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WHEN THE MEDICAL ESTABLISHMENT CLOSES RANKS, PATIENTS FEEL THE
EFFECTS  
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Pamela Paul
September 19, 2024
New York Times
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_ Medical journals and conferences regularly reject presentations and
articles that overturn conventional wisdom, even when that wisdom is
based on flimsy underlying data. This can have dire consequences. _

, Carl Godfrey

 

You probably know about the surge in childhood peanut allergies.
Peanut allergies in American children more than tripled
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1997 and 2008, after doctors told pregnant and lactating women to
avoid eating peanuts and parents to avoid feeding them to children
under 3. This was based on guidance
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by the American Academy of Pediatrics in 2000.

You probably also know that this guidance, following similar guidance
in Britain, turned out to be entirely wrong and, in fact, avoiding
peanuts _caused_ many of those allergies in the first place.

That should not have been surprising, because the advice violated a
basic principle of immunology: Early exposure to foreign molecules
builds resistance. In Israel, where babies are regularly fed
peanuts, peanut allergies are rare
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the studies on which the British advice was based showed
the _opposite_ of what the guidance specified.

As early as 1998, Gideon Lack, a British pediatric allergist and
immunologist, challenged the guidelines, saying they were “not
evidence-based.” But for years, many doctors dismissed Dr. Lack’s
findings, even calling his studies that introduced peanut butter early
to babies unethical.

When I first reported
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peanut allergies in 2006, doctors expressed a wide range of theories,
at the same time that the “hygiene hypothesis
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holds that overly sterile environments can trigger allergic responses,
was gaining traction. Still, the guidance I got from my pediatrician
when my second child was born that same year was firmly “no
peanuts.”

It wasn’t until 2008, when Lack and his colleagues published a
study [[link removed]] showing that babies
who ate peanuts were less likely to have allergies, that the A.A.P.
issued a report, acknowledging there was a “lack of evidence
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for its advice regarding pregnant women. But it stopped short of
telling parents to feed babies peanuts as a means of prevention.
Finally, in 2017, following yet another definitive study
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Lack, the A.A.P. fully reversed
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now telling parents to feed their children peanuts early.

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But by then, thousands of parents who conscientiously did what medical
authorities told them to do had effectively given their children
peanut allergies.

This avoidable tragedy is one of several episodes of medical
authorities sticking to erroneous positions despite countervailing
evidence that Marty Makary, a surgeon and professor at Johns Hopkins
School of Medicine, examines in his new book, “Blind Spots: When
Medicine Gets It Wrong, and What It Means for Our Health
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Rather than remaining open to dissent, Makary writes, the medical
profession frequently closes ranks, leaning toward established
practice, consensus and groupthink. (Makary acknowledges having been
guilty of this himself.)

In this kind of environment, what begins as opinion can quickly become
dogma, especially once the profession has become wed to an idea.

“There was an internal policy that all A.A.P. recommendations had to
be consistent,” a member of the committee that issued the original
peanut guidance told Makary. “It was old dogma, perpetuated.” In
other words, Makary writes, “protecting the institution was more
important than letting the public see alternative viewpoints.”

The causes of this perpetuated mistake replicate those of other
medical errors outlined in Makary’s book.

In 1983, near the beginning of the AIDS crisis, the American Red
Cross, the American Association of Blood Banks and the Council of
Community Blood Centers rejected a recommendation by a high-ranking
C.D.C. expert to restrict donations from people at high risk for AIDS.
Instead, they issued a joint statement
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“there is no absolute evidence that AIDS is transmitted by blood or
blood products.” The overriding concern was that Americans would not
trust the blood supply, or donate blood, if people questioned its
safety.

As with the advice on peanuts, a reversal came about far later than it
should have. It took years for the blood banking industry to begin
screening donors and it wasn’t until 1988 that the F.D.A. required
all blood banks
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test for H.I.V. antibodies. In the interim, half of
American hemophiliacs
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others, were infected with H.I.V. by blood transfusions, leading to
more than 4,000 deaths.

In the case of hormone replacement therapy, millions of women used
H.R.T. to relieve the symptoms of menopause and decrease the
likelihood of bone fractures, heart attacks and even Alzheimer’s
disease in later years. But in 2002, women were told
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that taking estrogen and progestin to treat menopause symptoms
increased their risk of breast cancer. The guidance that formed the
basis of that recommendation was based on a single study, even though
the lead author of that study acknowledged to Makary years later that
it did not show a statistically significant difference in rates of
cancer among women who were on H.R.T. and those on a placebo.

As with peanuts, early dissenters were ignored, ridiculed and suffered
professional consequences. It would be years before the guidance was
corrected
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In the interim, millions of women suffered withdrawal from hormone
therapy [[link removed]] and
missed out on H.R.T.’s health benefits.

While these mistakes are appalling, more worrisome are the enduring
root causes of those errors. Medical journals and conferences
regularly reject presentations and articles that overturn conventional
wisdom, even when that wisdom is based on flimsy underlying data. For
political or practical reasons consensus is often prized over
dissenting opinions.

“We’re seeing science used as political propaganda,” Makary told
me when I spoke to him by phone. But, he argues, mistakes can’t be
freely corrected or updated unless researchers are encouraged to
pursue alternative research.

“Asking questions has become forbidden in some circles,” Makary
writes. “But asking questions is not the problem, it’s the
solution.”

With trust in science
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the wane, conspiracy theories and misinformation proliferating and
anti-vaxxers like Robert Kennedy Jr. setting a deranged example, this
may not seem like the best time to criticize the medical profession.
Yet a dose of healthy skepticism may be the healthiest attitude when
information seems contradictory, whether it’s about a decades-long
practice or newer, faddish procedures like tongue-tie surgery
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When it comes to medical certainty in the face of dissent, it’s
useful to remember the case of Ignaz Semmelweis
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was the Hungarian doctor who in 1847 proposed that doctors wash their
hands before delivering babies, to reduce the chances of “childbed
fever,” now known as postpartum infection. For making the offensive
suggestion that doctors’ hands might somehow be unclean, Semmelweis
was denounced by the medical establishment and later lost his job
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His life ended at age 47 in an insane asylum and on an especially
cruel note. He died there of sepsis, the very disease he’d fought so
hard against as a doctor.

_Pamela Paul is an Opinion columnist at The Times, writing about
culture, politics, ideas and the way we live now. _

 

* medical mistakes
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* medical industry
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* misinformation
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