Dr. Bob’s Book Reviews
How We Do Harm:
A Doctor Breaks Ranks about Being Sick in America
by Otis Webb Brawley, MD, with Paul Goldberg,
St. Martin’s Press, NY, 2011.
Dr. Brawley is a highly-credentialed physician with many titles. The major one being chief medical and scientific officer of the American Cancer Society.
Making his way up through the ranks, this man of color has carried burdens of race and poverty which are frequently reflected in his estimable writing. In his book, Otis threads his life and training through a maze of cancer patients, medical studies, statistics and research. While the book is well done, the threads get tangled sometimes moving back and forth between patient struggles and medical malfunctions. It is sometimes a statistical jungle in which Brawley travels comfortably.
Brawley’s How We Do Harm book may just as well have been called How Money Runs Medicine. This doctor’s particular concern is with cancer patients and he gives ample examples of how financial incentives, commercial opportunities, conflicts of interests, etc. often “steal the show,” so to speak. Everybody seems to have his hands out trying to take in more and more while patients get lost in the jumble. “Too often, helping the patient isn’t the point. Economic incentives can dictate that the patient be ground up as expensively as possible with the goal of maximizing the cut of every practitioner who gets involved. When we, doctors, are at our best, we set aside our self-interest and put the patient’s interest first. When we aren’t at our best, the public pays more in fees, insurance premiums, taxes – poor outcomes.”
“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. The American health care system combines famine with gluttony.”
“Patients need to understand that more care is not better care, that doctors are not necessarily right, and that some doctors are not even truthful.”
Otis Brawley is a shrewd man, knows his business which includes cancer medicine, finances, politics, statistics and epidemiology [the study of how diseases appear and are distributed among populations]. He is obviously a bright scientifically-oriented man who believes science is the answer to medicine’s problems. Brawley is also a man with a heart. He talks to patients at home on the phone. If someone gets his number or attention, he will oblige with a conversation.
Otis started out with a scholarship to a Jesuit high school and reveres his mentors. But, Brawley neither invokes religion or God, nor the powers of spirit and community. Science is clearly his God. If only physicians knew more science, studied more, did more research, read more drug inserts. “Few doctors reading the entire label before prescribing the drug. I do.”
Brawley is convinced that humans and physicians in particular merely need to know more: More science and more science. But, then knowledge is ever changing and subject to all sorts of less than honest and factual influence. Father Polakawski at his Jesuit school in Detroit taught him, “Say what you know, what you don’t know, and what you believe––and label it accordingly.”
The good doctor Brawley might be served more so with the sage words of Mark Twain: “It ain’t what you don’t know that gets you in trouble. It’s what you know for sure that just ain’t so.”
Over the course of history and into modern times, medicine has “known” for sure what is best for human ills and injuries. The problem is that medics and surgeons and the science behind them have often been wrong. Tragically wrong. And they continue to be.
Such is hardly news, as Charles Sidney Burwell, Dean of the Harvard Medical School, made it a habit generations ago to speak with incoming classes on their first. Burwell gave a similar pep talk each year and always threw in a proviso about their medical education, “Half of what we teach you here will be outdated or simply shown to be untrue in twenty years. The problem is that we don’t know which half that is.”
Dr. Brawley admits quite the same as tells how he was brought up in the medical, then cancer system. Slowly realizing much of cancer treatment has been and continues to be mumbo-jumbo, witches brew, medical hubris. He tells how medical oncology was invented at NCI (National Cancer Institute) in the 50s and 60s. How he became part of “an ole boys’ club” from which all cancer programs in the USA were spawned. Brawley believed as “a conscript to the War on Cancer, that the cure was just around the corner.”
ONLY a core strategy needed to be executed. For many years, that amounted to the summation that “anyone who died of cancer died because he didn’t get enough chemo.” Everyone at NCI advocated “the no-guts, no-glory approach to medicine: hit the thing as hard as you can, nuke it, napalm it, and damn the consequence.”
“The power of cancer to kill is so fearsome that treating it naturally invites the metaphor of war. As oncologists, we crave big weapons and are eager to throw them into the field. This is our mind-set, our history, our culture. Sometimes it’s our folly, our madness.”
While Brawley still strives towards a clean system based on science, he recognizes that human factors influence medical trials, drug and procedure studies, screening efforts. And shares a number of horror stories on mistreatment and over-treatment of cancer patients. While even in daily situations, “Cancer patients and their doctors routinely accept horrific risks as they inject drugs intended to cure cancer or slow down its process.”
