Dr. Brawley: How we do harm

Whoa, okay, everyone, DEEP BREATH!

So VR, Violet, anyone who cares:  I DO plan on reading Dr Brawley's book as soon as I can get it from my Public Library.   And I hope it opens my eyes more than the excerpt did.

Violet I agree you did not receive over treatment any more than I did. But yes: the fact that both of us chose a course that, while not 'over treatment' in our own highly individual contexts (obviously my surgeon supported my BMX too at the end of the day too or else would never have done it), the point is we did receive treatments that were beyond the 'standard of care'.  Since we did more than what the national guidelines advise, beyond what the 'standard of care' is, can't that be considered 'over treatment'?  I just don't understand what 'over treatment" is - if we are going to rail against nameless people and our healthcare system because it 'overtreats' some (while undertreating others),  I just want a definition of what 'overtreatment' means.  

Or does it mean wholly unnecessary treatment?  To me, wholly unnecessary treatment is different.  Wholly unnecessary treatment borders almost on criminal, if its knowing. It is not overtreatment- when it comes to drugs with side effects - that 's bad treatment.  Chemotherapy when chemotherapy offers no benefit?  Tamoxifen when the risks are greater than the benefit?  Standard of care is exactly that, a professional standard. If a doctor offers you something that is not standard of care - ie chemo for something that standard of care says "no chemo"- well then, I would think that you can sue for malpractice if you have damages.  Maybe I'll understand more about what this is when I read Brawley's book and I can let you know what I think then.  I'm assuming it will inform me more than I am informed now....I totally understand the dichotomy/two systems of health care. I don't work in a hospital but I do work/ live in both worlds- those of the haves and the have nots - everyday, frankly.  I understand how Dr Brawley can be outraged.  I don't think I have to have read the book to be able to say that I  agree that he is brave and admirable.  I will let  you know more of what I think when I have read it, if you can bear it.  )  

PS I'm very sorry violet. I just see your added post re your child's death. Thanks for your thoughts on this. .I agree it is too much, the vaccines, more now than even 10 yrs ago, hepatitis, flu,  all of it, too much imho too.  

jessica, I would define "over-treatment" as a situation where the potential risks from the treatment are greater than the potential benefits from the treatment.  But I would say that the assessment must be done from more than just a strictly medical standpoint, and even medically, one should look beyond the current diagnosis. 

A MX might not be indicated for a small area of breast cancer but if there is an extensive family history of the disease (BRCA+ or not), or if it's a 2nd breast cancer diagnosis, or if the patient has already been diagnosed with a high risk condition in the other breast, or if the patient has gone through years and years of biopsies.... all those conditions might suggest that a BMX is indicated or at least is a very reasonable choice. 

Similarly, disease and treatments both have emotional and psychological effects and these need to be factored in too. So even if a BMX is not medically required, if a patient is well informed about her future risks and determines that she cannot deal with that level of risk or uncertainty, then a BMX could be considered a very reasonable choice.  Generally, I think that if a patient is well informed and has accurate information about her diagnosis and her risks, as well as an accurate understanding of the benefits and risks associated with each of the treatment (or non-treatment) options, then most patients (but certainly not all) will make a rational decision.

To me, the situations where I would be tempted to call out "over-treatment" or "under-treatment" are those where:

- the standard of care is different than the treatment that's being done   AND

- from a strictly medical standpoint, the health risks from the treatment outweigh the benefits of the treatment or vice versa, in cases where someone is passing on a treatment  AND

- the decision is made without full knowledge of the facts (particularly as related to risks vs. benefit, as much as we can know that)  AND / OR

- the decision is made largely out of fear, either of the disease (choosing a treatment that puts one's health at greater risk from the treatment than from the disease) or of the treatment (putting one's health at greater risk by choosing to not have a treatment or choosing a different treatment).

Personally I don't think that veering off "standard of care" necessarily means that there is malpractice or over- or under-treatment.  Standard of care is a starting point, based strictly on medical risk vs. benefit as defined by the diagnosis at hand.  Medical and family history and the patient's personal concerns/desires then need to be factored in.  You also have to consider that standards of care change over time, and if a doctor is on the leading edge and has a patient who is happy to go along with something different (with full knowledge, of course), then I don' think there's anything wrong with that.

So I agree with Colt that in most cases it's difficult to look at someone else's situation and point and say "that's over-treatment" or "that's under-treatment" but sometimes the medical argument for or against a treatment (relative to the diagnosis) is so compelling that it does become pretty obvious.

Jessica, I think you will enjoy reading his book and I look forward to your thoughts afterwards.

he is annoying, and then says god bless.

