Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health

by Marty Makary

From Johns Hopkins medical expert Dr. Marty Makary, the New York Times-bestselling author of The Price We Pay-an eye-opening look at the medical groupthink that has led to public harm, and what you need to know about your health.

More Americans have peanut allergies today than at any point in history. Why? In 2000, the American Academy of Pediatrics issued a strict recommendation that parents avoid giving their children peanut products until they're three years old. Getting the science perfectly backward, triggering intolerance with lack of early exposure, the US now leads the world in peanut allergies-and this misinformation is still rearing its head today.

How could the experts have gotten it so wrong? Dr. Marty Makary asks, Could it be that many modern-day health crises have been caused by the hubris of the medical establishment? Experts said for decades that opioids were not addictive, igniting the opioid crisis. They refused menopausal women hormone replacement therapy, causing unnecessary suffering. They demonized natural fat in foods, driving Americans to processed carbohydrates as obesity rates soared. They told citizens that there are no downsides to antibiotics and prescribed them liberally, causing a drug-resistant bacteria crisis.

When modern medicine issues recommendations based on good scientific studies, it shines. Conversely, when modern medicine is interpreted through the harsh lens of opinion and edict, it can mold beliefs that harm patients and stunt research for decades. In Blind Spots, Dr. Makary explores the latest research on critical topics ranging from the microbiome to childbirth to nutrition and longevity and more, revealing the biggest blind spots of modern medicine and tackling the most urgent yet unsung issues in our $4.5 trillion health care ecosystem. The path to medical mishaps can be absurd, entertaining, and jaw-dropping-but the truth is essential to our health.

Genres: Nonfiction, Health, Science, Medicine, Medical, Audiobook, Health Care

288 pages, Kindle Edition

First published September 17, 2024

About the author

Dr. Makary is a surgeon and researcher at Johns Hopkins University School of Medicine. He is the author of Unaccountable by Bloomsbury Press and a national advocate for transparency in health care.

Dr. Makary was the lead author of the original publications on the surgery checklist which he and Dr. Pronovost adapted from their experience with patient safety in the ICU. He subsequently served in leadership roles at the United Nations W.H.O., where the surgery checklist was adopted and expanded to become the W.H.O. surgery checklist. Dr. Makary also led the W.H.O. technical workgroup on developing metrics to measure surgical quality worldwide.

Dr. Makary’s current efforts focus on patient empowerment through increased transparency of medical information. He speaks nationally on the future of health care, accountability in medicine,
and new innovations to streamline health systems. He is the author of over 150 publications and a leading textbook of surgery, in addition to the New York Times Best Selling Book, "Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care." Dr. Makary is the recipient of grants from the Department of Health & Human Services to study surgical outcomes and is currently funded by AHRQ to implement an intervention to decrease surgical complications in 100 American College of Surgeons participating hospitals. He serves on the leadership council of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and is a frequent medical commentator for CNN and Fox News.

Clinically, he practices laparoscopic surgical oncology and is the director of the Johns Hopkins Pancreas Islet Transplantation Center. He lives in the Washington D.C. area.

Reviews

[michelle shaffner · Rating 5 out of 5]

Eye opening!!! Definitely recommend this, especially healthcare workers.

Let me start with I am a nurse in labor and delivery. My husband never wants to listen to my work stories, but one day, I came home and he had all kinds of work related questions for me, I was floored. He had heard the author speaking on a radio show promoting this book. He had me listen and asked me about some of things discussed related to the babies being born section. I listened and then I ordered the book! I have seen first hand some of things he talked about. Others were before my time, but shocking none the less to read how long things took to change because the "establishment" didn't want to believe. I used to be that person that went by the "literature." I didnt realize how much literature was being suppressed. There have been many things I have seen in my career that I at one time didn't believe in until I saw it firsthand. So I am aware the dogma exists to not believe, but after seeing it for myself, I now keep an open mind to new ideas. The section on skin to skin contact with mom is a perfect example. What sealed it for me was when I was caring for a mom whose baby had a congenital condition and birth defects that were incompatible with life, meaning the baby was going to die no matter what. Mom wanted to try to carry the baby to term, hopefully deliver a living baby, and hold him until he died in her arms. He was born and in doctors' hands, not doing well. I put him skin to skin with mom, and he immediately started improving. He was breathing and pink and like any otherwise healthy baby. He did so well that mom decided to let other family members hold him. In their arms he would stop breathing and turn purple, they would panic and ask me what to do, i would take baby and put him skin to skin with mom, reminding them, mom wanted to hold him while he died. However, every time he went skin to skin, he started breathing again and turned pink without any medical intervention at all. This went back and forth for hours as the various family members took their turns. In the end, the baby lived for 12 hours and eventually died in mom's arms as planned, but mom got 12 hours with her precious baby that she wouldn't have had without skin to skin contact. I had seen doctors recommend certain treatments or procedures that parents have refused, and everything turns out fine, to the point of me thinking, "miracles do happen." I now have changed my practice to side with patients and support whatever decisions they make. I stand up to doctors and routinely question the "why" when I dont agree. I share with them and my patients my experiences with "going against the norm." In many cases, it has strengthened my relationship and trust with patients and doctors.

