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How We Do Harm: A Doctor Breaks Ranks About Being Sick in America
How We Do Harm exposes the underbelly of healthcare today―the overtreatment of the rich, the under treatment of the poor, the financial conflicts of interest that determine the care that physicians' provide, insurance companies that don't demand the best (or even the least expensive) care, and pharmaceutical companies concerned with selling drugs, regardless of whether they improve health or do harm. Dr. Otis Brawley is the chief medical and scientific officer of The American Cancer Society, an oncologist with a dazzling clinical, research, and policy career. How We Do Harm pulls back the curtain on how medicine is really practiced in America. Brawley tells of doctors who select treatment based on payment they will receive, rather than on demonstrated scientific results; hospitals and pharmaceutical companies that seek out patients to treat even if they are not actually ill (but as long as their insurance will pay); a public primed to swallow the latest pill, no matter the cost; and rising healthcare costs for unnecessary―and often unproven―treatments that we all pay for. Brawley calls for rational healthcare, healthcare drawn from results-based, scientifically justifiable treatments, and not just the peddling of hot new drugs. Brawley's personal history – from a childhood in the gang-ridden streets of black Detroit, to the green hallways of Grady Memorial Hospital, the largest public hospital in the U.S., to the boardrooms of The American Cancer Society―results in a passionate view of medicine and the politics of illness in America - and a deep understanding of healthcare today. How We Do Harm is his well-reasoned manifesto for change.
320 pages, Hardcover
First published January 3, 2012
182 people are currently reading
4919 people want to read
About the author
Otis Webb Brawley
2 books11 followersAs the chief medical officer and executive vice president of the American Cancer Society, Otis Webb Brawley, MD, is responsible for promoting the goals of cancer prevention, early detection, and quality treatment through cancer research and education. He champions efforts to decrease smoking, improve diet, detect cancer at the earliest stage, and provide the critical support cancer patients need. He also guides efforts to enhance and focus the research program, upgrade the Society’s advocacy capacity, and concentrate community cancer control efforts in areas where they will be most effective. Further, as an acknowledged global leader in the field of health disparities research, Dr. Brawley is a key leader in the Society’s work to eliminate disparities in access to quality cancer care.
Dr. Brawley currently serves as professor of hematology, oncology, medicine and epidemiology at Emory University. From April of 2001 to November of 2007, he was medical director of the Georgia Cancer Center for Excellence at Grady Memorial Hospital in Atlanta, and deputy director for cancer control at Winship Cancer Institute at Emory University. He has also previously served as a member of the Society’s Prostate Cancer Committee, co-chaired the U.S. Surgeon General’s Task Force on Cancer Health Disparities, and filled a variety of capacities at the National Cancer Institute (NCI), most recently serving as assistant director.
Currently, Dr. Brawley serves as a member of the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection and Control Advisory Committee. He served as a member of the Food and Drug Administration Oncologic Drug Advisory Committee and chaired the National Institute of Health Consensus Panel on the Treatment of Sickle Cell Disease. He is listed by Castle Connelly as one of America’s top doctors for cancer. Among numerous other awards, he was a Georgia Cancer Coalition Scholar and received the Key to St. Bernard Parish for his work in the U.S. Public Health Service in the aftermath of Hurricane Katrina.
Dr. Brawley is a graduate of University of Chicago, Pritzker School of Medicine. He completed his internship at University Hospitals of Cleveland, Case-Western Reserve University, his residency at University Hospital of Cleveland, and his fellowship at the National Cancer Institute.
from http://pressroom.cancer.org/index.php...
Dr. Brawley currently serves as professor of hematology, oncology, medicine and epidemiology at Emory University. From April of 2001 to November of 2007, he was medical director of the Georgia Cancer Center for Excellence at Grady Memorial Hospital in Atlanta, and deputy director for cancer control at Winship Cancer Institute at Emory University. He has also previously served as a member of the Society’s Prostate Cancer Committee, co-chaired the U.S. Surgeon General’s Task Force on Cancer Health Disparities, and filled a variety of capacities at the National Cancer Institute (NCI), most recently serving as assistant director.
Currently, Dr. Brawley serves as a member of the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection and Control Advisory Committee. He served as a member of the Food and Drug Administration Oncologic Drug Advisory Committee and chaired the National Institute of Health Consensus Panel on the Treatment of Sickle Cell Disease. He is listed by Castle Connelly as one of America’s top doctors for cancer. Among numerous other awards, he was a Georgia Cancer Coalition Scholar and received the Key to St. Bernard Parish for his work in the U.S. Public Health Service in the aftermath of Hurricane Katrina.
Dr. Brawley is a graduate of University of Chicago, Pritzker School of Medicine. He completed his internship at University Hospitals of Cleveland, Case-Western Reserve University, his residency at University Hospital of Cleveland, and his fellowship at the National Cancer Institute.
from http://pressroom.cancer.org/index.php...
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July 21, 2019
I don't know that I've ever read anything that came so close to summing up my years in health care. That said, there's one thing to get out of the way. The title is misleading (shocker). The appropriate title would be:
Dr. Otis' Thoughts on a Broken Health Care System and His Career in Medicine.
Back to reality. Since Dr. Otis is African-American, male, from a prestigious family, trained as an epidemiologist as well as a medical doctor, and a national healthcare leader, we clearly have different relationships to the health system. But we've both spent years in oncology, done stints in the ER and have met many of the same types of patients and unfortunately, have noticed many of the same types of problems, so minus the Dr. Otis part, there's a lot here that I will attest to as being absolutely, sadly, totally true.
It's an extremely readable book, particularly considering the health-care focus and non-fiction aspect. Granted, I've been in the field, but compared to I Contain Multitudes, which was excellent but idea-dense, this flew by. I was halfway through the book in a day. No doubt, Otis' co-writer, Goldberg, gets much of the credit. As a journalist, he's probably comfortable conveying his ideas at a generalist level.
Otis has worked for much of his career at Grady, an Atlanta hospital known for providing care to the poor. The chapter 'Chief Complaint' discusses a working-class woman, Edna, who comes in with a case of breast cancer so severe that her breast has actually fallen off (okay, this I have never heard of, being in a relatively high-healthcare-using population). He discusses the ins and outs of late stages versus early stage and points out that "Had she come early in the course of her disease, it would have cost about $30k to cure her. She could have remained a taxpayer. Her kids could have had a mother. Now, a cure is not an option. Still we’ll fight... give chemotherapy that will cost more than $150k, even though chances are that she will still die in less than two years." Otis talks about some of the specifics of breast cancer (see blog), but if you haven't heard it by now, 25% of Medicare costs are for people in their last year of life, so this concept of preventative versus "heroic" care is hardly unique.
'Brawleyism' is a short chapter on Otis Brawley, the author, and his family history as rebels. He then discusses the overall economics of the American health care system, and the fact that we're 50th in life expectancy world-wide. Again, this isn't new, but what is interesting is that he states "A rational system of health care has to have the ability to say no, and to have it stick." Very powerful stuff, and he shows how people that wanted "more" got it, basically from unscrupulous or less-caring doctors ("If I didn't do it, someone with less expertise would have"). He does talk about about how financial incentives are (were? The ACA did give incentives for these small practices to become part of big systems) built in for doctors who own/profit-share in labs, pharmacies, and imaging centers. At the very least, many have a professional and implicit bias where they believe their profession can help, although evidence may be slight.
'Cadillac Care' discusses how even people who have access to advanced care can be steered wrong. Brawley spills the beans on how bone marrow transplant programs for breast cancer were money-makers in the 1990s -20s until they were proved useless. This treatment was based based on four randomized trials, with less than 1500 people, one of which was found later to be fraudulent.
There are some similarities going on right now with CAR-T cell therapy, hailed as the next cure for cancer, only current studies are based on about 150 people. Though roughly a third of the people died. But half of them were cured (and half of those with complications), so full speed ahead.
'Red Juice' talks about a drug called Procrit, another potential lifesaver on the cancer scene back in the 2000s that turned out to be deadly (more on blog) Otis shares a bit about a woman's personal experience with it (I think she might have had 200 doses during her treatments) and how it was a money-maker, with $4.9 billion in sales in 2006 (so you can stop the bullshit about research costs, Amgen).
So it feels a little like same snake oil, different decade. People wonder how I'm old and cynical. It's because of this reading thing. I tell you, don't do it.
