Marty Makary

This is one FABULOUS book. I don't know where I got the idea to read it from but it sure was an eye opener. It is about the many things medicine gets wrong and how the brotherhood closes ranks around new ideas and how much that is presented as fact...."safe and effective"....is a belief system not based on science or independent research. For example HRT Hormone Replacement Therapy was discouraged years ago because of the connection to breast cancer. Well guess what!!! There is no connection show more and those many women who would have greatly benefited from HRT were denied support by zealous misinformed doctors. The book is packed with examples and very interesting if not disturbing.

Makary has just been appointed head of the FDA so hoping he will be doing some major shaking up! show less

This was a frustrating read. The data was good; the analysis and conclusions, not so much.

The good parts: The data and stories about how much we pay, the inaccessible chargemasters, the opaque billing, CEOs who don't know their ass from their elbow and claim ignorance of how their hospitals operate. Dr. Makary does a great job of showing many of the ways in which the system fails.

The bad: Trying to analyze the situation and draw political conclusions. Makary is a fan of price transparency. show more I'm not opposed to that, per se, but he doesn't address the myriad limitations to the problem. Once your care costs enough, it is immaterial to you whether it's $30K or $50K; you've hit your maximum. Second, you don't always have the ability to do research, either because it's urgent or because the patient is generally incapable. The issue of pushing the burden onto patients isn't really addressed. Third, lack of competition. One of the highlighted stories is in Carlsbad, NM, where the local hospital has a record of suing for unpaid bills. The next nearest hospital is in Roswell, an hour away. That's usable for some people some of the time, but for other people and times, Carlsbad's hospital has a captive market. With increased consolidation in healthcare, transparency will be only so useful as a tool.

He's also a little overly generous about the motivations of doctors and administrators, which is interesting considering his opening story about predatory surgeons promoting unnecessary surgery. Doctors respond to incentives, both good and bad.

To his credit one segment is about improvement at the hospital level, by using data to improve surgical outcomes. However, in some cases he's prone to tossing off anecdotes. For example, that providing price data for deliveries meant "everyone" selected the cheaper hospital, with "no loss of quality." It's worth noting that the example was in Boston, where Partners Healthcare has been accused of driving costs up at the most prestigious hospitals. I know from personal and friends' experience that even when price data is available, that the more expensive option may be chosen because of real or perceived differences in quality or other factors. (For example, I chose to deliver in a more distant hospital because I preferred its maternal-fetal medicine team, and would have done so even if it had cost more.)

He also talks up companies self-insuring and the use of health shares without mentioning downsides (self insured companies are exempt from the requirements of the Affordable Care Act; health shares do not guarantee payment).

It's a shame because the basic data gathered is really interesting; he just doesn't know where to go with it. show less

