Dr. Marty Makary’s book Blind Spots: When Medicine Gets It Wrong and What It Means for Our Health has indeed sent shockwaves through the American medical community and beyond, pulling back the curtain on systemic issues that have long been whispered about but rarely addressed head-on. As a surgical oncologist and gastrointestinal laparoscopic surgeon at Johns Hopkins Hospital, Makary brings a rare blend of insider expertise and a willingness to challenge the status quo. His book doesn’t just point fingers—it lays bare a healthcare system riddled with inefficiencies, misaligned incentives, and a troubling lack of transparency that affects millions of patients. Let’s dive deeper into some of the key revelations and their implications.

The claim that over 50% of surgeries are unnecessary is staggering. This isn’t just about a few questionable decisions—it suggests a pervasive culture where surgical intervention is often the default rather than a last resort. Studies Makary cites likely draw from analyses of procedures like hysterectomies, spinal fusions, or appendectomies, where evidence shows many could be avoided with conservative management or alternative therapies. This over-reliance on surgery ties directly into the financial incentives he highlights: the fee-for-service model rewards doing more, not doing better. Surgeons earn significantly more for operating than for recommending physical therapy or watchful waiting, creating a subtle but powerful bias.

The statistic that medical errors are the third leading cause of death—behind only heart disease and cancer—underscores the human cost of these systemic flaws. This figure, often traced back to research like the 2016 Johns Hopkins study co-authored by Makary himself, estimates over 250,000 deaths annually from preventable mistakes, including unnecessary procedures. It’s a sobering reminder that the tools meant to heal can harm when wielded without sufficient scrutiny. Combine this with the $1 trillion in waste—a figure supported by groups like the Institute of Medicine—and you see a system bleeding resources that could be redirected to actual care.

Makary’s point about doctors avoiding procedures they recommend is particularly damning. It suggests a disconnect between professional practice and personal conviction, perhaps driven by fear of litigation (defensive medicine) or pressure to meet hospital quotas. For instance, a doctor might push a patient toward a spinal surgery they’d personally decline, knowing the risks outweigh the benefits for many. This hypocrisy erodes trust, a cornerstone of the doctor-patient relationship.

The overuse of specific interventions—like 40% of knee replacements or one in three C-sections—highlights how routine procedures can become normalized despite shaky evidence. Knee replacements, for example, are often marketed as a quick fix for arthritis, yet studies (e.g., from the New England Journal of Medicine) show physical therapy can be just as effective for many patients, with fewer risks. C-sections, meanwhile, are sometimes scheduled for convenience or to avoid potential lawsuits, even though they increase maternal complications like infection or hemorrhage compared to vaginal births when not medically indicated.

The overuse of antibiotics and misleading screening tests reveal another layer: overdiagnosis and overtreatment fueled by habit and profit. Antibiotics for viral infections—a practice debunked decades ago—persist because they placate anxious patients and pad billing. Screening tests like PSA or mammograms, while lifesaving for some, often detect indolent conditions that would never cause harm, thrusting patients into a cascade of biopsies, surgeries, and anxiety. Makary’s example of thyroid cancer overdiagnosis mirrors this: the rise in cases isn’t due to more disease, but more detection of harmless nodules, thanks to ubiquitous imaging.

Financial opacity compounds these issues. The lack of transparency in pricing means patients are blindsided by bills they can’t anticipate or negotiate, a problem unique to the U.S. among developed nations. Meanwhile, hospital rankings based on procedure volume rather than outcomes incentivize a conveyor-belt approach to care—more surgeries, more revenue, regardless of necessity or success.

Perhaps most troubling is the end-of-life overtreatment and lack of accountability. Aggressive interventions in a patient’s final months—think ventilators or chemo with no realistic benefit—drain resources and dignity, often against the patient’s wishes. Yet there’s little pushback because no one’s held responsible. Doctors aren’t trained to weigh costs (medical schools teach too little about this), and the system doesn’t penalize excess.

Makary’s call for second opinions (ignored by 90% of patients) and informed choice (patients rarely hear all options) points to a fix: empower patients. But that’s tough when burnout (high among providers) and entrenched interests—like higher pay for surgery over prevention—keep the machine humming. His book isn’t just a critique; it’s a plea for a healthcare revolution—one prioritizing outcomes over output, transparency over tradition, and patients over profits. The sales figures suggest the public’s listening. The question is whether the system will.