A couple of chapters--and again, an unfortunately common refrain in my experience--was the story of Mr. Huzjak, a 78-year old who had stage 4 non-small-cell-lung cancer (with a 5 year survival rate of about 6% for distant mets). He was comatose when brought in, but his children wanted "everything" done. The family practice doctor couldn't convince them. Otis couldn't convince them. He finally died after enduring pain (the only thing he reacted to) of LPs, CTs, chest tubes, tube feedings, a MI and chest compressions. End result: same. He passed on. Except it was traumatic for all concerned, particularly Mr. Huzjak. Oh, and expensive as well. I can't even tell you how upset I get with Americans and their concepts about death (see Death Panel Discussions, Health Care Reform). Personal example: my own mom is 74 and won't even talk about it like a reality, plan for it, whatever. Frigging baby boomers think they are going to live forever.
Some of his story is more about himself, particularly towards Part III, and about population statistics, epidemiology and preventative medicine. He uses the example of poor Ralph, who stopped in for a "free PSA screening" at a local mall, had a high PSA, had surgery, then radiation, then medical complications. (continued at blog)
TL; dr: The summation: use science-based medicine (not just evidence-based guidelines from societies, who have a vested interest); don't let your fears guide you into excessive treatment (as a patient or as a practitioner); preventative medicine costs less than curative; don't be afraid of death. There's many, many worse things than dying largely pain-free with people you love around you. Okay, I made that last part up. Otis didn't explicitly say that. He calls it "Rational Health Care."
Overall, I'd highly recommend it for people in hospitals and clinics. It should make practitioners think about what we recommend and why, and what and who is behind our recommendations. Likewise, as a consumer, it might help us understand that asking questions is good. Not just "have you done this before," or "what do other people do," but, "what does the evidence say?" Yes, there's an art to medicine, where careful assessment and questioning can get a good doctor far. A good practitioner should be able to couple that with cost-effectiveness and risk-analysis when it comes to exposure (if our cancer patients live, the odds of getting secondary cancers is quite high. We aren't helping with all the radioactive scans to 'reassure' on progress).
Reasons against five stars: It really should have left out the beginning bits of Otis' career, especially his training in epidemiology. I don't know that it was germane. There's a little tension in this story between the need to make it The Otis Story and the Breaks Ranks About Being Sick.
My blog has longer paragraphs with detail if you like, and links to stats. https://clsiewert.wordpress.com/2019/...
It's an extremely readable book, particularly considering the health-care focus and non-fiction aspect. Granted, I've been in the field, but compared to I Contain Multitudes, which was excellent but idea-dense, this flew by. I was halfway through the book in a day. No doubt, Otis' co-writer, Goldberg, gets much of the credit. As a journalist, he's probably comfortable conveying his ideas at a generalist level.
Otis has worked for much of his career at Grady, an Atlanta hospital known for providing care to the poor. The chapter 'Chief Complaint' discusses a working-class woman, Edna, who comes in with a case of breast cancer so severe that her breast has actually fallen off (okay, this I have never heard of, being in a relatively high-healthcare-using population). He discusses the ins and outs of late stages versus early stage and points out that "Had she come early in the course of her disease, it would have cost about $30k to cure her. She could have remained a taxpayer. Her kids could have had a mother. Now, a cure is not an option. Still we’ll fight... give chemotherapy that will cost more than $150k, even though chances are that she will still die in less than two years." Otis talks about some of the specifics of breast cancer (see blog), but if you haven't heard it by now, 25% of Medicare costs are for people in their last year of life, so this concept of preventative versus "heroic" care is hardly unique.
'Brawleyism' is a short chapter on Otis Brawley, the author, and his family history as rebels. He then discusses the overall economics of the American health care system, and the fact that we're 50th in life expectancy world-wide. Again, this isn't new, but what is interesting is that he states "A rational system of health care has to have the ability to say no, and to have it stick." Very powerful stuff, and he shows how people that wanted "more" got it, basically from unscrupulous or less-caring doctors ("If I didn't do it, someone with less expertise would have"). He does talk about about how financial incentives are (were? The ACA did give incentives for these small practices to become part of big systems) built in for doctors who own/profit-share in labs, pharmacies, and imaging centers. At the very least, many have a professional and implicit bias where they believe their profession can help, although evidence may be slight.
'Cadillac Care' discusses how even people who have access to advanced care can be steered wrong. Brawley spills the beans on how bone marrow transplant programs for breast cancer were money-makers in the 1990s -20s until they were proved useless. This treatment was based based on four randomized trials, with less than 1500 people, one of which was found later to be fraudulent.
There are some similarities going on right now with CAR-T cell therapy, hailed as the next cure for cancer, only current studies are based on about 150 people. Though roughly a third of the people died. But half of them were cured (and half of those with complications), so full speed ahead.
'Red Juice' talks about a drug called Procrit, another potential lifesaver on the cancer scene back in the 2000s that turned out to be deadly (more on blog) Otis shares a bit about a woman's personal experience with it (I think she might have had 200 doses during her treatments) and how it was a money-maker, with $4.9 billion in sales in 2006 (so you can stop the bullshit about research costs, Amgen).
So it feels a little like same snake oil, different decade. People wonder how I'm old and cynical. It's because of this reading thing. I tell you, don't do it.
A couple of chapters--and again, an unfortunately common refrain in my experience--was the story of Mr. Huzjak, a 78-year old who had stage 4 non-small-cell-lung cancer (with a 5 year survival rate of about 6% for distant mets). He was comatose when brought in, but his children wanted "everything" done. The family practice doctor couldn't convince them. Otis couldn't convince them. He finally died after enduring pain (the only thing he reacted to) of LPs, CTs, chest tubes, tube feedings, a MI and chest compressions. End result: same. He passed on. Except it was traumatic for all concerned, particularly Mr. Huzjak. Oh, and expensive as well. I can't even tell you how upset I get with Americans and their concepts about death (see Death Panel Discussions, Health Care Reform). Personal example: my own mom is 74 and won't even talk about it like a reality, plan for it, whatever. Frigging baby boomers think they are going to live forever.
Some of his story is more about himself, particularly towards Part III, and about population statistics, epidemiology and preventative medicine. He uses the example of poor Ralph, who stopped in for a "free PSA screening" at a local mall, had a high PSA, had surgery, then radiation, then medical complications. (continued at blog)
TL; dr: The summation: use science-based medicine (not just evidence-based guidelines from societies, who have a vested interest); don't let your fears guide you into excessive treatment (as a patient or as a practitioner); preventative medicine costs less than curative; don't be afraid of death. There's many, many worse things than dying largely pain-free with people you love around you. Okay, I made that last part up. Otis didn't explicitly say that. He calls it "Rational Health Care."
Overall, I'd highly recommend it for people in hospitals and clinics. It should make practitioners think about what we recommend and why, and what and who is behind our recommendations. Likewise, as a consumer, it might help us understand that asking questions is good. Not just "have you done this before," or "what do other people do," but, "what does the evidence say?" Yes, there's an art to medicine, where careful assessment and questioning can get a good doctor far. A good practitioner should be able to couple that with cost-effectiveness and risk-analysis when it comes to exposure (if our cancer patients live, the odds of getting secondary cancers is quite high. We aren't helping with all the radioactive scans to 'reassure' on progress).
Reasons against five stars: It really should have left out the beginning bits of Otis' career, especially his training in epidemiology. I don't know that it was germane. There's a little tension in this story between the need to make it The Otis Story and the Breaks Ranks About Being Sick.
My blog has longer paragraphs with detail if you like, and links to stats. https://clsiewert.wordpress.com/2019/...
June 6, 2013
Most of his substantive points make sense to me and seem almost unarguable. It's better to rely on clinical trials data to decide what to do than to base decisions on which Big Pharma rep just gave your MD free pizza and a pen. Quantitative reviews are useful for summarizing state of evidence on an intervention. Prostate cancer has been overtreated and represents "an epidemic of surveillance" as one of my friends likes to say. More screening is not always better. Wealth is unfortunately correlated with health care access in America. Prevention is underfunded.......
To try to be fair to the author......this may be an instance of my problem of being drawn to books on subjects on which I already know a lot. I've had cancer, conducted clinical trials, and teach assessment incl. many concepts and analyses relevant to evaluating screening tests. If you don't know anything about these subjects you might find it more informative. Even then......
[back to being snarky]......really terrible writer. Topics/chapters seemed randomly sequenced. MUCH too long. Abrasively self-impressed and contemptuous of his colleagues. Any given point (it took a long time to figure out that radical mastectomy wasn't always the best treatment for breast cancer, e.g.) is elaborated roughly as:
(a) the basic point is explained or history recounted
(b) a horror story of someone's misguided medical care is retold at great length, segmented in weird ways into multiple chapters.
