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

Here is the problem: Poor Americans consume too little healthcare, especially preventive healthcare. Other Americans—often rich Americans—consume too much healthcare, often unwisely, and sometimes to their detriment. The American healthcare system combines famine with gluttony.

When it comes to screening, a doctor who says ‘Let’s err on the side of caution,’ may actually err on the side of reckless ignorance and grave harm.

Generally places that are comfortable with excellence don’t call themselves centers of excellence. Has anyone heard of a Princeton University Center of Excellence? Memorial Sloan-Kettering Cancer Center of Excellence?

The system is not failing. It’s functioning exactly as designed. It’s designed to run up health-care costs. It’s about the greedy serving the gluttonous. Americans consume more health care per capita than the people of any other country.

Us TOO, which claims to be the world’s largest “grassroots, independent, patient-focused charitable organization” with more than 380 chapters in nine countries, is funded almost completely by the pharmaceutical industry.

When cure is possible, is it necessary, and when cure is necessary, is it possible?

She is also a victim of being well insured and perhaps too sophisticated, but not wise enough.

Americans don’t understand death. We cannot accept that death will come, and thus we cannot make a plan, talk reasonably about it, work our way to understanding, to the basic part of our humanity. This attitude—a combination of perpetual optimism, refusing the dark, and not living in reality—is unfair to patients, doctors, and insurance companies.

There is an underlying trust patients and consumers have in scientists, doctors, and the FDA regulators to look after their best interests as you evaluate the benefits and harms of the drugs, tests, and all interventions that become available to fight cancer.

Some advocacy groups do what doctors and drug companies tell them to do. Share is different. Share members are hard-nosed New Yorkers who seem to have an unlimited number of ways to make it amply clear that they don’t tolerate nonsense.

In fact, the company manufactured a medical condition: cancer fatigue. What cancer patient isn’t going to report feeling fatigued? Their bodies are being undermined by both the disease and interventions seeking to control it.

Many American cancer patients have to confront the same dilemma. Recently, the American Cancer Society found that one in four Americans undergoing cancer treatment had to put off getting a test or treatment. Among people older than sixty-five, one in five said they had used up all or most of their savings in getting cancer care, and one in seven reported incurring thousands of dollars of medical debt.

But our professional societies tend to choose misguided collegiality over the well-being of our patients, the people who trust us with their lives.

A rational system of health care has to have the ability to say no, and to have it stick. This is the only way to protect patients from misguided, scientifically unproven interventions, to cut out waste, fraud, and abuse. Those who pay—private insurers or the government—need to be able to protect the public from the miscarriage of medicine.

Here’s a secret: wealth in America is no protection from getting lousy care. Wealth can increase your risk of getting lousy care. I spend a lot of time explaining to wealthy, insured patients that treatments they are convinced they need can’t be expected to make them live longer or better lives.

In the back rooms of American medicine, the analysis of the patient’s financial durability has a glib name: a wallet biopsy. If it returns positive, you stay in the hospital, you get more treatment, you can make a follow-up appointment. If it returns negative, you have little hope of getting consistent care.

The system is not failing. It's functioning exactly as designed. It's designed to run up health-care costs. It's about the greedy serving the gluttonous. Americans consume more health care per capita than the people of any other country.

Proponents of science as a foundation for health care have not come together to form a grassroots movement, and until this happens, all of us will have to live with a system based on pseudoscience, greed, myths, lies, fraud, and looking the other way. Patients need to understand that more care is not better care, that doctors are not necessarily right, and that some doctors are not even truthful. Genuine health-care reform--like the right to vote--will not be granted magnanimously. Like civil rights, the right to good health care will have to be won in public struggle. To bring about real change, real people will have to say, "Enough!

Martin and Rae find an elevator bank. One of the doors is gold-colored (it’s bronze, actually). A placard says it leads to the Georgia Cancer Center of Excellence. Generally, places that are comfortable with excellence don’t call themselves centers of excellence. Has anyone heard of a Princeton University Center of Excellence? Memorial Sloan-Kettering Cancer Center of Excellence?