Blind spots in our thinking and decision-making are an inevitable part of the human experience.
But what does this mean in the context of medicine?
In this episode of CareTalk, David E. Williams and John Driscoll explore these challenges with guest Dr. Marty Makary, author of Blind Spots, delving into our natural resistance to new ideas, the impact of these tendencies on healthcare, and strategies for addressing blind spots in modern medicine.
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Episode Transcript:
David E. Williams: Even intelligent, well-meaning people often have huge blind spots in their thinking. In medicine, that's led to severe problems like the opioid crisis, overuse of antibiotics, and rejection of hormone replacement therapy. Where do these blind spots come from? And how can we erase them?
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That's BetterHelp, H E L P dot com slash care talk. CareTalk. Welcome to CareTalk, America's home for incisive debate about healthcare, business, and policy. I'm David Williams, President of Health Business Group. And I'm John Driscoll, Senior Advisor at Walgreens. Well, today's guest is Dr. Marty McCary. He's the author of Blindspots, a deep dive into the human tendency to resist new ideas and a guide to improving objectivity.
Join the vibrant care talk community on LinkedIn, where you can dig deep into healthcare business and policy topics, access care, talk content, and interact with the host and our guests. And please be sure to leave us a rating on Apple or Spotify while you're at it. Dr. Makary, welcome to CareTalk. Great to be
Dr. Marty Makary: with you, David, and John.
John Driscoll: So, Dr. Makary, if I could call you Marty, at least for the length of this podcast. Please. Just, what, what got you interested in this super important topic of blind spots and how do you, how do you define it?
Dr. Marty Makary: Well, it's amazing the power of groupthink and medical dogma that we see in every specialty in medicine can take on a life of its own.
And the purpose of science is really to challenge deeply held assumptions in the field. So what inspired me to write the book Blind Spots? is the young generation of doctors right now that are coming up and think differently. They want to change the way we deliver health care. They don't want to accept, well, this is the way it is.
You got to see patients in quick 10-minute visits and bill and code and burn out yourself. And they want to Redesign the entire healthcare system. They want to talk about treating diabetes with cooking classes instead of just throwing insulin at people They want to talk about school lunch programs.
Not just Ozempic for children. They want to talk about food as medicine And body inflammation and microbiome health So these are all topics where there's incredible emerging research, but it's not quite prime time It's just not accepted within the field in part because we have an old guard oligarchy in medicine that controls the, the gates of what goes in the journals, what gets funded at the NIH.
But this area of research is exciting and I thought the public deserves to know about it.
David E. Williams: If you look back, you, you mentioned in the book you, you go into a, a number of blind spots. Can you mention some of those that are, you know, the most interesting have had the biggest impact?
Dr. Marty Makary: Well, I think the, the one that was blew me away the most, the one where I did some original investigative journalism, was looking into the dogma that hormone replacement therapy for women after menopause, causes breast cancer.
It's not true. And it overshadowed the incredible benefits of hormone replacement therapy. That is estrogen plus or minus progesterone for women. When a woman starts hormone replacement therapy within 10 years of menopause, the data are overwhelming and we never hear about this because of the, this improper dogma that was put out that it causes breast cancer.
It turns out the benefits. Include cutting the risk of of heart attacks in half reducing cognitive decline by up to 60%, reducing the risk of Alzheimer's by 35%, reducing the risk of of bone fractures. If a woman falls, in half. The risk, the benefits are overwhelming. Women live three and a half years longer on average and feel better, not just alleviating the, the symptoms of menopause.
And so all, there's probably nothing that has improved the health of a population more. In terms of population-level outcomes than estrogen for women. And yet 90 percent of women to, to this day are still not offered estrogen because of the dogma that it causes breast cancer. So I did, I did a deep dive on it.
John Driscoll: Yeah. Marty. I actually think it's worse than that. I think the, the, the, the, because. is so common among women. And because of the, just the, the fear of the big C, there are still a lot of oncologists, PAs, techs, people working in oncologists offices who are, you know, appropriate are in, are inappropriately basing their recommendations of, Sort of against HRT in, in a way that kind of tar terrifies women who were suffering from this disease, which, which breast cancer, which touches so many women.
