How Medicine Works and When It Doesn't: Learning Who to Trust to Get and Stay Healthy

by F. Perry Wilson

Blending personal anecdotes with hard science, an accomplished physician, researcher, and science communicator gives you the tools to avoid medical misinformation and take control of your health ​: "A  brilliant step toward patients and physicians alike reclaiming a sense of confidence in a system that often feels overwhelming and mismanaged" (Gabby Bernstein, #1 New York Times bestselling author of The Universe Has Your Back ).
 
We live in an age of medical miracles. Never in the history of humankind has so much talent and energy been harnessed to cure disease. So why does it feel like it’s getting harder to live our healthiest lives? Why does it seem like “experts” can’t agree on anything, and why do our interactions with medical professionals feel less personal, less honest, and less impactful than ever?

Through stories from his own practice and historical case studies, Dr. F. Perry Wilson, a physician and researcher from the Yale School of Medicine, explains how and why the doctor-patient relationship has eroded in recent years and illuminates how profit-driven companies—from big Pharma to healthcare corporations—have corrupted what should have been medicine’s golden age. By clarifying the realities of the medical field today, Dr. Wilson gives readers the tools they need to make informed decisions, from evaluating the validity of medical information online to helping caregivers advocate for their loved ones, in the doctor’s office and with the insurance company.

Dr. Wilson wants readers to understand medicine and medical science the way he does: as an imperfect and often frustrating field, but still the best option for getting well. To restore trust between patients, doctors, medicine, and science, we need to be honest, we need to know how to spot misinformation, and we need to avoid letting skepticism ferment into cynicism. For it is only by redefining what “good medicine” is—science that is well-researched, rational, safe, effective, and delivered with compassion, empathy, and trust—that the doctor-patient relationship can be truly healed. 

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

304 pages, Hardcover

First published January 24, 2023

Reviews

[Emiliya Bozhilova · Rating 2 out of 5]

Посланието е съвсем просто. Пациенти и лекари не винаги са рационални, никой от тях не може да избегне капаните на подвеждащи и прибързани заключения на база на недостатъчно или несвързани факти, съчетани с нетърпение, разсеяност, предубеждения, невежество, отказ от изслушване на другия, селективен избор само на твърдения, потвърждаващи вече утвърдено мнение и т.н. Самата медицинска наука и инструментариумът и непрекъснато грешат, и една грешна медицинска практика с времето, ако имаме късмет и логиката се прилага консистентно, се сменя с по-малко грешна, но съвършенсъвото е много далеч. Медицинските изследвания са силно ограничени - рядко е възможно да събереш всички факти, а непредубеденото и най-вече правилното им тълкуване са такъв висш пилотаж, че и досега практиката изобилства от разнообразни и широко приети медицински легенди и митове, а как да ги разобличим е все така голямо предизвикателство.

Идеята е, че цялата тази окаяна ситуация не трябва да отчайва нито лекарите, нито пациентите - защото науката и специалистите, които я прилагат, все още остава най-доброто, измислено до момента.

Лично аз не можах да си извадя особено заключение от написаното и спрях да се опитвам, освен, че логическото мислене и обосновка на база факти, са абсолютно жизнено важно умение, но отсяването на зърното от плявата си остава трудна задача дори и в общества с добро ниво на медицина. Или - преди да глътнете или изпишете на пациента хапчето, мислете. Винаги възпитавайте логическото мислене, образовайте се, не вярвайте в светкавичните и уникални решения на проблемите - и в критични ситуации точно това ще се отблагодари.

2,5⭐️

[CatReader · Rating 5 out of 5]

As a fellow physician and scientist, I really appreciate books like these and would highly recommend them to people looking for insight into the practice of medicine. I thought Dr. Wilson did an excellent job reflecting on hard-earned, humbling lessons throughout his career and distilling them into cogent recommendations for patients seeking to get the best possible care and trying to understand what and who to believe.