(c) the motives, typically greed, of the providers are blamed for the horror story
(d) Dr. Brawley (sorry, he wants to be called "Otis", as he mentions many times in the book) to the rescue, explaining to the patient that she or he got terrible care and that he would have done everything differently
(e) Author congratulates himself for saying this and reminds you that he is a straight shooter willing to speak truth to power
(f) this will remind him of another time he spoke up in contrarian fashion, and he'll describe that meeting or conversation in detail
(g) Author will harken back to his high school days when one or another teacher advised him to always stick to the facts and evidence and not what some authority says
(h) wrapup of the now-lengthy story, with final round of self-congratulations before moving on to next anecdote.
All told, 4 stars for being right on most or all issues. 0 for being badly written and nearly insufferable. Averages to 2.
To try to be fair to the author......this may be an instance of my problem of being drawn to books on subjects on which I already know a lot. I've had cancer, conducted clinical trials, and teach assessment incl. many concepts and analyses relevant to evaluating screening tests. If you don't know anything about these subjects you might find it more informative. Even then......
[back to being snarky]......really terrible writer. Topics/chapters seemed randomly sequenced. MUCH too long. Abrasively self-impressed and contemptuous of his colleagues. Any given point (it took a long time to figure out that radical mastectomy wasn't always the best treatment for breast cancer, e.g.) is elaborated roughly as:
(a) the basic point is explained or history recounted
(b) a horror story of someone's misguided medical care is retold at great length, segmented in weird ways into multiple chapters.
(c) the motives, typically greed, of the providers are blamed for the horror story
(d) Dr. Brawley (sorry, he wants to be called "Otis", as he mentions many times in the book) to the rescue, explaining to the patient that she or he got terrible care and that he would have done everything differently
(e) Author congratulates himself for saying this and reminds you that he is a straight shooter willing to speak truth to power
(f) this will remind him of another time he spoke up in contrarian fashion, and he'll describe that meeting or conversation in detail
(g) Author will harken back to his high school days when one or another teacher advised him to always stick to the facts and evidence and not what some authority says
(h) wrapup of the now-lengthy story, with final round of self-congratulations before moving on to next anecdote.
All told, 4 stars for being right on most or all issues. 0 for being badly written and nearly insufferable. Averages to 2.
April 15, 2013
I rarely give contemporary books a 5-star rating.
This is one of those books that will help you think straight about what may be happening to you and maybe the guy next to you the next time you visit a doctor's office or clinic.
The main author, Otis Brawley, was formerly director of the National Cancer Institute. He is well-credentialed, yet he advises patients not to be swayed by titles like "chair of the department" but rather to challenge the luminaries to justify their treatment decisions.
Brawley encourages patients to become as knowledgeable as possible about their condition, to scan the credible medical literature (as opposed to only the pharmaceutical company ads), to ask probing questions, to be skeptical. If you find yourself a candidate for a complicated procedure, compel your doc to make these distinctions 'say what you know, what you don't know, and what you believe'. Don't let the doc confuse what he believes with what he knows for sure.
Not surprisingly, if you're a patient with good insurance, then it's much more likely you'll undergo an unnecessary and potentially harmful procedure.
Filled with patient stories, this book does not read like a dry textbook. But it is a timely indictment of the avarice and politics endemic in the health"care" arena.
This is one of those books that will help you think straight about what may be happening to you and maybe the guy next to you the next time you visit a doctor's office or clinic.
The main author, Otis Brawley, was formerly director of the National Cancer Institute. He is well-credentialed, yet he advises patients not to be swayed by titles like "chair of the department" but rather to challenge the luminaries to justify their treatment decisions.
Brawley encourages patients to become as knowledgeable as possible about their condition, to scan the credible medical literature (as opposed to only the pharmaceutical company ads), to ask probing questions, to be skeptical. If you find yourself a candidate for a complicated procedure, compel your doc to make these distinctions 'say what you know, what you don't know, and what you believe'. Don't let the doc confuse what he believes with what he knows for sure.
Not surprisingly, if you're a patient with good insurance, then it's much more likely you'll undergo an unnecessary and potentially harmful procedure.
Filled with patient stories, this book does not read like a dry textbook. But it is a timely indictment of the avarice and politics endemic in the health"care" arena.
September 4, 2017
The author of How We Do Harm, Otis Webb Brawley, is chief medical officer and executive Vice President of the American Cancer Society. A medical oncologist with an interest in epidemiology and biostatistics, Brawley works at one of the largest hospitals in the United States, the Brady Memorial, in downtown Atlanta. This is the facility where the indigent, the insurance-less, the unconscious accident or trauma victims come (if they were alert, they’d likely direct the attendants elsewhere), but is also the place that police and firefighters choose because of the optimal trauma care it provides. Brawley can tell you which cancer screening tests are useful, whether certain cancer drugs actually work, and the ways in which cancer strikes white and black Americans differently. In short, he is eminently qualified to provide “a guided tour of the back rooms of American medicine.” (p.20)
Quoting a friend, Brawley says the American health care system would be better named the sick care system. It is a system that combines famine (for poor Americans who receive too little health care, especially of the preventative sort) and gluttony (for the rich, who unwisely consume too much health care that is sometimes of spurious value, and even frankly detrimental). Brawley writes with some bluntness that because doctors are paid piecemeal for their services, most succumb to recommending procedures that will line their own pockets, even when these procedures are of questionable value. “Dismal outcomes on both ends of the spectrum [rich and poor]” could be improved, he says, “if we were simply faithful to science, if we provided and practiced care that we know to be effective.” (p. 12) He provides a number of quite compelling case studies of patients he has known who have faced life-altering, often terminal, cancer diagnoses to illustrate his points. Although he occasionally sounds a tad full of himself, his book is generally a worthwhile and interesting text of considerable educative value.
Quoting a friend, Brawley says the American health care system would be better named the sick care system. It is a system that combines famine (for poor Americans who receive too little health care, especially of the preventative sort) and gluttony (for the rich, who unwisely consume too much health care that is sometimes of spurious value, and even frankly detrimental). Brawley writes with some bluntness that because doctors are paid piecemeal for their services, most succumb to recommending procedures that will line their own pockets, even when these procedures are of questionable value. “Dismal outcomes on both ends of the spectrum [rich and poor]” could be improved, he says, “if we were simply faithful to science, if we provided and practiced care that we know to be effective.” (p. 12) He provides a number of quite compelling case studies of patients he has known who have faced life-altering, often terminal, cancer diagnoses to illustrate his points. Although he occasionally sounds a tad full of himself, his book is generally a worthwhile and interesting text of considerable educative value.
February 10, 2012
A great read. From the opening story about a woman whose.breast falls off from cancer to the resulting advocacy of a man who lost his wife to the disease, this book sheds light on the multiple systemic ills of our health care system. Brawley is a doctor, but more importantly a great storyteller. This book is.frightening, infuriating, and amazing to read.
February 17, 2012
Sometimes books line up in unpredictable ways. I just finished Kahneman's "Thinking Fast and Slow," which discusses how our native thinking is heavily emotional and resists the hard work of rationality, and along comes this book--as if to use my own thinking to verify Kahneman's thesis.
Take screening for health problems. As an oncologist, Brawley primarily discusses cancer screening--but the epiphenomena surrounding identification and treatment of cancer may be taken as illustrative of the general issue.
My own reflections-while-reading went something along the lines of: "what could be wrong with screening?" It seemed to me an entirely well-meaning and innocent activity. But as Brawley puts it: "With screening, you are redistributing risks and benefits across a population. You have to perform a screening test on a certain number of people to detect a certain number of cancers in order to save a life. You may be saving lives, but you accept the notion that you are also hurting people--possibly even killing some with interventions." My thinking about screening suffered from the halo effect--it was all good. I did not even begin to suspect a downside.
Brawley, the chief medical officer of the American Cancer Society, shows a significant downside of medical "care" that caused snowballing, bad outcomes for insufficiently good reason. He talks about a family that can't bring itself to allow their terminally ill father to be eased into death, but insists instead on "heroic" measures whose only result is to exacerbate the man's agony. He discusses our tendency to see cancer and the possibilities for treatment in all-or-nothing terms--cure or die--when often it would be better to understand that it's more about weighing the quality of life against the quantity of time actually available.
The result, in Brawley's damning terms, is a health care system that works "exactly as designed. It's designed to run up health-care costs. It's about the greedy serving the gluttonous. ... Much of the money currently spent on health care is money wasted on unnecessary and harmful, sick care. Even for the sick, a lot of necessary care is not given at the appropriate time. The result is more expensive care given later."
