Death by Medicine
By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD;
Debora Rasio, MD; and Dorothy Smith, PhD
CTM NOTE: The following article is lengthy but packed with
well-researched information. We felt constrained to reproduce it in its entirety.
Something
is wrong when regulatory agencies pretend that vitamins are dangerous, yet
ignore published statistics showing that government-sanctioned medicine is the
real hazard.
Until
now, Life Extension could cite only isolated statistics to make its case about
the dangers of conventional medicine. No one had ever analyzed and combined ALL
of the published literature dealing with injuries and deaths caused by
government-protected medicine. That has now changed.
A
group of researchers meticulously reviewed the statistical evidence and their
findings are absolutely shocking. These researchers have authored a paper
titled “Death by Medicine” that presents compelling evidence that
today’s system frequently causes more harm than good.
This fully referenced report shows the number of people having in-hospital, adverse reactions to prescribed drugs to be 2.2 million per year. The number of unnecessary antibiotics prescribed annually for viral infections is 20 million per year. The number of unnecessary medical and surgical procedures performed annually is 7.5 million per year. The number of people exposed to unnecessary hospitalization annually is 8.9 million per year.
The
most stunning statistic, however, is that the total number of deaths caused by
conventional medicine is an astounding 783,936 per year. It is now evident that
the American medical system is the leading cause of death and injury in the US.
(By contrast, the number of deaths attributable to heart disease in 2001 was
699,697, while the number of deaths attributable to cancer was 553,251.5)
We
had intended to publish the entire text of “Death By Medicine” in this
month’s issue. The article uncovered so many problems with conventional
medicine however, that it became too long to fit within these pages. We have
instead put it on our website (www.lef.org).
We
placed this article on our website to memorialize the failure of the American
medical system. By exposing these gruesome statistics in painstaking detail, we
provide a basis for competent and compassionate medical professionals to
recognize the inadequacies of today’s system and at least attempt to institute
meaningful reforms.
Natural medicine is under siege, as pharmaceutical company lobbyists urge lawmakers to deprive Americans of the benefits of dietary supplements. Drug-company front groups have launched slanderous media campaigns to discredit the value of healthy lifestyles. The FDA continues to interfere with those who offer natural products that compete with prescription drugs.
These
attacks against natural medicine obscure a lethal problem that until now was
buried in thousands of pages of scientific text. In response to these baseless
challenges to natural medicine, the Nutrition Institute of America commissioned
an independent review of the quality of “government-approved” medicine.
The startling findings from this meticulous study indicate that conventional
medicine is “the leading cause of death” in the United States .
The
Nutrition Institute of America is a non-profit organization that has sponsored
independent research for the past 30 years. To support its bold claim that
conventional medicine is America 's number-one killer, the Nutritional
Institute of America mandated that every “count” in this “indictment”
of US medicine be validated by published, peer-reviewed scientific studies.
What you are about to read is a stunning compilation of facts that documents that those who seek to abolish consumer access to natural therapies are misleading the public. Over 700,000 Americans die each year at the hands of government-sanctioned medicine, while the FDA and other government agencies pretend to protect the public by harassing those who offer safe alternatives.
A
definitive review of medical peer-reviewed journals and government health
statistics shows that American medicine frequently causes more harm than good.
Each
year approximately 2.2 million US hospital patients experience adverse drug
reactions (ADRs) to prescribed medications.(1) In 1995, Dr.
Richard Besser of the federal Centers for Disease Control and Prevention (CDC)
estimated the number of unnecessary antibiotics prescribed annually for viral
infections to be 20 million; in 2003, Dr. Besser spoke in terms of tens of
millions of unnecessary antibiotics prescribed annually.(2, 2a) Approximately
7.5 million unnecessary medical and surgical procedures are performed annually
in the US,(3)
while approximately 8.9 million Americans are hospitalized unnecessarily.(4)
As
shown in the following table, the estimated total number of iatrogenic
deaths—that is, deaths induced inadvertently by a physician or surgeon or by
medical treatment or diagnostic procedures— in the US annually is 783,936. It
is evident that the American medical system is itself the leading cause of
death and injury in the US . By comparison, approximately 699,697 Americans
died of heart in 2001, while 553,251 died of cancer.(5)
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Table
1: Estimated Annual Mortality and Economic Cost of Medical Intervention |
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Using
Leape's 1997 medical and drug error rate of 3 million(14) multiplied by the
14% fatality rate he used in 1994(16) produces an annual death rate of 420,000 for drug
errors and medical errors combined. Using this number instead of Lazorou's
106,000 drug errors and the Institute of Medicine 's (IOM) estimated 98,000
annual medical errors would add another 216,000 deaths, for a total of 999,936
deaths annually.
|
Table
2: Estimated Annual Mortality and Economic Cost of Medical Intervention |
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The
enumerating of unnecessary medical events is very important in our analysis.
Any invasive, unnecessary medical procedure must be considered as part of the
larger iatrogenic picture. Unfortunately, cause and effect go unmonitored. The
figures on unnecessary events represent people who are thrust into a dangerous
health care system. Each of these 16.4 million lives is being affected in ways
that could have fatal consequences. Simply entering a hospital could result in
the following:
In 16.4 million people, a 2.1% chance (affecting
186,000) of a serious adverse drug reaction(1)
In 16.4 million people, a 5-6% chance (affecting
489,500) of acquiring a nosocomial infection(9)
In16.4 million people, a 4-36% chance (affecting
1.78 million) of having an iatrogenic injury (medical error and adverse drug
reactions).(16)
In 16.4 million people, a 17% chance (affecting 1.3
million) of a procedure error.(40)
These
statistics represent a one-year time span. Working with the most conservative
figures from our statistics, we project the following 10-year death rates.
|
Table
3: Estimated 10-Year Death Rates from Medical Intervention |
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Our
estimated 10-year total of 7.8 million iatrogenic deaths is more than all the
casualties from all the wars fought by the US throughout its entire history.
Our
projected figures for unnecessary medical events occurring over a 10-year
period also are dramatic.
|
Table
4: Estimated 10-Year Unnecessary Medical Events |
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|
These
figures show that an estimated 164 million people—more than half of the total
US population—receive unneeded medical treatment over the course of a decade.
INTRODUCTION
Never
before have the complete statistics on the multiple causes of iatrogenesis been
combined in one article. Medical science amasses tens of thousands of papers
annually, each representing a tiny fragment of the whole picture. To look at
only one piece and try to understand the benefits and risks is like standing an
inch away from an elephant and trying to describe everything about it. You have
to step back to see the big picture, as we have done here. Each specialty, each
division of medicine keeps its own records and data on morbidity and mortality.
We have now completed the painstaking work of reviewing thousands of studies
and putting pieces of the puzzle together.
Is American Medicine
Working?
US
health care spending reached $1.6 trillion in 2003, representing 14% of the nation's
gross national product.(15) Considering this enormous expenditure, we should
have the best medicine in the world. We should be preventing and reversing
disease, and doing minimal harm. Careful and objective review, however, shows
we are doing the opposite. Because of the extraordinarily narrow,
technologically driven context in which contemporary medicine examines the
human condition, we are completely missing the larger picture.
Medicine
is not taking into consideration the following critically important aspects of
a healthy human organism: (a) stress and how it adversely affects the immune
system and life processes; (b) insufficient exercise; (c) excessive caloric
intake; (d)
highly processed and denatured foods grown in denatured and chemically damaged
soil; and (e)
exposure to tens of thousands of environmental toxins. Instead of minimizing
these disease-causing factors, we cause more illness through medical
technology, diagnostic testing, overuse of medical and surgical procedures, and
overuse of pharmaceutical drugs. The huge disservice of this therapeutic
strategy is the result of little effort or money being spent on preventing
disease.
Underreporting of
Iatrogenic Events
As
few as 5% and no more than 20% of iatrogenic acts are ever reported.(16,24,25,33,34) This
implies that if medical errors were completely and accurately reported, we
would have an annual iatrogenic death toll much higher than 783,936. In 1994,
Leape said his figure of 180,000 medical mistakes resulting in death annually was
equivalent to three jumbo-jet crashes every two days.(16) Our considerably
higher figure is equivalent to six jumbo jets are falling out of the sky each
day.
What
we must deduce from this report is that medicine is in need of complete and
total reform—from the curriculum in medical schools to protecting patients from
excessive medical intervention. It is obvious that we cannot change anything if
we are not honest about what needs to be changed. This report simply shows the
degree to which change is required.
