Death by Medicine

by Gary Null, PhD;, ND; Martin Feldman, MD; Debora Rasio, MD;
Dorothy Smith, PhD, Carolyn Dean

Something is drastically wrong when regulatory agencies pretend that natural hormones and nutritional supplements are dangerous, yet ignore published statistics showing that government-sanctioned medicine is the real hazard. The statistics in this report show American medicine is the number one cause of death in the United States. Until recently, those who challenged the medical establishment could cite only isolated statistics to make its case about the dangers of conventional medicine. No one had ever analyzed and compiled all of the published literature dealing with injuries and deaths caused by government-protected medicine. A group of researchers meticulously reviewed the statistical evidence and their findings are absolutely shocking. These researchers have authored an article titled Death by Medicine that presents compelling evidence that today?'s health care system frequently causes more harm than good.
Just a cursory examination reveals alarming statistics:
Cancer Deaths (from American Cancer Society)565,000
High-Death Rate Figure (from the CDC) 445,700
Deaths from Heart Failure 292,200
Deaths from Myocardial Infarction 151,000
Deaths from Stroke 143,000

This fully referenced report reveals shockingly high numbers of people that
suffered in-hospital adverse reactions to prescribed drugs; who were
prescribed unnecessary and/or inappropriate antibiotics; who received
1
unnecessary medical and surgical procedures; and who were exposed to
unnecessary hospitalization.
The most stunning statistic, however, is that the total number of deaths
caused by conventional medicine is nearly 581,926 per year. It is now
evident that the American medical system is one of the leading causes of
death and injury in the U.S.
I am re-printing this Death by Medicine article in its entirety to call attention
to the failure of today?'s broken system. By exposing these statistics in
painstaking detail, a basis is provided for competent and compassionate
medical professionals to recognize the inadequacies of today?'s system and at
least attempt to institute meaningful reforms.
The Death by Medicine article is authored by Nutrition Institute of America
and was commissioned as an independent review of the quality of
?"government-approved?" medicine. The startling findings from this study
document that conventional medicine is failing millions of American each
year.
The Nutrition Institute of America is a nonprofit organization that has
sponsored independent research for the past 33 years. To support its bold
claim that conventional medicine is a leading killer of Americans, the
Institute mandated that every ?"count?" in this ?"indictment?" of U.S. medicine
be validated by published scientific studies and reports.
This stunning compilation of facts documents the urgent need to overhaul
how medicine is practiced in the United States. More than 500,000
Americans die each year at the hands of government-sanctioned medicine.
Yet the FDA and other government agencies pretend to protect the public by
harassing those who offer safe alternatives.

Death by Medicine
By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora
Rasio, MD; and Dorothy Smith, PhD

Introduction
2
The term iatrogenesis means deaths induced inadvertently by a physician or
surgeon or by medical treatment or diagnostic procedures.
Never before have 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.
Government not blind to its own health care deficiencies
Agencies and organizations affiliated with the federal government who
attack alternative medicine often act as their own critics. The Institute of
Medicine, a part of the United States National Academy of Sciences, states:
Health care in the United States is not as safe as it should be . . .
Among the problems that commonly occur during the course of
providing health care are adverse drug events and improper
transfusions, surgical injuries and wrong-site surgery, suicides,
restraint-related injuries or death, falls, burns, pressure ulcers, and
mistaken patient identities . . . 1a
all of which exact ?"their cost in human lives.?"1a The Institute of Medicine
even refers to ?"the nation?'s epidemic of medical errors,?"1a many of which
involve adverse drug reactions (ADRs). The U.S. Food and Drug
Administration states: ?"ADRs are one of the leading causes of morbidity and
mortality in health care.?" 1b
The Archives of Internal Medicine published ?"A Special Article?" by Curt
D. Furberg, M.D., Ph.D., et al., ?"The FDA and Drug Safety: A Proposal for
Sweeping Changes.?" The section ?"Problems with the Current System?"
begins: ?"We see 8 major problems with the current system of assessment
and assurance of drug safety at the FDA.?" The first of these states:
?"The initial review for approval often fails to detect serious ADRs.