New book in USA

*Blind Spots: when medicine gets it wrong and what it means for our health

Dr Marty Makary, who practices surgical oncology and gastrointestinal laparoscopic surgery at the Johns Hopkins Hospital, has caused an earthquake in the American medical world by putting in black and white certain facts which are normally kept away from public gaze. No wonder his book, Blind Spots: When Medicine Gets it wrong and what it means for our health’ is selling like the proverbial hot cakes!

He reveals that: 1. *Over 50% of Surgeries Are Unnecessary*: Studies suggest that more than half of all surgeries performed in the U.S. may not be medically necessary. 2. *Medical Errors Are the Third Leading Cause of Death*: Medical errors, including unnecessary treatments and surgeries, are the third leading cause of death in the United States, after heart disease and cancer. 3. *$1 Trillion in Waste*: The U.S. healthcare system wastes an estimated $1 trillion each year due to unnecessary treatments, tests, and administrative inefficiencies. 4. *Doctors Perform Procedures They Would Avoid for Themselves*: Many doctors admit that they would not undergo certain surgeries or treatments that they routinely recommend to their patients. 5. *Hospital Rankings Are Misleading*: Many hospital ranking systems are based on the number of procedures performed rather than the quality of outcomes, incentivising hospitals to do more, not better. 6. *40% of Knee Replacements Are Unnecessary*: A significant portion of knee replacement surgeries is unnecessary and could be avoided with less invasive treatment options. 7. *C-Sections Are Overperformed*: In the U.S., about one in three babies is delivered via cesarean section, often without a medical necessity, increasing risks for both mother and child. 8. *Overuse of Antibiotics*: Antibiotics are frequently prescribed for viral infections, which they do not treat, contributing to antibiotic resistance and harming patients’ microbiomes. 9. *Lack of Transparency in Healthcare Pricing*: Most patients have no idea what a procedure will cost until after it is performed, contributing to skyrocketing healthcare expenses. 10. *End-of-Life Overtreatment*: A significant portion of healthcare spending is on aggressive treatments in the last year of life, even when these treatments offer little or no benefit to the patient. 11. *Misleading Screening Tests*: Many routine cancer screening tests, like PSA for prostate cancer or mammograms, can lead to overdiagnosis, resulting in unnecessary treatments and anxiety. 12. *90% of Patients Don’t Get a Second Opinion*: Despite the importance of second opinions in avoiding unnecessary treatments, the vast majority of patients don’t seek them. 13. *Financial Incentives for Overtreatment*: The fee-for-service payment model encourages doctors to perform more procedures, as they are paid per treatment rather than for outcomes. 14. *Routine Care for Low-Risk Pregnancies*: Many low-risk pregnancies are treated as high-risk, leading to unnecessary interventions, tests, and procedures. 15. *Doctors Are Paid More for Surgery Than Non-Surgical Care*: Doctors are financially incentivised to perform surgeries because they are reimbursed more for surgical interventions than for preventive or conservative treatments. 16. *Overuse of Imaging*: Diagnostic imaging tests like MRIs and CT scans are overused, leading to incidental findings that often result in unnecessary surgeries and treatments. 17. *Up to 30% of Healthcare Is Unnecessary*: Research suggests that up to 30% of all healthcare provided in the U.S. is unnecessary or even harmful. 18. *Overdiagnosis of Thyroid Cancer*: The rise in thyroid cancer diagnoses is largely due to overdiagnosis of small, non-threatening tumours, leading to unnecessary surgeries and treatments. 19. *Defensive Medicine*: Physicians frequently order unnecessary tests or treatments not because they are needed, but because they are afraid of being sued for malpractice. 20. *Lack of Accountability for Overtreatment*: There is little accountability in the healthcare system for doctors who perform unnecessary treatments or surgeries. 21. *Medical Schools Teach Too Little About Costs*: Medical schools rarely teach doctors about the cost of healthcare services, leaving them unaware of the financial burden their recommendations place on patients. 22. *Prostate Cancer Overdiagnosis*: The PSA test for prostate cancer often leads to overdiagnosis and unnecessary treatments, such as surgery or radiation, which may cause more harm than good. 23. *Patients Are Rarely Informed of All Options*: Many doctors do not inform patients of all treatment options, including less invasive or conservative alternatives. 24. *Surgical Complication Rates Are Underreported*: Many hospitals underreport their surgical complication rates, hiding the true risks of certain procedures from the public. 25. *Burnout in Healthcare Professionals*: The pressure to perform more procedures, combined with the administrative burden, contributes to high rates of burnout among healthcare providers.

These facts from Blind Spots expose the widespread problem of unnecessary healthcare in the United States and other developed nations, emphasizing the need for systemic changes to prioritise patient safety, informed decision-making, and value-based care..