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74 reviews for:
Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health
Marty Makary
4.02 AVERAGE
74 reviews for:
Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health
Marty Makary
4.02 AVERAGE
challenging
informative
fast-paced
reflective
medium-paced
informative
reflective
slow-paced
While somewhat of a slow read this books touches on many medical topics. It challenges best practices in medicine (historical and current). This book encourages open mindedness in science which is refreshing. It also is refreshing to hear a medical professional admit when the science lacks a clear conclusion.
The only reason I gave this book 4 stars was because I struggled with the slow pace and being overwhelmed with statistics.
The only reason I gave this book 4 stars was because I struggled with the slow pace and being overwhelmed with statistics.
challenging
informative
inspiring
reflective
medium-paced
The hard thing with a book like this is knowing whether the studies are being correctly interpreted. There were quite a few I'd heard of and some I hadn't. Keeping an open and curious mind is wise.
Content Warnings
Minor: Alcoholism, Bullying, Cancer, Child death, Death, Drug abuse, Drug use, Eating disorder, Mental illness, Suicidal thoughts, Terminal illness, Blood, Medical content, Medical trauma, Car accident, Schizophrenia/Psychosis , Pregnancy, Injury/Injury detail, Classism, Pandemic/Epidemic
informative
reflective
slow-paced
Just because there's a study to support an idea does not mean the study was designed properly, conducted ethically, or reported accurately. .... One of my greatest concerns is that today's public health experts, and certainly the media, have lost the ability to critically appraised research quality. If a shoddy study supports what people already believe, it's hailed as definitive science. But if a strong study conflicts with a forgone conclusion, it's ignored or nitpicked
While I ultimately agree with Makary’s main point — we need to be able to question things, because that’s how you discover new and better ways of practicing medicine, and there are dozens of examples to back up how we thought a new practice was “dangerous” or “stupid” until we realized oh, our traditional thinking was wrong — as a reader, I would have liked to see a bit more… I suppose humility is the word. He is absolutely right that as a society we are reticent to change or new ideas (medicine was against handwashing and was quite literally causing women’s deaths because a gentleman’s hands were never thought to be dirty), but his approach to communicating this sometimes came off as holier-than-thou or bombastic. I would have also liked to see a bit more in here explaining why doctors and scientists might be trapped into not being able to speak up or follow new science, rather than leaning on reasoning that borderline sounded like conspiracy theories, because I think that would have made his argument (which, again, has very sound foundations!) that much stronger. Having read it, even though this wasn’t a five star for me, I can confidently say I am fine with him being FDA commissioner if he’s confirmed — you’re never going to agree with someone 100% of the time on everything, but I understand his approach, and just hope he brings a bit more humility to his government role.
challenging
informative
inspiring
reflective
tense
fast-paced
I realized that a lot of medicine is plagued by dogma but the field is make progressive strides. The only way to take action about the misinformation and disinformation in the medical field is first recognizing a problem. Then, how do we change the status quo for the better.
Damn this book was aggravating to read. Frustrating but aggravating, nonetheless.
Some "takeaways" / high points that jumped out to me;
- definition of GROUPTHINK = "the human tendency to follow a crowd and not think independently" - as the author states in the beginning of the book, this often creates an illusion of consensus which is FOR SURE dangerous in the medical industry but I'd add that's true for EVERYWHERE (politics the last 20 years anyone?)
ON PEANUT ALLERGIES....
- When the AAP guideline came out in 2000 with a big splash, Dr. Buckley recognized that it violated a basic principle of immunology known as immune tolerance: the body’s natural way of accepting foreign molecules present early in life. It’s like the dirt theory, whereby newborns exposed to dirt, dander, and germs may then have lower allergy and asthma risks. Dr. Buckley confidently told her students and residents to ignore the AAP recommendation, and in fact, to do the opposite. She explained that peanut abstinence doesn’t PREVENT peanut allergies, it CAUSES them.
