How We Do Harm: A Doctor Breaks Ranks About Being Sick in America [Hardcover]

Otis Webb Brawley (Author), Paul Goldberg (Author)

Book Description

Release date: January 31, 2012

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.

Editorial Reviews

Review

“My friend and colleague Otis Brawley has written a raw and honest portrayal of our health care system. There are certain to be special interest organizations and medical groups that take issue with Dr.Brawley's conclusions, but few can argue with the scientific rigor he has demonstrated in writing this book. Otis is the go- to oncologist I send so many patients to see, because he is not only a great doctor, but also a compassionate man. As we discuss the transformation of health care in this country, put Dr. Brawley's book at the top of your list.”-Sanjay Gupta, Associate Chief of Neurosurgery Grady Memorial Hospital, Chief Medical Correspondent, CNN

“Otis Brawley is one of America’s truly outstanding physician scientists.  In How We Do Harm, he challenges all of us-- physicians, patients, and communities-- to recommit ourselves to the pledge to 'do no harm.'”-David Satcher,Former Surgeon General of the United States, Director, Satcher Health Leadership Institute, Morehouse School of Medicine

“Sweeping, honest and brave . . . How We Do Harm dazzles with a wealth of  scientific insight, but its genius lies in the author’s recounting of individual patient stories that illuminate the dark underbelly of medicine’s missteps. Brawley does not shrink from revealing medicine’s warts, butthis book  offers much more. It is a  triumph of humanity and clarity in which oncology becomes a Rorschach for the practice of American medicine. You will finish this arresting book reluctantly, with a new appreciation of what American medicine could be.”-Harriet A .Washington, author of Deadly Monopolies: The Shocking Corporate Takeover of Life Itself and the Consequences for Your Health and Our Medical Future and Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

“Dr. Brawley is a premier academic oncologist and a minority doctor in the nation's largest inner city hospital. How We Do Harm places in stark contrast the health care resources available to the rich and the poor, the insured and the uninsured, the white community and the community of color . He makes  the  cogent  point that more testing, screening, and interventions available to the rich does not always  mean better medical care .”-Bruce Chabner, MD, Director of Clinical Research, Massachusetts General Hospital Cancer Center

“Otis Brawley shares in equal measure his compelling personal story, the development of modern medical oncology, and the wide range of his strong opinions.  Whether you agree with him or not, the reader is given access to Dr. Brawley’s unambiguous scientific and ethical framework.  He provides an anvil for shaping your own perspectives and biases.”-Michael A. Friedman, MD, President and Chief Executive Officer, Director Comprehensive Cancer Center, City of Hope

“A tough-minded, solidly argued indictment of health care. . . Brawley’s sense of outrage is palpable.” -The Boston Globe

"A powerful contribution to the ongoing discussion on health-care reform.”-Kirkus

This book is shockingly detailed and it should serve as a wake-up call to fix the dismal mess and rethink the politics of illness in America. Dr. Brawley provides a well-reasoned manifesto for change.”-Tucson Citizen

“Any who want to know how behind-the scenes healthcare works will find this a key title." –Midwest Book Review

About the Author

DR. OTIS BRAWLEY is the chief medical and scientific officer and executive vice president of the American Cancer Society. Dr. Brawley currently serves as professor of hematology, oncology, medicine and epidemiology at Emory University. He is also a CNN medical consultant. He is a graduate of the University of Chicago, Pritzker School of Medicine, and completed a residency in internal medicine at University Hospitals of Cleveland, Case-Western Reserve University, and a fellowship in medical oncology at the National Cancer Institute.

PAUL GOLDBERG is an award-winning investigative reporter who covers oncology for The Cancer Letter, a weekly publication focused on drug development and the politics of cancer. His articles have appeared in The New York Times, The Wall Street Journal, The Washington Post, The Washington Monthly and he has been featured on 60 Minutes, 20/20, CNN and NPR. Goldberg is also the author of two books on the Soviet human rights movement.

