BOOK REVIEW: HOW WE DO HARM Part 1

by Yeong Sek Yee & Khadijah Shaari

How we do harm

 THE AUTHOR is Dr. Otis Webb Brawley, MD, the chief medical and executive Vice president of the American Cancer Society, and currently serving as Professor of Hematology, Oncology, Medicine, and Epidemiology at Emory University and a fellow in Medical Oncology at the National Cancer Institute, USA. 

WHAT THE BOOK IS ABOUT:  Yes, the book carries a very unique title. You must really read the whole book to find out how oncologists/doctors do harm…..contrary to the first precepts of medical ethics taught in medical school….”FIRST, DO NO HARM

Dr Brawley exposes the dark side of healthcare today in America—the overtreatment of the rich, the under treatment of the poor, the financial conflicts of interest that determine the care that physicians provide, and that pharmaceutical companies are only concerned with selling drugs, regardless of whether they improve health or do harm. In the book, Dr Brawley tells of doctors who select treatment based on the 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 company will pay).

Through case examples, mostly involving cancer, Dr Brawley documents the sometimes excessive and unnecessary treatments patients receive because doctors prescribe medications and push protocols that have no clinical basis while having clear financial gain for the many doctors and pharmaceutical companies involved. From the woman who received a hemoglobin-building drug during breast cancer treatment that likely stimulated more tumor growth and shortened her life, to the elderly gentleman who underwent a free prostate screening that led to numerous treatments ultimately leading to his death (when some forms of prostate cancer don’t need to be treated at all), Dr. Brawley is trying to make patients and doctors alike question the policies and self-interest that drive our health care system.

Listen to these videos.

Medical Book Review: How We Do Harm

https://www.youtube.com/watch?v=cKsSBchsCpo

Comments by Dr Kathy Miller, MD

https://www.youtube.com/watch?v=9ndImCj1A2M

Otis Brawley at TEDMED 2012

https://www.youtube.com/watch?v=ctsqa7J4Ank

How American Medicine Does Harm To Patients

a) In the back room of American medicine, the analysis of the patient’s durability has a special name: A Wallet Biopsy.  If the biopsy returns positive, you get to stay in the hospital, you get more treatment, and you can make a follow-up appointment. If it returns negative, you have little hope of getting consistent care (page 23).

b) Although the “wallet biopsy” syndrome favours the rich or insured, wealth in America is no protection from getting lousy care. Ironically wealth can increase your risk of getting lousy care. When wealthy patients demand irrational care, it’s not hard to find a doctor willing to provide it. If you have more money, doctors tell you more of what they sell, and they just might kill you (page 23).

c) Our (American) medical system fails to provide care when care is needed and fails to stop expensive, often unnecessary and frequently harmful ‘interventions’ even in situations when science has proven these interventions are wrongheaded (page 22).

d) The financial incentives that drive the medical community have a devastating impact on patients and health care costs….doctors who own labs or medical facility, have been shown to order more tests than doctors who don’t. A doctor at a for-profit practice is more likely to prescribe the treatments that benefit him (the doctor) the most (page 25).

e) Would a doctor who sells radiation therapy tell you to go across the street to get chemotherapy even in cases where studies show that it’s more appropriate? Would either of these medical entrepreneurs advise you to wait for six months to see whether your disease is of the sort that would actually harm you? All too often, the answers to these questions are NO!!! (page 25).

The following are some of Dr Brawley’s strong views on some aspects of modern medicine as we browse through the book again:

