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Marty Makary MD, “Blind Spots,” Part 2
One week ago, I wrote a post about the mind-blowing discoveries of Marty Makary, M.D. concerning the medical field and its reliance on alleviating its own cognitive dissonance, to the detriment of the public and medicine. I promised,
however, that I would write a more comprehensive book review of Blind Spots, because I want every person who hasn’t read the book to learn some life-changing information — and maybe even be motivated to read his book. It has changed my life, and will certainly change the life of many people.
I don’t plan to even try to cover everything in the book, but I’ve chosen to focus on key subjects: those that may lead potentially to serious illness or death. I’m not trying to be overly dramatic, but some of the decisions that have been made in the past because of a lack of good information are frightening. There are doctors who still follow these faulty guidelines.
The key areas I want to draw your attention to are allergies, hormone replacement therapy, the microbiome, ovarian cancer, cholesterol, obesity, and diabetes. In every case, at least one fact provided me with new information. I am providing only a brief description of each topic, and I encourage you to read the book for an in-depth analysis.
Allergies: The most devastating allergy for many families is peanut allergies. Doctors had essentially been propagandized to believe that peanuts could put babies at risk. As a result, parents avoided giving their children any peanuts, which prevented them from developing any immunity to them:
Avoiding peanuts had been the correct answer on medical school tests and board exams, which were written and administered by the American Board of Pediatrics.
Eventually, two doctors, named Lack and Combs, discovered the illegitimacy of this diagnosis and favored tiny exposures to peanut products at first:
Extrapolating the principle to other potential allergens, Dr. Combs also encouraged the early introduction of eggs, milk, strawberries, and even early exposure to dogs and cats. As a result, the children in his practice rarely developed an allergy to these things, and when they did, it was mild.
Hormone Replacement Therapy: A flawed study claimed there was a relationship between HRT and breast cancer, and untold numbers of women stopped their HRT treatment. Not only is there not a connection, but the benefits of this kind of therapy, usually taken within the onset of menopause, are impressive:
Women taking estrogen have a 35% lower incidence of Alzheimer’s. That’s according to a University of Southern California study of more than 8,800 women.
Danish researchers randomized 343 women in early menopause to receive HRT versus placebo and followed them for up to 15 years. They found that taking HRT for even just two to three years reduced the risk of cognitive impairment by 64%.21 Wow.
Heart disease is the leading cause of death in American women. HRT reduces that risk by about 50%.
The microbiome: This system was not part of any of my health discussions with doctors:
The microbiome is one of the least understood organ systems in the body, yet it may be central to our health. It’s a garden of billions of different bacteria, fungi, and other organisms in our gut that normally live in a healthy balance.
Overuse and early ingestion of antibiotics can damage the microbiome. (By the way, those of you who think that probiotics help may be wasting your time.)
I couldn’t help but be amused by this comment by Dr. Makary:
Microbiome research can be done at a fraction of the cost of drug development. This is not the Manhattan Project or the lunar landing; it’s just basic research.
Ovarian cancer: One of the most shocking revelations was about ovarian cancer, a deadly cancer often identified too late to save the patient. Researchers finally discovered that women were not suffering from ovarian cancer, but from fallopian cancer. All these many years, ovaries were needlessly being removed when cancer was growing on the fallopian tubes. Some doctors have still not gotten the message and are removing ovaries, which causes a woman to lose the benefits from a small source of hormones.
Cholesterol: For all of us who are taking statins, this might come as a shock:
Study after study has failed to demonstrate the connection between dietary cholesterol and heart disease, or between the cholesterol in your diet and the cholesterol levels in your blood.
In fact, every cell in the body has a wall that is made out of cholesterol. Cholesterol is also the building-block precursor for estrogen, progesterone, testosterone, and corticosteroids—critical hormones for normal physiology and health.
Obesity and Diabetes: Our country has an alarming number of people who would be identified as obese, as well as afflicted with diabetes. Yet how many of us religiously shop for low-fat foods:
But 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.
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.
They noticed something peculiar: Some patients with high cholesterol would have no blockages and, conversely, some patients with low cholesterol had severe blockages. They began to question conventional wisdom.
