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870 The Underbelly of Health Care

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Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here's what it's about:

Cancer is a terrifying diagnosis, and people with cancer deserve compassion as well as competent accessible care. But disparities in our health care system mean that some people can't get timely care, and others may get unnecessary care that causes them serious consequences.

Dr. Otis Brawley is chief medical and scientific officer of the American Cancer Society. He talks with us about the strengths and weaknesses of American health care. Why aren't more screening programs and treatments based on solid scientific evidence? Dr. Brawley is outspoken about how well-intentioned doctors may do harm and how the system could do better.

Guest: Otis W. Brawley, MD, is chief medical and scientific officer and executive vice president of the American Cancer Society. He is also professor of hematology, oncology, medicine and epidemiology at Emory University. In addition, Dr. Brawley is chief of hematology and oncology services and the medical director of the Georgia Cancer Coalition Center of Excellence at Grady Memorial Hospital. His book is How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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Did you enjoy this radio show? Average rating: 4.2/5 (88 votes)
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14 Comments

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I am very disappointed with your uncritical hopping onto the prostate screening bandwagon.

Regarding the story of the 72 year old man who insists on prostate surgery after a biopsy shows a 3/3 Gleason tumor: the moral of the story is that MEDICARE SHOULD NOT PAY FOR THIS SURGERY. If he wants to get it because of his anxiety, then he should pay for it. If he can't afford to pay for a foolish surgery, too bad. He should not expect the rest of us to pay for it for him.

HOWEVER, It is a very different thing to say that men of any age should not get periodic PSA testing. True, they might discover a 3/3 Gleason tumor that need not be treated. They might also discover an 8/8 Gleason tumor that will probably kill them if left untreated. The claim that "not one life has been saved by psa screening" is obviously nonsense. Many of us have personal knowledge of men who because of a PSA anomaly discovered and successfully treated an aggressive cancer. Many of us have personal knowledge of men who ignored PSA screening (as we are now being told we should do) and discovered an aggressive cancer (upon noticing "symptoms" as you put it, Joe) after it was too late to successfully treat. And please, let's dispense with the claim that the pain and potential complications of a biopsy (what are the data on just how many biopsies lead to these potential complications?) are so serious that we should forego a psa screen that can easily (and cheaply) be added to routine blood screens that most of us(foolishly??) get every couple of years.

Once the gloss wears off, the anti-psa campaign will inevitably give results-based medicine a bad name. Deal with over-aggressive surgeons and hyper-anxious patients by establishing rational results-based standards of treatment based on the diagnosis revealed by psa and biopsy. And then link insurance and medicare reimbursement to those standards. This is what health care reform should be about. It's what, as I understand it, the ACA is going to try to accomplish.

Don't dispense with the diagnostic screening, thereby creating a treatment standard based on the premise that ignorance is better than information. That is a very hard sell in the age of technology and information, and it should be a very hard sell. Because most people won't buy it.

I was very impressed with the honesty and candor of the Speaker! He communicated in a simple, forthright manner and is obviously very ethical.

Thank you.
Carol

If a doctor does not test or treat and the patient dies (they all die) will the defense to the lawsuit be "I didn't do what other doctors routinely do because they might be wrong." The effect of litigation on forcing over treatment was never mentioned.

Another blockbuster program. Anyone who learned from this one would enjoy listening to Dr. Roper's program (Number 859) at the end of May. Healthcare reform is the most critical issue facing us today. All voters need to be informed on this issue and Dr. Brawley and Dr. Roper have many helpful observations to help us decide. I made fairly extensive comments on the blog for Dr. Roper's program so I will refrain here.

Joe and Terry, keep those roots and berries programs coming, but throw in one like this on occasion!

Another great show!! Thank you.

Great program!

I am undergoing treatment for pancreatic cancer and am very surprised that this deadly cancer is so avoided in discussions. There needs to be more awareness about it.

I stopped the PSA two years ago. I believe in the odds and the odds of 48 treated to save one life is not good. While I may well be shortening my life and I may die of prostate cancer I have a 95% odds of not having to undergo any treatment that will reduce the quality of my life.

I have seen what a relative has undergone and I will take the chance of shorter life vs quality. Once you get the high PSA then the anxiety starts and the quality of life declines. What we need is a definitive test for prostate cancer and maybe genetic analysis of how aggressive the cancer is. I am under the impression that current estimates of aggressiveness are SWAGS at best. Joe and Terry am I wrong on this impression?

I was glad to hear toward the end of the broadcast dr. Brawley mentioned something about prevention. If we are to improve and save out medical system in America we should, in addition to discussing malpractice, overmedication, overcaring, etc. be discussing the food we eat and the lifestyle we live. This should begin with physicians adivising people what to eat to prevent and to reverse diet-related health conditions such as heart diseases, some cancers, diabetes and obesity, to name a few.

Unfortunately the majority of them are ignorant when it comes to diet and nutrition. They get almost no training in nutrition and few of them have any clue how simply dietary changes can improve people's health.

Listeners might appreciate a clarification of what Dr. Brawley stated about the United States life expectancy. If I recall correctly, he twice stated that the U.S. is 50th in life expectancy.

That ranking of 50th is based on the CIA, Central Intelligence Agency, which compares life expectancy data for more countries than the WHO, World Health Organization.

The World Health Organization data has the United States as 30th in life expectancy.

Yes, it's still pitiful. Here are 6 free-market countries who are all in the top 15 in the world in the lists of both the CIA and the WHO data: Japan, Australia, Italy (with those 3 being in that order for both lists), Canada, France, and Spain.

Fortunately, all other free-market countries implemented universal health care, most of them between 1883 and 1975. That's health care for all within each country. [Ours can and will be the best with national single-payer health care, Improved Medicare for All.]

Bob the Health and Health Care Advocate

Excellent program. With few PSA's beforehand and a very early case radiation I have seemingly lost muscle tone, nerve-response and I suspect blood and lymph limitations. A year later I still bleed and I cannot run or walk as I used to. I would like to see a more effective and long running PSA screening with or without sampling and Gibson scores all of which seem to be of variable quality. You make us think about the future care and life expectancy of the radiation after effects. Thanks

Regarding PSA testing, my recent PSA test results were significantly elevated from previous levels. After a retest, level was normal. My physician advised that PSA will fluctuate and that some research as show that vigorous bike riding and sexual activity can increase PSA. I do ride a bike frequently and at least once a week for 10-15 miles.

Did it save you? Please rest your case.

I had no idea a man could get an e-coli infection from a prostate biopsy. My brother-in-law has been suffering for two months with prostate and bladder infection. His surgeon wants nothing more to do with him and has transferred his case to an infectious disease doctor.

How often does this occur? (The biopsy was normal.) How much longer will he be on an antibiotic before his body can rid itself of the e-coli bacteria?DP

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