---
product_id: 1700806
title: "How We Do Harm: A Doctor Breaks Ranks About Being Sick in America"
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---

# How We Do Harm: A Doctor Breaks Ranks About Being Sick in America

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A startling and important exposé on the state of medicine, research, and healthcare today by the Chief Medical and Scientific Officer of the American Cancer Society How We Do Harm exposes the underbelly of healthcare today―the overtreatment of the rich, the under treatment of the poor, the financial conflicts of interest that determine the care that physicians' provide, insurance companies that don't demand the best (or even the least expensive) care, and pharmaceutical companies concerned with selling drugs, regardless of whether they improve health or do harm. Dr. Otis Brawley is the chief medical and scientific officer of The American Cancer Society, an oncologist with a dazzling clinical, research, and policy career. How We Do Harm pulls back the curtain on how medicine is really practiced in America. Brawley tells of doctors who select treatment based on payment they will receive, rather than on demonstrated scientific results; hospitals and pharmaceutical companies that seek out patients to treat even if they are not actually ill (but as long as their insurance will pay); a public primed to swallow the latest pill, no matter the cost; and rising healthcare costs for unnecessary―and often unproven―treatments that we all pay for. Brawley calls for rational healthcare, healthcare drawn from results-based, scientifically justifiable treatments, and not just the peddling of hot new drugs. Brawley's personal history – from a childhood in the gang-ridden streets of black Detroit, to the green hallways of Grady Memorial Hospital, the largest public hospital in the U.S., to the boardrooms of The American Cancer Society―results in a passionate view of medicine and the politics of illness in America - and a deep understanding of healthcare today. How We Do Harm is his well-reasoned manifesto for change.