See all Editorial Reviews

Product Details

• Hardcover: 320 pages
• Publisher: St. Martin's Press; 1 edition (January 31, 2012)
• Language: English
• ISBN-10: 0312672977
• ISBN-13: 978-0312672973
• Product Dimensions: 8.3 x 5.8 x 1.2 inches
• Shipping Weight: 14.4 ounces (View shipping rates and policies)
• Average Customer Review: 4.8 out of 5 stars  See all reviews (82 customer reviews)
• Amazon Best Sellers Rank: #38,230 in Books (See Top 100 in Books)
  • #27 in Books > Medical Books > Administration & Medicine Economics > Health Policy
  • #43 in Books > Medical Books > Medicine > Internal Medicine > Pathology > Clinical Chemistry
  • #50 in Books > Medical Books > Administration & Medicine Economics > Health Care Delivery

More About the Author

Otis Webb Brawley, M.D.


As the chief medical and scientific officer and executive vice president of the American Cancer Society, Otis Brawley, MD, is responsible for promoting the goals of cancer prevention, early detection, and quality treatment through cancer research and education.

Dr. Brawley currently serves as professor of hematology, oncology, medicine and epidemiology at Emory University. He is also a medical consultant to the Cable News Network (CNN). Currently 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 has co-chaired the U.S. Surgeon General's Task Force on Cancer Health Disparities.

He is listed by Castle Connelly as one of America's Top Doctors for Cancer. Among 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 a residency in internal medicine at University Hospitals of Cleveland, Case-Western Reserve University, and a fellowship in medical oncology at the National Cancer Institute.

Most Helpful Customer Reviews

102 of 107 people found the following review helpful

5.0 out of 5 stars The Unfortunate Reality of American Medicine January 31, 2012

By Loyd E. Eskildson HALL OF FAME

Format:Hardcover

First, a few words on Dr. Otis Brawley and my bias - he's the Chief Medical Officer for the American Cancer Society, Professor of Medicine at Emory University, and a CNN medical consultant. As for my bias, after reading his book and bio, I would trust him to give me the best medical recommendations. I wish I lived closer so he could be my physician - I'm really impressed!

'First, do no harm' is the first precept of medical ethics taught in medical school 'How We Do Harm' is Dr. Brawley's description of the real world, of how medical practice deviates from that basic ethic. The bulk of the book consists of anecdotal examples that he has become aware of.

Dr. Brawley begins by comparing how much America spends on health care vs. other nations. We're now at 18% of GDP, and Switzerland is #2 - at 12%, obviously much lower. We spend 3.5X as much on health care as on food. Canadians spend half what we do, and are ranked #7 in life expectancy. We're #50. More is not better - in fact, American health care is making our nation sick, in an economic sense.

Many health care providers allege that they're financially short-changed by Medicare and Medicaid; others contend that the relatively low reimbursement rates of those programs is a form of 'cost-shifting' that raises rates for others. Dr. Brawley, however, states that providers can still make money at those reduced rates treating complex cases involving uncontrolled diabetes, kidney failure, heart disease, and late-stage cancer.

As for Tea Party allegations of ObamaCare medical rationing, per 'Death Panels', Dr. Brawley says this is already happening - via insurance companies. Yet, irrational spending is still rampant.... We need to return to a focus on not doing harm, peddling snake-oil and false hope - that will lower costs and improve quality. The current financial incentives driving medical practice have a bad impact on patient health and costs. Doctors who own labs order more tests than those who don't. Some community oncology practices hold regular meetings to inform physicians about treatment techniques that maximize billing. 'Disease Mongering' is overly prevalent - the proactive marketing of disease with free initial tests followed by lots of expensive for-pay follow-up. Another example - 'Zero,' an advocacy group that sponsors prostate screening vans, receives funding from the makers of Depend diapers. (Prostate removal, usually not required or recommended, subsequent to these screenings creates incontinence.)

Professional medical societies have chosen collegiality over patient well-being. Professional doctor societies issue 'evidence-based' guidelines for performing expensive procedures that are anything but evidence-based. Many patient advocacy groups act as unquestioning advocates for drug companies and medical specialists, not realizing that the interests they advocate run counter to their own. Debates between Tea Partiers and fictional characters created by PR firms further mislead.

Pseudoscience, greed, myths, lies, fraud, and looking the other way have far too often taken the place of science in directing health care. Good health care will have to be won in a public struggle, just as civil rights were. We need more stress on prevention, starting with health education.