Why isn't that necessary care not given? Money. "51 million American adults who have no insurance live desperate lives." They don't get the necessary, appropriately-timed preventive and educational care. And meanwhile, those with "access"? Some of them insist on paying 12 times more for name-brand medicines because their insurance covers it, a practice that earns Brawley's scorn: "As a scientist, I can assure you that we are being laughed at."
This book is a scathing indictment of the current system of healthcare in the US: "As I look at this mess, I realize that we don't need health-care reform. We need health-care transformation. Americans need to change how we view health care. We need to change how it is provided and how it is consumed."
Take screening for health problems. As an oncologist, Brawley primarily discusses cancer screening--but the epiphenomena surrounding identification and treatment of cancer may be taken as illustrative of the general issue.
My own reflections-while-reading went something along the lines of: "what could be wrong with screening?" It seemed to me an entirely well-meaning and innocent activity. But as Brawley puts it: "With screening, you are redistributing risks and benefits across a population. You have to perform a screening test on a certain number of people to detect a certain number of cancers in order to save a life. You may be saving lives, but you accept the notion that you are also hurting people--possibly even killing some with interventions." My thinking about screening suffered from the halo effect--it was all good. I did not even begin to suspect a downside.
Brawley, the chief medical officer of the American Cancer Society, shows a significant downside of medical "care" that caused snowballing, bad outcomes for insufficiently good reason. He talks about a family that can't bring itself to allow their terminally ill father to be eased into death, but insists instead on "heroic" measures whose only result is to exacerbate the man's agony. He discusses our tendency to see cancer and the possibilities for treatment in all-or-nothing terms--cure or die--when often it would be better to understand that it's more about weighing the quality of life against the quantity of time actually available.
The result, in Brawley's damning terms, is a health care system that works "exactly as designed. It's designed to run up health-care costs. It's about the greedy serving the gluttonous. ... Much of the money currently spent on health care is money wasted on unnecessary and harmful, sick care. Even for the sick, a lot of necessary care is not given at the appropriate time. The result is more expensive care given later."
Why isn't that necessary care not given? Money. "51 million American adults who have no insurance live desperate lives." They don't get the necessary, appropriately-timed preventive and educational care. And meanwhile, those with "access"? Some of them insist on paying 12 times more for name-brand medicines because their insurance covers it, a practice that earns Brawley's scorn: "As a scientist, I can assure you that we are being laughed at."
This book is a scathing indictment of the current system of healthcare in the US: "As I look at this mess, I realize that we don't need health-care reform. We need health-care transformation. Americans need to change how we view health care. We need to change how it is provided and how it is consumed."
March 31, 2012
Dr. Brawley has written a powerful indictment of the current state of health care in the United States. He asks the questions that need to be asked in an age where advertisement trumps evidence and he challenges those who know better to do better. Be warned: once you truly internalize the reality of the "wallet biopsy", you will never be able to see medicine the same way again. And that's a good thing.
March 20, 2019
In which I learned that breasts can fall off. It makes sense, given the context--very advanced breast cancer--but my reaction was nevertheless, "Holy shit, they can do that?"
I am a skeptic and rationalist, Scully to the world's Mulder. Science is the best explanation for how everything works.
And yet, every encounter I've had with conventional medicine has reinforced my belief that the science and practice of medicine is horribly corrupted by the unrelenting power of money.
(This of course, has the nasty side affect of putting me in the same company as loony anti-vaxers and nutters who believe you can cure cancer with the right application of crystals and apricot seeds. Sigh.)
How We Do Harm: A Doctor Break Ranks About Being Sick in America is a well-researched call for rational health care in the U.S. Citing examples primarily from his own practice, Dr. Brawley explores how little effort (read: money) is put into true prevention and cures, and how the emphasis for the "greatest health care system in the world" is on extracting as much money as possible from patients. He also explores how the pharmaceutical industry exploits the public's scientific ignorance and our false belief that "new is better" to push expensive drugs with mediocre to poor efficacy. In one of the most wrenching narratives, he shows how one family's unwillingness to accept death resulted in the medical torture of a dying, catatonic, elderly man.
It's pretty much an indictment of the whole system, from the highest corporate levels down to the patient. While Dr. Brawley tries to remain hopeful that change will come, my inner cynic only sees the situation getting worst, especially given the current political climate.
As frustrated as it left me, this book was worth reading, if only for providing concrete reasons for my extreme aversion of the U.S. medical system.
I am a skeptic and rationalist, Scully to the world's Mulder. Science is the best explanation for how everything works.
And yet, every encounter I've had with conventional medicine has reinforced my belief that the science and practice of medicine is horribly corrupted by the unrelenting power of money.
(This of course, has the nasty side affect of putting me in the same company as loony anti-vaxers and nutters who believe you can cure cancer with the right application of crystals and apricot seeds. Sigh.)
How We Do Harm: A Doctor Break Ranks About Being Sick in America is a well-researched call for rational health care in the U.S. Citing examples primarily from his own practice, Dr. Brawley explores how little effort (read: money) is put into true prevention and cures, and how the emphasis for the "greatest health care system in the world" is on extracting as much money as possible from patients. He also explores how the pharmaceutical industry exploits the public's scientific ignorance and our false belief that "new is better" to push expensive drugs with mediocre to poor efficacy. In one of the most wrenching narratives, he shows how one family's unwillingness to accept death resulted in the medical torture of a dying, catatonic, elderly man.
It's pretty much an indictment of the whole system, from the highest corporate levels down to the patient. While Dr. Brawley tries to remain hopeful that change will come, my inner cynic only sees the situation getting worst, especially given the current political climate.
As frustrated as it left me, this book was worth reading, if only for providing concrete reasons for my extreme aversion of the U.S. medical system.
September 27, 2012
Beware of the free cancer screening: just one of many wise ideas found in this infuriating book, written by Otis Brawley, MD, the chief medical/scientific officer of the American Cancer Society. Brawley has been on the frontline of the healthcare system for years, both as a policymaker and scientist in the national battle against cancer, and as a physician treating the urban poor at Grady Hospital in Atlanta. And let me tell you, Otis ain't happy with things, and he's calling bullshit. I became interested in this book after seeing Twitter explode one day with live posts from a speech Brawley made at the annual meeting of the Association of Health Care Journalists. In his trademark colorful manner, he excoriated the American healthcare system from top to bottom. After spending my own life working in a large urban hospital, I know how uncommon it is to hear those in power tell the truth about the system, so I knew that I had to read his book. Brawley outlines the problems of the system in many areas, including: undertreatment of the poor, overtreatment of those with wealth and insurance, and the widespread harm done to patients as physicians follow expensive treatment regimens that have no scientific basis. And, Dr Brawley takes his greatest pleasure in blasting the worst offenders: pharmaceutical/medical equipment giants who exert tremendous influence on the system for financial gain. (This is a personal favorite topic of mine: one of the physicians who trained me, and whom I love dearly, had the same feelings as Dr Brawley, and we had many great discussions about this topic over the years. I miss you, Dr Rhodes!)
The best parts of the book deal with the failures of the medical establishment to use screening tests wisely, namely the PSA test (used to detect prostate cancer) and the mammogram. Brawley tells unbelievable stories from patients who were harmed by inappropriately obtained and interpreted screening tests, which led to multiple harmful and unnecessary procedures and, ultimately, the patient's loss of healthy life. Dr Brawley uses the great example of free prostate antigen screening tests offered at shopping malls and community health fairs during National Prostate Health Month. These "free" screenings are usually sponsored by Depends and Viagra. And, why on earth would Depends and Viagra sponsor these things? Because "free" PSA blood tests, which are interpreted by physicians based on very uncertain national guidelines, lead men to agree to unnecessary removal of their prostate glands out of fear that they will die of prostate cancer. And, removal of the prostate gland leads to - you guessed it - incontinence and impotence. So, now all these poor guys need Depends and Viagra, and the companies who make these products cash in.
This book is recommended for healthcare workers, for anyone interested in the failures of the healthcare system, and especially for those interested in cancer care and patient advocacy (particularly in the area of breast cancer).
The best parts of the book deal with the failures of the medical establishment to use screening tests wisely, namely the PSA test (used to detect prostate cancer) and the mammogram. Brawley tells unbelievable stories from patients who were harmed by inappropriately obtained and interpreted screening tests, which led to multiple harmful and unnecessary procedures and, ultimately, the patient's loss of healthy life. Dr Brawley uses the great example of free prostate antigen screening tests offered at shopping malls and community health fairs during National Prostate Health Month. These "free" screenings are usually sponsored by Depends and Viagra. And, why on earth would Depends and Viagra sponsor these things? Because "free" PSA blood tests, which are interpreted by physicians based on very uncertain national guidelines, lead men to agree to unnecessary removal of their prostate glands out of fear that they will die of prostate cancer. And, removal of the prostate gland leads to - you guessed it - incontinence and impotence. So, now all these poor guys need Depends and Viagra, and the companies who make these products cash in.