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As a result of these discoveries, I’ve come away with mixed feelings about the medical industry. When should we trust their diagnoses? Are practitioners drawing conclusions independently or based on “conventional wisdom”? To try to answer these questions, we need to find doctors who we believe we can trust, and who consider these final points that Dr. Makary raised with his colleagues:
We must hold high the scientific method and recognize our biases. As Dr. Festinger pointed out, we all have a natural tendency to dismiss information we simply don’t like. Calling an intervention a ‘parachute’ when it deserves a proper study is one way smart people make bad policy. Second, sometimes in medicine, the right answer is ‘I don’t know.’ Third, health professionals and the public must know which recommendations are based on opinion and which are based on robust medical evidence. Fourth, the best way to fight bad ideas is with better ideas, not by canceling scientists. Finally, scientists and business innovators in medicine alike should be inspired to think differently and challenge deeply held assumptions in the field.
Thank you, Dr. Makary, for your dedication to your patients and to medicine.
Published in Healthcare
I tried to “like” your post but the system or my computer itself will not let me.
You and former ricochet member Bryan S are the only people that I have noticed this happening to on a frequent basis.
Anyway I like this.
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I’m sorry our computers aren’t getting along, but I appreciate your effort, CarolJoy!
I also recently read this book and found it enlightening. On the issue of peanut allergies, reading this book made me deeply grateful to the pediatrician who gave me permission to introduce peanut butter to my daughter at 15 months of age. He discussed it thoughtfully with me. He said that a lot of doctors think parents should wait until age 3 to introduce peanut butter, but that he thought it wasn’t so clear. He was already a very experienced pediatrician by this point, in 2006, so it’s very likely that the peanut avoidance recommendation appeared to him to be new and untested rather than settled science. My daughter, now 19, has had severe tree nut allergies since 2011. Those allergies worsened with each exposure, resulting in the need for an Epipen and an emergency room visit on several occasions. Thankfully, she has been able to eat peanut butter on a daily basis. I don’t know if the tree nut allergy could have been prevented, but her sisters are not allergic even though we have not had included very many tree nuts in their diets.
On the obesity and low-fat diet issue, I find it infuriating that people still don’t know about the backwardness of this diet recommendation. I think all the low-fat diet crazes of the 80s and 90s, and the vilification of eggs and beef, contributed to my mother being in a constant struggle to lose weight. Also, people don’t seem to know that obesity is increases your risk of getting cancer. In 2018, my husband’s doctor recommended that he go on a Keto diet, which emphasizes foods high in fat and protein. He lost 65 pounds and found relief from pain in his hands that had been plaguing him. I’ve done Keto since 2019 and I lost over 20 pounds. I find that my energy level is so much more consistent and I can really tell that carbs bring me down. Coincidentally, peanut butter is one of my favorite foods and I just eat the natural kind with no added sugar.
Susan,
This is a very timely post, what with RFK’s nomination to head HHS getting lots of attention lately. Andrew Klavan had an excellent interview with Dr. Makary a couple of weeks ago. You can watch it here:
After I listened to it, I thought about getting his book; your review has convinced me!
I’m always thrilled when I meet people who try to be informed and knowledgeable. Good for you, Lilly! And about the tree nuts, you can’t necessarily think of every single thing a person can be allergic to; there are too many choices!
She has since been tested for various allergies and found that she’s allergic to egg whites. Apparently, that allergy is indicative of increase allergies in general. I have various food allergies, although not to nuts. And my dad has had various allergies, along with his mother. We’re all allergic to cats. I’m assuming there’s a strong genetic component.
My concern with the medical approach to weight maintenance or loss through the keto (or originally Atkins) diet is that it is certainly not an answer for many people. I’m sure there is a genetic issue. Each person should try each way of eating to see which way works.
The other concern that doctors ignore, I think, is that it is as important to be mindful of the outgoing is it is to be mindful of the incoming. :) In other words, fiber is essential to a healthy digestive system. Soluble fiber–apples, for example–is pretty easy to get in the course of normal diet, but insoluble fiber–wood chips :)–is not. To get enough fiber, usually people have to really work at it.
And the need for fiber can be supplied only through carbs or dietary supplements or a combination of both.