3
A study by the US General Accounting Office (GAO) concluded that
51% of all approved drugs had at least 1 serious ADR that was not
recognized during the approval process.?"1c
The irony is that safer (and less expensive) preventive alternatives are often
attacked or strategically ridiculed by regulatory powers, even (or perhaps
especially) when proven effective. This condescending stance toward
alternatives may be fueled by their relative lack of side effects in a
competitive marketplace.
The findings revealed in this report show that the number of people having
in-hospital, adverse reactions to prescribed drugs to be approximately 2.2
million annually. The number of unnecessary and/or inappropriate
antibiotics prescribed annually is an expert estimate of 45 million per year.
The number of unnecessary medical and surgical procedures performed is
7.5 million per year. The number of people exposed to unnecessary
hospitalization is 8.9 million per year.
The most stunning statistic, however, is that the total number of deaths
caused by conventional medicine is nearly 581,926 per year. It is now
evident that the American medical system is one of the leading causes of
death and injury in the US. By contrast, the number of deaths attributable to
heart disease in 2005, the most recent year for which Final Data is available,
is 652,091, while the number of deaths attributable to cancer is 559,312. 5 ?"It
is estimated that . . . 565,650 men and women will die of cancer of all sites
in 2008,?" according to the National Cancer Institute, a projected increase of
6,338 deaths from cancer.5a
The courageous FDA doctor who blew the lid off the FDA
On November 18, 2004, David J. Graham, M.D., M.P.H., Associate Director
for Science and Medicine in the FDA?'s Office of Drug Safety, testified
before the U.S. Senate. Dr. Graham ?"graduated from the Johns Hopkins
University School of Medicine, and trained in Internal Medicine at Yale and
in adult Neurology at the University of Pennsylvania. After this, ?"he
?"completed a three-year fellowship in pharmaco-epidemiology and a
Masters in Public Health at Johns Hopkins, with a concentration in
epidemiology and biostatistics.?" 5b His education and extensive experience
qualify him to offer an expert opinion on pharmaceutical drugs.
4
Dr.Graham, who had spent 20 years working at the FDA, told the Senate:
During my career, I believe I have made a real difference for the cause
of patient safety. My research and efforts within FDA led to the
withdrawal from the US market of Omniflox, an antibiotic that caused
hemolytic anemia; Rezulin, a diabetes drug that caused acute liver
failure; Fen-Phen and Redux, weight loss drugs that caused heart
valve injury; and PPA (phenylpropanolamine), an over-the-counter
decongestant and weight loss product that caused hemorrhagic stroke
in young women.5b
My research also led to the withdrawal from outpatient use of Trovan,
an antibiotic that caused acute liver failure and death. I also
contributed to the team effort that led to the withdrawal of Lotronex, a
drug for irritable bowel syndrome that causes ischemic colitis; Baycol,
a cholesterol-lowering drug that caused severe muscle injury, kidney
failure and death; Seldane, an antihistamine that caused heart
arrhythmias and death; and Propulsid, a drug for night-time heartburn
that caused heart arrythmias and death. 5b
I have done extensive work concerning the issue of pregnancy
exposure to Accutane, a drug that is used to treat acne but can cause
birth defects in some children who are exposed in-utero if their
mothers take the drug during the first trimester. During my career, I
have recommended the market withdrawal of 12 drugs. Only 2 of
these remain on the market today--Accutane and Arava, a drug for the
treatment of rheumatoid arthritis that I and a co-worker believe causes
an unacceptably high risk of acute liver failure and death.5b
?"Merck & Co. and the Food and Drug Administration knew before the
agency approved the company's Vioxx painkiller in 1999 that the drug could
have serious adverse effects on the heart, witnesses told a powerful Senate
panel [on November 18, 2004]. But the FDA gave its approval without
resolving the concerns, and Vioxx was aggressively marketed to point up its
pain relief qualities, not its risks.?" 5e Testifying about Merck?'s Vioxx, Dr.
Graham states:
Today . . . you, we, are faced with what may be the single greatest
drug safety catastrophe in the history of this country or the history of
the world. We are talking about a catastrophe that I strongly believe
5
could have, should have been largely or completely avoided. But it
wasn?'t, and over 100,000 Americans have paid dearly for this failure.
