Always appreciate Dan -- coming up here -- I learn something every day. Well we're moving on and this is pretty pretty stark. A 160 people die each week in Louisiana of cancer. That's one of the highest cancer mortality rates in the nation. The question is why. Is it our lifestyle the incredible food we consume perhaps too much of is it are smoking and drinking habits is in our environment. The chemicals and our air and water. Is it not going to the doctors soon enough. Is that the medical care we get or don't get is that a little bit of all of this. We're here to discuss cancer is the chief medical officer of the American Cancer Society. Doctor Otis Brawley who was also a professor at Emory University. And the former medical director at the Georgia cancer center at Grady Memorial Hospital in Atlanta. And much much more I'd literally can go on this Nancy V -- analysts. But I wanna mention among his many accomplishments. He receives the key to saint Bernard parish for his work with the US public health service in the aftermath of Katrina. Not doctor -- I can't tell you how much he would look forward to meeting. You are such an interesting man thank you again for helping in Saint Bernard we we think every single person who had to begin -- part to come in and do the hard stuff. -- you and we have much to talk about I do wanna start this about cancer because that is your Forte. But I want to tell our listeners that this man has written a very interesting book. On the bigger picture of our health care landscape and I think you're gonna be fascinated by what he has to step. -- let -- start with cancer and giving out those figures even startling when I read them. Why is it do you think. Not to pitch on the spot but in a wheezing and we do have such a high mortality rate. Thank you the way it's wonderful piece here the answer to the problem really is lifestyle. Especially smoking. In -- nationally a third of all cancers are linked to tobacco use. That smoking cigarettes. Chewing tobacco smoking of cigars and so -- The next. Cause of cancer the second leading cause of cancer in the United States. Is. Nutrition physical activity problem and it's really a three legged stool of obesity. Too many calories in the diet and lack of physical activity so many people being couch potatoes it's not just obesity. It's too many calories and lack of physical activity and obesity. And that's the cause of right now about 28 to 30%. Of all cancers in the United States and. An Iraqi zero 'cause I think that that is startling unto itself. We have done many shows on this program. Attacking -- obesity issue childhood obesity as well as adult obesity. And we really I think most people look at it as heart issues but when you now link it with those numbers of cancer. That's painful. That's right that's right it's. It causes. Diabetes. Cardiovascular disease. Increased rates of orthopedic injury and the need for peak surgery and obesity has now been willing to twelve different cancers. It's not chest. Breast cancer it's breast cancer colon cancer prostate cancer pancreatic cancer. As we look at the United States which has the obesity problem unique to the western world. We have increasing rates of pancreatic cancer purely based on the fact that we have an obesity problem. Other countries that do not have this obesity problem do not have this increasing rate of pancreatic can't. And your sang that obesity would be the direct cause. For these various cancers. What happens is. People who are obese have insulin. These insulin doesn't work as well in people who wrote a piece. And they have higher levels of insulin. One of the reasons is insulin acts as a growth factors stimulating cancer protection. There's some of their. More molecular reasons but. One of the ways that people can lower their rate of getting cancer. Is by staying fan and by exercising. And eating a moderate number of calories per day. In an intellectually I think we get that it's just a difficult thing to change. Especially in this community which is glorious. And but the in the food to -- And some of this or may be a little more health conscious -- you have got to throw my Eminem to cook up. But but in a serious note it's a very difficult thing to change likes to. It's gonna require. A cultural change in the United States. To stem this problem. The change that we need United States is perhaps only been seen a couple of times in our history. Clearly. You know we used to have a world where 55% of adult men and smokes cigarettes 35%. Of adult women smokes cigarettes. And we now around 20% nationally for that it's actually in many places unfortunately not Marlins in Louisiana. In many places you're not allowed to smoke in restaurants or bars season. And that's a cultural change. We've had a cultural change in race relations. Over the last fifty years we're gonna have to have a cultural change in how we eat how we exercise. You know in Louisiana. About half football adults get no recreational physical activity. And all any given week. And we could actually to a lot better in terms of cancer if people just walked and how were 45 minutes every day. Just that just that 45 minutes to an hour walk that -- move. -- -- your -- yes and by the way. They're mrs. Obama has a program called let's move. That's aimed at kids because this is and special problem among children among adults six to eleven. 