I just, I think it's an incredibly important call. I think in your book you actually suggest that HRT may actually be somewhat preventative. I mean, like, it's actually, it's, it's not, it's not, it's not, it's not. choosing one set of benefits against another. It's really, you, you're sort of unpack how weak the data is that this is in some ways promotes breast cancer.
Dr. Marty Makary: That's right. About 1 percent of postmenopausal women cannot take hormone replacement therapy for a number of reasons, but overwhelmingly this has tremendous benefits to a population. And I'm glad you said what you said, because fear is a, Is what drove so many people away and it's amazing when they had the initial deliberate deliberation within the study committee.
I interviewed one guy at that meeting who said something there was a shouting match before they released the results because many felt it was misleading. Turns out there was never any statistical significance that it, that it increases breast cancer. And women who took estrogen alone had lower rates of breast cancer, ironically.
That was wild. That was wild. But one guy said, look, if you put this out there when it's not true, when there's no statistically significant increase in breast cancer, you will never be able to put the genie back in the bottle with an issue as sensitive as breast cancer. And to this day, there's never been a study showing that it increases the death rate of breast cancer, but 90 percent of doctors still do not prescribe it because that announcement made by an NIH researcher.
And researchers from Harvard and all the top regalia, but it was so loud that people can't undo it in their mind. And it's lived on as medical dogma.
David E. Williams: So here's another one. How about peanuts for kids?
Dr. Marty Makary: So yeah, the modern-day peanut allergy epidemic. Does not exist in many countries. There's no peanut allergies in Africa, according to the doctors there and people who live there.
And so what happened was there was a slight increase in peanut allergies in the 1970s. The pediatrician community didn't know what to do, the American Academy of Pediatrics. So they decided they're going to issue a recommendation for all mothers and young children to avoid peanuts. Thank you 100 percent until age three to prevent peanut allergies from developing in those kids.
Turns out they got it backwards. Peanut avoidance causes peanut allergies. They forgot about basic immune tolerance, or what's been known as the Dirt Theory. So, by and large, this, well, at that time, when the recommendation went out, in the year 2000 the peanut allergy rate in the United States soared. I mean, a massive surge, and we had a new type of peanut allergy, which is this severe, severe, Allergy you can't even a kid can't even be near peanuts It just being close to a peanut without even ingesting it can put him into this severe Anaphylactic reaction and we saw ER visits go way up.
I mean, this is a horrible epidemic It's still dominating in the United States But other countries don't have it because they didn't put out medical dogma that was wrong now It came out New England Journal Papers is one as recent as a few months ago proved this peanut avoidance idea wrong that that's how you prevent peanut allergies.
They pointed out that early exposure of little bit of peanut butter when a kid's four or five months of age and in infancy prevents peanut allergies. But you didn't hear an apology. And I think right now we have a big trust problem in medicine. People deserve an apology when we get things wrong, when the oligarchs get things wrong, I'm not talking about rank-and-file docs, I'm talking about when the medical elites put out something with such absolutism, and the reality is they don't know, and look, I don't talk about COVID in the book, but there's a connection there.
Many times during COVID, the right answer was we don't know. We don't
John Driscoll: know. Marty. I, I, I, my, I think my 90-year-old mother would most like to hear your, your, your, your, your, your insight on do eggs, you know, create heart attacks because she always serves everybody in the family eggs. And there's obviously, there's been a demonization of eggs over time.
Can you talk a little bit about what you, what you found in terms of eggs and cholesterol?
Dr. Marty Makary: I love this topic. So it's to say like every family, there's There's some pro egg member of the family that, you know, typically that from prior generation and then there was this medical dogma that inserted itself starting about 50 years ago, that fat causes saturated fat, natural fats in food.
Causes heart disease. It was dogma. It was based on a flawed study. I go through all the stuff in the book blind spots Turns out they got it backwards. It's not the natural fats It's the refined carbohydrates and other drivers of inflammation ultra processed foods And so it turns out that eggs are a great source of protein which most Americans are deficient in protein As long as you're not, you know overeating with massive portions, which is a separate issue It's a great source Of food, and we don't talk about food as medicine enough, but it turns out that there's no evidence.