Further reading:
The Laws of Medicine: Field Notes from an Uncertain Science by Siddhartha Mukherjee, MD
Quackery: A Brief History of the Worst Ways to Cure Everything by Lydia Kang, MD, and Nate Pedersen
Pandora's Lab: Seven Stories of Science Gone Wrong by Paul Offit, MD
Overkill: When Modern Medicine Goes Too Far by Paul Offit, MD
You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation by Paul Offit, MD
Bad Advice: Or Why Celebrities, Politicians, and Activists Aren't Your Best Source of Health Information by Paul Offit, MD
The Panic Virus: A True Story of Medicine, Science, and Fear by Seth Mnookin (about the debunked link between vaccines and autism)
Overdiagnosed: Making People Sick in the Pursuit of Health by Gilbert Welch, MD, Lisa Schwartz, MD, and Steven Woloshin, MD
How Doctors Think by Jerome Groopman, MD
Bad Science: Quacks, Hacks, and Big Pharma Flacks by Ben Goldacre, MD
The Data Detective: Ten Easy Rules to Make Sense of Statistics by Tim Harford

[Betsy · Rating 3 out of 5]

[14 Mar 2023]
This book was interesting, but somewhat disappointing.

The author is a research physician and instructor and he writes well. Not too technical. The only time he lost me was in some of the statistical calculations, but that was rare and not critical to the purpose of the book. Although the purpose of the book was a little confused. Sometimes he seemed to be talking to patients, trying to influence their expectations of their medical experiences. Sometimes he seemed to be talking to physicians. Both are possible of course, but I found it a little frustrating. For example, he spent quite a lot of time talking about how to evaluate medical research. Not something most non-physicians are likely to need to do. And even physicians seem to have little time to keep up with that kind of tasks. But, since that is his specialty, he focused on it a lot. It was interesting but not very useful to me.

What I really would like for him to have discussed more was the general state of our medical system, why it is so bad, and how it can be improved. He did briefly cover that, but not in the kind of detail I wanted. Mostly he seemed to be hoping to improve the relationships between physicians and their patients, which is a worthy goal, but the book was a little too diffuse to be really successful.

However, the book is short and an easy read. If you're interested, it's worth reading.

[Marie · Rating 4 out of 5]

In Medicine and in life: if it seems too good to be true, it probably is.

Kale. Isoflavones. Red wine. Caffeine. Garlic. Each of these and hundreds more are aggressively marked as essential to improving health and well being. Why? It may be relevant to note that dietary supplements are not regulated by the US Food and Drug Administration. If a phrase is used like "supports your immune system:, or "increases energy", the FDA states that it does not suggest that it prevents, treats or cures a disease, but to the average consumer, the implication is suggested.

There is no one thing that will help you live longer. There are healthy things, less healthy things and unhealthy things. The secret is that there is no super food. The secret is that there is not secret.

We all want simple solutions to complex situations.

[Aria · Rating 3 out of 5]

Highly recommend for non-scientist types to get a grasp on what motivates medical decision making from a science-minded perspective. Appreciated the quick statistics refresher.

[Stetson · Rating 3 out of 5]

How Medicine Works and When It Doesn't covers some of the basic intellectual principles that physicians use to treat patients whether with clinical interventions like surgery or pharmacological options. It is also a sort of statement about what F. Perry Wilson's vision of "good medicine" is. I don't have any significant disagreement with Wilson about what the practice of good medicine and science looks like, but my views diverge quite sharply from Wilson's on economic and healthcare policy.

Despite the title, How Medicine Works and When It Doesn't isn't a deep dive on the practice of medicine. Wilson doesn't delve into diagnostic approaches or treatment algorithms. He doesn't walkthrough patients cases end-to-end despite including several anecdotes from cases. He also isn't doing much philosophizing about medicine. Instead, he provides a memoir-like tour of his experience learning and practicing science-based medicine that are packaged along with a loose normative vision for U.S. healthcare - a technocratic and progressive vision. A great deal of the latter portion of the book is comprised of this wide-ranging commentary.

