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.
![[Start the discussion]](http://g-ecx.images-amazon.com/images/G/01/x-locale/communities/discussion_boards/start-new-discussion-sec._V192250339_.gif){kind=small}
