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

Dr. Brawley has achieved something rare in a non- fiction work. He has combined his clear passion for medicine with a fair but brutal portrayal of what is terribly wrong with our system as it presently stands. Dr. Brawley is highly credentialed and has over 30 years experience in his craft, yet he writes with a balance of humility and moral outrage that is rare in this type of work. I have been in healthcare for over 20 years and have watched horrified as the system has become more, not less broken and ineffectual while at the same time knowing that no American can really know the gaping problems of pharmacuetical companies offering medicines that have questionable merit and do real harm, the multi "tier" system of care where in general the wealthy recieve MORE care, but not necessarily better care and are often over treated for pure profit and the horrific truths about incopetent and dangerous physicians and systems allowed to treat patients while no one dares to ask for QA. "How We Harm" addresses the issues every consumer of medical services need to understand before they or someone they love becomes sick. Sadly some of the families I care for only discover how broken the system is at the moment of their greatest vulnerability- when a family member or themselves become very ill and they are left to fight insurers, billing departments and conflicting prognosises and treatment plans without a rational, science based resource to ensure they are making the right choices. Dr. Brawley describes how the "system" as it currently stands seems to know that sick consumers can not fight for their rights, and are often too frightened and overwhelmed to even ask the right questions when they face major medical decisions. Insurers will be held more accountable after ACA full implementaion in 2014, but this is clearly not enough to fix the systems that you and I the taxpayer supplement when big pharma and for profit medicine have taken all the meager resources that many Americans have to pay for their co-pays and expensive treatments for serious illness. The "system" knows that eventually Medicaid will take over payment for these desperate patients. The case illustrations Dr. Brawley presents are fair and deadly accurate. I see similar terrible outcomes all the time. The book also describes aspects of caring for the 'under served' that are spirtually affirming and make this book a very positive read for that reason alone.Dr. Brawley clearly loves to teach medical students as well and he he even seems to love his patients- a rare but amazing quality in a physician. Dr. Brawley is a national voice of reason and passion for making things right. I look forward to his next move as a leader in American medical reform.

I am a former teacher, school librarian, published author, and book reviewer for the Society of Children's Book Writers and Illustrators, as well as judge and book reviewer for the IPPY and MOONBEAM BOOK Awards. Many years ago I was diagnosed with GUILLAIN-BARRE SYNDROME. Since I was diagnosed with this terrible neurological disease, I have continued to experience symptoms which I ignored while finishing my BA and MA degrees, teaching in several school systems including Department of Defense Overseas Schools, and traveling around the world. Even though I was often ill and constantly plagued with symptoms of my disease, I ignored the problems and did not see neurologists or undergo transfusions and/or infusions, as well as be a guinea pig for the huge variety of experimental drugs. I workout daily, eat nutriciously, and try to always be positive, laugh, and have fun. Many people have died from my disease. And I wonder if I am still alive due to NOT SEEING DOCTORS and undergoing UNPROVEN or FLAWED PROCEDURES and DRUGS. Dr. Brawley's book showed me that my choices probably helped me to be active and live, not experience an early death while doctors harmed me with their techniques. I have briefly reviewed Dr. Brawley's outstanding book which helped me to conclude that I made the best choices by not seeing neurologists over the years. Also, I was afraid my neurological disease would be labled a "PRE EXISTING CONDITION" which my insurance policies would not cover. Otis Webb Brawley, author of HOW WE DO HARM; A DOCTOR BREAKS RANKS ABOUT BEING SICK IN AMERICA, is an oncology (Cancer) professor at Georgia's prestigious Emory University as well as the Chief Medical and Scientific Officer of the American Cancer Society. Using personal anecdotes from past patients, Dr. Brawley illustrates many things which are wrong with our medical system as well as medical and nonmedical groups and doctors who need to totally change this system. Every page was packed with specific information about medical problems with protocol, procedures, chemotherapy, and uninformed patients who blindly follow doctors' suggestions as to the best way of treating thier cancers. Much of the medical research is flawed making it almost impossible for patients to research their diseases and make intelligent choices. It is imperative that everyone, men and their well-meaning wives, read about the patient, Ralph, whose wife urged him to get a free PROSTATE PSA TEST in a mall which led to horrendous FLAWED procedures which 'caused him misery and pain until he died an early death. Dr. Brawley thought prostate screening was not at all useful for anyone without symptoms. I also think that many tests we have are just to generate money for doctors and the groups they work for. In fact, just this week they are now saying women should not have MAMMOGRAMS every year as I did since I turned forty. Now the recommendation is for women to have mammograms every three to five years. Dr. Brawley said in his book that women more often find their own cancer, and mammograms should not be taken on a yearly basis. This book was the best nonfiction book I have read in years. But I was disappointed Dr. Brawley did not write a chapter on the FDA, though he referred to the organization many times. I was also interested in more specific information about drugs, particularly STATINS which are taken by most people over 50 even though they have many serious side effects. One chapter was titled GUILLAIN-BARRE SYNDROM but only mentioned the disease briefly. I am a former librarian, and like most librarians look for BIBLIOGRAPHIES, GLOSSARIES, INDEXES, and CHARTS and GRAPHS illustrating important things to better illustrate the text. In the back of the book Dr. Brawley does include specific NOTES about information in each chapter. I could only read a few pages of this information packed book per day, because there was so much information I wanted to retain. I urge every adult of both genders and any age to read this book. And if you are capable and not disabled, volunteer to help the various advocacy groups who are attempting to change our hea;th system. This book was published two years ago before Barack Obama presented his new health care plan, therefore there is nothing in the book about it. Dr. Brawley, I am looking forward to another book from you about the goings on at the FDA, since they release many drugs which are later involved in class action suits. Also, cholesterol and cholesterol drugs should be examined in detail like you did oncology. Also, Dr. B, please have your publisher publish this book in a LARGE PRINT EDITION!!! I first saw Dr. Otis Brawley on BOOKTV.ORG weeks ago. I was so impressed with Dr. Brawley's speech which was perfect as well as his honesty that I bought HOW WE DO HARM. Go to BookTV.org and look for the video of Dr. Brawley's speech. Karen Joan McWilliams, Naples, FL