On the medicine front, Wilson delivers a primer on evidence-based medicine. He describes what randomized controlled trials are and why they are necessary to demonstrate the effectiveness of a medical intervention. This section includes the usual rundown of statistical literacy (confounders, casual inference, p-values, etc) and some of the problems that beset modern research (p-hacking, bias, and fraud). He also provides some important insights for lay people about how they can think about claims about the effectiveness of an intervention and its risks. This includes ideas like relative risk, "number needed to treat" (NNT), and surrogate vs real health outcome measures. Wilson's take-home message on medical interventions is that they can only do so much for our health. We should have as specific an understanding of probabilities relevant to us individually as possible before assuming the risks (financially and physically).

Jumping off from the discussion about the limitations of interventions, Wilson offers a fair bit of criticism of the pharmaceutical industry. The general focus of his criticism is that the incentives for pharma are divergent from physicians and patients by design, and the influence of pharma has a way of inserting itself between doctor and patient. Essentially, Wilson pines for a future where financial incentives are somehow extracted from our system of healthcare so that the focus can be on delivering the best care. Most of Wilson's commentary on healthcare systems and economic policy comes off as short-sighted, utopian, and somewhat misleading. I think any critique of say drug prices in the U.S. needs to come with a full reckoning with the regulatory apparatus (FDA's policy and practices) and tradeoffs (innovation vs safety/cost; affordability vs access; etc), and scientific challenges (drug development is hard and expensive). The system we have exists for reasons that are identifiable and for the most part rational. Americans want the most effective and safe drugs possible for any and every disease. We should be honest about the balance of tradeoffs we've come to and the obvious hurdles that prevent re-ordering our system in dramatic ways. It is not that Wilson has totally forgotten to do some of this. For instance, he acknowledges the problems inherent to eliminating private health insurance, such as the half million jobs currently occupied. It is just that his efforts on these topics is inadequate and assumes a like-minded audience.

This book is also invested in the public discourse about misinformation, trust in experts, etc. The passages on this topic are probably a bit too topical. He spends a most of his time on COVID-19 related issues like the research on alternative treatments (HCQ & ivermectin) and vaccine hesitancy rather than a broader discussion of the issue. His perspective is balanced as he puts more of the onus on experts themselves rather than just blaming figures in the informational ecosystem (not that he doesn't do this) or lay people themselves. Our social crisis of epistemology and cacophonous informational ecosystem are obviously a function of technological change (e.g. internet media). We've yet to adapt to this new system. It will take time and no one has the right answer yet nor will this be a problem that is neatly solved.

Generally, this is a decent book to read about medicine, especially if you're a lay person looking for some basic insights.

[Alina · Rating 5 out of 5]

I wish everyone would read this book. The author explains in thorough but simple terms how medical research works, what biases may come into play from the patient AND the doctors/researchers, and how you can use this information to better the relationship between you and your doctor. And on top of that, it's told in an engaging manner. I found the anecdotes presented quite entertaining!

Coming from a background in economics, the statistics were not new to me (and in fact brought up some flashbacks of my senior thesis), but I thought it was presented in a friendly and easy to understand way so that even those without any background in stats would not struggle with it. I also appreciated the author's humility as he points out not only how a patient may struggle with logical fallacies and biases, but also how that might affect a researcher or a doctor. Also, a lot of what goes under the hood in the medical research community was fascinating!

[Sandy Potts · Rating 5 out of 5]

4.5 ⭐ This should be more widely read by the general public. In a day where everyone likes to do their 'own research' in regards to medicine, he teaches the reader how to actually understand medical research in a simple way. He goes over how doctors think and apply studies to their practices. Also, and most importantly, he talks about expectations for medicine and how to spot a good doctor from a bad one. As hard as it is, medicine is never 100% and your doctor should not pretend it is. This book goes over the flaws in medicine as well as how amazingly beneficial it is. He helps the reader understand why some flaws are present in medicine and offers a few suggestions on how to make it better. I would 100% recommend for anyone who wants to understand the medical field better and learn how to have more effective conversations with their doctor. Overall, I really enjoyed this book.

[Debra · Rating 5 out of 5]

I think everyone should read this book. It gives practical advice on how to trust the research out there AND when to trust the research. We need to question but we also need to realize that science isn't static and that Doctors aren't perfect. Ultimately if it sounds to easy or too good to be true it probably isn't a good thing. Nothing in this world is full proof! Loved this doctor's perspective from the inside.