In my opinion, the FDA has let the American people down, and sadly,
betrayed a public trust.5b
Much as the FDA attempts to quash vitamins, they allegedly attempted to
suppress research, presumably to keep Vioxx and other drugs afloat,
according to Dr. Graham. ?"[N]ot only did the FDA ignore known risks from
Vioxx and related drugs but . . .it tried to prevent Graham and others from
publicizing their own research that proved the extent of these risks.?" 5c
When it comes to new medications, Attorney Blake Bailey observes, ?"The
FDA . . . uses the studies of the companies who stand to gain billions of
dollars and are under intense pressure to beat a competing company to make
it to the market with a similar product. Many of the scientists and medical
doctors go to work for these companies after a tenure with FDA.?"5d Dr.
Graham made it clear in his testimony that, throughout his career, he had
only worked for the FDA, 5b not for any companies. ?"Committee Chairman
Charles E. Grassley (R-Iowa) said he was concerned that the FDA ?'has a
relationship with drug companies that is too cozy.?'?"5e "Sen. Jeff Bingaman,
D-New Mexico, said the problem was within the FDA's own culture.
?'The culture within the FDA, being one where the pharmaceutical industry,
which the FDA is supposed to regulate, is seen by the FDA as its client
instead,?' he said.?" 5f
?"In Graham?'s view, the drug safety problems began in 1992 with the passage
of a law aimed at getting lifesaving drugs onto the market faster. To speed
up approvals, the law forced pharmaceutical companies to foot most of the
bill for the review process. That left the FDA ?'captured by industry,?' says
Graham. ?'He who pays the piper calls the tune.?'?"5h
?"Edward J. Markey (D-Massachusetts) noted that a 2006 survey conducted
by the Union of Concerned Scientists reported that 18.4% of FDA scientists
surveyed reported that they had been asked to inappropriately exclude or
alter technical information or their conclusions in an FDA scientific
document.?"5g
The American Society of Health-System Pharmacists reports that Graham
testified ?"in February [2007] that, had it not been for the protection of
6
Senator Charles Grassley (R-Iowa), FDA would have fired him for publicly
speaking out about his concerns about Vioxx and other drugs.?"5g
Dr. Graham says, "You need to weed the garden patch of drugs that aren't
doing what they're supposed to do. The FDA has not been very good about
that; it likes to cultivate all these weeds.?" 5j Dr. Graham ?"named five other
drugs whose safety is suspect, and noted that ?'the FDA as currently
configured is incapable of protecting America against another Vioxx.?'?"5b
(Many media sources, such as the Los Angeles Times and Medscape
Medical News,(5h) that were present in the court, report that Graham then
added, ?"We are virtually defenseless,?"5e, but this sentence does not appear
in the final transcript and may have been stricken from the record. One
report begins, ?"The American public is ?'virtually defenseless' if another
medication such as Vioxx proves to be unsafe after it is approved for sale, a
government drug safety reviewer told a congressional committee.?"5i) Yet
the FDA crusades to prevent us from taking dandelion root.
Natural medicine is under siege, as pharmaceutical company lobbyists urge
lawmakers to deprive Americans of the benefits of dietary supplements and
bioidentical hormones. 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, we present this independent review
of the quality of ?"government-approved?" medicine.
What you will read is a stunning compilation of facts that documents that
those who seek to abolish consumer access to natural therapies are
misleading the public. Nearly 581,926 Americans die each year at the hands
of government-sanctioned medicine, while the FDA and other government
agencies harass 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.
7
Each year at least 2.2 million US hospital patients experience adverse drug
reactions (ADRs) to prescribed medications.6 The FDA acknowledges that
(compared with IOM data), studies
conducted on hospitalized patient populations have placed much
higher estimates on the overall incidence of serious ADRs. These
studies (6) estimate that 6.7% of hospitalized patients have a serious
adverse drug reaction with a fatality rate of 0.32%. 6
If these estimates are correct, then there are more than 2,216,000
serious ADRs in hospitalized patients, causing over 106,000 deaths
annually. . . . These statistics do not include the number of ADRs
that occur in ambulatory settings. Also, it is estimated that over
350,000 ADRs occur in U.S. nursing homes each year. 6a The exact
number of ADRs is not certain and is limited by methodological
considerations. However, whatever the true number is, ADRs
represent a significant public health problem that is, for the most part,
preventable.?" 1b
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.7,8
In 2005, Dr. Philip Tierno, director of clinical microbiology and
immunology at New York University Medical Center said that each year
?"about 90 million antibiotic prescriptions are written and about half of those
are either unnecessary or inappropriate, which is the leading cause of
antibiotic resistance in America.?" 8a
In October 2008, Dr. Lauri Hicks, medical director of the CDC?'s Get
Smart: Know When Antibiotics Work program warns: ?"Antibiotic overuse
is a serious problem and a threat to everyone?s health.?" The CDC reports,
?"[U]pper respiratory tract infections usually caused by viruses . . . can?t be
cured with antibiotics. Yet, each year, health care providers in the U.S.