This book really opened my eyes to the politics involved in research studies that i was never aware of. It actually angers me to see how closed-minded and set in their ways some of these doctors are. I, too, was fired from a job for standing up for what I believed in when I didn't agree with how things were happening, and it turned into a blessing in disguise. I have very strong feelings on some healthcare concerns that are being politicized and just tried to "fly under the radar" and not share my thoughts with people with opposing views just to not rock the boat, but once i started opening up debate dialogue I found both sides have valid points. I agree with Dr. Makary that we need more studies. On any topic, there should be 2 independent studies to validate results. Politics has no place in scientific research. Doctors should be allowed to research what they want, and journals shouldn't be able to quash legitimate articles just because they don't like how the results turned out. Their job should be to review the methodology and statistics to ensure it was not an "altered outcome" but not reject it on topic alone. To think that so many people have died because of the politics involved in progressive doctors questioning the status quo and trying to make it better is appalling. As Dr Makary says, saying, " I don't know" is better than making something up or passing off opinion as fact. His discussion about studies being done or falsified just to push the agenda of an industry shows the bias in the medical community is not towards improving healthcare and looking for a better way to help people, but to uphold their own prior achievements. I grew up learning that the only thing constant is change. Things are constantly changing. It is ok for things to be one way and new discoveries to change those things multiple times. Hopefully those behind the scenes responsible for preventing good new research will read this and take the blinders off and open their eyes to new ideas, at least be open to legitimate debate and research to prove or disprove those ideas, and not just shut them down because they dont like the idea initially.

[Justin Singleton · Rating 2 out of 5]

My favorite insane quote in this book: “I believed breakfast was the most important meal of the day even through medical school.” Maybe someone who took a cereal ad as medical advice for 30 years shouldn’t be lecturing on scientific dogmas.

This book is full of groupthink dogmas he himself has fallen into. Very few things are cited properly (at one point near page 75 he literally CITES HIS PERSONAL DIARY), and the things that are cited correctly have no explanation. The actual science in this book and the historiography is very interesting and actually quite well written, but also seems ignorant of the fact that this is literally how science works. People get things wrong, we change our minds, we correct, that’s how progress is made.

Overall this book turned me from cautiously optimistic about his forthcoming FDA appointment, to appalled.

[Barry · Rating 5 out of 5]

Makary’s project here is to examine areas where current medical dogma may deviate from what the latest scientific studies seem to show. I imagine most people already understand that historically, the medical “consensus” has often been grievously wrong, and this consensus can stubbornly persist even when new scientific studies contradict it. The truths about antisepsis, vaccines, and germ theory took generations to gain wide acceptance within the medical community. Common sense should tell us that there are surely some aspects of current medical practice that will eventually be shown to be erroneous. Makary examines several particular areas where medical recommendations need to catch up with the science:

- Peanut allergies: previous recommendations that children avoid peanuts to prevent the possibility of an allergic reaction have actually significantly increased the rates of life-threatening peanut allergies. It’s better for children to be introduced to peanuts at a young age.

- Hormone replacement therapy: HRT for post-menopausal women was largely abandoned after a study in 2002 was interpreted as showing an increased risk of breast cancer in women taking HRT. This finding was not statistically significant, but it changed the recommendations for 20 years. This despite studies that show HRT reduces risk of heart attacks, bone fractures, cognitive decline, and colon cancer. And HRT does not increase the risk of breast cancer.

- The idea that there are no downside to prescribing antibiotics: Overuse of antibiotics leads to drug-resistant bacteria and adversely affects our microbiome which can have far-reaching effects. For instance, children given antibiotics in the first two years of life have a 20% higher risk of obesity, 21% higher risk of a learning disability, 32% higher risk of ADHD, 90% higher risk of asthma, 289% higher risk of celiac disease.

- The idea that a heart-healthy diet means a low-fat and/or low-cholesterol diet: Makary shows that this common recommendation never had solid scientific support, but contributed to the promotion of high-carb diets which are not cardio-protective and are much worse for overall health.

- Most of the deadliest forms of ovarian cancer actually derive from the fallopian tubes: Approximately “2,000 lives a year could be saved by simply removing a woman's fallopian tubes (sparing the ovaries) at the time of hysterectomy, or in lieu of tying one's tubes.” Furthermore, “removing the fallopian tubes is at least ten times more protective against cancer than a screening mammogram and colonoscopy combined.”

Makary also recounts the tragic deaths of nearly an entire generation of patients with hemophilia that occurred because officials did want to acknowledge the risk of HIV from transfusions lest the public lose faith in the nation’s blood supply. It doesn’t make one a conspiracy nut to consider that the same type of paternalism may have influenced the CDC’s recommendations and the downplaying of risks associated with Covid vaccinations.

I should probably point out that Dr. Makary is not some fringe kook. He is a well-respected Johns Hopkins surgeon. A such, this book makes an excellent companion to Sharyl Attkisson’s Follow the Science. While Makary primarily blames physicians’ apparent reluctance to accept new scientific findings as simple inertia or deferral to the institutional old guard, Attkisson isn’t afraid to point out the elephant in the room—the corrupt influence of the pharmaceutical industry.

