How We Do Harm
A Doctor Breaks Ranks About Being Sick in America
Reviewed by Mira de Vries
Cancer is Brawley's specialty and the main channel through which he surveys the U.S. health care system. Although copyrighted in 2011, Otis, as he prefers to be called, apparently wrote the manuscript during the Bush II administration, before Obama(care). His main theme is that the uninsured die from treatable diseases while the insured are over-treated with just about anything billable, often at the expense of their health.
Lack of funds is not the only reason some people fail to receive necessary medical care. The author himself points out fear: of the disease, of being scolded, of being experimented on, of receiving noxious drugs, and of losing one's job for taking too much time off for treatment. He might have added unwillingness to sacrifice privacy and dignity. At the other end of the spectrum a factor that fosters over-treatment in addition to the greed of doctors, hospitals, and the manufacturers of medical devices and pharmaceuticals, is pressure from patients and families who have unrealistic expectations. He could have added in the U.S. physicians' fear of litigation. A doctor can be blamed for treating too little but never for treating too much.
Brawley makes his points mainly through a series of personal stories and anecdotes. Early in the book race plays an important role. Race is an issue in the U.S. Brawley deserves credit for not shying away from it. But he continues to mention the appearance and ethnicity of almost every character in the book even when it is irrelevant to the anecdote being related, crossing the line between honest discussion of racism and participating in it. Perhaps co-author Goldberg suggested doing so to add color to the writing. If so, it was bad advice.
AZT was synthesized in 1964 [before the AIDS epidemic was invented - reviewer], but was shelved after being found ineffective in mice. It was revived out of desperation when NCI initiated a search for something -- anything -- that might work against the emerging viral disease that was destroying the immune systems of homosexual men, drug addicts, and prostitutes.Brawley, who harps on the dangers of drugs and is sensitive to bigotry in medicine, doesn't buy into the HIV/AIDS paradigm, right? Wrong. Directly preceding this passage he calls AZT, a failed drug plucked out of a pharmaceutical waste bin to treat a perceived disease that supposedly affects society's outcasts, "the first efficacious AIDS drug."
Strangely, while Brawley warns against screening for prostate cancer, he favors "mammography for women in their forties ... mammography among women age forty to forty-nine saves lives." That is surely a position that tantalizes women aged 39 or 50.
We never learn how he proposes to help the uninsured, but his antidote to excessive and harmful treatment is science. He quotes a founder of the National Breast Cancer Coalition: "We don't want to just get more money for the scientific community and then let them do what they want with it. We wanted to be able to oversee how the funds are spent and collaborate with scientists to set priorities and design research." Do they? Does it work? How is the research those scientists do different from research in which NBCC is not involved? And is the former research not outshouted by the latter? Brawley doesn't tell us.
He does enthusiastically endorse LEAD, a program designed by the NBCC to educate women about medicine. Now he's talking. MeTZelf endorses educating everybody in every form of medicine.
It's a shame the book lacks an index.