prescribe tens of millions of antibiotics for viral infections.?" Dr. Hicks
explains, ?"Taking antibiotics when you don?t need them or not as prescribed
increases your risk of getting an infection later that resists antibiotic
treatment.?"8b
8
The CDC announces, ?"To bring attention to this increasing problem,?" they
would initiate ?"Get Smart About Antibiotics Week October 6-10, 2008, a
campaign to educate the public (8b) and, by implication, to sensitize
physicians to the danger of over-prescribing, a practice that has been
building with impunity for many years, but which can no longer be readily
tolerated.
Approximately 7.5 million unnecessary medical and surgical procedures are
performed annually in the US,9,10 while approximately 8.9 million
Americans are hospitalized unnecessarily.1-4 The National Coalition on
Health Care states, ?"The Institute of Medicine estimates that nearly 100,000
patients die in hospitals each year due to medical errors. This is three times
the number who die on the highways.?"17e
Deaths from nosocomial infections have risen from 88,000 (16,17) to 99,000
per year in 2002 (17a). The CDC website notes,?"A new report from CDC
updates previous estimates of healthcare-associated infections. In American
hospitals alone, healthcare-associated infections [HAIs] account for an
estimated 1.7 million infections and 99,000 associated deaths each year.?"17a
The CDC original report states: ?"In 2002, the estimated number of HAIs in
U.S. hospitals, adjusted to include federal facilities, was approximately 1.7
million: 33,269 HAIs among newborns in high-risk nurseries, 19,059 among
newborns in well-baby nurseries, 417,946 among adults and children in
ICUs, and 1,266,851 among adults and children outside of ICUs. The
estimated deaths associated with HAIs in U.S. hospitals were 98,987: of
these, 35,967 were for pneumonia, 30,665 for bloodstream infections,
13,088 for urinary tract infections, 8,205 for surgical site infections, and
11,062 for infections of other sites.?"17b.
Table 1: Estimated Annual Mortality and Cost of Medical Intervention
Condition Deaths Cost Author
Hospital Adverse Drug
Reactions 106,000+ $ 2 billion+ Lazarou (6), Suh (11) , FDA (1B)
Hospital Medical Errors 98,000 $2 billion IOM (1a), (12), (13)
Hospital Bedsores 17,160 $ 90 billion Xakellis (14), Barczak (15),
Health Grades(153)
9
Hospital Infections 88,000 $5 billion CDC(17a), Weinstein (16),
MMWR(17)
Nursing
Homes/Malnutrition 4,630 -----------
Coalition for Nursing
Home Reform (18)
Consumer Affairs(154)
Outpatient Adverse Drug
Reactions 199,000 $77 billion Starfield(19,20), Weingart(21)
Unnecessary Surgical
Procedures 37,136 $30 billion HCUP(3,13) Leape(81)
Surgery-Related 32,000 $9 billion AHRQ per Zhan and Miller
(92)
Total 581,926+ $215 billion +
Estimtated Annual Mortality and Economic Cost of Medical Intervention
As shown in Table 1, 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 at least 581,926.