Review: A soaring indictment of what really needs to be reformed in American health care - Dr. Brawley has achieved something rare in a non- fiction work. He has combined his clear passion for medicine with a fair but brutal portrayal of what is terribly wrong with our system as it presently stands. Dr. Brawley is highly credentialed and has over 30 years experience in his craft, yet he writes with a balance of humility and moral outrage that is rare in this type of work. I have been in healthcare for over 20 years and have watched horrified as the system has become more, not less broken and ineffectual while at the same time knowing that no American can really know the gaping problems of pharmacuetical companies offering medicines that have questionable merit and do real harm, the multi "tier" system of care where in general the wealthy recieve MORE care, but not necessarily better care and are often over treated for pure profit and the horrific truths about incopetent and dangerous physicians and systems allowed to treat patients while no one dares to ask for QA. "How We Harm" addresses the issues every consumer of medical services need to understand before they or someone they love becomes sick. Sadly some of the families I care for only discover how broken the system is at the moment of their greatest vulnerability- when a family member or themselves become very ill and they are left to fight insurers, billing departments and conflicting prognosises and treatment plans without a rational, science based resource to ensure they are making the right choices. Dr. Brawley describes how the "system" as it currently stands seems to know that sick consumers can not fight for their rights, and are often too frightened and overwhelmed to even ask the right questions when they face major medical decisions. Insurers will be held more accountable after ACA full implementaion in 2014, but this is clearly not enough to fix the systems that you and I the taxpayer supplement when big pharma and for profit medicine have taken all the meager resources that many Americans have to pay for their co-pays and expensive treatments for serious illness. The "system" knows that eventually Medicaid will take over payment for these desperate patients. The case illustrations Dr. Brawley presents are fair and deadly accurate. I see similar terrible outcomes all the time. The book also describes aspects of caring for the 'under served' that are spirtually affirming and make this book a very positive read for that reason alone.Dr. Brawley clearly loves to teach medical students as well and he he even seems to love his patients- a rare but amazing quality in a physician. Dr. Brawley is a national voice of reason and passion for making things right. I look forward to his next move as a leader in American medical reform.
Review: A MUST READ BOOK ABOUT OUR HEALTH CRISES--REVIEWED BY AN EDUCATOR, PUBLISHED WRITER, AND BOOK REVIEWER - I am a former teacher, school librarian, published author, and book reviewer for the Society of Children's Book Writers and Illustrators, as well as judge and book reviewer for the IPPY and MOONBEAM BOOK Awards. Many years ago I was diagnosed with GUILLAIN-BARRE SYNDROME. Since I was diagnosed with this terrible neurological disease, I have continued to experience symptoms which I ignored while finishing my BA and MA degrees, teaching in several school systems including Department of Defense Overseas Schools, and traveling around the world. Even though I was often ill and constantly plagued with symptoms of my disease, I ignored the problems and did not see neurologists or undergo transfusions and/or infusions, as well as be a guinea pig for the huge variety of experimental drugs. I workout daily, eat nutriciously, and try to always be positive, laugh, and have fun. Many people have died from my disease. And I wonder if I am still alive due to NOT SEEING DOCTORS and undergoing UNPROVEN or FLAWED PROCEDURES and DRUGS. Dr. Brawley's book showed me that my choices probably helped me to be active and live, not experience an early death while doctors harmed me with their techniques. I have briefly reviewed Dr. Brawley's outstanding book which helped me to conclude that I made the best choices by not seeing neurologists over the years. Also, I was afraid my neurological disease would be labled a "PRE EXISTING CONDITION" which my insurance policies would not cover. Otis Webb Brawley, author of HOW WE DO HARM; A DOCTOR BREAKS RANKS ABOUT BEING SICK IN AMERICA, is an oncology (Cancer) professor at Georgia's prestigious Emory University as well as the Chief Medical and Scientific Officer of the American Cancer Society. Using personal anecdotes from past patients, Dr. Brawley illustrates many things which are wrong with our medical system as well as medical and nonmedical groups and doctors who need to totally change this system. Every page was packed with specific information about medical problems with protocol, procedures, chemotherapy, and uninformed patients who blindly follow doctors' suggestions as to the best way of treating thier cancers. Much of the medical research is flawed making it almost impossible for patients to research their diseases and make intelligent choices. It is imperative that everyone, men and their well-meaning wives, read about the patient, Ralph, whose wife urged him to get a free PROSTATE PSA TEST in a mall which led to horrendous FLAWED procedures which 'caused him misery and pain until he died an early death. Dr. Brawley thought prostate screening was not at all useful for anyone without symptoms. I also think that many tests we have are just to generate money for doctors and the groups they work for. In fact, just this week they are now saying women should not have MAMMOGRAMS every year as I did since I turned forty. Now the recommendation is for women to have mammograms every three to five years. Dr. Brawley said in his book that women more often find their own cancer, and mammograms should not be taken on a yearly basis. This book was the best nonfiction book I have read in years. But I was disappointed Dr. Brawley did not write a chapter on the FDA, though he referred to the organization many times. I was also interested in more specific information about drugs, particularly STATINS which are taken by most people over 50 even though they have many serious side effects. One chapter was titled GUILLAIN-BARRE SYNDROM but only mentioned the disease briefly. I am a former librarian, and like most librarians look for BIBLIOGRAPHIES, GLOSSARIES, INDEXES, and CHARTS and GRAPHS illustrating important things to better illustrate the text. In the back of the book Dr. Brawley does include specific NOTES about information in each chapter. I could only read a few pages of this information packed book per day, because there was so much information I wanted to retain. I urge every adult of both genders and any age to read this book. And if you are capable and not disabled, volunteer to help the various advocacy groups who are attempting to change our hea;th system. This book was published two years ago before Barack Obama presented his new health care plan, therefore there is nothing in the book about it. Dr. Brawley, I am looking forward to another book from you about the goings on at the FDA, since they release many drugs which are later involved in class action suits. Also, cholesterol and cholesterol drugs should be examined in detail like you did oncology. Also, Dr. B, please have your publisher publish this book in a LARGE PRINT EDITION!!! I first saw Dr. Otis Brawley on BOOKTV.ORG weeks ago. I was so impressed with Dr. Brawley's speech which was perfect as well as his honesty that I bought HOW WE DO HARM. Go to BookTV.org and look for the video of Dr. Brawley's speech. Karen Joan McWilliams, Naples, FL

## Technical Specifications

| Specification | Value |
|---------------|-------|
| Best Sellers Rank | #555,026 in Books ( See Top 100 in Books ) #213 in Health Policy (Books) #282 in Sociological Study of Medicine #623 in Health Care Delivery (Books) |
| Customer Reviews | 4.7 out of 5 stars 608 Reviews |

## Images

![How We Do Harm: A Doctor Breaks Ranks About Being Sick in America - Image 1](https://m.media-amazon.com/images/I/71kxRSAWZYL.jpg)

