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Official: Dollar-driven health care causes harm

Dr. Otis W. Brawley, chief medical and scientific

Dr. Otis W. Brawley, chief medical and scientific officer and executive vice president of the American Cancer Society, addresses the unsustainably high cost of medicine and of cancer in particular during a lecture at NYIT Wednesday March 5, 2014. Credit: Newsday / Alejandra Villa

U.S. patients not only are spending too much on medical treatments, there are still too many ways dollar-driven health care causes harm, according to a top official with the American Cancer Society.

Dr. Otis Brawley, the cancer society's chief medical and scientific officer, told an audience of physicians-to-be last week that medicine's scientific basis too often takes a backseat to superfluous concerns.

An address to students at NYIT's School of Osteopathic Medicine in Old Westbury, the lecture was designed as one in a series of talks on provocative subjects in medical care. Brawley tackled high costs and the irrational use of medical resources. A lecture scheduled for later this year, featuring another speaker, will focus on the growing doctor shortage.

Dr. Barbara Ross-Lee, the school's vice president for health sciences, said she and her colleagues purposely seek out speakers who can stimulate vigorous debate.

"This is a minefield we are walking through as practitioners and you have to remain questioning. It is the only way you can do the best job for the patient," Ross-Lee said.

She added that physicians such as Brawley raise questions that doctors -- and patients -- should be asking, especially regarding the costs of medical care and prescription drugs.

Brawley told students some doctors ignore scientific evidence, overuse unreliable screenings and charge too much for some procedures.

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In 2010, he said, $2.6 trillion was spent in the United States on health care. In simple arithmetic, 18 cents of every dollar spent in this country flows into health care, Brawley said.

Yet, other countries, such as Switzerland, have better health outcomes and spend less.

"If the U.S. health care system was an economy, it would be the sixth-largest in the world," Brawley said. "At $2.6 trillion, we spent more on health care than France spent on everything."

The result in this country is an uneven distribution of medical care based on who has the most money, he said.

He predicted severe damage to the U.S. economy within 15 years unless medicine's unsustainable costs are curbed now.


Survival based on money?

As an oncologist and executive vice president at the cancer society's headquarters in Atlanta, Brawley said money-driven medicine too often dictates outcomes in cancer survival.

He said he has served as a clinical investigator on research projects that illustrate how clearly dollar-oriented motives determine who lives and dies.

"You're better off having stage 2 advanced colon cancer with insurance than stage-1 localized [colon] cancer without insurance," he said.

Patients with the best health care insurance, treated for stage 2 metastatic colon cancer, experience a 90-percent survival rate five years after diagnosis, compared with an 80-percent five-year rate for those with less severe disease and no insurance, Brawley said.

Cancer screenings are another area of concern.

Although screenings such as mammograms and prostate-specific antigen -- PSA -- tests have offered the public a sense of security knowing cancer might be caught in an early, treatable stage, a growing number of studies have weakened the underlying tenets of that belief, he said.

Brawley cited a flurry of recent investigations that have kindled debates about overscreening, while simultaneously questioning the value of the PSA.

In 2012, for example, in its most recent evaluation of PSA testing, the U.S. Preventive Services Task Force recommended against the screening, noting "very small potential benefit and significant potential harms."

The PSA is notorious for producing false positive and false negative results, according to the National Cancer Institute.

In its latest guidelines released last year, the American Urological Association recommended against routine screening of men between ages 40 to 54 as well as for men 70 and older. For those 55 to 69, an expert panel convened by the association strongly recommended shared doctor/patient decision-making regarding the test.

A recent Canadian analysis, Brawley added, reignited the debate about mammography's value. That research project, known as The Canadian National Breast Screening Study, published last month in the British Medical Journal, cast doubt on mammograms by concluding the screening does not lower death rates from breast cancer.


Prescription drug pricing

Brawley, a professor of medicine at Emory University in Atlanta, also questioned the exorbitant pricing of prescription drugs and criticized pharmaceutical giant AstraZeneca, maker of Nexium, which he described as one of the 10 best-selling medications in the country.

Nexium, he said, is not the unique stomach acid reducer that AstraZeneca has made it out to be. It is the chemically tweaked cousin of Prilosec, another acid reducer, which is now sold over the counter.

AstraZeneca did not return Newsday's phone inquiries. In the past, AstraZeneca has defended its campaign promoting Nexium, saying that all of its claims about the product were supported by data.

On average, Brawley said, Nexium costs $6 per pill, which means patients or their insurers must pay $180 for a month's supply. Prilosec, which has closely related chemistry, costs 25 cents per pill, he said.

"This is some of the irrationality and some of the reason why we should be skeptical," he said, adding that Nexium was widely advertised to consumers as "the purple pill."

Ross-Lee said the Nexium example helped medical students understand the power of direct-to-consumer advertising and why patients often request certain medications.

"He's a skeptic," Ross-Lee said of Brawley. "Most physicians can give you an example, but he has pulled it together and presented a number of issues that we should be thinking about."

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