Health
317 ‒ Reforming medicine: uncovering blind spots, challenging the norm, and embracing innovation
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In this episode, we discuss:
0:01:10 – The issue of groupthink and cognitive dissonance in science and medicine
0:06:30 – How a non-operative treatment for appendicitis sheds light on cognitive dissonance
0:13:22 – How cognitive dissonance and effort justification shape beliefs and actions
0:17:53 – How misguided peanut allergy recommendations created an epidemic
0:26:15 – The enduring impact of misinformation and fear-based messaging around hormone replacement therapy allegedly causing breast cancer
0:29:13 – The dangers of extreme skepticism and blind faith in science, and the importance of understanding uncertainty and probability
0:35:45 – The overuse of antibiotics and the rise of antibiotic resistant infections and poor gut health
0:43:09 – The potential correlations between early antibiotic use and chronic diseases
0:53:29 – The historical and evolving trends in childbirth and C-section rates
1:09:57 – Rethinking ovarian cancer: recent data challenging decades of medical practice and leading to new preventive measures
1:26:10 – Navigating uncertainty as a physician
1:28:40 – The urgent need for reform in medical education
1:34:55 – The major barriers to innovative medical research
1:46:45 – The dogmatic culture of academic medicine: why humility and challenging established norms are key for progress
2:01:30 – The major successes and ongoing challenges of modern medicine
The biggest association is that most recommendations DO increase profits for big pharma as opposite to less intrusive interventions
Cognitive dissonance is definitely a problem for right wingers. Please get this on right wing propaganda outlets.
They got it wrong on purpose so big pharma can profit for another couple decades until the You Tubers saved us!
Bias is not your friend.
This has been the best podcast you’ve done and that’s sayin a lot since all of them are wonderful but this is spectacular! Thank you you thank you thank you. You truly have no idea how incredibly valuable you are and how appreciated you are. Don't ever stop. This is a discussion that’s has been needed for years . I can’t wait to read Dr. Makary’s book. This talk should be a mandatory for every healthcare student and professional in america.
I a Hopkins Public Health (before Bloomberg) and London Med alumna. I just bought Marty Makary's latest book — actually 4 of them, one for me and one each for the three medically inclined early 20s adult in my life considering medicine careers. Inspiring interview and I hope it gets multiple views.
After listening to this show, and both your and Dr. Makary's appearances on Econtalk, I'm forming a list of questions and tests for my next primary care visit. Your media, and others like it, is changing how patients look at their own medical care for the better.
Two Ben Franklins 💪🏻
How does this video not have 1 million views. Dr. Makary is a national treasure! Thank you for this conversation!!
We need to bring this to nursing as well. We are in even worse position.
Why say” don’t want to talk about covid”? What are they afraid of?
you guys forgot about Ignaz Semmelweis, he invented anti sepsis 1847, decrease maternal mortality 18 to 2%! Also one of the best examples of dome overcoming evidence, his colleagues sent him to a lunatic asylum in 1865!
Peter's not a big fan of "Ben Franklin Thinkers".
I’ve wondered in the past – why are doctors so arrogant, certain that they know it, unwilling to consider “regular” people’s opinion or information. I came up with the following explanation: doctors go through gruelling education where they have to learn (memorize) A LOT of stuff. It’s inevitable to start believing you know it all when you’ve learned a lot. Many doctors, on the other hand, don’t have enough mental fuel left to do real thinking because their capacity has been spent in getting through med school. With a degree and a job in hand, they can now relax and float through life.
Thank you for your honesty and willingness to find better ways 🙏
Respect your work Peter but Bill Maher? Really ??
My mother’s ovarian oncologist from world leading cancer center told me 15 years ago that they suspected fallopian tubes as origin of the disease but didn’t know why. I wish I had known more before my hysterectomy.
Great episode! It would v been great to hear him mention his minor procedure infection rate ever since he stopped doing the preop antibiotics
Fantastic conversation. I am a fan of Dr Marty Makary. Very informative episode especially on the subject of ovarian cancer.
