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.
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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