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Vol. LXVI, No. 8
April 11, 2014
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Brawley Calls for ‘Rational, Evidence-Based’ Medicine

Dr. Otis W. Brawley

Dr. Otis W. Brawley

Inefficient, unequal and irrational. That’s how Dr. Otis W. Brawley described the United States’ health care system at a recent Contemporary Clinical Medicine Great Teachers Grand Rounds lecture.

“We spend a lot of time focusing on treating illness as opposed to preventing people from getting illness,” said Brawley, chief medical and scientific officer of the American Cancer Society and a former NCI
scientist.

According to Brawley, in 2010, U.S. health care expenditures reached $2.6 trillion, roughly $8,000 for each American. That’s more than any other country in the world. Yet the U.S. lags behind many developed countries in such key health indicators as life expectancy and infant mortality.

“In our health care system, some people over-consume resources, meaning they get unnecessary care,” he said. “Some people under-consume resources, meaning they don’t get the care
they need.”

Brawley added that cancer mortality rates reflect this health inequity. Overall, the cancer mortality rate has declined by about 20 percent in the past 20 years. He attributes the decline to a decrease in smoking, improved treatments, early detection and cancer awareness. However, not every population is benefitting from these advances.

In many cases, stark differences in the availability of treatment exist between underserved minorities and other Americans. For example, African-American women diagnosed with breast cancer are more likely to die from the disease than white women with a similar diagnosis. In 2010, the disparity between the two populations was greater than in any other year previously. Similarly, African Americans diagnosed with colorectal cancer are also more likely to die from the disease than are whites with the same diagnosis.

Brawley greets Dr. Fred Ognibene, Clinical Center deputy director for educational affairs and strategic partnerships, at the lecture. “In our health care system, some people overconsume resources, meaning they get unnecessary care,” said Brawley. “Some people under-consume, meaning they don’t get the care they need.”

Brawley greets Dr. Fred Ognibene, Clinical Center deputy director for educational affairs and strategic partnerships, at the lecture.



“In our health care system, some people overconsume resources, meaning they get unnecessary care,” said Brawley. “Some people under-consume, meaning they don’t get the care they need.”

Photos: Ernie Branson

Brawley also charged that practitioners have a history of ignoring evidence-based medicine, particularly when it comes to the limitations of cancer screening. In 2011, the National Lung Screening Trial found that lung cancer screening can reduce the risk of death by about 20 percent for adults who are at least 55 years old and have smoked a pack of cigarettes a day for 30 years or adults who have quit smoking in the past 15 years. However, 80 percent of lung cancer diagnoses still resulted in death.

The trial also found that almost a quarter of adults screened will need further testing, such as a chest x-ray, lung biopsy or surgery. Roughly 24 out of 25 adults who receive further testing will not have lung cancer. Complications from further testing may lead to permanent disability or even death.

Today, researchers are using genomics to identify the genetic causes of different types of cancer. They hope to use what they learn to provide the foundation of individualized therapeutic approaches for different types of cancers.

“That 5-millimeter lesion may be genetically programmed to stay there and never grow,” Brawley said. “Or it may be genetically programmed to grow, spread and kill. This may allow us to treat those that need to be treated and spare those that do not need treatment.”


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