from los angeles, i am tavis smiley. tonight, we continue our road to health series with a look at health care in america and the disparities we face with dr. otis brawley, the chief medical officer at the american cancer society. his profound new text, "we do harm," offers unconventional views on the health care we all receive. a candid conversation about the state of health care in america with dr. otis brawley, coming up. >> every community has a martin luther king boulevard. it's the cornerstone we all know. it's not just a street or boulevard, but a place where walmart stands together with your community to make every day better.

>> the california endowment. in neighborhoods. learn more. >> and by contributions to your pbs station from viewers like you. thank you. tavis: and dr. otis brawley is the chief medical officer at the american cancer society and works in atlanta and is also the author of the new provocative, and i do mean provocative, a new text, "we do harm: and dr. breaks ranks about being sick in

america." dr. brawley, big shoes to fill, but you are doing it. we all know that the credo that you all take is to do no harm, and yet you write a book on how we do harm. that is the kind of thing that can get you into some trouble. >> yes, yes. the reason i did it was during the health-care reform debate, there was some talk about how we had the best health care system in the world if it is true if you can afford it and know how to get through it, but as i look back over a number of my patients, and the book is stories about my patients and how the health-care system actually occur to them. there is over treatment, people getting too much treatment. there is under treatment, people who need treatment and cannot get it.

unfortunately, medicine is a big business, so there are people selling things, and under the guise of health information, they are actually advertisements with all of the things you get with advertisements, including a corruption of the truth. in here -- tavis: i am asking you how, not what, but how did it become such a big business? ostensibly thinking you all go into this business to treat people and to make them healthier and to help people live healthy lives. somehow, money has corrupted the whole process. >> is not just doctors. once you read the book, i believe the fault lies with doctors, patients, hospitals, drug companies, and device manufacturers, the insurers, the lawyers, politicians. everybody has helped cause the system going right, and everyone

seems to make money off of it as it goes awry. we have the most expensive health system in the world. it costs about $8,000 for every man, woman, and child every year. that is the per capita cost. the average and other countries is about $4,000, half that. tavis: what does that get us? >> if we do not have the best outcomes. we are 50th in life expectancy, and we have an expensive system in the world and our 50th and life expectancy. we criticize countries like canada, who have a better life expectancy. as -- tavis: sharing the blame for the money corrupting the system. you said patients. i get everybody else in the process, because they are making money, but how are the patients to blame? >> there are some patients that

are just colonists. they get too much health care, and several chapters are about too much health care and how it can be harmful to your health. there are people decide they want this drug or that drug. for example, let's name names. there is a drug called nexium which is $6 per pill, take one pill per day. it is equivalent to a generic which is available for about 35 cents, 40 cents per pill. it is fda approved because it is equivalent to the 40-cent pill, but many insist on getting the big, purple pills. they tell the doctors that they do not want the generic. they want the expense of pill. that is adding to our health- care system. many insist on going to their doctors to get screening tests, some wanting screening for lung cancer, a test that might actually cause lung cancer, and

is unlikely to save lives. patients can also be a solution if they start being more skeptical, start asking more questions of their doctor. do i need this test? why do i need this medicine? how does this medicine work? if patients start getting interested in their health and our starting to be more skeptical. tavis: you tell some alarming stories about patients and the book. you mentioned the health-care debate a moment ago, which really, as we all know, is not over. if republicans have their way, they will turn this over, and some parts of this law are still being challenged in the court system as we know it now, but what most troubles you about that debate? >> that debate was on numbers, and it was devoid of the fact that there are human beings, there are people are hurting

because they do not get enough health care. there are people who are dying in this country because of the health care. i partly wrote the book because i wanted to put a human face on this and get away from these broad concepts and make people actually realized that this health care debate is about people hurting and people dying because they are not getting the care that they need. >> -- tavis: to your point, there is a story in your book about a woman who walks grady -- walks into grady memorial, and she had something wrapped in paper. i will let you tell the story. >> this is a woman who actually had a job, and she walked into the emergency room, and her chief complaint was that her breast fell off and she wanted to know if it could be reattached. tavis: she had wrapped it up and

had put it in a moist terrycloth and put it in a plastic bag and wanted to know if we could have reattached it. what this is called is an auto- mastectomy. she had known something was growing in her breast for over 10 years. she could dated two when her son was in the second grade, and she had him graduate from high school. she ignored that this thing was growing in her breast. she was at times afraid to go get health care, at times could not afford it do to work and lack of insurance. her breast literally fell off. it is called an auto-mastectomy. we see that at grady about twice a year. this is the only time i have

seen someone walked in and asked to have it reattached, but in the united states in 2012, that sort of thing happens in big public hospitals. tavis: in the story that you just told, i heard two or more things, in a particular order. i heard about fear. did not take care of it. number two, i heard an ability to pay over the course of that 10-year period. which raises the question for me, about responsibility, you mentioned earlier that patients can be responsible for the cost. but how much of what troubles our system has to do with individuals not been proactive, not taking care of themselves? >> i think of large part of the system is individuals not being proactive and not taking care of themselves, but a large part also is people who simply do not have access. it cannot afford it.

