Multilevel Interventions in Health Care Conference: Keynote address by Otis Brawley, MD

>>>DR. STEPHEN TAPLIN: We're going to try to wrap things
up here. And we're really happy to have with us Otis Brawley,
an old friend of NCI. There are questions about whether he ever
left NCI. But the truth is he has left NCI. He's the Chief
Medical Officer and Executive Vice President of the American
Cancer Society. As such, he's responsible for promoting the
goals of cancer prevention, early detection and quality
treatment through cancer research and education.
He's a Professor of Hematology and Oncology and Medicine and
Epidemiology at Emory University. From April, 2001 to
November, 2007, he was Medical Director of the Georgia Cancer
Center for Excellence at Grady Memorial Hospital in Atlanta.
He's led a long and distinguished career. We've
seen Otis in the media. He has a way of saying things that
excite and we'll just leave it at that. And we are glad to
have him here. And we are hoping that he will excite.
So welcome, Otis. And we really appreciate your participation.
>>>[APPLAUSE]
>>>DR. OTIS BRAWLEY: Thank you, very much. It's a pleasure to
be here. It's almost like an NCI reunion when you come into
a room and there's Rachel Ballard-Barbash and Helen
Meissner and Bob Hiatt. We were all there when Ernie Hawk was
the young kid down the hallway. And it was actually a fun time.
It's neat to see how we've all turned out. It's a pleasure to
be here in Las Vegas I think after having walked through
that area and got exposed to all those carcinogens that are
among the gamblers. I got here late last night and I decided
to walk down the strip a little bit. And I saw four Elvis
Presleys walking towards me. And the first thing I did was
"am I drunk?" because I had been drinking. And then I
realized I was the only person who thought that was unusual.
But in any event, I had a wonderful time sitting through
some talks today and hearing some things. I want to just
sort of reflect on those things. What we need is not
perhaps reformation of health care, but transformation
of health care. Some of the things that I heard
today made me think, gee interesting.
Never heard anybody talk about the Internet
as a source of information. Maybe it was mentioned and I
missed it, but I just didn't hear anybody talk about that.
We heard a lot of talk about the electronic medical record
and it seems that much is vested in it as the salvation
of health care increasing efficiency and so forth.
Perhaps too much is vested in it. And were really need to
think about how we're going to direct that. Good talk about
effectiveness versus efficacy. Unfortunately, many doctors
don't know the difference between the two. I didn't hear
these words, but it was in the room talking about rational use
of health care as opposed to what the politicians scare us
about with the rationing of health care. One of the
problems with American health care is it just sort of
happened. It didn't get designed. And you know that old
saying that a camel is a horse designed by a committee.
American health care didn't even have a committee and so it
just sort of happened. And we've got a lot of issues going
on. Within cancer, we have a number of vested interest
groups. By the way, what I'm going to talk about is the
American Cancer Society as a player amongst those vested
interest groups, an overview of the entire situation, including
looking at the health economy, America's poor health IQ and
really the urgency of the situation that we're talking
about and the need to focus on prevention. Instead of health
care reform, we need health care transformation, from
treatment and consumption of health care to one that
actually values prevention. The ACS has several leadership
roles. We think of ourself as a source of information at
multiple levels. Information primarily to the patient and to
policymakers, but also to health care providers, be they
nurses or physicians, through our Internet websites as well
as through our journals. We're a sponsor of research in
universities for the most part. It would be wonderful if we
sponsored research in more social settings as opposed to
more academic settings. We are very interested in quality of
life of the cancer patient, and the cancer patient's caregiver
in supporting the cancer patient, and the caregiver.
And we're very interested in prevention and early detection.
Perhaps we're most famous for our screening guidelines.
We are dedicated to helping people get well, stay well,
finding cures and fighting back. Fighting back is a euphemism
for we do a lot of stuff in Washington. We have seventy
people in our advocacy (do not call them lobbyists) office.
Those seventy people do things such as supporting health care
reform or health care transformation, supporting
smoking controls, including taxation of tobacco. They do a
great deal of supporting NIH and the National Cancer
Institute's budget. Arnie Kaluzny was up here earlier
today and he's an old, old friend, indeed a wise fellow.
