Otis Brawley Chief Medical Officer of the American Cancer Society and author of How We Do Harm, has an important message for healthcare stakeholders. I hope you take the time to watch the video but follow along here for a few of the highlights. This video is from a prior Preventing Overdiagnosis--Winding Back the Harms of Too Much Medicine conference and focuses on similar topics as this current year.
Dr Brawley acknowledges that physicians have the wisdom and courage to want to adopt early but that may be part of the problem. The rapid progression of science is a critical driver of overdiagnosis--identifying diseases that are not really diseases. This leads to unnecessary interventions, and suffering (mental, physical, and financial).
Healthcare in america is big business. In 2010 we spent 2.6 trillion dollars on healthcare. More than the entire GDP of France--in fact, on healthcare expenditure alone, the US would be the 6th largest economy if healthcare costs were the same is GDP. Unfortuantely we don't have the outcomes to support the costs--we are 49th in life expectancy and fall behind on numerous measures of healthcare outcomes.
The good news is that healthcare reform will be here by 2030 but not because we have made the necessary investments and priorities. But because the costs are unsustainable and our economy will collapse under the burden.
American healthcare and the scientific method are under assault. Journalists and writers within the news media aren't discussing the presentation of findings or the rational use of medicine. Dr Brawley warns that rational medicine is not the same as rationing healthcare.
Misleading headlines, simplification of findings, and a blind eye to the evidence have empowered media to spread misconceptions being packaged by fear-mongers who intend to profit from the uptake of panic.
The world owes the understanding of the cellular basis for many diseases, such as cancer, to Rudolf Virchow. Particularly passionate about pathological histology, the science of diseased cells and tissues, he published a scientific paper in 1845, that discussed the oldest known pathological descriptions of leukemia. --
Rudolf Virchow defined cancer as uncontrolled cell growth, defining leukemia in the mid 1800s by autopsies and light microscope using H&E staining. Believe it or not we are using basically the same definitions today--160 years later.
Although we have evolved technology such as mammography, CT, MRI, ultra-sound, and even biopsy technology patented within last 10 years--we are still performing biopsies on 5 mm tumors using 21st century light microscopes (electricity) fitting the profile of what Virchow defined 160 years ago. In modern medicine however, we do now know that cells from within the 5 mm biopsy may not be programed to divide, spread, and kill.
We are cautioned by Dr Brawley that perhaps the answer lies in the evolving variabilty of biologic cells and advances in genomic analysis. It is critical that we approach research and unknown issues--ethically, logically, and rationally. We need to label what it is we "know" and what it is we "believe".
When there are legitimate questions we need to tell people that there are legitimate questions. Patient centricity and shared decision making encourages discussion of questions and defining better questions to ponder. Be careful. The answer is only known by people with a financial interest in the answer.--Otis Brawley, MD, Chief Medical Officer of the American Cancer Society.