  •  Professional societies of doctors who perform expensive medical procedures issue “evidence-based guidelines” that is anything but evidence based guidelines. Instead, the purpose of many of these documents (“guidelines”) is to protect the specialties’ financial stake in the system (page 26).
  • Patients need to understand that more care is not better care, that doctors are not necessarily right, and that some doctors are not even truthful (page 27).
  • In most cancers, the quality of the surgery is the most important factor in the ultimate outcome. You only get one chance to do the surgery right, so choose your surgeon well and pray you have an exceptional surgeon having an exceptionally good day (page 32).
  • Comparing the prognosis with and without chemotherapy is key to the decision to forgo treatment (page 56)… (and consider the costs as well).
  • Adjuvant chemotherapy for breast cancer was relatively easy, like following a recipe from a cook book. Providing adjuvant therapy for breast cancer is a great place to be mediocre: no clinical judgements need to be made, and the money is good (page 63).
  • Doctors who don’t know the limits of their knowledge are another matter. Doctors who don’t know what they don’t know–and don’t care–are dangerous (page 64).
  • God expects us to work for social justice, and the best way to serve Him is through caring for others. Some people praise GOD by going to church on Sunday. I, (Dr Brawley) seek to do the same daily by helping those in distress, and by telling the truth (page 76).
  • ….Overtreatment equals harm (page 78).
  • Physicians in private practice are expected to generate certain revenues, and their take-home pay is usually determined by the amount of medical services and drugs they provide (page 85).
  • With powerful incentives set in motion, many hospitals and oncology practices in the US instructed nurses to ask leading questions about “fatigue” with the intent of expanding sales to a growing number of patients and upping the dosage to each patient. This is referred to as “an ESA treatment opportunity” (ESA means erythropoiesis-stimulating agents, drugs used to overcome fatigue, low blood counts). (page 85).
  • To increase their earnings, drug companies and doctors set out on a search for treatment opportunities, often forgetting about the sacred trust between doctors and patients (page 85).
  • The exact magnitude of harm is harder to gauge…most of the money was spent on drugs (e.g. ESAs) that were prescribed for the wrong reasons and under false, manufactured pretences. These drugs were not used to cure disease or make patients feel better. They were used to make money for doctors and pharmaceutical companies at the expense of patients, insurance companies…the technical term for this is overtreatment and overtreatment equals harm (page 97).
  • Doctors do some horrible, irrational things under the guise of seeking to benefit patients….For example offering a bone marrow transplant for a breast cancer patient, prophylactic doses of ESA drugs…these are only a few examples. The system rewards us for selling our goods and services, and we play the game (page 122).
  • You don’t deviate from the science. You don’t make it up as you are going along. You have to have a reason to give the drugs you are giving. You have to tell the patients the truth (page 145).
  • Commenting further on ESA drugs, some doctors didn’t bother to check what the patient’s haemoglobin was and erred on the side of giving the ESA every time they give chemotherapy. Doctors routinely prescribed the drugs for uses, in which it had not been studied-such as anaemia caused by cancer itself, as opposed to anaemia caused by chemotherapy (page 78).
  • ….Doctors try out things just to see whether they will work (page 160) Earlier in the book (page 29), Dr Brawley mentioned that “A hospital was the place where they withheld treatment or where they tried things on you without telling you what they were doing and why (page 29/30).
  • When a drug succeeds in controlling cancer, we learn about it at conferences and in scientific journals. Stories of our fiascos, though no less instructive, are almost invisible, especially if there are cautionary tales that lay bare the fundamental flaws in the system (page 157).
  • Cancer is hard to understand, and yet doctors rush patients (page 182).
  • Survival measures time that elapses after diagnosis. By diagnosing a cancer earlier, survival rates are increased. The more you diagnose, the more you push up survival (page 193).
  • Somewhere along the way, we have been conditioned to believe that a new treatment is always better (page 197) A new drug must be better than the old. A new medical device must also be better (page 202).
  • Inappropriate use of certain drugs can be attributed to the profit motive. A recent study of prescribing pattern demonstrated that as soon as the profit motive weakened, inappropriate prescribing of these drugs dropped (page 197).
  • The overuse of radiologic imaging is a major problem…..”up to one-third of radiologic imaging tests are unnecessary. This is a serious problem, not just because these tests are expensive, but because they expose the patient to radiation that can cause cancer. Some have estimated that 1% of cancers in the United States are caused by radiation from medical imaging” (page 202).
  • Even when administered properly, cancer drugs can bring the patient to the brink of death. An overdose can easily push him off the cliff (page 279).
  • Much of the money currently spent on healthcare (in the US) 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 (page 281).
  • The medical profession frequently allows bad doctors to continue to practice. The profession doesn’t police itself. Chalk it all up to apathy. Or ignorance (page 282).
  • Many physicians are ignorant of some aspects of the field of medicine in which they practice. They tend to think the newer pill or newer treatment must be better because it is new. Ignorance is a failure to think deeply. It is a failure to be inquisitive. It is a failure to keep an open mind (page 282).

Dr Brawley’s most direct and blunt statement in the book is….”America does not have a health-care system. We have a sick-care system”. Is Malaysia there yet?? We welcome your views.