We
are fully aware of what stands in the way of change: powerful pharmaceutical
and medical technology companies, along with other powerful groups with
enormous vested interests in the business of medicine. They fund medical
research, support medical schools and hospitals, and advertise in medical
journals. With deep pockets, they entice scientists and academics to support
their efforts. Such funding can sway the balance of opinion from professional
caution to uncritical acceptance of new therapies and drugs. You have only to
look at the people who make up the hospital, medical, and government health
advisory boards to see conflicts of interest. The public is mostly unaware of
these interlocking interests.
For
example, a 2003 study found that nearly half of medical school faculty who
serve on institutional review boards (IRB) to advise on clinical trial research also serve as
consultants to the pharmaceutical industry.(17) The study authors
were concerned that such representation could cause potential conflicts of
interest. A news release by Dr. Erik Campbell, the lead author, said, "Our
previous research with faculty has shown us that ties to industry can affect
scientific behavior, leading to such things as trade secrecy and delays in
publishing research. It's possible that similar relationships with companies
could affect IRB members' activities and attitudes.”(18)
Jonathan
Quick, director of essential drugs and medicines policy for the World Health
Organization (WHO), wrote in a recent WHO bulletin: "If clinical trials
become a commercial venture in which self-interest overrules public interest
and desire overrules science, then the social contract which allows research on
human subjects in return for medical advances is broken."(19)
As
former editor of the New England Journal of Medicine , Dr. Marcia
Angell struggled to bring greater attention to the problem of commercializing
scientific research. In her outgoing editorial entitled “ Is Academic
Medicine for Sale?” Angell said that growing conflicts of interest are
tainting science and called for stronger restrictions on pharmaceutical stock
ownership and other financial incentives for researchers:(20) “When the
boundaries between industry and academic medicine become as blurred as they are
now, the business goals of industry influence the mission of medical schools in
multiple ways.” She did not discount the benefits of research but said a
Faustian bargain now existed between medical schools and the pharmaceutical
industry.
Angell
left the New England Journal in June 2000. In June 2002, the New
England Journal of Medicine announced that it would accept journalists who
accept money from drug companies because it was too difficult to find ones who
have no ties. Another former editor of the journal, Dr. Jerome Kassirer, said
that was not the case and that plenty of researchers are available who do not
work for drug companies.(21) According to an ABC news report, pharmaceutical
companies spend over $2 billion a year on over 314,000 events attended by
doctors.
The
ABC news report also noted that a survey of clinical trials revealed that when
a drug company funds a study, there is a 90% chance that the drug will be
perceived as effective whereas a non-drug-company-funded study will show
favorable results only 50% of the time. It appears that money can't buy you
love but it can buy any "scientific" result desired.
Cynthia
Crossen, a staffer for the Wall Street Journal, i n 1996 published Tainted
Truth : The Manipulation of Fact in America , a book about the
widespread practice of lying with statistics.(22) Commenting on the
state of scientific research, she wrote: “The road to hell was paved with
the flood of corporate research dollars that eagerly filled gaps left by
slashed government research funding.” Her data on financial involvement
showed that in l981 the drug industry “gave” $292 million to colleges and
universities for research. By l991, this figure had risen to $2.1 billion.
Dr.
Lucian L. Leape opened medicine's Pandora's box in his 1994 paper, “Error in
Medicine,” which appeared in the Journal of the American Medical
Association (JAMA).(16) He found that Schimmel reported in 1964 that 20%
of hospital patients suffered iatrogenic injury, with a 20% fatality rate. In
1981 Steel reported that 36% of hospitalized patients experienced iatrogenesis
with a 25% fatality rate, and adverse drug reactions were involved in 50% of
the injuries. In 1991, Bedell reported that 64% of acute heart attacks in one
hospital were preventable and were mostly due to adverse drug reactions.
Leape
focused on the “Harvard Medical Practice Study” published in 1991, (16a) which found a 4%
iatrogenic injury rate for patients, with a 14% fatality rate, in 1984 in New
York State. From the 98,609 patients injured and the 14% fatality rate, he
estimated that in the entire U.S. 180,000 people die each year partly as a
result of iatrogenic injury.
Why
Leape chose to use the much lower figure of 4% injury for his analysis remains
in question. Using instead the average of the rates found in the three studies
he cites (36%, 20%, and 4%) would have produced a 20% medical error rate. The
number of iatrogenic deaths using an average rate of injury and his 14%
fatality rate would be 1,189,576.
Leape
acknowledged that the literature on medical errors is sparse and represents
only the tip of the iceberg, noting that when errors are specifically sought
out, reported rates are “distressingly high.” He cited several autopsy
studies with rates as high as 35-40% of missed diagnoses causing death. He also
noted that an intensive care unit reported an average of 1.7 errors per day per
patient, and 29% of those errors were potentially serious or fatal.
Leape calculated the error rate in the intensive care unit study. First, he found that each patient had an average of 178 “activities” (staff/procedure/medical interactions) a day, of which 1.7 were errors, which means a 1% failure rate. This may not seem like much, but Leape cited industry standards showing that in aviation, a 0.1% failure rate would mean two unsafe plane landings per day at Chicago's O'Hare International Airport; in the US Postal Service, a 0.1% failure rate would mean 16,000 pieces of lost mail every hour; and in the banking industry, a 0.1% failure rate would mean 32,000 bank checks deducted from the wrong bank account.
In trying to determine why there are so many medical errors, Leape acknowledged the lack of reporting of medical errors. Medical errors occur in thousands of different locations and are perceived as isolated and unusual events. But the most important reason that the problem of medical errors is unrecognized and growing, according to Leape, is that doctors and nurses are unequipped to deal with human error because of the culture of medical training and practice. Doctors are taught that mistakes are unacceptable. Medical mistakes are therefore viewed as a failure of character and any error equals negligence. No one is taught what to do when medical errors do occur. Leape cites McIntyre and Popper, who said the “infallibility model” of medicine leads to intellectual dishonesty with a need to cover up mistakes rather than admit them. There are no Grand Rounds on medical errors, no sharing of failures among doctors, and no one to support them emotionally when their error harms a patient.
Leape
hoped his paper would encourage medical practitioners “to fundamentally
change the way they think about errors and why they occur.” It has been
almost a decade since this groundbreaking work, but the mistakes continue to
soar.
In
1995, a JAMA report noted, "Over a million patients are
injured in US hospitals each year, and approximately 280,000 die annually as a
result of these injuries. Therefore, the iatrogenic death rate dwarfs the
annual automobile accident mortality rate of 45,000 and accounts for more
deaths than all other accidents combined."(23)
At
a 1997 press conference, Leape released a nationwide poll on patient iatrogenesis
conducted by the National Patient Safety Foundation (NPSF), which is sponsored
by the American Medical Association (AMA). Leape is a founding member of NPSF. The survey
found that more than 100 million Americans have been affected directly or
indirectly by a medical mistake. Forty-two percent were affected directly and
84% personally knew of someone who had experienced a medical mistake.(14)
At
this press conference, Leape updated his 1994 statistics, noting that as of
1997, medical errors in inpatient hospital settings nationwide could be as high
as 3 million and could cost as much as $200 billion . Leape used a 14% fatality
rate to determine a medical error death rate of 180,000 in 1994.(16) In 1997, using
Leape's base number of 3 million errors, the annual death rate could be as high
as 420,000 for hospital inpatients alone.
In
1994, Leape said he was well aware that medical errors were not being reported.(16) A study conducted
in two obstetrical units in the UK found that only about one-quarter of adverse
incidents were ever reported, to protect staff, preserve reputations, or for
fear of reprisals, including lawsuits.(24). An analysis by Wald and Shojania found that only
1.5% of all adverse events result in an incident report, and only 6% of adverse
drug events are identified properly. The authors learned that the American
College of Surgeons estimates that surgical incident reports routinely capture
only 5-30% of adverse events. In one study, only 20% of surgical complications
resulted in discussion at morbidity and mortality rounds.(25) From these
studies, it appears that all the statistics gathered on medical errors may
substantially underestimate the number of adverse drug and medical therapy incidents.
They also suggest that our statistics concerning mortality resulting from
medical errors may be in fact be conservative figures.