One of the things that we used to talk about a lot is how you
need to tell people what's known, what's not known and
what's believed. And that's what we're going to talk about
today. I believe that one of the great threats to America's
future is apathy, ignorance and greed; apathy, ignorance and
greed on the part of multiple levels, patients, doctors and
others. And in reforming how health care is paid for is
actually going to be incredibly important, because right now
we're based on consumption of services as opposed to quality
outputs. We need to transform how we view medicine. And the
"we" is at multiple levels. It's the patients. It's the
doctors. It's the hospitals. It's the health insurers.
It's the policymakers. And if we can truly transform health
care, we're going to be able to decrease costs, which is going
to be very important as I talk about cost, decrease
disparities, which is something that is very dear to me, and we
can improve quality. This is going to require some broad
critical thinking and an understanding of the scientific
method. One of the things that perhaps I didn't hear as much
about today, maybe it was talked about yesterday, is
people, be they patients, family members, doctors,
nurses, frequently don't understand the scientific
method. Indeed, that's why alternative medicine is so
popular in the United States. We need to use evidence
based care and prevention. If we understood the scientific
method, I think that would be easier. And again, we need to
start rationally using medicine and stop scaring
people with talks about rationing of medicine.
Although, I think we should all realize that rationing of
medicine already occurs. Our goals should be good outcomes
and saving lives. And I want to point out that we can do better
and we should. Saving lives is an interesting point. I had a
great conversation with Bob Croyle not too long ago. My
boss, John Seffrin, the CEO of the American Cancer Society, is
very fond of saying we're about saving lives. I keep telling
him that what we really do is avert mortality. And then
Bob Croyle reminded me that what we really do is we delay
mortality. But anyway, all of those things are good outcomes,
be it saving lives, averting deaths or averting mortality or
delaying mortality. The issues are that there are huge
irrational patterns of consumption of health care in
the United States. And this is due to a lack of education and
a lack of understanding of science on the part of both
physicians and patients. There is a huge lack of basic
prevention. All of you who walked over here from the hotel
saw the obesity, lack of exercise, high caloric intake
and especially the smoking that is increasing health care
costs. In addition, there's an aging of the American
population, partially due to the fact that our colleagues...
We have actually had some successes but our colleagues in
cardiology and infectious disease have had even more.
And as a result, there are 30 million people over sixty-five
in the year 2000. And there's going to be 71 million over
sixty-five in the year 2030. Keep in mind, the average age
of a person diagnosed with cancer in the United States is
seventy-one. So there's an increasing number of candidates
to get cancer. I just threw this in because somebody had
asked me about it earlier at lunch. This slide goes from
1975 through the year 2020. The blue solid line is the actual
number of deaths of Americans from cancer by year. That is
the actual number. The dotted blue line is our projection of
how many people will be dying in the future after 2010 if we
continue at our current rate of health promotion. The red line
represents, with the aging of the population, growing of the
population, the red line represents how many people
would have died if we had not started many of the cancer
control things that we started in the 1960s. The red line
versus the blue line actually does indicate that such things
as smoking cessation is the big driver here, but also things
like colon cancer screening, breast cancer screening, sun
avoidance and some of our treatment improvements actually
have averted mortality. And this is evidence that we are
doing something good. The green dotted line, which starts
around 2013, actually shows what our epidemiologists think
we could do in terms of number of deaths in a given year if we
simply started employing all the things that we know work.
In that all the things that we know work actually has smoking
going from a 20 percent prevalence in the United States
down to the 10 or 11 percent prevalence in California. If we
could drive smoking to zero, this green line would be even
steeper downward. Things that we know about obesity, about
exercise, about... and especially since we're talking
about just in the next ten years, about getting the
screening and treatment that we actually know is beneficial to
people who currently don't get it. And that brings up the
concept of health disparity, something very dear to
my heart. And that's the concept that some patients,
however defined, don't do as well as others. And you can
define them in a number of different ways. "How can we
provide adequate high quality care, to improve preventative
care, to people who so frequently don't get it?" is I
think one of the most important questions that we can ask
ourselves. This is a slide I always try to throw into talks
because I think it's one of the most important slides that we
who claim to be proud of America should be aware of.
