How Good Medicine Gets Stuck — and Why That Matters in Southern Oregon
Imagine a river that has been flowing the same way for forty years. Engineers built the levees, the towns grew around the banks, and everyone agrees the water flows correctly. Then someone notices a drought forming upstream. A few people say the course should change. But the levees are expensive. The engineers spent their careers building them. The towns were designed for the current flow. And so the water keeps going the same direction — even as the landscape shifts.
This is not a story about a river. It is a story about how medical consensus works, and why understanding it matters — not just in academic journals, but right here in the Rogue Valley.
The Big Idea: Science Has a Human Problem
In his 2024 book Blind Spots, Dr. Marty Makary — a surgeon and public health researcher at Johns Hopkins — argues that medicine’s greatest threat is not ignorance. It is certainty. Specifically, it is the tendency of the medical community to take an idea that made sense at one point in time, embed it in guidelines, build training programs around it, and then defend it with a ferocity that has nothing to do with the evidence.
To understand why, you need to know about a psychologist named Leon Festinger. In the 1950s, Festinger developed the concept of cognitive dissonance — the mental discomfort we feel when new information conflicts with what we already believe. His research showed that the human brain, when faced with that conflict, almost never responds by simply updating its beliefs. Instead, it works overtime to dismiss, reframe, or discredit the new information. The belief stays. The evidence gets explained away.
Festinger went so far as to embed himself inside a doomsday cult in Chicago — a group that believed aliens would rescue them before a great flood on a specific date. He wanted to watch what happened when the aliens didn’t come. They didn’t. And rather than abandon their belief, the members dug in deeper. One physician in the group, Festinger noted, said quietly: “I just have so much vested in this now. My job, my family, my friends — everybody knows I’m into this. I have to hold on.”
“The purpose of science is to challenge deeply held assumptions. That’s something I follow as a thread in so many areas of modern day health recommendations.”
— Dr. Marty Makary, Blind Spots (2024)
What Festinger described in cult members plays out every day in hospital conference rooms, medical school lectures, and clinical guidelines. Makary calls this “effort justification” — the more sacrifice a person has made in service of an idea (years of training, a career built on a protocol, a reputation staked on a recommendation), the more fiercely they defend that idea even when evidence turns against it.
A Concrete Example: Treating Appendicitis Without Surgery
Consider one of the most common emergency surgeries in the United States: appendectomy. For over a century, the approach has been automatic — inflamed appendix means surgery, period. It was taught as reflex. Diagnose. Treat. Don’t think. Don’t wait.
Then a major randomized controlled trial published in JAMA in 2015 showed something unexpected: in the majority of appendicitis cases — those without rupture or an obstructing stone — a course of antibiotics was effective in about two-thirds of patients. No surgery required. The patient avoided an incision, anesthesia, infection risk, and hernia risk. A second randomized trial confirmed it. Then a third.
Makary describes sharing this research with a surgical colleague. The colleague said he didn’t believe it. Makary pointed to the first randomized controlled trial, published in a top journal. The colleague said he needed to see two. A second came out a year later. He needed three. A third came. The colleague’s final response: “I just think you’re better with it out.”
This is not a story about a bad doctor. By all accounts he was skilled and dedicated. It is a story about what happens when a belief becomes identity — when the procedure you’ve performed thousands of times becomes something you are, not just something you do. Changing feels like self-betrayal.
Why This Matters Locally: Asante Rogue Regional Medical Center in Medford handles the region’s emergency surgical cases as a Level II trauma center. The non-operative protocol for uncomplicated appendicitis is well-documented in the literature and is offered at progressive institutions. If you or a family member is diagnosed with appendicitis, it is now entirely reasonable to ask whether non-operative management with antibiotics is an option for your specific case.
The Peanut Allergy Story: When a Wrong Recommendation Became Law
In the year 2000, rates of peanut allergies in American children were low and largely mild — estimated at about half a percent of the population. Concerned, the American Academy of Pediatrics issued a sweeping recommendation: all children from birth to age three should avoid all peanut products entirely. Pregnant and nursing mothers should also avoid peanuts.
The recommendation spread fast. Schools posted signs. Parents threw out peanut butter. Pediatricians enforced the rule like doctrine.
Within a few years, peanut allergy rates in the United States began to climb — sharply. A new category of allergy emerged: the severe, anaphylactic reaction so extreme that traces of peanut residue on a shared ice cream scoop could send a child to the emergency room. Emergency visits skyrocketed. Today, estimates suggest that roughly 1 in 18 American children has a peanut allergy. About 20% of schools have banned all peanut products.