The other issue that doctors are ignoring, in my experience with friends and family members, is the orthopedic angle.
I’ve been close to a couple of people who developed serious weight gain problems over a decade or so, and in both cases, joint pain–feet, knees, ankles, hips, and back–preceded the weight gain. I’ve become somewhat fanatical about this now. We need to intercede at around age 50 for people and get them to have a complete orthopedic workup. Problems in joints need to be addressed at that time if that person is going to live well to age 80 or older. If that means two knee or hip replacements–one at age 50, another at age 70–so be it.
Exercise stimulates the metabolism. It is the most critical body part as people get older, and it is the most vulnerable to injury. These pain-reducing surgeries should not be postponed. When we postpone them, the muscles get weak over time, the physical activity habits fade, and a sedentary lifestyle takes over.
Exercise keeps all of the other systems going. I read somewhere that people who take gardening even late in life after age 50 live longer. I can really see that. As my aunt once said, “I’ve just got to get that weed.” :) Any activity that requires some weightlifting is great.
What happens to a lot of people is that they simply adjust their lifestyle gradually to accommodate the chronic pain they start having in midlife.
The new medical goal, if I were in charge, would be to keep people as limber as possible throughout their lifespan.
I do not think it is the diet in and of itself that is causing the obesity problem in the United States. I think it is the sedentary lifestyle many people adopt as it becomes more and more painful to move around. As they are sitting more, they are reading more and they are bored, so they are eating more and grabbing a high-calorie snack to pass the time. And they are sleeping poorly because (a) they can’t get comfortable and (b) reading and watching videos is not enough to tire them out to really sleep well and deeply. They never get up feeling refreshed and rarin’ to go. :)
Human health has many interlocking components. We can’t look at just one component and fix it. Doing that won’t restore good health.
When we love people, we see them differently. We notice things that we wouldn’t otherwise. We can see the complexity of their lives. And the medical profession can’t do that very well. They tend to take a very targeted approach to problems. That works for a lot of things, but it doesn’t work very well for weight gain issues.
So if you notice people avoiding some physical activities because it is painful for them, encourage them to get whatever it is that hurts fixed as soon as they are able to. Be confident in pushing them out the door and into the orthopedic specialist’s office. :)
All very good points, Marci! Here in FL, lots of people seem to be overweight, and I constantly hear about people having knee surgeries and other issues. They are essentially abusing their bodies, and it’s a real shame. It is complicated, but I think Makary had some good information to share.
I switched to the newer computer and I have to admit “she” is less moody today than the older one!!
Carbs are usually the problem. Genetics are a significant factor. I recommend Gary Taubes’ books.
Low fat foots are nonsense. My brother has struggled with his weight for years. He ate lots of vegetables, little meat. Then had his stomach stapled, with almost no effect. Finally got a new doc who put him on a carnivore diet and he is under 200 lbs, from a high of almost 300.
I think few realize how much sugar -in the form of high fructose corn syrup -is in almost every processed food, which really distorts the body’s ability to manage its sugar load. It’s “sweeter” than cane sugar and in everything since the late ‘70’s when they changed the so-called food pyramid to emphasize carbs of all kinds over proteins and veg – even not sweet things – I think in part because it makes the feel of the food smooth/nice or something. So kids grow up with bodies looking for more sugar, without knowing why. And its effect on metabolism when it’s substituted for cane sugar is really awful.
I liked your post as soon as I got through the first topic.
I know this is anecdotal but since I ate everything that hit the kitchen table and anything I could find in the wild growing up and I was free as a child to do almost anything I liked and I spent most of those childhood days in the woods, digging caves, or swimming in the creek, for some reason I seem to have a strong immune system.
I’m now 86 years old and I’ve had only three occasions for significant medical interventions, two open-heart surgeries for a congenital abnormality and surgery and radiation treatments for cancer probably caused by my 25 years smoking. So I’ve never had much in the way of sickness although I did have pretty much the complete list of childhood illnesses growing up. I’m still looking out for shingles. I have great trust in my immune system. The only treatment I have taken during this Covid period is a few Ivermectin capsules. I’ve taken vaccines in the past but not anymore.
