How We Do Harm

December 15, 2011
With the assistance of investigative journalist Goldberg (The Final Act: The Dramatic, Revealing Story of the Moscow Helsinki Watch Group, 1988, etc.), Brawley (Medicine/Emory Univ.), chief medical scientific officer of the American Cancer Society, delivers a scathing indictment of the American medical system. The authors provide solid documentation in support of the case that the American health system is fundamentally flawed, drawing on illustrative examples taken from his own experience as an oncologist as well as his expertise in public health. Brawley presents a shocking conclusion: "The system is not failing. It's functioning exactly as designed," with "the greedy serving the gluttonous." While low-income Americans are denied adequate medical care, the wealthy are also poorly served, often paying for unneeded treatments that can have dangerous side effects. The authors describe the case of a man whose experience was not atypical. While receiving chemotherapy as a precaution against cancer following colon surgery, he became too debilitated to work. When he could no longer afford the co-pays, he landed at Atlanta's Grady Hospital, which accepts patients with financial problems. After evaluating the patient's case, Brawley concluded that he was fortunate that his high-priced previous oncologist would no longer treat him, since he had mishandled the chemotherapy. "A negative wallet biopsy may have saved his life," he writes ironically. Less fortunate was the breast-cancer patient who received a fatal bone-marrow transplant intended to reduce the risk of recurrence-- a procedure based on positive data later proved to be fraudulent. Brawley provides citations from a variety of cases--pharmaceuticals that have dangerous side effects, unnecessary treatments for prostate cancer, etc.--including those of misguided patients who demanded excessive treatment and threatened lawsuits if it was denied. A powerful contribution to the ongoing discussion on health-care reform.

(COPYRIGHT (2011) KIRKUS REVIEWS/NIELSEN BUSINESS MEDIA, INC. ALL RIGHTS RESERVED.)

Starred review from February 15, 2012

Brawley's (medicine, Emory Univ.; chief medical officer, America Cancer Society) dual perspective as both a rigorous scientist and a compassionate practicing physician illuminates this powerful account of the best and worst aspects of this country's medical care. He illustrates these issues with stories of actual patients he has treated throughout his career at distinguished hospitals, including Atlanta's Grady Hospital and the National Cancer Institute. He describes tragedies caused by overtreatment administered by financially self-interested doctors, the dangerous side effects of questionable (though heavily advertised) drugs, and the misguided wishes of relatives who insist that everything be done--even painful, invasive treatments and tests--for dying patients with no viable options left. Interspersed with these stories are tributes to the teachers and mentors who shaped Brawley's admirable vision. VERDICT Brawley challenges readers with his calls for strict scientific standards for medical treatments and a national commitment to caring and effective medical care for all our citizens. Thoughtfully argued and compellingly readable, this book will reward both general readers and health-care professionals interested in health policy.--Kathy Arsenault, St. Petersburg, FL

Copyright 2012 Library Journal, LLC Used with permission.

Starred review from December 1, 2011
American medicine is infected. Greed, apathy, and ignorance are the pathogens. Brawley, chief medical officer of the American Cancer Society, has seen enough. In this no-holds-barred peek at the contemporary health scene, he relishes his role as a rabble-rouser. Drawing on true stories to make his points, Brawley, aided by coauthor Goldberg, illustrates how more care is not better care and that doctors are not necessarily right. Many of these clinical cases conjure frustration, heartache, and outrage. A middle-aged woman comes to the hospital because her breast has fallen off (an automastectomy). She has disregarded the presence of breast cancer for nine years. A 23-year-old man with congenital heart disease and cardiac arrhythmia shows up at the ER about every other month in need of electrical cardioversion. Without health insurance, he cannot obtain an implantable defibrillator. At his wife's urging, a healthy retired man goes for a free screening PSA blood test. He receives much more than he bargained for: a radical prostatectomy, incontinence, and a colostomy. The benefits of any medical treatment must always be balanced with the potential for harm. Brawley finds the right formula for mixing autobiography, the politics of modern medicine, controversies in cancer care, and wisdom.(Reprinted with permission of Booklist, copyright 2011, American Library Association.)