An
article in Psychiatric Times (April 2000) outlines the stakes involved
in reporting medical errors.(26) The authors found that the public is fearful of
suffering a fatal medical error, and doctors are afraid they will be sued if
they report an error. This brings up the obvious question: who is reporting
medical errors? Usually it is the patient or the patient's surviving family. If
no one notices the error, it is never reported. Janet Heinrich, an associate
director at the U.S. General Accounting Office responsible for health financing
and public health issues, testified before a House subcommittee hearing on medical
errors that "the full magnitude of their threat to the American public
is unknown” and "gathering valid and useful information about
adverse events is extremely difficult." She acknowledged that the fear
of being blamed, and the potential for legal liability, played key roles in the
underreporting of errors. The Psychiatric Times noted that the AMA
strongly opposes mandatory reporting of medical errors.(26) If doctors are
not reporting, what about nurses? A survey of nurses found that they also fail
to report medical mistakes for fear of retaliation.(27)
Standard
medical pharmacology texts admit that relatively few doctors ever report
adverse drug reactions to the FDA.(28) The reasons range from not knowing such a
reporting system exists to fear of being sued.(29) Yet the public
depends on this tremendously flawed system of voluntary reporting by doctors to
know whether a drug or a medical intervention is harmful.
Pharmacology
texts also will tell doctors how hard it is to separate drug side effects from
disease symptoms. Treatment failure is most often attributed to the disease and
not the drug or doctor. Doctors are warned, “Probably nowhere else in
professional life are mistakes so easily hidden, even from ourselves.”(30) It may be hard to
accept, but it is not difficult to understand why only 1 in 20 side effects is
reported to either hospital administrators or the FDA.(31, 31a)
If
hospitals admitted to the actual number of errors for which they are
responsible, which is about 20 times what is reported, they would come under
intense scrutiny.(32) Jerry Phillips, associate director of the FDA's
Office of Post Marketing Drug Risk Assessment, confirms this number. “In the
broader area of adverse drug reaction data, the 250,000 reports received
annually probably represent only 5% of the actual reactions that occur.”(33) Dr. Jay Cohen,
who has extensively researched adverse drug reactions, notes that because only
5% of adverse drug reactions are reported, there are in fact 5 million
medication reactions each year.(34)
A
2003 survey is all the more distressing because there seems to be no
improvement in error reporting, even with all the attention given to this
topic. Dr. Dorothea Wild surveyed medical residents at a community hospital in
Connecticut and found that only half were aware that the hospital had a medical
error-reporting system, and that the vast majority did not use it at all. Dr.
Wild says this does not bode well for the future. If doctors don't learn error
reporting in their training, they will never use it. Wild adds that error
reporting is the first step in locating the gaps in the medical system and
fixing them. Not even that first step has been taken to date.(35)
In
a telephone survey, 1,207 adults ranked the effectiveness of the following
measures in reducing preventable medical errors that result in serious harm.(36) (Following each
measure is the percentage of respondents who ranked the measure as “very
effective.”)
Giving doctors
more time to spend with patients (78%)
Requiring hospitals to develop systems to avoid
medical errors (74%)
Better training of health professionals (73%)
Using only doctors specially trained in intensive
care medicine on intensive care units (73%)
Requiring hospitals to report all serious medical
errors to a state agency (71%)
Increasing the number of hospital nurses (69%)
Reducing the work hours of doctors in training to
avoid fatigue (66%)
Encouraging hospitals to voluntarily report serious
medical errors to a state agency (62%).
Prescription
drugs constitute the major treatment modality of scientific medicine. With the
discovery of the “germ theory,” medical scientists convinced the public
that infectious organisms were the cause of illness. Finding the “cure”
for these infections proved much harder than anyone imagined. From the
beginning, chemical drugs promised much more than they delivered. But far
beyond not working, the drugs also caused incalculable side effects. The drugs
themselves, even when properly prescribed, have side effects that can be fatal,
as Lazarou's study(1) showed. But human error can make the situation
even worse.
A
survey of a 1992 national pharmacy database found a total of 429,827 medication
errors from 1,081 hospitals. Medication errors occurred in 5.22% of patients
admitted to these hospitals each year. The authors concluded that at least
90,895 patients annually were harmed by medication errors in the US as a whole.(37)
A
2002 study shows that 20% of hospital medications for patients had dosage
errors. Nearly 40% of these errors were considered potentially harmful to the
patient. In a typical 300-patient hospital, the number of errors per day was
40.(38)
Problems
involving patients' medications were even higher the following year. The error
rate intercepted by pharmacists in this study was 24%, making the potential
minimum number of patients harmed by prescription drugs 417,908.(39)
Recent Adverse Drug
Reactions
More-recent
studies on adverse drug reactions show that the figures from 1994 published in
Lazarou's 1998 JAMA article may be increasing. A 2003 study followed
400 patients after discharge from a tertiary care hospital setting (requiring
highly specialized skills, technology, or support services). Seventy-six
patients (19%) had adverse events. Adverse drug events were the most common, at
66% of all events. The next most common event was procedure-related injuries,
at 17%.(40)
In
a New England Journal of Medicine study, an alarming one in four
patients suffered observable side effects from the more than 3.34 billion
prescription drugs filled in 2002.(41) One of the doctors who produced the study was
interviewed by Reuters and commented, "With these 10-minute
appointments, it's hard for the doctor to get into whether the symptoms are
bothering the patients."(42) William Tierney, who editorialized on the New
England Journal study, said “… given the increasing number of powerful
drugs available to care for the aging population, the problem will only get
worse.” The drugs with the worst record of side effects were selective
serotonin reuptake inhibitors ( SSRIs), nonsteroidal anti-inflammatory drugs
(NSAIDs), and calcium-channel blockers. Reuters also reported that prior
research has suggested that nearly 5% of hospital admissions (over 1 million
per year) are the result of drug side effects. But most of the cases are not
documented as such. The study found that one of the reasons for this failure is
that in nearly two-thirds of the cases, doctors could not diagnose drug side
effects or the side effects persisted because the doctor failed to heed the
warning signs.
Medicating Our Feelings
Patients seeking a more joyful existence and relief from worry, stress, and anxiety often fall victim to the messages endlessly displayed on TV and billboards. Often, instead of gaining relief, they fall victim to the myriad iatrogenic side effects of antidepressant medication.
Moreover,
a whole generation of antidepressant users has been created from young people
growing up on Ritalin. Medicating youth and modifying their emotions must have
some impact on how they learn to deal with their feelings. They learn to equate
coping with drugs rather than with their inner resources. As adults, these
medicated youth reach for alcohol, drugs, or even street drugs to cope.
According to JAMA , “Ritalin acts much like cocaine.”(43) Today's marketing
of mood-modifying drugs such as Prozac and Zoloft ® makes them not only
socially acceptable but almost a necessity in today's stressful world.
Television Diagnosis
To
reach the widest audience possible, drug companies are no longer just targeting
medical doctors with their marketing of antidepressants. By 1995, drug
companies had tripled the amount of money allotted to direct advertising of
prescription drugs to consumers. The majority of this money is spent on
seductive television ads. From 1996 to 2000, spending rose from $791 million to
nearly $2.5 billion.(44) This $2.5 billion represents only 15% of the total
pharmaceutical advertising budget. While the drug companies maintain that
direct-to-consumer advertising is educational, Dr. Sidney M. Wolfe of the
Public Citizen Health Research Group in Washington, DC, argues that the public
often is misinformed about these ads.(45) People want what they see on television and are
told to go to their doctors for a prescription. Doctors in private practice
either acquiesce to their patients' demands for these drugs or spend valuable
time trying to talk patients out of unnecessary drugs. Dr. Wolfe remarks that
one important study found that people mistakenly believe that the “FDA
reviews all ads before they are released and allows only the safest and most
effective drugs to be promoted directly to the public.”(46)
Another
aspect of scientific medicine that the public takes for granted is the testing
of new drugs. Drugs generally are tested on individuals who are fairly healthy
and not on other medications that could interfere with findings. But when these
new drugs are declared “safe” and enter the drug prescription books,
they are naturally going to be used by people who are on a variety of other
medications and have a lot of other health problems. Then a new phase of drug
testing called “post-approval” comes into play, which is the
documentation of side effects once drugs hit the market. In one very telling
report, the federal government's General Accounting Office "found that
of the 198 drugs approved by the FDA between 1976 and 1985... 102 (or 51.5%)
had serious post-approval risks... the serious post-approval risks (included)
heart failure, myocardial infarction, anaphylaxis, respiratory depression and
arrest, seizures, kidney and liver failure, severe blood disorders, birth
defects and fetal toxicity, and blindness."(47)
NBC
Television's investigative show “Dateline” wondered if your doctor is
moonlighting as a drug company representative. After a yearlong investigation,
NBC reported that because doctors can legally prescribe any drug to any patient
for any condition, drug companies heavily promote "off label"
and frequently inappropriate and untested uses of these medications, even
though these drugs are approved only for the specific indications for which
they have been tested.(48)
The
leading causes of adverse drug reactions are antibiotics (17%), cardiovascular
drugs (17%),
chemotherapy (15%),
and analgesics and anti-inflammatory agents (15%).(49)
According
to William Agger, MD, director of microbiology and chief of infectious disease
at Gundersen Lutheran Medical Center in La Crosse, WI, 30 million pounds of
antibiotics are used in America each year.(50) Of this amount,
25 million pounds are used in animal husbandry, and 23 million pounds are used
to try to prevent disease and the stress of shipping, as well as to promote
growth. Only 2 million pounds are given for specific animal infections. Dr.
