Overview
In How We Do Harm, Otis Webb Brawley, MD, the Chief Medical and Scientific Officer and Executive Vice President of the American Cancer Society, combines decades of anecdotes backed by empirical data to disprove the notion that the American healthcare system is the best in the world. Indeed, we aren’t even close. Most of the book draws from his time at Grady Memorial Hospital in Atlanta, a public hospital which primarily serves poor, minority patients.
The book is a searing indictment of our healthcare system, which, as he tells it, some of his colleagues call a “sick-care system” because it doesn’t prioritize health – especially not for everyone. Instead, our system costs more than any other in the world, and the outcomes are less desirable.
Moreover, we are one of the only countries to not guarantee healthcare to all of our citizens. Put it in other words: we pay more for healthcare, cover fewer people, and we’re less healthy. Doesn’t sound so good, does it? For Dr. Brawley, the solution to our sick-care system is what he calls “rational care:” paying for what works, not paying for what doesn’t, and practicing preventative care.
Primum non nocere
This is the oath and fundamental principle of medicine: first, do no harm. Unfortunately, our healthcare system doesn’t live up to it.
Dr. Brawley opens with the shocking story of Edna Riggs, a woman admitted into Grady’s emergency room. Edna wandered in one night with her rotting breast in a plastic bag; she had experienced an automastectomy, in which a tumor had grown for nine years and became so large that it forced the breast to fall off the chest. Unfortunately, Edna had some health insurance until it became too expensive, and her employer wouldn’t allow her to take short amounts of time off for medical visits.
It ended up costing more than $150,000 to treat her cancer; it would have cost about $30,000 to cure her if she had visited the doctor in the early stages of her disease. Edna passed away twenty months after wandering into the ER, at age fifty-three, leaving behind three children.
“Here is the problem: Poor Americans consume too little health care, especially preventative 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.” – How We Do Harm
Meanwhile, wealthy Americans sometimes consume too much care, or they pursue treatments that don’t work. Additionally, some doctors order tests that and screenings that are overpriced when cheaper, equally effective alternatives exist. The best example of this is our use of CT scanners; indeed, looking at the number of scanners per million population, we have three times as many scanners as Canada. A CT scan costs $2,000 while a $60 chest x-ray provides the same information. For some clinics and doctors, their motive isn’t rooted in maximizing patient care; instead, it’s rooted in maximizing profit.
Recommendation
For Dr. Brawley, whether it’s the government or private insurers paying for it, our health care system must begin with rational care. No longer can we overpay for unnecessary, overpriced treatments, and no longer can impoverished, and even middle-class people not receive the care they need.
I recommend How We Do Harm. I wish it had compared our health care system to others, and that it used more empirical data. For me, statistics, charts, and the like help me understand the system better than anecdotes. Nonetheless, the book is vivid, eye-opening, and informative.
Because you’re still reading, I would like to implore you to call your senator at (202) 224-3121 and demand that Republicans in Congress release details of their “health care plan,” the AHCA, which they’ve kept a mystery. If it’s anything like the House plan, it will throw millions of Americans off of health insurance, raise costs for the elderly and the sick, and damage Medicaid and Medicare. People will die. It does give a massive tax break to the rich, though.
It’s a disgrace that a bill like this passed the House, and it’s shameful and unprecedented that the Senate is hiding their grotesque Sickcare/Deathcare/WeDon’tCare/Trumpcare plan from the public. Please call and demand transparency and a health care system that focuses on rational care.
Get your copy of How We Do Harm today