[Catherine · Rating 1 out of 5]

The title and description of the book are interesting and contain accurate information about problematic issues in the medical field, such as oxycontin being promoted to doctors as nonaddictive despite the opposite being true. At the start of the book, he talks about how one would think that the medical field is primarily based on rigorous scientific research, so he does not seem like a likely individual to be spreading pseudoscience and poorly done research. However, once you get past the handful of examples mentioned in the book's descriptions, the book and the majority of his other content consist of fear-mongering pseudoscience. He seems like he is someone who values engaging in rigorous scientific methods; yet, he wrote the infamous commentary that incorrectly concluded that medical errors were the third leading cause of death by extrapolating numbers from studies in a way that did not account for the non-representativeness of the study samples (people who are in the hospital for life-threatening diseases which is a different group of people than the overall population of people who visit hospitals, including those with non-life-threatening diseases and injures). It also did not appropriately account for the differences in definitions of medical errors across the studies nor did it adequately address the issue of patients who experienced non-fatal medical error but died due to the terminal illness (not less severe medical error). It is not to say that medical error is not important. It is important, and it needs to be studied in a methodologically rigorous way, which researchers have since done and have estimated much lower rates of medical error (by an order of magnitude) in both terminally ill and non-terminally ill patient samples. He starts off the book writing of the importance of addressing medical misinformation and using rigorous scientific methods to study and determine medical practices; yet, his own work does not meet those standards. Consequently, it creates an illusion of trustworthiness before he then promotes his own misinformation and fear-mongering around GMOs, conventional pesticides (even though organic farming uses pesticides too), diet, and vaccines. He has been very vocal proponent of herd immunity (which goes against the current body of scientific evidence and is dangerous to the public health, and there was available research at the time that indicated this). He says that bad science and groupthink are primarily to blame for current status of U.S. public health, even though he promotes and publishes bad science and appears to be equally as influenced by groupthink within his network of other medical and non-medical individuals who promote the same mis- and dis-information and pseudoscience even when confronted with scientific evidence that says otherwise.

[Ben Schmidt · Rating 3 out of 5]

Ironically this book sparks a lot of cognitive dissonance for me as a doctor- a topic the book discusses extensively. Much of the book is ultimately depressing, revealing even established truths as made up, stretched or plain wrong. It promises some hope for the future but much of that for me was muddied by the author’s own arrogance leaking onto the page- but with so many impressive accomplishments, maybe it’s hard to avoid. I just can’t ignore the many times he criticized a practice for not being strongly evidence based and then introducing his own controversial claims based on 1 or 2 anecdotes from his “friends”. The ultimate thesis of this book- that we must recognize our blind spots and not be afraid to question each other and require proof of practice- is correct but at times it veers (seemingly) intentionally controversial and inflammatory seemingly for its own sake

[Kris · Rating 4 out of 5]

Considers the effects of medical establishment guidelines surrounding peanut allergies, hormone therapy, use of antibiotics, recommendations for cholesterol intake, appendicitis treatments, hospital practices for giving birth, opioid prescriptions, and more. He criticizes flaws in publication processes in medical journals, calling for more transparency, less relationship-politics, more civil disagreement and discourse, and a need to willingly accept new ideas. Criticizes today’s medical education system, including its rote memorization and regurgitation, and its clear conflicts of interest in testing and regulations.

For similar books, see also:
--Follow the Science: How Big Pharma Misleads, Obscures, and Prevails
--Good Energy: The Surprising Connection Between Metabolism and Limitless Health

[lily ✿ · Rating 5 out of 5]

i found this book really interesting! even as someone who is not in the medical field at all and, honestly, sucked at science classes, i still found this book easy to read and understand. i’m a sucker for seeing a nonfiction book with an interesting premise and then suffering to actually get through it, but i was able to devour this one in only a few days. i learned a lot about the hundreds of thousands - if not millions - of fatalities caused by medical paternalism and, let’s be honest, sexism and racism. neither of those two themes were overtly mentioned in the book, but they were common themes throughout the examples listed in depth. here are some of the topics explored by this book:

-the american academy of pediatrics (AAP) recommended, just to be safe, that parents avoid introducing peanuts to their children’s diet until the child is at least three years old, with the hope being that this would help prevent allergies. this decision was made citing a study that did not support the recommendation, and without consulting with immunologists or allergists. and, it ended up being wrong. peanut allergies are more prevalent and more extreme than ever, because the best way to prevent an allergy is actually to introduce the foreign food to your child as soon as possible 🙂

-hormone replacement therapy (HRT) is something of a medical miracle for menopausal women. it alleviates many of the bothersome symptoms of menopause, and comes with a host of positive health benefits: it reduces cognitive decline, increases bone density, reduces colon cancer risk, and can even help prevent heart attacks. but in 2002, the results of a study were falsely portrayed to state that HRT causes breast cancer. it doesn’t! but too bad, because dogma rules the day and many physicians still believe that it does 👍🏻 after all, why take the risk when there’s ’no positives?’ (aka: what do men care about women’s suffering?)

-antibiotics burst onto the scene as a cure-all drug with no negative side effectives, and have since been prescribed liberally, whether the patient actually needs them or not, from birth onwards. as it turns out, there ARE negative side effects to antibiotics, one of which being new super-bugs that are resistant to all antibiotics (which is something that i did already know and have learned about previously, in part because my meme died from one), and another is that they alter the microbiome, one of the least understood organs in the body that may be central to our health. antibiotics eliminate bacteria that live in our gut and help up maintain a healthy balance.

-one (1) man with hubris the size of the sun and a charming and convincing personality said that fat/cholesterol cause heart attacks. he manipulated his own studies to support his claims, and the entire country of america fell for it. if you’ve ever heard that cholesterol is bad for you, dr. ancel keys is the reason why. his hypothesis worked beautifully for the sugar industry, who, by the way, helped fund all this anti-fat research, because many ‘low-fat’ alternatives are stuffed with sugar. sugar, who is the actual culprit…(i actually learned about this as well while listening to my ‘conspiracy theories’ podcast!) another fun fact: ‘breakfast is the most important meal of the day’ is a mantra created by dr. kellogg himself. hmmm, not biased at all!

