor that predicts whether or not somebody gets a meaningful workout is not the equipment they’re using, or whether or not they have this dumbbell, or whether or not the, you know, this particular machine is in the gym. It’s the presence of a workout partner.
Talk to anybody who’s got a personal trainer. And what we’re seeing is, medicine is adopting this model now, saying, you know what, we’re not just going to tell you what to do, we’re going to help you do it, and when you’re healthier, care is cheaper, and everybody is better.
Yeah. In my experience, that’s exactly true. I can think of times I’ve sat in front of clients who ask me for a meal plan, and I’ll Google “meal plan.” And what comes up, 65,000, or four million meal plans, and I said, choose whatever one you want. What you really need is accountability and support to get through the tough times, you know, to make the hard choices when it’s not popular to make the hard choice, you know? So, you’re right.
Everyone knows generally what to do, but it’s the combination of the accountability, and the support, and the camaraderie that really, you know, lights the spark, and then makes the system work, the flywheel spin.
Dr. Marty Makary
And when eating well all of sudden now is addiction management, all of a sudden it’s, how do you manage the cravings? And one of the reasons why we’ve seen success with the plant-based diet out there is that it really manages cravings well. When I eat a burger, and I love burgers, and I’m not one of these people that thinks the meat in and of itself, if it’s healthy meat, is bad for you, I just don’t think the data are conclusive, but when I’m done with a burger that’s juicy and delicious, even if it’s my ideal grass-fed, free-range burger, I’m ready to eat a horse after that. I love it, right?
And so, I’ve got a massive craving after that burger. Now, you don’t have that kind of craving as strong with a more plant-based diet. So, people a lot of times are trying to figure out, well, which diet should I eat? And the reality is, Paul, as you know very well, there’s so many out there. Almost any diet is going to manage portions in a way that a non-diet will not, right? So, if you don’t have a diet, if you’re not on a diet plan, your portion control is either up to your self-will and personal discipline, or it’s out of control.
And when you are on a diet plan, almost regardless of what the plan is, there’s some portion control, which in and of itself is powerful. So, the reality is, there are so many diets out there. The worst out of all of them out there, number-one worst of all the diet plans out there is what we call the standard American diet, or the SAD, the SAD. And all diets are better than SAD, right? So, people start saying, hey, I’m on this, I’m on that, this is working, that is working. I personally am a big fan of the low-glycemic-load diets. When you say “diets,” really it’s just healthy eating, but almost anything is better…
Yeah, eating patterns.
Dr. Marty Makary
Yeah, I agree with you. I mean, you know, obviously, energy balance matters, and there’s a few different ways to achieve energy balance, and the biggest priorities on the diet side are getting adequate protein. You know, no matter what dietary pattern you choose, get enough protein to build and maintain healthy, lean tissue, and help control satiety with higher-fiber choices than lower-fiber choices. And usually, if you address those two things with your chosen dietary pattern, a lot of the other problems get fixed.
So, I’m with you there, and it’s easier said than done, in my experience, and I’m sure with your patients as well, but having that, you know, clear guidance and a little bit of accountability and support, and some ideas on how to make it fun and engaging, and not boring is going to make all the difference in the world. With regards to your, with your book The Price We Pay, what are the main messages that everyone should take away from that book?
Dr. Marty Makary
So, the book was designed to be The Business of Medicine 101 for the everyday American. You know, we get in school the wrong education. We get a partial education. We get mathematics, English, and that’s good, that’s necessary, to a degree. I don’t know if we need to be teaching Calculus 3 in college, you know, in high schools. You know, I don’t know if every college kid in America must take geology, right? Higher education has gone off the deep end, but…and I’ve had a lot of it, to be able to say. But we’re never taught financial literacy.
We’re never taught, in all the schooling that we have, relationship literacy. We’re never taught medical literacy. And yet, understanding how the system works, and how the billing, financial side of it works as well, how we should eat, basic health education and health literacy, that’s all been absent. And so, what I try to do in the book is really just break it down for folks in sort of 101 class. And so, that means that if we want to really talk about redesigning care in a way that’s not theoretical, that’s actually happening on the ground, and I give examples in every chapter of how somebody is actually already disrupting and fixing the problem.
We have to address, I think, three primary problems. And that is financial toxicity, that is price gouging and predatory billing, number two, the appropriateness of care. You know, we got two problems in healthcare, under-treatment and over-treatment, but by far over-treatment dominates the system in a way that people need to be aware of the very specifics. And also, there’s a revolution now to get to more appropriate care, and how to navigate the system to find appropriate care.
And then, the final area is care coordination, and health, and that’s what we’re talking about with having a partner to help you achieve your goals.
I think that’s an incredible lesson for everyone to learn, and I encourage everyone to go check it out. It’s really empowering, you know, to go through everything that Dr. Makary talks about in his book, and other lectures he gives around these topics, because the way I see it and what I took away as the main thing, for me, is the more people pay attention to their own health and how it impacts the health of the people immediately around them, their family and friends and their community, the easier it will be to reimagine and redesign this health and wellness system in a sustainable way.
That’s not creating financial burdens, and predatory billing practices, and you know, over-spending and under-treating, and whatever. It really boils down to personal responsibility to find whatever it takes to help you pursue whatever your optimal health is, as an individual. No one’s going to do it for you. If you rely on others, it’s going to cost you an arm and a leg, and it’s going to bring down a lot of other people’s financial wellness in the process.
So, that’s what I took away from your most recent work, and I can’t thank you enough for bringing all these conversations to the forefront. I know you’re sticking your neck out on the line. These are not popular conversations to have. I’m sure there’s a lot of healthcare executives that are really unhappy with what you’re bringing to the table, but I applaud you for doing that.
Dr. Marty Makary
Well, thank you, Paul. It’s been a good ride. You know, I got to give credit to my many students, and the young doctors and nurses on my team. They do a great job. So, I was really privileged to tell their story, the story of all of their work in what I’ve written about, but it’s great to chat through all this stuff with you, Paul. Keep up the great work. Love your podcast here. You’re doing great work and promoting good health, so, thanks for having me.
Thank you for taking the time, again, and where should people go to find out more about what you and your group are doing?
Dr. Marty Makary
So, MartyMD.com is where we’ve got some information on the book, and a new book trailer that we just put out with the paperback. And then, on all forms of social media, I’m not that good with Instagram, but LinkedIn, and Twitter, unfortunately, it’s a nasty place, Twitter, I wouldn’t recommend it for my worst enemy, but I do try to put out the latest information on what we’re doing, our research, and some stuff with COVID, too, that I’ve been working on.
Awesome. Well, thanks again for taking the time.
Dr. Marty Makary
Good to be with you, Paul.
Be well, Marty.
Thanks for joining us for this episode. As always, we’d love to hear your thoughts on our conversation today, and how you approach this aspect of healthy living in your own life. What works for you? Where do you run into challenges? Where do you need help?
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Life Time Talks is a production of Life Time, healthy way of life. It’s produced by Molly Schelper, with audio engineering by Peter Perkins, and video production by Kevin Dixon, Coy Larson, and the team at LT Motion. A big thank you to the team who pulls together each episode, and everyone who provided feedback.
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