This is a Kaplan-Meier curve. Stage one is red. This is colon
cancer. Stage two is blue. Stage three is green.
Stage four is yellow. The solid lines are insured and the
dotted lines are uninsured. And this is just to show if you
look over on the far right here that stage two...
insured has a better five year survival than stage one
uninsured. That you are better off having the more advanced
colon cancer in the United States with insurance than
having the least advanced colon cancer without insurance.
And at every stage, the uninsured do not do as
well as the insured, at every stage.
This is part of the problem with American health care
today. Indeed, some people consume too much health care,
meaning unnecessary care is given. Some consume too little.
And we could actually decrease the waste and improve overall
health if we simply adapted evidence based medicine and
tried to get that evidence based medicine to everyone.
In talking about the situation that you're going to...
that you are doing research in, we all need to realize that
American health care in 2009 cost $2.53 trillion. That seems
like a small number when you say $2.53 trillion. But how big
is a trillion? A million seconds ago was Friday of last
week, eight days ago. A billion seconds ago was about the time
Richard Nixon resigned in 1974. A trillion seconds ago was
30,000 years before Christ. A trillion is a big number.
And we spent $2.53 trillion on health care. Let's put it into
another perspective. We spent $1.1 trillion in 2009 on food
and $2.53 trillion on health care. And personal consumption
in all of China was only $1.4 trillion. Health care was 17.3
percent of our gross domestic product. 17.3 cents out of
every dollar spent in the United States in 2009 was
health care. At the current rate of growth, by 2025 a
quarter of every dollar spent in the United States will be
spent on health care. And that, my friends, is about the point
where we will have health care reform. And our choice is, are
we going to have health care reform sooner? And are we going
to take over and actually model it? Or are we going to let
economic forces allow health care reform do essentially what
happened in designing the current system. There was no
plan. There was nobody actually trying to mold something.
And we got something that's far worse than a camel. This is
price of health care per person on a per capita basis. And you
can see as a country gets wealthier, health care costs
more. And indeed, this line is incredibly linear. Iceland and
Switzerland are countries that are better off than Poland and
Portugal. And so their health care on a per person is more
expensive. There's the United States. We are off the line,
okay? We are off the line. Now, we don't really get what
we pay for. We are 49th in life expectancy. We're in good
company. Albania is 50th. Some people say that we ought to
look at people who reach the age of sixty-five and that's
what I've shown you here. Among people who get to the age of
sixty-five, we are twelfth overall for males and we are
16th overall for females. And you'll note Canada is actually
farther to the left. They're about the seventh country from
the left there. And a number of countries do far better than
we do. Zeroing in on Canada and Switzerland, Infant mortality.
We don't get what we pay for with our expensive health care
system. White male life expectancy -- we don't get what
we pay for. And what we pay is their per capita costs. By the
the way, we're 1.5 times more expensive per person than
Switzerland which is the number two country in per capita
costs. Number two, by the way, in gross domestic product is
Israel. And they're slightly less than 12 percent. We're at
17 percent and growing. That's on a mega level. On the
employer level, that's one level that we haven't talked
about much in at least today. And being an administrator at
the American Cancer Society, I have to deal with this all the
time. And I will tell you that these national averages are
actually very close to the American Cancer Society's costs
for our 6,200 employees. In the year 2000, health insurance
cost $2,471 on average for an individual policy as bought by
an employer and $6,438 for a family policy as bought by an
employer. By the year 2009, you can see that those prices have
gone up dramatically. They've more than doubled. Indeed, at
the American Cancer Society, we have clerks and administrative
assistants who get paid $24,000 a year. But when we hire them,
we have to think that the family insurance plan for them
is going to cost us $14,000 a year. So one of the things that
actually keeps us from hiring people, especially people who
get paid less than $50,000 a year, is literally the fact
it's going to cost us $14,000 more in health insurance.