-in an effort to protect the sanctity of the red cross and to avoid scaring people away from donating blood, all major medical associations promised the public that there was only an extremely low risk of contracting HIV/AIDS from donated blood. the same ‘extremely low risk’ that killed nearly an entire generation of people with severe hemophilia, who rely on frequent blood transfers for survival.

-for a long time, childbirth had high mortality rates for both mother and baby. in an effort to fix this problem, we have since turned the tables towards over-medicalization of birth, like, in the 1950s, separating healthy babies from their mothers at birth and holding them in the hospital for up to a week. other disturbing medical history from this chapter: for a long time, doctors believed that babies didn’t experience any pain, and therefore did not give them any anesthetic for procedures. additionally, premature infants on the border of viability were literally put in a closet to die.

-hundreds of millions of women have had their ovaries removed in the name of ovarian cancer prevention…just for someone to actually study the cause of ovarian cancer and learn that the most lethal form actually originates in the fallopian tubes. ovaries, even after menopause, continue excreting lower levels of hormones that women and afab people can benefit from. the fallopian tubes’ only purpose, however, is reproduction.

-a news anchor (!!! not even a doctor) did a dazzling report with three women who had silicone breast implants and claimed to have negative side effects from them, which came to be known as “breast implant illness.” no studies ever actually proved this, but who needs science when it comes to litigation, right? and while the FDA was spending years fighting this particular battle, they were approving the use of opioids, including oxycontin, for public use, because the creators (!!!) of the drug claimed that they aren’t addictive and, well, why would they lie, right? :)

-the ONLY problem i had with this book was present in the last chapter, in which the author listed current major health recommendations that may prove to be wrong in later years, once more research has been conducted. one of these examples was the use of puberty blockers and ‘surgery’ on transgender children. the entire point of this book is to have an open mind, because the men in charge of medical journals and foundations have been very close-minded historically, leading to massive mistakes and blocking out, shaming, and, in the past, even burning at the stake scientists who dare to challenge the current dogma. i want to approach this section with an open mind too, but i’d argue that several key points were missing. for example, gender reconstruction surgery isn’t done on minors. it just isn’t! second, he’s arguing that americans should be debating this topic. this book was written in 2023 and published in 2024, so all anyone had to do was go online to see that, yes, whether transgender children have the right to gender-affirming care HAS been a HUGE public debate in recent years. and with trump in office, no need to worry another longer, Cisgender Man! :-))) nobody will be allowed access anymore!!! :)) (which, in turn, loops back to the chapter on HRT. because hormone replacement therapy is so often equated with transgender people, cis women who want to use it for menopause will also be blocked 👍🏻). transgender people/children are an at-risk minority and a vulnerable population who should be allowed to make decisions for themselves.

[Galen Johnson · Rating 1 out of 5]

This is one of the more hypocritical books I have read-- taking a totally normal facet of science (our understanding of topics increases as more science is done!) to discredit the "medical establishment" and then trying to sell a bunch of opinions that, while delivered using scientific rhetoric, are based on cherry-picking and/or mis-representing studies. The misuse of statistics should have been enough to send the manuscript to the dumpster bin. The author is known for taking stories with a kernel of truth (e g., medical errors happen) and then using improper analyses to sell a story that fits his politics and pocketbook (see his widely debunked medical errors "study"), and this is just a book-length version of that. There are obvious truths stated (medical doctors should confirm that there is evidence for their "evidence-based" practices, should try to be unbiased, and should be open to new information!), but Makary does not apply the same standards to his own stories or his own blind spots and makes a number of unsupported claims. Should go over well with the "do your own research" crowd but not going to hold weight with people who know anything about actually conducting good research.

[Jennifer McKenna · Rating 3 out of 5]

Interesting perspective from someone in the medical profession doing research. The examples he highlights are powerful. He starts by stating his goal is to restore faith in the scientific method, but he didn’t highlight examples of GOOD science, so I’m not sure he’s being transparent. Is he really festering more distrust in the medical community by highlighting a few wrongs, making people think they should distrust everything medically? It’s good to encourage people to ask questions but the general public doesn’t know how to interpret medical literature to determine its quality, so I’m not sure what this book accomplishes for the layperson. But as a medical professional myself, I did learn a lot.

[Sara · Rating 2 out of 5]

I found the early chapters to be well written and full of nuance regarding past mistakes in medical thinking. I was encouraged by the cheering for science and data driven decision making. However, as the book progresses the focus on overcoming dogma with data is left behind and the promotion of “different ideas” takes over. It eases so gently into “everyone’s entitled to an opinion” that some readers may miss that this is what has happened.

[Michelle · Rating 4 out of 5]

In “Blind Spots”, Dr. Makary critically examines how entrenched medical dogmas—such as those around peanut allergies, hormone replacement therapy, and antibiotics are often reversed, exposing the fallibility of modern health recommendations. His insights advocate for greater transparency and accountability in the medical field. “Blind Spots” is a compelling and worthwhile read, and I highly recommend it to those interested in uncovering the truth about health.

Many thanks to NetGalley, Bloomsbury Publishing, and Dr. Makary for the opportunity to read and review "Blind Spots" prior to its publication date.