- As things got worse, a dissenting Dr. Lack decided to conduct the study to end all studies—a clinical trial randomizing infants to peanut exposure (at 4–11 months of age) versus no peanut exposure. He found that early peanut exposure resulted in an 86% reduction in peanut allergies by the time the child reached age 5 compared to children who followed the AAP recommendation. He blasted his findings to the world in a New England Journal of Medicine publication in 2015, finally proving what immunologists like Dr. Buckley had known for decades: Peanut abstinence causes peanut allergies. It was now undeniable; the AAP had it backward.
ON FEMALE HORMONE REPLACEMENT THERAPY...
- one doctor interviewed said “This may be the greatest farce in modern medicine.”
- ...to this day, many doctors still believe that HRT should not be prescribed because it causes breast cancer. If you ask them why, they will almost certainly cite this famous study—the most expensive clinical study in history—known around the world as the Women’s Health Initiative (WHI). The NIH had spent approximately $1 billion in taxpayer dollars on the study.
- In the year following the WHI publication, some of the lead authors claimed credit for the decrease in U.S. breast cancer rates. But a closer look revealed that the decline had begun in 1999, three years before the WHI publication. Actually, rates of breast cancer went up by 0.5% annually after the 2002 publication, the year that HRT use plummeted. Regardless, Drs. Chlebowski and Anderson have claimed credit for preventing over 100,000 diagnoses of breast cancer.
- In analyzing 30 trials with a total of 26,708 women participants, HRT was not associated with an increase in cancer mortality, according to a study by researchers from Santa Clara Medical Center, Stanford, and the University of California San Francisco. Conversely, women who took HRT lived longer. In the subset of 17 trials in which women began HRT before age 60, “HRT was associated with a reduction in total mortality of 39%.”
ON ANTIBIOTICS...
- A newborn is born sterile, that is, with no bacteria in its gut. Its microbiome is formed from vaginal bacteria the baby picks up during delivery along with bacteria from the mom’s skin and breast milk and kisses from its mommy and daddy. By contrast, babies born by C-section are extracted from a sterile womb into a sterile operating room, bypassing exposure to the vaginal canal as the natural first bacterial exposure. As a result, their microbiome can be seeded from bacteria that normally live in the hospital. And because women who have a C-section are routinely given an antibiotic just prior to the procedure, their babies are born with antibiotics in their system. This is especially unfortunate: A study of more than 55,000 patients found that there is no difference in surgical infection rates when the antibiotics are given to a mother after her baby is born.
ON CHOLESTEROL...
- The fact that dietary cholesterol plays almost no role in blood cholesterol has actually been known since the 1950s. And more recently, in an uncharacteristic act of humility, the American Heart Association (AHA) acknowledged this fact in 2015, albeit quietly. But for the prior half century, the AHA and the broader medical establishment locked arms and walked off a cliff together. Some critics have alleged that this may have been fostered by dollars flowing from pharmaceutical companies that make cholesterol-lowering drugs to the association and individual researchers in the field. Regardless of whether pharma played a role, this mob mentality beat up on cholesterol and saturated fat so much that any challengers to the dogma were dismissed as heretics.
- Dr. John Yudkin, a prominent British nutrition expert, challenged Dr. Keys throughout the 1960s and ’70s. He argued that sugar was the leading driver of inflammation causing heart disease, not saturated fat. As early as 1957, he wrote that “both the proponents and opponents of a dietary [fat] hypothesis are quoting only those data which support their view.” In his book Pure, White, and Deadly, Yudkin made a strong scientific rebuttal of Dr. Keys’s hypothesis, but few doctors were convinced. Keys was their man. Dr. Yudkin saw Dr. Keys’s hypothesis “go viral” and watched the food industry increasingly pound sugar and salt into foods in order to make them low-fat and still retain taste. In a 1974 Lancet article he warned, “The cure should not be worse than the disease.
