Chief medical officer of American Cancer Society blasts health care system
Dr. Otis Brawley has more than a few problems with the way health care is delivered in this country. When the chief medical officer of the American Cancer Society surveys the terrain, he sees a system teetering under the weight of costly inefficiencies, bald profiteering, insidious marketing, and all too often, widespread disregard for evidence-based medicine.
Spend an hour or so with Dr. Brawley, as fellows participating in the 2013 California Endowment Health Journalism Fellowship did Sunday evening, and one’s hopes for this country’s pending health care reforms are quickly downsized. In his keynote address, Dr. Brawley had ample blame for just about everyone involved in our “failing system,” including patients, doctors, drug companies, marketers and insurers. If we’re to save our health care system and our economy, he argues, we must better educate people on how to be healthy and more rational about the care they seek.
One of Dr. Brawley’s recurrent criticisms of our health care system is that too often doctors adopt procedures that aren’t supported by sound science. He points to several disturbing examples, starting with a once widespread procedure known as the Halstead mastectomy, a severe procedure dating back to 1903 that entailed the removal of a breast-cancer patient’s breast as well as much of the underlying muscles and lymph nodes (the surgery greatly limited the patient’s motion and led to swelling, as well as disfigurement). The debilitating procedure was widely practiced up until the 1970s, Dr. Brawley said, because too few doctors questioned the science behind the surgery. Since the surgery was pioneered by a surgeon at the prestigious John Hopkins Hospital, it must be valid, or so went the prevailing wisdom.
Some of the doctors who did dare question the procedure paid by losing their jobs, until finally in the late 1960s, studies began to emerge that supported far less drastic surgeries for breast cancer patients. “This is an example of how we in medicine have been sort of stupid,” Dr. Brawley said.
But that’s not the only example (indeed, Dr. Brawley has recently penned a whole book of them with journalist Paul Goldberg called “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America”). Consider the more recent spate of bone marrow transplants for breast cancer patients that took place in the late ’80s and ’90s. The procedure was developed in order to allow cancer patients to undergo extremely high doses of chemotherapy as a means of killing off any remnant cancer in the body. The only problem with such high doses? They also killed off the patient’s bone marrow. The solution hatched by a couple Boston-based doctors was to extract a bit of the patient’s bone marrow, have her undergo the super-chemo treatment, and then reintroduce the bone marrow to her body. The procedure was soon being delivered across the nation to thousands of women, albeit without much scientific evidence backing it up.
Then, in 1999, three studies came out that showed that this bone marrow therapy was actually delivering worse outcomes than standard treatments. “Within four months of the publication of these three articles in the New England Journal of Medicine, 220 bone marrow transplant centers in the United States all just quietly closed,” Dr. Brawley said. “Almost 70,000 women had been transplanted in the 1990s alone, and there was no science that actually showed it was beneficial. There were a couple of guys who thought it was the right thing to do, and they were from Boston, so they must have been right. And then there was a whole bunch of people who realized they could make money off of it.”
That leads to another of Dr. Brawley’s themes: When evidence-based medicine falters, marketers jump in. One of his favorite examples is a controversial one — prostate screening. “There is no organization of specialists in the U.S., Canada or Europe that says men should be screened for prostates,” he said. While leading organizations advocate informed-decision making, they also note the uncertainty over whether PSA testing results in more benefit than harm. But that’s not necessarily the message you’ll hear from those who stand to profit from the medical services and product sales prompted by prostate screening (the disease, if treated, can lead to incontinence and impotence, for instance).
Dr. Brawley singles out a campaign organized by diaper-maker Kimberly-Clark, in which traveling buses offer free prostate screening, touting the message that prostate screening saves lives. Those with abnormal screens are referred to doctors, thus launching potentially lucrative revenue streams for doctors, marketers and manufacturers, according to Dr. Brawley, who cites conversations with marketing experts in which they can predict with alarming accuracy how many artificial sphincters, penile prostheses and adult diaper sales might eventually result from a screening of, say, 1,000 men.
“The Chief Medical Officer of the American Cancer Society is about to tell you, I don’t know if prostate screening saves lives but it sure as hell sells adult diapers,” Dr. Brawley said.
But it’s not just dubious marketing campaigns and a lack of science-based medicine that plagues American health care, according to Dr. Brawley. Gluttonous consumers who demand tests and procedures regardless of their advisability are also part of the problem. “There are some people who consume too much health care, unnecessary care, and some people who consume too little care, meaning they don’t get necessary care,” he said. “We actually could improve overall health and decrease the waste by just being scientific and attentive to the science, practicing evidence-based medicine.”
The efficient use of resources will be all the more critical in coming decades as we face what Dr. Brawley referred to as “a tsunami of chronic disease.” “Over the next 15 to 20 years the problem of nutrition and physical activity will become the leading cause of cancer in the United States, surpassing tobacco use,” Dr. Brawley said.
The mounting strains placed on our health care system by chronic diseases means that changing peoples’ lifestyles and bolstering preventative care will be crucial to creating a sustainable and humane health care system.
“We don’t need health care reform; we need health care transformation,” Dr. Brawley said. “We need to transform the way we actually view health care to focus on prevention, to focus on using evidence-based medicine and the scientific method, and that’s how we’re going to actually save this country.”
Image by Parker Knight via Flickr