“Sometimes we treat one hundred people to benefit ten. All one hundred will be subjected to harm, and ninety people will pay the price for the lucky ten.”
“Cancer is hard to understand and doctors rush patients.” It is not patients only who do not understand cancer. Neither do physicians. The medical profession doesn’t know what causes cancer any more than they know the cause of the vast majority of medical conditions. Thus, almost all cancer therapy is experimental: “Shooting in the dark.”
Brawley remembers sadly that, “Folks I grew up with were worried that the doctors who treated them had no idea what they were doing, that they were experimenting, trying various drugs or treatment, hoping that something might finally work. My family members were afraid they would pay the price for exercises in trial and error. It was about trust.”
Physicians are still practicing on patients and no more powerfully and dangerously than in cancer diagnosis and treatment. Thankfully, people like Otis Brawley are still asking questions like, “How can we identify the cancers that are a threat to a man’s life and need to be treated from those that are not a threat and need to be watched?”
But, the War on Cancer has been running full bore for two generations. Science has not met the challenge. People still die regularly and horrifically from cancer and its treatments.
A friend once remarked to me his opinion that, “More people make money on cancer than benefit as patients from its treatment.” That is in so many words the foundations of the book How We Do Harm.
Dr. Brawley concludes his tome with the following pronouncements:
“The system is not failing. It’s functioning exactly as designed. It’s designed to run up health-care costs. It’s about the greedy serving the gluttonous.”
“We need a health-care transformation. Americans need to change how we view health care. We need to change how it is provided and how it is consumed.”
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What Doctors Don’t Tell You:
The Truth About The Dangers of Modern Medicine
by Lynne McTaggart
Avon Books, NY, 1998.
There are vast numbers of things that doctors don’t tell you or anybody. That is partly because there is so much to know about human beings, their problems and their illnesses. Setting the enormity of human living and dying aside, the obvious need for physicians to know and understand HEALTH remains. “As sophisticated as it is in many regards, medical science utterly lacks any understanding whatsoever of the extraordinary dynamics of the human body.”
But, HEALTH is not part of the standard medical school curriculum. So, how could physicians know much about it to share with patients? Disease is their calling. But doesn’t understanding disease suggest the value of understanding HEALTH?
Often trained physicians don’t even know what they are supposed to know. Because “medical science” is a rapidly moving target. Then, there are gaping holes in the training of physicians as suggested above. And, questions are often not asked. Patients are often unprepared or simply afraid to ask. When they do, such questions may be taken as affronts to the education, reputation, and goodness of the practitioner.
So, Lynne McTaggart wrote this book twenty years ago to tackle some of the numerous questions worthy of asking. Her questions are largely related to specific diseases and treatments, drugs and operations. Much was left unaddressed. Nonetheless, she gave it a worthy try. And, her effort has much value, particularly as a resource when consumers have questions in the areas of diagnostic procedures, prenatal testing, screening, vaccination, as well as medications, operations, and technology. Medicine has changed more in expense than in practice since 1998. So, her book still retains much reference value.
To this physician viewer, what Ms. McTaggart did address was well handled although long in statistics and data. A modest number of personal and patient stories are included in her book intending to drive home certain points. But, these often don’t ring true because the vignettes are so brief and leave their own unanswered questions.
Like other writers, McTaggart quite bluntly takes on the medical system more than individual doctors. “The problem isn’t the carpenter, but his tools. The fact is that medicine is not a science, or even an art. Many of your doctor’s arsenal of treatments don’t work – indeed, have never been proven to work, let alone to be safe. It is a false science, built upon conjuring tricks, supposition, and blind preconceptions, whose so-called scientific method is a vast amount of stumbling in the dark.”
She repeatedly points out how so-called medical science has really studied little and often poorly the methods and practices it follows.
“a good deal of what we regard as standard medical practice today amounts to little more than twentieth-century voodoo.”
“Medical science is, in the main, a triumph of statistics over common sense.”
“Two-thirds of medical practices don’t have any proof at all. There is no such regulatory agency like the Food and Drug Administration to monitor surgery, screening, or diagnostic tests …”
“The greatest reason that medical research is tainted is that the majority of it is funded by the very companies who stand to gain by certain results…. It’s wise to keep in mind that this industry, in a sense, has a vested interest in ill health: If drug companies found cures, rather than lifelong ‘maintenance’ therapies, they’d soon be out of business.”