the bills would be too overwhelming. in this woman's case, she had a job, but she had family responsibilities to keep up, a roof over kids head, to keep them fed, and that came first as opposed to paying for doctor bills. tavis: getting to the nitty gritty about physicians themselves, and the hunger, the greed. i do not want to indict the entire field, but agreed to make more money by recommending product x, y, and z nz, and z. tell me about the harm. >> i appreciate your saying some, but unfortunately, it is a larger group than one would think. doctors tend to prescribe things that are a benefit for them. a surgeon is must more -- much

more likely to suggest operating when radiation therapy might also be an option, for example. we really do have to question our doctors and actually ask them, "why do you suggest is a versus that?" and second opinions. patients need to get interested in their health care and do some reading about things are treated. by the way, even among doctors like myself, i think myself someone very interested in patients and very interested in the best interests of patients. i think i give better service when people in iraq and ask questions, but, yes, in the field that i practice and, medical oncology, and there are several stories in the book, where doctors a chemotherapy, and they would choose to give drugs where the mark up where they got paid was higher than other drugs that are equally as useful but they do not make as much money off of.

you will see this happening a lot, even in dentistry. you will see cavities that it felt that perhaps ought to be watched. tavis: what is a patient to do about that? i mean, if i asked my position why he is doing x as opposed to y, and he or she gives an answer, given that i did not spend 15 years going to residency and all of that, what do i do about it? >> i think most people, the debt ceiling actually goes a long way, and if you have a doctor who is willing to interact with you and willing to discuss these sorts of things, i think that is a good doctor. if you have a doctor who is not willing to talk about those things, i think maybe you had better get a different doctor. tavis: you do not a really deep into this, and i know you touch on it in your work, and you have some thoughts about it, so i am

going to ask, and that is how much damage has to do with culturally and competent care, and i ask that because it was the first african-american president, while seven others tried, to get this through, and he did it at a moment in american history where we have the most multi ethnic nation ever. that is not reflected in the color of the physicians to provide the care. how much of this is a lack of cultural competence? >> there is some harm due to a lack of courtroom competence, but it can actually go in the ways that people do not think. a black patients taking -- doctor taking care of a black patient can actually think themselves better than that patient. there can be socio-economic discrimination among black people. my uncle actually used to say that he preferred jewish positions, because it was his

experience that -- jewish positions understood where he was coming from and were interested in him. i am very interested in the doctor-patient relationship, but i can see problems in terms of cultural confidence in blacks' taking care of blacks, hispanics taking care of hispanics, and even why it's taking care of whites, and socio-economic discrimination is one of the things we worry about, or people who are not very sophisticated being thought of in a way that is very negative by the opposition and getting not as good care because they are not sophisticated. i see that happening a lot. tavis: having nothing to do with race, what about the notion of a bedside manner? i am asking big as these are conversations i have with my friends, who feel that harm is being done to them. maybe not asking them, but bedside manner is a terribly important thing. >> it is incredibly important

and something that many of us all down on. unfortunately, many systems that doctors work in an outpatient madison, you have to see four to five patients per hour, so we are talking about how was a doctor going to establish rapport and understand what the patient needs are and make a diagnosis and make a suggestion for treatment and to this explaining all in what is basically 10 to 15 minutes. it can be very difficult. that is one of the ways where insurance companies and those that reimburse, it is very unfortunate. doctors get paid to operate account -- on people but do not get paid very well to talk to patients and counsel them. that is one of the problems in the system. >> tell me about the intersection, and you talk about this and a variety of ways, tell me about the intersection increasingly, to my reader, at least, increasing intersection between madison and politics,

and we have seen it play out of late on a number of different fronts, in no particular order, the susan g. komen catastrophe, that they had to do a 180 degrees on and apologize for. this war on women about contraception, and where this debate is going to end up, medicine and politics. i am giving you a bunch of examples, which i do not need to do because you are the expert, but give us your read about medicine and politics. >> actually, i think the title of the book is perfect for this, because what we need to do in medicine is figure out how we can make people healthy, how we can promote health and try to keep people from getting sick, and if they are sick, how we can get them cured. unfortunately, money can be made in medicine, and whenever money can be made, politics starts getting involved. we desperately, desperately need

to try to keep politics out of it as much as possible, and we need to focus, get the medical profession and include not just doctors but people in the insurance business, people in the business of making medicines and running hospitals, everybody has got to change their mind set and start thinking what is best for the patient. the meeting of the word profession is a group of people who put the interest of their client, in this instance the patient, ahead of their own best interests, and who also polices itself. we in medicine are not putting the interests of our patients ahead of our own interests right now, and we are also letting politicians delve into madison and starting to regulate it. unfortunately, not regulating in ways that would improve outcomes. >> bj tavis -- tavis: we have