Bottom-Line: Dr. Brawley is to be commended for shattering the 'good-old boy' image of medicine. Reality is that, like Wall Street, the profession is driven by outrageous greed. Days of family practitioners making house calls, accepting payment in eggs and chickens (if paid at all), are long gone. My most recent health care experiences (dental and medical) both follow Dr. Brawley's observations. Also amazing is the disparity between providers' 'list prices' and the prices paid by insurance firms - if list prices matched even the highest insurance payment, far fewer uninsured patients would be bankrupted by health care, and expenditures wasted on health care overheads (advertising, patient 'selection,'care review) would drop.

"How We Do Harm" is an invaluable contribution to those wanting to improve health care. Read more ›

50 of 51 people found the following review helpful

5.0 out of 5 stars Horror stories about health care, Breast Cancer, PSA Test February 8, 2012

By jwt99

Format:Hardcover|Amazon Verified Purchase

I could not put this book down. I would say this is a must read for anyone that might get or who has cancer. Also anyone who has a chronic health problem should put this book in their library.

I think Dr. Brawley gives compelling examples that illustrate how our health care systen is broken.

Read this book!

This is an excellent book unless you are a quack, a greed driven doctor or drug rep. Dr.Brawley points out that we should not waste valiable tax money or even insurance money on unproven cures or on drugs that cost 10-20 times as much as a proven drug. All medical care should be research based, rational and above all "do no harm".

I hate to tell you this, but we as a country cannot afford to waste massive amounts of money anymore. If we don't get serious about health care it will break the country. We cannot afford to transfer wealth to quack doctors or for procedures that don't work. A spinal fusion costs about $80,000 yet 80% of the research says it does no good and it does a lot of harm. Is this any way to run a health care system?

If you don't believe Dr. Brawley read the research for yourself.

Use a little of your time to dig and see if he is telling the truth.

A lot of the raw research is locked up tight and hard to access and not easy for a lay person to understand. We must rely on honest doctors like Dr. Brawley to tell us the truth about our healthcare system

The chapters on the "PSA" test for prostate cancer were shocking to say the least.

All the examples about the breast cancer problems are on point.... My wife went through this several years ago and thank goodness we had a doctor whose first words were us was " I don't give any treatment that has not been through a double blind study."

We feel like my wife received excellent treatment without receiving too much treatment. Too much can be as bad as too litttle as Dr. Brawley states.

Dr. Brawley points out through his examples that "raw greed" on the part of hospitals, doctors and drug companies has layed waste to our health care system.

The economic incentives are all on the side of more care not appropriate care. There is a vast difference between the two.

Thank you Dr. Brawley. Read more ›

44 of 45 people found the following review helpful

5.0 out of 5 stars Terrible and true February 2, 2012

By Kara S. Croker

Format:Hardcover|Amazon Verified Purchase

Dr. Brawley (excuse me, Otis) has written a book about the kind of things doctors say to each other, but not out loud and certainly not for publication. The contrast of healthcare for the overprivileged to the lack of care for the underserved (and the sea of confusion for those in-between) should not exist in the United States, and yet it does. That so much of this happens in the care of people with cancer is really unforgivable. Many will be unhappy with the author, but many more will have to agree that he is indeed telling the truth -- and doing so in a way that is compulsively readable. Otis knows how to get your attention and weave a tale that points out the things you should be seeing. He does not claim to have the answers and is free with admitting his own missteps along the way. I already sent a copy to my niece who is a 2nd year resident at an inner-city hospital and told her to be sure to pass it around once she has read it.

31 of 33 people found the following review helpful

5.0 out of 5 stars Moving and compelling account of American healthcare in crisis January 31, 2012

By Elizabeth Archer

Format:Hardcover|Amazon Verified Purchase

After reading about "How We Do Harm" on line, I had to read the book. Every American voter concerned about the real state of American medicine needs to read Dr. Brawley's moving descriptions of his struggles to deliver the best care to his critically ill patients. I literally could not put it down. Do I have all the answers now to a complex problem? Far from it, but Dr. Brawley has definitely added compelling arguments to the debate that more isn't always better, and throwing money isn't always a solution. Having lost my own mother to breast cancer in circumstances close to those he describes, I am all too ready to concede that the patient can suffer from too much care as much as from too little, especially when the treatments are experimental and do nothing to prolong life, or quality of life. The voices of doctors need to be heard as loudly as politicians, and Dr. Brawley's patients provide examples that are both haunting and inspiring.