[Chrisanne · Rating 4 out of 5]

I, personally, have experienced negative effects from poor medical care, miscommunication, and antiquated treatment methods.

I also will never forget the owlish ICU doctor who looked at me and told me his side of OxyContin---the pressure from superiors to prescribe it because it "wasn't habit forming," etc.

I share these stories because it's one of the many reasons I like Dr. Makary. He makes me feel seen. I worked for 4 surgeons for almost 3 years, and informed consent gets me every time. As does his point about some suave, softspoken doctors who are angels of destruction. Or the people who make their living off of semi-unnecessary surgeries. He does have his own blind spots(one example: I thought it unwise to bring COVID into the discussion when studies are developing and unfinished). He's also quite funny, when appropriate.

I highly recommend this book.

I should say, as untraditional or maybe traditional (?) as I may be, I'm not a MAHA groupie. For a lot of reasons. The main one being that I don't really think it will work. But a close secondary one is that you can't just flip a switch. It took me 3-4 months of real health care to feel different and an additional 2 years of lifestyle changes (to which I am still adding, I might say) to really see, hopefully, lasting reversal to some things I've a genetic tendency towards. You can't mandate lifestyle changes---especially when so many of them are expensive and smack of privilege.

Last point: In one of my mom groups, women will constantly come on and post something like this: "my doctor prescribed [this medication] for [my issue]. Can anyone tell me if it worked for them and what the side effects were?"

People. The burden of proof is on your doctor, not the mommies in your ADHD parenting group. You should feel comfortable asking him/her to send you studies(yes, multiple, according to Dr. Makary), inserts, etc. If you don't, you are not getting true informed consent.

[Howard · Rating 5 out of 5]

A well written "evidence based" exploration of groupthink and gatekeeping in the medical field, both historical and current. The author, Marty Makary, MD, leads the Evidence-Based Medicine and Public Health Research Group at Johns Hopkins. Well documented and explores controversial topics in a non-hysterical manner. Since this book was published in 2024, the author was nominated to head the FDA by President Elect Trump.

Selections from the book:
"Ironically, OxyContin was approved by the FDA for chronic use based on a 14-day clinical trial, ...
It would not be until 2017 that the medical field would be humbled by a study that was embarrassingly simple. Researchers ... looking at pharmacy fill records found that 1 in 16 patients who were given opioids after surgery were still taking opioids three to six months later." [p. 156]

"In 2010, three years after Kessler's departure, the FDA began to spy on its own scientists who expressed safety concerns about device approvals; four whistleblowers were fired. The agency accessed their private emails using spyware that took screenshots of their laptops every five seconds." [p. 160]

"Freedom of speech is not designed for easy speech -- speech which is welcomed by the majority because it affirms their beliefs. It's designed to protect speech which is uncomfortable -- speech which challenges groupthink." [p. 184]

[Donna · Rating 5 out of 5]

UPDATE 2ND READ: I've decided to spend some time this month and next, to do some rereads. So to kick it off, I've picked some NF books that I really liked. I still liked this one and it is still 5 stars.
===============================================


I've heard this author on a few different podcasts, talking about his book. I was definitely intrigued and picked up a copy when I had an opportunity.

He goes into some detail in describing where medical professionals got it all wrong in their health "suggestions". The author's point isn't to discredit, but to point out how this type of action, without scientific proof, has done more harm than good.

I would love to see this promote future discussion as well as putting some guidelines in place before the powers that be, issues advice that becomes so entrenched into current healthcare that it takes literally decades to dispell.

[Annika Schmid]

Idk about all that, Marty…

[Megan Sussman · Rating 1 out of 5]

Does anyone know that Marty Makary has been chosen by Trump to lead the FDA? And that he propogated falsehoods about herd immunity during Covid and opposed vaccine mandates?
I started this book and listened to the first few chapters. Interesting points but some blatantly false statements. HRT has been shown to decrease the risk of fractures and osteoporosis in postmenopausal women. This is true, but then he stated if women don't use HRT then they might as well not take calcium and vitamin D for bone health because they're basically useless without HRT.
This is false and particularly hit home, because as someone with stage 4 estrogen positive breast cancer, I'm not a candidate for hormone replacement therapy.
I am so glad I forwarded it this book to a friend who educated me on who this doctor really is.

[MJ · Rating 4 out of 5]

A fascinating exploration into many of the commonly held medical misconceptions. Makary is a physician and he effectively highlights some of the biggest issues in medicine. He starts off with a deep dive into the peanut allergy crisis and how misguided studies created the problem in the United States. Each of the subsequent chapters are equally interesting and enlightening. The main point here is that dogma creates blind spots that create major health problems. His main argument is that questioning the science has been villainized at the cost of providing effective care.

[CatReader · Rating 4 out of 5]

Dr. Martin Makary is a hepatobiliary and pancreatic surgeon at Johns Hopkins with a strong interest in health policy; of note, as of Jan 2025 as I'm reviewing this book, he's President-Elect Trump's nominee for the next FDA commissioner, to succeed outgoing President Biden's appointee, Robert Califf. (And you may be wondering why FDA commissioner is a political appointee to begin with -- the truth is healthcare policy is very much a political issue.)