They tried three different times in massive studies to prove that natural fat causes heart disease. All three giant studies. Did not prove it to be true. And yet you did again, humility. You did not see that lack that humility, the humility to say we got this terribly wrong. I mean, this is the number one health recommendation we as doctors put in front of patients, maybe second to smoking, you know, not smoking.
For the last 60 years, we got it wrong for about 60 years.
John Driscoll: This is just to be clear. This is not, you're not just going after Paul Dudley White and Eisenhower and all that stuff. This is the recommendation that cholesterol, the dietary cholesterol is kind of driving, you know, cardiac risk. And I think you, you point out that don't absorb enough.
It's, it's, it's, there's a whole series of other things that are, that are, that are, that create heart risk. It's just another endorsement of I think you sort of underestimate Marty, the, the insight that you're bringing to these really everyday healthcare issues.
Dr. Marty Makary: I mean, dietary cholesterol is not even absorbed by the body, it's esterified, so it's too bulky to be absorbed, so a very small proportion, 99 percent of your cholesterol is made by your body, produced by your, not from dietary sources, so I still see low cholesterol foods out there, you still see low fat, Cookbooks put out by the massive industry.
It's so big. And the medical establishment created this massive industry and we created this low-fat, high-carbohydrate move over the last 60 years. So we gotta, we have to do an honest. Reckoning, apologize and tell the public, we got this wrong. Opioids being non-addictive, we got it wrong. Peanut avoidance, we got it wrong.
Hormone replacement therapy causing breast cancer.
John Driscoll: I think on the opioids, you know, you may have something to do with the Sacklers may have had something to do with creating, I don't think the opioids, I think are pretty, that may have been shared a little bit by their search that was purloined by the, the, the, the folks who've been convicted on the issue.
Who are pushing it, but maybe you could, so beyond apologies, Marty, what, what's the right way to start establishing reestablishing trust? Because I do think again, you don't, you don't go into COVID that's obviously an open wound, but I think there's, there's no question. We've had Peter Hotez on the, Dr. Peter Hotez on the, on the, on the show. And. You know, it's trust is a big issue because it both is the foundation of, of, of how patients, you know, engage with the system. And without that, I, I worry that, that, that, that the important clinical impact of, of, of doctors is w is, it was sort of lost.
Like, how did we rebuild that?
Dr. Marty Makary: Well, civil discourse. I and I'm glad you had Dr. Hotez on. People should hear from multiple different medical points of view, but in the medical establishment right now, that is seen as, no, no, we cannot share, share multiple medical opinions with the public. They're too stupid to handle it.
It could result in them following the wrong thing. Well, we don't know what the right thing is sometimes. Now, Peter Hotez and I have a different opinion. He. Recently said that he thinks the Department of Homeland Security needs to get involved in fighting misinformation. I tend to think you fight bad ideas with more ideas with good ideas.
And if we're going to rebuild trust, I think it is. Inviting dissenting ideas to a civil discourse, just like you do on your podcast. It's avoiding intimidation, creating a culture where people feel comfortable speaking up. That's what I do as a surgeon in my operating room. I want every medical student and nurse tech to speak up if they see something that doesn't look right.
And if I mock them or intimidate them after they say something, then I'm not creating a culture. of a civil discourse. We need to recognize our biases. The father of modern medicine, Claude Bernard, said we all have our biases. We need to recognize them. It's an active process and then temporarily suspend them as we hear new ideas to try to be impeccably objective.
If you remember, Obama said when he first ran for president, when asked, what's your favorite book? He said, Team of Rivals. Because he believes in a group, a sort of robust discussion of different ideas that would spar. And that is the essence of science. We've lost it. We've sort of developed this cancel culture in medicine, like the rest of society.
David E. Williams: I wonder if looking back at some of these historical blind spots, if some of it has to do with the fact that a negative something that's scary will overwhelm positive ones. So if there's, you know, one study that says something is bad or scary, does that overwhelm? Do you need, you know, some ratio three or four to one to cancel that out?
Or is it just, you hear one thing that's big and loud enough and bad enough that it actually just keeps you away from it in the first place?
Dr. Marty Makary: Well, I'm glad you raised that David, because we live in a scary time. And that is, if a study supports a foregone conclusion that somebody wants to believe. It's held up as the great scientific evidence.