## Customer Reviews

### ⭐⭐⭐⭐⭐ A soaring indictment of what really needs to be reformed in American health care
*by I***G on April 14, 2013*

Dr. Brawley has achieved something rare in a non- fiction work. He has combined his clear passion for medicine with a fair but brutal portrayal of what is terribly wrong with our system as it presently stands. Dr. Brawley is highly credentialed and has over 30 years experience in his craft, yet he writes with a balance of humility and moral outrage that is rare in this type of work. I have been in healthcare for over 20 years and have watched horrified as the system has become more, not less broken and ineffectual while at the same time knowing that no American can really know the gaping problems of pharmacuetical companies offering medicines that have questionable merit and do real harm, the multi "tier" system of care where in general the wealthy recieve MORE care, but not necessarily better care and are often over treated for pure profit and the horrific truths about incopetent and dangerous physicians and systems allowed to treat patients while no one dares to ask for QA. "How We Harm" addresses the issues every consumer of medical services need to understand before they or someone they love becomes sick. Sadly some of the families I care for only discover how broken the system is at the moment of their greatest vulnerability- when a family member or themselves become very ill and they are left to fight insurers, billing departments and conflicting prognosises and treatment plans without a rational, science based resource to ensure they are making the right choices. Dr. Brawley describes how the "system" as it currently stands seems to know that sick consumers can not fight for their rights, and are often too frightened and overwhelmed to even ask the right questions when they face major medical decisions. Insurers will be held more accountable after ACA full implementaion in 2014, but this is clearly not enough to fix the systems that you and I the taxpayer supplement when big pharma and for profit medicine have taken all the meager resources that many Americans have to pay for their co-pays and expensive treatments for serious illness. The "system" knows that eventually Medicaid will take over payment for these desperate patients. The case illustrations Dr. Brawley presents are fair and deadly accurate. I see similar terrible outcomes all the time. The book also describes aspects of caring for the 'under served' that are spirtually affirming and make this book a very positive read for that reason alone.Dr. Brawley clearly loves to teach medical students as well and he he even seems to love his patients- a rare but amazing quality in a physician. Dr. Brawley is a national voice of reason and passion for making things right. I look forward to his next move as a leader in American medical reform.

### ⭐⭐⭐⭐⭐ A MUST READ BOOK ABOUT OUR HEALTH CRISES--REVIEWED BY AN EDUCATOR, PUBLISHED WRITER, AND BOOK REVIEWER
*by K***S on July 6, 2014*

I am a former teacher, school librarian, published author, and book reviewer for the Society of Children's Book Writers and Illustrators, as well as judge and book reviewer for the IPPY and MOONBEAM BOOK Awards. Many years ago I was diagnosed with GUILLAIN-BARRE SYNDROME. Since I was diagnosed with this terrible neurological disease, I have continued to experience symptoms which I ignored while finishing my BA and MA degrees, teaching in several school systems including Department of Defense Overseas Schools, and traveling around the world. Even though I was often ill and constantly plagued with symptoms of my disease, I ignored the problems and did not see neurologists or undergo transfusions and/or infusions, as well as be a guinea pig for the huge variety of experimental drugs. I workout daily, eat nutriciously, and try to always be positive, laugh, and have fun. Many people have died from my disease. And I wonder if I am still alive due to NOT SEEING DOCTORS and undergoing UNPROVEN or FLAWED PROCEDURES and DRUGS. Dr. Brawley's book showed me that my choices probably helped me to be active and live, not experience an early death while doctors harmed me with their techniques. I have briefly reviewed Dr. Brawley's outstanding book which helped me to conclude that I made the best choices by not seeing neurologists over the years. Also, I was afraid my neurological disease would be labled a "PRE EXISTING CONDITION" which my insurance policies would not cover. Otis Webb Brawley, author of HOW WE DO HARM; A DOCTOR BREAKS RANKS ABOUT BEING SICK IN AMERICA, is an oncology (Cancer) professor at Georgia's prestigious Emory University as well as the Chief Medical and Scientific Officer of the American Cancer Society. Using personal anecdotes from past patients, Dr. Brawley illustrates many things which are wrong with our medical system as well as medical and nonmedical groups and doctors who need to totally change this system. Every page was packed with specific information about medical problems with protocol, procedures, chemotherapy, and uninformed patients who blindly follow doctors' suggestions as to the best way of treating thier cancers. Much of the medical research is flawed making it almost impossible for patients to research their diseases and make intelligent choices. It is imperative that everyone, men and their well-meaning wives, read about the patient, Ralph, whose wife urged him to get a free PROSTATE PSA TEST in a mall which led to horrendous FLAWED procedures which 'caused him misery and pain until he died an early death. Dr. Brawley thought prostate screening was not at all useful for anyone without symptoms. I also think that many tests we have are just to generate money for doctors and the groups they work for. In fact, just this week they are now saying women should not have MAMMOGRAMS every year as I did since I turned forty. Now the recommendation is for women to have mammograms every three to five years. Dr. Brawley said in his book that women more often find their own cancer, and mammograms should not be taken on a yearly basis. This book was the best nonfiction book I have read in years. But I was disappointed Dr. Brawley did not write a chapter on the FDA, though he referred to the organization many times. I was also interested in more specific information about drugs, particularly STATINS which are taken by most people over 50 even though they have many serious side effects. One chapter was titled GUILLAIN-BARRE SYNDROM but only mentioned the disease briefly. I am a former librarian, and like most librarians look for BIBLIOGRAPHIES, GLOSSARIES, INDEXES, and CHARTS and GRAPHS illustrating important things to better illustrate the text. In the back of the book Dr. Brawley does include specific NOTES about information in each chapter. I could only read a few pages of this information packed book per day, because there was so much information I wanted to retain. I urge every adult of both genders and any age to read this book. And if you are capable and not disabled, volunteer to help the various advocacy groups who are attempting to change our hea;th system. This book was published two years ago before Barack Obama presented his new health care plan, therefore there is nothing in the book about it. Dr. Brawley, I am looking forward to another book from you about the goings on at the FDA, since they release many drugs which are later involved in class action suits. Also, cholesterol and cholesterol drugs should be examined in detail like you did oncology. Also, Dr. B, please have your publisher publish this book in a LARGE PRINT EDITION!!! I first saw Dr. Otis Brawley on BOOKTV.ORG weeks ago. I was so impressed with Dr. Brawley's speech which was perfect as well as his honesty that I bought HOW WE DO HARM. Go to BookTV.org and look for the video of Dr. Brawley's speech. Karen Joan McWilliams, Naples, FL

