By Mark W. Fowler

“There is no place for dogma in science.” —J. Robert Oppenheimer

Marty Makary, M.D., is a physician, author, medical expert, and affiliate of Johns Hopkins, one of the premier medical facilities in the world. He is also a contrarian, bringing a gimlet eye to medical dogma. Professors of medicine have a certain esteem in the eyes of the public. In many ways, this reputation is deserved based on their accomplishments. Regrettably, their reputation carries with it a sort of intellectual inertia. They are reluctant to admit when they are wrong. And, like all humans, they can be wrong.

Modern physicians like to pride themselves on the application of the “scientific method” — meaning diagnosis and treatment based on evidence, knowledge of chemistry, biology, and physics, and verified by replication and statistical analysis. Thus, we no longer bleed people to eliminate bad “humours,” a technique said to have contributed to the death of George Washington. We don’t use cupping to treat pneumonia as was portrayed in “The Godfather Part II.” Nevertheless, even now we doctors get it wrong.

In a fascinating and readable book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health, Dr. Makary sheds light on a number of mistakes medical experts have made that inflicted significant harm on their patients. Let us look at two: peanut allergies and hormone replacement therapy for menopausal women.

In 1996, an article in the British Medical Journal reported a suspected association between childhood peanut allergies and peanut allergies in their mothers. In reality, no such association existed. Nevertheless, the American Academy of Pediatricians began to recommend withholding peanuts from infants. A peanut allergy is a problem in that it can led to death. On the other hand, peanuts are relatively easy to grow and full of protein and fat, making them a key ingredient in the fight against malnutrition. This recommendation snowballed into a significant and unnecessary health crisis.

Segue to Israel, where a common snack called Bamba made from popped corn and peanut butter is softened in liquid and given to infants. A sudden increase in peanut allergies occurring after 1996 could only be attributed to three things: a change in the human genome; a change in the immunogenicity of peanuts; or a change in exposure to peanuts. But antigenic shifts do not occur rapidly in complex organisms. That meant a change in human behavior was involved.

Someone noticed that the prevalence of peanut allergies in Jewish children in the United Kingdom was 10 times the rate of peanut allergies in Israeli Jews. This was attributed to the early exposure of Israeli children to peanuts. In other words, the AAP was wrong. Not only was early exposure to peanuts not harmful, but in reality, early exposure reduces the development and severity of peanut allergies.

This phenomenon was replicated in East Tennessee when it was noticed that a certain pediatrician had no patients with peanut allergies because he did not advocate withholding peanuts from children. Incidentally, at the time peanut allergies were increasing, so were sales and the price of EpiPen autoinjectors. Much, but not all, of the medical profession is now abandoning peanut avoidance in infants as a viable strategy. It’s about time.

Menopause, though a natural life event, causes significant distress in many women. As estrogen levels decline, post-menopausal women become susceptible to osteoporosis, dementia, and heart disease. We now know that hormone replacement therapy (HRT) started within 10 years of menopause can delay or ameliorate some of these issues. The Women’s Health Initiative, funded by the federal government to the tune of $1 billion, was interpreted in a way that suggested HRT increased breast cancer. But the study was flawed, and an argument can be made that one of the authors intentionally interpreted the data in such a way as to stop hormone replacement therapy.

The WHI studied women who had been post-menopausal longer than 10 years. HRT is not helpful to that cohort of women but is helpful if started earlier. When the data was reexamined, it developed that HRT did not increase the risk of cancer, but institutional inertia deprived many women of the benefits of HRT.

HRT can reduce osteoporosis, diminish menopausal hot flashes, and lower the risk of cardiac disease. Nevertheless, many doctors are reluctant to prescribe HRT out of fear of breast cancer. While the authors of the study claimed that they had prevented thousands of deaths from breast cancer, in reality, Dr. Makary makes a compelling argument that they exposed many women to the difficulties of menopause for no good reason other than an unwillingness to admit they were wrong. That is a bad way to practice medicine.

The airwaves are full of direct-to-consumer ads touting this or that preparation for any number of maladies including brain fog, erectile dysfunction, and lack of energy. Such products are marketed as dietary supplements. Dietary supplements are subject to limited regulation by the FDA. The products must be safe to ingest, but claims about solving medical issues have not been subject to independent testing. When a dietary supplement has a disclaimer that says, “Not intended to diagnose, treat, cure or prevent any disease,” you can assume that the product has not been proven to do much of anything.

There is no substitute for a good physician-patient relationship in making decisions about medical management. And patients should engage in the process of asking about side effects, which can be severe.

Unfortunately, not everything you see or hear about medicine is true. Dr. Makary sheds much-needed light on the difficulty of translating research into practice. His book is well written in a manner laymen can understand.

Mark Fowler is a board-certified physician and former attorney. He can be reached at [email protected].