And if they don't like the results, they ignore it or downplay it or find some way to nitpick, which you can do with any study. And so we've lost this ability to critically appraise research based very objectively on the research methodology. So I'm concerned about that. Now, that's a skill set that we don't actively promote.
But people need to understand when there's a study that shows that. A multivitamin helps you live longer. Was it just an observational study where healthier people tended to take a multivitamin? That is the critical appraisal of research. That is what we're missing. Most of my frustration with COVID was that almost all these controversies during COVID-19 could have been resolved with randomized control trials that were run expeditiously.
on everything from how it spreads from surfaces to airborne. You know, there was a recommendation for teachers to wear goggles and gloves during COVID-19 in the middle of the summer in July of 2020. Now, why did it take six months for us to realize, no, it's spread airborne? Those are studies that could have been done rapidly.
And we've sort of lost There's allegiance to the scientific process itself.
John Driscoll: Well, and I, and I think one of the important points Dr. Macri is, you're not, you're not suggesting that that an idea is a bad idea. You're saying that all ideas need to run through a rapid fire, real, clinical trial. And if the idea is wrong, you change it.
But I am reminded of a wise man once told me that it, that it that I think was at Harvard, that, that science tended to advance one funeral at a time, that there, that arrogance in, in, in fields is, is not uncommon. And I think in your book, you talk about Dr. Semmelweis who, who's, who's, who's who's really revolutionary.
The recommendation that just washing your hands. When delivering babies would deliver more healthy babies. I believe the medical establishment so rejected that his recommendations that he ended up being be, be, be, be, becoming mentally ill. I mean, this is not, this has been a problem for hundreds of years.
And I, I just welcome the fact that you're reminding science of, of how science can move forward through. Kind of classic randomized control you know, the, the, the, the trial where you actually test every idea, I think, but embedded in your recommendations is that we have to do this a lot faster in order to be a lot smarter.
Do you, have you seen any examples where that's happened?
Dr. Marty Makary: It happens well with pharmaceutical-related products, so when there's a question, does a cancer drug help? We see the pharma industry rush. To run their tests and they do it with all the might of modern-day sophistication and financing. But when it comes to assessing whether or not cutting the frenulum under the tongue of babies actually helps or hurts a child.
Now this is a rampant practice that's taking off like crazy. I write about it in the book Blind Spots. It's, it is a classic thing. Where no one knows the real answer, now many of us have a hypothesis that it's has a net harm to children, but taking kids routinely, cutting the frenulum under their tongue with under with the argument that, oh, it's going to help them with their sleep and latching and breastfeeding and maybe with their speech in the future and maybe prevent sleep apnea.
It's dogma. We don't know. It needs a randomized controlled trial. Who's going to fund that study? Pharma? No, no way. The American Academy of Pediatrics? I don't think so. NIH? Not in one of their siloed organ system you know, centers. And so this is the Bermuda Triangle of research. Practices take off like wildfire.
That desperately needs scientific study. They desperately need a randomized trial. And we don't have the infrastructure to do that. That's why we have to look at where our tax dollars are going. The NIH is sort of latched on to these old-guard ideas and they're ignoring The microbiome, now they actually have a tiny microbiome center.
The microbiome is the lining of the gut with millions of different bacteria that's involved in digestion and the immune system and mental health. Some of the bacteria produce serotonin. What we're learning about antibiotics and the microbiome is revolutionizing medicine. We may even have some clues as to what's causing cancer if you've seen cancers increasing in young people.
You're welcome. colon cancer in particular. There are incredible new studies that are telling us, Hey, alert, here's a signal in the data. Look at this. This is unbelievable. We've had no progress in addressing learning disabilities and celiac disease. And we may have an underlying unifying theory here with the microbiome, but it's, there's no department of the microbiome.
There's no microbiome center at the NIH. There's no journal. What, what specialty is the microbiome? Infectious diseases, GI, primary care. It doesn't have a specialty. And this is the broader story in healthcare. We've got to pursue what matters to patients, not what matters to our NIH funding centers.
David E. Williams: So maybe, maybe one of the you know, one of the, one of the advantages of the calling for the grand unifying theory on the microbiome is gut.