### ⭐⭐⭐⭐ Fabulous book but seems a little biased
*by B***E on June 20, 2012*

I read a lot on the healthcare system and also have a biology PhD and a healthcare-related career, so I read 'How We Do Harm' with real interest and found that I tremendously enjoyed it, largely due to its distinctive and refreshing down-to-earth, no-holds-barred, friend-of-the-people style attack on many different sacred cows of the healthcare system. He exposes ignorance, shysterism, laziness and other commonplace human failings AMONG HIS FELLOW PHYSICIANS, where these everyday human foibles have an enormous impact on the life and death and quality of life of the patients treated by them. And he is not just any physician, he is the Chief Medical and Scientific Officer of the American Cancer Society. It reads like the system has turned on itself. This is a 'People's History' of the current healthcare system. The language is carefully unacademic and the cases he chooses are heart-wringing for the most part. I think there is much to learn from the diverse cases he selects, and he goes after problems originating with patients and their families as well as doctors and the system. If each of the problems that Dr. Brawley characterizes were systematically addressed, we would have a somewhat better and MUCH cheaper system - I think essentially a Canadian system, even if there were multiple payors. Once everyone followed the same rules and there was little role for physician discretion, and little role for new therapies until massive clinical studies achieved definitive conclusive results, inefficiencies in the system would be dramatically reduced, and many patients would receive better care. The problem with this objective, IMHO, is that the heterogeneity of cancer and the rate of advance in this particular field would not be well-served by a system where no new therapies were paid for until they had achieved p values of <0.05 in clinical trials IN THE PRECISE PATIENT POPULATION of the patient who needs treatment. Some cancers are so rare that this would never happen. In other cases, new research information evolves in small case series that wouldn't meet Dr. Brawley's standards but would provide vital information for selection of therapy. All-in-all, Dr. Brawley appears overly philosophically committed to the concept of clinical certainty, iron-clad treatment paradigms, and saving the system money. I'm all for saving the system money, but Dr. Brawley goes after cancer screening with the dedication of a hero confronting his nemesis. He barely acknowledges the potential for good to come from screening. For example, he is dismissive of the value provided by lung cancer screening, in spite of a roughly 50,000 patient randomized controlled study that showed a 20% reduction in cancer mortality in heavy smokers who received screening! This was without even specifying how these patients were treated - the 20% reduction in the leading cause of cancer mortality was simply from looking for a spot on the lung, and then letting the doctor and patient decide what treatment to pursue. I see that as a tremendous breakthrough. Dr. Brawley sees it as a roughly even set of risks and benefits that the system presumably should hesitate to fund. (Updated August 2013 to note that the U.S. Preventive Services Task Force has now issued a strong recommendation for CT screening of heavy smokers for early detection of lung cancer, based primarily on the data above. "As many as 20,000 deaths a year could be prevented by screening", according to Michael LeFevre, MD, co-vice chair of the task force). The book is well worth reading; but there are other intelligent, reasonable viewpoints on the burning thesis presented by this book, and one unfortunately comes away with the impression that Dr. Brawley would not acknowledge this. I found myself comforted by the fact that other checks and balances in the system will limit Dr. Brawley's impact on cancer treatment paradigms, even with his role at the ACS.

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