I’m quite interested in this subject....both from the perspective of a strong belief in mainstream medicine and a science based approach. But also in terms of having a healthy scepticism about much of medical dogma....on the grounds that it’s do dammed hard to actually prove or disprove most interventions in medicine. Especially when the placebo effect is a real phenomenon. But even after reading it, I find I’m still wary of the author’s claims. For example that high dietary show more cholesterol does not lead to heart disease. Is he right....and I’m just a victim of propaganda or is he wrong or half wrong? How can I know...even if I study the literature myself.
Here are some extracts that give some of the flavour of the book...though it should be noted that this review is based on the Blinkist summary version of the book...so maybe not a fair review of the full book.
How medical misinformation created the peanut allergy epidemic
In the late 1990s, peanut allergies were rare, with only about 0.6 percent of US children affected. But by 2004, something had changed......So why were peanut allergies exploding in the US but still virtually nonexistent in other parts of the world, like Africa and the Middle East?
Experts like Dr. Rebecca Buckley understood that early exposure to allergens, including peanuts, could actually prevent allergies by helping the immune system develop tolerance. Yet the AAP’s guidance dominated, and pediatricians across the country adopted the mantra: no peanuts for babies.
Immunologists like Dr. Gideon Lack further challenged the peanut avoidance guideline,
His 2015 clinical trial confirmed it: early exposure to peanuts reduced the risk of developing allergies by a staggering 86 percent.
Even after the AAP reversed its guidance, many parents continued to avoid peanuts, unaware that the recommendation had changed.
always question medical advice, especially when it lacks solid evidence,
The hidden dangers of antibiotic overuse
Often seen as harmless, antibiotics can wreak havoc on the body’s microbiome, which is critical for digestion, immune health, and even mental well-being.........20 percent of hospitalized patients treated with antibiotics experience adverse effects, from kidney damage to more severe conditions...Some 14,000 children were involved in an experiment where it was found that those who took antibiotics before the age of two had significantly higher risks of developing chronic conditions such as obesity, asthma, and learning disabilities.....there is also a strong link between early antibiotic exposure and long-term health problems.
The myth of cholesterol and heart disease
There is a widely promoted belief that dietary cholesterol leads to heart disease. However, modern research shows that this connection was never supported by solid evidence. For years, the medical establishment promoted the idea that avoiding dietary cholesterol and saturated fat would prevent heart disease, based largely on the work of Dr. Ancel Keys.
Yet multiple large studies have since debunked this myth......Despite this evidence, the low-fat, low-cholesterol message has persisted in popular culture and healthcare, influencing millions of people like Uncle Sam....... Refined carbohydrates and sugars, not saturated fat, are major drivers of inflammation in the arteries.
Rethinking birth practices for healthier babies and happier moms
In the mid-twentieth century, the medical field developed a highly clinical, intervention-heavy approach to childbirth...... modern research shows these practices can do more harm than good......Delayed cord clamping is now more common in US hospitals, but for decades, the immediate rush to clamp the cord was standard......Another key shift has been in promoting skin-to-skin contact between mothers and newborns right after birth....... The over-medicalization of childbirth often overshadowed common-sense practices that align with the body's natural rhythms.
The misguided panic over breast implants and the missed opioid crisis
For years, debates raged between doctors, patients, and the legal system about whether silicone implants truly caused autoimmune diseases or cancer......Today, silicone implants are considered safe, but the legacy of the controversy reminds us of the power of media-driven narratives and the importance of evidence-based medicine.
Other medical myths that could harm your health
A few decades ago, doctors wrongly believed that melanoma- a deadly form of skin cancer - did not affect black people..... What else are we getting wrong today?
Countries that do not fluoridate their water, like many in Europe, have seen similar declines [to countries that have fluoridated] in cavity rates, suggesting fluoride's benefits might not be as strong as once thought. [This may be true but I notice that dental caries in 12 year olds in Australia, where fluoridation is generally practiced, are 38% lower than in the USA, and I do recall my Dentist in Canberra, years ago, stating that the nature of their business had changed dramatically since the introduction of fluoridation....no longer fillings].
The widespread belief that marijuana is harmless should be challenged. Today's marijuana contains much higher levels of THC..... and studies indicate significant risks for adolescents, including an increased likelihood of developing schizophrenia....... leading us to question whether we should still consider it a safe, recreational drug.
Treating fevers with Tylenol is another practice that warrants re-evaluation. ........Research shows that treating fevers can prolong illnesses, meaning that we might need to rethink the automatic use of fever-reducing drugs..... These examples reflect the broader issue of medical dogma - when opinions masquerade as facts.
Main Takeaways: Many accepted medical practices are rooted in outdated or poorly supported evidence, often leading to unintended consequences. From the surge in peanut allergies to the overuse of antibiotics and persistent myths about cholesterol, these examples highlight the importance of questioning medical advice and seeking out evidence-based solutions. By staying informed and open to evolving science, we can better protect our health and avoid falling victim to harmful medical dogma. Ultimately, it's about empowering yourself to make more informed health decisions.”
My overall take on the book? Interesting. Easy to read. Strongly formulated arguments....which I’m inclined to believe though I have the problem of wondering whether his myth-busting is correct. How would I know if he is correct or just cheery picking or just plain wrong? Not an easy call. But certainly quite fascinating. I give it five stars. show less

A profoundly disturbing "inside look" at America's health care system, but also a hopeful call for more transparency, accountability, and patient-oriented treatment. Much of the book is difficult to read, as Makary recounts horror stories from his career and reveals the dirty little secrets that hospitals don't want you to find out. His suggestions, though, are almost all based on pure common sense and seem as though they'd save a great number of lives.