I read a lot on the healthcare system and also have a biology PhD and a healthcare-related career, so I read 'How We Do Harm' with real interest and found that I tremendously enjoyed it, largely due to its distinctive and refreshing down-to-earth, no-holds-barred, friend-of-the-people style attack on many different sacred cows of the healthcare system. He exposes ignorance, shysterism, laziness and other commonplace human failings AMONG HIS FELLOW PHYSICIANS, where these everyday human foibles have an enormous impact on the life and death and quality of life of the patients treated by them. And he is not just any physician, he is the Chief Medical and Scientific Officer of the American Cancer Society. It reads like the system has turned on itself. This is a 'People's History' of the current healthcare system. The language is carefully unacademic and the cases he chooses are heart-wringing for the most part. I think there is much to learn from the diverse cases he selects, and he goes after problems originating with patients and their families as well as doctors and the system. If each of the problems that Dr. Brawley characterizes were systematically addressed, we would have a somewhat better and MUCH cheaper system - I think essentially a Canadian system, even if there were multiple payors. Once everyone followed the same rules and there was little role for physician discretion, and little role for new therapies until massive clinical studies achieved definitive conclusive results, inefficiencies in the system would be dramatically reduced, and many patients would receive better care. The problem with this objective, IMHO, is that the heterogeneity of cancer and the rate of advance in this particular field would not be well-served by a system where no new therapies were paid for until they had achieved p values of <0.05 in clinical trials IN THE PRECISE PATIENT POPULATION of the patient who needs treatment. Some cancers are so rare that this would never happen. In other cases, new research information evolves in small case series that wouldn't meet Dr. Brawley's standards but would provide vital information for selection of therapy. All-in-all, Dr. Brawley appears overly philosophically committed to the concept of clinical certainty, iron-clad treatment paradigms, and saving the system money. I'm all for saving the system money, but Dr. Brawley goes after cancer screening with the dedication of a hero confronting his nemesis. He barely acknowledges the potential for good to come from screening. For example, he is dismissive of the value provided by lung cancer screening, in spite of a roughly 50,000 patient randomized controlled study that showed a 20% reduction in cancer mortality in heavy smokers who received screening! This was without even specifying how these patients were treated - the 20% reduction in the leading cause of cancer mortality was simply from looking for a spot on the lung, and then letting the doctor and patient decide what treatment to pursue. I see that as a tremendous breakthrough. Dr. Brawley sees it as a roughly even set of risks and benefits that the system presumably should hesitate to fund. (Updated August 2013 to note that the U.S. Preventive Services Task Force has now issued a strong recommendation for CT screening of heavy smokers for early detection of lung cancer, based primarily on the data above. "As many as 20,000 deaths a year could be prevented by screening", according to Michael LeFevre, MD, co-vice chair of the task force). The book is well worth reading; but there are other intelligent, reasonable viewpoints on the burning thesis presented by this book, and one unfortunately comes away with the impression that Dr. Brawley would not acknowledge this. I found myself comforted by the fact that other checks and balances in the system will limit Dr. Brawley's impact on cancer treatment paradigms, even with his role at the ACS.