And we haven't started talking about the other insurances.
This is actually a threat to the economy. Now, consumption
of health care and over utilization is also a
multi-level problem. And one of the problems is we are very
individualistic in the United States. We're very into "me"
versus "us." And individualism is a real problem. Patients who
believe in cost containment for health care until you're
talking about them as the patient. Doctors who are paid
to treat. We're not paid to prevent. And by the way, I'm a
treater. Hospitals and clinics that are paid to treat.
Insurance is a huge big business. By the way, most
insurance companies have 20 percent overhead costs.
And most insurance companies have been making money hand
over fist, health care insurance companies for the last decade.
We have huge medical gluttony. Screening tests have no proven
value. Treatments have no proven value. Laboratory and
radiologic imaging done for convenience because we can't
find the original film, done for legal defense, be it real
or imagined. Sometimes we do x-rays purely out of tradition.
Canada versus the United States. I showed you that
Canada has better outcomes than the United States. Yet, for CT
scanners, we have three times more CT scanners on a
population basis than Canada, five times more MRI scanners.
It might very well be said that we don't make people live
longer in the United States, but we sure as hell do a better
job taking pictures of them dying. Reforming how health
care is paid for in transforming how we view and
consume it is incredibly important. Our health care
system is heavily focused on addressing all this. And the
system needs to transform into one that values prevention.
Obesity -- high caloric intake and lack of physical activity
is increasing rates of diabetes, cardiovascular
disease, orthopedic injury and cancer. I specifically should
warn you that I talk about obesity. I don't not talk about
the condition known as overweight because of a
conflict of interest. Trends in obesity prevalence are a
huge problem. Now, I have a lot of data to show that getting
fat causes cancer. I have very little data to show that losing
weight prevents cancer. It might prevent cancer. I just
don't have the data to show it. And for that reason, I think
one of the groups that we need to focus on is pediatrics.
And please note that for kids aged six to eleven, four
percent of them were obese in the years 1971-74 and twenty
percent are obese in the last survey 2007 to 2008.
This is NHANES data. For teenagers, it's gone from
six percent to eighteen percent,
a tripling for teenagers and actually a quadrupling,
more than a quadrupling, for kids age six to eleven.
This is something that we desperately need to
focus on. We need to turn towards prevention. We need to
figure out how we can provide adequate high quality care to
include preventive services to populations that so often have
not received it. Indeed, the white middle class is a
disparate population when it comes to prevention, because
they have not been getting that care. And so in summary, how
do we increase the health IQ of Americans? How do we increase
America's interest in health? And how do we create a healthy
skepticism of American medicine, realizing that we
have... we treaters have a significant conflict of
interest? Because right now, we make money... actually, I was
kind of joking with somebody about it, but it's actually
true. All those smokers out there, for me that's revenue.
That's my future income, because I treat cancer. So I'm
going to stop at that point and maybe there will be some people
who have some other comments that they want to make, or God
help me if they have questions. Thank you.
>>>[APPLAUSE]
>>>DR. STEPHEN TAPLIN: There is a chance for questions.
There are questions. He doesn't want questions, but we invited
him. We helped him get here. So we're going to ask him a few
questions. Anybody have any questions for Dr. Brawley?
>>>MS: I think your talk is pretty radical.
I wonder if you'd consider radicalizing even a bit more.
Your talk referred about the conference basically
says that the U.S. health care sucks.
And I wonder if would consider actually talking about
the effects of the huge sucking sound of U.S. health care?
You can see it in the decisions that governors have to make in
the states around the country. We're sucking so many resources
into health care that we're taking resources away from the
social determinants of health. That probably have [inaud.]
that we see. So you can say all those things. You can say even
while we're providing more access, even while we're trying
to produce positive, even while we're trying to [inaud.] at the
same time, we actually need to spend less on that. So we can
do other things that are about health, not about the [inaud.]
commodity health care. I mean, you're on the edge of it.
