Tag Archives: American Cancer Society

New book on the market–has anyone read this? Opinions are welcome!

I don’t usually post articles about political subjects in medicine, but this one caught my eye.  Let me know what you think. 

ATLANTA – The woman walked quietly into the busy emergency room at Grady Memorial Hospital, Atlanta’s safety net hospital for the poor and uninsured. She waited four or five hours to be seen, sitting patiently on a gurney and clutching a plastic bag.

  • By Otis Brawley, professor of hematology and oncology at the Winship Cancer Institute in Atlanta, visits with patients at Grady Memorial Hospital. He is accompanied by Amanda Yassin, Pharmacy student at South University, and Brian Lingerfelt, oncology fellow at Grady Memorial Hospital.Michael A. Schwarz, USA TODAY (full link to the article)
  • Otis Brawley, professor of hematology and oncology at the Winship Cancer Institute in Atlanta, visits with patients at Grady Memorial Hospital. He is accompanied by Amanda Yassin, Pharmacy student at South University, and Brian Lingerfelt, oncology fellow at Grady Memorial Hospital.
Inside the bag was a moist blue towel. Wrapped inside that towel was her right breast. She was hoping it could be reattached.

Doctors in the United States don’t see cancer patients like this every day. A mixture of fear, poverty and lack of paid sick leave had led her to delay cancer treatment for years. Eventually, the tumor grew so large that it cut off the blood supply, causing her right breast to die and fall off, says Otis Brawley, chief medical officer at the American Cancer Society, who saw the woman in the ER that morning in 2003.

In his new book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, Brawley presents the woman’s suffering as a metaphor for a rotting health system that is run, he says, “by the greedy serving the gluttonous.”

Americans often assume that more is better. But supersizing

Supersize Me!

your healthcare — by getting tests and procedures that you don’t really need and which aren’t based on sound science — can kill you, according to a revealing new book by the American Cancer Society’s chief medical officer, Otis Brawley. 

A nation of extremes

Brawley uses the book, on sale this week (St. Martin’s Press, $25.99) and co-written with journalist Paul Goldberg, to show that ours is a nation of extremes, with the poor or uninsured frequently denied even the most basic care while the well-insured often are “overtreated,” receiving unproven drugs and procedures that can cause real harm.

On the other end, he writes, “wealth in America is no protection from getting lousy care.… Wealth can increase your risk of getting lousy care. If you have more money, doctors sell you more of what they sell, and they just might kill you.”

Brawley says he doesn’t want to ration care or dash the hopes of desperate patients who are willing to gamble on experimental therapies. But he says he’s tired of those hopes being exploited by a medical system that’s too lazy to insist that care be based on science rather than profit or best guesses.

Patient advocates such as Fran Visco, a breast cancer survivor, welcome Brawley’s call to action. “We pour so much money into overtreatment,” says Visco, president of the National Breast Cancer Coalition. “All of that could be channeled into getting more people care.”

Brawley’s message may resonate with policymakers because of his high rank within the cancer society, says Dartmouth Medical School professor Lisa Schwartz, who co-wrote a book last year called Overdiagnosed: Making People Sick in the Pursuit of Health. Brawley’s folksy style and sense of humor — his take on medicine is often darkly funny — makes complex issues easy for the public to understand, says Barry Kramer, director of cancer prevention at the National Cancer Institute.

There is always another opinion about every book published and here it is—>

“I’m quite sure Otis remembers the patients who didn’t do well, more than the patients who did, because that’s the kind of caring individual he is,” says Michael Friedman, director of City of Hope cancer center in Duarte, Calif. “It’s not that Otis has all the answers, but he’s asking all the right questions.”

Some point out that doctors aren’t deliberately trying to harm their patients.

But doctors may not question the system, either, says Thomas Smith, director of palliative care at Johns Hopkins Medical Institutions in Baltimore. “Most doctors are sleepwalkers, not evildoers,” Smith says.

“A lot of people are trying to do their best in a broken system,” Schwartz says, adding that it’s too simple to say it’s all about greed. “It’s about how hard it is to come up with a system that gives people what they need.”

Making the best decision about care — such as when to provide hospice care, for example, rather than more invasive procedures — can be complicated and doesn’t necessarily reflect a doctor’s desire to make money, says Smith.