Egger reminds us that low concentrations of antibiotics are measurable in many
of our foods and in various waterways around the world, much of it seeping in
from animal farms.
Egger
contends that overuse of antibiotics results in food-borne infections resistant
to antibiotics. Salmonella is found in 20% of ground meat, but the constant
exposure of cattle to antibiotics has made 84% of salmonella resistant to at
least one anti-salmonella antibiotic. Diseased animal food accounts for 80% of
salmonellosis in humans, or 1.4 million cases per year. The conventional
approach to countering this epidemic is to radiate food to try to kill all
organisms while continuing to use the antibiotics that created the problem in
the first place. Approximately 20% of chickens are contaminated with Campylobacter
jejuni, an organism that causes 2.4 million cases of illness annually. Fifty-four
percent of these organisms are resistant to at least one anti-campylobacter
antimicrobial agent.
Denmark
banned growth-promoting antibiotics beginning in 1999, which cut their use by
more than half within a year, from 453,200 to 195,800 pounds. A report from
Scandinavia found that removing antibiotic growth promoters had no or minimal
effect on food production costs. Egger warns that the current crowded,
unsanitary methods of animal farming in the US support constant stress and
infection, and are geared toward high antibiotic use.
In
the US, over 3 million pounds of antibiotics are used every year on humans.
With a population of 284 million Americans, this amount is enough to give every
man, woman, and child 10 teaspoons of pure antibiotics per year. Egger says
that exposure to a steady stream of antibiotics has altered pathogens such as Streptococcus
pneumoniae, Staplococcus aureus, and entercocci, to name
a few.
Almost
half of patients with upper respiratory tract infections in the U.S. still
receive antibiotics from their doctor.(51) According to the CDC, 90% of upper respiratory
infections are viral and should not be treated with antibiotics. In Germany,
the prevalence of systemic antibiotic use in children aged 0-6 years was 42.9%.(52)
Data
obtained from nine US health insurers on antibiotic use in 25,000 children from
1996 to 2000 found that rates of antibiotic use decreased. Antibiotic use in
children aged three months to under 3 years decreased 24%, from 2.46 to 1.89
antibiotic prescriptions per patient per year. For children aged 3 to under 6
years, there was a 25% reduction from 1.47 to 1.09 antibiotic prescriptions per
patient per year. And for children aged 6 to under 18 years, there was a 16%
reduction from 0.85 to 0.69 antibiotic prescriptions per patient per year.(53) Despite these
reductions, the data indicate that on average every child in America receives
1.22 antibiotic prescriptions annually.
Group
A beta-hemolytic streptococci is the only common cause of sore throat that requires
antibiotics, with penicillin and erythromycin the only recommended treatment.
Ninety percent of sore-throat cases, however, are viral. Antibiotics were used
in 73% of the estimated 6.7 million adult annual visits for sore throat in the
US between 1989 and 1999. Furthermore, patients treated with antibiotics were
prescribed non-recommended broad-spectrum antibiotics in 68% of visits. This
period saw a significant increase in the use of newer, more expensive
broad-spectrum antibiotics and a decrease in use of the recommended antibiotics
penicillin and erythromycin.(54) A ntibiotics being prescribed in 73% of
sore-throat cases instead of the recommended 10% resulted in a total of 4.2
million unnecessary antibiotic prescriptions from 1989 to 1999.
In
September 2003, the CDC re-launched a program started in 1995 called “Get
Smart: Know When Antibiotics Work.”(55) This $1.6 million campaign is designed to educate
patients about the overuse and inappropriate use of antibiotics. Most people
involved with alternative medicine have known about the dangers of antibiotic
overuse for decades. Finally the government is focusing on the problem, yet it
is spending only a miniscule amount of money on an iatrogenic epidemic that is
costing billions of dollars and thousands of lives. The CDC warns that 90% of
upper respiratory infections, including children's ear infections, are viral
and that antibiotics do not treat viral infection. More than 40% of about 50
million prescriptions for antibiotics written each year in physicians' offices
are inappropriate.(2) U sing antibiotics when not needed can lead to the
development of deadly strains of bacteria that are resistant to drugs and cause
more than 88,000 deaths due to hospital-acquired infections.(9) The CDC, however,
seems to be blaming patients for misusing antibiotics even though they are
available only by prescription from physicians. According to Dr. Richard
Besser, head of “Get Smart”: "Programs that have just targeted
physicians have not worked. Direct-to-consumer advertising of drugs is to blame
in some cases.” Besser says the program “teaches patients and the
general public that antibiotics are precious resources that must be used
correctly if we want to have them around when we need them. Hopefully, as a
result of this campaign, patients will feel more comfortable asking their
doctors for the best care for their illnesses, rather than asking for
antibiotics."(56)
What constitutes the “best care”? The CDC does not elaborate and ignores the latest research on the dozens of nutraceuticals that have been scientifically proven to treat viral infections and boost immune-system function. Will doctors recommend vitamin C, echinacea, elderberry, vitamin A, zinc, or homeopathic oscillococcinum? Probably not. The CDC's common-sense recommendations that most people follow anyway include getting proper rest, drinking plenty of fluids, and using a humidifier.
The
pharmaceutical industry claims it supports limiting the use of antibiotics. The
drug company Bayer sponsors a program called “Operation Clean Hands”
through an organization called LIBRA.(57) The CDC also is involved in trying to minimize
antibiotic resistance, but nowhere in its publications is there any reference
to the role of nutraceuticals in boosting the immune system, nor to the
thousands of journal articles that support this approach. This tunnel vision
and refusal to recommend the available non-drug alternatives is unfortunate
when the CDC is desperately trying to curb the overuse of antibiotics.
We
have reached the point of saturation with prescription drugs. Every body of
water tested contains measurable drug residues. The tons of antibiotics used in
animal farming, which run off into the water table and surrounding bodies of
water, are conferring antibiotic resistance to germs in sewage, and these germs
also are found in our water supply. Flushed down our toilets are tons of drugs
and drug metabolites that also find their way into our water supply. We have no
way to know the long-term health consequences of ingesting a mixture of drugs
and drug-breakdown products. These drugs represent another level of iatrogenic
disease that we are unable to completely measure.(58-67)
It's
not just the US that is plagued by iatrogenesis. A survey of more than 1,000
French general practitioners (GPs) tested their basic pharmacological knowledge
and practice in prescribing NSAIDs, which rank first among commonly prescribed
drugs for serious adverse reactions. The study results suggest that GPs do not
have adequate knowledge of these drugs and are unable to effectively manage
adverse reactions.(68)
A
cross-sectional survey of 125 patients attending specialty pain clinics in
South London found that possible iatrogenic factors such as “over-investigation,
inappropriate information, and advice given to patients as well as
misdiagnosis, over-treatment, and inappropriate prescription of medication were
common.”(69)
In
1989, German biostatistician Ulrich Abel, PhD, wrote a monograph entitled “Chemotherapy
of Advanced Epithelial Cancer.” It was later published in shorter form in a
peer-reviewed medical journal.(70) Abel presented a comprehensive analysis of
clinical trials and publications representing over 3,000 articles examining the
value of cytotoxic chemotherapy on advanced epithelial cancer. Epithelial
cancer is the type of cancer with which we are most familiar, arising from
epithelium found in the lining of body organs such as the breast, prostate,
lung, stomach, and bowel. From these sites, cancer usually infiltrates adjacent
tissue and spreads to the bone, liver, lung, or brain. With his exhaustive
review, Abel concluded there is no direct evidence that chemotherapy prolongs
survival in patients with advanced carcinoma; in small-cell lung cancer and
perhaps ovarian cancer, the therapeutic benefit is only slight. According to
Abel, “Many oncologists take it for granted that response to therapy
prolongs survival, an opinion which is based on a fallacy and which is not
supported by clinical studies.”
