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Pamela Paul

The Medical Establishment Closes Ranks, and Patients Feel the Effects

By Pamela Paul

Opinion Columnist

You probably know about the surge in childhood peanut allergies. Peanut allergies in American children more than tripled between 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 issued 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 . Moreover, at least one of 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 on peanut allergies in 2006, doctors expressed a wide range of theories, at the same time that the “ hygiene hypothesis ,” which 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 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 ” 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 by Lack, the A.A.P. fully reversed its early position, now telling parents to feed their children peanuts early.

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 .”

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 insisting that “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 to test for H.I.V. antibodies. In the interim, half of American hemophiliacs , and many 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 unequivocally 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 . In the interim, millions of women suffered withdrawal from hormone therapy 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 on 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 .

When it comes to medical certainty in the face of dissent, it’s useful to remember the case of Ignaz Semmelweis . Semmelweis 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 . 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.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .

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

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Pennsylvania state senator sues critics of his book about wwi hero sgt. york.

Mark Scolforo

Associated Press

HARRISBURG, Pa. – A Pennsylvania state senator and former GOP gubernatorial candidate whose support for Donald Trump drew him to the U.S. Capitol on Jan. 6 has sued a Canadian university and nearly two dozen academics over criticism of him and his research into World War I hero Sgt. Alvin York.

Sen. Doug Mastriano's defamation, racketeering and antitrust lawsuit, filed in western Oklahoma federal court, seeks at least $10 million in damages from defendants including history professors and the University of New Brunswick.

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A motion seeking to have the case thrown out, filed Thursday by one of the defendants, argued that the case violates an Oklahoma law against lawsuits designed to stifle public debate, that it makes a defamation claim that isn't legally viable, and that Mastriano is trying to stretch antitrust and racketeering laws “beyond recognition to silence critics of his scholarship.”

Backlash against his research claims by experts in World War I history and on York — and from a faculty member at the Canadian university about how his degree was awarded — was the subject of a March 2021 story by The Associated Press . Mastriano, with former President Trump's backing, lost the Pennsylvania governor's race the following year to Democrat Josh Shapiro by nearly 15 percentage points .

York was awarded the the Medal of Honor for leading U.S. soldiers behind German lines in France during World War I to disrupt machine gunfire. More than 20 German soldiers were killed and 132 captured. A movie about York's heroics won Gary Cooper a best actor Academy Award, and the story was memorialized in comic books.

Mastriano is represented by Emmitsburg, Maryland, lawyer Dan Cox, a Republican who lost the Maryland governor's race in 2022 and spent most of 2023 as Mastriano's $46-an-hour state Senate chief of staff. Cox and Mastriano did not respond to messages seeking comment.

In seeking dismissal of the case, University of New Brunswick administrators and staff called it “a dispute over academic protocol that should be resolved by an educational committee but instead has been dressed up as an international conspiracy.” They argued Mastriano's allegation that he was harmed personally is not the type of injury to competition required for an antitrust claim.

Mastriano, the university defendants said, “does not assert precisely what he contends were false and defamatory about the statements” they are purported to have made. They called the lawsuit “vague, conclusory and utterly incomprehensible.”

University officials and lawyers did not respond to messages seeking comment.

In response, Mastriano argued in a filing that he “does not have to recite the defamation word for word, becoming his own distributor of what is false, in order to well plead a defamation claim.”

The lawsuit filed in May describes Mastriano as “the victim of a multi-year racketeering and anti-trust enterprise seeking to derivatively steal, use and thereupon debunk his work, taking the equity and market therefrom," costing Mastriano millions in "tourism-related events, validated museum artifacts, book, media, television and movie deals." He says his publisher has “greatly reduced publications” and stopped possible second editions of his books.

He claims that he has been prevented from getting university job opportunities, that his book sales have been reduced and that the criticisms interfered with his short-lived interest in seeking the 2024 Republican nomination for U.S. Senate . As a result, he says, he has endured “sleepless nights, physical illness and extreme emotional pain and suffering.”

The lawsuit says Mastriano has been “assessed by the Veteran Affairs (VA) administration as 100% disabled,” but the retired colonel does not explain the how his service in the U.S. Army “took a heavy toll on him.”

He sued University of New Brunswick President Paul Mazerolle and professor David MaGee, the school's vice president of research, as well as professor Drew Rendall, who a few months before the 2022 election for Pennsylvania governor made public Mastriano's dissertation that was based on his research into York.

Another defendant is James Gregory, who as a University of Oklahoma graduate student and researcher into World War I history and York filed an academic fraud complaint against Mastriano with the University of New Brunswick. Gregory is now director of the William A. Brookshire LSU Military Museum in Baton Rouge, Louisiana.

“Mastriano asserts that voters ‘tied’ Gregory's criticism of Mastriano's scholarship to their decisions not to vote for him on several occasions,” Gregory argued in the motion to dismiss. “That's not an anti-trust violation — it's democracy.”

The University of New Brunswick has been reviewing events around its decision to grant Mastriano a doctorate in 2013 for his York research, setting up an investigative committee whose work has been done out of the public eye. Mastriano sued three people he said constitute that committee, and they have also argued in a court filing the case should be dismissed.

Mastriano said he was in regular contact with Trump in the months after Trump lost the 2020 election and sought to overturn the results. Mastriano had been scheduled to speak on the U.S. Capitol steps during the early afternoon of Jan. 6 and had organized charter buses to Trump’s speech . He was also photographed in the crowd outside the Capitol. Mastriano has maintained he broke no laws and has not been charged.

Copyright 2024 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

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