This book is recommended for healthcare workers, for anyone interested in the failures of the healthcare system, and especially for those interested in cancer care and patient advocacy (particularly in the area of breast cancer).
March 17, 2012
This Dr. is the chief medical & scientific officer of the American Cancer Society and a professor at Emery University. He is a practicing oncologist at Grady Memorial Hospital in Atlanta. I find him objective and realistic in his assessment of the challenges in our medical system. Driven by profits the rich are over-treated and the poor are under-treated. The well insured patient is an economic incentive to maximize the cut of every practioner who gets involved. (He calls this the 'wallet biopsy'. The uninsured/underinsured suffer deadly outcomes from waiting till problems are critical and miss the preventative opportunities to be treated outside of the ER. Doctors are mired in a system where there are conflicts of interest because of insurance companies and pharmaceutical companies. I believe there is not sufficient call for change on the part of the patients because of the false messages and comfort in denial that surround medicine in the US.
Facts: America is number 50 for quality health care. Taiwan is 51. Canada is 12 and the UK is 28.
Our per capita health care spending is the highest in the world. This is where we are number 1 - paying the most for mediocre results.
This book argues that the very things that drive health care decisions - insurance and profits are the problem. Dr. Brawley calls out for an approach that has never been tried before: health care drawn from result-based, scientifically justifiable treatment. Health care based on science not economics.
Facts: America is number 50 for quality health care. Taiwan is 51. Canada is 12 and the UK is 28.
Our per capita health care spending is the highest in the world. This is where we are number 1 - paying the most for mediocre results.
This book argues that the very things that drive health care decisions - insurance and profits are the problem. Dr. Brawley calls out for an approach that has never been tried before: health care drawn from result-based, scientifically justifiable treatment. Health care based on science not economics.
June 13, 2017
Depressing all around. A sharp criticism of our health care system, filled with hopeless tidbits, such as America has the forty-fifth worst infant mortality rate on the planet, yet per capita our healthcare spending is the highest in the world. Well great, way to be, America! Expect horrific stories such as the woman with a tumor in her breast that was so big, her breast fell off or the man who had prostate cancer & begged for possibly unnecessary radiation after his surgery, which ended up giving him a rectal fistula into his bladder (this is just as appalling as it sounds); this one's a real downer. Most unfortuantely, Brawley is extremely unlikable & comes across as the one man who can do no wrong; even mistakes made early in his career seem glossed over. He portrays most doctors as either buffoons who are bumblingly in it for the money or cold-blooded charlatans who don't care who they hurt with their faulty science.
May 11, 2012
This is an excellent discourse on the economics of medicine, using the economics of cancer and the history of bad science on treating cancer as a rubric.
This book is really required reading for e-patient advocates because it dispels some of the core myths inherent in the pursuit of "better medicine".
Most notably, it really skewers the basic notion that "more testing" is a good thing. It shows how testing can be more dangerous than not testing, especially for poorly understood diseases.
It also shows how different professional organizations recommendations differ from what is actually best care. This was probably the most disturbing part of the book, because it shows how easily influenced doctors can be when their wallets are on the line.
This book is really required reading for e-patient advocates because it dispels some of the core myths inherent in the pursuit of "better medicine".
Most notably, it really skewers the basic notion that "more testing" is a good thing. It shows how testing can be more dangerous than not testing, especially for poorly understood diseases.
It also shows how different professional organizations recommendations differ from what is actually best care. This was probably the most disturbing part of the book, because it shows how easily influenced doctors can be when their wallets are on the line.
March 10, 2012
Dr. Otis Webb is brutally honest.....if we could all stand up to the "health care" system that we have like Dr. Otis, it would only change for the better. Would highly recommend.
May 11, 2012
Brawley examines the failings of the current American medical system from both sides, meaning he looks at how we fail to properly treat those who are uninsured and can't afford to pay for skyrocketing medical costs as well as how we are often overtreated for a variety of reasons. Brawley is an oncologist so he looks at the issue through the lens of cancer treatment sharing both stories from his experiences as a doctor and as executive vice president of The American Cancer Society. I think what he has to say is important, but I felt the book dragged in places, and I got a little tired of what came across as his sanctimonious attitude of I'm this awesome doctor who would never do the things I'm describing in this book. I'm sure it wasn't intentional, but it kind of irked me. If you're interested in the subject matter it's not a bad read, but I would recommend two books that independently look at these two issues over this one (Overtreated: Why Too Much Medicine is Making Us Sicker by Shannon Brownlee and The Healing of America: The Global Quest for Better, Cheaper, and Fairer Healthcare by T.R. Reid).
March 13, 2014
Interesting information regarding the harm that medical care can inflict on the patient. Always remember, first and foremost, medicine is a money making industry. It can be useful but as in any field what you don't know may harm or kill you. In addition, the medical professional you are trusting may or may not know much more about what they are recommending than you do.
Sometimes it's better/easier to die of the disease than to die from the treatment.
This is a book that everyone should read.
Sometimes it's better/easier to die of the disease than to die from the treatment.
This is a book that everyone should read.
June 16, 2015
This is a must-read for everyone. I will be thinking about this book the next time I see my doctor.
March 15, 2012
A prominent doctor provides a sobering inside perspective on problems with the American medical system and important questions ordinary people should ask when involved with this system. For each topic he begins with the stories of patients and his own experiences, and then analyzes why faulty outcomes are happening. These include people without insurance or access to the medical system except emergency rooms; doctors, industries and medical specialties driven by the profit motive (the more treatment and drugs given each patient, the more money these players make); patients who demand too much or the wrong type of treatment; screenings at health fairs that often lead to inappropriate or unnecessary treatment of those screened (such screenings often are sponsored by companies which benefit financially from patient treatment; when you're offered something for free then you're the product being "sold"), etc. For example, he points out that treatment protocols are usually written or financed by those who will benefit financially if that protocol is followed; anyone can publish such a protocol without it representing the totality of scientific findings/studies in the field. Searching the web to find information to help you make a medical decision is often useless because much of the information is not authoritative science, and much is misleading. He gives the web address of the one group he believes makes objective scientific protocols about screenings with no financial stake involved: www.preventiveservicestaskforce.org.
His concluding assessment is damning: "The system is not failing. It's functioning exactly as designed. It's designed to run up health-care costs. It's about the greedy serving the gluttonous. Americans consume more health care per capita than the people of any other country.... We desperately need to focus on rational consumption of health care. Much of the money currently spent on health care is money wasted on unnecessary and harmful, sick care. Even for the sick, a lot of necessary care in not given at the appropriate time. The result is more expensive care given later.... The bad actors include doctors and health-care providers, hospitals, drug and device manufacturers, insurance companies, lawyers, and patients... three evils have infected American medicine: apathy, ignorance, and greed." This book is an attempt to alert people on a grassroots level to be appropriately skeptical of the system and to work intelligently toward changing it to one that serves the interests of the populace rather than of those currently profiting at the public's expense.
His concluding assessment is damning: "The system is not failing. It's functioning exactly as designed. It's designed to run up health-care costs. It's about the greedy serving the gluttonous. Americans consume more health care per capita than the people of any other country.... We desperately need to focus on rational consumption of health care. Much of the money currently spent on health care is money wasted on unnecessary and harmful, sick care. Even for the sick, a lot of necessary care in not given at the appropriate time. The result is more expensive care given later.... The bad actors include doctors and health-care providers, hospitals, drug and device manufacturers, insurance companies, lawyers, and patients... three evils have infected American medicine: apathy, ignorance, and greed." This book is an attempt to alert people on a grassroots level to be appropriately skeptical of the system and to work intelligently toward changing it to one that serves the interests of the populace rather than of those currently profiting at the public's expense.
March 9, 2012
This book is one of a long string of books that caution against uncritically following your doctor's advice. Many factors contribute to U.S. citizens being overtreated and underserved: over-aggressive cancer treatment is just one of them. I'd go on about this, but for me it's a soap box issue. There'a a new book on my to-read list "The New Prescription: How to Get the Best Health Care in a Broken System" - perhaps it will be of more guidance to a broader spectrum than Dr. Brawley's book.