Well, Dr Attia, I seriously doubt you'll see this comment but I'll try anyway. I paused the video at the end of the chapter on Extreme Skepticism. I'm extremely skeptical about seeing doctors, but not because I believe crazy nonsense. It's from personal experience. The last time I was treated by a doctor, over 10 years ago now, I was going through a rough patch – working two jobs, in a troubled marriage, etc. He gave me a 2-week sample of antidepressants and told me to come back after a week or two to see how they were doing. The second day I took them (I was quite naive back then and didn't question it), I went from feeling bummed to feeling suicidal. Needless to say, I threw out that crap and told him so when I went back. I haven't been back to a doctor since except for a physical that I was required to take for employment, and I have no intention of going back any time soon unless I break a bone or something. I have no use for so-called "doctors" who push pills on you for no good reason, and there is far too much of that going on. Needless to say, since I follow your work, I'm doing a lot of the right things so I have little need for a doctor. Your profession really needs to work hard to regain the trust of people like me.
By the way, if you want an interesting guest for your show, why don't you try to book Casey Means, MD? She's the author of a book I'm currently reading, Good Energy, and says a lot of the same things you said in your book.
Great interview. I put a sticker on my car saying “Reform the Medical Establishment” after going through the meat grinder with a friend at my local hospital. I can only describe it as assembly line medicine at its worst with very little analysis of observable data or patient history to guide decisions. When a wrong diagnosis got into the medical chart it was impossible to get it out, and subsequent hospitalists would blindly follow the chart. It was like being held medical hostage by the hospital. No personalized or precision medicine observed. This interview gives me hope that one day this might change.
Psychology is awful..science wise. I used to fully support it and went through a personal crisis when confronted with the evidence which disproves a large portion of it.
Glad to hear you address COVID clampdowns and how it didn’t make sense not to discuss or test all potential treatments. Happy to hear those who were so sure are now rethinking positions. We have a long way to go and much trust has been lost in the medical and pharmaceutical industries among many others. This discussion brings me hope. Thank you.
Most doctors sell interventions for the most common stuff they see. That's where the money is. Effectively "I have a menu, don't come to my restaurant and ask for stuff I don't make." The more rare doctor is the detective / engineer minded doctor who says "interesting, let's see if we can figure this out, it's not on my menu, can I grow the menu and learn something from this case. If I can't solve it, who do I know, who can?" A huge amount of people go to see doctors and the doctor turns out to be a procedure seller and they are just left out in the cold with no options.
In the case of appendicitis, there was a lot not discussed. Dr Makary didn’t say the studies showed antibiotics were ‘not inferior’ to surgery, which is a way to say it’s acceptable but not a good as the gold standard of surgical removal. Appendectomy is cured 100% of the time with surgery with really low complication rate.
The problem if you fail in the antibiotic treatment arm, the appendix can rupture and you can become very sick and have a long hospitalization and complications down the road as well as long treatment with antibiotics (discussed as very bad later in the podcast).
Dr. Makary gave a personal case study of one patient he tried this on, and feels it worked, but he had no follow up from one month or one year later. My feeling is that Dr. Makary is no longer doing much patient care or surgery and primarily research and publishing from his ivory tower.
In reality surgeons are performing appendectomy because it’s safe and it works and prevents complications and recurrence. Even the authors of some of these studies on antibiotic treatment of appendicitis, if asked individually, still recommend surgery as first line treatment. They will offer antibiotic therapy as an option but they know surgery is the gold standard.
The whole way the medical system is organized by profession is a disaster
How about integrating behavior change life style medicine using certified health coaches and having insurance pay for it.
The STIC lesions in the fallopian tubes aren't that new of an idea. It's been known for at least 10+ years. It took them long enough to start studies recruiting BRCA1/2, Lynch syndrome, PALB2, RAD51C/D carriers, etc. for bilateral salpingectomies as a prophylactic surgery option (finnaly recruiting over the last 5 years). Especially considering the menopausal hell we have been putting these gene carriers through.
