Medicine is an art for good reason: it's practiced by imperfect, subjective humans prone to bias and error (also known as doctors). Yet despite these human constraints, medicine strives to uncover biological truths that can reduce suffering and treat disease. In his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health, surgeon Dr. Marty Makary explores numerous instances where medicine has fallen short of this ideal.
While Makary provides valuable observations about medicine’s shortcomings, in this review I’ll argue that his solutions—like urging physicians to “ask more questions”—don’t fully address the core issue: medicine is practiced by humans, and humans are inherently flawed. Although we must continue striving for higher standards, a better future in healthcare depends on designing systems that recognize and work with these flaws, rather than pretending they don’t exist.
Strengths of Blind Spots
Makary’s storytelling makes Blind Spots engaging and thought-provoking. Each chapter delves into a particular failure in medicine, such as the rise in peanut allergies, misguided hormone-replacement therapy, and overuse of antibiotics. Through interviews with experts and decision-makers, Makary exposes the flawed logic and assumptions behind many widely accepted medical practices.
The strength of Blind Spots lies in how it balances evidence and nuance while maintaining a narrative that flows smoothly. Makary also highlights the crucial role of outlier physicians—those who held unconventional views that proved correct over time but were often shunned by the medical establishment. I think we need to challenge groupthink and embrace new perspectives — especially when we’re working with limited information — and Makary drives that point home.
Makary’s not wrong; most of the topics he covers I’ve known about — and agreed with — for years and are certainly ripe for his criticism. I recall a professor in medical school telling us we should refer to topics without good evidence as “an area of ignorance,” rather than assuming what we were taught was automatically true.
While reading the book, I got the sense that Dr. Makary and I are cut from the same cloth, so I understood where he’s coming from:
- We both deeply value evidence-based medicine over tradition and recognize that modern medicine still has gaps in understanding human health.
- We both enjoy challenging the status quo and pushing against conventional norms.
- We have created online resources to promote better medical care—my contributions include MDCalc and theNNT.
Although we must continue striving for higher standards, a better future in healthcare depends on designing systems that recognize and work with human limitations rather than expecting perfection.
Where Blind Spots Falls Short
Some of Dr. Makary’s solutions are overly optimistic, or to me not actionable enough? Asking doctors to “challenge assumptions” and “say ‘I don’t know’ more often” is great, but the deeper issue is that medicine will always be constrained by human nature. Physicians are highly trained and experienced, but they are still emotional, tribal, and imperfect humans. The expectation that doctors will consistently remain objective or free from bias is unrealistic (however ideal). Ironically, it’s the pressure to meet such impossible standards that contributes to many of the problems Makary highlights. (It would be sacrilege for the New England Journal to say “we don’t know” — it’s the New England Journal after all, they should know!)
The Tradeoffs of Guidelines and Groupthink
Makary is right to criticize the rigid structures in medicine, such as guidelines, committees, and consensus-driven policies,which then often turn into regulatory and quality metrics. But these structures also serve a purpose. Without at least some consensus, care would become infinitely chaotic, with no consistent standards to guide decision-making.
Doctors rely on heuristics like “give Tylenol for fever” or “always transfuse 2 units of blood” (two more examples from the book) not because they’re perfect, but because they’re heuristic starting points. While rigid guidelines have drawbacks (and I’ll be the first to tell you that), removing them entirely would create new challenges to tackle.
Makary's Own Blind Spots
An Insider Critiquing the System
Throughout the book, Makary positions himself as one of these outsiders: a critic of the medical establishment, but his career is an academic one: he is a famous pancreatic surgeon at Johns Hopkins. While his critiques of groupthink and rigid structures are valid, it’s essential to recognize that he’s railing against a system that he seems to also represent.
Makary’s Most Controversial Claims
I believe Dr. Makary has made some significant errors in his previous work that warrant the same level of skepticism as those he rails against in Blind Spots. One of the most prominent examples is his Wall Street Journal opinion piece in February 2021 suggesting that the US would reach herd immunity by April—a claim that was tragically incorrect, as hundreds of thousands of American deaths followed that period.
Even more concerning is Makary’s 2016 paper in the British Medical Journal, where he and his co-author claimed that medical errors are “the third-leading cause of death in the US.” This paper has been widely criticized for using flawed statistical methods and drawing questionable conclusions. (Taken at face value, the paper implies that 1 in 3 hospital deaths is due to medical error.) Makary's assertion about medical errors undermines public trust in healthcare professionals and contributes to a more adversarial patient-doctor relationship. (Even the NRA used it to boast that medical error is deadlier than firearms.)
If Makary is to hold others accountable for their errors, it's only fair that he scrutinizes his own past claims which have influenced public perception, too.
The Slow Pace of Progress in Medicine
Makary’s frustration with the slow pace of change is understandable, but I believe this incremental progress is, to some degree, a necessary safeguard. Medicine is slow to adopt new ideas because it prioritizes patient safety (ironically sometimes prioritizing the status quo actually creates harm, as Makary points out in the book). Institutional review boards, for example, are often reluctant to approve studies that question established standards of care, but this caution stems from a dark history of unethical medical experimentation. I suspect Makary, like me, would like to see more questioning of assumptions and status quo — and one of his best recommendations comes in his final chapter: health professionals and the public must know which recommendations are based on opinion and which are based on robust medical evidence.
Additionally, advancement in medicine will always lag behind scientific discovery because new ideas require time for testing, validation, and acceptance. While we should strive to accelerate this process (and big data offers some exciting possibilities), we must also recognize that slow progress isn’t always a flaw—it’s part of ensuring that changes are safe.
Finally, I think some of this slow progress is again, just human nature. We often hear this as Planck’s Principle and we see this in many fields: Science progresses one funeral at a time. Said another way by Arthur Schopenhauer, “All truth passes through three stages: First, it is ridiculed; Second, it is violently opposed; and Third, it is accepted as self-evident.”
Conclusion: Building Systems that Embrace Human Limitations
Makary's Blind Spots succeeds in diagnosing medicine's ailments but prescribes incomplete remedies. Yes, doctors should question more and acknowledge uncertainty. But lasting change requires something more fundamental: healthcare systems designed to anticipate and accommodate human limitations rather than ignore them.
I also think Dr. Makary misses his own blind spots, and that weakens the book. Perhaps he thinks he's batting a thousand, and his own claims have never been as wrong as the assumptions made by the rest of the healthcare system. But without some introspection from the author that he's been wrong in the past as well, his "ask more questions" mantra feels a little bit *holier-than-thou. *
For those inside and outside medicine, this book offers crucial insights into how medical knowledge evolves—and why it often evolves too slowly. Makary's stories are compelling, and even for a seasoned physician, there are fascinating revelations—like the fact that many so-called ovarian cancers actually originate in the fallopian tubes. While these insights make the book worth reading, we must recognize that the solution isn't to demand superhuman or un-human performance from doctors. Instead of demanding perfection from individuals, we need systems that channel our very human limitations into collective strengths.