It is evident that the American medical system is itself one of the leading
causes of death and injury in the US. By comparison, approximately
652,091Americans died of heart disease in 2005, while 559,312 died of
cancer.5
The mortality costs alone exceed $215 billion a year. ?"Health care costs in
the United States are growing at an unsustainable rate,?" according to Senator
Ron Wyden, who serves on the Senate?'s Finance Committee, Subcommittee
on Health Care.17c
The National Coalition on Health Care reports, ?"Annual health care
spending in the U.S. has been increasing two to five times the rate of
inflation since 2000.?"17d ?"In 2006, Americans spent more than $2.2 trillion
on health care.?"17c ?"Total spending was $2.4 trillion in 2007, or $7900 per
person. Total health care spending represented 17 percent of the gross
domestic product (GDP).?"17f ?"In 2008, health care spending in the United
States [again] reached $2.4 trillion,?"17f [?"about 4.3 times the amount spent
on national defense?"17e] ?"and was projected to reach $3.1 trillion in
2012.?"17f
The National Coalition on Health Care further states: ?"It is estimated that we
have spent as a nation nearly 16 trillion dollars on health care since 2000,
but this expenditure has not resulted in demonstrably better quality of care or
10
better patient satisfaction compared to other nations.?" 17e
Using Dr. Lucian L. Leape?'s 1997 medical and drug error rate of 3 million
(24) multiplied by the 14% fatality rate he used in 1994 (25) produces an
annual death rate of 420,000 for drug errors and medical errors combined.
Using this number instead of Lazarou?'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 797,926 deaths annually, as shown in
Table 2.
?"In the past, medicine was ?'simple, relatively safe, and ineffective,?' . . . ?'But
today medicine is complicated ?— . . . which has made it less safe, and it is
still ineffective,?'" according to Dr. Leape. 25a Emergency Medicine helps
many.
Unnecessary medical events, including pointless hospitalization, are
important in our analysis. These events are among the most lamentable in all
of medicine. They are usually preventable. Any invasive inappropriate
medical procedure puts a patient at risk for an iatrogenic cascade of injuries,
possibly death. Unfortunately, cause and effect go unmonitored.
?"At least 150 times [in the seven years between 1996 and 2003], surgeons in
American hospitals have operated on the wrong arm, leg, eye or other body
part.?"25b Do not imagine that hospitals viewed as role models for research
and fine clinical care are perfect. Memorial Sloan-Kettering Cancer Center
in New York City ?"advertises that it delivers the best cancer care anywhere.
But in 1995, its chief neurosurgeon operated on the wrong side of a patient?'s
brain in part because of a mix-up in X-rays.?" 25b?"Lapses in basic quality
checks and ordinary standards of patient care led to most of the mishaps.?"
25b
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 344,400) of a
serious adverse drug reaction (6)
11
? In 16.4 million people, a 5-6% chance (affecting 902,000) of
acquiring a nosocomial infection (16)
? In 16.4 million people, a 4-36% chance (affecting between 656,000
and 5.9 million) of having an iatrogenic injury (medical error or
adverse drug reactions) (25)
? In 16.4 million people, a 17% chance (affecting 2.8 million) of a
procedure error (50)
Table 1: Estimated Annual Mortality and Economic Cost of Medical
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 2: Estimated 10-Year Death Rates from Medical Intervention
Condition 10YearDeaths Reference
Hospital Adverse Drug
Reaction 1.06 million +
Lazarou(6), FDA(1b)
Hospital Medical
Error 0.98 million IOM(1a), (12), (13)
Hospital Bedsores 1.15 million
Xakellis(14),Barczak (15)
Hospital Infection 0.88 million
CDC(17a), Weinstein (16),
MMWR(17)
Nursing
Home/Malnutrition 1.09 million Coalition for Nursing Home
Reform (18)
Outpatients 1.99 million
Starfield(19,20),
Weingart(21)
12
Unnecessary
Procedures
371,360
HCUP(22)
Surgery-related 320,000
AHRQ per Zhan and Miller
(92)
Total 7,841,368 +
Our estimated 10-year total of 7.84 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 are also striking. 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.
Table 3: Estimated 10-Year Unnecessary Medical Events
Unnecessary Events 10-year Number Iatrogenic Events
Hospitalization 89 million (1-4) 17 million
Procedures 75 million (9, 10, 22) 15 million
Total 164 million
IS AMERICAN MEDICINE WORKING?
US health care spending reached $1.6 trillion in 2003, representing 14% of
the nation?'s gross national product.26 When spending rose to $2.4 trillion
per year in 2007, it would represent ?"17% of the gross domestic product.?"
