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

**Peter Attia** (0:11)
Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is returning guest, Dr. Marty Makary. Marty is a surgeon and public policy researcher at Johns Hopkins University as well as a former colleague of mine during our residency. He's a member of the National Academy of Medicine and writes quite regularly for The Washington Post, The New York Times and The Wall Street Journal. He is also the author of two New York Times bestselling books, Unaccountable and The Price We Pay. His current book, Blind Spots, When Medicine Gets It Wrong and What It Means For Our Health, is set to be released on September 17th. In this episode, we talk about many of the themes in his new book, including how a new generation of doctors are thinking differently to ask new questions about the way things have been practiced in medicine historically. We lay the foundation for the conversation by discussing cognitive dissonance and how this theory applies to the medical community today. We discuss a few examples of the blind spots from the book, such as the treatment for appendicitis, the peanut allergy epidemic, the misunderstanding of HRT as it relates to breast cancer, antibiotic use, how childbirth has evolved over the years and more. All detailing the many scenarios in which a new medical approach may be possible if we're able to ask different questions. We also reflect on where medicine has done a good job over the last few decades and where Marty believes there is room to challenge historic practices and pave a new way. So without further delay, please enjoy my conversation with Marty Makary.
Hey Marty, thanks for coming in.

**Marty Makary** (2:33)
Good to be with you, Peter.

**Peter Attia** (2:34)
Great to see you again as always. So you've got a new book out, Blind Spots. This is a book I guess I certainly remember talking about with you as it was in the works. We've had many dinners together when some of these topics have come up. Can I take 5 percent credit for the inclusion of HRT in this book?

**Marty Makary** (2:51)
No, you get 99 percent credit for that. That was incredible.

**Peter Attia** (2:55)
That was a late addition, right, to the book.

**Marty Makary** (2:57)
That tipped me off to do my own investigative journalism. So I tracked down the people that made that initial announcement, saying it caused breast cancer, and I pinned them down and I went over the stats with them hard and finally got them to confess that it did not. I said thanks for tipping me off there and helping me shape the book.

**Peter Attia** (3:15)
So the book is a great read and it goes through a number of situations that all have this theme in common, which is an idea comes up, the idea is a bit shaky in terms of lack of evidence, which in and of itself is not really a problem. That really is the way medicine and science have to work. They have to start with ideas that we may or may not have great evidence for. But what goes wrong? Why is there a book about this instead of a bunch of case studies of how everything has gone really well?

**Marty Makary** (3:45)
So there's a science to group think, and that's really what's going on a lot of times. It's the bandwagon effect. It's not just in medicine, it's in business, it's in politics, it's in relationships. People are dead set on an idea, not because they're convinced of it, but because they simply heard it first. And there was a psychologist named Leon Festinger, who since passed away, but had written a tremendous amount of material on this idea of cognitive dissonance. He really carved this entire discipline out in psychology. And the idea is that the brain doesn't like to be uncomfortable with conflicting ideas, it likes to settle and be lazy with one thought. And so it's often the first thing you hear. So if something comes along that challenges your deeply held views, or just what you've happened to have heard before, there's this internal conflict. So what the body does is it will reframe the new information to make it fit what you already believe, or it'll dismiss it completely, kind of the modern day cancel culture.