4% world peace in 1970 and by 2010 it was 20%. Increase by a factor of five. You obviously have your work cut out for you. On on a happier note. It seems as if there are more survivors of cancer absolutely and so that's that's saying a lot about science and medicine. That is that is absolutely trial. Had thirty year career in medicine now and we can actually it is a great time -- -- a doctor because it's the time where. Many of the treatment especially in breast and colorectal cancer really came together and we actually have patients who have. Are cured. Now when I first became a medical oncologist. The dirty little joke was -- a four letter word now we can actually use that word be proud of the we also have people who interestingly especially breast cancer. Have metastatic disease. And live for very long periods of time with good quality of life. With metastatic disease and peaceful coexistence with the disease and many of these cancers we're actually starting to think of them the way we think of diabetes where someone is never cured the disease but. Lives with the disease getting treatment but having good quality of life while suffering. -- home or while having the disease. We are going to take a break but please stay with this because I wanna talk to this man about the book is written and his thoughts on health care today. Please stay with this I'm Angela on WW well. Our very special guest today doctor Otis Brawley and as we says he is the chief medical officer for the American Cancer Society in is also a professor at Emory. But he has written a wonderful book and it's called. How we do harm. A doctor breaks rank about being sick in America. I want to talk about that the government ask you what motivated you derided and sort of what the essence of it is yeah well. I wrote it really because I turned fifty. And I look back on my career. And -- -- become an expert in disparities on why people too well what people go too well and I saw a United States that was spending an awful lot of money on health care. And I saw people are actually being harmed because they were over consuming health care. At the same time there were people who are dying because they could not get enough health care. And I just sort of got outrage and I just wrote a series of -- Stories about patients that taking care of about some people who abuse the system or some people who were abused by the system. And really wanted to get across the fact that they're some group of people who consume too much health care. And are actually harm to because they consume that health care -- -- some examples here now. There are folks who need to have every diagnostic test that you have for. Had. Or ever heard of and they don't realize that people can be harmed from those -- past and Tess. When I look at the test I always look at the potential benefit the potential risk for example. Lung cancer screening with spiral CT is common tests now -- days it is -- Using a computer a cat scanner to screen for lung cancer. If you -- to that test over a large number of people who are smokers. We have studies show that you're going to save some lives but that study also shows that you're going to cause. Some people to get biopsies and further work up in the valuation that can cause collapsed lungs cause oxygen deprivation. To the point that. We actually have a study that shows that -- five point four alive she say he cause medical interventions that would lead to one yet. Yes there is a net benefit. And I think people who are thinking about getting screened for colon cancer. Ought to realize. That they -- using net benefit after you look at the benefits and harms. Many people only think about benefit and never think about -- When we talk about colonoscopy screening. For colon cancer which saves lives and we need to do more. We also have to realize that certain small proportion of people will be. Harmed and get sicker because they got the colonoscopy screens. By the actual test itself the actual test in preparation perforation of the colon is what I'm thinking about in this instance. There -- few people who will actually get sick because of the preparation for. The colonoscopy put it to a pile. National studies show that about 1500. People getting a colonoscopy. We'll end up with a perforation from the colonoscopy most of those people will be sick for about a week you have the cement nominal payment to well. Rarely rarely would you have someone who's going to worse than that but the other thing to think about people in the United States don't focus on it. But people in Europe DO. The studies that showed that just testing stool for blood. Saves lives are actually stronger. In the studies that show the colonoscopy saves lives. Now stool blood testing is thirty dollars attacks colonoscopy is about 3000 dollars. There's actually a reason why the colon cancer death rate is lower in most countries