Peanut butter has been a staple of my diet my entire life. I probably had it close to every day while growing up. I never heard of any children I knew having a problem.
I saw Dr. Makary several times during Covid and I would say he and others like him reinforced my determination to make my own decisions about vaccines. I think the medical profession has been led down a false path that fosters endless treatment for as many as possible.
re the Peanut thing, here’s something I wrote a couple of months ago: Science, Expertise, Trust…and Peanuts.
Most of what follows this in your post is true, and has been well established for decades.
But it is also true that it has become so obvious that statins make people live longer that it has been considered unethical to have a placebo group in a statin trial for nearly 30 years. It’s the only drug class I can think of in which you’re not allowed to have a placebo group. If you know that a drug will make people live longer, you’re not allowed to deny that to half the people in your study. You’re not allowed to intentionally kill people in research.
Statins aren’t cholesterol drugs. They’re heart drugs. Their impact is much more complex than just LDL. This obvious point isn’t controversial, although we’re still arguing about how exactly these drugs work.
Statins have saved more lives than any other drug class in history, and that includes antibiotics. The data is simply overwhelming.
It is true that subendothelial pathophysiology is a highly complex multifactorial process. But it is also true that statins clearly work.
It’s fun to wonder about the mystery of how all this works. But please, don’t stop your statin because you don’t understand their mechanism. If you have vascular disease, they prolong life. So there you go.
I’m signing off on this thread. I really try not to give medical advice in this forum. I just didn’t want anybody to stop their statin because of what they read. That could be a catastrophic mistake, obviously.
Well, I didn’t know this and have leaned in the other direction for quite a while. I have been on statins for over thirty years so I think I’ll keep taking it.
I agree with much of what you’re saying, and I think moderation is key (everything in moderation, including moderation), as is exercise. I do think the amount of added sugar in so many foods caused more episodes of low-blood sugar and carb cravings for me. Generally, I don’t have the cravings now. I only say generally because hormones are a real thing. My thing is that low fat foods just add sugar for taste and they don’t satisfy.
Thank you for elaborating and adding clarity, Dr. B.
Mine is an unscientific but perhaps more “common sense” approach. It occurred to me one year when we were growing spinach well in to the winter, when snow was on the ground, that perhaps we could look to nature and know what we are supposed to eat, and how much. Since I can plant and harvest spinach almost the year ’round, and daily, while it take 2+ years and a lot of work to grow a cow, that perhaps I’m supposed to “eats me spinach” more often than I have a steak.
Around that same time I spent a couple of hours sitting on the back porch of a beef rancher, looking at his cows, and hearing him talk about the science of raising quality beef and how the regulatory regime makes it impossible for him to sell good beef at supermarket prices, and why “feed lot” beef is bad for you but grass fed beef isn’t.
I guess what I’m saying is that we probably ought to eat a lot more stuff that’s alive when we put it in our mouth, or at least things that ate stuff that was alive when it was in their mouth. Instead it’s all from a can or a box or a bag or a wrapper. And I think that stuff is all killing us.
And of course, as someone mentioned above: exercise.
It just seems we all want the quick and easy way to fat and happy…
That could only mean that cows and other animals that eat plants, are supposed to eat plants, because those plants are available to them sometimes year-’round.
Consider also how many plants were before we started meddling with them. Have you seen how “original” tomatoes, bananas, etc, looked before we started making them more to our liking?
Very few, if any, plants were “designed” for us.
David Foster’s post is definitely worth reading.
Bingo we have a winner.
Expert researchers and doctors with plain old common sense have been raising a hue and cry over the High Fructose Sugar and Corn Syrup issue for decades. Often scoffed at, by those who teach at our medical schools as well as by the doctors who are educated there.
But the proof is in the pudding. Put someone who is overweight on a diet free of HFCS and they do much better.
Of course if they go to a KETO or carnivore diet they do the best.