the practice of medicine. there is a reason why they call it the practice of medicine. but there are increasingly debates about science. what about that? >> yes, many doctors have forgotten the scientific side of medicine, or they do not understand it. unfortunately, medical school, they do not teach you statistics or clinical trial methodology and things like that. we talked to a woman who got a broker -- bone marrow transplant for breast cancer. that treatment became very popular in the late 1980's. by 1998, 1999, there were more than 200 centers in the united states that actually offered bone marrow transplant for breast cancer. 1999 is when the four clinical trials were finally published to show that the bone marrow transplant for breast cancer not only did not work, it was not

harmful over the old standard therapy, so we have 200 sites around the united states who are doing something, and the science is finally completed 12 to 15 years after they started doing it. there are so many things we do in medicine without the science. and an outspoken. we did prostate cancer screening. we did prostate cancer screening in this country for 20 years before we had a clinical trial that suggested that it was actually beneficial. i was outspoken on prostate cancer screening because in the late 1990's, i actually met a fellow who was a marketer for a large hospital system who had this wonderful business plan on how much money they would make off of prostate cancer screening at a mall, free prostate cancer screening being very lucrative for the hospital, off of the guys you read that at normal, people try it with cancer, and

they knew how many different treatments they were going to get. they even knew how many men were going to read urinary incontinence and impotence, and i asked the guy how many lives they would set off of this prostate screening, and he said, "do you not know? there is no scientific study that shows that this saves lives." it was all about money. it was based on making money with the possibility that it might be beneficial. we do this so often in medicine. those are just two examples. tavis: give me your read on the insurance industry. we talked earlier about the whole health-care debate. some people call in health-care reform. i do not go that far because i do not think much got reformed, but give me your read on the insurance. >> actually, what i think got reformed was paid. what we actually need is health- care transformation. we need to have a tremendous focus on prevention of disease

instead of the current focus, which is on fixing people once they get sick. tavis: there is no money in prevention. i am a story to tell you later. >> that is it. there is no money into prevention greece and the insurance companies have been a great gravy train. 20% of their revenue is profit. they have had a great run for the last few years. and i do not see it stopping. unfortunately, even the not-for- profit health insurance is that we used to have have become really for-profit health insurance is, when you look at what some of the executives are getting paid. tavis: my mother watches this show back in indiana, and i do not want to scare her. i was at the doctor's office the other day. i am fine, mom. i was complaining about something, and i said to my doctor, i would like to get this tested, and he thought it made

sense and called the insurance company and asked them. it was being done for preventative measure. they absolutely refused to pay for it, so i am thinking, i am tavis smiley. maybe if i get on the phone, maybe i can talk them into it. after all, i am the guy who pays the premiums. so i get on the telephone and try to talk them into it, and they would absolutely not budge on paying for this, and i found myself in a huge fight on the phone with my own insurance about what they would not pay for something that i was asking to have done for a preventive measure and absolutely would not do it. upset. it made me live in the other day. the point is, and there it is not any money in prevention. >> there are certain things that we ignore and do not do, and

then there are certain things that doctors very frequently get into and start advocating that we actually do not have science to promote, so there needs to be a good interchange and a discussion with the patient about what the science is, and unfortunately, many doctors do not know what the science is. when the preventive services task force last fall suggested that they might recommend that men not be screen for prostate cancer, there were a lot of doctors that were surprised at that recommendation. i, by the way, do not agree by the recommendation, but i am not surprised by it. i understand why they would do that and how there is harm associated with some screening tests, armas associated with some tests that might be done for preventive measures, as well, so we need to keep an open line, and there needs to be a discussion as to what the science says.

we use the phrase evidence-based medicine. there are those of us who want to get more science into it, but back to your original point, medicine is an art that involves report the patient, and it involves science, evidence- based medicine. tavis: my time is up, but there are examples in the book where you say if x had happened early on, the money that it costs a later on to try to address the problem would not have been spent, and the person might still be living today is something on the preventive side would have been done. >> that is right, that is right. that is exactly right. tavis: the book is "we do harm." dr. otis brawley, i know this can get you into some trouble,

but i appreciate it. that is our show for tonight. until next time, keep the faith. >> for more information on today's show, visit tavis smiley at pbs.org. tavis: if you are in the new york tristate area, join us at the center for performing arts for a conversation about women, children, and poverty in america. guests include the labor secretary, the teacher union head, financial expert suze orman, and others. visit our website at pbs.org. tavis: hi, i'm tavis smiley. join me next time for a conversation with david e. kelley. that is next time. we will see you then. >> every community has a martin luther king boulevard. it's the cornerstone we all know. it's not just a street or

boulevard, but a place where walmart stands together with your community to make every day better. >> the california endowment. health happens, in neighborhoods. learn more. >> and by contributions to your pbs station from viewers like you. thank you. >> be more.