Many fundamental issues persist regardless of medicine’s long journey and McTaggart’s valuable effort. Some day, medicine will add health and consciousness, spirit and nature to their studies. Knowledge, real knowledge, will be approached in the curriculum and in practice. In the meantime, physicians and patients settle for so-called medical science.
But in practice and in fact, “Medicine is not based on science – it’s based on faith.” So said her early mentor, Robert Mendelsohn. McTaggart for some years helped him put out his newsletter, The People’s Doctor. For more on Mendelsohn, see the review on his Confessions of a Medical Heretic.
Lynne McTaggart concludes her book the questions and quandaries of medicine reminding the reader of its major shortcomings juxtaposed to the natural human form: “Medicine never takes into account the exquisite mechanism of the organism it is trying to fix or the body’s extraordinary potential to operate …”
More often than not, “your doctors often don’t know what they are doing – not because they aren’t good people with good intentions, but because the equipment inside their black bags doesn’t work particularly well. In fact, most of the time, your body can manage things better than any doctor can.
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They will receive response.
Confessions of a Medical Heretic
by Robert Mendelsohn
Warner Books, NY, 1979.
Robert Mendelsohn (1926-1988) was a vocal pediatrician and medical school professor in Illinois. Author of several books and a newsletter called The People’s Doctor, Mendelsohn was also a medical heretic and a medical critic. Although his books go back forty years, their essentials are still valuable to readers in the current day. The books are compact, very readable and not overgrown with statistics and minutiae.
Medicine has changed in a generation, but largely in outer trappings, increased costs, fancier tests, expensive machines, and more jargon to confuse patients and physicians themselves.
Basically, Mendelsohn’s writings provide warnings to medical consumers who are generally “awed by doctor’s powers,” while be quite unaware of their ill-education and limitations, foibles and shortcomings. Many of these expose more the guilt of the system than of individual physicians. Here are some things of which every patient and consumer should be aware, according to Dr. Mendelsohn:
• “In the Church of Modern Medicine, the doctor who treats without drugs is regarded as a heretic because he or she appears to have rejected the sacrament of medication.”
• Physicians often work in their own self interest. “Doctors almost always get more reward and recognitions for intervening than for not intervening.” He told his students to always respond with the most interventionist answer on examinations.
• Annual exams and x-rays are more ritual than useful.
• Mammography itself may can cause more breast cancer than it will detect.
• Lab tests often do more harm than good. Mendelsohn’s favorite study was “one in which 197 out of 200 people were ‘cured’ of their abnormalities by repeating their lab tests.”
• Antibiotics are hugely over-prescribed. “They have a place in the practice of medicine – a severely limited place.”
• Mendelsohn opposed the immunizations of children, common in his time and in the present.
• A large percentage of patients in hospitals get there due to Adverse Drug Reactions.
• Surgery is a cash cow, much overdone. “My feeling is that somewhere around ninety percent of surgery is a waste of time, energy, money, and life.”
In Mendelsohn’s day, surgeons paid fee-for-service performed three times as many hysterectomies and tonsillectomies than surgeon who got regular salaries in prepaid group practices. The good doctor believed that at least half of American surgeons were superfluous.
“If doctors reduced their involvement with people by ninety percent and attended only emergencies, there’s no doubt in my mind that we’d be better off.”
• Mendelsohn called hospitals Temples of Doom … “virtual models of ineptitude. There are so many simple mistakes …” that can lead to no end of serious and expensive problems for which the patient has to pay physically, financially, and emotionally. “The psychological dangers of the hospital are very much as deadly as the physical dangers.”
“The Temple has nothing to do with health. There are no facilities in hospitals for health or for any of the things commonly recognized as contributing to health.”
Home births are safer than hospital births, according to Dr. Mendelsohn.
• Apropos of the current debate over Obamacare, Mendelsohn took a wider view: “There’s no way anybody can justify the billions of dollars we spend every year on ‘health care.’ We’re not getting healthier as the bill gets higher, we’re getting sicker. Whether or not we have national health insurance is, at best, irrelevant and, at worst, one of the most dangerous decisions facing us in the years ahead. Because even if all doctors’ services were free, disease and disability would not decrease.”
Mendelsohn closes his book quoting John McKnight saying, “Only the hands of citizens can cure medicine. Medicine cannot cure itself because its prescriptions come from its own system of values.”
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