[Nina Gao · Rating 5 out of 5]

Actually really pleased with how this book was written to explain the science behind clinical trials and interpretation of risk. Would highly recommend to everyone to improve literacy regarding doctor visits, and will skim reviews to see how people who are not trained as scientists / healthcare practitioners view the book.

[Baal Of · Rating 5 out of 5]

One of the greatest lies told by those with entrenched interests in our commercial, expensive, inefficient healthcare system is that it is unfixable.

So true.

[Savannah Smith · Rating 5 out of 5]

As a Registered Nurse, I could relate many ways to this book. I really enjoyed reading!!!

“The average physician waits approximately 11 seconds before interrupting their patient.” *Author*

[Cathy Goodwin · Rating 4 out of 5]

I completed Dr. Wilson’s excellent course at Coursera, which I highly recommend (though it may be difficult without at least some statistics knowledge).

Dr. Wilson does an excellent job of explaining relative vs absolute risk, tactfully suggesting that the former is appropriate to public health while the latter is for individual decision-making. He’s one of the few professionals to highlight the true results of the Sprint blood pressure study. He explains surrogate outcomes, which are rarely discussed. He introduces us to parachute theories, which seem to be everywhere.

The vast majority of us will be exposed to medicine through screenings, not a serious disease. Therefore, I’d recommend supplementing this book with Gilbert Welch’s book Overdiagnosis or his less technical book, Less Medicine More Health.

You can google the NPR report, the “bone disease that grew to fit the prescription,” before agreeing to a bone density scan. Most likely you won’t hear about the JAMA report on the low effectiveness of statins (less than 1% absolute reduction of cardiovascular disease and stroke), published after Dr. Wilson wrote the book.

Most importantly,Dr. Wilson states the goal of increasing trust between doctors and patients. Quite honestly that goal seems neither attainable nor desirable.

In today’s medical world, you risk your life if you fail to question everything in your medical portal. You can read the comments on any article about medical practice, not to mention the comments on YouTube videos made by licensed MDs who question the system. One horror story after another.

Exaggerated? I don’t see doctors often yet almost every encounter includes errors in reading tests, outright false information, and persuasive language that turn a board-certified MD into a used car sales rep. One doctor told me I’d add ten years to my life if I’d accept certain screening tests. Another told me my condition was normal “for your age.”

In her book Cancer, Schmancer the actress Fran Drescher reports numerous instances of bad medical advice. Advised to undergo brachytherapy, she discovers her surgeon had omitted key facts that would affect her decision. Drescher (p 148 of the ebook version) writes: “I’ll never again get treated for even a hangnail without reading every piece of information available on the Internet.”

I feel the same way. There are significant and shocking differences between research findings and medical “guidelines.”

Doctors work in hospitals and clinics that engage in deceptive practices. They send bogus bills. They take blood pressure incorrectly. They tell the waiting room staff to leave a television on, even if nobody’s watching and the programming raises everyone’s blood pressure.

Dr. Wilson disparages alternative treatments that haven’t been supported by research, yet mainstream doctors often require tests and procedures that mainstream journal articles report as useless. Examples include EKGs (77-82% false positive rate) and pre-op workouts for surgery requiring light or local anesthesia.

I like Dr. Wilson’s suggestion to be tactful with doctors, using language like, “I’d rather roll the dice.” However, I resent having to dumb down my conversation with a trained professional. All too often I’m the one saying, “This article suggests the procedure has little value,” while the doc responds emotionally: “A woman who turned it down is now in the hospital, dying.”

In summary the book can be extremely valuable to anyone dealing with the medical system. However, Dr. Wilson is much kinder and less directly critical compared to other books in the genre, which openly question the value of many practices and warn of the potential for actual harm.

[Natalie · Rating 3 out of 5]

At the introduction to this book, I was a little bit hesitant to continue reading because of how much this book on the physician-patient relationship has perspectives that only really come from the physician side (and how physicians and researchers understand patient behavior). But I recognize that some of that hesitancy does come from my own experiences being on the receiving end of many poor patient-physician relationships that impacted my health. The desire to learn from perspectives within the medical industry on patient-care kept me reading.