Over
a decade after Abel's exhaustive review of chemotherapy, there seems no
decrease in its use for advanced carcinoma. For example, when conventional
chemotherapy and radiation have not worked to prevent metastases in breast
cancer, high-dose chemotherapy (HDC) along with stem-cell transplant (SCT) is
the treatment of choice. In March 2000, however, results from the largest
multi-center randomized controlled trial conducted thus far showed that,
compared to a prolonged course of monthly conventional-dose chemotherapy, HDC
and SCT were of no benefit, (71) with even a slightly lower survival rate for the
HDC/SCT group. Serious adverse effects occurred more often in the HDC group
than the standard-dose group. One treatment-related death (within 100 days of
therapy) was recorded in the HDC group, but none was recorded in the
conventional chemotherapy group. The women in this trial were highly selected
as having the best chance to respond.
Unfortunately,
no all-encompassing follow-up study such as Dr. Abel's exists to indicate
whether there has been any improvement in cancer-survival statistics since
1989. In fact, research should be conducted to determine whether chemotherapy
itself is responsible for secondary cancers instead of progression of the
original disease. We continue to question why well-researched alternative
cancer treatments are not used.
Periodically,
the FDA fines a drug manufacturer when its abuses are too glaring and
impossible to cover up. In May 2002, The Washington Post reported that
Schering-Plough Corp., the maker of Claritin, was to pay a $500 million dollar
fine to the FDA for quality-control problems at four of its factories.(72) The indictment
came after the Public Citizen Health Research Group, led by Dr. Sidney Wolfe,
called for a criminal investigation of Schering-Plough, charging that the
company distributed albuterol asthma inhalers even though it knew the units
were missing the active ingredient.
The
FDA tabulated infractions involving 125 products, or 90% of the drugs made by
Schering-Plough since 1998. Besides paying the fine, the company was forced to
halt the manufacture of 73 drugs or suffer another $175 million fine.
Schering-Plough's news releases told another story, assuring consumers that
they should still feel confident in the company's products.
This
large settlement served as a warning to the drug industry about maintaining
strict manufacturing practices and has given the FDA more clout in dealing with
drug company compliance. According to The Washington Post article, a
federal appeals court ruled in 1999 that the FDA could seize the profits of
companies that violate "good manufacturing practices." Since
that time, Abbott Laboratories has paid a $100 million fine for failing to meet
quality standards in the production of medical test kits, while Wyeth
Laboratories paid $30 million in 2000 to settle accusations of poor
manufacturing practices.
In
1974, 2.4 million unnecessary surgeries were performed, resulting in 11,900
deaths at a cost of $3.9 billion.(73,74) In 2001, 7.5 million unnecessary surgical
procedures were performed, resulting in 37,136 deaths at a cost of $122 billion
(using 1974 dollars).(3)
It
is very difficult to obtain accurate statistics when studying unnecessary
surgery. In 1989, Leape wrote that perhaps 30% of controversial surgeries—which
include cesarean section, tonsillectomy, appendectomy, hysterectomy,
gastrectomy for obesity, breast implants, and elective breast implants(74)— are unnecessary.
In 1974, the Congressional Committee on Interstate and Foreign Commerce held
hearings on unnecessary surgery. It found that 17.6% of recommendations for
surgery were not confirmed by a second opinion. The House Subcommittee on
Oversight and Investigations extrapolated these figures and estimated that, on
a nationwide basis, there were 2.4 million unnecessary surgeries performed
annually, resulting in 11,900 deaths at an annual cost of $3.9 billion.(73)
According
to the Healthcare Cost and Utilization Project within the Agency for Healthcare
Research and Quality(13), in 2001 the 50 most common medical and surgical
procedures were performed approximately 41.8 million times in the US. Using the
1974 House Subcommittee on Oversight and Investigations' figure of 17.6% as the
percentage of unnecessary surgical procedures, and extrapolating from the death
rate in 1974, produces nearly 7.5 million (7,489,718) unnecessary procedures
and a death rate of 37,136, at a cost of $122 billion (using 1974 dollars).
In
1995, researchers conducted a similar analysis of back surgery procedures,
using the 1974 “unnecessary surgery percentage” of 17.6. Testifying
before the Department of Veterans Affairs, they estimated that of the 250,000
back surgeries performed annually in the US at a hospital cost of $11,000 per
patient, the total number of unnecessary back surgeries approaches 44,000,
costing as much as $484 million.(75)
Like
prescription drug use driven by television advertising, unnecessary surgeries
are escalating. Media-driven surgery such as gastric bypass for obesity “modeled”
by Hollywood celebrities seduces obese people to think this route is safe and
sexy. Unnecessary surgeries have even been marketed on the Internet.(76) A study in Spain
declares that 20-25% of total surgical practice represents unnecessary
operations.(77)
According
to data from the National Center for Health Statistics for 1979 to 1984, the
total number of surgical procedures increased 9% while the number of surgeons
grew 20%. The study notes that the large increase in the number of surgeons was
not accompanied by a parallel increase in the number of surgeries performed, and
expressed concern about an excess of surgeons to handle the surgical caseload.(78)
From
1983 to 1994, however, the incidence of the 10 most commonly performed surgical
procedures jumped 38%, to 7,929,000 from 5,731,000 cases. By 1994, cataract
surgery was the most common procedure with more than 2 million operations,
followed by cesarean section (858,000 procedures) and inguinal hernia
operations (689,000 procedures). Knee arthroscopy procedures increased 153%
while prostate surgery declined 29%.(79)
The
list of iatrogenic complications from surgery is as long as the list of
procedures themselves. One study examined catheters that were inserted to
deliver anesthetic into the epidural space around the spinal nerves for lower
cesarean section, abdominal surgery, or prostate surgery. In some cases,
non-sterile technique during catheter insertion resulted in serious infections,
even leading to limb paralysis.(80)
In
one review of the literature, the authors found “a significant rate of
overutilization of coronary angiography, coronary artery surgery, cardiac
pacemaker insertion, upper gastrointestinal endoscopies, carotid
endarterectomies, back surgery, and pain-relieving procedures.”(81)
A
1987 JAMA study found the following significant levels of inappropriate
surgery: 17% of coronary angiography procedures, 32% of carotid endarterectomy
procedures, and 17% of upper gastrointestinal tract endoscopy procedures.(82) Based on the
Healthcare Cost and Utilization Project (HCUP) statistics provided by the
government for 2001, 697,675 upper gastrointestinal endoscopies (usually
entailing biopsy) were performed, as were 142,401 endarterectomies and 719,949
coronary angiographies.(13) Extrapolating the JAMA study's
inappropriate surgery rates to 2001 produces 118,604 unnecessary endoscopy
procedures, 45,568 unnecessary endarterectomies, and 122,391 unnecessary
coronary angiographies. These are all forms of medical iatrogenesis.
MEDICAL AND SURGICAL
PROCEDURES
It
is instructive to know the mortality rates associated with various medical and
surgical procedures. Although we must sign release forms when we undergo any
procedure, many of us are in denial about the true risks involved; because
medical and surgical procedures are so commonplace, they often are seen as both
necessary and safe. Unfortunately, allopathic medicine itself is a leading
cause of death, as well as the most expensive way to die.
Perhaps
the words “health care” confer the illusion that medicine is about
health. Allopathic medicine is not a purveyor of health care but of disease
care. The HCUP figures are instructive,(13) but the computer program that calculates annual
mortality statistics for all US hospital discharges is only as good as the
codes entered into the system. In email correspondence, HCUP indicated that the
mortality rates for each procedure indicated only that someone undergoing that
procedure died either from the procedure or from some other cause.
Thus
there is no way of knowing exactly how many people die from a particular procedure.
While codes for “poisoning & toxic effects of drugs” and “complications
of treatment” do exist, the mortality figures registered in these
categories are very low and do not correlate with what is known from research
such as the 1998 JAMA study(1) that estimated an average of 106,000 prescription
medication deaths per year. No codes exist for adverse drug side effects,
surgical mishaps, or other types of medical error. Until such codes exist, the
true mortality rates tied to of medical error will remain buried in the general
statistics.
