A promise, a pact: advice and practices born from scientific evidence will improve our health. There modern medicine rests on this pillar, a bond of trust between the science and the peoplewhich is based on research and on guidelines: the result of years of study, trials and reviews. But sometimes, they hide behind the labels of absolute certainty decisions made hastily, fragile evidence And economic interests. «And what if medicine, in an attempt to protect us, had sometimes gone the wrong way?». It is a disturbing question, because it delves into the heart of our pact, and relegating it to the delirium of the usual anti-science guru would be convenient and reassuring: only that asking it is one of the most important scientists in the world.
The book that makes medicine tremble
Marty Makary, yeah oncologist surgeon at the John Hopkins School of Medicine and by March 2025 commissioner of the US FDAawakens our sleepy consciences with his latest book, When medicine gets it wrong (Newton Compton, 352 pages, 14.90 euros), released in Italy a few weeks ago. Pages that force you to measure the distance betweenauthority of the medical council and the data fragilityand to deal with an uncomfortable reality: many healthcare decisions arise from lobbying interests or from methodological errorsthen raised to indisputable truths. “Time and time again, institutions and organized medicine have silenced the dissenting opinions of highly qualified doctors, creating the illusion of consensus,” says Makary. «This attitude has a very high cost: extinguishes the voice of the pioneersslows down error correction e undermines public trust».
A “disruptor” of science
Attention: the American scientist he is not an enemy of sciencefar from it. It’s what in America is called a “disruptor”an innovator who is not afraid to go against the established order to create new things. Early in his career, he set out to create a control checklist – modeled on that of airplane pilots – to improve the safety of surgical interventionsbecause “simplicity, in medicine, is often the highest form of innovation”. Subsequently, those protocols came into force everywhere. He shined a light onabuse of antibioticslong before the problem ofantibiotic resistance were it a global emergency like today.
The debate that divides the medical world
This is why his book stands monopolizing the medical debate all over the world. «The paradox is both methodological and cultural» says a Panorama Daniel Coenmember of the board of the Academy of emergency medicine and care. «Medicine also gains credibility by admitting its limitations, because this is the way knowledge proceeds. If he doesn’t, and Marty Makary is right about this, undermines the relationship of trust with people. I would add that doctors often think in qualitative and not quantitative terms: it’s good or bad, it’s black or white.”
It’s a shame that in reality things are more faded: playing with i numbers it is one of the easiest ways to give weight to the results of your research, and it is often used in various studies relative improvement percentages rather than absolute. «If I say that treatment “That is, instead of having a 96 out of 100 chance of not dying, I will have a 97. Good thing, but certainly not exciting.”
Mistakes that cost lives
Also because then the consequences of this methodological confusionin the long run, they can be destabilizing: Makary cites an estimate that approx 140 thousand women they would have died prematurely, within twenty years, because they did not resort to hormone replacement therapy and therefore suffered pathologies related to menopause. Hence his fierce criticism against gynecologists and general practitioners who have not prescribed it for decades. «Telling women to avoid hormone replacement therapy because it causes breast cancer may have been the biggest mistake of modern medicine. Yet, inexplicably, the dogma is still alive”, writes the scientist, who now as FDA commissioner has taken action.
And what about theappendicitis? Although three randomized trials have shown that in 75 percent of cases patients do not need surgery – the problem can be controlled with antibiotics – today, says Makary, «only half of surgeons have incorporated this approach into their practice. The other half continues to operate on all patients. This means that, in America, whether you go under the knife for appendicitis depends on who’s on duty when you enter the emergency room.”
Guidelines: tools or dogmas
But what’s behind these systemic errors? The author identifies multiple levels of responsibility: the selection of evidencethe audit processes subjected to dominant narratives, economic and institutional pressurescommittees that rarely review recommendations as rigorously as they promulgated them. The result is a structure that rewards institutional certainty more than theself-correction.
And right on guidelines we need to clarify. “They are a decision support tool, to be adapted on a case-by-case basis,” he says David New Yearfull professor of Cardiology at the University of Catania. «They arise from a rigorous process, but they have to constantly updatebecause science evolves. Admitting limitations does not weaken medicine: on the contrary, it demonstrates that it is a living system.”
From the pandemic to the price of dogmas
Obviously, if we’re talking about breach of the trust agreementthoughts turn to the pandemic COVID-19between contradictory indications, bans, changes of direction on vaccines and a communication that has left profound consequences. Makary also recounts a personal episode: the ban on participating in a conference because he was not “up to date” with vaccinations, despite having had two doses and already contracted an infection. On the topic of vaccines, the confusion – especially around AstraZeneca – has created along wave of skepticism which today is even reflected in the decline in flu vaccinations.
Makary then shines a spotlight on the gender dysphoriaciting the doctor’s case Lisa Littmann from Brown University, dismissed after a study that challenged the dominant narrative. “What was his crime?” writes Makary. «Having published results that they didn’t like them».
Rebuilding trust
«One of the great problems of medicine today is having transmitted to doctors a delegation logic” explains Guido BertoliniIRCCS Mario Negri. «He lost his know how to know: it’s not enough to know, you have to know how to manage knowledge.” Autonomy, acceptance of the error And transparency thus they become the key words to rebuild the lost pact.
«If we try to close the door to all errors, the truth will remain outside» he states Carlo Maria Petrinidirector of the Bioethics Unit of the Higher Institute of Health. «Communicating change and self-criticism promotes credibility of science». Return to the sickbed, with humility and competence. Admit you were wrong. Because the error is not a defeat of science: it is its own heartbeat. And the price of dogma, as we should have understood by now, is always paid in human lives.
