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

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Drive with Dr. Peter Attia

Key Takeaways

• In medicine (and everywhere), there is a resistance to new ideas, tied to effort justification – the idea that you’ve spent so much time holding a certain belief, that the cost is too high to change
• Nothing in science is not 100% certain – there are no proofs; science is not a ‘thing’ it’s a process
  • You shouldn’t cling to hypotheses with absolute certainty and should be open to updating beliefs based on new information
  • “Just having a crazy idea is not sufficient. You have to have a means of stating what a hypothesis is, determining how to test that hypothesis, and above all else – having the ability to update your hypothesis based on new, emerging information.” – Peter Attia
• The distrust in science and medicine is because there is no humility in walking back incorrect information; it’s created two camps: (1) Blind faith in science and medicine; (2) Complete rejection of science and medicine
  • “Women are confused because the same megaphone used to say estrogen causes breast cancer has not been used to correct course.” – Peter Attia
• Don’t throw out the baby with the bath water: “C-sections and antibiotics have saved more lives than anything that we’re doing today. That has doubled the human lifespan.” – Peter Attia
• The vast majority of what we call ovarian cancer is a fallopian tube cancer
  • We need to increase public awareness, we’re targeting the wrong organ
  • At Johns Hopkins, fallopian tubes are removed instead of tied to eliminate the 1 in 78 chance of getting ovarian cancer
• Difficulty in advancing knowledge: People are doing things in a blackhole with no scientific evidence – we need appropriate studies but the NIH controls $80 billion in research dollars
  • The NIH doesn’t fund big, new ideas – it funds small ideas that are a likely bet
  • We don’t have a vehicle to encourage big thinkers

Read the full notes @ podcastnotes.org

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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 research [1:27:30];
• The dogmatic culture of academic medicine: why humility and challenging established norms are key for progress [1:38:15];
• The major successes and ongoing challenges of modern medicine [1:51:00]; and
• More.

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