AN
HONEST LOOK AT US HEALTH
CARE
In
1978, the US Office of Technology Assessment (OTA) reported: “Only 10-20% of
all procedures currently used in medical practice have been shown to be
efficacious by controlled trial."(83) In 1995, the OTA
compared medical technology in eight countries ( Australia , Canada, France,
Germany, the Netherlands, Sweden, the UK, and the US ) and again noted that few
medical procedures in the US have been subjected to clinical trial. It also
reported that US infant mortality was high and life expectancy low compared to
other developed countries.(84)
Although
almost 10 years old, much of what was written in the OTA report holds true
today. The report blames the high cost of American medicine on the medical
free-enterprise system and failure to create a national health care policy. It
attributes the government's failure to control health care costs to market
incentives and profit motives inherent in the current financing and
organization of health care, which includes such interests as private health
insurers, hospital systems, physicians, and the drug and medical-device
industries. “Health Care Technology and Its Assessment in Eight Countries” is
the last report prepared by the OTA, which was disbanded in 1995. It also is
perhaps the US government's last honest, detailed examination of the nation's
health care system. An appendix summarizing this 60-page report follows this
article.
SURGICAL ERRORS FINALLY
REPORTED
An
October 2003 JAMA study from the US government's Agency for Healthcare
Research and Quality (AHRQ) documented 32,000 mostly surgery-related deaths
costing $9 billion and accounting for 2.4 million extra hospital days in 2000.(85) Data from 20% of
the nation's hospitals were analyzed for 18 different surgical complications,
including postoperative infections, foreign objects left in wounds, surgical
wounds reopening, and post-operative bleeding.
In
a press release accompanying the study, AHRQ director Carolyn M. Clancy, MD, noted:
“This study gives us the first direct evidence that medical injuries pose a
real threat to the American public and increase the costs of health care.”(86) According to the
study's authors, “The findings greatly underestimate the problem, since many
other complications happen that are not listed in hospital administrative data.”
They added: "The message here is that medical injuries can have a
devastating impact on the health care system. We need more research to identify
why these injuries occur and find ways to prevent them from happening."
The study authors said that improved medical practices, including an emphasis
on better hand washing, might help reduce morbidity and mortality rates. In an
accompanying JAMA editorial, health-risk researcher Dr. Saul Weingart
of Harvard's Beth Israel-Deaconess Medical Center wrote, “Given their
staggering magnitude, these estimates are clearly sobering.”(87)
When
x-rays were discovered, no one knew the long-term effects of ionizing
radiation. In the 1950s, monthly fluoroscopic exams at the doctor's office were
routine, and you could even walk into most shoe stores and see x-rays of your
foot bones. We still do not know the ultimate outcome of our initial
fascination with x-rays.
In
those days, it was common practice to x-ray pregnant women to measure their
pelvises and make a diagnosis of twins. Finally, a study of 700,000 children
born between 1947 and 1964 in 37 major maternity hospitals compared the
children of mothers who had received pelvic x-rays during pregnancy to those of
mothers who did not. It found that cancer mortality was 40% higher among
children whose mothers had been x-rayed.(88)
In
present-day medicine, coronary angiography is an invasive surgical procedure
that involves snaking a tube through a blood vessel in the groin up to the
heart. To obtain useful information, X-rays are taken almost continuously, with
minimum dosages ranging from 460 to 1,580 mrem. The minimum radiation from a
routine chest x-ray is 2 mrem. X-ray radiation accumulates in the body, and
ionizing radiation used in X-ray procedures has been shown to cause gene
mutation. The health impact of this high level of radiation is unknown, and
often obscured in statistical jargon such as, “The risk for lifetime fatal
cancer due to radiation exposure is estimated to be 4 in one million per 1,000
mrem.”(89)
Dr.
John Gofman has studied the effects of radiation on human health for 45 years.
A medical doctor with a PhD in nuclear and physical chemistry, Gofman worked on
the Manhattan Project, discovered uranium-233, and was the first person to
isolate plutonium. In five scientifically documented books, Gofman provides
strong evidence that medical technology—specifically x-rays, CT scans, and
mammography and fluoroscopy devices—are a contributing factor to 75% of new
cancers. In a nearly 700-page report updated in 2000, “Radiation from
Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease:
Dose-Response Studies with Physicians per 100,000 Population,”(90) Gofman shows that
as the number of physicians increases in a geographical area along with an
increase in the number of x-ray diagnostic tests performed, the rate of cancer
and ischemic heart disease also increases. Gofman elaborates that it is not x-rays
alone that cause the damage but a combination of health risk factors that
include poor diet, smoking, abortions, and the use of birth control pills. Dr.
Gofman predicts that ionizing radiation will be responsible for 100 million
premature deaths over the next decade.
In
his book, “Preventing Breast Cancer,” Dr. Gofman notes that breast
cancer is the leading cause of death among American women between the ages of
44 and 55. Because breast tissue is highly sensitive to radiation, mammograms
can cause cancer. The danger can be heightened other factors including a
woman's genetic makeup, preexisting benign breast disease, artificial
menopause, obesity, and hormonal imbalance.(91)
Even
x-rays for back pain can lead someone into crippling surgery. Dr. John E.
Sarno, a well-known New York orthopedic surgeon, found that there is not
necessarily any association between back pain and spinal x-ray abnormality. He
cites studies of normal people without a trace of back pain whose x-rays
indicate spinal abnormalities and of people with back pain whose spines appear
to be normal on x-ray.(92) People who happen to have back pain and show an
abnormality on x-ray may be treated surgically, sometimes with no change in
back pain, worsening of back pain, or even permanent disability. Moreover,
doctors often order x-rays as protection against malpractice claims, to give
the impression of leaving no stone unturned. It appears that doctors are
putting their own fears before the interests of their patients.
Nearly
9 million (8,925,033) people were hospitalized unnecessarily in 2001.(4) In a study of
inappropriate hospitalization, two doctors reviewed 1,132 medical records. They
concluded that 23% of all admissions were inappropriate and an additional 17%
could have been handled in outpatient clinics. Thirty-four percent of all
hospital days were deemed inappropriate and could have been avoided.(93) The rate of
inappropriate hospital admissions in 1990 was 23.5%.(94) In 1999, another
study also found an inappropriate admissions rate of 24%, indicating a
consistent pattern from 1986 to 1999.(95) The HCUP database indicates that the total number
of patient discharges from US hospitals in 2001 was 37,187,641,(13) meaning that
almost 9 million people were exposed to unnecessary medical intervention in
hospitals and therefore represent almost 9 million potential iatrogenic
episodes.(4)
Dr.
Martin Charcot (1825-1893) was world-renowned, the most celebrated doctor of
his time. He practiced in the Paris hospital La Salpetriere. He became an
expert in hysteria, diagnosing an average of 10 hysterical women each day,
transforming them into “iatrogenic monsters” and turning simple “neurosis”
into hysteria.(96)
The number of women diagnosed with hysteria and hospitalized rose from 1% in
1841 to 17% in 1883. Hysteria is derived from the Latin “hystera” meaning
uterus. According to Dr. Adriane Fugh-Berman, US medicine has a tradition of
excessive medical and surgical interventions on women. Only 100 years ago, male
doctors believed that female psychological imbalance originated in the uterus.
When surgery to remove the uterus was perfected, it became the “cure”
for mental instability, effecting a physical and psychological castration.
Fugh-Berman notes that US doctors eventually disabused themselves of that
notion but have continued to treat women very differently than they treat men.(97) She cites the
following statistics:
In
1983, 809,000 cesarean sections (21% of live births) were performed in the US,
making it the nation's most common obstetric-gynecologic (OB/GYN) surgical
procedure. The second most common OB/GYN operation was hysterectomy (673,000),
followed by diagnostic dilation and curettage of the uterus (632,000). In 1983,
OB/GYN procedures represented 23% of all surgery completed in the US.(104)
In
2001, cesarean section is still the most common OB/GYN surgical procedure.
Approximately 4 million births occur annually, with 24% (960,000) delivered by
cesarean section. In the Netherlands, only 8% of births are delivered by
cesarean section. This suggests 640,000 unnecessary cesarean sections—entailing
three to four times higher mortality and 20 times greater morbidity than
vaginal delivery(105)—are
performed annually in the US.
