Doctor Denounces Medical Dogma and ‘Groupthink’ in New Book

Warning: A doctor known as "an advocate for disruptive innovation in medicine" calls out widespread "groupthink" and an epidemic of medical dogma in his new book, "Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health." That may make some readers momentarily feel sick at heart.

Author Dr. Marty Makary shares that reaction. He writes of feeling flabbergasted, appalled and even apoplectic as he reports on how quickly "smart people can succumb to bandwagon thinking." But throughout the book, Makary also introduces doctors who are challenging conventional thinking and working for change in health care.

A surgeon and public policy researcher at Johns Hopkins University, Makary also is the author of "Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care" and "The Price We Pay: What Broke American Health Care — and How to Fix It," both bestsellers, and he writes for the Washington Post and the Wall Street Journal. He was a leader for the World Health Organization's Patient Safety program and has been elected to the National Academy of Medicine.

Makary's new book expresses his deep concern about how "inherited medical wisdom" on various issues — including  peanut allergies, antibiotics, autoimmune diseases, cholesterol, consumption of eggs and hormone replacement therapy (HRT) — continues to harm patients. Plus, Makary presents the latest scientific research and includes tips on how to find a doctor.

As he interviewed scores of colleagues about their concerns over medical dogma, Makary found himself wondering "if there is anything we do right." (He concluded that there is, though he is "blown away" by how new medical research takes years to become widely disseminated.)

Well aware that the brain has a natural tendency to resist any new idea that conflicts with what we already believe to be true, Makary determined that "creating a civil discourse that challenges deeply held assumptions" is one way to change health care for the better.

Just how widespread is that discussion in doctors' offices, hospitals and medical research centers today?

"First of all, we don't have bad people — we have good people working in a bad system we've inherited, one that pigeonholes clinicians to take a narrow view of health," Makary says in an interview from his office in Baltimore. "That focus has done tremendous good when it comes to heart valve replacement, for instance, but in other areas of medicine, the approach has created blind spots."

Makary continues, "The currency of academics in medicine is research grants from the National Institutes of Health (NIH), which is interested in a narrow area of medicine and supports what old-guard researchers like." Funding, he adds, rewards incremental benefits rather than supporting big ideas. "We don't have Ben Franklins today, and in a factory of focused research, it's almost impossible to conduct cross-disciplinary research."

But a new generation of doctors is speaking up in favor of just that, Makary says. They are asking whether diabetes treatments might be expanded to include cooking classes and improvements in school lunches, asking whether we should have fluoride in our drinking water and asking whether marijuana is indeed "perfectly safe."

More good news: These same innovators also are calling for research on environmental exposures that may cause cancers. Makary notes that currently, the U.S. "spends billions of dollars to research old ideas that treat conditions with no benefit, while spending pennies to learn what causes these conditions."  

As a result of DNA sequencing technologies, the microbiome is the new frontier of medicine. "We've barely scratched the surface of its influence on mental health, digestive health or the immune system," Makary says. "So many aspects of health are tied to the microbiome, but it has no home, no NIH funding center, because it doesn't fit one of our silos."

Makary continues, "That highlights a bigger problem — incredible medical interventions in front of our eyes that we cannot see — and so we lose sight of challenging deeply held assumptions, even though that's exactly how we make major scientific advances."

Science requires constant investigation and the willingness to revisit accepted practices, but Makary issued this caveat: "Just because there is a study to support an idea does not mean the study was designed properly, conducted ethically or reported accurately."

Flawed studies and misleading reports can lead to incorrect medical recommendations. Remember when doctors insisted that opioids were not addictive? That leads to a lack of trust on the part of consumers. "The hottest topic in medical literature just now is how to rebuild public trust," Makary said. "When we get a health recommendation perfectly backwards, we need to apologize and reverse the recommendation, not just fade away." 

That requires humility, a trait that Makary says is the most important characteristic of any good doctor. In the book, he asserts that medical paternalism still looms large. "That is starting to change," he said. "The younger generation of docs has little tolerance for b.s., and they don't want to go down the standard path. They know people are hungry for honesty, and they want to redesign how we deliver medical care."

Makary has suggestions for how patients can assess where their doctors rank on the humility scale. "It can be difficult for consumers to discern whether their doctor is appropriately interpreting medical literature and applying the best medical wisdom," he says. "However, they can assess whether a doctor listens, acknowledges his or her limits and empowers patients."  

He recommends avoiding a doctor who refuses to prescribe HRT because it causes breast cancer. "This is a prime example of a topic where dogma looms large," Makary says, "because we know now that no medical intervention improves the health of women more than HRT."

If a patient has questions about probiotics, a doctor may respond they have no benefit, but Makary suggests that a more admirable answer would be, "I don't know, as I haven't seen good research."

Makary also warns patients about doctors who speak definitively when they are outside their area of expertise. "There is no role for absolutism when there is uncertainty," he says, "and that does not indicate the level of humility that patients deserve."

Will reading "Blind Spots" spark more cynicism about consumers of health care? That's not Makary's intention.

"The purpose of the book is to encourage people to recognize that consensus among organized medical organizations does not constitute scientific evidence," he says. "We are the most medicated population in history, and we have to try something new."

Patricia Corrigan is a professional journalist, with decades of experience as a reporter and columnist at a metropolitan daily newspaper, and also a book author. She has written for Next Avenue since February 2015. Read more from Patricia at latetothehaight.blogspot.com. Read More