I liked the blend of personal anecdotes, research, and statistics education. I agree with the author that people should have more access to education on how information is gathered and communicated. Being able to assess risk and the validity of information is such an important skill, and one that has implications for the health care we provide and receive (patients and providers alike).

What I wish that this book would have done more is really interrogate the healthcare system more deeply. I really appreciated and learned much from the sections on pharmaceutical and insurance companies, and how they impact the care we receive. However, there were many points when other influences on patient care were discussed, like the implicit biases of providers, and I wished that those concepts would have been applied more broadly to medicine and healthcare as an industry. Historically, medicine has both acted as and been advanced by acting as discriminatory practice. The impacts of racism, sexism, and other social determinants of health felt like a footnote in this book. It was good to have acknowledged that the failings of medical care are also a social issue, but I was really looking for this to go further. I wish I felt as enthused as this author does in terms of reforming a broken system. Patient-centered care what I dream of most, and I also see it as difficult to achieve in our current system—even if doctors spent more time with patients, or payment was more equitable across the board.

Nonetheless, I thought it was an interesting book and one that I think a lot more people could benefit from reading. It’s helpful to understand the physician’s point of view, and how research, pharmaceuticals, and insurance influence patient care.

[Sara Hrkach · Rating 3 out of 5]

Quotes that I liked:

- “Health is never clear-cut; nothing is 100 percent safe and nothing is 100 percent effective. Anyone who tells you otherwise is selling something.”
- “A doctor who tells you they have never made an error is either enjoying their first day on the job or lying.”
- “So how do you know whether your doctor is processing information properly? One powerful tool that has emerged in this space is called the "'surprise' question." Instead of asking a physician how long a patient has to live, we can ask "Would you be surprised if this patient lived six months?" "Nine months?" "Twelve months?" And so on. These simple, binary choices help to short-circuit the motivated reasoning that pushes us in overly optimistic directions. And the "surprise" question isn't limited to predicting death. It can be used to get an honest assessment of the likelihood of response to a medication or other treatment, the risk of surgery, or whether a lifestyle intervention is likely to meaningfully improve your health.”
- “Yet providing hope sometimes means providing false hope, and that is something I've never been able to do. Maybe my patients would like me more if I did. But I wouldn't like myself very much.”
- “When one of my patients shows up in the emergency room in a diabetic coma because he couldn't afford his insulin prescription, we should all acknowledge that the system has fundamentally failed him.”
- “Don't Let the Chief of Surgery Pull Your Chest Tube”
- “If loneliness is a significant risk factor for death, it would seem that your doctor should be asking about your loneliness at every visit, but we don't. It's an awkward question, to be sure, but I don't think "Are you lonely?" is particularly more loaded than "How many sexual partners have you had in the last year?”
- “I didn't get into Medicine to hurt people. But, like all doctors, I have.”
- “Physicians must attend not just to the biological health of our patients but to their social health as well. We must take the time-demand to have the time—to uncover those issues, because they do not come out in the first five minutes of a visit.”

[AnnieM · Rating 5 out of 5]

This book is a must-read! I have read the author's newsletters and found them extremely informative so was looking forward to reading his new book and it does not disappoint! At the heart of this book is helping patients and doctors build a trusting open relationship. Given I am currently looking for a new doctor since mine just retired and am in the middle of dealing with aging parents and their navigation of the health care system, I got many great insights and tips about how to build that relationship. Some nuggets in this book - a JAMA Open Network Study showed that doctors while accurate at predicting likely outcomes of disease, they overestimate the benefits of medication. He is in no way suggesting to refuse to take medication, but rather as a patient we should be asking more questions about benefits, probability of improvement, studies conducted, side effects, etc. We all get led astray searching for the "one thing" that will "cure" us -- he suggests we hedge our bets and have a portfolio of options (for example could be a mix of western and alternative approaches as well as standard things like diet and exercise). The main point here is we need to create a health portfolio we can stick to. The other key parts of the book address scientific research and how to be a much more savvy consumer of this data -- who funded the study? Who did the research? Who and how many were the subject of the study (was it a small sample size?) Could the results be attributed to something else (correlation or causation?) Dr. Wilson writes with such candor and humility I found this to be an incredibly accessible read and as I mentioned, I personally got a lot out of it. I highly recommend this book.

