Blind Spots: When Medication Will get It Flawed, and What It Means for Our Well being

Well Done, Disturbing, and Thought Provoking
Peanut allergies were rare before health policy makers decided that children should abstain from eating any peanut products the first years of their lives to address those very infrequent occurrences. The result: peanut allergies exploded among children who never had any contact with peanuts during their early years.Silicone breast implants were satisfying many patients who needed reconstructive surgery or who wanted augmentation until some medical researchers (who it appears did not approve of cosmetic surgery) used very weak study linkages to proclaim them dangerous. Lawsuits exploded and millions of women had their implants removed. Later scienced proved that wrongheaded. The FDA reversed itself and today labels Silicone breast implants safe.Dr. Makary (at this writing, the nominee to run the FDA), has written an important book that is eye opening to the public and I imagine also many physicians.His book illustrates several medical policy positions beyond peanut abstention and breast implants taken by the medical establishment (AMA, AHA, FDA, leading medical journals) which have stood upon weak evidence, evidence that contradicts the policy position, or even the strongly held beliefs of medical policy gatekeepers who rely on their wisdom that certain causations “just make sense.”Almost all of these have been reversed or superseded – but usually only after years or even decades of existence guiding standards of care and medical interventions. Some of these did great harm to patients and people and some like over reliance on antibiotics reverberate today.This book is very well written and accessible to non-physicians and the public. He explains medical topics for the layperson. It is very much worth reading.In addition to those standards of care named above, Makary tells the stories of over prescribing of antibiotics and the effect on the gut biome, the lack of understanding that dietary cholesterol has little to no effect on body cholesterol levels, and how wrong thinking around many aspects of medical care related to childbirth led to premature babies having worse outcomes and children born of c-sections having altered gut biomes (due to lack of maternal germs gained through passage down the birth canal) which negatively influences other aspects of their development. Perhaps the most interesting to me is that science has recently concluded that ovarian cancer actually starts from cancerous fallopian tube cells that migrate to the ovaries. It appears generations of women who had ovaries removed as a preventive measure were removing the wrong organ to no benefit (and even to their detriment as ovaries provide important hormones for the body). Today due to studies that appear sound, many physicians recommend a fifteen-minute procedure to remove fallopian tubes for women who are either not having more children or past child baring age in some cases.What gives credence to Dr. Makary’s examples is that in each case he goes back to the initial study that resulted in new and mistaken medical standards of care and explains poor data, lack of causation or just incorrect data assessments, or poor study structure that changed lives for millions because of physician adherence to promulgations by our medical standards gatekeepers. His arguments are greatly enhanced because he tracked down either the initial study authors or the AMA committee members or medical journal editors that blessed the care changes and talked to them about the data and study problems that underpinned these changed standards. These people either admitted they were wrong, or the studies were not conclusive, or defensively fall back on arguments of “needed to not upset the public,” or “keeping consistent with our positions” as reasons for why they made or supported positions that turned out to be wrong. None of the original protagonists with whom he discussed these wrong turns did or were able to defend their original positions.Some of the conclusions the author makes which are important if we are going to get new standards of care right:1. The data underpinning studies must be made available for review (shockingly to me they were not available in most cases)2. Authors of studies should be blinded so reviewers / journal editors cannot play favorites among their colleagues or support studies done by their own institutions3. The AMA, FDA and other gate keepers must become comfortable with saying “we don’t know” instead of perceiving a need to quickly solve frustrating and high visibility issues for public satisfaction4. Leadership positions at medical societies and journals need to be rotated so fresh thinking can be injected into assessment processes and defensiveness minimized5. Journals and associations and the government need to embrace studies related to care delivery more than they historically have.6. Topic myopia – where grants go in large part to the same narrow topic areas and fresh ideas are shunted aside needs to be reduced so that new thinking can be tested and studied7. Politics and extraneous considerations need to be removed from grant making, publication, and committee work.This is a captivating book that seems to show difficult to refute case studies (usually because in most cases the offending incorrect standard of care has been reversed or significantly altered). His prescriptions to improve the environment in which medical knowledge is advanced and standards of care embraced make a lot of sense and are worthy of open debate.

Essential to understand the failures of modern medicine.
Amazing, shocking book. Did you know that ovarian cancer actually starts in the fallopian tubes? That one man in the CDC caused the peanut allergy epidemic?Hope Dr. Mackary writes another book and includes covid myths and “gender affirming care” as topics. So glad that he will be Director of FDA in Trump administration

Finally some facts!
A well-written, appropriately researched and life-enhancing book. As a research scientist and someone who has seen the ins and outs of groupthink both in my professional career and as a patient, I encourage everyone to read this book. It will open your eyes and guide you to advocate better for yourself and your loved ones. Doctors are sadly very narrow in their knowledge and don’t always have the patient’s best interest at heart. Some just want to follow protocol vs heal. Most patients lack the knowledge to do their own research about their health and healthcare recommendations by these so-called experts. This easy to read book will give you some great discussion points and the courage to demand the best solutions for your health. Gift this book to those you love! Bravo Dr. Makary and thank you for leading with data vs opinion.