October 29, 2014
this is a great book. it's well written and absolutely fascinating. the author is intelligent, well-read, and well-versed in his chosen profession. if i had the money, i'd send a copy of this book to each and every person on Capitol Hill and every person in every state senate, governor's mansion, and insurance company in the U.S.
April 2, 2012
A physician who speaks honestly and openly about the conflicts of interest that influence our current healthcare system. A must read for anyone who ever finds themself a patient.
March 12, 2012
In his book How We Do Harm, Otis Webb Brawley, M.D (whose credentials run on nearly forever and include being the chief medical and scientific officer and executive president of the American Cancer Society) gets especially upset when he hears politicians and pundits declare that America has the best health care system in the world. Those who say we have the best health care in the world are either completely ignorant and out of touch with the reality or they are straight up lying out their asses. Just look at the statistics. The U.S. ranks 50th in the world in life expectancy with an average of 78.37 years. Meanwhile Canada is over 81 and the UK is over 80. And Monoco - at 89.7- has an average life expectancy at almost 90 years of age. The U.S. also ranks 44th in infant mortality. Yet we pay more in health care than any other nation on earth. We pay 50 percent more than Switzerland for instance who is the number two nation in health care costs. American's health care costs account for 17.3 percent of our gross domestic product and are on course to hit 25% by 2025.
Brawley writes, "I have seen enough to conclude that no incident of failure in American medicine should be dismissed as an aberration. Failure is the system."
And he quotes Peter Bach as saying, "America does not have a health-care system. We have a sick-care system." Bach goes on to say that "system" is not an accurate word to describe it, because "system" denotes organization.
Brawley further criticizes the "system" by saying, "Too often, helping the patient isn't the point. Economic incentives can dictate that the patient be ground up as expensively aspossible with the goal of maximizing the cut of every practitioner who gets involved."
Question: Who is responsible for American's health-care/sick-care "system" being such a disaster?
1) Large corporations, (including the health insurance and pharmacudical companies)
2) Medical professionals and health clinics
3) Consumers, i.e. patients.
4) The government
5) All of the above
It seems like a trick question. I mean, is the patient to be blamed for taking the advise of experts who recommend procedures and drugs that do more harm than good? Obviously not. But is that same patient to be blamed for a lifetime of smoking, eating poorly, engaging in unhealthy or exceedingly risky behavior and not properly exercising? Yes. They are.
Or who's fault is it that patients do not trust the medical profession, and instead of going to them early enough to be treated in the early stages of a disease (in which they could be fully cured for $30,000) they wait years until they have no choice but to see a medical professional and end up having treatment that costs over $150,000 which will only delay death from that disease for a few months?
Or are the doctors at fault for experimenting with drugs and procedures that have been approved by health care agencies and experts? What if these doctors did not reveal everything they know and everything they do not know about these procedures/drugs to the patient.
And what about large corporations that are polluting the environment and pumping toxins into the air, water and earth we live with? Like in 1977 when big chemical corporations decided they could make billions of dollars for years and years if they convinced our corporate-politicans to put fluoride in the water, even after Congress used the National Toxicology Program (NTP) to determine that fluoride caused the bone cancer called osteosarcoma. That was over 20 years ago, but guess what we still have in our water?
Also, who is to fault for there not being enough quality medical professionals available to treat all Americans?
The finger pointing can go round and round and in the end everyone involved is acountable for some of the blame. Brawley writes of middle-aged black women who are so afraid of hospitals and doctors that they go without medical attention, knowing they have breast cancer, for nine years or more until their tumor becomes so big that it actually causes their breast to fall off. He writes of sick Americans who actually can not afford health care or who can not afford to take off work to get treatement when they need it. He writes of patients whose health care companies pay for unesseasry procedures recommended by doctors who are taking advantage of a system that is just out to make money. He writes of patients who are prescribed unproven drugs that lead to worse health problems and then have their insurance companies drop them because they are too much of a risk. So in this vicious cycle, where there is plenty of balme to go around, there is one thing that is for certain: SOMETHING most be done to change the "system".
ObamaCare in a Nutshell
The first step in instituting ObamaCare came in the form of two ("fucking big deal") health care acts passed by Congress in 2010. Assuming that The Supreme Court does not declare these two acts unconstitutional (the Supreme Court has scheduled six hours for oral arguments from March 26 to March 28 of this year and will issue a decision by the end of June) then the next step in ObamaCare is for Congress to pass the public option. The public option, for those of you not up to speed on the debate, would basically be a government-run health insurance agency which would compete with other health insurance companies - it would not be the same as publicly funded health care (like Medicare) because it would be financed entirely by premiums paid by those who buy into it (with no subsidies from the Federal government). President Obama, the Congressional Democrats and others say that the public option would:
~Drive down premiums and provide choice where few options exist.
~Break up monopolies that control state and local markets
~Be a moral advancement (as Paul Krugman wrote in his New York Times column, "The most successful [health insurance] companies are those that do the best job of denying coverage to those who need it most.")
~Force other insurance companies to share information and reduce costs.
~Possibly force several insurance companies out of business.
Obama and the Democrats believe that the public option will cost people less money to buy into than privately owned companies. In an address to Congress, Obama said that the public option would avoid "some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and treat their customers better." That logic sounds a bit idealistic, but many Right-wingers who oppose the public option use this logic as well to express concern that the public option is simply a stepping stone toward a single-payer health care system. They say that the public option will eventually run the competition (the other insurance comanies) out of business and that the public option is an attack on the free trade market since it would mean that the federal government would not only be providing a health care option, but it would also be regulating the health care industry--which is sorta like playing football against a team that not only has their own players in the game, but has their own referee and commissioner as well.
Even if all of these things are true and the public option makes history of the private health care insurance companies, most Americans honestly won't mind. Most Americans do not have no love loss for big private insurance companies. The real concern with such a public option that eventually evolves into a single-payer system of course is that:
1) the federal government has too often been a breeding ground for fraud, waste and abuse as witnessed in several of its other large government agencies and it would breed fraud, waste and abuse into a single-payer system.
And 2) that the government will become even more intrusive into our daily lives--making decisions about our very heath and depriving each of us to make these decisions for ourselves.
But despite these concerns the pulbic option (and then eventually a single payer system) appears to be the only way forward in repairing a broken, corrupt and disasterous private health care system that is draining the American people and ruining the American way of life. The alternative is the Right-wing Republican option which is to DO NOTHING.
So What Changes Should a Government Run Health Care System Implement?
A governent run health care should would be best if it implemented The Wagemann Health Care Plan. The first part of the Wagemann Plan is something we see already being done: Sin taxes. But the Wagemann Plan calls for this concept to be expanded. Alcohol, cigarettes, foods with transfat, foods with pesticides and preservatives, etc should all be taxed at 100%. Under the Wagemann Plan a bag of potato chips should cost 9 dollars. A single doughnut or a Twinkie should cost 4 dollars. And so on. The idea is that this will encourage folks to consume these things in moderation. By the way, the Wagemann Plan also has something that Right-wingers should like since under this plan none of the SIN foods will be able to be purchased with food stamps. If Ghetto Joe wants to buy junk food that is going to risk his health and make him a burden on the health care system, then Joe is going to have to pay for it out of his own pocket--NOT THE TAXPAYERS.
The second part of the Wagemann Plan calls for something similar to a program that our military partakes in, where military members are required to have a physical fitness test once a year. The Wagemann Plan calls for the institution of giving all individual in the health care system a physical fitness tests at least once a year, and then using that fitness score to determine the cost that each individual pays for their health care. Different factors go into determining the test results, like age and height, etc. And of course the plan calls for exemptions for people with disabilities.
If implemented, the Wageman Plan would not only be an incentive for people to eat right and exercise--which would dramatically lower the costs of health care in this country--but it would also be the most fair Health Care Plan there ever was and put some factual mustard on such statements as "America has the best health care system in the world".
©2012 Rockism 101. All Rights Reserved
Brawley writes, "I have seen enough to conclude that no incident of failure in American medicine should be dismissed as an aberration. Failure is the system."
And he quotes Peter Bach as saying, "America does not have a health-care system. We have a sick-care system." Bach goes on to say that "system" is not an accurate word to describe it, because "system" denotes organization.
Brawley further criticizes the "system" by saying, "Too often, helping the patient isn't the point. Economic incentives can dictate that the patient be ground up as expensively aspossible with the goal of maximizing the cut of every practitioner who gets involved."
Question: Who is responsible for American's health-care/sick-care "system" being such a disaster?
1) Large corporations, (including the health insurance and pharmacudical companies)
2) Medical professionals and health clinics
3) Consumers, i.e. patients.