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.

In "How We Do Harm,' author Otis Webb Brawley, M.D., shares his healthcare system experience from his early days at the Pritzker School of Medicine (University of Chicago), as a resident at University Hospitals of Cleveland, as a fellow at the National Cancer Institute, and as a physician specializing in medical oncology at Grady Hospital in Atlanta. Brawley has both the experience and credentials to call our attention to the systemic failures of a system that our politicians call the "best in the world (ignorance is elegant)." He is recognized as an outstanding physician-scientist who serves today as the chief medical and scientific officer of the American Cancer Society, and as professor of hematology, oncology, medicine, and epidemiology at Emory University In this book, the author takes the reader on a "guided tour of the back rooms" of the American healthcare system. He charges that "no incident failure in American medicine should be dismissed as an aberration...failure is the system, a system in which helping patients is not the point. Economic incentives dictate that the patient be ground up as expensively as possible with the goal of maximizing the cut of every practitioner who gets involved." Brawley's view is that of skeptic and health-reform advocate. Brawley uses his personal experience and stories to show how our system "fails to provide care when care is needed and fails to stop expensive, often unnecessary, and frequently harmful interventions." He feels one antidote to sure the ills of the system would be to base the system on science. His stories include: 1. The treatment provided to a woman whose breast fell-off due to cancer. 2. Misguided collegiality among physicians. "Should I tell the patient that the previous doctor was incompetent? And get hauled into court for slander?" 3. The saving of Mr. Huzjak whose daughter, despite his condition, wants everything to be done to save his life. "We never give up" when the humane thing is to give up. 4. The Wallet Biopsy - the reason why people are turned away from private hospitals and end up at public hospitals like Grady. 5. Treating colon cancer Colon Cancer. "If you are poor, black, and uninsured, you get no care until its too late. But if you are rich, white, and insured, you face another deadly menace, doctors (some socially prominent) who are just plain bad. Expensive drugs and tests that patients don't need." 6. The implantable defibrillator, and the growing disparity between the insured and the uninsured which increases as technology improves. 7. Procrit, Nexium, Vioxx, Intensity Modulation Radiation Therapy and other approved drugs and therapies that are leading patients to serious complications, and/or a worsening of disease, or death. And how overtreatment may be beneficial to everyone but the patient - doctors, hospitals, and the pharmaceutical industry. 8. The perverse incentive system in which has extended the standards of care enormously from three decades ago due to the willingness of insurance companies to pay and the willingness of private physicians to make a buck. Brawley, by "breaking the ranks about being sick in America," points to his Jesuit education as a foundational experience for his life journey. A Jesuit teacher, Fr. Richard Polakowski, early in his life taught "Say what you know, what you don't know, and what you believe - and label it accordingly." Along the way, Brawley developed a set of maxims what would shape his life: 1. Be a man for others. Find work where you can make a difference. Use your God-given gifts to improve the lot of others. Always focus on improving the lot of others. Do this for the greater glory of God. 2. Be binary, know right and wrong. Be truthful. Have the courage to speak truth to power. 3. Never worry about people thinking you are different. Realize, people, both black and white, will try to discourage you. They will try to get at your self- confidence. 4. You will be tested. Always know your subject matter better than anyone else. You must be good. You must stand up to scrutiny. 5. Do not let the naysayers make you feel you cannot do something. They will call you arrogant. They will call you aloof. They will question your intelligence...spite them by succeeding. 6. Do not tolerate fools. Don't compromise on excellence. 7. Never let people put you down. 8. Feel sorry for people who see no challenges to overcome. Feel sorry for the selfish. Feel sorry for the fools. Remember you have character they cannot understand. Relish you have overcome challenges they could never overcome. As someone who has worked for over 40 years in healthcare, Brawley's book resonated with some of my own experiences. His perspective, while not inclusive, has great value. However, he fails to note the role of government in shaping the system we have today - diagnosis related groups (DRGs), resource-based relative value scale (RBRVS), CMS CP codes, Medicare and Medicaid cost shifting, and, for me personally, the role of the FDA in driving up the cost of medical innovation. Much of what he describes as systemic failure can be attributed to government intervention. The private sector's greediness is a response, much like Wall Street's and the public's greedy response to the government's "everyone should own a home" policy which led to the Great Recession of 2007-2009.

