Marty Makary, “Blind Spots”

Marty Makary, Blind Spots: When Medicine Gets it Wrong and what it Means for our Health, Bloomsbury, NY, 2024 (265 pp.)

The thesis of this book is that the practice of modern medicine is bedevilled with certain blind spots, despite the knowledge concentrated in that discipline, and its many undeniable advances. He makes out a very strong case, even while avoiding the response to the outbreak of Covid. Lest one immediately rush to cynicism, the book equally documents instances where the blind spots were overcome. In fact, in all the major instances he raises, he can only speak about them as he does because of the near consensus qualification if not reversal of opinion about what had once been considered best practice.

The tacit message is even deeper: that we must exercise careful judgment in seeking and following not only medical advice, but also when considering anything we are told by what I shall call “the ‘progressive’ establishment” – as to which, see below.

Makary has an eminent position at the prominent Johns Hopkins School of Medicine (Baltimore, Maryland). President-Elect Trump has nominated him as commissioner of the Food and Drugs Administration. I have heard him several times on podcasts. He strikes me as highly intelligent, practical, effective, and well-intentioned. In short, he strikes me as a relatively balanced man. I am hopeful that, together with the team being assembled in the USA now, he will improve health care there, and that the flow-on will be felt throughout the world.

This volume is organised in twelve chapters. Most of these deal with specific examples of where physicians and relevant politicians and other opinion-makers (the ‘progressive’ establishment), suffered from the “blind spots” which give the book its title (e.g. chapter one on the treatment of the threat of peanut allergies). Other chapters are more thematic (e.g. chapter five on cognitive dissonance and why we resist new ideas).

It is not as if he is saying other doctors are blind. To say that someone has a blind spot is in fact to say that he can see, but in all respects but one. This passage from chapter 12 sums up the burden of this volume and some of its content:

In science, you have to be able to ask questions. … Experts told people for decades that opioids were not addictive – igniting the opioid crisis. They insisted infants avoid peanut butter – fuelling the peanut allergy epidemic. They demonised natural fat in foods – driving people to process carbohydrates as obesity rates soared. They prescribed antibiotics haphazardly – altering the gut microbiomes of a generation and causing a drug-resistant bacteria epidemic. They unfairly used fear to scare women away from HRT [Hormone Replacement Therapy] resulting in a generation of women being denied the life-extending and quality of life benefits. And some might say that “experts” experimented on a bat coronavirus in the lab for no good reason, causing a global pandemic.

Medical dogma continues to loom large. Sometimes because people are railroaded for asking questions, and sometimes because loud medical establishment leaders who got things perfectly backward have never apologised dor their decades-long hubris. (221)

Note the use of the word “establishment” here. One particularly striking example of such a reversal appears in chapter, “Bad Blood,” dealing with the refusal of the medical establishment to accept the 1981 and 1982 warnings of Dr Don Rucker and other physicians that there was cause to think that HIV was being spread by blood transfusion, and that haemophiliacs were at special risk. In 1983, Anthony Fauci, he of the Covid catastrophe (fiasco is too weak a word)  declared that “the risk of acquiring AIDS through a blood transfusion is extremely small.” (99) In 1984, he reiterated that such transmission of the virus was possible but rare. (101) As Makary notes, the media fell into line, although there was now evidence that this was plain wrong. The result was that “nearly an entire generation of people with sever haemophilia died … the “haemophilia holocaust”.” (102)

Where blood banks did screen for HIV, many patients were saved from contracting HIV, but it would take many years until the practice became universal. (105) Dr Makary refers to “medical paternalism,” and a desire to maintain public confidence in blood banks. (101-105)

Another noteworthy point is that the authorities involved in this failure often spoke of there being “no evidence,” which, as Makary states, was often understood to mean that there was evidence of no correlation. (105) But in fact, it does not – it only means that we do not know what the causes are. I would add one further point. The progressive establishment (see below) often say “there is no evidence,” when this is there merest debating point, turning on the dictionary definition of “evidence” as “sound proof.” There is often reason or cause to think something, even to believe something to be the case, before there is evidence. In this instance, Dr Rucker had good cause long before the evidence became available: he saw men he knew to have HIV lining up to earn money by giving blood donations in 1983, and he knew enough medicine to know that the pathogen would almost certainly be in their blood. (94-95) When evidence was eventually available, he was vindicated.

Dr Makary does not speak in these terms; he may not even think in them. But his book provides more support for what I think must be obvious by now, that there is an informal alliance of left-wing or self-styled ‘progressive’ government and certain political forces (in the USA, these are associated with the Democrats), and their many allies in media, academe, Hollywood, and certain powerful industries, especially, from what I can see, the pharmaceutical and munitions industries, but also entertainment and book publishing, and even certain spheres within some churches (much as it pains me to say it).

The Association of American Medical Colleges is one organ of this establishment; as Dr Makary states: “Because American medical education is controlled by a slow, political, distracted, and centralised authority, medical schools propagate outdated groupthink.” (28) The informal alliance between medicine and industry was evidenced by the quondam power of the tobacco lobby to prevent doctors telling the truth about their poisonous product (an evil which Dr Makary worked against). (190)

This brings me to one of the most significant practical points in the book: how Makary came to write a “surgery checklist,” which was initially rejected but is now used in many hospitals, with beneficial effects. The doctor writes, and the moral is obvious:

As a resident, I was struck by another big issue no one was talking about: the high number of people harmed by preventable medical errors. I had witnessed people die, not from the disease which brought from to care, which from the care it self. I personally made mistakes from being foisted into situations above my level of training, from poor judgement when experiencing sleep deprivation, and from breakdowns in communication. (190)

This book gives me hope, not only because Dr Makary and many of those he mentions strike me as decent people, but because the problem is not medicine, it is not even government, media or industry, it is sleeping people in those areas. So we need to awaken and remember ourselves. Even in small ways, this is possible, as this excellent book demonstrates.

 

 

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