- ...then epidemiologists began to look at obesity and diabetes trends. They noted that after each major low-fat recommendation push, obesity and diabetes in the U.S. accelerated. The first turning point started in 1961 with the first major low-fat recommendation. Rather than reexamine the basis for the recommendation, doctors dug in. When confronted with surging obesity rates, doctors dismissed the possibility that it could be a consequence of eating low-fat food that happened to be loaded with more sugar. To the medical establishment, the reason for the spike was clear: Americans were cheating or noncompliant with doctors’ orders. In their paternalistic minds, doctors just needed to push harder.
- Dr. George Mann later came out and said he had been forbidden from publishing the early results of the Framingham study back in the 1960s. He was threatened that if he kept up his contrarian behavior, he would never get another grant. And that’s exactly what happened. He courageously wrote in 1985 that, “A generation of citizens have grown up since the diet/heart hypothesis was launched as official dogma. They have been misled by the greatest scientific deception in our times: The notion that consumption of animal fat causes heart disease.”
- The AHA’s hardline guideline to avoid cholesterol and fat, albeit based on flawed science, has stuck in people’s minds. To this day, when overweight people go to their doctor, they are often told to eat low-fat foods. Moreover, most people whose blood tests reveal a high total or LDL cholesterol are told to reduce their cholesterol intake. These recommendations are nothing more than a remnant from a prior era of junk science and groupthink.
- interesting factoid; ApoB and LPa are probably the best screening tests to evaluate your lipoprotein profile—better than HDL and LDL
ON HIV and BLOOD TRANSFUSIONS...
- Even today, patients evaluated for an organ transplant are not able to see where they stand on the waitlist. Sometimes, people are not even on the list and don’t know. If you’re on the standby list for an upgrade on an airplane, you see where you are, but if you’re waiting for an organ, the medical transplant community has no such list where you can see your position.
- Arthur Ashe would have had his life saved by Dr. Rucker’s cautious approach to blood transfusion. Ashe, one of the greatest tennis players and civil rights leaders of his day, underwent a major heart operation in 1983, nearly three years after Dr. Rucker and others knew the blood supply was not safe.
AND TO BRING IT ALL TOGETHER...
- Freedom of speech is not designed for easy speech—speech that is welcomed by the majority because it affirms their beliefs. It’s designed to protect speech that is uncomfortable—speech that challenges groupthink. Today, more than ever, organized medicine is finding ways to limit and stifle scientific debate. Some of these ways are subtle, such as inviting like-minded people to editorial boards, committees, and conferences. Other methods of suppression are overt, such as hospital communications departments telling doctors that they can’t talk to the media without going through them—a policy that American doctors share with doctors in North Korea. Dozens of leading medical experts have privately told me that someone from their hospital’s communications department staff has called them to give them a hard time, or even bully them, after they say something in a media interview that the hospital didn’t like. Americans don’t want to hear from medical propogandists, they want to hear from doctors speaking freely.
- It’s not just in medicine. In 2024, Harvard economics professor Dr. Roland Fryer was told not to publish his 2017 study that showed that while police were more likely to show excessive force against racial minorities, they were less likely to shoot them compared to white suspects.25 Colleagues told him he should publish the first part, which they liked—but not the second part. But he decided to publish all the results. In an interview with journalist Bari Weiss of the Free Press, he explained how after that, his life became “hell.” He immediately became the subject of an internal investigation at Harvard and was suspended for two years without pay. He was not fired, because he was tenured—the youngest Black tenured professor at Harvard. “People lose their minds when they don’t like the result,” he told Weiss. (Dr. Fryer’s boss who suspended him, Dr. Claudine Gay, would later be named president of Harvard, and then be forced to resign due to plagiarism
- It’s okay to be wrong. In science, when people get things wrong when little information is available, they are being human. But when they make absolutist claims for years that go against overwhelming medical evidence simply to protect an institution’s or political party’s brand, they are propogandists.
