Meet the Board: Otis Brawley Talks Health, Racial Disparities, Cancer Screenings and More

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In the first episode of Tuning Into The C-Suite podcast's "Meet the Board" series, Managed Healthcare Executive's Senior Editor, Peter Wehrwein, and Associate Editor, Briana Contreras, welcomed Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University, Otis Brawley. Brawley is most known as the former Chief Medical and Scientific Officer and Executive VP of the American Cancer Society (ACS), as well as a global leader in cancer research and health disparities. Additionally, he has recently become a member of MHE's Editorial Advisory Board.

Otis Brawley

In this discussion, listeners not only get to know a bit about Brawley's start and where his interests sparked in science and cancer research, but how his experience in this field provides key information in today's oncology and racial and health disparities.

Racial disparities

Brawley says he is hopeful when seeing those who fight for racial justice is evolving. You now see more and different races who are taking part in the movement.

"I think civil rights, health equity is a long-term struggle," he says. "In terms of what happened recently (verdict of Breonna Taylor's killers and the death of George Floyd), I take a great deal of solace that there's a lot of people who are protesting. I sense the movement has garnered a lot of support from people that hasn't even been seen in the civil rights movement in the '60s.

"I don't think this is going away. I do see the movement being much more than black and expanding to talk about Native American rights, women's rights, poverty and socioeconomic disparity. I look at what's going on in terms of those tragedies and it gives me great hope to the future, but it's long-term effort."

In addition, he thinks the response to COVD-19 is partially due to racism and other factors. However, the biggest issue is that there is not a strong focus on healthcare in American. Brawley feels there are a number of people who express their care, but they don't show it in their actions.

"We are Americans leaving a lot of people behind," he says.

Everyone should have some form of healthcare that is accessible for everyone, because everyone deserves it, he adds.

"I'm in favor of all people having access to healthcare," Brawley says. "Giving them insurance is not enough, they need programs to help them utilize their insurance."

Brawley expresses the Affordable Care Act is meeting many of those needs for people who have harder access to affordable healthcare, however, it does need improvement to reach more or all populations.

Cancer Over-Screening

Recently, the United States Preventive Services Task Force (USPSTF) expanded the population of people who they recommend to get lung cancer screening.

While screening is appropriate in certain diseases and populations, Brawley says he believes the U.S. is still over-screening for cancer, especially in the lungs.

"I'm against inappropriate screening, I am for applying science to figure out what screening tests are appropriate for what populations," he says. "The United States Preventive Services Task Force has applied science very well."

Brawley says many organizations are, however, recommending lung cancer screenings or screenings for the wrong reasons.

"Every organization that recommends lung cancer screenings actually doesn't recommend lung cancer screening," he says. "But every organization that has a statement positive toward lung cancer screening says 'if the individual qualifies for the screening test and has access to the doctors and medical facilities that can do the screening well, and that person also understands the potential risks and potential benefits and wants screening, they should get screening.'"

Additionally, the National Lung Screening Trial conducted over 15 years ago documented that lung cancer screenings saved lives, but screening associated with instrumentation and diagnostic procedures cost lives. Brawley says some people who died in the study did not have cancer.

He added that a previously written story for the ACS stated if lung cancer screenings were fully implemented in the U.S., about 8,000 to 10,000 lives per year would be saved and would cost around 1,500 lives per year.

With less studies and research on cancer screenings more than 20 years ago, Brawley says people were pushing prostate screenings, in specific, with hope that it was beneficial, but the knowledge that it made a lot of money.

He noted in a conversation he once had with a marketing employee who expressed how much money was made in prostate cancer screening, that screening for it "has never been shown to save lives," after Brawley asked for the amount of lives were saved.

"When we do things in medicine that don't work, we hurt people and we hurt people in a number of ways," he says. "We hurt not just those people who are getting those tests or getting that treatment that doesn't work and shouldn't be used, but hurting other people who need the hospital and are crowded out of the hospital and can't get the services that they actual need. Unnecessary care causes health disparities. Not necessarily in the person getting the unnecessary care, (and) not to mention it drives up the costs of the insurance and a number of things."

Applying screening and treatment with orthodox science and concern about disparities, are all interwoven, he added.