>>>[LAUGHTER]
>>>DR. BRAWLEY: Well, you know, the issue is what you're
talking about really does get into rationing. And I think
that would be a turnoff to a lot of people. You can get way, way
out there with what you're saying there. And maybe I can
keep saying what I'm saying and maybe we can push people in
the direction of where we want to go, realizing that neither
of us are going to get ... what I'm saying right now I
don't... I honestly don't believe is where we're going
to be... we're not going to be able to get that far.
But I think we can get a little bit more prevention.
I just worry that the economy won't... the economy is
going to collapse. I really am very concerned about that.
>>>DR. STEPHEN TAPLIN: Comment over here.
>>>DR. THERESA GILLEPSIE: Hi, Theresa Gillepsie,
Emory University. Thank you so much. You alluded
to how can we increase the health IQ of the country, but
you didn't really give us any specific ways to do that.
And you made the comment that while obesity, we know that
being fat may increase the risk of cancer, but we don't know
what losing weight does. However, we do know that
losing weight is very good for other parts of health.
>>>DR. OTIS BRAWLEY: That's true.
>>>DR. THERESA GILLEPSIE: So maybe the people in the lobby
have read that drinking alcohol may decrease their risk
of heart disease. And so there is a lot of mixed messages
that American people get. And they're not really
sure how to discern what is most pertinent to them, what
should they be doing? And I think [inaud.] is part of those
messages. And can you maybe just comment on them?
>>>DR. OTIS BRAWLEY: Yeah, our statements by the way on
the Web... and usually when I have a longer time to talk
about it, we encourage weight loss because it definitely does
decrease cardiac disease, diabetes and even decreases
orthopedic injury, which is a significant cost in the
United States. So it's a good thing for adults to lose
weight, and it may actually even prevent cancer. We just don't
have that evidence. I am very concerned ... I think when I
look at health messaging ... this is perhaps Barbara Rimer's
influence on my thinking. And to a certain extent Dick
Warnecke who's in the audience. So I've got to be very careful.
I think of health messaging the same way I think of my T1
line on my computer. If we send out a lot of messages, some of
those messages are not going to be received or are going to be
received in a distorted fashion. If we send out a few
key important messages, we're actually more likely to do more
good in terms of effecting change among people's health
care, among people's health behavior. And that's one of
the reasons why, for example, when Congresswoman Debbie
Wasserman Schultz decided to come up with a bill to take
money and teach kids in high school how to do breast
self-exam and to scare them about breast cancer, I was
worried. Because what we need to be talking about with high
school girls is diet, obesity, caloric intake and not scaring
them about breast cancer. Actually, we went very public
about that and that was in the newspapers a lot. So that's why
I bring that one up. But I think you're absolutely right
that there are too many convoluted messages. Some of
those messages, by the way... and here I'm going to get
controversial... are by people who have a moneyed interest.
That's a huge problem. Especially screening
advertisements from hospitals. I come from... well, you're in
Atlanta. You know the RC Cancer... I name names.
That's another thing. The RC Cancer Center, which is a huge
radiotherapy practice in Atlanta, was recently giving
tickets to Atlanta Hawks basketball games to men who
showed up at the Kroger parking lot and went into the van and
got screened for prostate cancer. There's no informed
decision making there. It's just we're giving these guys
these tickets so that they can get screened, so that we can
make money. And it implies to these guys that prostate cancer
screening is more effective that we know it to be. There's
all kinds of issues with diet and the alcohol one is a
great one. You know, the wine industry finds every
study that suggests that wine is good for you.
They don't find any studies in publicized studies
that suggest wine is bad for you. You're right.
>>>DR. RUSSELL GLASGOW: Thank you, Dr. Brawley, for a great,
inspiring, provocative talk. I'm Russ Glasgow from the NCI,
the new Deputy Director under Bob Croyle for implementation
science. Again, to follow-up on this general topic that
Kurt started off and on the issues that we raised about
messaging, which it is really critical and I think we didn't
hear much about it today. It was the topic,
as I'm sure you know. I forget if you were there or
your colleagues about a week and a half ago in Atlanta on
the meeting on health communication science.