Dr. Makary has written several books on health policy. In his latest book, Blind Spots, Dr. Makary gives a long history of medical interventions or treatments that were long believed to be helpful or at least not harmful that have since been proven harmful, and vice versa. He talks about ways data has been maligned and twisted by those with vested interest in certain outcomes, and actually goes as far to recount how he confronted some individuals involved in attempts at "gotcha" journalism I was very surprised to read in a book like this. It definitely takes job security and substantial seniority to do those things, which may be why so many don't or can't publicly challenge the status quo regardless of industry.

Though I don't necessarily agree with Dr. Makary point-for-point, this was definitely an interesting and thought-provoking read that I'd recommend to other healthcare workers and those working in health policy.

Further reading: medical errors
Lifelines: A Doctor's Journey in the Fight for Public Health by Leana Wen, MD
What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City by Mona Hanna-Attisha, MD
When We Do Harm: A Doctor Confronts Medical Error by Danielle Ofri, MD
Bad Science by Ben Goldacre
Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions by Richard Harris

Book 11 for 2025
Book 1937 cumulatively

[Ben Chase · Rating 3 out of 5]

This book has a lot of important information and helpful history and tips on how the medical industry can perpetrate dangerous ideas and refuse to change.

At the same time, it can be problematic in how it presents information. Selective citations towards the end of the book, when Dr. Makary makes a big wishlist of possibly incorrect ideas in medicine, are a great example of how hard it can be to parse all his ideas.

When he discusses the potential dangers of flouride in drinking water, he cites one source. Two pages later, when he discusses a tech firm using a cancer test of dubious efficacy, he cites 13! As to the quality of these sources, honestly, who knows. Nobody has the time to check all these sources, and the author knows that.

So then it comes down to a matter of trust, an issue which is severely impacts the health of everyone in this nation. How much can you trust Dr. Makary to give you the Truth vs presenting the information in a way to get you to believe his viewpoint?

I don’t have an answer to that question, but I’ll leave my review with this:

Cognitive dissonance is explored in the book as a reason behind why doctors and the medical industry struggle to change their beliefs. As an antidote, Dr. Makary touts the importance of proper science again and again. The fact that Dr. Makary has agreed to become the head of the FDA under Trump and Robert Kennedy, whose health care and anti-scientific policies are currently and will kill many many people in the US and the world, is one of the grandest examples of irony and cognitive dissonance that I have ever seen.

[Luke · Rating 2 out of 5]

Clear thesis that medicine by opinion and reputation-driven dogma harms us rather than saying "we don't know" and seeking evidence in basic research. Chapter case studies of past opinion-driven tragedies - infant peanut allergy guidelines, discouraging hormone replacement therapy, low-fat low cholesterol diet for heart health, blood bank testing for HIV - are presented with institutional context and evidence, while other case studies may be less supported. However, rather than solid advice for evaluating evidence or identifying opinion, or cases of time-tested evidence in scientific medicine, Makarty tragically switches to offering his own declared opinions about what may or may not be "dogma" to be overturned ahead, all with a nod to the "do your own research" crowd he's adopted, including fluoride, gender-affirming care, and covid immunity. What to do about trust in medical consensus and basic research is set aside, leaving us scared and blind towards the future, though plausibly still evidence-based and science-promoting.

[Geoff Thomas · Rating 3 out of 5]

Eye opening and informative. All too often the medical community falls prey to groupthink without regard to verified clinical trials and studies.

I gave this a 3 star review due to its consistent repetition.

[Becca Maginn · Rating 5 out of 5]

I was 99% through this book before looking up the author. It turns out he is the FDA commissioner nominee. If America is looking for my endorsement, he seems like a smart guy.

[Bradley Plausse · Rating 4 out of 5]

I went into the book with a few opinions about where the medical establishment errs (having lived through COVID, and being married to a nurse), and I still can say I learned a lot in the book. The authors writes with authority yet remains mostly whimsical, and I can see that being persuasive to a reader who might be less comfortable challenging medical authorities. So, you can give this book to your boomer parents/grandparents!

[Neill Bates · Rating 4 out of 5]

4.87 ✴️

[Stefanie Flack · Rating 5 out of 5]

Quite an eye opening and interesting read. Wish more doctors would be as humble and inquisitive as he is rather than falling prey to groupthink.

[Amanda · Rating 5 out of 5]

As a future health care provider, I found this book relatable. I have seen many accepted practices based on expert opinion that I assumed was factual. How silly I feel! I’m currently in a graduate research course that emphasizes the importance of randomized control trials, so why have I not asked if the things I’m being taught are backed by research? The term evidence based practice is thrown around a lot in Speech-Language Pathology, that I think I assumed if I was learning it, it must be true! Two major topics in my field were discussed: kangaroo care and frenulum clipping. What was said about KC is exactly what I’ve learned in class. I felt good about the rest of my field. Then towards the end, the author discussed dentists performing frenotomies on babies when there is not substantial research to support that decision. Wow! I will definitely be doing my own research going forward. I didn’t realize how group think has affected me without my notice. The author posed a question that will stick with me: why take something as truth because it’s assumed (hello heart stents). Why wouldn’t it be? The clipping of a frenulum is a perfect example. People assume it’s going to help a child later in life, but they don’t know that because there’s no research. For at least 2 to 3 months based on what I was told I agreed that it should be clipped. It makes sense to me the frenulum can hinder tongue movement, which affects speech, but never once did I ask to show me the literature supporting that idea I could probably write paragraphs on this book, but I think it’s ultimate goal is to get you to ask questions and think critically.