- Chronic diseases are the leading cause of death in the U.S. and consume a majority of the $4.5 trillion we spend on health care. The current reactionary, siloed, Whac-A-Mole health care system isn’t working. Most American adults take four or more prescription medications regularly, making the U.S. the most medicated population in the world. We need to try new approaches to health. We need fresh ideas.
-SOME INTERESTING FACTOIDS SPRINKLED THROUGHOUT;
- One in seven women in the USA has diabetes
- OxyContin was approved by the FDA for chronic use based on a 14-day clinical trial,
- The term “vaccine” is a derivative of the Latin word vacca, for “cow (the first vaccine was cow pox scraped from one infected blister and applied to the open wound of a child)
- In the Middle Ages, doctors believed the body turned food into blood, and blood just sat in the body stagnant. Blood doesn’t circulate, they believed. It would only be replaced by eating more food that then converted to blood. The heart, the pounding thing everyone could feel in their chests, was thought to be a source of heat.
- an editor of the medical journal "Anaesthesia", examined 500 clinical trials and found that a whopping 44% of them contained false data.
Some "takeaways" / high points that jumped out to me;
- definition of GROUPTHINK = "the human tendency to follow a crowd and not think independently" - as the author states in the beginning of the book, this often creates an illusion of consensus which is FOR SURE dangerous in the medical industry but I'd add that's true for EVERYWHERE (politics the last 20 years anyone?)
ON PEANUT ALLERGIES....
- When the AAP guideline came out in 2000 with a big splash, Dr. Buckley recognized that it violated a basic principle of immunology known as immune tolerance: the body’s natural way of accepting foreign molecules present early in life. It’s like the dirt theory, whereby newborns exposed to dirt, dander, and germs may then have lower allergy and asthma risks. Dr. Buckley confidently told her students and residents to ignore the AAP recommendation, and in fact, to do the opposite. She explained that peanut abstinence doesn’t PREVENT peanut allergies, it CAUSES them.
- As things got worse, a dissenting Dr. Lack decided to conduct the study to end all studies—a clinical trial randomizing infants to peanut exposure (at 4–11 months of age) versus no peanut exposure. He found that early peanut exposure resulted in an 86% reduction in peanut allergies by the time the child reached age 5 compared to children who followed the AAP recommendation. He blasted his findings to the world in a New England Journal of Medicine publication in 2015, finally proving what immunologists like Dr. Buckley had known for decades: Peanut abstinence causes peanut allergies. It was now undeniable; the AAP had it backward.
ON FEMALE HORMONE REPLACEMENT THERAPY...
- one doctor interviewed said “This may be the greatest farce in modern medicine.”
- ...to this day, many doctors still believe that HRT should not be prescribed because it causes breast cancer. If you ask them why, they will almost certainly cite this famous study—the most expensive clinical study in history—known around the world as the Women’s Health Initiative (WHI). The NIH had spent approximately $1 billion in taxpayer dollars on the study.
- In the year following the WHI publication, some of the lead authors claimed credit for the decrease in U.S. breast cancer rates. But a closer look revealed that the decline had begun in 1999, three years before the WHI publication. Actually, rates of breast cancer went up by 0.5% annually after the 2002 publication, the year that HRT use plummeted. Regardless, Drs. Chlebowski and Anderson have claimed credit for preventing over 100,000 diagnoses of breast cancer.
- In analyzing 30 trials with a total of 26,708 women participants, HRT was not associated with an increase in cancer mortality, according to a study by researchers from Santa Clara Medical Center, Stanford, and the University of California San Francisco. Conversely, women who took HRT lived longer. In the subset of 17 trials in which women began HRT before age 60, “HRT was associated with a reduction in total mortality of 39%.”
ON ANTIBIOTICS...