4) The government
5) All of the above
It seems like a trick question. I mean, is the patient to be blamed for taking the advise of experts who recommend procedures and drugs that do more harm than good? Obviously not. But is that same patient to be blamed for a lifetime of smoking, eating poorly, engaging in unhealthy or exceedingly risky behavior and not properly exercising? Yes. They are.
Or who's fault is it that patients do not trust the medical profession, and instead of going to them early enough to be treated in the early stages of a disease (in which they could be fully cured for $30,000) they wait years until they have no choice but to see a medical professional and end up having treatment that costs over $150,000 which will only delay death from that disease for a few months?
Or are the doctors at fault for experimenting with drugs and procedures that have been approved by health care agencies and experts? What if these doctors did not reveal everything they know and everything they do not know about these procedures/drugs to the patient.
And what about large corporations that are polluting the environment and pumping toxins into the air, water and earth we live with? Like in 1977 when big chemical corporations decided they could make billions of dollars for years and years if they convinced our corporate-politicans to put fluoride in the water, even after Congress used the National Toxicology Program (NTP) to determine that fluoride caused the bone cancer called osteosarcoma. That was over 20 years ago, but guess what we still have in our water?
Also, who is to fault for there not being enough quality medical professionals available to treat all Americans?
The finger pointing can go round and round and in the end everyone involved is acountable for some of the blame. Brawley writes of middle-aged black women who are so afraid of hospitals and doctors that they go without medical attention, knowing they have breast cancer, for nine years or more until their tumor becomes so big that it actually causes their breast to fall off. He writes of sick Americans who actually can not afford health care or who can not afford to take off work to get treatement when they need it. He writes of patients whose health care companies pay for unesseasry procedures recommended by doctors who are taking advantage of a system that is just out to make money. He writes of patients who are prescribed unproven drugs that lead to worse health problems and then have their insurance companies drop them because they are too much of a risk. So in this vicious cycle, where there is plenty of balme to go around, there is one thing that is for certain: SOMETHING most be done to change the "system".
ObamaCare in a Nutshell
The first step in instituting ObamaCare came in the form of two ("fucking big deal") health care acts passed by Congress in 2010. Assuming that The Supreme Court does not declare these two acts unconstitutional (the Supreme Court has scheduled six hours for oral arguments from March 26 to March 28 of this year and will issue a decision by the end of June) then the next step in ObamaCare is for Congress to pass the public option. The public option, for those of you not up to speed on the debate, would basically be a government-run health insurance agency which would compete with other health insurance companies - it would not be the same as publicly funded health care (like Medicare) because it would be financed entirely by premiums paid by those who buy into it (with no subsidies from the Federal government). President Obama, the Congressional Democrats and others say that the public option would:
~Drive down premiums and provide choice where few options exist.
~Break up monopolies that control state and local markets
~Be a moral advancement (as Paul Krugman wrote in his New York Times column, "The most successful [health insurance] companies are those that do the best job of denying coverage to those who need it most.")
~Force other insurance companies to share information and reduce costs.
~Possibly force several insurance companies out of business.
Obama and the Democrats believe that the public option will cost people less money to buy into than privately owned companies. In an address to Congress, Obama said that the public option would avoid "some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and treat their customers better." That logic sounds a bit idealistic, but many Right-wingers who oppose the public option use this logic as well to express concern that the public option is simply a stepping stone toward a single-payer health care system. They say that the public option will eventually run the competition (the other insurance comanies) out of business and that the public option is an attack on the free trade market since it would mean that the federal government would not only be providing a health care option, but it would also be regulating the health care industry--which is sorta like playing football against a team that not only has their own players in the game, but has their own referee and commissioner as well.
Even if all of these things are true and the public option makes history of the private health care insurance companies, most Americans honestly won't mind. Most Americans do not have no love loss for big private insurance companies. The real concern with such a public option that eventually evolves into a single-payer system of course is that:
1) the federal government has too often been a breeding ground for fraud, waste and abuse as witnessed in several of its other large government agencies and it would breed fraud, waste and abuse into a single-payer system.
And 2) that the government will become even more intrusive into our daily lives--making decisions about our very heath and depriving each of us to make these decisions for ourselves.
But despite these concerns the pulbic option (and then eventually a single payer system) appears to be the only way forward in repairing a broken, corrupt and disasterous private health care system that is draining the American people and ruining the American way of life. The alternative is the Right-wing Republican option which is to DO NOTHING.
So What Changes Should a Government Run Health Care System Implement?
A governent run health care should would be best if it implemented The Wagemann Health Care Plan. The first part of the Wagemann Plan is something we see already being done: Sin taxes. But the Wagemann Plan calls for this concept to be expanded. Alcohol, cigarettes, foods with transfat, foods with pesticides and preservatives, etc should all be taxed at 100%. Under the Wagemann Plan a bag of potato chips should cost 9 dollars. A single doughnut or a Twinkie should cost 4 dollars. And so on. The idea is that this will encourage folks to consume these things in moderation. By the way, the Wagemann Plan also has something that Right-wingers should like since under this plan none of the SIN foods will be able to be purchased with food stamps. If Ghetto Joe wants to buy junk food that is going to risk his health and make him a burden on the health care system, then Joe is going to have to pay for it out of his own pocket--NOT THE TAXPAYERS.
The second part of the Wagemann Plan calls for something similar to a program that our military partakes in, where military members are required to have a physical fitness test once a year. The Wagemann Plan calls for the institution of giving all individual in the health care system a physical fitness tests at least once a year, and then using that fitness score to determine the cost that each individual pays for their health care. Different factors go into determining the test results, like age and height, etc. And of course the plan calls for exemptions for people with disabilities.
If implemented, the Wageman Plan would not only be an incentive for people to eat right and exercise--which would dramatically lower the costs of health care in this country--but it would also be the most fair Health Care Plan there ever was and put some factual mustard on such statements as "America has the best health care system in the world".
©2012 Rockism 101. All Rights Reserved
September 2, 2020
I got into this type of literature after a patient asked one of the Doctors at my clinic "If it was your mother, what would you recommend?"
She thought that was a smart question and it might have been if she had known this man well. But she didn't. If you want a real opinion of a doctor, ask the lower-downs at his clinic out to lunch and ask them who they would choose as their physician, unless it's specified in their employment contract that they can't(you'd be surprised how many do).
Facts:
--[Most] "Drs practice the best of medicine of the year they graduated from medical school." But that doesn't necessarily mean you should choose the youngest one in the system because...
--"The System is not broken. It's functioning exactly as designed. It's designed to run up health-care costs. It's about the greedy serving the gluttonous." Or those with humongous student loans often trying live as if they've been practicing for years.
-"Much of the money currently spent on health care is money wasted on unnecessary and harmful, sick care."
-- "Bad actors include doctors and health-care providers, hospitals, drug and device manufacturers, insurance companies, lawyers, and patients."
--"The medical system frequently allows bad doctors to continue to practice." But Google malpractice/citations/patient reviews +Dr's name just in case.
-- "Ignorance manifests itself as unrealistic expectations." So make sure they explain all the side effects. And read both sides and the fine print. And get your own copy to take home.
--"Patients... can be their best advocates... They need to have skepticism and ask probing questions."
Finally, "How do we protect ourselves, our loved ones, our neighbors? There is only one way. We do it by demanding a health-care system that can say "Prove it," a system that can say "No," and make it stick. For this to happen, real people---ideally, all 300 million of us---will have to say "Enough!"
You'd hope that things have gotten better since the publishing of this book. It has, after all, been eight years. My aunt was diagnosed with cancer last year and had the offending organ removed. The doctors didn't recommend chemo--- they were reasonably confident that the cancer had been contained within the organ.
After talking to her sister and her mother(and ignoring others) My aunt had 6 months worth of chemo anyway.
She thought that was a smart question and it might have been if she had known this man well. But she didn't. If you want a real opinion of a doctor, ask the lower-downs at his clinic out to lunch and ask them who they would choose as their physician, unless it's specified in their employment contract that they can't(you'd be surprised how many do).
Facts:
--[Most] "Drs practice the best of medicine of the year they graduated from medical school." But that doesn't necessarily mean you should choose the youngest one in the system because...
--"The System is not broken. It's functioning exactly as designed. It's designed to run up health-care costs. It's about the greedy serving the gluttonous." Or those with humongous student loans often trying live as if they've been practicing for years.
-"Much of the money currently spent on health care is money wasted on unnecessary and harmful, sick care."
-- "Bad actors include doctors and health-care providers, hospitals, drug and device manufacturers, insurance companies, lawyers, and patients."
--"The medical system frequently allows bad doctors to continue to practice." But Google malpractice/citations/patient reviews +Dr's name just in case.