The
US cesarean rate rose from just 4.5% in 1965 to 24.1% in 1986. Sakala contends
that an “uncontrolled pandemic of medically unnecessary cesarean births is
occurring.”(106)
VanHam reported a cesarean section postpartum hemorrhage rate of 7%, a hematoma
formation rate of 3.5%, a urinary tract infection rate of 3%, and a combined
postoperative morbidity rate of 35.7% in a high-risk population undergoing
cesarean section.(107)
NEVER ENOUGH STUDIES
Scientists
claimed there were never enough studies revealing the dangers of DDT and other
dangerous pesticides to ban them. They also used this argument for tobacco,
claiming that more studies were needed before they could be certain that
tobacco really caused lung cancer. Even the American Medical Association (AMA)
was complicit in suppressing the results of tobacco research. In 1964, when the
Surgeon General's report condemned smoking, the AMA refused to endorse it,
claiming a need for more research. What they really wanted was more money,
which they received from a consortium of tobacco companies that paid the AMA
$18 million over the next nine years during which the AMA said nothing about
the dangers of smoking.(108)
The
Journal of the American Medical Association (JAMA), "after careful
consideration of the extent to which cigarettes were used by physicians in
practice," began accepting tobacco advertisements and money in 1933. State
journals such as the New York State Journal of Medicine also began to
run advertisements for Chesterfield cigarettes that claimed cigarettes are
"Just as pure as the water you drink… and practically untouched by
human hands." In 1948, JAMA argued "more can be said
in behalf of smoking as a form of escape from tension than against it… there
does not seem to be any preponderance of evidence that would indicate the
abolition of the use of tobacco as a substance contrary to the public health."(109) Today,
scientists continue to use the excuse that more studies are needed before they
will support restricting the inordinate use of drugs.
The
Lazarou study(1)
analyzed records for prescribed medications for 33 million US hospital
admissions in 1994. It discovered 2.2 million serious injuries due to
prescribed drugs; 2.1% of inpatients experienced a serious adverse drug
reaction, 4.7% of all hospital admissions were due to a serious adverse drug
reaction, and fatal adverse drug reactions occurred in 0.19% of inpatients and
0.13% of admissions. The authors estimated that 106,000 deaths occur annually
due to adverse drug reactions.
Using
a cost analysis from a 2000 study in which the increase in hospitalization
costs per patient suffering an adverse drug reaction was $5,483, costs for the
Lazarou study's 2.2 million patients with serious drug reactions amounted to
$12 billion.(1,49)
Serious
adverse drug reactions commonly emerge after FDA approval of the drugs
involved. The safety of new agents cannot be known with certainty until a drug
has been on the market for many years.(110)
BEDSORES
Over
one million people develop bedsores in U.S. hospitals every year. It's a
tremendous burden to patients and family, and a $55 billion dollar healthcare
burden. (7)
Bedsores are preventable with proper nursing care. It is true that 50% of those
affected are in a vulnerable age group of over 70. In the elderly bedsores
carry a fourfold increase in the rate of death. The mortality rate in hospitals
for patients with bedsores is between 23% and 37%. (8) Even if we just
take the 50% of people over 70 with bedsores and the lowest mortality at 23%,
that gives us a death rate due to bedsores of 115,000. Critics will say that it
was the disease or advanced age that killed the patient, not the bedsore, but
our argument is that an early death, by denying proper care, deserves to be
counted. It is only after counting these unnecessary deaths that we can then
turn our attention to fixing the problem.
MALNUTRITION IN NURSING
HOMES
The
General Accounting Office (GAO), a special investigative branch of Congress, cited
20% of the nation's 17,000 nursing homes for violations between July 2000 and
January 2002. Many violations involved serious physical injury and death.(111)
A
report from the Coalition for Nursing Home Reform states that at least
one-third of the nation's 1.6 million nursing home residents may suffer from
malnutrition and dehydration, which hastens their death. The report calls for
adequate nursing staff to help feed patients who are not able to manage a food
tray by themselves.(11) It is difficult to place a mortality rate on
malnutrition and dehydration. The Coalition report states that malnourished
residents, compared with well-nourished hospitalized nursing home residents,
have a fivefold increase in mortality when they are admitted to a hospital.
Multiplying the one-third of 1.6 million nursing home residents who are
malnourished by a mortality rate of 20%(8,14) results in 108,800 premature deaths due to
malnutrition in nursing homes.
The
rate of nosocomial infections per 1,000 patient days rose from 7.2 in 1975 to
9.8 in 1995, a 36% jump in 20 years. Reports from more than 270 US hospitals
showed that the nosocomial infection rate itself had remained stable over the
previous 20 years, with approximately five to six hospital-acquired infections
occurring per 100 admissions, a rate of 5-6%. Due to progressively shorter
inpatient stays and the increasing number of admissions, however, the number of
infections increased. It is estimated that in 1995, nosocomial infections cost
$4.5 billion and contributed to more than 88,000 deaths, or one death every 6
minutes.(9)
The 2003 incidence of nosocomial mortality is quite probably higher than in
1995 because of the tremendous increase in antibiotic-resistant organisms.
Morbidity and Mortality Report found that nosocomial infections cost $5 billion
annually in 1999,(10) representing a $0.5 billion increase in just four
years. At this rate of increase, the current cost of nosocomial infections
would be around $5.5 billion.
Outpatient Iatrogenesis
In
a 2000 JAMA article, Dr. Barbara Starfield presents well-documented
facts that are both shocking and unassailable.(12) The U.S. ranks
12th of 13 industrialized countries when judged by 16 health status indicators.
Japan, Sweden, and Canada were first, second, and third, respectively. More
than 40 million people in the US have no health insurance, and 20-30% of
patients receive contraindicated care.
Starfield
warns that one cause of medical mistakes is overuse of technology, which may
create a "cascade effect" leading to still more treatment. She
urges the use of ICD (International Classification of Diseases) codes that have
designations such as "Drugs, Medicinal, and Biological Substances
Causing Adverse Effects in Therapeutic Use" and "Complications
of Surgical and Medical Care" to help doctors quantify and recognize
the magnitude of the medical error problem. Starfield notes that many deaths
attributable to medical error today are likely to be coded to indicate some
other cause of death. She concludes that against the backdrop of our poor
health report card compared to other Westernized countries, we should recognize
that the harmful effects of health care interventions account for a substantial
proportion of our excess deaths.
Starfield
cites Weingart's 2000 article, “Epidemiology of Medical Error,” as well
as other authors to suggest that between 4% and 18% of consecutive patients in
outpatient settings suffer an iatrogenic event leading to:
Unnecessary Surgeries
While
some 12,000 deaths occur each year from unnecessary surgeries, results from the
few studies that have measured unnecessary surgery directly indicate that for
some highly controversial operations, the proportion of unwarranted surgeries
could be as high as 30%.(74)
A
five-country survey published in the Journal of Health Affairs found
that 18-28% of people who were recently ill had suffered from a medical or drug
error in the previous two years. The study surveyed 750 recently ill adults.
The breakdown by country showed the percentages of those suffering a medical or
drug error were 18% in Britain, 23% in Australia and in New Zealand, 25% in
Canada, and 28% in the US.(113)
HEALTH INSURANCE
The
Institute of Medicine recently found that the 41 million Americans with no
health insurance have consistently worse clinical outcomes than those who are
insured, and are at increased risk for dying prematurely (114).
When
doctors bill for services they do not render, advise unnecessary tests, or
screen everyone for a rare condition, they are committing insurance fraud. The
US GAO estimated that $12 billion dollars was lost to fraudulent or unnecessary
claims in 1998, and reclaimed $480 million in judgments in that year. In 2001,
the federal government won or negotiated more than $1.7 billion in judgments,
settlements, and administrative impositions in health care fraud cases and
proceedings.(115)
One
way to measure the moral and ethical fiber of a society is by how it treats its
weakest and most vulnerable members. In some cultures, elderly people lives out
their lives in extended family settings that enable them to continue
participating in family and community affairs. American nursing homes, where
millions of our elders go to live out their final days, represent the pinnacle
of social isolation and medical abuse.
In America, approximately 1.6 million elderly are
confined to nursing homes. By 2050, that number could be 6.6 million.(11,116)
Twenty percent of all deaths from all causes occur in
nursing homes.(117)
Hip fractures are the single greatest reason for
nursing home admissions.(118)
Nursing homes represent a reservoir for
drug-resistant organisms due to overuse of antibiotics.(119)
Presenting
a report he sponsored entitled "Abuse of Residents is a Major Problem
in U.S. Nursing Homes" on July 30, 2001, Rep. Henry Waxman (D-CA) noted that “as
a society we will be judged by how we treat the elderly." The report
found one-third of the nation's approximately 17,000 nursing homes were cited
for an abuse violation in a two-year period from January 1999 to January 2001.(116) According to
Waxman, “the people who cared for us deserve better." The report
suggests that this known abuse represents only the “tip of the iceberg”
and that much more abuse occurs that we aware of or ignore.(116a) The report
found:
Dangerously
understaffed nursing homes lead to neglect, abuse, overuse of medications, and
physical restraints. In 1990, Congress mandated an exhaustive study of
nurse-to-patient ratios in nursing homes. The study was finally begun in 1998
and took four years to complete.(120) A spokesperson for The National Citizens'
Coalition for Nursing Home Reform commented on the study: “They compiled two
reports of three volumes each thoroughly documenting the number of hours of
care residents must receive from nurses and nursing assistants to avoid
painful, even dangerous, conditions such as bedsores and infections. Yet it
took the Department of Health and Human Services and Secretary Tommy Thompson
only four months to dismiss the report as ‘insufficient.'”(121) Although
preventable with proper nursing care, bedsores occur three times more commonly
in nursing homes than in acute care or veterans hospitals.(122).