17f Considering this enormous expenditure, which occurred in 2008 as well,
17f 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
13
missing the larger picture. Medicine is not taking into consideration the
following critically important aspects of a healthy human organism:
? stress and how it adversely affects the immune system and life processes
? insufficient exercise
? excessive caloric intake
? highly processed and denatured foods grown in denatured and chemically
damaged soil
? 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, as evidenced by efforts to curtail use of
effective vitamins and bioidentical hormones. The recent article, ?"U.S.
spends $700 billion on unnecessary medical tests,?" which appears in
Healthcare Economist, reflects the state of our techno-med nation:
?'Peter Orszag, director of the Congressional Budget Office,
estimates that 5 percent of the nation?'s gross domestic product-?—
$700 billion per year ?–goes to tests and procedures that do not actually
improve health outcomes?…The unreasonably high cost of health care
in the United States is a deeply entrenched problem that must be
attacked at its root.?' This quotation comes from a Progressive Policy
Institute (PPI) report. There is little doubt that much of health care
is unnecessary or at least is not worthwhile in the cost-benefit
sense.26a
?"Some medical experts say the American devotion to the newest, most
expensive technology is an important reason that the United States spends
much more on health care than other industrialized nations ----- . . . without
providing better care. ?…[A] Rand Corporation study estimated that one-third
or more of the care that patients in this country receive could be of little
value. If that is so, hundreds of billions of dollars each year are being wasted
on superfluous treatments.?" 26b
?"[A] much larger trend in American medicine?" appears. ?"A faith in
innovation, often driven by [quick] financial incentives, encourages
14
American doctors and hospitals to adopt new technologies even without
proof that they work better than older techniques.?"26b ?"The problem is not
that newer treatments never work. It is that once they become available, [too
often prematurely], they are often used indiscriminately, in the absence of
studies to determine which patients they will benefit.?"26b ?"And sometimes,
the new technologies prove harmful.?"26b Some ?" doctors in private practice
who own their [CT] scanners, use the tests aggressively,?"26b as if it were ?"a
new toy in the office,?"26b endangering asymptomatic patients for whom the
scan may be inappropriate.26b
To determine whether American medicine is working, we also need to know
if enough people have access to the American health care system:
? The National Coalition on Health Care reports, ?"Nearly 46 million
Americans, or 18 percent of the population under the age of 65, were
without health insurance in 2007, the latest government data
available.?" 26c As of September 2007, ?"one out of three Americans?"
was ?"uninsured.?"26c, 26d This number is apt to rise sharply for 2008
and 2009 because so many Americans are losing their jobs in the
recession.
? ?"The number of uninsured children in 2007 was 8.1 million ?– or 10.7
percent of all children in the U.S.?" 26c
? ?"The large majority of the uninsured (80 percent) are native or
naturalized citizens.?"25c
? ?"The number of uninsured rose 2.2 million between 2005 and 2006
and has increased by almost 8 million people since 2000.?" 26c
? ?"A study found that 29 percent of people who had health insurance
were ?"underinsured?" with coverage so meager they often postponed
medical care because of costs. Nearly 50 percent overall, and 43
percent of people with health coverage, said they were ?'somewhat?' to
?'completely?' unprepared to cope with a costly medical emergency
over the coming year.?" 26c
The National Coalition on Health Care advises, ?"Getting everyone covered
will save lives and money. The impacts of going uninsured are clear and
severe. Many uninsured individuals postpone needed medical care which
15
results in increased mortality and billions of dollars lost in productivity and
increased expenses to the health care system.?" 26c
The Los Angeles Times almost waxes poetic about health care insurance as
journalist Ricardo Alonso-Zaldivar observes, ?"Some people marry for love,
some for companionship, and others for status or money. Now comes
another reason to get hitched: health insurance.?" 26e
A poll of 2,003 adults released on April 27, 2008 (on the cusp of our
economic recession) by the Kaiser Family Foundation found that ?"7% of
Americans said they or someone in their household decided to marry in the
last year so they could get healthcare benefits via their spouse.?" 26e Not
surprisingly, ?"Those who cited health insurance as a factor in deciding to
marry tended to have modest incomes. About 6 in 10 were in households
making less than $50,000 a year, said Mollyann Brodie, who directs Kaiser?'s
opinion research.?"26e
?"What surprised researchers was that such costs had become a factor in
marriage decisions. ?'We should have asked about divorce,?'?" said Drew E.