Thank you to Netgalley and Grand Central Publishing for an ARC in exchange for my honest review.

[Chris · Rating 4 out of 5]

If you have had even an introductory statistics course, understand how clinical trials and medical research work, and grasp that doctors are fallible human beings and that Medicine is better at some kinds of interventions (e.g., lifesaving) than others (e.g., quality-of-life-improving), you might not need to read this book. That said, though, I felt like I knew all of those things already, but still learned (or was reminded of) some things, like:
- Doctors are notoriously bad at predicting outcomes. Ask them "Would you be surprised if... [I am alive in 5 years? or, this medication lowered my blood pressure by 30 points?]" instead.
- Just numbers-wise, most medications won't work for most people who take them. This is related to the concept of Number Needed to Treat (NNT), which means the average number of people who would have to take a medication in order for one to experience benefits. Wilson says we should think of medications as just one component of our health "regime," along with diet, exercise, stress management, etc.
- Doctors and patients can disagree--and both can have absolutely justifiable perspectives in terms of medication potential, risks, etc. Look for doctors who aren't afraid to say when they don't know something for sure.
Wilson's whole "thing" is helping doctors and patients work together better, and helping patients better understand how Medicine works and what they can reasonably expect from it. If that sounds worthwhile to you, this book is a good place to start. And if you've already gotten that far, check out Wilson's web site (https://www.methodsman.com/), media appearances, etc. to dig even deeper.

[Kalyan · Rating 5 out of 5]

I must admit, I initially picked up the book "Learning Who to Trust to Get and Stay Healthy" by F. Perry Wilson more out of compulsion than choice. After tirelessly searching through my online public library and Audible for a book that caught my interest, I was disappointed to find nothing compelling after four hours of searching. With low expectations, I assumed this book would be just another mediocre read with a flimsy theme. However, I was pleasantly surprised.

This book delves into the captivating history of medicine, shedding light on how it works and providing valuable insights into the world of clinical trials and their journey to the marketplace. It delves into thought-provoking topics such as the role of big pharmaceutical companies, the limitations of the FDA, and much more. The author skillfully presents these complex subjects in an educational and engaging manner.

If I had the power, I would incorporate excerpts from this book into reading comprehension sections of competitive exams and high school textbooks. It is through books like this and authors like F. Perry Wilson that we can empower the general public to make wise decisions regarding their health.

Overall, "Learning Who to Trust to Get and Stay Healthy" is a pleasant surprise and a highly informative read. It has the potential to broaden our understanding of the medical field and equip us with the knowledge necessary to navigate healthcare decisions wisely. I would highly recommend it to anyone seeking a deeper insight into the workings of medicine and the healthcare industry.

[Rachel · Rating 4 out of 5]

I've read a lot about most of the aspects of medicine that the author covers. A couple chapters in, I thought maybe I should skim over the parts that were old hat to me. But I realized that, though it seems fairly redundant to me, it covers all the ground to make the reader understand how things work and how he comes to his conclusions. Also, his low-key treatment of things that are not okay makes him seem mainstream and conventional, but he actually advocates things that would seem quite radical if said in a different tone. This is a good thing; readers can follow the points he makes, gradually (yes, it gets repetitious), to his logical conclusions.

I love his dedication to science and the scientific method. I liked how he handled poorly done studies and outright fraud, trying to give the reader some tools to evaluate what they read. He gave good examples of historical medical "facts" that turned out to be untrue and harmful. His evaluation of Big Pharma, largely as it relates to costs of treatments, was well thought out; he was not hostile, but the facts are damning. He's also an advocate of treating patients as people and being compassionate.

By the end of the book, I was totally won over, not only to his viewpoint, but to the way he put together the book. Lots of information, and it all logically led to specific and general conclusions about, as the title says, How Medicine Works and When It Doesn't. If the medical professions and institutions, companies, and regulatory agencies adopted the author's recommendations, we would all be in better shape.