in Western Europe and -- it's day. And news that we believe screening works in this country. But we use colonoscopy which is very expensive in only about half of adults over fifty get screened for colon cancer. If you go to France -- Germany where the use -- to blood testing which is easier to do. And much less expensive. Think that's seventy to 80% of people over the age of fifty who've been screened for colon cancer. What has been the response of the medical community to your thoughts on that actually I was amazed I thought -- would be a lot of negative response but. The American society for clinical oncology. The cancer doctors actually gave me -- and award. For writing the book. The American Medical Association actually referred to his conscience of American medicine which I really enjoy hearing. I've gotten very little criticism. From the doctor community. When I've gotten criticism. It's from a small group of people who truly -- and medicine because they wanna make money. I've got a lot of doctors who said they wished they. Had written the book which -- think that it says some of the things I said but it was all about how we need to be rational. In her application of resources. A big theme of the book is. Politicians try to scare us with things like rationing. Medicine what we need to realize is a lot of what we're doing. Is irrational. And if we were simply rational in how we practice medicine. A lot of suffering with go way we can help a lot more people. If we which is rational with our use of Madison. And worse than that these this group of people who are so we're rationally -- actually harmed by overuse of. Let me into what influence. Do you feel the legal community has sad because I think we often hear that the doctors have to kind of cover themselves malpractice right. I think it's the legal community is part of the problem but I think it's overblown. I think the problem is that many doctors. Many hospitals. Many drug companies and many patients. Failed to appreciate that there is a scientific method there is a body of evidence. And they failed to follow that body of evidence. In terms of what we should be doing in Madison. And say consumers a patient. I know I've lived long enough. That I got the message about having colonoscopy after a certain age put it off because I was afraid that still that it got the message about the importance of mammograms. It's it's gonna be difficult to change my mind. Even the one open minded at this point of at this stage of life. I want to make sure everything is okay. Yeah no one -- the issues that we've run into is and we talk about this book. Our definitions of cancer actually changing. As we've developed all of these diagnostic studies would actually realize that there are some breast cancers that we find nowadays and cure. That if we had never found they would never -- and the patient this is particularly a problem with some prostate cancers and I'm not. In any means saying that people have prostate cancer had breast cancer should not get treated. They should have a good conversation with that doctor and look at their role for all hell. And then an assessment needs to be made with their doctors. Probably doctors plural. About what treatment they should -- But we're starting to realize that there are some cancers and some lung cancers. Yes they look like cancer under a microscope and I can see it on the CT scan. But if I didn't do anything to the patient. I didn't treat them. God's plan was that they were gonna grow old and die of something totally I'm related to that cancer. So we're curing some cancers that don't need to be cured that's one of the great problems that we have right now. With all of this screen. And now we need to focus screening. Where we know we save lives screening sick clearly saves lives for women with tomography H fifty and above. Although I do tend to recommend that women and their forties get annual tomography to this day. I too want to know that there's some limitations of that screening we're going to do. A lot of invasive. Secondary. Studies on women who have false positive exams. What women and know that before handsome -- that frightened when they get that call and say that your first screen was -- normal so we have to do more stuff. Indeed for women in their forties about half of them are going to get that call while they're in their forties getting -- These are complicated we need to understand. The science a lot of doctors don't understand the science a lot of doctors who understand the science. I have difficulty communicating. We have a lot to learn from you please stay with -- every one doctor Otis Brawley are special guests were gonna go to the newsroom check in what's happening there. But we'll be right back I'm Angela on WW well. We're talking with doctor Otis Brawley who honored as we mentioned earlier the chief medical officer. Of the American Cancer Society but he's also professor at Emory University. And former medical director of the Georgia cancer center at Grady Memorial Hospital in Atlanta. But he is also written an incredible book and that's what we sort of lecture on. How we do