How Doctors Do Harm: Case of Breast Cancer

by Yeong Sek Yee & Khadijah Shaari

How we do harm

 

 

Being an oncologist, the following are Dr Brawley’s comments on cancer treatments:

In Chapters 3 and 4, a typical breast cancer treatment case was described. Helen, 50 had mastectomy in 1990 to remove a 4cm lump together with 21 lymph nodes, all negative, and classified stage II. She was “offered” post surgical chemotherapy. Her oncologist explained that a stronger dose is better than a weaker dose. “More is better” has been the hallmark of the oncology profession since the 1950s, the more chemotherapy you administered to the patient, the more effective in terms of killing the disease.

  • To save Helen from succumbing to the toxic effects of chemotherapy, she was “offered” autologus bone marrow transplantation since her insurance company will pay for more of the costs of the transplant and chemotherapy (page 32).
  • The side effects (page 33) Helen experienced from the transplant and chemotherapy was far more severe than she expected or was explained to her.

She experienced the following:

  • Nausea, vomiting, diarrhoea, dehydration,
  • Her marrow was slow to re-implant and start producing,
  • She had bleeding caused by a low platelet count and severe anaemia,
  • She had gastrointestinal bleeding and bleeding from the incisions made to harvest her bone marrow,
  • She had mouth and gum problems and cardiac rhythm problems,
  • She had a change in mental status due to electrolyte imbalance,
  • She had respiratory arrest and is put on a ventilator,
  • She developed pneumonia and had a tracheotomy

Altogether, she spent 5 months in a hospital only to be discharged to a rehabilitation hospital.

  • Helen survived it all. However three years after her discharge, she read a news story about randomized clinical trials that showed that bone marrow transplantation for breast cancer doesn’t prolong survival!! (page 33).
  • Naturally she was devastated. Why had she been subjected to a devastating procedure when no one, including her doctor, could say with certainty whether it worked? Why wasn’t she told about this uncertainty? Was it possible she was duped? Was it possible she had nearly died to help her doctor and various medical institutions accumulate wealth? (page 30)
  • When confronted, her oncologist admitted and responded that…”this was what everybody was doing at the time” (page 34)…so much for “FIRST, DO NO HARM!!”
  • Four years later, a routine chest X-ray showed a lesion in Helen’s lungs… had Helen’s breast cancer returned despite the transplant? As further lesions developed in her lungs after the initial chest X-rays, Helen was told by her insurance company that she was pronounced uninsurable (page 36).
  • From a middle-class woman who has done everything her doctors told her to do and had been put through tremendous amount of what is now considered unnecessary treatments that she suddenly found herself uninsured and dying of cancer. What are her options now? (page 36).
  • A few months later, Dr Brawley was handed Helen’s PET-CT scan which she described as” it lit up like a Christmas tree.” Indeed the scan lights up bright, showing lesions in the spine, ribs, pelvis, lung, liver and the opposite breast…. What happened to her? (page 40).
  • This is indeed a real tragedy of “modern, scientifically tested, evidence-based medicine.” Helen received a bone marrow transplant without being told all that was known about it, and, more important, all that was unknown. She got the transplant because she was insured and doctors could convert her suffering into cash (page 45).
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