Altman, president of the Kaiser Family Foundation, ?"joking.?" 26e
UNDERREPORTING OF IATROGENIC EVENTS
As few as 5% and no more than 20% of iatrogenic events are ever
reported.25,27-30 This implies that if medical errors were completely and
accurately reported, we would have an annual iatrogenic death toll much
higher than 581,926+. 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.25 Our considerably higher figure is equivalent to
six jumbo jets 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.
16
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.
For example, a 2003 study found that nearly half of medical school faculty
who serve on institutional review boards (IRBs) to advise on clinical trial
research also serve as consultants to the pharmaceutical industry.31 The
study authors were concerned that such representation could cause potential
conflicts of interest. In a news release, Dr. Erik Campbell, the lead author,
wrote, ?"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.?"32 The
public is mostly unaware of these interlocking interests.
Government medical advisors play a role in adequate reporting of iatrogenic
events. The FDA announced in March 2007:
Expert advisers to the government who receive money from a drug or
device maker would be barred for the first time from voting on
whether to approve that company?'s products under new rules . . . for
the FDA?'s powerful advisory committees. Indeed, such doctors who
receive more than $50,000 from a company or a competitor whose
product is being discussed would no longer be allowed to serve on the
committees, though those who receive less than that amount in the
prior year can join a committee and participate in its discussions. A
?'significant number?' of the agency?'s present advisers would be
affected by the new policy, said the F.D.A. acting deputy
commissioner, Randall W. Lutter, though he would not say how
many.32a
17
MEDICAL ETHICS AND CONFLICT OF INTEREST IN
SCIENTIFIC MEDICINE
Jonathan Quick, director of essential drugs and medicines policy for the
World Health Organization (WHO), wrote in a 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.?"33
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 wrote that growing conflicts of interest are
tainting science and called for stronger restrictions on pharmaceutical stock
ownership and other financial incentives for researchers:34 ?"When the
boundaries between industry and academic medicine become as blurred as
they are now,?" Angell wrote, ?"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.35 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, in 1996 published
Tainted Truth: The Manipulation of Fact in America, a book about the
18
widespread practice of lying with statistics.36 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 1981,
the drug industry ?"gave?" $292 million to colleges and universities for
research. By 1991, this figure had risen to $2.1 billion. "?'Universities have
been treading on dangerous ground with their increasingly complex financial
ties to industry,?' said Jerome Kassirer, former editor of the New England
Journal of Medicine [quoted above]. ?'They are worried that these things
could ultimately affect their tax-free status,?'" Dr. Kassirer said in September
2008.36a
In September 2008, ?"The Wall Street Journal reported that Chair of
the Senate Finance Committee Sen. Chuck Grassley . . . confronted about 20
universities across the nation, including Brown, Harvard and Stanford for
failing to publicize additional grants obtained from drug makers.?"36b
The university is not the only venue for pharmaco-gifts. "Right now
the public has no way to know whether a doctor's been given money that
might affect prescribing habits," Grassley said. 36c Sen. Grassley continues
in these excerpts from ?"Floor Statement of U.S. Senator Chuck Grassley
of Iowa Ranking Member of the Committee on Finance Introduction of
the Physician Payments Sunshine Act Thursday, September 6, 2007" for
public disclosure of payments to physicians:
?'Payments to a doctor can be big or small. They can be a simple
dinner after work or they can add up to tens of thousands and even
hundreds of thousands of dollars each year. That's right -- hundreds of
thousands of dollars for one doctor. It's really pretty shocking.
Companies wouldn't be paying this money unless it had a direct effect
on the prescriptions doctors write, and the medical devices they use.
Patients, of course, are in the dark about whether their doctor is
receiving this money.?'36c
?'This practice, and the lack of transparency around it, can obscure the
most important question that exists between doctor and patient: what
is best for the patient??'36c
19
THE FIRST IATROGENIC STUDY
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).25 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
1991,37 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 US, 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 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
20
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.?"27
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.24
21
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 1994.25 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.
ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED
"If the medical system were a bank, you wouldn't deposit your money
here, because there would be an error every one in two to one in three
times you made a transaction."
Stephen Persell, M.D.
Northwestern University's Feinberg School of Medicine 24a
In 1994, Leape said he was well aware that medical errors were not being
reported.25 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.28
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.38
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 conservative figures.
