Medicine has a huge “blind spot” that has led to an explosion of childhood obesity, diabetes, autism, peanut allergies, and autoimmune diseases in the United States, says Martin Makary, M.D., author of the bestselling book Blind Spots.
“We have the sickest population in the history of the world … right here in the United States, despite spending double what other wealthy countries spend on health care,” said Makary during a September 20 presentation at the Cato Institute, titled “Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health.” Also on the panel were Cato scholars Jeffrey A. Singer, M.D., and David A. Hyman, M.D.
Makary became well-known during the COVID-19 lockdowns as one of a small group of prominent physicians who publicly questioned the government’s response to the virus. Makary is a professor of surgery at Johns Hopkins Medicine, where he researches the underlying causes of disease and has written numerous scientific articles and two other bestselling books.
Chronic-Disease Epidemics
Makary said the rates of some diseases have reached epidemic proportions. Half of all children in the United States are obese or overweight, with 20 percent now diabetic or prediabetic. The rate of children being diagnosed with autism is up 14 percent every year for the last 23 years, one in five U.S. women have been diagnosed with an autoimmune disease, and gastrointestinal cancers have doubled in the last two decades.
“We have got to ask the big questions,” said Makary said in his remarks. “We have developed blind spots not because we’re bad people but because the system has a groupthink, a herd mentality.”
Health care has become assembly-line medicine, with health professionals pressured to focus more on productivity and billing output than on improving overall health, says Makary.
“We need to look at gut health, the microbiome, our poisoned food supply; maybe we need to look at environmental exposures that cause cancer, not just the chemo to treat it; maybe treat diabetes with cooking classes instead of throwing meds at people; maybe we need to treat high blood pressure by talking about sleep quality,” said Makary.
Sticky Theories
Hyman says cognitive dissonance can cause blind spots, highlighting an example of a surgeon initially resistant to trying less-invasive antibiotics before surgically removing an appendix, as recounted in Makary’s book.
“Easy problems are already fixed, so how do we fix this hard problem?” said Hyman at the presentation, pointing out unjustified medical opinions can persist for decades.
Such opinions include the ideas that “opioids are not addictive, or antibiotics won’t hurt you, or hormone therapy causes breast cancer even though the data never supported it, the dogma of the food pyramid,” said Makary.
“We love to hold on to old ideas not because they’re better or more logical or [more] scientifically supported than new information, but just because we heard it first,” said Makary. “And it gets comfortable. It will nest in the brain, and subconsciously we will defend it.”
Peanut Allergy Mixup
Singer asked Makary about the peanut allergy dogma the American Academy of Pediatrics pushed in 2000, recommending children not eat peanuts before the age of three. It turned out to be wrong, said Singer.
“We have peanut allergies in the U.S. at epidemic proportions, [yet] they don’t have them in Africa and parts of Europe and Asia,” said Makary. The United States “got it perfectly backward,” said Makary. “Peanut abstinence results in a sensitization at the immune-system level.”
An early introduction of peanuts reduces the incidence of people identified with peanut allergies at a rate of 86 percent, Makary told the audience.
Makary said he confronted those who argued for peanut abstinence, noting there were no studies to back up the recommendation. They replied that they felt compelled to weigh in because the public wanted something done, said Makary.
‘Demonized’ HRT
The recommendation against hormone replacement therapy (HRT) for older women because of breast cancer risk is another example of misguided groupthink, Makary told the audience.
“It is probably the biggest screw-up in modern medicine,” said Makary.
“HRT replaces estrogen when the body stops producing it,” said Makary. “Women who start it within 10 years after the onset of menopause live on average three and a half years longer, have healthier blood vessels, they will have 50 to 60 percent less cognitive decline, the risk of Alzheimer’s goes down by 35 percent. Women feel better and live longer. The rate of heart attacks goes down by half. And their bones are stronger. There is probably no medication that has a greater impact on health outcomes in populations than hormone therapy.”
A demonization campaign against HRT began 22 years ago when a single scientist at the National Institutes of Health held a press conference saying HRT was linked to breast cancer, Makary told the audience.
“The incredible back story is that no data were released at that announcement,” said Makary. “And today there is no statistically significant increase [of breast cancer].”
Political Challenges
Among the broad range of topics in the 75-minute discussion, the panelists considered how medical groupthink affects government policy.
“Agencies make decisions in the shadows of how [they think] Congress will react,” said Hyman. “Congress can make your life really miserable if you’re a federal regulator. They can cut your budget, call you in, and yell at you because you haven’t taken aggressive steps to protect the American public.”
Makary said doctors must avoid making recommendations based on “gut feelings.”
“We spend a staggering amount of money on delivering health care, and very little money on what actually works,” said Hyman.
AnneMarie Schieber ([email protected]) is the managing editor of Health Care News.