>>>DR. OTIS BRAWLEY: I was there for just the first morning.
>>>DR. RUSSELL GLASGOW: Yeah. Well, I'm struck by how similar
the issues are at the two meetings, but how we're not
making a connection between the two. In particular, I think you
just pointed, maybe that will make Kurt happy, we'll see.
One made the connection with advertising. Money to be
made there. And I think that we need to have a greater
attention to the issues of health communication messaging
and framing at [inaud.] at the current issues here.
And I think one thing that would be interesting for all of us
in this room who predominately are researchers or federal
employees is to think about how we connect with all the
various players, all the way up from patients, families,
to health care providers to help decision makers and things.
Around issues there's a phenomenal little paperback
book called "The Political Mind" by George Ladoff. And it talks
about, it's essentially about reaching the population and how
generally those of us interested in pushing this type
of health care reform, interested in prevention, we
naively think that we're going to win the day with our data,
with our rational arguments, with our logical things like we
were taught to make to last. When in fact usually who frames
the debate related to an emotional push button issue is
the one that wins and frames the debate. But [inaud.] its not
additional care at the end of life. So I just wondered if you
had any thoughts about that and how that might interact
with kinds of issues of science, policy and [inaud.]
>>>DR. OTISE BRAWLEY: You are so right that the people who
frame the issues, Death Panels is a great example,
can frequently overwhelm data. My first experience with this
was when I was at the NCI and Sam Broder was our director.
And we had the fraud in Montreal. And Congressman
Dingell called us all down. And Broder, Sam was wonderful in
explaining that, yes, there had been this one trial. But thank
God there were seven other trials that had verified
this finding. And he said this very nicely in an open hearing.
It was on C-SPAN. And then there's this lady, breast
cancer survivor, who got a lumpectomy and radiation,
who followed Sam. And she's crying about did she
get the right treatment? And she won. Sam not only had data,
he had data from seven other trials. But she won.
And very frequently, on Capitol Hill... by the way, I have had
the opportunity once to try to explain to one congresswoman
the difference between incidence and mortality.
So their health IQ is frequently not very good.
But the one individual in the anecdote can be incredibly
powerful and overwhelm data. I mean, it's part of the
anti-science. Coming down the elevator today, Arnie Kaluzny
was saying that he was concerned about everybody
starting to not appreciate science. In government, very
much in government, a lot of places there's not just a lack
of appreciation for science, but a disdain for it.
And that's part of what you're talking about.
Arnie, I hope I didn't misrepresent you.
>>>MS: [inaud.] Indiana University. And I have a
question with the recent policy developments of the medical
home and the accountable care organizations,
how you think those developments relate to the quality
of cancer care across the continuum?
>>>DR. OTIS BRRAWLEY: I'm still struck by the comment
this morning about accountable care organizations being
HMO in drag. I really like that. We desperately need to try
other ways of paying for health care and reimbursing for
health care. We desperately need to do that. Many of you
may be familiar with the story about McAllen, Texas that
was in the New Yorker, Atul Gawande's article.
I've actually been down to McAllen, Texas.
And let me tell you how that happened. There's a
wonderful man, a Mexican immigrant, named Cantu.
Mr. Cantu became a billionaire building things. And he wanted
to do something for McAllen. So he built a hospital for
McAllen, and a doctor's office building next to the hospital.
And then he went around the country and he'd find good
doctors and say if you move to McAllen, I will give you a
stake in the hospital, doctor's hospital. And I'll give you a
sweetheart rate for renting office space. And my company
will build you a new house. You have to pay for it. But in any
event, he attracted all these doctors to McAllen, Texas.
And he put them all into a doctors' office building next
to the hospital that the doctors had part equity in. The end
result was the general internist would see a patient with
diabetes. And instead of providing the metformin,
he would send the patient over to the endocrinologist
who would then start seeing him and providing the metformin.
If he had a patient who had complicated high blood
pressure, he'd send him over to the cardiologist.
