In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. They are making a difference in healthcare. This is the story of Otis Brawley, MD .
This profile was published in the December, 2014 issue of HealthLeaders magazine.
Regardless of personal cost, some Americans find it impossible to remain silent when they believe the country is careening toward disaster.
Otis Brawley, MD, chief medical officer of the American Cancer Society and author of a scathing book on what ails U.S. medicine, has no fear of acting as a lightning rod in the ongoing storm of healthcare reform. The 55-year-old has the ability to speak damning truths to powerful healthcare stakeholders, for which he credits his parents, a parochial school education, and the violence-plagued streets of his childhood in Detroit.
"I was one of the few black males in my neighborhood to make it to the age of 35," Brawley says. "I think I just have a strong moral compass. … I see the path this country is going down, and it's bad. We're going to bring the economy of the country down with healthcare, of all things."
One of the central premises of the oncologist's 2012 book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, is that the growing cost of U.S. healthcare is a recipe for an economic calamity. If the 20-year trend of increased spending continues, medical services will swallow 35% of the U.S. economy, Brawley says. "That is not sustainable. We cannot exist in the United States if we're spending one-third of our dollars on healthcare."
Brawley is a leader in the field of health disparities research. His views on uneven access to healthcare services in America are both idealistic and pragmatic. "There is basic healthcare that every human being has a fundamental right to," he says, insisting that a combination of technology and cost-effective delivery of primary care and preventive medical services is possible even for people living in poor, remote areas of the country.
"We have this mind-set that the more medicine we consume, the better off we are. There is harm in that."
"Not only do we have disparities in healthcare, we have disparities in preventive care," he adds, noting the level of health education in the general public is woefully short of where it needs to be for people to appreciate the value of their health. "There are a whole lot of people who don't understand health."
Prevention is sharply undervalued, Brawley says. "Nixon declared war on cancer in 1971. Our investments in cancer research have been better applied in Europe. We're irrational. We have this mind-set that the more medicine we consume, the better off we are. There is harm in that. Overconsumption can be incredibly harmful. Our healthcare system is designed to treat people. There's very little in our system that's designed to prevent disease."
He notes that European physicians' emphasis on prevention is paying huge dividends in lower obesity rates, better exercise habits, and other lifestyle-linked health factors. "We give them a diagnosis, then we treat them for that illness," he says of the American doctor-patient relationship. "In Europe, doctors get paid to consciously help people from getting sick. … We don't pay and reimburse for prevention. We pay for treatment. Preventive services need to be appreciated more."
Brawley has several stern prescriptions to improve the status of American health. First is to promote cost-effective screening techniques, particularly among underserved populations. "At $30, stool blood testing is just as effective as colonoscopy, which costs $3,000 per procedure. Let's get some poor folks some stool test kits," he says. But at the same time, disease screening must be deployed judiciously to avoid false positives and unnecessary treatments, including potentially dangerous surgical procedures: "People just don't understand how screening might not be good for them."
In addition, "high caloric intake, lack of exercise, and obesity" are fundamental challenges to American health. Brawley says obesity has been identified as a cause of a dozen cancers and is a particularly vexing problem: "It complicates treatment of all other illnesses."
Lastly, he calls for increasing daily servings of fruits and vegetables, walking at least four hours per week, and quitting smoking.
"A truly informed consumer would be very, very helpful," Brawley says. "The problem is the people who think they are informed about healthcare who are not."
Christopher Cheney is the CMO editor at HealthLeaders.