Otis Brawley's resume is impressive. He is the chief medical officer and executive vice president of the American Cancer Society, a practicing oncologist at Grady Memorial Hospital in Atlanta, and professor of hematology, oncology, medicine, and epidemiology at Emory. He graduated from the school of medicine at the University of Chicago and among other things, he completed a fellowship in medical oncology at the National Cancer Institute.
Because he is an oncologist in Atlanta who sees some of the poorest and some of the richest people in our country, and because he has taught medicine, participated in clinical research, and seen for decades the political influence that can both help and hinder medical procedures and research, I have little doubt that this guy knows what he's talking about. And what he has to say about the current state of the American health care system is pretty damned depressing.
There are, as we all know, the devastating, heart-wrenching cases of lives cut short due to inadequate access to health care that our poorest citizens experience each and every day. But in our land of disparity, there is another ugly and equally appalling side to the system that we rarely hear about--the overuse of care that ends up causing lots of agony, loss of quality of life, and at the same time, lines the pockets of doctors, drug and device makers, and others. Beware the "Cadillac" health insurance policies. Depending upon your diagnosis, and Brawley focuses primarily on cancer for the entire book, you may suffer almost as much from having too much insurance as from having not enough. This overuse of care, or specifically, the application of treatments and medications to patients who do not need them and will not benefit from them, is a major part of why health care is so expensive in America, and why it is that we spend more money than most industrialized countries and yet get much less out of the system.
Brawley spends a few chapters discussing his experiences with, and research into, prostate and breast cancers. And his controversial stance on screening for these diseases, especially among younger (under 50) people who have no signs or symptoms, is backed up with a lot of statistical data that will make most people rethink the benefits of screenings for themselves and their loved ones. Small percentages of lives are saved, but many, many more lives are damaged and much harm done to the people who test positive during these screenings, many of whom will exhibit cancers that may never grow or metastasize and may therefore never cause any problems or pose any real harm. But the option of "wait and see" is rarely offered up, even when tremendously detrimental procedures and treatments may completely diminish a person's quality of life or may even shorten their lives. Brawley goes so far as to say that the rates of death from prostate cancer may have gone down in part because of so many men dying from treatment complications before they would naturally have died from their cancer. If your treatments result in a stroke, for instance, your death will be recorded as such, rather than as "complications from prostate cancer treatment." This means that official statistics record an increase in stroke deaths and a decrease in prostate cancer. It's a reshuffling of data that is disingenuous at best.
Brawley's solution to all the problems within the health care system is simply to base treatment upon solid science and to minimize harm as much as possible. As reasonable as this seems, it means trying to untie treatment decisions from patients' insurance or money (whether the issue is lack of, or abundance of). It also means having open conversations with patients and making clear, as he so often states throughout, what the doctors know to be true, what they don't know about an issue, and what they merely believe could be true. And perhaps as importantly, it means educating ourselves and knowing what questions to ask in order to make sure we are receiving treatments that will improve our health, instead of causing us harm while helping our doctors and pharma reps line their pockets.
I wanted to read this book after seeing parts of Brawley's keynote speech to the Association of Health Care Journalists, which you can watch here:
http://www.youtube.com/watch?v=LOdDS8rd4-8&feature=related
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