SEEING THE BOOKS
Skin Spots: Medication Mistakes and What They Mean for Our Health
Marty Makary, MD; Bloomsbury Press, 2024
288 pages; $23 (hardcover)
Reviewed by Dinah Miller, MD
The public health messages surrounding the COVID-19 pandemic have made us all realize that medical opinion sometimes moves faster than research, and that medical institutions are not immune to the politics and disagreements that affect the public. With the pandemic still visible through our lens, it’s a good time for Marty Makary, MD’s best seller, Skin Spots: Medication Mistakes and What They Mean for Our Health.1
It’s interesting, Makary says, that other countries don’t have the outbreaks of peanut disease that we see in the United States. In fact, it is not known in Africa where babies are fed groundnut soup. In response to the increased awareness of peanut disease, the American Academy of Pediatricians (AAP) suggested that pregnant and lactating women, as well as infants and children under 3 years of age, should not eat peanuts. Avoidance was thought to be the key to avoiding allergies. This was in the year 2000 and in the years that followed our incidence of peanut allergies skyrocketed. The difficult part of this law was that there was no training to support it. Evidence-based medicine has been criticized, the recommendations lacked data. A simple study on this line showed that very quick contact with small amounts of peanuts prevented peanut allergies. In 2015, the AAP changed their mind—stop eating peanuts—and science won.
Makary goes through example after example where medicine went wrong. There was a time when postmenopausal women were encouraged, even pushed, to use hormone replacement therapy (HRT): good for the heart, brain, bones, and sex life. And then the Women’s Health Initiative (WHI), a study of 16,608 women randomized to different hormone replacement sites, stopped when women receiving HRT were found to have an increased risk of breast cancer. . Anyone who was practicing medicine (or taking HRT) during this time is well aware of the changing treatment mindset.
Makary tells an interesting and very sad story of how this happened. It was in June 2002 in Chicago and the first 40 researchers from each site of the WHI trial gathered in a formal meeting. As soon as the meeting began, the group was informed that the leaders of the study had determined that HRT was causing breast cancer and that the trial had to be stopped. The results had already been recorded and approved by a Journal of the Medical Association (JAMA). Testimonials were shared, researchers were given minutes to read, and at least 2 hours to make revisions. The changes were not successful JAMA at the time of day; magazines had already started to be published. And surprisingly, Makary tells the reader, that the data did not reach statistical significance! He follows the trends in the work of his colleagues and makes the case that HRT should be introduced in more women.
In the following chapters, Makary shares that silicone implants were taken off the market by the US Food and Drug Administration due to a link to autoimmune diseases. The case was overturned by later studies, but years before the lawsuits changed our legal landscape of medicine and resulted in many women being unnecessarily aborted. The Food Pyramid and its recommendations for low-fat, high-carbohydrate diets led to obesity. Childbirth has been heavily drugged, so children are taken from their mothers. There was no known science behind this and skin-to-skin contact with the woman helped to produce positive results.
Makary writes about “groupthink” – the idea that it is difficult to break the establishment. Academia is described as a culturally restrictive world where scientists can be shunned, even fired, for challenging the status quo. Finally, Makary questions some of the things we take for granted—that fluoridated water is good for us, that cancer screenings save lives, that fevers should be treated with Tylenol.
Blind Spots it’s an easy and compelling read, perfect for opening people’s eyes and exposing flaws in our medical thinking. Recruiting books often have fun quotes, too Blind Spots it’s the same. My tendency is to read these kinds of books with a bit of skepticism.
Makary has ideas about the support we should provide, which he advocates for education. He is an unabashed supporter of HRT, despite the most recent review of the WHI trial being published JAMA in May 2024 disagrees with hormonal changes on behalf of women with menopause-recommends the small things needed to deal with postmenopausal symptoms.2 They provide ample evidence of the microbiome being affected by antibiotics, yet the studies they cite are inconsistent. In most of the stories he takes on, the opposites are covered in the media so frequently that it’s like watching a ping pong match. It’s no wonder that healers and the general public are confused, and that there are thriving communities of other healers.
Finally, Makary is very difficult in the medical profession. He divides his ideas into good and bad, and gives many examples of amazing, innovative medicine, starting with the discovery that citrus fruits cure scurvy and ending with the mRNA vaccine—which was met with outrage and scorn. These things are easy to see in retrospect when we have final answers, but there are still many new ideas being proposed. It is not possible to explore every new idea or every old idea that we have taken for granted. However, we’re not doing everything wrong, people are living longer and healthier lives, and I’m not sure the reader would know this from reading. Blind Spots.
This book made me think about the assumptions we make about mental health. Makary cites the controversy surrounding gender-affirming care and its implications for researchers who have reported negative results. There are many other areas of psychiatry where these issues are problematic. Antidepressants and psychotherapy are more widely available than ever, yet our suicide rates have steadily risen, as has our rate of depression. Do black box warnings help, or do they prevent doctors from prescribing effective drugs? Are psychedelic drugs a new hope for sustainable treatment without the dangers of ongoing drugs? Is there any way to do an unbiased, placebo-controlled study to get definitive answers about how it works? And why do people with severe mental illness live shorter lives? Is it the ravages of chronic disease or is our medicine leaving patients at risk of premature death (or combination)? What is causing the rise in autism spectrum disorder and are we doing enough to uncover the etiology? There are other questions about mental health, but this is my start.
Although I doubt it, Blind Spots it gets 5 stars from me—I learned a lot and sometimes I feel like I’ve come out of a cave. What has been revealed behind the health concepts that have changed our lives is amazing. The take-home message is great: ask what we think, check out what’s in store, open our minds with our money to innovate. It’s quick, compelling, and something all doctors will want to read. Blind Spots makes a strong argument against following medical advice and practicing what we don’t know. Medicine does not like to do this.
References
1. Makary M. Skin Spots: Medication Mistakes and What They Mean for Our Health. Bloomsbury Publishing; 2024.
2. Manson JE, Crandall CJ, Rossouw JE, et al. The Women’s Health Initiative randomized trials and clinical practice. JAMA. Published online May 1, 2024.
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