What happened? The recommendation violated a fundamental principle of immunology: you must be exposed to things early in life to develop tolerance to them. This is sometimes called the “dirt theory” — children who grow up around animals, soil, and varied microbes tend to develop more robust immune systems. Parents who had followed their grandmother’s instinct and given their infants small amounts of peanut butter were, it turned out, doing the right thing. They were ridiculed as “anti-science.”
In 2015, fifteen years after the original recommendation, a landmark study published in the New England Journal of Medicine enrolled 640 infants at risk for peanut allergy and randomly assigned them to early peanut exposure versus avoidance. The result was an eightfold difference in allergy rates — one of the largest odds ratios seen in clinical research. Two years later, in 2017, the National Institute of Allergy and Infectious Disease quietly issued guidance reversing the original recommendation.
Quietly. Without a press conference. Without the leaders of the original recommendation going on television to say: we were wrong, and we are sorry.
“The medical establishment got opioids wrong for 35 years. They got heart stents wrong for 15 years. They got the low-fat diet wrong for over 60 years. They got peanut allergies wrong for 17 years. Where’s the apology? Where’s the humility? That’s why there’s distrust right now.”
— Dr. Marty Makary
The Asymmetry of Fear and Correction
There is a deep asymmetry in how medical information moves. Fear travels fast. A press release saying “hormone therapy causes breast cancer” — even a flawed one, even one that misrepresented its own data — reached millions of women overnight. The correction? A footnote in a follow-up paper a decade later, read by specialists.
This is not conspiracy. It is architecture. Our media, our institutions, and our professional cultures are better designed for alarm than for careful updating. Headlines are built for catastrophe, not nuance. And when a generation of clinicians has practiced around a guideline for fifteen years, the new study telling them they were wrong does not feel like information. It feels like accusation.
Dr. Peter Attia, who discussed these ideas at length with Makary on his podcast The Drive, makes an important point about how to navigate this as a patient and as a physician. The answer is not to distrust everything — that is its own form of cognitive failure. The answer is to think in probabilities rather than certainties. Not “is this true or false?” but “how likely is this to be true, given what I know today, and what new information would cause me to update?”
That is how science is supposed to work. It is also, not coincidentally, how good doctors think — and increasingly, how empowered patients think too.
The Southern Oregon Context: A Region That Needs This Conversation
Jackson County has been designated a Health Professional Shortage Area by the federal government — meaning the region does not have enough primary care providers to meet the needs of its population. La Clinica, the region’s federally qualified health center, added twenty new providers in 2024 and is still struggling to keep pace. A 2024 Oregon workforce report found that rural and remote areas of the state have a primary care provider ratio of just 0.69 — meaning the supply of physicians falls well short of what the population actually needs.
What does this have to do with blind spots in medicine? Everything. When you can barely get an appointment, you are unlikely to spend that appointment questioning the protocol. You are grateful for the fifteen minutes. You take the prescription. You follow the recommendation. The structural shortage of time and access becomes a structural barrier to the kind of informed, questioning relationship that produces better care.
Southern Oregon is also a region with a meaningful and growing integrative medicine community. Practices like Siskiyou Vital Medicine in South Medford, Valley Integrative Health in Ashland, Bear Creek Naturopathic Clinic, Monarque Health & Wellness, and Resolute Integrative Health in Rogue River represent a parallel ecosystem of providers who are already asking different questions — about root cause, about lifestyle, about the gut, about the whole person. These providers often have more time per patient than overburdened primary care physicians in large systems. They are, in many ways, already practicing what Makary is calling for.
The gap is not between conventional and integrative medicine. The gap is between the speed of evidence and the inertia of practice — in every corner of healthcare. Reimagine Healthcare exists to help bridge that gap, so that every person in Southern Oregon — regardless of income, insurance status, or geography — has access to what the science actually says.
Call to Action
Here is what you can do, starting today:
- When your doctor gives you a recommendation, it is not rude to ask: “How strong is the evidence for this? Is this based on randomized trials, or on older consensus?” Good doctors welcome this question.
- If you are told a procedure is the only option, ask whether there are non-operative or less invasive approaches that have been studied. The appendicitis case is just one example. There are many.
- Pay attention to asymmetry in how medical news reaches you. Fear travels faster than correction. If a recommendation scared you years ago, look up what the current science says. It may have changed.
- Think in probabilities. Nothing in medicine is 100% certain. A good working assumption is: what your doctor tells you today is probably right, probably useful, and may need updating as the evidence evolves.
- Support healthcare organizations like Reimagine Healthcare that fund independent education and advocacy — not tied to pharmaceutical companies, insurance reimbursement schedules, or the inertia of academic consensus.
Source Note: The ideas and examples in this episode are drawn primarily from Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health by Dr. Marty Makary (2024). Key studies referenced include the APPAC randomized trial on antibiotic treatment of appendicitis (JAMA, 2015) and the LEAP trial on peanut exposure in infancy (NEJM, 2015).