[Eden Cohen · Rating 4 out of 5]

Helped reignite my hope to work in medicine and influence policy✅✅✅✅

[Carmel Hanes · Rating 4 out of 5]

Blind Spots gives some interesting historical information about several medical practices that have gone through an evolution over time, with changing understanding resulting in altered recommendations for treatment. While this might be understandable as our technology improves and we become more capable of new and inventive treatments, the underlying premise of this book is to expose how medical "dogma" and research practices can interfere with that process and delay needed changes.

Makary's experiences within the medical field lead him to the belief that needed research is not always supported or can even be suppressed when it conflicts with "conventional wisdom and practices". Research that does get funded is frequently due to some connected political or pharmaceutical interests, which can skew our medical care. Medical recommendations are often made based on limited or even no research, which can lead to outcomes creating the opposite of what was needed or desired (he cites peanut allergies as an example).

Makary promotes greater transparency and accountability in medical research, and a willingness to discuss contradictory results rather than suppression of that which is unexpected, which he believes would lead to less delay in refining practices and better evolution of care. Some of the previous practices that have undergone revision do make one shake one's head. While we have to try to trust our medical providers, it is wise to approach all situations with a "take-it-with-a-grain-of-salt" attitude and listen to your own instincts as well. And to advocate for that transparency and accountability and willingness to move more quickly when questions are raised about a particular treatment. We are all better off when contradictory ideas are exposed and discussed rather than hidden or suppressed.

[Sarah Cupitt · Rating 3 out of 5]

(US BOOK NOT AU) From nutritional guidelines to everyday medical treatments, the risk of relying on outdated information has serious consequences for public health.

Notes:
- In 2000, the American Academy of Pediatrics – AAP for short – recommended that young children avoid peanuts until age three, believing this would reduce the risk of allergies. However, this well-intentioned advice was based on weak evidence and went against known immunological principles. Experts like Dr. Rebecca Buckley understood that early exposure to allergens, including peanuts, could actually prevent allergies by helping the immune system develop tolerance.
- Even after the AAP reversed its guidance, many parents continued to avoid peanuts, unaware that the recommendation had changed.
- The overprescription of antibiotics is a significant problem. Studies estimate that about half of the antibiotics prescribed in the US are unnecessary, often given for viral infections that they don’t treat. This careless use not only contributes to antibiotic resistance but also causes immediate harm by killing the beneficial bacteria that keep the body in balance.
- research shows that 20 percent of hospitalized patients treated with antibiotics experience adverse effects, from kidney damage to more severe conditions.
-
Blind Spots
There’s no denying that the medical field has made incredible advancements. However, many widespread health practices remain rooted in outdated or unproven theories. For years, medical professionals have issued recommendations that later turned out to be based on shaky evidence, creating a disconnect between what we believe to be true and what science actually supports. From nutritional guidelines to everyday medical treatments, the risk of relying on outdated information has serious consequences for public health. How did so many well-meaning ideas go so far off course?

In this Blink, you’ll uncover key areas where modern medicine may still be falling short. You’ll explore the rise of peanut allergies and the role that misguided advice played in their increase, as well as the potential dangers of overprescribing antibiotics. You’ll also learn about the persistence of myths surrounding cholesterol and heart disease, and how outdated childbirth practices might still affect mother and baby health today. Lastly, you’ll see how a media-driven panic over breast implants overshadowed the growing opioid crisis.

Let’s begin with the alarming rise of peanut allergies.
In the late 1990s, peanut allergies were rare, with only about 0.6 percent of US children affected. But by 2004, something had changed. Schools were banning peanuts, and emergency room visits for life-threatening peanut reactions were on the rise. A question lingered: why were peanut allergies exploding in the US but still virtually nonexistent in other parts of the world, like Africa and the Middle East?

In 2000, the American Academy of Pediatrics – AAP for short – recommended that young children avoid peanuts until age three, believing this would reduce the risk of allergies. However, this well-intentioned advice was based on weak evidence and went against known immunological principles. Experts like Dr. Rebecca Buckley understood that early exposure to allergens, including peanuts, could actually prevent allergies by helping the immune system develop tolerance. Yet the AAP’s guidance dominated, and pediatricians across the country adopted the mantra: no peanuts for babies.

Meanwhile, in rural Tennessee, pediatrician Dr. Stephen Combs, following Dr. Buckley’s teachings, was advising the opposite – introducing peanuts to infants early. His patients were thriving, with no peanut allergies reported, while peanut allergies soared among children elsewhere. Immunologists like Dr. Gideon Lack further challenged the peanut avoidance guideline, observing that Israeli children who consumed peanut-based snacks had dramatically lower rates of allergies than their British counterparts. His 2015 clinical trial confirmed it: early exposure to peanuts reduced the risk of developing allergies by a staggering 86 percent.

Despite this breakthrough, the damage from the AAP’s initial recommendation had already been done. Peanut allergies skyrocketed, affecting an entire generation of children and burdening families with fear and anxiety. For many children who developed a severe peanut allergy, daily life became a battle against accidental exposure and the threat of anaphylaxis. Even after the AAP reversed its guidance, many parents continued to avoid peanuts, unaware that the recommendation had changed.

