Reforming medicine: uncovering blind spots, challenging the norm, and embracing innovation | Marty Makary, M.D., M.P.H.

Peter Attia

Sep 16, 2024

Episode description

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Marty Makary, a Johns Hopkins surgeon and New York Times bestselling author, returns to The Drive to discuss his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. In this episode, Marty explores how a new generation of doctors is challenging long-held medical practices by asking critical new questions. He discusses the major problems of groupthink and cognitive dissonance in the medical community and delves into several of the "blind spots" raised in the book, including treatments for appendicitis, the peanut allergy epidemic, misunderstandings about HRT and breast cancer, antibiotic use, and the evolution of childbirth. He explains the urgent need for reform in medical education and the major barriers standing in the way of innovative medical research. Throughout the conversation, Marty offers insightful reflections on where medicine has succeeded and where there’s still room to challenge historic practices and embrace new approaches.

We discuss:

  • The issue of groupthink and cognitive dissonance in science and medicine [2:30];

  • How a non-operative treatment for appendicitis sheds light on cognitive dissonance [7:00];

  • How cognitive dissonance and effort justification shape beliefs and actions [13:15];

  • How misguided peanut allergy recommendations created an epidemic [17:45];

  • The enduring impact of misinformation and fear-based messaging around hormone replacement therapy allegedly causing breast cancer [25:15];

  • The dangers of extreme skepticism and blind faith in science, and the importance of understanding uncertainty and probability [28:00];

  • The overuse of antibiotics and the rise of antibiotic resistant infections and poor gut health [33:45];

  • The potential correlations between early antibiotic use and chronic diseases [40:45];

  • The historical and evolving trends in childbirth and C-section rates [50:15];

  • Rethinking ovarian cancer: recent data challenging decades of medical practice and leading to new preventive measures [1:05:30];

  • Navigating uncertainty as a physician [1:19:30];

  • The urgent need for reform in medical education [1:21:45];

  • The major barriers to innovative medical

Episode description

View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

Sign Up to Receive Peter’s Weekly Newsletter

Marty Makary, a Johns Hopkins surgeon and New York Times bestselling author, returns to The Drive to discuss his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. In this episode, Marty explores how a new generation of doctors is challenging long-held medical practices by asking critical new questions. He discusses the major problems of groupthink and cognitive dissonance in the medical community and delves into several of the "blind spots" raised in the book, including treatments for appendicitis, the peanut allergy epidemic, misunderstandings about HRT and breast cancer, antibiotic use, and the evolution of childbirth. He explains the urgent need for reform in medical education and the major barriers standing in the way of innovative medical research. Throughout the conversation, Marty offers insightful reflections on where medicine has succeeded and where there’s still room to challenge historic practices and embrace new approaches.

We discuss:

  • The issue of groupthink and cognitive dissonance in science and medicine [2:30];

  • How a non-operative treatment for appendicitis sheds light on cognitive dissonance [7:00];

  • How cognitive dissonance and effort justification shape beliefs and actions [13:15];

  • How misguided peanut allergy recommendations created an epidemic [17:45];

  • The enduring impact of misinformation and fear-based messaging around hormone replacement therapy allegedly causing breast cancer [25:15];

  • The dangers of extreme skepticism and blind faith in science, and the importance of understanding uncertainty and probability [28:00];

  • The overuse of antibiotics and the rise of antibiotic resistant infections and poor gut health [33:45];

  • The potential correlations between early antibiotic use and chronic diseases [40:45];

  • The historical and evolving trends in childbirth and C-section rates [50:15];

  • Rethinking ovarian cancer: recent data challenging decades of medical practice and leading to new preventive measures [1:05:30];

  • Navigating uncertainty as a physician [1:19:30];

  • The urgent need for reform in medical education [1:21:45];

  • The major barriers to innovative medical

Mindsip insights from this episode:

Delay umbilical cord clamping to enhance newborn health

Delaying umbilical cord clamping to 90 seconds, instead of 45, provides a statistically significant clinical benefit to the newborn.

Understand C-section impact on baby's microbiome and cancer risk

Babies born via C-section have their microbiome seeded by hospital bacteria rather than the mother's vaginal bacteria, which may be linked to higher rates of colon cancer before age 50.

Remove fallopian tubes to prevent ovarian cancer risk

The most lethal type of ovarian cancer originates in the fallopian tubes, not the ovaries, meaning removing the tubes during other surgeries could be a preventative measure.

Limit childhood antibiotics to reduce disease risk

A Mayo Clinic study found antibiotic use in the first two years of life is correlated with a significant increase in obesity, learning disabilities, asthma, and a 289% increase in celiac disease.

Introduce peanuts early to reduce allergy rates

The official recommendation for children to avoid peanuts until age three caused the allergy epidemic, with early exposure now shown to reduce allergy rates eight-fold.

Consider antibiotics to treat non-ruptured appendicitis and avoid surgery

A short course of antibiotics is 67% effective for treating non-ruptured appendicitis, potentially avoiding surgery and its associated risks.

Transform medical education to foster critical thinking

Medical education forces students into rote memorization of facts like enzyme names, which they could look up, instead of teaching critical appraisal of research and how to deal with uncertainty.

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