Smith agrees with Brawley that changing the system will require educating patients and families. “This can’t come just from doctors and nurses. It will require some changes in society and people, to accept the medical facts,” Smith says.

Patients affect care, too

Brawley notes that patients themselves often ask for unproven treatments, even demanding that insurers pay for them. In many cases, however, those extra tests and treatments aren’t in patients’ best interests. “Prostate-cancer screening and aggressive treatment may save lives,” Brawley writes, “but it definitely sells adult diapers.”

Standing at the window of Grady’s tenth-floor cancer center, in his white doctor’s coat, Brawley points out Ebenezer Baptist Church, where Martin Luther King once preached, and the building where the Southern Christian Leadership Conference met. “This is the cradle of the civil rights movement,” Brawley says.

And like the civil rights movement, change will have to come from the bottom up, Brawley says, and from patients who have had enough.

“The health care system is dramatically broken,” Brawley says. “All of us need to radically change. I’m convinced that health care transformation is a civil rights issue.”

Brawley has broken ranks with his peers before, often by saying things on the record — clearly, and in colorful language — that others acknowledge only in private.

While his supervisors at the cancer society have always supported him — Brawley says he was a “known commodity” when hired in 2007 — his unvarnished assessments of cancer drugs and screening tests have often gotten him in hot water with patient advocates, and even cancer society members. While Brawley recommends mammograms, he says doctors should be honest with women about their limitations and risks: “There is this pervasive belief,” he says, “that mammography is better than it is.”

Prostate cancer advocate Tom Kirk is familiar with Brawley’s arguments, and his rhetorical flourishes. “There are a great number of us who have learned to engage with Otis, and it is rare that he says something about prostate cancer where there isn’t a chorus of us who respond,” says Kirk, president and chief executive officer of the group Us TOO. While Kirk says he appreciates Brawley’s efforts to get men to think carefully about health care decisions, he also fears that men could use Brawley’s words as an excuse to avoid doctors entirely. Men “have come too far in this country not to play an active role in our health care,” Kirk says.

Brawley praises other patient-led efforts, such as the National Breast Cancer Coalition’s Project LEAD. The free training program teaches patients and their supporters to understand medical evidence, and advocate for treatments and policies that reflect the best science.

Consumers typically misinterpret any attempt to limit care as a cost-saving scheme, Schwartz says. “Even if we had all the money in the world,” Schwartz says, “we would still want to make better decisions about how to make people feel better and live longer.”

Some of Brawley’s concerns are already being addressed, says John McDonough, a professor at the Harvard School of Public Health.

Beginning next year, Medicare will penalize facilities where patients get a lot of hospital-acquired infections, and where a lot of patients are readmitted shortly after being discharged, McDonough says.

The Affordable Care Act, the healthcare law championed by the Obama administration, also provided funding for a research center that compares existing treatments against each other, something that’s not ordinarily done when new drugs are approved, McDonough says.

The Affordable Care Act also creates community groups, called accountable care organizations, through which hospitals can work with local groups to improve community health, says Gerard Anderson, of the Johns Hopkins School of Public Health.

But McDonough also says it’s not possible to make the system work perfectly. “The notion that there is a pure, rational way to do something, on which everyone could agree, just doesn’t fit reality,” McDonough says.

And Anderson says that even the most educated and empowered patients may still have trouble challenging their doctors.

“When your doctor says, ‘You need this procedure,’ it’s really hard to say, ‘Really? I don’t think I need that,’ ” Anderson says.

“We just don’t have enough information as consumers.”

Too much of a good thing? 

Here are some of my thoughts about procedures in allergy & asthma:

  • Are too many allergy patients placed on immunotherapy (allergy shots)?
  • Testing for lung function (PFTs) can be expensive, but this test is very helpful for the proper diagnosis.  Is the cost worth it for you?
  • This article didn’t mention the legal aspect of NOT performing a test.  Doctors won’t get a break in court if they didn’t perform a test and say “I was trying to save the patient money.” 

Don’t think we’ll get this solved today but let’s have fun with it. 

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Don’t light up! Is This Your New Year’s Resolution?