I would give this book 6 stars if I could. The book talks about medical care and cancer care in the United States. The care that many receive is very limited for the poor and poorly managed for the rich or well insured. We need treatments that have a scientific basis and a proven track record. Often Patients get pushed into testing that has not been shown to prolong life or decrease morbidity. A good example is PSA testing. The potential therapies can kill you or drastically take away quality of life. Would you take a test that might lead to wearing diapers for the rest of you life and not prolong your life ? If Your PSA is elevated does your doctor offer you 3 or 4 possible treatments and compare possible and likely outcomes? Is there any financial incentives for the proposed therapy? Is there an expensive piece of equipment that needs to be paid for? Have you been given a list of alternatives and expected outcomes? Unfortunately the current medical health care system is flooded with ignorance, apathy and often greed. Consumers (patient) need to know something about their disease. They must become active players. They should ask for proof that this therapy is better than another therapy. They also need to be able to ask their doctors "how many of these have you done and what outcomes have you had?" They need real expectations. If you have localized prostate disease that has a low risk of metastasis then why get the prostate ripped out ? Maybe it can be watched for 4 - 5 years before surgery and diapers and impotence. Greed? Yes boys and girls somebody has to pay for that 3 million dollar particle accelerator at your local hospital. Why should it be your life and body for some unproven therapy? Unfortunately education is a very difficult thing to do. You can tell I loved this book. Why is it the USA has such poor health outcomes? Over treatment can cause harm. Bone Marrow transplants for breast cancer is proof of the harm.

I can't think of a better book to introduce health policy to students studying to become a health professional.

I had the privilege of working with Otis during part of his training at the National Cancer Institute at a time that policies on PSA and mammography screening were being newly scrutinized with respect to risk/benefit. The notion that screening might actually do more harm than good was seen as absolute heresy and I fondly remember the wonder and amazement in Otis' eyes as he unraveled to me just how this counter-intuitive idea could be so. Twenty years later, the truths I learned from Otis back then are still not widely appreciated among patients, indeed even doctors more sadly. I eagerly snatched this book up not only because I knew Otis and expected a riveting review of healthcare but because my experience in pharmaceutical development has led me to participate unintentionally in some of the perverse systems of conflicts of interest that characterize our healthcare system. I am at a personal watershed and this book is a strong antidote for what ails me, i.e. I feel emboldened to take my career in the direction of a solution rather than continue to contribute to the problem. Written for the general audience, We Do Harm breaks the ranks of legions of doctors who are invested in perpetuating a broken but remunerative healthcare system by introducing specific and by no means isolated instances where patients have been harmed. This book is at once disparaging of blind trust of one's physician and optimistic in that some stars like Otis and microcosms like Grady Memorial can and do avoid patient-disadvantaged conflicts of interest. This book provides evidence and motivation for every person in every role they engage in in the healthcare system: patient, consumer, provider, insurer, politician. No one can escape the relevance and import of the key message of this book that "more" is not always "better." Until such time, if ever, that our healthcare system operates under transparency, this is a must read for all. That means you! Now! It can't wait! I am a believer that healthcare quality will come from the bottom up and not the top down and this book exemplifies this spirit; read it and be empowered to ask the hard questions as to who is motivated to provide what care and at what personal gain.

Wonderful read. Otis Webb Brawley is insightful and knowledgable and helps shed light on the flaws of the American health care system.

I expected this to be an attack on the inequalities of the US healthcare system. Instead I found a well presented argument that goes beyond insurance to highlight problems with the "let's battle cancer by throwing everything we have at it." The real life case studies Otis Brawley brings to our attention and the fashion for hitting cancer with all we have, truly made me hope I will take time to breathe and consider all options if I or my loved ones are diagnosed with cancer.

A must read for all doctors

Dr Otis tells it as it is - warts and all - to be a medical patient in the USA. He shows how the size of your wallet and the extent of your health insurance dictates how you will be treated by the medical profession in the US. Thank heaven for the NHS in the UK: we don't know how lucky we are by comparison!

Great book, well written! If you have any interest in public health in the States, buy that book right now.