[Karel Baloun · Rating 5 out of 5]

Dr. Perry Wilson achieves so much in this masterfully crafted patient manual to Medicine. If we stop looking for single miracle solutions, and critically read evidence to disempower frauds and charlatans, we can gradually work with doctors to build our “health portfolio” including community and strong social ties, exercise and healthy food, and stress/addiction management. Life can truly be so much better now than at any moment in history, and innovations will usher in even more optimism.

While we are all interested in health benefits, Dr Perry slides in many scientific comprehension, cognitive bias and critical thinking lessons that help in all aspects of life, and could even dramatically improve society. He also powerfully advocates for specific policy and systemic changes, such as open data, legal shielding, same-rate billing, hacking away medical administration and consumer Rx advertising, etc.

I’ll even accept his brief yet accurate criticism of social media, and media channels and feeds in general. They aren’t tuned for our personal wellbeing, and they could be.

“understanding something deeply is more satisfying than feeling the mystery of it” Yates:

I hope he also inspire many young doctors and researchers to pursue this most noble of professions. Love this impassioned celebration of Science, and its path to true knowledge.

[Natalie (booknerdalie)]

HOW MEDICINE WORKS AND WHEN IT DOESN’T by Dr. F. Perry Wilson breaks down the world of medicine — from big pharma’s biggest issues to doctor vs. patient motivations.

Humans and medicine have evolved so much (yay!) but we’ve gotten to a place where we think we can take a pill to fix anything. It’s just not the case. We need to be asking our doctors, challenging them to give us medical care that goes beyond the prescription pad, and this book will give you a good mindset on how to navigate those conversations.

Doctors aren’t intentionally keeping some homeopathic cure from us so that they aren’t out of the job. They are human — and if there was a miracle cure they’d bring it to the public for the recognition they’d deserve! But they can be motivated differently than patients. Doctors tend to look at the big picture — the forest — and you’re just a lil ole tree.

Anyways, those are my thoughts after this one. I loved the audiobook — so if informative podcasts are your thing, you’ll love this one too!

[Laney Poye · Rating 4 out of 5]

A topic near and dear to my heart - how medicine (meaning the practice there of, not just "drugs") works and why and when it doesn't. The author delves deep into the challenges of a medical practice that is evidence-based science, because the nature of science is that it is continual proven and disproven through rigorous testing. Alas, this has led our general population to question whether medicine even knows anything because there are always times where science gets it wrong. It's in the very nature of research science and why people question vaccines, COVID treatments, and everything in-between.

He gives numerous practical examples of how science and medicine have proven itself wrong but also where we've gotten it right, as well as the fallacy of assuming "more testing" must be better. Basically, if you run a whole battery of tests on a human, you will eventually find some flaw in the system - but it's probably not a flaw that will kill you, because human beings are built on redundancies.

Overall a very enjoyable and informative read.

[Dan Wingfield · Rating 5 out of 5]

Anyone who is confused with what goes on behind the scenes in the practice of Medicine (and I believe that to be the vast majority) needs to read this book. Dr. Wilson brilliantly and very clearly gives the reader a peek into such areas as good vs. bad (and even fraudulent) research, what motivates Doctors and why they are on our side, the profit motive of large pharmaceutical corporations (and how this is both good and bad), the over administration of healthcare and the concept of “all-payer rate setting" as a potential fix to many of the problems, all of these underpinning how Doctors and Patients can build trust in each other, which is the primary objective of the book. Dr. Wilson weaves in personal stories that all help the reader to fully understand the subject matter and you do not need a degree in statistics to understand. I will be recommending this book to each of my Doctors and many of my friends.

[Deb · Rating 5 out of 5]

An excellent review of the state of modern medicine and how you as a patient can become more knowledgeable of the issues affecting your care and advocate for optimal outcomes working with your doctor. The author elucidates all aspects of medical care from how medical studies are conducted and efficacy evaluated, including how those results can be evaluated by the individual versus the population, to conflicting motivations of doctors versus healthcare companies. Each area is reviewed in sufficient depth that I as a patient will be a far more informed consumer of healthcare in the future and be more proactive about doing research regarding patient studies on any drugs proposed and also understanding what results actually mean. I would recommend this book highly to any patient to have a better and more productive relationship with their healthcare provider and understand what their responsibilities are in ensuring that care.