If you’re a parent, it’s essential to stay informed and critically assess health recommendations. Early introduction of common allergens like peanuts may help protect your child from developing life-threatening allergies. The lesson here is clear: always question medical advice, especially when it lacks solid evidence, and trust the science that evolves with better understanding.
When Chris, a teenager with chronic abdominal pain, visited the hospital, no doctor could pinpoint the cause of his misery. His medical history, however, revealed the likely culprit: his microbiome had been severely disrupted. Over time, Chris had been given multiple courses of antibiotics, which wiped out the beneficial bacteria in his gut, leaving him vulnerable to inflammation and bacterial imbalances. This story exemplifies a widespread issue with antibiotics. Often seen as harmless, antibiotics can wreak havoc on the body’s microbiome, which is critical for digestion, immune health, and even mental well-being.

The overprescription of antibiotics is a significant problem. Studies estimate that about half of the antibiotics prescribed in the US are unnecessary, often given for viral infections that they don’t treat. This careless use not only contributes to antibiotic resistance but also causes immediate harm by killing the beneficial bacteria that keep the body in balance. Doctors have long reassured patients that there are no downsides to antibiotics, but that’s far from the truth. In fact, research shows that 20 percent of hospitalized patients treated with antibiotics experience adverse effects, from kidney damage to more severe conditions.

More alarmingly, antibiotics can have long-term consequences, especially in children. Research conducted at the Mayo Clinic followed over 14,000 children and found that those who took antibiotics before the age of two had significantly higher risks of developing chronic conditions such as obesity, asthma, and learning disabilities. The more antibiotics a child took, the greater their risk of developing these issues, indicating a strong link between early antibiotic exposure and long-term health problems.

Antibiotic use is essential in certain cases, but you should be aware of the risks and avoid unnecessary prescriptions. Overusing antibiotics not only damages your microbiome but contributes to the growing problem of antibiotic resistance. Always weigh the benefits against potential harm, and don’t be afraid to question whether antibiotics are truly necessary for you or your family.
Uncle Sam, a 93-year-old man, lived much of his life avoiding his favorite food: eggs. When he moved to the US in the 1970s, doctors warned him that eggs were filled with cholesterol that would clog his arteries and shorten his life. For decades, he reluctantly followed this advice, believing it would help him live longer. His story reflects a widespread myth that has shaped public health for decades: the belief that dietary cholesterol leads to heart disease. However, modern research shows that this connection was never supported by solid evidence.
- Research, such as the 2020 study involving 177,000 people, showed that eating eggs and other foods high in cholesterol does not significantly impact blood cholesterol levels or increase the risk of cardiovascular disease. In fact, cholesterol is essential for the body, playing a critical role in building cell membranes and producing important hormones.
- Another key shift has been in promoting skin-to-skin contact between mothers and newborns right after birth. For decades, hospitals routinely separated mothers and babies, keeping newborns in sterile nurseries. However, studies and clinical practice have shown that keeping babies with their mothers – particularly through skin-to-skin contact – helps regulate the baby’s heart rate, body temperature, and stress hormones, and significantly improves breastfeeding rates. This natural bonding time also reduces the incidence of postpartum depression in mothers.
- Interestingly, while the FDA heavily scrutinized breast implants, it failed to apply the same rigor to opioids. During the same period, OxyContin was approved with minimal oversight, leading to an opioid epidemic that has since claimed over a million lives. This stark contrast illustrates the dangers of misplaced regulatory focus, where an unsubstantiated health scare overshadows a genuine public-health crisis.
- A few decades ago, doctors wrongly believed that melanoma – a deadly form of skin cancer – did not affect Black people.
- Fluoride in drinking water is one area worth reconsidering. For years, fluoride has been praised for reducing cavities, but new research suggests potential downsides. A 2019 study found that higher maternal exposure to fluoride was linked to lower IQs in children. Additionally, the original research supporting fluoride’s effectiveness is outdated, mostly conducted before 1975. Countries that do not fluoridate their water, like many in Europe, have seen similar declines in cavity rates, suggesting fluoride’s benefits might not be as strong as once thought. With fluoride potentially affecting the microbiome and even brain function, we need to question whether it remains a public health win or poses more harm than good.

[Петър Стойков · Rating 5 out of 5]

Всички разчитаме на медицината, ама всички помним когато върхът на медицината е било кръвопускането. И не бива да го забравяме.

Защото медицината постоянно се развива, постоянно излизат нови неща, постоянно се опровергават стари неща, смятани преди за верни, но вече доказано че не са. Но, както е казал Макс Планк, науката напредва през гробищата (science advances one funeral at a time) - т.е. трябва първо да умрат от старост учените, които държат на закостенелите си разбирания, да освободят академичните позиции, на които са се окопали от десетилетия, за да може новото знание да навлезе и да се разпространи.

Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health разказва десет истории на големи пробиви в медицината, които са направени въпреки отчаяното отрицание и даже отрито отхвърляне и враждебност на медицинската и научната общност.

Колко от вас знаят, че язвата е бактериална инфекция и се лекува с антибиотици, а не се получава "от стрес"? Даже повечето лекари все още не знаят това. Пък Barry J. Marshall и J. Robin Warren даже Нобелова награда за медицина взеха през 2005 г. за това откритие, след като години наред всички научни журнали отказват да публикуват изследването им, защото е "безумно".

И ако прескочим малко назад във вековете, историята на Игнац Семелвайс и хирурзите, крайно обидени от настояването му да си мият ръцете преди операция, заслужава да се потърси и прочете даже да не вземете точно тази книга.

Това е книга за скептицизма, за истинската наука, основана на постоянното съмнение и проверка.