An American Cancer Society executive will bring his blunt critique of the country's medical system to Bakersfield next week -- just in time for the hoopla of breast cancer awareness month.
Dr. Otis W. Brawley, chief medical and scientific officer for the American Cancer Society and a professor at Emory University, took the system -- and everyone in it -- to task in his 2011 book, "How We Do Harm: A Doctor Breaks Rank About Being Sick in America." He will offer the 9th Annual Kegley Institute of Ethics Fall Lecture on Wednesday at Cal State Bakersfield. Institute Director Christopher Meyers called the engagement "a must-see for everyone" who has been affected by cancer.
Brawley spoke with The Californian by phone Thursday. The Q & A was edited for conciseness and clarity.
TBC: I'm curious how long you had the idea for this book and where it came from.
Brawley: Actually Paul Goldberg, my coauthor, suggested that I write the book 20 years ago. Some of the stories in the book actually were gathered from notes taken starting (30 years ago) when I was a medical student. The book really is a compilation of examples of things I've run across in health care that really I think are quite upsetting and examples of how health care has gone wrong in the United States.
TBC: You definitely don't sugarcoat your take on the medical system and its flaws. One line that stood out from your book is, "Failure is the system, and those of us who are not yet its victims are at high risk of being sucked into its turbines." What are a few of the points you'll bring up when you're speaking here next week that might surprise folks?
Brawley: I think the first thing that would surprise folks is that there is such a thing as over-consumption of health care and over-consumption of health can actually be harmful. That's the first point that many people are shocked about.
The second is that many organizations that have screening guidelines in the case of cancer or other guidelines -- heart disease or diabetes -- actually have a financial interest in those guidelines. Sometimes those guidelines are not as based in science as we would think.
The third is that we, as physicians, sometimes are not very scientific. We end up being very prejudiced about what we think is right ... The issue is a lot of doctors confuse what they believe with what they know, and forget about the scientific process.
TBC: When you're speaking about the brokenness of the American medical system as you're going to be doing here in Bakersfield, what is the reception like? Do you get a lot of people who are in disbelief or shocked by what you have to say?
Brawley: I don't get too many people who are in disbelief or shock. I get a lot of people who say, 'You know, I never thought of it that way.' They're accepting of the facts but they never just put it together to realize how bad our system is.
Another line that I very frequently use and I really do believe is, 'There's a subtle form of corruptionin American health care and all of us are responsible for it because all of us let it happen.' When I say all of us, I'm talking about the doctors, the hospitals, the insurance companies, the lawyers, and the patients ... the pharmaceutical companies. Literally everyone who is involved in American health care is allowing this subtle form of corruption where there is over-consumption and in many instances unwise use (of health care) going on. We let our politicians scare us by talking about rationing of health care when what all of us ought to be talking about is the rational use of health care.
TBC: Since your book was published in 2011 do you think anything has changed or anything has improved?
Brawley: I am not super-optimistic about American health care and about the change, quite honestly. The Affordable Care Act is an improvement on the system that we have had. It's going to make health care more available for a lot more people. It's going to control some pricing but not a lot of pricing. It didn't go far enough in my mind. Quite honestly, the Affordable Care Act is more insurance payment reform when what we is need is a transformation in how we consume health care ...
We spend a lot of money on health care in this country ... and our outcomes are far worse than what we pay for... I actually see health care costs continuing to go up to the point that the economy will be strangled by health care costs ... I foresee the economy collapsing under the weight of health care costs.
TBC: What do you think the solutions are?
Brawley: The first biggest thing is we have to respect science and we have to respect the scientific process. In the United States we very frequently don't respect science and the scientific process. In the United States we frequently don't do some of the simplest things that are proven to be beneficial in terms of health care, yet we do many things that are very expensive that are theorized to be good for health care and sometimes found not to be.
We need to become scientific and we need to become rational ... How do we become rational? We need to actually have treatment guidelines for many of these major diseases where groups of experts without emotional conflicts of interest look at the scientific data and come up with pathways on how people should be treated. And doctors should be judged by whether or not they stay on those pathways. If they deviate from those pathways they should be called to justify for the deviations ...
TBC: What would you like to add to encourage people to come out to hear you speak next week?
Brawley: One of the things we're really going to talk about is what does an individual need to know to be mindful of their health and to advance their health. It's a little different from some of the advertisements that we hear; it's actually quite interesting, right now, as we enter breast cancer awareness month and the pinking of the United States. This is information on what an individual really needs to know in order to have good health, as opposed to what the commercials say.