Book review: Why the medical system often makes mistakes

Publication date: March 19, 1403 visit: 200 views

Tags Blind Spots book In the book Blind Spots, medical expert Marty Makary strongly criticizes false science and baseless opinions in the field of health.

Like many surgeons, Marty McCreary has for years treated appendicitis with surgery and appendectomy, a procedure performed nearly 300,000 times a year in the United States. But about a decade ago, he found through a research study that antibiotics can be an effective alternative to surgery.

for Click to buy the book Blind Spots with Farsi translation

Despite subsequent research confirming this finding, McCree estimates that only about half of surgeons have adopted the procedure. He writes in the book Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health: "This means that in America today, whether or not you get surgery for appendicitis depends on which doctor is on call when you go to the emergency room."

McCree, a surgeon and public health researcher at Johns Hopkins University, examines real-life examples in this book to show how and why doctors often support false science and baseless opinions, even at the cost of harming patients.

Meanwhile, he claims that the medical system has caused the opioid crisis and the spread of peanut allergy. Thousands of women have lost their lives due to misinterpretation of data about the risks of hormone replacement therapy. The US government also banned the use of silicone breast implants for 14 years without any evidence of harm. Also, the over-prescription of antibiotics by doctors has probably caused countless suffering and problems. In addition, doctors still advise overweight people to eat low-fat foods, even though low-fat diets are associated with obesity and diabetes.

McCree writes: "Much of what people are told about health is actually medical prejudice—an idea or practice that is accepted simply because someone thinks it's true and without valid scientific backing."

In his book, he confirms these claims by citing hundreds of scientific sources, but this does not mean that all doctors and researchers agree with him. For example, in one of the studies that examined 13 studies comparing the treatment of appendicitis with antibiotics and surgery, it was found that almost one-third of patients who were initially treated with antibiotics ended up undergoing surgery within a year. While the other two-thirds did not require surgery, the researchers concluded that the evidence for the superiority of antibiotics was "very uncertain." Therefore, surgeons who decide to operate immediately are not necessarily doing something wrong.

"Much of what people are told about health is actually medical prejudice."

McCray, who is one of the leading critics of the medical system, has been criticizing the American health system since 1998, when he was a medical student. In the same year, an article of his was published in the prestigious journal Journal of the American Medical Association, which asked hospitals, medical schools and health insurance companies to stop investing in the tobacco industry. A few years later, despite the criticism of his colleagues, Makary (Makary) created a checklist to improve surgical safety. After proving that these checklists reduce the rate of surgical errors and mortality, they are now used in most operating rooms around the world. His 2012 book, Unaccountable, called on hospitals to disclose their infection rates and medical errors. A few years later, Medicare required public reporting of this information and other indicators of the quality of medical care. His 2019 book, The Price We Pay, investigated unfair hospital pricing practices and called for the release of cash rates for certain services—a request that is now being enforced by law.

Macari cannot claim to be the sole cause of these major changes, but he is undoubtedly one of the most influential voices in this field. Both of his books—as well as Blind Spots—are on the New York Times bestseller list.

A recurring thread in Makari's critiques is that the American health care system makes many mistakes. Blind Spots focuses on the failings of the "medical establishment"—a term Macari does not clearly define but refers to more than 40 times in the book, almost always in a critical tone.

He blames medical journals, government agencies, and medical professional societies for actions that he sees as harming the public. Macari does not describe the medical establishment as malevolent, but accuses it of often accepting a narrative—like the belief that stress causes ulcers—without sufficient evidence, ignoring scientific findings that contradict it, and dismissing people who challenge such views.

Medical journals are one of the main sources through which doctors get acquainted with new scientific knowledge and provide medical services based on it. Most of these journals use a peer-review process, meaning that an article is published only if a panel of experts evaluates it for accuracy and quality.

Macari has published more than 250 peer-reviewed articles in medical journals, but is not a fan of the field. According to him, editorial boards, which act as gatekeepers for the publication of articles, are "mostly made up of like-minded friends."

He strongly criticizes medical journals, government agencies, and medical associations for actions that, in his view, harm the public.

"I have been shocked many times to see studies so flawed that their results lack credibility, yet published in reputable medical journals and presented as scientific evidence, when in fact they only support a bigoted narrative."

Invalid results? The publication of contradictory and false data in medical journals is common, and in 2023 alone, more than 10,000 articles were retracted from these journals. Earlier this year, the Dana-Farber Cancer Institute retracted seven published papers due to errors or allegations of image manipulation and corrected 31 others.

The National Institutes of Health, which is the largest public funding body for biomedical research in the world, has also not escaped Macari's critical eye. In particular, he criticizes the institute for its 2002 decision to halt a clinical trial on the long-term effects of hormone replacement therapy (HRT) based on inaccurate data showing an increased risk of breast cancer. In a strong defense of the benefits of this treatment, Macari points to an estimate that shows that about 140,000 women have died prematurely over the past two decades because of the avoidance of hormone replacement therapy. "The message being pushed was that HRT causes breast cancer," she writes. And this message is still believed by most doctors.” Medical societies that provide guidance to doctors and the general public have also been criticized by Makary. For example, the American Heart Association promoted a low-fat diet for six decades, even though there was no evidence that fat causes heart disease. The unfounded recommendation of the American Academy of Pediatrics that children under the age of three should not eat peanuts has led to an increase in cases of peanut allergy in the United States, when early consumption of peanuts actually reduces the risk of developing this allergy. The American Medical Association also supports what McCree calls government censorship of health information.

McCray's criticism of the medical system is reminiscent of Vinay Prasad's criticism of cancer treatment in the book "Malignant: How Bad Policy and Bad Evidence Harm People with Cancer", which was published in 2020. The similarity between the aggressive style of these two authors is not accidental; McCree mentions Prasad as a "great teacher" in the acknowledgments section.

McCray's writing style makes it easy for general readers to follow his material. He first identifies a "blind spot", then travels to various locations to gather information about its background, and finally gathers the desired data by reviewing research studies. Of course, his digressions and extrapolations—such as his detailed and unpleasant description of the symptoms of scurvy in a sailor, John Adams's defense of British soldiers in court, or the problems posed by VIP patients—may be unexpected at first for readers. Still, his passion for his subjects, peppered throughout the book with phrases like "wonderful" and "amazing," is infectious.

McCree points to an estimate that shows that about 140,000 women have died prematurely over two decades due to the lack of hormone replacement therapy.

However, it seems that doctors, especially those he considers part of the medical system, are his main audience; Because his book is full of calls to action. including that he wants an apology from government institutions and medical associations for giving incorrect advice. He also calls for funding for replication studies to confirm research results. In addition, he wants the medical education system in America to stop promoting "obsolete groupthink".

His most important request is to create a space for civil debate in which the scientific consensus can be challenged, without critics being dismissed or discredited. Of course, his strong opinions and general criticism of the medical system may alienate some of the people he aims to influence. But his record of making changes cannot be ignored.

So perhaps readers can hope that his vision will come true: "Free discussions and examination of the value of data instead of prejudices will lead to a stronger society, more civilized dialogue and a faster pace of medical discovery."