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After the Smith government recently announced its shift to a new approach for funding hospitals, known as “activity-based funding” (ABF), defenders of the status quo in Alberta were quick to argue ABF will not improve health care in the province. Their claims are simply incorrect. In reality, based on the experiences of other better-performing universal health-care systems, ABF will help reduce wait times for Alberta patients and provide better value-for-money for taxpayers.
First, it’s important to understand Alberta is not breaking new ground with this approach. Other developed countries shifted to the ABF model starting in the early 1990s.
Indeed, after years of paying their hospitals a lump-sum annual budget for surgical care (like Alberta currently), other countries with universal health care recognized this form of payment encouraged hospitals to deliver fewer services by turning each patient into a cost to be minimized. The shift to ABF, which compensates hospitals for the actual services they provide, flips the script—hospitals in these countries now see patients as a source of revenue.
In fact, in many universal health-care countries, these reforms began so long ago that some are now on their second or even third generation of ABF, incorporating further innovations to encourage an even greater focus on quality.
For example, in Sweden in the early 1990s, counties that embraced ABF enjoyed a potential cost savings of 13 per cent over non-reforming counties that stuck with budgets. In Stockholm, one study measured an 11 per cent increase in hospital activity overall alongside a 1 per cent decrease in costs following the introduction of ABF. Moreover, according to the study, ABF did not reduce access for older patients or patients with more complex conditions. In England, the shift to ABF in the early to mid-2000s helped increase hospital activity and reduce the cost of care per patient, also without negatively affecting quality of care.
Multi-national studiesontheshift to ABF have repeatedly shown increases in the volume of care provided, reduced costs per admission, and (perhaps most importantly for Albertans) shorter wait times. Studieshavealsoshown ABF may lead to improved quality and access to advanced medical technology for patients.
Clearly, the naysayers who claim that ABF is some sort of new or untested reform, or that Albertans are heading down an unknown path with unmanageable and unexpected risks, are at the very least uninformed.
And what of those theoretical drawbacks?
Some critics claim that ABF may encourage faster discharges of patients to reduce costs. But they fail to note this theoretical drawback also exists under the current system where discharging higher-cost patients earlier can reduce the drain on hospital budgets. And crucially, other countries have implemented policies to prevent these types of theoretical drawbacks under ABF, which can inform Alberta’s approach from the start.
Critics also argue that competition between private clinics, or even between clinics and hospitals, is somehow a bad thing. But all of the developed world’s top performing universal health-care systems, with the best outcomes and shortest wait times, include a blend of both public and private care. No one has done it with the naysayers’ fixation on government provision.
And finally, some critics claim that, under ABF, private clinics will simply focus on less-complex procedures for less-complex patients to achieve greater profit, leaving public hospitals to perform more complex and thus costly surgeries. But in fact, private clinics alleviate pressure on the public system, allowing hospitals to dedicate their sophisticated resources to complex cases. To be sure, the government must ensure that complex procedures—no matter where they are performed—must always receive appropriate levels of funding and similarly that less-complex procedures are also appropriately funded. But again, the vast and lengthy experience with ABF in other universal health-care countries can help inform Alberta’s approach, which could then serve as an example for other provinces.
Alberta’s health-care system simply does not deliver for patients, with its painfully long wait times and poor access to physicians and services—despite its massive price tag. With its planned shift to activity-based funding, the province has embarked on a path to better health care, despite any false claims from the naysayers. Now it’s crucial for the Smith government to learn from the experiences of others and get this critical reform right.
Officials at the the National Institutes of Health and the Centers for Medicare & Medicaid Services announced a partnership Wednesday to research “root causes of autism spectrum disorder.”
As part of the project, NIH will build a real-world data platform enabling advanced research across claims data, electronic medical records and consumer wearables, according to the agencies.
“We’re using this partnership to uncover the root causes of autism and other chronic diseases,” said HHS Secretary Robert F. Kennedy Jr. “We’re pulling back the curtain – with full transparency and accountability – to deliver the honest answers families have waited far too long to hear.”
CMS and NIH will start this partnership by establishing a data use agreement under CMS’ Research Data Disclosure Program focused on Medicare and Medicaid enrollees with a diagnosis of autism spectrum disorder or ASD.
“This partnership is an important step in our commitment to unlocking the power of real-world data to inform public health decisions and improve lives,” NIH Director Dr. Jay Bhattacharya said. “Linking CMS claims data with a secure real-world NIH data platform, fully compliant with privacy and security laws, will unlock landmark research into the complex factors that drive autism and chronic disease – ultimately delivering superior health outcomes to the Americans we serve.”
Researchers will focus on autism diagnosis trends over time, health outcomes from specific medical and behavioral interventions, access to care and disparities by demographics and geography and the economic burden on families and healthcare systems, according to a news release.