I wrote a post, and then somehow lost it! it was the best post ever! it saved lives, and opened eyes! actually, i wrote about another book i was rereading from over a year ago. the author is susan sontag's son. the book is called "swimming in a sea of death", and his name is david rieff. in it, he does talk about her diagnosis and treatment, and how it affected them. she had a halstead done in 1974, and she was stage lV. he talked of her reasoning, about how she was down on her newly diagnosed friends who chose lumpectomies instead. she was willing to endure any amount of pain and suffering, just to live. and all through the course of her illness, what it did to them, psychologically too. he is very good. also talks about overtreatment etc. she did live for a good many years after. when i first read it i wasnt even diagnosed yet, so after reading this topic i decided to read it again, and to reread Dr Brawleys book. He is definately one of my heroes! Hi, Violet! I am from sacramento, and miss my rivers! you look so young! i am going there in sept. to see my family, whom i havent seen since diagnosis and tx. i will try to remember any other books i found fascinating, and i will also try to send links of other blogs i have found, later.

P.S. I'll be 48 in November!

Hi Violet! They definately ARE different planets. Sorry you had to move. I love the down town shady trees, the only city in the world with more trees than sacramento, is Paris. There are a lot of good people there, and the traffic used to be ok, but ive heard its getting almost as bad as los angeles. being an artist is wonderful in la, it is full of materiels, specialized or not, and full of natural beauty and architecture, specialty shops, and walkable streets and coffeeshops. Yum. I will be 54 in sept. about regular bloodwork, I dont know yet, because i am still doing herceptin. even tho i was equivocal, not really positive, they said they would like me to do it. and then i had to stop for a few months as my ejection fraction fell greater than 10 %, and now i have 4 more left. they do a blood test on those infusion days. Plus, it might be differant for stage one. But even for me, all that i really am scheduled for, ongoing, is regular mammos, and gynecological exams. I tried anastrazole for 6 months, horrible pain, trigger finger, worsening lymphedema, horrid stuff. so now tamox. i glare at the bottle, and take them irregularly... i see my gyno next week, and will talk with him about it. I am sure i will be the woman it messes up, just about ready to just take my chances. really wished i had had more time to make tx decisions. i may have said off with thier heads instead. My good man(15 yrs) and i make art, and remodel houses in agood way, restoration instead of home depo-ization,make  a living that way. Hard or impossible to do many of the things i used to do, with LE. Another good book, if you want to feel better about drs, and to see how it can really be better, is Tracy kidders Mountains beyond mountains, about the changes that one good doctor can make. Amazingly good. ill still go to my bookmarks later for other womens blogs for you to check out.

Violet 1 - Losing a child is the worst fear of every mother. I am so very sorry it happened to you.

You mentioned a cat getting sick after a vaccination. I had one develop an osteo scrcoma - bone cancer - in his hip after a particular one. Unfortunately, it was very aggressive and we eventually had to have him put to sleep.

The Veterinary Association had noticed an unusual number of cats developing osteo scarcomas after being vacinated, but was not sure which shot was causing them. They decided to recommend that all vets put specific vacinations in specific widely seperated spots (left hind, right hind, left front, right front) to see if it could be identified. When cats began developing it consistantly in the same area they were able to identify the culprit. They believe that it was probably something in the adjuvant that was the cause. I was asked to fill out paperwork and send it into the Department of Agriculture which was collecting data.

My chemo brain is not allowing me to remember which shot it was, but it wasn't distemper or rabies. Ask your vet next time you are in there.

However, the thought of an adjuvant causing my cat to develop such a scarily aggressive cancer has worried me ever since. In his case - and in that of many other cats - the cancer grew in the area the shot was given. I have to wonder if it might be possible for cancers related to adjuvants to grow in other areas.

Regarding vaccines, Paul Offit, MD, has been among the most vocal proponents of vaccinations. His most recent book, Do You Believe in Magic is likely to ruffle feathers among people who enjoy alternatives to "evidence based medicine."



Last evening I read about the latest outbreak of measles here in The United States. I hadn't realized how contagious it was. For those unvaccinated, or not effectively vaccinated, 90% of those individuals who come in contact with a person incubating the disease will get it. We must all keep in mind 2 important points about vaccinations. One is that in developed countries where most people are vaccinated, the population lives longer...Children in developed counties go on to reach adulthood because of vaccinations.



The second point made during the news about the measles was the importance of people accepting vaccines so that their communities are protected.



While growing up, my oldest son had immunity issues which lead to frequent illnesses that led to procedures and surgeries. Back then, the vocal opposition to vaccination hadn't yet started. I wonder what would have happened to my son if, as the broadcaster mentioned last night about upper middle class communities, who lead the opposition, would have grown a decade later, if he would be as well as he is now...



Without a doubt I wish we knew more about vaccinations. Hopefully now, in this digital age, information about side effects will make potential issues be known of sooner, which will make our understanding of them better known as well.

I just started reading this book and I can't put it down.....it is very interesting.

It's not new but the other cancer book I read I liked a lot. There was a lot in it I didn't know. It's called 'The Emperor of All Maladies'. It goes through a lot of the history of cancer research and treatment.

Other NEW book:

The Cancer Chronicles: Unlocking Medicine's Deepest Mysteries

by George Johnson

Thank you, will read it next!

Another NEW book I just ordered from Amazon:



The Truth in Small Doses: Why We're Losing the War on Cancer--And How to Win It

by Clifton Leaf...:)

Planet. ..

But WHERE to put it?...;)