harm a doctor breaks rank about being sick and America. Such an interesting discussion on. -- -- were saying in the commercial. We are so happy that the technology is more sophisticated and better in diagnosing. But sometimes it comes back and haunts us. That's right that's right. In the case of cancer for example like definitions of cancer. We developed using top -- in the 1850s. And some German pathologist did biopsies and they said this is what cancer looks like under the microscope this is what killed these patients -- to a autopsy on. Now with our memorize receipt teaser ex race. All this amazing imaging. We are able to diagnose a woman with a five millimeter lesion in her breast. And say it looks just like what they call cancer the cause of death for this womanizer in sixty years ago. And we tell the patient with a five millimeter lesion. They have they cancer. What we don't adequately explain. Is some of these cancers are destined to grow spread and harm and some of these small. Localized cancers. Will never grow and spread. We are. At the cost of developing genomic tests. Where we can actually say this looks like cancer but it's destined to behave. In have been nine ish way and this is something that needs to be. Even treated less aggressively or perhaps even watched where at that point in prostate cancer with that point in breast cancer we will get there. In lung cancer and several others. This will allow us to figure out who we need to treat who needs to be cured. And who we need to watch because they don't need to be cured. Even though they have a tissue in them that looks under the microscope of of those definitions of can't. But for those who believe if there's something there that shouldn't be -- get it out. Those folks need to realize that there are actually harms associated. With some of our prostate cancer treatment to actually talked to. The way to. Of a man who had a heart attack while under anesthesia gaining his prostate remote. When you look at his prostate cancer biopsy and you look at the pathology. And you look at the fact that he was sent -- five years -- already with heart disease. The odds were incredibly good. That this man's prostate cancer was never going to bother come. Yet he died because he was being treated for something wasn't one of bother him apps we see that a lot here it's. So the message is if you're told you have a certain something. You must get the full spectrum of the discussion about it. You need to have a good discussion of benefits and risks of therapy. Therapy is very appropriate many times. Therapy is not appropriate allotted times. I have wonderful conversation yesterday with a dermatologist friend of mine about people who have. Very mild eczema. Yet they see and on the TV and they have good insurance and they want this drug that costs 30000 dollars a year. And they had an allergic reaction from the drug and being hospitalized. Work. Because. This eczema drug caused that have been allergic reaction. These are people who would have done very well if they'd just let their -- the meaning to -- very mild. Excellent now if you have eczema that very life threatening harm is interfering with the quality of -- this 30000 dollar a year drug might be very. Very good thing very good treatment of people in the United States and not making. Decisions about treatment realizing that there is always a harm whenever there's a benefit and you need to look at the benefit to harm ratio. And decide if it's right for you. I have a couple questions one is why as a drug -- 30000 dollars here. Well I'll tell you many of -- cancer drugs are even more than that I can name several within -- -- a 100000 dollars a year for treatment. And some of these drugs that are not very effective -- that. I don't know why they're that expensive. They tend not to be as expensive in Europe is there -- that states. Is frequently these things are priced on what the market will -- and the and I also by the way notice people will. One not forty or 50000 dollar a year drug. If they can get it with a ten dollar a month co -- But if that same drug costs them fifty dollar mark co -- and they have to start thinking do I really need. Well you bring up I think something that's a evolving as we speak we've done any number of programs. Trying to learn what the Affordable Care Act is just sort of this morphing but one of the messages loud and clear is that as patients. We're going to be sort of more responsible. For our own health and we're gonna have to learn. What procedures cost. I think that we is patience to be. People who are interest to your health focused and it could start asking questions and have good conversations were working went. Their doctor. You know very good friend of -- and reporter Elizabeth Cohen wrote a book called empowered patient. We all need to be empowered patients who actually. Are not just taking information from our doctors. But taking and that yes and it asking questions and sometimes even -- second and third opinion. Stay with us everyone we're gonna continue our conversation with doctor Otis Brawley right after this. He's the medical officer of