- A newborn is born sterile, that is, with no bacteria in its gut. Its microbiome is formed from vaginal bacteria the baby picks up during delivery along with bacteria from the mom’s skin and breast milk and kisses from its mommy and daddy. By contrast, babies born by C-section are extracted from a sterile womb into a sterile operating room, bypassing exposure to the vaginal canal as the natural first bacterial exposure. As a result, their microbiome can be seeded from bacteria that normally live in the hospital. And because women who have a C-section are routinely given an antibiotic just prior to the procedure, their babies are born with antibiotics in their system. This is especially unfortunate: A study of more than 55,000 patients found that there is no difference in surgical infection rates when the antibiotics are given to a mother after her baby is born.
ON CHOLESTEROL...
- The fact that dietary cholesterol plays almost no role in blood cholesterol has actually been known since the 1950s. And more recently, in an uncharacteristic act of humility, the American Heart Association (AHA) acknowledged this fact in 2015, albeit quietly. But for the prior half century, the AHA and the broader medical establishment locked arms and walked off a cliff together. Some critics have alleged that this may have been fostered by dollars flowing from pharmaceutical companies that make cholesterol-lowering drugs to the association and individual researchers in the field. Regardless of whether pharma played a role, this mob mentality beat up on cholesterol and saturated fat so much that any challengers to the dogma were dismissed as heretics.
- Dr. John Yudkin, a prominent British nutrition expert, challenged Dr. Keys throughout the 1960s and ’70s. He argued that sugar was the leading driver of inflammation causing heart disease, not saturated fat. As early as 1957, he wrote that “both the proponents and opponents of a dietary [fat] hypothesis are quoting only those data which support their view.” In his book Pure, White, and Deadly, Yudkin made a strong scientific rebuttal of Dr. Keys’s hypothesis, but few doctors were convinced. Keys was their man. Dr. Yudkin saw Dr. Keys’s hypothesis “go viral” and watched the food industry increasingly pound sugar and salt into foods in order to make them low-fat and still retain taste. In a 1974 Lancet article he warned, “The cure should not be worse than the disease.
- ...then epidemiologists began to look at obesity and diabetes trends. They noted that after each major low-fat recommendation push, obesity and diabetes in the U.S. accelerated. The first turning point started in 1961 with the first major low-fat recommendation. Rather than reexamine the basis for the recommendation, doctors dug in. When confronted with surging obesity rates, doctors dismissed the possibility that it could be a consequence of eating low-fat food that happened to be loaded with more sugar. To the medical establishment, the reason for the spike was clear: Americans were cheating or noncompliant with doctors’ orders. In their paternalistic minds, doctors just needed to push harder.
- Dr. George Mann later came out and said he had been forbidden from publishing the early results of the Framingham study back in the 1960s. He was threatened that if he kept up his contrarian behavior, he would never get another grant. And that’s exactly what happened. He courageously wrote in 1985 that, “A generation of citizens have grown up since the diet/heart hypothesis was launched as official dogma. They have been misled by the greatest scientific deception in our times: The notion that consumption of animal fat causes heart disease.”
- The AHA’s hardline guideline to avoid cholesterol and fat, albeit based on flawed science, has stuck in people’s minds. To this day, when overweight people go to their doctor, they are often told to eat low-fat foods. Moreover, most people whose blood tests reveal a high total or LDL cholesterol are told to reduce their cholesterol intake. These recommendations are nothing more than a remnant from a prior era of junk science and groupthink.
- interesting factoid; ApoB and LPa are probably the best screening tests to evaluate your lipoprotein profile—better than HDL and LDL
ON HIV and BLOOD TRANSFUSIONS...
- Even today, patients evaluated for an organ transplant are not able to see where they stand on the waitlist. Sometimes, people are not even on the list and don’t know. If you’re on the standby list for an upgrade on an airplane, you see where you are, but if you’re waiting for an organ, the medical transplant community has no such list where you can see your position.
- Arthur Ashe would have had his life saved by Dr. Rucker’s cautious approach to blood transfusion. Ashe, one of the greatest tennis players and civil rights leaders of his day, underwent a major heart operation in 1983, nearly three years after Dr. Rucker and others knew the blood supply was not safe.
