Cancer Society official touts 'rational medicine'

In the national debate on health reform, there is plenty of rhetoric about rationing medicine but little constructive talk about practicing "rational medicine," said Dr. Otis Brawley, chief medical officer for the American Cancer Society.

On Thursday, Brawley spoke to faculty members and students at the Medical University of South Carolina Hollings Cancer Center about the dire need for reform and how it relates to patterns of care -- including disparities between the rich and poor; the insured; underinsured and uninsured, and whites, blacks and Hispanics.

"Rationed medicine is already practiced in America," said Brawley. "We should be worrying less about rationed medicine and more about rational medicine."

Brawley underscored the need for the medical community to practice evidence-based medicine, such as not assuming that expensive treatments are better, and to help wage a long-term campaign against obesity, similar to successful efforts against smoking and racism in the past 40 years.

"The American population can change the way it thinks," he said, regarding obesity. "It's just going to take time."

Brawley's visit to MUSC coincided with an announcement of the Cancer Society awarding the Hollings center a $450,000 grant to support junior faculty research.

Hollings Director Andrew Kraft says the money will be used for investigations that range from effective prevention programs to studying new molecules that could lead to a new cure for cancer.

In an interview before Brawley's talk, the Emory-based oncologist and epidemiologist touched on many issues that are at the heart of the health care crisis in the United States. But, he said, for now, the cancer society is not taking any specific positions on reform bills that are under consideration.

"While we are not taking a position, we are adamant that access to care is a huge issue in the United States," Brawley said.

On the current path, he said, health care will rise from 17 percent of gross domestic product to 30 percent in the next 15 years.

"That will paralyze our economy," he said and predicted that the recent recession will pale in comparison to the "economic tsunami" caused by an unchecked health care crisis.

Part of the solution to reform starts with the medical community, and citizens, changing the ways they look at health care, he said.

For example, he said that many men are encouraged to be screened for prostate cancer, but that data does not support the idea that it saves lives. Meanwhile, screenings for colon-rectal cancer does.

Yet 80 percent of men age 50 and up get screened for prostate cancer and only 40 percent get checked for colon cancer.

"It just doesn't make sense," Brawley said.

Another example he used comes from the case of Vioxx, which was taken off the market in 2004 because of increased risk of heart attack and stroke associated with long-term, high-dosage use.

Vioxx was approved by the Food and Drug Administration, even though it was shown to be no more effective than over-the-counter Motrin, or ibuprofen, for arthritis pain. Yet for the same dosage, Vioxx cost $300 and Motrin $8.

"Many doctors started prescribing it (Vioxx) and many Americans started using it because of advertising and because, in their minds, it was newer and more expensive and so it must be better than Motrin," Brawley said.

"But guess what? It wasn't. That (the idea that new and expensive must be better) is the mind-set of Americans in health care. ... We've got to decrease our health care costs by getting away from that and by staying healthier," he said.

Regarding the latter, Brawley said obesity must be addressed, reiterating the cancer society's recommendation to eat five to nine fruits and vegetables per day and to exercise, preferably, five times per week.

Yet he had some sobering thoughts on how to make those simple solutions stick.

"The thing we really need to do, quite honestly, is focus on the kids. In some respects, people who are in their 30s, 40s and 50s -- there is no real way to save them. It's easier to keep people from gaining weight than it is to get them to lose weight," he said.

"We need to refocus on health education in grade school, which now consists of throwing a basketball around and shooting hoops. It needs to be more about diet and nutrition, and aerobic health.

"If this is done right, some of the information is going to be carried home by third- and fourth-graders and influence their parents to take care of their health."