We Do Harm: A Doctor Breaks Ranks About Being Sick in America

CURE, Summer 2012, Volume 11, Issue 2

Otis Brawley, MD, writes on healthcare in the U.S.

Otis Brawley, MD, has a bone to pick with the American healthcare system and everyone is at fault: doctors, hospitals, insurers, drug companies, politicians, lawyers and even the patients themselves. In his book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, Brawley, chief medical and scientific officer of the American Cancer Society, tells a raw tale of how the U.S. healthcare system fails patients every day.

"Here is the problem," writes Brawley. "Poor Americans consume too little health care, especially preventive health care. Other Americans—often rich Americans—consume too much health care, often unwisely, and sometimes to their detriment. The American health-care system combines famine with gluttony."

Now a professor of hematology, oncology, medicine and epidemiology at Emory University in Atlanta, Brawley uses patient stories from his days at Atlanta's Grady Memorial Hospital, University Hospitals Case Medical Center in Cleveland, Ohio, and the National Cancer Institute to reveal gross negligence due to these extremes in care. In the case of Edna Riggs, her breast cancer has been left untreated for so long—nine years—that her body reacts with an automastectomy, which is what happens when a tumor grows so large that it cuts off the blood supply to the breast, causing it to detach itself from the chest wall and fall off. At the opposite end of the spectrum is Ralph DeAngelo, whose free screening for prostate cancer in a shopping mall sparks seven years worth of expensive medical procedures. Disastrous complications from those procedures, which no one can say with any certainty prolonged his life, certainly, according to Brawley, helped line the wallets of doctors, hospitals and pharmaceutical companies along the way.

Brawley writes poignantly, albeit bluntly, about a healthcare system that is based on financial conflicts of interest and not on science or the best interest of the patient. Whether it's doctors and hospitals getting paid by the quantity of procedures performed rather than the quality of healthcare delivered; insurance companies covering ineffective or even harmful treatments based on old or bad science; or pharmaceutical companies reinventing drug equivalents, marketing them as the next best thing and then charging 12 times that of the original, the system, as witnessed from Brawley's perspective, does indeed sound broken.

"As I look at this mess," writes Brawley, "I realize that we don't need health-care reform. We need a health-care transformation."

While readers might well be ready for a healthcare transformation by the time they reach the end of this riveting tome, at the very least, they will certainly become better, more critical consumers of healthcare.