Dr. Otis Brawley, an oncologist and chief medical officer for the American Cancer Society, has long been an outspoken critic of unnecessary medical tests and procedures.
On this topic, he is perhaps best known for his opposition to the routine screening of men for prostate cancer, pointing out repeatedly that the scientific evidence does not support it — and stating that anybody who says otherwise is “not telling the truth.”
Earlier this week, Brawley spoke before a group of medical reporters at the annual conference of the Association of Health Care Journalists in Atlanta. Although I didn’t attend the event, I watched Brawley’s on-the-record speech on YouTube.
Once again, he didn’t mince words.
Unsustainable costs
Brawley began by pointing out that health-care costs are currently 18 percent of our gross domestic product (GDP), a cost that’s projected to climb to 25 percent in 2020. That’s just eight years away.
If we don’t start reining in those costs, Brawley said, “it’s going to cause our economy to collapse.”
Yet despite all the money we spend on health care in the United States, we still lag behind other countries in many important health indicators.
“When we had the conversation about health-care reform, I can remember some of the politicians talking about how great our health care system is,” Brawley said. “And I was thinking, ‘Gee, we’re 50th in life expectancy. We’re 47th in infant mortality rate. Countries such as Cuba do better than the United States in those measures.’”
In fact, said Brawley, we spend more than any other country on health-care costs — about $8,000 annually per man, woman and child. “The number two country, which is Switzerland, is a little less than $4,000 dollars,” Brawley noted. “Switzerland is fourth among [United Nation] countries in life expectancy, and we’re 50th. I don’t think we get what we pay for.”
Brawley also talked in his speech about how “the whole discussion about health care and health-care reform seemed to lack the fact that there were people out there who were suffering. There were people out there dying.”
He quoted a saying used by the Marines: “We are Americans. We leave no one behind.”
It’s a message, Brawley said, that appears to have eluded many of the politicians and others who are developing our health-care policies. “We are Americans, and we leave a lot of people behind in our health-care system,” he said.
'Irrational form of medicine'
Brawley also pointed out that much of the spiraling health-care costs in the United States comes from waste and greed. Doctors need to be paid more for prevention than intervention, he said, and all treatments and procedures should have solid scientific evidence behind them to show that they’re both effective and safe.
We practice “an irrational form of medicine,” Brawley said. “When I hear politicians talking about death panels and rationing, we need to be talking about the rational use of medicine — not rationing, but rational. But unfortunately, that’s not happening in the United States.”
He peppered his speech with several examples of irrational medicine. Routine prostate cancer screening was one. But he also mentioned how pharmaceutical companies are able to make a minor change in a drug that is about to go off patent and then market it as a new — and, of course, much more expensive — drug, even though it’s essentially the same medication. His example was AstraZeneca’s transformation of the heartburn drug Prilosec into Nexium. The off-patent drug, Prilosec, now sells for about $1 a pill, while Nexium sells for about $6, according to Brawley. (A generic version of the drug sells for about 35 cents.)
Brawley also criticized the medical community for adopting medical treatments long before their benefits — or safety — have been proven. As an example, he cited autologous bone marrow transplantation for breast cancer, which was widely used in the late 1980s and 1990s. The theory behind the treatment seemed reasonable, Brawley said, so doctors and hospitals began providing it to their patients (and women began demanding it), despite the fact that nobody had done any studies to prove that it worked.
“The folks who wanted to make money said, ‘Why don’t we just do it?’” said Brawley.
Finally, in 1999, researchers published four clinical trials that showed that the treatment was more likely to kill women than to benefit them. But by then, said Brawley, “there were more than 220 bone marrow transplant breast-cancer centers in the United States" and thousands of women had received the treatment.
‘Subtle form of corruption’
Health care today is “a subtle form of corruption,” said Brawley.
Who’s at fault for this corruption? All of us. “Quite honestly, it’s the doctors, it’s the hospitals, it’s the hospital system, it’s the insurers, it’s the drug companies, it’s the lawyers, and it’s even the patients,” he said.
“What we desperately need to do is not reform health care,” said Brawley. “We need to transform how we view health care. We need to become more appreciative of health-care prevention efforts.”
We also need, he added, “to understand and appreciate science. We’re not going to have improvements in our health-care system until the mass population demands that doctors appreciate science [and] demands and asks doctors to justify their recommendations and justify their decisions. We need the skeptical, educated consumer. We need people who consume medicine to think about health care the same way they think about buying a television set at a Best Buy. We need people to stop just accepting things and start being skeptical.”
You can listen to Brawley’s speech — and the question-and-answer session that followed — on YouTube.