This is a New Year’s resolution you love to hate.  Success rates for smokers may not look all that great, but you triple your chances of being a “quitter” if you use medications combined with counseling.  This article has lots of quotes that I left as is. 

Despite the known dangers of smoking, about 20 percent of Americans still light up, but almost 70 percent want to quit, a new government report shows.

“This study is reassuring to us,” Dr. Tim McAfee, director of the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention.
 
There was a concern that there was a group of smokers who would remain smokers and not be interested in quitting, but, “in fact, what this study shows is quite the opposite,” McAfee said.

The percentage of smokers appears to hover around 20 percent as people take up the habit, he said. “But there has been a decline in the last five years in the rate of smoking, and smokers are actually smoking less,” he added.

“Perhaps the most dangerous situation we are in is we have seen over the past five years a flattening of the downward trend in youth initiation. We are very worried that there are a number of things that have been happening in terms of tobacco industry marketing techniques that affect youth,” McAfee said.

The report was published in the Nov. 11 issue of the CDC‘s Morbidity and Mortality Weekly Report.

According to the report, 68.8 percent of current smokers say they want to quit and 52.4 percent tried to quit during the past year.

In addition, 48.3 percent of smokers who saw their doctor in the past year say they got advice to quit. Moreover, 31.7 percent had counseling alone or with drugs to help them quit in the past year. And about 6 percent quit successfully in the past year. 

McAfee noted that most smokers who manage to quit do so without the help of drugs or counseling. “About 20 percent of people take medication or sign up for counseling,” he said.

Other factors that are equated with quitting are education, where 11 percent of those with a college degree were able to quit, compared with 3 percent of those who did not graduate from high school, McAfee said.

In addition, blacks had the highest interest in quitting and the highest quit attempt rate than any other group, but blacks also had the lowest rate of successful quitting, McAfee said. Blacks were also less likely to use medication or counseling, he noted.

In addition, blacks were more likely to smoke menthol cigarettes, which decreases the rate of quitting, McAfee said.

If you can’t quit by yourself, the best way to quit is with a combination of counseling and drugs like Zyban, Chantix or other nicotine replacement therapy, the CDC report said.

“Smokers who try to quit can double or triple their chances by getting counseling, medicine or both,” CDC director Dr. Thomas R. Frieden said in a statement.

The CDC is releasing the report as part of the annual Great American Smokeout on Nov. 17. The event is sponsored by the American Cancer Society, and encourages smokers to make a plan to quit, or quit smoking that day.

The report also notes that the growth of smoke-free workplaces and public places offer smokers another incentive to quit.

Smoking is still the leading preventable cause of death and disease, including cancer, chronic obstructive pulmonary disease and other lung diseases. Each year in the United States, smoking and exposure to secondhand smoke kill some 443,000 people, the report noted.

In addition, for every smoking-related death there are 20 people living with a smoking-related disease, the agency said.

Vince Willmore, vice president of the Campaign for Tobacco-Free Kids, said that “the CDC report confirms that most smokers want to quit, but too many don’t get the help they need to succeed.”

“To help more smokers quit, it is critical that all private and government health plans provide affordable and accessible coverage for smoking-cessation medication and counseling, and that states use more of their tobacco revenues to properly fund tobacco prevention and cessation programs,” he said.

States must also continue to enact policies that encourage quitting, including higher tobacco taxes and smoke-free air laws, Willmore said.

In a related move, the U.S. Food and Drug Administration said Thursday that most of the warning letters it recently sent to more than 1,200 tobacco retailers were about illegal sales of cigarettes and smokeless tobacco products to minors.

FDA inspections of tobacco retailers found that most are in compliance with the law, but some still sell tobacco products to youngsters. Retailers who continue to violate the law could face fines.

“It should worry every parent that 20 percent of U.S. high school students smoke cigarettes,” FDA Commissioner Margaret A. Hamburg said in an agency news release.

“For many young people, that first cigarette or use of smokeless tobacco will lead to a lifetime of addiction, and for many, serious disease,” she said. “More than 80 percent of adult smokers begin smoking before 18 years of age. Retailers are vital partners in the FDA’s efforts to prevent tobacco use among kids.”

With all this bad news, is there anything that can be done?  Oklahoma State University is now a smoke-free campus since 2008–way to go Pokes!