So maybe that'll be some of the the branding for that. When you look ahead at some of the blind spots, you know, it's interesting to look. back and see where the blind spots have been and what have we learned from them. I would argue that some of these are maybe slowly being changed now, being addressed, the peanut allergies, the HRT, silicone implants you mentioned in the book as well, fats and cholesterol.
Looking ahead, some of the ones you cite have some of the same characteristics, but also maybe relate to social movements or political side and I'm thinking about in particular cannabis and gender-affirming care for children for a couple that you that you talk about. I wonder what your perspective is.
You know, are we just are they just new blind spots that are very similar to what we had in the past? Is there something different? And what does that mean in terms of. What you do about it.
Dr. Marty Makary: So the modern-day application of all of these lessons of modern medicine, where I go through the blind spots of the last 20 years or so of medical recommendations from the establishment, including many that are still out there today that are wrong.
And I write about them so people can know the truth. It does beg the question, if we got all of these things wrong in the last 20 years, what are we doing right now that may not be correct or in the best interest of patients? And I get concerned when I see a community, a medical community, a specialist community, an activist community in the general population speak about a scientific question with such absolutism.
When the reality is it's never been properly studied. So if we are truly objective and if we're true scientists, are we open to what a future study might tell us about marijuana? For example the marijuana of today is not the marijuana of hippies. 50 years ago, it's 10 to 20 times more potent and it may, it appears to have a different effect on an adolescent developing mind than it does on an older adult.
So, are we open to these nuances? Are we open to being to results that may show our deeply held assumptions we're wrong, or are we absolutely certain marijuana is totally safe and we're closed to the scientific process?
John Driscoll: So Marty, maybe, We could, we could tie it back to what should a patient, how does a patient approach medicine?
We've been made, so you identified the blind spots. You've, we've talked a little bit about what the NIH should do, but okay, you're a, you're, you're a patient and you're, and you've got some members of your family that are healthy and those that are chronically ill. How, how should a patient start to think about navigating healthcare?
Without sort of a specialist's view, what, what, what is your recommendation to your, your neighbors and your friends?
Dr. Marty Makary: Well, I find that people who love their doctors often love their doctors because their doctors are reasonable. They show humility. They know their limits. When I see a surgical trainee come through our residency at Johns Hopkins and get so frustrated by how they are placing a stitch and it's not the perfect way they want to place it, I tell them, look, What's going to define you as a great doctor is learning from your own actions, listening to the patients, and knowing your limits.
Knowing when to call for help. It's not, you know, I put in 76 stitches, I could have done it with 75. It is understanding your limits and the humility of being honest with patients. People are very forgiving with the medical establishment and their doctors. Cheers. If they're being talked to in an honest way.
So I don't want people to be cynical about physicians. Most rank-and-file physicians are thinking independently, but we're living in a new era now where organized medicine with a small oligarchy at the top are making centralized decisions and they're out of touch sometimes with everyday folks and docs.
And so I encourage people to look for doctors that they connect with, the doctors that listen to them, who demonstrate humility, who will say I don't know when they don't know, who will have conversations, who will spend time with them. This is what the new generation of medical students and residents want to do.
They want to spend time with people. They don't want to be billing and coding on a, some hamster wheel their whole lives. And so I, I, that's what I encourage. And then there are certain truths. From the scientific literature, people should know antibiotics are not totally safe. The dogma that, Oh, you might as well just take an antibiotic.
It won't probably won't help, but it won't hurt. Well, let me show you some incredible data now. Antibiotics and C-sections save lives. Absolutely, but they're massively overused and sometimes you got to take an issue straight to the public and say, here's some health information that's good for everyone to know.
David E. Williams: Well, that's it for yet another episode of CureTalk. We've been speaking today with Dr. Marty McKerry. He's the author of Blind Spots, which is a deep dive into the human tendency to resist new ideas and a guide to improving objectivity. I'm David Williams, president of Health Business Group. Thanks for
John Driscoll: And I'm John Driscoll, senior advisor at Walgreens.
If you like what you heard or you didn't, we'd love it if you'd subscribe on your favorite service. And thank you so much, Marty.
Dr. Marty Makary: Great to be with you guys. Enjoyed it. Thanks.
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