the American cancer society and a professor at Emory. But doctor Otis Brawley has also written a very interesting but I wanna do a quote here. This is from a speech I think. At some point in time health care is going to so dominate commerce. And so -- cost in the United States so dominate our economy it's going to cause our economy to collapse. What we've gone through in the last couple of years is going to be nothing compared to what we will go through when health care is 25 to 30%. Of every dollar spent in the United States and that's only going to be in the next ten or fifteen years. That's right that's right and that's coming. Yeah right now for every dollar spent the United States eighteen and nineteen cents of that dollars spent on health care we you know. Spent two point seven trillion dollars on health care last year the United States if health care war its own country. We would be the sixth it would be the sixth largest economy in the world who what do you think you know it is. More was spent on health care and United States last year that was spent on everything in France which is the sixth largest economy. And it's growing as a proportion of our gross domestic product. Then when you look in Europe. Where by the way the outcomes are better we have the greatest health care system in the world if you know the use. But if you look at the population of the United States. Where 49 and life expectancy. If you look at infant mortality rates too terrible if you look at white male life expectancy because some people say that. The minorities. And the poor in the United States -- -- house just look at white males. A white male and can. Has life expectancy it's about three years longer than a white male and the United States you just called north of the border the camp that we love. The criticized the Canadian health care system but their outcomes by almost every measure are -- here. Then in the United States and expand about half as much on health care -- week two and the United States. Do you think that we will ultimately -- all of the dust settles on talking in the next ten years not the next year. Go to one Payer system as you can go to that. I don't think we're ever going to get to one Payer system in the United States had to think that there are multi Payer system like Switzerland. That we might be able emulate and we might be able to practice medicine now much more rational way and people. Including wealthy people who consume a lot of health care now will actually be better off for. I two I don't think we'll ever get to a one care system although. One has to realize that Medicare. For people over 65 is a one care system what we don't think of it that way in the United States but. That being said I think. We will help multiple health insurance -- but we're gonna have to get a little bit more rational and how we consume health. Or else we will go over fiscal cola. Because our economy will collapse when we get to about 25 to 30% of our economy being all health care. By the way. We spent two point seven trillion dollars on health care last year. We spent one point three trillion dollars on food. Very interest. I have done a couple of shows one was on college years Madison another was on a group of doctors who. Are dropping insurance. I'm not handling it not for people going to the hospital but for office visits and some some some procedures and they've gotten their cost down because they don't have. All the overhead and they don't have that menagerie of things have to fill up for the federal government but their words not mine. But to a person interviewed. The common ones. I went to medical school for a reason. And I want to help people and this system work their rotating him. Every ten minutes isn't health care as they want. To service. And so they're finding other methods and I just want your thoughts on the. You know Leo most of the doctors. I mean he. Could people who went to medical school for the right thing. They're not trying to shakedown system. When I wrote the book I want to specifically says that this problem. Is that because of the doctors this problem it's not the cause of the nurses hospitals. It's everybody's problem patients are big factors and while we have health care system that's flawed right now. Lawyers are a problem but -- has been the problem as we'd like to sometimes things. The drug companies are problem the politicians. Who don't want to solve this mess are part of the problem. Everybody. Has some blame to bear. When it comes to why we have a flawed health care system. That really has out columns that -- pathetic and should be an embarrassment. When we look at other. Countries you know I'm a cancer. And now I was talking to a group earlier today I told them that. We had a 22%. Decline in cancer death rates in the United States over the last twenty years that something very good thing. The shame is we -- -- 31 country in the world to have a 20%. Decline in death rate in the world. We've invested tremendously. In medical research. Yet. France Germany Switzerland Norway. Canada. Utilized that investment much better than we do though and the end