THE MEDICAL RENAISSANCE GROUP
THE STATISTICAL EVIDENCE OF
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)
Table 1: Estimated Annual Mortality and
Economic Cost of Medical Intervention | ||||||||||||||||||||||||||||||||||||||||
|
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 | ||||||||||||||||||||||||||||||||||||
|
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 | ||||||||||||||||||||||||||||||
|
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 | ||||||||||||
|
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
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)
Table 1: Estimated Annual Mortality and
Economic Cost of Medical Intervention | ||||||||||||||||||||||||||||||||||||||||
|
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 | ||||||||||||||||||||||||||||||||||||
|
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 | ||||||||||||||||||||||||||||||
|
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 | ||||||||||||
|
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