AND TO BRING IT ALL TOGETHER...
- Freedom of speech is not designed for easy speech—speech that is welcomed by the majority because it affirms their beliefs. It’s designed to protect speech that is uncomfortable—speech that challenges groupthink. Today, more than ever, organized medicine is finding ways to limit and stifle scientific debate. Some of these ways are subtle, such as inviting like-minded people to editorial boards, committees, and conferences. Other methods of suppression are overt, such as hospital communications departments telling doctors that they can’t talk to the media without going through them—a policy that American doctors share with doctors in North Korea. Dozens of leading medical experts have privately told me that someone from their hospital’s communications department staff has called them to give them a hard time, or even bully them, after they say something in a media interview that the hospital didn’t like. Americans don’t want to hear from medical propogandists, they want to hear from doctors speaking freely.
- It’s not just in medicine. In 2024, Harvard economics professor Dr. Roland Fryer was told not to publish his 2017 study that showed that while police were more likely to show excessive force against racial minorities, they were less likely to shoot them compared to white suspects.25 Colleagues told him he should publish the first part, which they liked—but not the second part. But he decided to publish all the results. In an interview with journalist Bari Weiss of the Free Press, he explained how after that, his life became “hell.” He immediately became the subject of an internal investigation at Harvard and was suspended for two years without pay. He was not fired, because he was tenured—the youngest Black tenured professor at Harvard. “People lose their minds when they don’t like the result,” he told Weiss. (Dr. Fryer’s boss who suspended him, Dr. Claudine Gay, would later be named president of Harvard, and then be forced to resign due to plagiarism
- It’s okay to be wrong. In science, when people get things wrong when little information is available, they are being human. But when they make absolutist claims for years that go against overwhelming medical evidence simply to protect an institution’s or political party’s brand, they are propogandists.
- Chronic diseases are the leading cause of death in the U.S. and consume a majority of the $4.5 trillion we spend on health care. The current reactionary, siloed, Whac-A-Mole health care system isn’t working. Most American adults take four or more prescription medications regularly, making the U.S. the most medicated population in the world. We need to try new approaches to health. We need fresh ideas.
-SOME INTERESTING FACTOIDS SPRINKLED THROUGHOUT;
- One in seven women in the USA has diabetes
- OxyContin was approved by the FDA for chronic use based on a 14-day clinical trial,
- The term “vaccine” is a derivative of the Latin word vacca, for “cow (the first vaccine was cow pox scraped from one infected blister and applied to the open wound of a child)
- In the Middle Ages, doctors believed the body turned food into blood, and blood just sat in the body stagnant. Blood doesn’t circulate, they believed. It would only be replaced by eating more food that then converted to blood. The heart, the pounding thing everyone could feel in their chests, was thought to be a source of heat.
- an editor of the medical journal "Anaesthesia", examined 500 clinical trials and found that a whopping 44% of them contained false data.
Super fascinating discussion of popularly held beliefs about medicine that aren’t actually supported by science, and that are in fact often directly contradicted by credible studies. Definitely gives you a lot to think about and be aware of.
I read this as recon for work - wholeheartedly do not recommend but I'm keeping it here for my book count and to vent about how he sucks It's like if Joe Rogan was a book except this guy is going to be the FDA commissioner. Makary excoriates scientists for not "following the data" and then in the next chapter cites anecdotal evidence from his uncle to support his theory of "just asking questions." When the evidence proves Makary is so smart and everyone else is dumb? Makary: Gotta stick to the facts! When the evidence contradicts his personal, unproven theory? Makary: People should be able to disagree! Truly the have it your way of ethos but make it pretend science.
Still waiting for the herd immunity he so smugly declared would protect us all from COVID. Not like you can get it more than once or anything!
Still waiting for the herd immunity he so smugly declared would protect us all from COVID. Not like you can get it more than once or anything!