[Tanya · Rating 3 out of 5]

During the Covid lockdown I took an online course from Dr. F. Perry Wilson of Yale School of Medicine about how to evaluate medical studies. Much of what I learned in that class also appears in his book, but in a more conversational, condensed form. There's talk of causation versus correlation, clinical versus statistical significance, p values and the extolling of randomized trials. Wilson discusses the lack of surety surrounding medication efficacy, which kind of surprised me. He also talks about the challenges of building trust between doctors and patients; those looking for answers are hoping for certainty, but an honest physician cannot typically give you guarantees about diagnosis or prognosis.

Anyway, I enjoyed reading the book, both to review things I learned about medical studies back in 2020, and to ponder the strengths and weaknesses of our health care system. 3.75 stars.

[kashiichan · Rating 4 out of 5]

I am not living in America, yet this book was still broadly applicable to the way medicine works in my country as well. It explains motivated reasoning and "one thing" medicine, relative risk vs absolute risk, how human evolution has left us vulnerable to illusory truth (particularly on social media), why it's actually good if your physician changes their mind, information about causality and correlation, trust and fraud. It also discusses the flawed behemoth that is the current American healthcare system: pharma, privilege, profit, and politics. Something I found particularly interesting is the reminder that "universal healthcare" and "single-payer healthcare" are not the same thing; I'd never heard of "all-payer rate setting" before, and will definitely be looking into that further. I think this is a book worth reading, especially if you're American (but even if you're not); ask your local library if they have a copy available.

[Bethany Kwarta · Rating 5 out of 5]

Thank you for the great reminders on how to practice the art of medicine including being honest with yourself and patients and how to implement and interpret medical research in a careful way.

Background story…
A few years ago I moved to Connecticut with my husband (who is a resident physician at Yale) and we needed a dining room table. We found one we liked for sale second hand and drove a UHaul to pick it up. That’s when we met Dr Wilson, who was friendly, and through some small talk, found out that my husband was about to start his intern year. He didn’t let us pay for the table after learning that he was starting out his own journey as a physician.

When I found out that Dr F Perry Wilson wrote a book I knew I had to read it! I can tell that he is as gracious as a physician as he is as a human. If you ever read this Dr Wilson thank you for your kindness and I enjoyed your book 😊

[Stacey · Rating 4 out of 5]

This book was excellent. I even used this as a reference, specifically Chapter 4, for my presentation on Just culture in nursing school. This book reminded me to question things, doubt, ask why. I really enjoyed the stories peppered throughout. This doctor went over ways that we can be patient advocates and question doctors decision trees because they may not be aligned with ours as individuals versus doctors perspectives of treating postulations. It gave me good insight into the importance of randomized clinical trials and those individuals who volunteer themselves for the progression of medicine. I think this book will help me be a better nurse and more annoying patient.

[David Meyer · Rating 4 out of 5]

There is plenty to like and agree with here. As someone also in the healthcare world, I will say I think Wilson writes with too much of a pro-doctor bias. He seems to assume most all doctors act altruistically, morally, and ethically at all times which just can't be said for any profession. He complains about the price of healthcare, but only rarely talks about the cost of seeing a physician or the types of bills patient's get from them, and when he does, can't imagine it being in any way the fault of the doctor. While I'm sure he finds it generous of him to suggest another physician specialty should be paid more, I'm not sure that that opinion will sit well with the average reader.

[Jen Bergeron · Rating 4 out of 5]

Read this after hearing the author speak on NephJC and he was a very relatable speaker.
I wish this was assigned reading for patients everywhere- I’ve often said that it would be nice if patients could see the constraints and strengths of the system physicians work in, as without knowing the “rules of engagement” it damages the patient physician relationship. Most doctors are good people and are trying their best to help.
There were some scary reminders of how bad capitalism is and how harmful these lovers of conspiracy are. But we will keep going to work and trying to best for the person in front of us.