How We Do Harm

The Book of the Week is “How We Do Harm” by Otis Webb Brawley, M.D. with Paul Goldberg, published in 2011. This is yet another lamentation on the sorry state of affairs of the oncology industry in the United States. As is well known, the fear-mongering, lying and profit-seeking never stop in many parts of “the system.”

Brawley prudently wrote, “It’s always about the balance of what I know, what I don’t know, and what I believe.” However, so many medical professionals ignore the second, and offer up as facts, the third. This is where guidelines go awry. Hundreds of organizations globally distribute thousands of guidelines every year; many of them from profit-seekers.

American medical culture changed for the worse in the 1990’s. For, “…commercial interests usurped the language of clinical epidemiology, making it impossible even for an educated person to distinguish a real recommendation based on science from a thinly disguised advertisement for medical services.”

The author served as a medical oncologist, professor, and officer of the American Cancer Society, among other roles in his career. He provided a series of anecdotes on the system’s victims and critical analyses of the fear-mongerers and liars.

One major irony is that people whose top-dollar medical care is supposedly dispensed by “experts” become victims of fear-mongering and lying and get overtreated and die unnecessarily. Whereas, poor people who forgo medical care except to save their lives and end up receiving publicly-funded care– because they can’t afford better– are more likely to survive because the caregivers have their patients’ best interests in mind rather than a desire to make more money.

The American mentality is that more is better– more early detection and treatment must be better than less. Not necessarily true. Often, the screening tests and the treatment are themselves carcinogenic, so more of each actually increases the likelihood of more medical problems.

The author described an FDA-approved (but insufficiently tested) drug launched in the single-digit 2000’s whose makers claimed it strengthened patients and reduced fatigue; it actually caused strokes and heart attacks and even tumors. But it was lucrative! That became apparent at an FDA advisory committee session, where “Billions of dollars in [stock] trades hinge[d] on the words of the [medical] doctors and the scientists…”

American oncology is reminiscent of the Jack Benny joke: A robber approaches a man on the street, points a gun at him and menacingly says, “Your money or your life.” The man becomes pensive for a few seconds. The robber says, “Well??” The man replies, “I’m thinking, I’m thinking.” The joke is that the man can’t spend his money after he’s dead, but he values both money and life equally.

But thinking is the right answer– instead of succumbing to panic instilled by the oncology industry that leads to the loss of both money and life. All of the victims in the author’s anecdotes had panic in common.

Read the book to learn the answer to the question “Does treatment of localized prostate cancer save lives?” (hint– statistically, tens of men might become incontinent and impotent unnecessarily for one life to be “saved”) plus other thought-provoking, awareness-raising issues in American medicine, and how not to get fooled by liars and fear-mongerers.