-- "Ignorance manifests itself as unrealistic expectations." So make sure they explain all the side effects. And read both sides and the fine print. And get your own copy to take home.
--"Patients... can be their best advocates... They need to have skepticism and ask probing questions."
Finally, "How do we protect ourselves, our loved ones, our neighbors? There is only one way. We do it by demanding a health-care system that can say "Prove it," a system that can say "No," and make it stick. For this to happen, real people---ideally, all 300 million of us---will have to say "Enough!"
You'd hope that things have gotten better since the publishing of this book. It has, after all, been eight years. My aunt was diagnosed with cancer last year and had the offending organ removed. The doctors didn't recommend chemo--- they were reasonably confident that the cancer had been contained within the organ.
After talking to her sister and her mother(and ignoring others) My aunt had 6 months worth of chemo anyway.
August 6, 2024
Definitely incendiary, will stick with me as I progress in my training as a primary care physician - committing to not sliding into apathy or turning a blind eye to greed. Being well-read and questioning everything. He definitely was very self-congratulatory though which grated on me at the beginning but earned my respect throughout. His passion and fury towards some of his colleagues isn’t just due to hubris or self-congratulation, it comes from his genuine care for and outrage on behalf of his patients and friends (like Ralph). There could have been an acknowledgment of that bias, however- that his anger stemming from mistreatment or overbearing care for one single patient of his has now shaped his opinions upon which he doubles down and shouts from the rooftops (does that fervor prevent him from seeing things clearly, like others’ self-interest does in the opposite direction? I don’t think so but I think it could have been explored in a self-aware way as an elevation to his argument)
October 21, 2020
As an individual new to the United States and to the healthcare industry, I found this book to be fascinating. While diving into the treatment process and industry was interesting, the biggest take away I got, related to decision making, regardless of industry.
Specifically, when evaluating options, “say why you know, what you don’t know, and what you believe - and label it accordingly”.
Often our leaders state beliefs and facts; beliefs are often interpreted as fact, and what they don’t know is labeled as fact.
I believe this maxim is valuable in all walks of life, professional and personal.
Specifically, when evaluating options, “say why you know, what you don’t know, and what you believe - and label it accordingly”.
Often our leaders state beliefs and facts; beliefs are often interpreted as fact, and what they don’t know is labeled as fact.
I believe this maxim is valuable in all walks of life, professional and personal.
November 27, 2024
Oh, man. This is an excellent book.
Otis Brawley is a credible guy. According to the book flap, he's Vice President of the American Cancer Society, a professor at Emory University, and a practicing oncologist with a CV that'll blow anyone's hair back. In this book, he and his ghost writer (who also boasts a CV that oozes credibility), discuss the shortcomings of the American medical system, particularly as they apply to cancer treatment.
Interspersed with compelling stories from Dr. Brawley's own life, this book is readable, informative, and thought provoking. I flew through it, and I can think of a number of people on my Christmas list who can expect to receive a copy this year. Wow.
Otis Brawley is a credible guy. According to the book flap, he's Vice President of the American Cancer Society, a professor at Emory University, and a practicing oncologist with a CV that'll blow anyone's hair back. In this book, he and his ghost writer (who also boasts a CV that oozes credibility), discuss the shortcomings of the American medical system, particularly as they apply to cancer treatment.
Interspersed with compelling stories from Dr. Brawley's own life, this book is readable, informative, and thought provoking. I flew through it, and I can think of a number of people on my Christmas list who can expect to receive a copy this year. Wow.
November 17, 2014
Dr. Otis Webb Brawley has a splendidly admirable mission to change the face of healthcare in the United States through patient advocacy, education and critical thinking. Dr. Brawley aims for his patients to have the knowledge base to effectively analyze their own treatment and for physicians to be held accountable to a higher grade of practice. Using various personal war stories from his experiences as a resident, physician and health advocate, Brawley seeks to drive home the point that the American Healthcare system is in need of a drastic overhaul. Thus, it is quite unfortunate that his emotions get the best of him and muddle his message throughout the entirety of How We Do Harm.
While Brawley’s arguments for better physician practice and equitable patient care are centered around the scientific method, he often reinforces the story with an anecdote showing his fury at other physicians. While it may seem to present a stronger case, it in fact does just the opposite. By making the writing less objective, Brawley’s cases are dependent on the reader being comfortable with his righteous bravado and passionate advocacy. Brawley seems to revel in recounting the failures of other physicians and damning them for their clinical decisions should they not fall in line with his medical opinion. The writing comes off as overbearing and fueled by frustration. While the frustration may be warranted, it removes a sense of credibility from Brawley’s writing.
It should be noted that not the entire book suffers from the angry rhetoric of Brawley. He does provide objective displays of his knowledge and allows the reader to come to a sense of outrage on their own, instead of being forced to follow in the wake of his righteous indignation. The most powerful sections from the book come from the retelling of Brawley’s clinical experiences which provide the reader with an insight into his critical thinking process and why he believes the treatment he chose was most appropriate. Brawley also makes for a fine medical historian and his recounting of clinical trials of days gone by are effective and provide the most interesting sections of the book. The failures of the book begin when Brawley’s finger pointing pulls the reader from the subject matter he is describing to tear off on a rant about physicians profiting from the American Healthcare system. While I have no doubts that this is indeed the case, Brawley insisting that he would never make such irrational decisions make him sound like a tattletale rather than an advocate for change. If you are seriously interested in medical science in the US, and you don't mind a very angry read, give it roll.
While Brawley’s arguments for better physician practice and equitable patient care are centered around the scientific method, he often reinforces the story with an anecdote showing his fury at other physicians. While it may seem to present a stronger case, it in fact does just the opposite. By making the writing less objective, Brawley’s cases are dependent on the reader being comfortable with his righteous bravado and passionate advocacy. Brawley seems to revel in recounting the failures of other physicians and damning them for their clinical decisions should they not fall in line with his medical opinion. The writing comes off as overbearing and fueled by frustration. While the frustration may be warranted, it removes a sense of credibility from Brawley’s writing.
It should be noted that not the entire book suffers from the angry rhetoric of Brawley. He does provide objective displays of his knowledge and allows the reader to come to a sense of outrage on their own, instead of being forced to follow in the wake of his righteous indignation. The most powerful sections from the book come from the retelling of Brawley’s clinical experiences which provide the reader with an insight into his critical thinking process and why he believes the treatment he chose was most appropriate. Brawley also makes for a fine medical historian and his recounting of clinical trials of days gone by are effective and provide the most interesting sections of the book. The failures of the book begin when Brawley’s finger pointing pulls the reader from the subject matter he is describing to tear off on a rant about physicians profiting from the American Healthcare system. While I have no doubts that this is indeed the case, Brawley insisting that he would never make such irrational decisions make him sound like a tattletale rather than an advocate for change. If you are seriously interested in medical science in the US, and you don't mind a very angry read, give it roll.
May 25, 2022
Published in 2011, this book is a scathing critique of healthcare in America. Otis Brawley was "the chief medical and scientific officer of the American Cancer Society and an oncologist with a dazzling clinical, research, and policy career." He "pulls back the curtain on how medicine is really practiced in America." This guy doesn't hold back, and I appreciated everything he had to say. It's technical and science heavy, which is the kind of book I like to read once in awhile. Western (allopathic) medicine as practiced in the U.S. is often based on treatments that will bring in the most money, treatments that aren't based on demonstrated scientific results, and sometimes these treatments are foisted on people who don't need them at all--in other words, causing harm.
April 5, 2012
An important revelation to us healthcare consumers, as well as important input for policy makers. Dr. Brawley's real-life stories illustrate the problem with healthcare in our society. I am grateful for the warning and am renewing my personal commitment to refuse unnecessary and potentially harmful medications and procedures. But who will act to fix this? The drug companies and big health systems are so imbedded.
June 9, 2012
This book is devastating to read, yet essential. Dr. Brawley is chief medical officer for the American Cancer Society. The most care is not necessarily the best care, especially at the end stages of life. Do you have a living will? Will your loved ones know your wishes about the continuation of care when you can not make the decision yourself? End of life care is just one issue that Dr. Brawley touches on. I learned a great deal from reading this book.
May 3, 2012
Loved reading this book. Dr.Otis correctly penned my outlook and opinion about the medical field in general. He may seem quite polarized in his view point but he has written the book with utmost honesty . If you are connected to the medical field ,you will understand this better as he mentions many drugs and treatment plans.Either ways quite an eye opener.
Thank you Sir....for an honest book..
Thank you Sir....for an honest book..
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