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

Otis Webb Brawley, M.D., with Paul Goldberg

St. Martin's Griffin



Trade Paperback

320 Pages



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A Booklist Top 10 Science and Health Book

How We Do Harm exposes the underbelly of healthcare today—the over-treatment of the rich, the under-treatment of the poor, the financial conflicts of interest that determine the care that physicians' provide, insurance companies that don't demand the best (or even the least expensive) care, and pharmaceutical companies concerned with selling drugs, regardless of whether they improve health or do harm.

Dr. Otis Brawley is the chief medical and scientific officer of The American Cancer Society, an oncologist with a dazzling clinical, research, and policy career. How We Do Harm pulls back the curtain on how medicine is really practiced in America. Brawley tells of doctors who select treatment based on payment they will receive, rather than on demonstrated scientific results; hospitals and pharmaceutical companies that seek out patients to treat even if they are not actually ill (as long as their insurance will pay); a public primed to swallow the latest pill, no matter the cost; and rising healthcare costs for unnecessary—and often unproven—treatments that we all pay for. Brawley calls for rational healthcare; healthcare drawn from results-based, scientifically justifiable treatments, and not just the peddling of hot new drugs.

Brawley's personal history—from a childhood in the gang-ridden streets of black Detroit, to the green hallways of Grady Memorial Hospital, the largest public hospital in the U.S., to the boardrooms of The American Cancer Society—results in a passionate view of medicine and the politics of illness in America—and a deep understanding of healthcare today. How We Do Harm is his well-reasoned manifesto for change.


Praise for How We Do Harm

"A tough-minded, solidly argued indictment of health care . . . Brawley's sense of outrage is palpable."—The Boston Globe

"[Brawley] is actually full of righteous fury about the inequities in our healthcare system. The book, in fact, is a call for no less than a social movement for sane and science-based healthcare for all. Healthcare reform hasn't worked from the top down, he argues. What we need is a groundswell inside and outside medicine. 'Genuine healthcare reform—like the right to vote—will not be granted magnanimously,' he writes. '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!"' How we get to 'Enough!' is laid out thoughtfully in the following 250 pages. Brawley promises a 'guided tour of the back rooms of American medicine,' and he delivers with story after story of what Brawley thinks is wrong with America's healthcare system."—Heather Boerner, National Nurse

"Brawley [shows] that ours is a nation of extremes, with the poor or uninsured frequently denied even the most basic care while the well-insured often are 'overtreated,' receiving unproven drugs and procedures that cause real harm."—USA Today

"This book is shockingly detailed and it should serve as a wake-up call to fix the dismal mess and rethink the politics of illness in America. Dr. Brawley provides a well-reasoned manifesto for change."—Tucson Citizen

"Now, for the first time, a leading health-care clinician—the Chief Medical Officer of the American Cancer Society—Dr. Otis Webb Brawley is breaking ranks—literally and figuratively."—

"Any who wants to know how behind-the-scenes health care works will find this a key title."—Midwest Book Review

"My friend and colleague Otis Brawley has written a raw and honest portrayal of our health care system. There are certain to be special interest organizations and medical groups that take issue with Dr. Brawley's conclusions, but few can argue with the scientific rigor he has demonstrated in writing this book. Otis is the go- to oncologist I send so many patients to see, because he is not only a great doctor, but also a compassionate man. As we discuss the transformation of health care in this country, put Dr. Brawley's book at the top of your list."—Sanjay Gupta, Associate Chief of Neurosurgery Grady Memorial Hospital, Chief Medical Correspondent, CNN

"Otis Brawley is one of America's truly outstanding physician scientists. In How We Do Harm, he challenges all of us—physicians, patients, and communities—to recommit ourselves to the pledge to 'do no harm.'"—David Satcher, Former Surgeon General of the United States, Director, Satcher Health Leadership Institute, Morehouse School of Medicine

"Sweeping, honest and brave . . . How We Do Harm dazzles with a wealth of scientific insight, but its genius lies in the author's recounting of individual patient stories that illuminate the dark underbelly of medicine's missteps. Brawley does not shrink from revealing medicine's warts, but this book offers much more. It is a triumph of humanity and clarity in which oncology becomes a Rorschach for the practice of American medicine. You will finish this arresting book reluctantly, with a new appreciation of what American medicine could be."—Harriet A .Washington, author of Deadly Monopolies: The Shocking Corporate Takeover of Life Itself and the Consequences for Your Health and Our Medical Future and Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

"Dr. Brawley is a premier academic oncologist and a minority doctor in the nation's largest inner city hospital. How We Do Harm places in stark contrast the health care resources available to the rich and the poor, the insured and the uninsured, the white community and the community of color. He makes the cogent point that more testing, screening, and interventions available to the rich does not always mean better medical care."—Bruce Chabner, MD, Director of Clinical Research, Massachusetts General Hospital Cancer Center

"Otis Brawley shares in equal measure his compelling personal story, the development of modern medical oncology, and the wide range of his strong opinions. Whether you agree with him or not, the reader is given access to Dr. Brawley's unambiguous scientific and ethical framework. He provides an anvil for shaping your own perspectives and biases."—Michael A. Friedman, MD, President and Chief Executive Officer, Director Comprehensive Cancer Center, City of Hope

"A powerful contribution to the ongoing discussion on health-care reform."—Kirkus Reviews

"Brawley challenges readers with his calls for strict scientific standards for medical treatments and a national commitment to caring and effective medical care for all our citizens. Thoughtfully argued and compellingly readable, this book will reward both general readers and health-care professionals interested in health policy."—Library Journal (starred review)

"In this no-holds-barred peek at the contemporary health scene, he relishes his role as a rabble-rouser . . . Brawley finds the right formula for mixing autobiography, the politics of modern medicine, controversies in cancer care, and wisdom."—Booklist (starred review)

Reviews from Goodreads



Read an Excerpt

Chapter 1

Chief Complaint

SHE WALKS THROUGH the emergency-room doors sometime in the early morning. In a plastic bag, she carries an object wrapped in a moist towel.
She is not bleeding. She is not in shock. Her vital signs...

Read the full excerpt


  • Otis Webb Brawley, M.D., with Paul Goldberg

  • Dr. Otis Brawley is the chief medical and scientific officer and executive vice president of the American Cancer Society. Dr. Brawley currently serves as professor of hematology, oncology, medicine and epidemiology at Emory University. He is also a CNN medical consultant. He is a graduate of the University of Chicago, Pritzker School of Medicine, and completed a residency in internal medicine at University Hospitals of Cleveland, Case-Western Reserve University, and a fellowship in medical oncology at the National Cancer Institute.
    Paul Goldberg is an award-winning investigative reporter who covers oncology for The Cancer Letter, a weekly publication focused on drug development and the politics of cancer. His articles have appeared in The New York Times, The Wall Street Journal, The Washington Post, The Washington Monthly and he has been featured on 60 Minutes, 20/20, CNN and NPR. Goldberg is also the author of two books on the Soviet human rights movement.

  • Otis Webb Brawley MD Richard Lubrant
    Otis Webb Brawley MD
  • Paul Goldberg Gilles Frydman