result is they have a healthier population more productive population. From our investment. Gimme some specifics on what to some of those countries to that we could do we don't have to reinvent their wheels. Well. For example -- talk about Louisiana. And specific. Play many of these countries have banned smoking in bars and restaurants. Raise the taxes on cigarettes as much as possible. Put labeling on cigarettes that are very graphic talking about the harms that can record. And -- group in the prevalence of smoking down from. You know in some instances this prevalence was over 50% of adult men. Most of these countries now have smoking prevalence it's about 10% 12%. In Louisiana where about 25%. Of adults smoking cigarettes. We have this huge obesity problem. The second worst country for. Obesity rate now is England and your adult obesity rates are half those in the United States. The second worst country for obesity. Is England and they're. Like rates are in the United States. If you go to Canada go to Switzerland go to Germany. Then the obesity rates are -- -- or less of what the -- the United States so. We need to start focusing on. Diet. By the way one way lower than number of calories is to try to eat five to nine servings of fruits and vegetables every day. The average number of servings of fruits and vegetables in Mississippi right now it's less than one serving day for adults. If we can just in five to nine servings of fruits and vegetables that day were lower caloric intake. If we can just walk for 45 minutes to an hour every day will increase their physical activity. And then we stop smoking and these are going to -- -- his cancer with diabetes. Cardiovascular. Disease and orthopedic diseases well in -- decreased a lot of our demand for medical care. I think that so many of us have learned. That we do have some control over our lines and as tough as it is to give up the imminent. And other things. And I used to be smokers smoked for twenty years I haven't in twenty years and it was very difficult to quit. The greatest single thing I -- infamous we do have some control. And I like that and I think anybody listening who's saying you know why should I be owned by a cigarette why should IB. I hear -- and I agree with you I'm I'm going to -- idea I respect the fact that it is very hard to stop smoking. Is also very hard to do no good eating habits that these these are very difficult things detail I have tremendous respect. For people who. He used to smoke and can actually say I stopped and I haven't smoked in six months. Yes its nature it is a powerful powerful drug. And then for food and and our wonderful community and it is wonderful. So much of our culture is based on net and and being with people and enjoying things and you don't wanna lose that we just have to modify it. That's exactly right you know food is actually harder than tobacco there's no redeeming social value to tobacco. But food we have to have. And there are a lot of good things about food. But trying to develop moderate -- it is CTO. -- I worry a great -- up fast food or obesity problems in the United States paralleled the ads and the fast food. And -- -- can help us move in the suburbs without. Sidewalks and we didn't walk anymore and increasing crime problems such that people who live in the inner city can walk. Those are a lot of reasons for our obesity problem. A tea I have loved this conversation I really can't if you are ever back in New Orleans please come back as we have many more things we can talk about. Thank you for being here on note that -- going to be at essence -- that -- going to be at the American Cancer Society Booth they are so that anybody is there will meet doctor on Otis Brawley. Thank you. Thank you very good team and we'll be right. I just think it's it's a fascinating discussion that we need to continue to have and that is what is happening. In health care both the good and the bad and I I think doctor Otis Brawley is perspective. What we focus a lot on. Insurance companies -- folks on drug companies with a missile lots of times on doctors hospitals on. These incredible costs. Of our of our health care. But in fact part of it is the patient. And I think we need to hear what he's saying. That as we all hopefully become a little more sophisticated and -- to pass the right questions if we are diagnosed with something. -- were looking at sometimes. We need to look at the very test or the examination or whatever and say isn't. Is it necessary. Those are big big decisions because I think all of this just frankly wanna be healthy and you hear certain words in its trigger. And we say to ourselves oh my gosh I need everything. And what he is saying is not always. So again hopefully he will come back and visit this will continue that talk very interesting man. But I hope you're also gonna stay for our next hour because I love these people. -- families. Families that are blending. Not -- But there -- there's help out there and we're gonna listen to the people who were actually doing this and some of the authorities who can help so I hope you'll stay with us. I'm Angela under the -- well.