Because
many nursing home patients suffer from chronic debilitating conditions, their
assumed cause of death often is unquestioned by physicians. Some studies
show that as many as 50% of deaths due to restraints, falls, suicide, homicide,
and choking in nursing homes may be covered up.(123,124) It is
possible that many nursing home deaths are instead attributed to heart disease.
In fact, researchers have found that heart disease may be over-represented in
the general population as a cause of death on death certificates by 8-24%. In
the elderly, the overreporting of heart disease as a cause of death is as much
as twofold.(125)
That
very few statistics exist concerning malnutrition in acute-care hospitals and
nursing homes demonstrates the lack of concern in this area. While a survey of
the literature turns up few US studies, one revealing US study evaluated the
nutritional status of 837 patients in a 100-bed subacute-care hospital over a
14-month period. The study found only 8% of the patients were well nourished,
while 29% were malnourished and 63% were at risk of malnutrition. As a result,
25% of the malnourished patients required readmission to an acute-care
hospital, compared to 11% of the well-nourished patients. The authors concluded
that malnutrition reached epidemic proportions in patients admitted to this
subacute-care facility.(126)
Many
studies conclude that physical restraints are an underreported and preventable
cause of death. Studies show that compared to no restraints, the use of
restraints carries a higher mortality rate and economic burden.(127-129) Studies have
found that physical restraints, including bedrails, are the cause of at least 1
in every 1,000 nursing-home deaths.(130-132)
Deaths
caused by malnutrition, dehydration, and physical restraints, however, are
rarely recorded on death certificates. Several studies reveal that nearly half
of the listed causes of death on death certificates for elderly people with
chronic or multi-system disease are inaccurate.(133) Even though 1 in
5 people die in nursing homes, an autopsy is performed in less than 1% of these
deaths.(134).
Dr.
Robert Epstein, chief medical officer of Medco Health Solutions Inc. (a unit of
Merck & Co.), conducted a study in 2003 of drug trends among the elderly.(135) He found that
seniors are going to multiple physicians, getting multiple prescriptions, and
using multiple pharmacies. Medco oversees drug-benefit plans for more than 60
million Americans, including 6.3 million seniors who received more than 160
million prescriptions. According to the study, the average senior receives 25
prescriptions each year. Among those 6.3 million seniors, a total of 7.9
million medication alerts were triggered: less than one-half that number, 3.4
million, were detected in 1999. About 2.2 million of those alerts indicated
excessive dosages unsuitable for seniors, and about 2.4 million alerts
indicated clinically inappropriate drugs for the elderly. Reuters interviewed
Kasey Thompson, director of the Center on Patient Safety at the American
Society of Health System Pharmacists, who noted: “There are serious and
systemic problems with poor continuity of care in the United States .” He
says this study represents only “the tip of the iceberg” of a national problem.
According
to Drug Benefit Trends , the average number of prescriptions dispensed
per non-Medicare HMO member per year rose 5.6% from 1999 to 2000, - from 7.1 to
7.5 prescriptions. The average number dispensed for Medicare members increased
5.5%, from 18.1 to 19.1 prescriptions.(136) The total number of prescriptions written in the
US in 2000 was 2.98 billion, or 10.4 prescriptions for every man, woman, and
child.(137)
In
a study of 818 residents of residential care facilities for the elderly, 94%
were receiving at least one medication at the time of the interview. The
average intake of medications was five per resident; the authors noted that
many of these drugs were given without a documented diagnosis justifying their
use.(138)
Seniors
and groups like the American Association for Retired Persons (AARP) are demanding
that prescription drug coverage be a basic right.(139) They have
accepted allopathic medicine's overriding assumption that aging and dying in
America must be accompanied by drugs in nursing homes and eventual
hospitalization. Seniors are given the choice of either high-cost patented
drugs or low-cost generic drugs. Drug companies attempt to keep the most
expensive drugs on the shelves and suppress access to generic drugs, despite
facing stiff fines of hundreds of millions of dollars levied by the federal
government.(140,141) In 2001, some of the world's largest drug companies were fined a
record $871 million for conspiring to increase the price of vitamins.(142)
Current
AARP recommendations for diet and nutrition assume that seniors are getting all
the nutrition they need in an average diet. At most, AARP suggests adding extra
calcium and a multivitamin and mineral supplement.(143)
Ironically,
studies also indicate underuse of proper pain medication for patients who need
it. One study evaluated pain management in a group of 13,625 cancer patients,
aged 65 and over, living in nursing homes. While almost 30% of the patients
reported pain, more than 25% received no pain relief medication, 16% received a
mild analgesic drug, 32% received a moderate analgesic drug, and 26% received
adequate pain-relieving morphine. The authors concluded that older patients and
minority patients were more likely to have their pain untreated.(144)
WHAT REMAINS TO BE
UNCOVERED
Our
ongoing research will continue to quantify the morbidity, mortality, and
financial loss due to:
*
Part of our ongoing research will be to quantify the mortality and morbidity
caused by hormone replacement therapy (HRT) since the 1940s. In December 2000,
a government scientific advisory panel recommended that synthetic estrogen be
added to the nation's list of cancer-causing agents. HRT, either synthetic
estrogen alone or combined with synthetic progesterone, is used by an estimated
13.5 to 16 million women in the US.(145) The aborted Women's Health Initiative Study (WHI)
of 2002 showed that women taking synthetic estrogen combined with synthetic
progesterone have a higher incidence of ovarian cancer, breast cancer, stroke,
and heart disease, with little evidence of osteoporosis reduction or dementia
prevention. WHI researchers, who usually never make recommendations except to
suggest more studies, advised doctors to be very cautious about prescribing HRT
to their patients.(100,146-150)
Results
of the “Million Women Study” on HRT and breast cancer in the UK were
published in medical journal The Lancet in August 2003. According to
lead author Prof. Valerie Beral, director of the Cancer Research UK
Epidemiology Unit: "We estimate that over the past decade, use of HRT by
UK women aged 50-64 has resulted in an extra 20,000 breast cancers,
estrogen-progestagen (combination) therapy accounting for 15,000 of these.”(151) We were unable
to find statistics on breast cancer, stroke, uterine cancer, or heart disease
caused by HRT used by American women. Because the US population is roughly six
times that of the UK, it is possible that 120,000 cases of breast cancer have
been caused by HRT in the past decade.
Death by Medicine (Appendix)
By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman,
MD; Debora Rasio, MD; and Dorothy Smith, PhD
OFFICE
OF TECHNOLOGY ASSESSMENT (OTA)
Health
Care Technology and Its Assessment in Eight Countries, 1995.
General Facts
Hospitals
·
In 1990, the
NIH had just begun to do meta-analysis and cost-effectiveness analysis.
Pharmaceutical and
Medical-Device Industries
Controlling Health Care
Technology
Examples
of Lack of Proper Management of HealthCare
Treatments
for Coronary Artery Disease
RAND researchers evaluated CABGS in New York in
1990. They reviewed 1,300 procedures and found 2% were inappropriate, 90% were
appropriate, and 7% were uncertain. For 1,300 angioplasties, 4% were
inappropriate and 38% uncertain. Using RAND methodologies, a panel of British
physicians rated twice as many procedures “inappropriate” as did a US panel
rating the same clinical cases. The New York numbers are in question because
New York State limits the number of surgery centers, and the per-capita supply
of cardiac surgeons in New York is about one-half of the national average.
The estimated five-year cost is $33,000 for
angioplasty and $40,000 for CABGS. Angioplasty did not lower costs, due to its
high failure rates.
Computed Tomography (CT)
Magnetic Resonance
Imaging (MRI)
Laparoscopic Surgery
Infant Mortality
Screening for Breast
Cancer
Summary
The OTA concluded: “There are no mechanisms in
place to limit dissemination of technologies regardless of their clinical value.”
Shortly after the release of this report, the OTA was disbanded.
References
LE Magazine, March 2004