Blind Spots

Starred review from July 29, 2024
The medical establishment suffers from a reluctance to reexamine its own beliefs in light of new evidence, according to this impassioned cri de coeur. Makary (The Price We Pay), a surgeon at Johns Hopkins Hospital, discusses how a 2002 study on hormone replacement therapy reported that the treatment causes breast cancer, even though its data didn’t support that conclusion. Though the initial error may have arisen from a rushed publication process, the lead authors still insist on the erroneous correlation despite not being able to point to any supporting evidence in their own study. Elsewhere, Makary argues that the modern epidemic of deadly peanut allergies can be attributed to the American Academy of Pediatrics’ misguided recommendation that young children be shielded from nuts (subsequent research has shown that “peanut abstinence causes peanut allergies”), a suggestion drawn from a misreading of a single research paper. The sensational case studies demonstrate the depths of doctors’ intransigence, and Makary’s clinical experience offers penetrating insights into the psychological mechanisms at play, as when he attributes a colleague’s stubborn refusal to accept that appendicitis can be effectively treated by antibiotics to his urge to believe that the countless appendectomies he had performed previously were necessary. Incisive and damning, this is a much-needed wake-up call. Agent: Glen Hartley, Writers’ Representatives.

September 1, 2024
The misguided prevalence of "gut feeling" in medical dogma. In his follow-up toThe Price We Pay (2019), Makary, a public health researcher and professor at Johns Hopkins School of Medicine, elaborates on the enduring misconceptions plaguing modern medicine in terms of research breakthroughs that have been largely underappreciated, overlooked, or simply ignored in a clinical setting. He cites several recent studies to bolster his position, such as a 16,608-woman study on menopausal hormone replacement therapy concluding that it causes breast cancer development. Despite the lack of evidentiary support for this conclusion, the study's authors continue to tout it to clinicians while overlooking HRT's considerable benefits. The overuse of prescribed antibiotics for infections is juxtaposed against research citing the microbiome imbalance they cause by obliterating beneficial bacterium. Makary also discusses the medical groupthink about dietary cholesterol, ovarian cancer, silicone breast implants, and complicated childbirths, among others. Presenting a fascinating study on peanut anaphylaxis, Makary rails against the American Academy of Pediatrics' recommendation that children avoid the nuts altogether instead of considering research indicating that reintroducing small doses of peanuts (in conjunction with powerful immune suppressants) can actually prove curative. He pauses midway through the book to lucidly examine how the mechanisms of the human mind naturally resist innovative ideas and approaches. As a public health advocate, Makary is simultaneously dazzled by the sophistication of modern medicine and alarmed by the medical industry's stubborn reluctance to adapt and evolve in the midst of supportive research meant to challenge interventional therapies and procedures. The author's critical eye is well suited to this clinically sound report appealing for closer scrutiny and a redesigning of the medical establishment, and he coaches readers with or without clinical expertise to "ask for the underlying evidence or rationale to support a health recommendation." An eye-opening look at how the American medical industry's rigidity has stunted its reliability.

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