Great speaker
Very interesting to see the part about appendicitis. Four years ago i was hospitalized with appendicitis, in which they did a CT and found an uncomplicated appendicitis case, but with an appendicolith. I had read about it online, that antibiotics could be an option, and i presented it to my doctor(Norway). He was very hesitant and insisted that the normal procedure was to have surgery. I asked if we could try the antibiotics, as i wasnt a fan of getting anaesthesia etc. He said ok, and that i had to come back if it didnt work. I took my antibiotics and the matter resolved pretty fast, and i was practically without symptoms within a couple of days. It did not come back, even tho they could see an appendicolith on the scan. So in my case, even that did not stop the treatment from being curative on my part. Now, four years after i have still never heard of another person being treated with antibiotics for appendicitis, and doctors i have mentioned it to seem very surprised, almost in disbelief.
Interesting discussion. At 82 and soon going to my annual "wellness" visit, I have decided that the primary function of the doctor ( part of a large health care organization) is to decide if there is a drug to prescribe or is there a specialist to refer me to!
There is absolutely zero conversation about nutrition, exercise, sleep, mental health. And, unfortunately, my physician is not where I would go for information on what I consider prevention! They have a "protocol " to follow. It is up to me to question whether that protocol is appropriate.
A key example is pre-diabetes. The protocol is, apparently, come back in a year and we will check it again. When I requested a new appointment in 3 months, I was asked "why". My answer was that I would research the topic and try to improve my health. Which is what I did and continue to do- with zero help or information from my health care provider. If blood work is in the normal range, but at the high end, I am "healthy ". If it goes over slightly, there must be a pill for it!
I wish you both the best in your attempts to improve our health care system! I suspect that I will be long dead before there are significant changes.
Best interview! Fantastic important information! Thanks for having Dr. Makary! I want to get the book
Thanks to Dr Attia and DR Makary for bringing up the faulty conclusions drawn from the WHI. Their study does NOT show that estrogen causes cancer. NOW , how about the authors publicly apologize PUBLIC ALLY to the women they damaged?? It will NEVER happen.
How about a NUTRITION course in med school??? How about oncologists stop saying that diet has nothing to do with cancer , that getting cancer is just bad luck??? Could doctors get their nerve up and recommend decreasing their added sugar intake to 25 grams ( 6 teaspoons) or less!!
Thanks to Dr. Attia for pointing out the glaringly false conclusions drawn from the WHI studies. I knew the statistics didnt support that estrogen causes breast cancer and amso sick of hearing this misinformation mindlessly repeated. So Dr.MKary hunted down the authors of this medical drivel admitted that their conclusion that breast cancer was caused by estrogenwas WRONG ???!!! Millions of women suffered because of this , coming offhormones abruptly!! Where is the press conference?? Whereis the apology ???!?😮😮😢
Thanks to Dr. Attia for pointing out the glaringly false conclusions drawn from the WHI studies. I knew the statistics didnt support that estrogen causes breast cancer and amso sick of hearing this misinformation mindlessly repeated. So Dr.MKary hunted down the authors of this medical drivel admitted that their conclusion that breast cancer was caused by estrogenwas WRONG ???!!! Millions of women suffered because of this , coming offhormones abruptly!! Where is the press conference?? Whereis the apology ???!?😮😮😢
Thanks to Dr. Attia for pointing out the glaringly false conclusions drawn from the WHI studies. I knew the statistics didnt support that estrogen causes breast cancer and amso sick of hearing this misinformation mindlessly repeated. So Dr.MKary hunted down the authors of this medical drivel admitted that their conclusion that breast cancer was caused by estrogenwas WRONG ???!!! Millions of women suffered because of this , coming offhormones abruptly!! Where is the press conference?? Whereis the apology ???!?😮😮😢
I have to say I think this is one of the best presentations I have ever seen/heard.
I've been in medicine for 30 yrs. I think group-think is worse than ever. I work with students and residents, and they are selected for a reason.