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BOOK REVIEW

‘How We Do Harm’ by Otis Webb Brawley

Richard Lubrant

Dr. Otis Webb Brawley calls for the “rational use of health care.’’

Much is wrong with our health care system. Despite being the most costly in the world, many of its outcomes are surprisingly mediocre. The United States ranks 50th in the world in life expectancy, and 45th in infant mortality. Canada, by contrast, spends half of what we do but comes in 12th in life expectancy and 40th in infant mortality, respectively.

Dr. Otis Webb Brawley is an oncologist at a large public hospital in Atlanta and has been chief medical officer of the American Cancer Society since 2007. He is very disillusioned by what he sees as the enormous disparities in both access to and the quality of medical care in this country.

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He believes this is because of ignorance, intellectual laziness, even greed on the part of individual doctors who practice substandard medicine; professional medical societies and the pharmaceutical industry; and regulatory bodies that simply are not doing their jobs.

“[N]o incident of failure in American medicine should be dismissed as an aberration,’’ writes Brawley. “Failure is the system, and those of us who are not yet its victims are at high risk of being sucked into its turbines.’’

In “How We Do Harm,’’ Brawley, with assistance from veteran investigative journalist Paul Goldberg, presents a tough-minded, solidly argued indictment of health care in America, backed by solid documentation and illustrated by examples of specific cases (including one involving the cancer treatment of the late US Representative Silvio Conte from Western Massachusetts), some taken from Brawley’s personal experiences as an oncologist.

He describes the hospital he works at as a “950 bed behemoth [which] stands for another form of segregation: poor versus rich, separate but with no pretense to equality.’’ And indeed, while everyone is vulnerable, minorities and the poor are especially so. Brawley notes that people without health insurance or who are insured through Medicaid are 1.6 times more likely to die from cancer within five years of diagnosis than those with private insurance. He also shows that one-quarter of Americans with cancer delay testing or treatment because of cost.

Brawley’s sense of outrage is palpable, and he makes clear what his purpose was in writing this book: “I am not especially concerned about the rationing of health care. I am more concerned about something else entirely: rational use of health care.’’ He continues: “Poor Americans consume too little health care, especially preventive health care. Other Americans - often rich Americans - consume too much health care, often unwisely, and sometimes to their detriment.’’ And elsewhere: “[M]y hope [is] that a genuine popular movement will form to make medicine accessible, driven by science, and trustworthy . . . nothing short of another civil rights movement will do . . . [civil] rights are important, but the right to equality in health care is no less important, and it has been left behind.’’

Brawley also focuses attention on the quality of care delivered to Americans fortunate to have health insurance and finds it lacking. One example involves recommendations for aggressive screening for early forms of cancer that lead not only to huge expense, but also to excessive and unnecessary radiation exposure and surgery in patients who would have died with, and not of, their disease.

I came away from this book sharing Brawley’s frustration and agreeing with much of his basic outlook on how medicine should be practiced. He reminds the reader that “[o]ne of the greatest honors a human being can bestow upon another is to say, ‘Can you help me?’ ’’; and that doing just that while first doing no harm continue to be at the core of good medical practice.

Dennis Rosen, a pediatric pulmonologist, can be reached at dennis.rosen@childrens.harvard.edu.
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