FURTHER REFERENCES:

FOR BOOKS OF A SIMILAR NATURE, WE RECOMMEND THE FOLLOWING:

1)    MORE HARM THAN GOOD by Dr Alan Zelicoff, MD (Read what your doctor may not tell you about common treatments and procedures). ISBN NO: 978-0-8144-0027-2 (2008).

2)   OVERDIAGNOSED by Dr H. Gilbert Welch, MD and Dr Lisa M. Schwartz, MD and Dr Steven Woloshin, MD. (An expose of…making people sick in the pursuit of health). ISBN NO: 978-08070-2199-6 (2011).

3)   MONEY DRIVEN MEDICINE by Dr David K. Cundiff, MD (Read about tests and treatments that don’t work). ISBN NO: 0-9761571-0-1 (2006).

4)   DOCTORS ARE MORE HARMFUL THAN GERMS by Dr Harvey Bigelsen, MD (Find out how surgery can be hazardous to your health and what to do about it). ISBN NO: 978-1-55643-958-2 (2011).

5)   WHAT YOUR DOCTOR WON’T (OR CAN’T) TELL YOU by Dr Evan S. Levine, MD (Read about the failures of American Medicine and how to avoid becoming a statistic). ISBN NO: 978-04252000-87 (2004).

6)   DEATH BY PRESCRIPTION by Dr Ray D Strand, MD (Find out the shocking truth behind an overmedicated nation) ISBN NO: 0-7852-6484-1 (2003).

7)   OVERDOSE by Dr Jay S. Cohen, MD (Discover how prescription drugs and its side effects affect your health) ISBN NO: 978-1585-4237-05 (2004).

8)    HOPE OR HYPE by Dr Richard A. Deyo, MD, MPH and Dr Donald L. Patrick, PH.D (Read how the obsession with medical advances and the high costs of false promises and a lot more). ISBN No: 978-0814408-452 (2005).

9)   A WORLD WITHOUT CANCER by Dr Margaret Cuomo, MD (A radiologist herself, she describes very candidly that conventional cancer treatments are fatally flawed….find out why Chapter 4 is entitled CUT, POISON AND BURN).

ISBN NO: 978-1-60961(2012).

10)   NATURAL STRATEGIES FOR CANCER PATIENTS by Dr Russell Blaylock, MD and a neurosurgeon. (Find out why Chapter 3 is called CHEMOTHERAPY: POISONING CANCER AND YOU and Chapter 4 is RADIATION THERAPY: BURNING CANCER). ISBN NO: 0-7582-0221-0 (2003).

11)   HOW MODERN MEDICINE KILLED MY BROTHER by Dr Russell Blaylock, MD and a neurosurgeon. (Read Dr Blaylock’s expose at the following link: http://www.wnho.net/medicine_killed_brother.htm

12)   BAD PHARMA by Dr Ben Goldacre, MD (An expose how the drug companies mislead doctors and harm patients). ISBN NO: 978-0-00-735074-2 (2012)

13)  HOW AMERICAN HEALTHCARE KILLED MY FATHER by David Goldhill (In 2007, David Goldhill’s father died from infections acquired in a hospital, one of more than two hundred thousand avoidable deaths per year caused by medical error…and the bill was enormous). Read David’s summary at the following link: http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/   or you may wish to read his just released book called CATASTROPHIC CARE: HOW AMERICAN HEALTH CARE KILLED MY FATHER (ISBN NO: 978-0307961549….Jan 2013).

14)  HOW MODERN MEDICINE IS KILLING YOU……just Google the title and you will find lots of articles to read and videos to view.

15)  WHEN DOCTORS DON’T LISTEN: HOW TO AVOID MISDIAGNOSES AND UNNECESSARY TESTS by Dr Leana Wen MD and Dr Joshua Kosowsky (The authors argue that diagnosis, once the cornerstone of medicine, is fast becoming a lost art, with grave consequences). ISBN NO: 978-0312-5949-916.

NB: THERE IS A LOT MORE BOOKS OF SUCH NATURE TO FILL UP THE NEXT FEW PAGES.

NB: THESE NOTES, COMPILED BY YEONG SEK YEE AND KHADIJAH SHAARI, ARE MEANT STRICTLY FOR YOUR INFORMATION AND NOT INTENDED TO DISSUADE YOU FROM SEEKING CONVENTIONAL CANCER TREATMENTS. THIS HAS TO BE SOLELY YOUR RESPONSIBILITY/DISCRETION.
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