In the world of securities and stocks,
this is called churning, okay? And that's why per person
health care in McAllen, Texas was the highest anywhere
in the United States for Medicare. Medicare was paying
$18,000 a person for care in McAllen, Texas in 2009,
where the Medicare average is somewhere on the order of
$8,000 around the country. Now, if you can get some type of way
of controlling that kind of situation... and I don't know
what the answer is. The answer is to do some experiments
and find out what the answer is. And these various
things, these various other ways of paying are
all things that we need to look into.
>>>DR. STEPHEN TAPLIN: One last comment, thanks.
>>>MS: I wanted to follow-up on that last comment which
you made. Certainly we heard a lot during the health care
reform debates about we have to figure out what to do.
There are twenty-three developed nations who deliver
health care for half or less than we do and have better
outcomes. I don't understand why we have to spend so much
time figuring out what to do when there are so many
examples in the world of people doing so much better.
Why don't we just do what they do?
>>>DR. OTIS BRAWLEY: Because I'll tell you the exact reason.
A single payer system is politically unpalatable.
>>>[inaudible audience comment]
You're right. As a matter of fact, Switzerland which
is a system that I think is probably the best,
has several different insurance companies.
By the way, tort reform was never tackled in health care
reform because people were afraid of it. There are
some things that are politically not palatable
that people are just afraid to deal with.
>>>MS: But the problem is political and social.
It isn't figuring out that it's...
>>>DR. OTIS BRAWLEY: What he said was the problem
is political and social and not figuring out a better
system. I agree with the problem is political and social.
But I actually do believe that the system in the
United States needs to change. It may need to
change closer towards a system in Europe.
>>>DR. STEPHEN TAPLIN: Well, as promised, Dr. Brawley
was exciting. We've got one more.
>>>DR. MARTIN CHARNS: One practical question.
>>>DR. STEPHEN TAPLIN: One practical question from
Dr. Charns. And then we'll wrap it up. Because we...
>>>DR. MARTIN CHARNS: You forced me up
there to answer questions all day.
>>>DR. STEPHEN TAPLIN: So you get to ask one.
>>>DR. MARTIN CHARNS: Let me ask one.
>>>DR. STEPHEN TAPLIN: All right. Go for it.
>>>DR. MARTIN CHARNS: In taking your last comment
about things that haven't been politically acceptable
why we don't have reform and the issue about the data.
On the way out here, I had a five and a half
hour airplane ride. This is the story. And sitting next to me
was a nice fellow. And as we were talking... I had a middle
seat on top of it... as we were talking, you know,
how I say, "Oh, I do health care research." And he said,
"Oh, well, tell me all about health care reform." So he
started asking questions. And I was pointing out the facts.
I have lots of facts because I interact with people like you.
And I explained about the statistics in terms of the
quality of care in the United States and our health status
and so on. And I was pointing out how other countries,
for example, in the U.K., Canada, England, Australia have
better health care systems. And he said to me, "Oh, I hated...
I'm Irish. I hated the health care system over there."
And I didn't have a way, no matter how many statistics I
cited, I didn't ... by the end of that terribly long plane
flight, I didn't have a way of convincing him that in fact
health care reform is moving in the right direction, although
it falls way short of what we want to do. But he, like many
people that I hear, resists the changes that we're trying to
make. So how do we convince people; that if the numbers
don't work, what do we do? And I have another flight going back.
>>>[LAUGHTER]
>>>DR. OTIS BRAWLEY: Well, you know, what you bring up...
remember that Tom Cruise movie where he plays a lawyer and
there's this crusty Marine colonel who's a famous actor I
can't remember who. Jack Nicholson. And Tom Cruise
screams, "I want the truth." And the crusty colonel says,
"You can't handle the truth." I feel like that colonel
sometimes. The American people cannot handle the truth.
And until people start realizing that the entire... the entire
economy is going to collapse unless we start doing something
rational about this, until they realize that, nothing is going
to be done that's going to be productive. Thank you.
>>>[APPLAUSE]
>>>DR. STEPHEN TAPLIN: Thank you,
Dr. Brawley. You did not disappoint.