Cognitive Dissonance in the Medical Field

Marty Makary, M.D. has written a fascinating and frightening book about the Blind Spots that people in the medical field are subject to—the kinds we saw especially play out during Covid 19. But the reason for the lies and deceptions run much deeper than experts running amok and exerting excessive power. Dr. Makary has done the research—that’s right—real scientific research—to explain the crippling effect that cognitive dissonance has on medical and research professionals. I plan to review the book fully when I finish it, but I couldn’t resist explaining the impact of cognitive dissonance. What is cognitive dissonance?

Cognitive dissonance is a discomfort caused by inconsistency which most of us are then motivated to try to reduce. In particular, it can be a feeling of hypocrisy or a realization of having made a mistake, and it’s unpleasant. Or it’s supposed to be unpleasant.

In another post I will summarize his findings about misinformation that has been distributed about peanut allergies, hormone replacement therapy, antibiotics, and cholesterol. I consider myself to be pretty well-informed, but I was stunned to learn how the facts were misrepresented.

Dr. Makary explains the reasons why the field of medicine is so reluctant to at least consider new information. He gives some examples that were baffling to me.

One of the first was surgery for an appendix, which he has done hundreds of times. He had a patient come in one day with what was clearly appendicitis. The problem was that the patient was going to his sister’s wedding the next day! Clearly, surgery would not allow him to do that. And Dr. Makary remembered he had an alternative treatment:

Then one day, a new study challenged our go-to treatment of this ancient disease. The study found that a short course of antibiotics alone can cure appendicitis, avoiding the need for surgery. The study seemed to be well-conducted with dramatic results.

Makary was torn about the decision, even after consulting his patient, who was thrilled at this other option. The doctor gave him the antibiotics which worked within hours. The young man never needed surgery. The antibiotics had worked.

But many physicians are extremely reluctant to even consider new ideas. Makary told a colleague about the study, and he refused to believe it; he insisted that a randomized controlled study be conducted. When one was completed successfully, the surgeon colleague insisted he needed two to believe it. And after the second, he insisted on a third. Later, Makary asked him about his reluctance since he knew his colleague as an honest man of integrity. Here’s what the colleague said:

'Marty, I just think people are better off with their appendixes out,' he replied. Amazing. All the research in the world wouldn’t matter. For him, it wasn’t a scientific view, it was a belief system. My colleague (now retired) did not want to change his mind.

According to Makary, after a decade, only half of surgeons have incorporated the use of antibiotics into their treatment plans; the rest are still conducting surgery.

I related to this story as a former cancer patient, but I had a different kind of issue: how much information should a doctor have before changing the protocols? When I was receiving chemotherapy, my oncologist told me that he would like me to go through six treatments, every three weeks. He was honest about the fact that the decision to finish all six treatments would depend on how my body responded to chemo. He didn’t explain what the repercussions might be. I admit, I didn’t ask him.

After four treatments, I said to the nurse providing the treatment that I would see her again in three weeks. Oh no, she said, that was the last treatment. After dealing with my confusion, I visited my oncologist and asked what was going on. He finally explained that the protocol used to be four treatments but a new study had shown that six treatments got better results than four. I asked, how much better? He couldn’t tell me. I think now I should have stayed with the original protocol, but I agreed to negotiate: if I could tolerate the fifth treatment, I would continue. I found out later (by accident) that after four treatments, I was already getting early signs of peripheral neuropathy (numbness in my toes). No one asked me if I had any signs, including my oncologist, and the signs were so slight that I wasn’t even sure that I was experiencing symptoms. Did my doctor know the number of people who experienced peripheral neuropathy after these treatments? Should I have been told that neuropathy might occur? Should I have expected to be fully informed?

After the fifth chemo treatment, my toes and the front of my feet went numb.

Now, I know that medicine is as much art as science. But I want to believe that my doctors are fully informed, and that they will fully inform me about the consequences of my treatments.

If we can’t trust them, who can we trust?