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I’ve been taking statins for nearly 20 years. Initially it was because my cholesterol was elevated and my father, a heavy smoker, had one mild heart attack when he was 51. That put me in a risk category, so I was prescribed Lipitor. I’d been taking 10mg but a young doctor doubled my dose because I was still going over the acceptable level of cholesterol. This year I began having leg cramps. A little research said statins can cause this. I stumbled upon some of the research cited in your post regarding statins and the extremely small probability of statins extending my life. I knew there could be side effects, but I hadn’t experienced any until the dose increased and the cramps started. A few months ago I just stopped taking statins. I’m not completely free of leg cramps but they have declined significantly since I stopped taking statins.
I’m 70 now and am beginning to think that I’ve passed the point in my life that a preventative medication is going to have a significant impact on my health. I’ve always trusted conventional wisdom as my grandfather and his two sons were family practice MDs, and I was raised to believe the AMA was the final medical authority. COVID and the vaccine that I declined, changed my mind about the AMA and the entire American medical system and it’s established protocols. My current doctor is young, and I’ve not had any chronic health issues aside from elevated cholesterol and hypertension. I’ll see him again next month as he likes complete blood panel every six months because of my BP med. We’ll see what he says next time I see him.
You sound like a thoughtful and sincere person, Casey73, and weigh your decisions carefully. Thanks so much for the input. I just turned 75 yesterday, so you’ve given me some things to think about.
It’s a difficult thing because great trust was put into the profession, and then, after the polio vaccine was presented without patent, great trust was put into pharmaceuticals. Pharma industry approval levels now rank below that of the government, according to some surveys.
What is a patient to do? The most important thing is don’t let a physician override your own judgment. Look, doctors are people too, and we have some excellent examples of doctors here on Ricochet. The whole profession, however, is not as conscientious as Dr. Makary, nor do they make the connections he does. There are some who are diagnosticians, meaning that if certain boxes are checked they will deliver the same diagnosis every time without taking individual histories or circumstances into account.
This is not unique, and it’s not lazy, it’s a result of the changes in the practice that incentivize seeing many patients in short intervals. There are many in the industry attempting to improve patient experiences and outcomes, but they work within this system rather than trying to change it.
I certainly don’t have answers in terms of change, but my sense is that health care providers are as frustrated as patients, and many individuals are doing the best they can within a flawed system.
I followed my doc into a 65+ practice. He has lots of time to see patients, and I greatly appreciate that.
I think almost all of us started out believing in the AMA. But as time has gone by, and that org has behaved like an ostrich with its head buried under the ground over simple basic items involving common sense, many people have discovered the truth.
The AMA’s original and basically only purpose was to ensure that the Rockefeller Foundation’s allopathic methods of medicine via pills and surgeries had no competition from cheaper, more natural and more effective cures brought about from backyard healers like Hoxsey to world class researchers.
This is not to discredit all modern day medicines and medical devices, as some of them are indeed godsends.
But early on, statins were responsible for far too many cases of Lou Gehrig’s disease, aka ALS, which disables the human body’s ability to have working muscles. Within two years, these patients die as they can no longer swallow or breathe. Finally the medical community decided to do as alt practitioners had instructed them at least 4 years earlier and to prescribe the supplement COQ10 for anyone taking the statins.
I’m glad you considered that it could be the statins causing your leg cramps. Far to many people don’t think of deteriorating health as having anything to do with some pill they take every day. They simply go off to a different doctor as the original one tells them something like “It’s all in your head.” Or “At your age of course you’ll have a few cramps now and then.” With luck, that new GP may point out that leg cramps and/or muscle weakness is a side effect of a statin medicine. They may then advise the individual to stop taking it. But in other cases, the patient leaves the new doctor’s office with yet another prescription med that will have still another serious health effect.
In terms of simple natural items that take care of debilitating diseases, the story of scurvy is one interesting tale. It is well told at this link: https://www.mentalfloss.com/article/24149/how-scurvy-was-cured-then-cure-was-lost
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As far as I know, the AMA has never had anywhere near the majority of physicians as member; and, their primary source of income is owning patents/copyrights to the medical diagnostic codes required by government.
My understanding is they have an enabling statute that gives them authority over which med schools are accredited. They’ve used this to keep the number of physicians artificially low. I imagine it gives them a big say in curricular content, not to mention continuing education.
Cronyism: Government, the AMA, and Med Schools
Have you heard the latest?
That Makary was nominated by Trump for the FDA?