*Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health*

 [[{“value”:”That is the new book by Marty Makary.  Since Makary has been nominated to head the FDA, I am surprised this work is not receiving more attention. In the book, Makary is sympathetic to HRT, skeptical about a lot of antibiotic use (microbiome issues), says it is fine to ingest the cholesterol in eggs, and
The post *Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health* appeared first on Marginal REVOLUTION.”}]] 

That is the new book by Marty Makary.  Since Makary has been nominated to head the FDA, I am surprised this work is not receiving more attention.

In the book, Makary is sympathetic to HRT, skeptical about a lot of antibiotic use (microbiome issues), says it is fine to ingest the cholesterol in eggs, and he is critical of earlier attempts to separate mothers and their babies.  He believes silicone breast implants got a bum rap, and thinks we have screwed up the treatment of peanut allergies.  A common theme is that there is too much groupthink in modern medicine and medical research.  He wonders if we should be suspicious of fluoride, in part because of microbiome issues.  He briefly worries about the ingestion of microplastics.  I would not say I have concrete views on these questions, but overall I came away from this book comfortable with him running the FDA, at least relative to past candidates.  I am skeptical of his views on fluoride, however, as the recent flurry of debate seems to have settled on a “fluoride is a net benefit” side.  I also worry a bit he is picking on some easy cases (e.g., separating mothers from their babies), and not going hard enough on the incentive problems in U.S. health care and its research communities.

Makary is not obviously an accelerationist.  Most of all, he likes to avoid groupthink and give matters a further look.  While such a view is hard to disagree with, it makes me nervous in a bureaucratic context.  In reality, “groupthink” is how many things get approved as quickly as they do.  Just how many public health debates are we supposed to be reopening here?  Should that be the priority of the FDA?  Or should speeding up clinical trials and lowering their cost be the emphasis?

When he thinks about FDA matters, is he willing to have questions of incentives arise first in his thoughts?  If so, that would be a break from his writing career so far.

I also would be curious to know why he thinks “his sides of these debates” will, on the whole, avoid groupthink more than the status quo has done.  Lemon-picking from the status quo, even if we agree with him on every point, does not clarify this all-important question.  Groupthink stems from incentives, and what kind of better incentives will he build into the U.S. health care system?  He does write about “common sense,” and making things “physician-centered,” both fine and well, but I don’t see either of those as answering my questions in a scalable manner.

Makary wanted to approve and accelerate the Johnson and Johnson vaccine, a good sign in my view.  Still, on some issues he will, for my tastes, be insufficiently consequentialist (“go ahead and let them try!”) and too worried about “getting the science right” and “sampling more data.”

Marty has strong academic and research credentials, here is his Wikipedia page.  Here is more on what he has done, all positives in my view:

Makary is a director on the board at Harrow, an ophthalmic pharmaceuticals company, and an adviser to Sidecar Health, an insurance provider that aims to lower customer costs by eliminating provider networks and drug formularies.

He’s also chief medical adviser to Nava, a benefits brokerage, and chief medical officer at Sesame, a cash-pay health service market that offers compounded semaglutide, Stat reported over the weekend, raising questions about how Makary will approach the GLP-1 shortage brouhaha should he be confirmed.

Sesame’s founder, David Goldhill, wrote a well-known piece in The Atlantic about his father’s death from a hospital-acquired infection that references a surgery checklist Makary helped develop to reduce errors and adverse events.

During the pandemic he called for universal masking and opposed vaccine mandates.  He supported national lockdowns and called for “first doses first.”  He also raised doubts about children needing two doses of the Covid vaccine.  Rather than relitigate whether those are all the correct views or not, I will simply note he is not a deregulator per se.  He donated to Obama in 2008.

Here is a recent Russ Roberts podcast with Makary.

Overall, I see only upsides from this pick.  Nonetheless I also see a good chance he focuses on reform directions where I think the expected benefits are small.  So I am not excited by this pick, at least not yet.

The post *Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health* appeared first on Marginal REVOLUTION.

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