An article in Psychiatric Times (April 2000) outlines the stakes involved in
reporting medical errors.39 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.
22
Janet Heinrich, an associate director at the US 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.39 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.40
Standard medical pharmacology texts admit that relatively few doctors ever
report adverse drug reactions to the FDA.41 The reasons range from not
knowing such a reporting system exists to fear of being sued.42 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.?"43
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.44
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.29
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.?"30 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.45
23
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 do not 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.46
In their article, ?"Underreporting of medical errors affecting children is a
significant problem, particularly among physicians,?" the Agency for
Healthcare Research (AHRQ) reports that a study in 2004, in Pediatrics,
discovered that most medical errors made by nurses and physicians treating
children are never reported. 46a, 46b
On February 17, 2008, Indiana University School of Medicine aired a
revealing radio interview with Lauris Kaldjian, M.D., Ph.D., Dept. of
Internal Medicine and Program in Biomedical Ethics, University of Iowa
Roy J. and Lucille A. Carver College of Medicine, Iowa City, ?"Doctors
Don't Report Medical Errors.?" A question is posed. ?"Let's say you?'re a
doctor -- a heart surgeon. And you make a mistake. Maybe you prescribe the
wrong medicine. Maybe you cut something you're not supposed to. And it
might not be a big deal. But then again, it might. The question is: do you
admit your mistake and report it to the higher ups??"46c
?"Lauris Kaldjian directs the bioethics program at the University of Iowa.
According to his recent study, the answer to that question is probably no.
Most doctors he surveyed agree in theory that's it's a good thing to report
medical errors. But few actually do it.?"46c Dr. Kaldjian?'s report on medical
errors appears in the January 14, 2008 issue of the Archives of Internal
Medicine.
PUBLIC SUGGESTIONS ON IATROGENESIS
In a telephone survey, 1,207 adults ranked the effectiveness of the following
measures in reducing preventable medical errors that result in serious
24
harm.47 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%).
Various initiatives are under way to address these problems. The Patient
Safety and Quality Improvement Act of 2005, Pub L109-41, signed into law
on July 29, 2005,47a ?"was enacted in response to growing concern about
patient safety in the United States . . . The goal of the Act is to improve
patient safety by encouraging voluntary and confidential reporting of events
that adversely affect patients.?"47b The success of this legislation will
depend in large part upon the willingness of health care providers to reveal
errors of colleagues, as well as their own in a challenging medical
environment that reveres the concept of accuracy.
A new specialty in modern medicine that is developing in part from
the focus on the need for improved quality of hospital care is Hospital
Medicine that trains physicians as ?"hospitalists?" to devote themselves to the
safety of hospital patients. These would be the doctors referred to above
?"specially trained in intensive care medicine on intensive care units.?" These
would also be the physicians who are there to relieve doctors in training
whose shifts may now be limited to combat fatigue and reduce errors. In
2009, The American Board of Hospital Medicine (ABHM), was founded as
the first board of certification for hospital medicine in North America. The
specialized training of ?"hospitalists?" and increase in their future numbers
may enable them to spend more time with patients, which appears to be a
priority with the public. There are campaigns to increase the number of
hospital nurses and to educate them regarding hospital errors.
25
DRUG IATROGENESIS
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 study6 showed.
But human error can make the situation even worse.
On December 10, 2007, the headline read: ?"The Quaid Twins 'Fighting
for Their Lives': Dennis and Kimberly Quaid Keep Vigil as Their Newborns
Struggle to Survive a Devastating Hospital Error That Resulted in an
Overdose of Blood Thinner.?"47d ?"[T]he twins were hospitalized at Cedars-
Sinai [Medical Center in L.A.] due to staph infections-- . . .At the hospital on
Nov. 18, [2007] they were allegedly among three patients given 1,000 times
the recommended dose of heparin, a drug used to prevent IV catheters from
clotting. The dosage was high enough to cause severe bleeding and death if
left untreated.?"47c
Infant care, famous parents, renowned hospital. How could such a thing
happen? you may ask. That is what The Patient Safety and Quality
Improvement Act of 2005 is in place to discover.
Drug iatrogenesis may also include anesthesia. Fatal anesthesia errors still
occur:
Major complications of spinals and epidurals include damage to
nerves or the spinal cord by infection (meningitis and abscess),
bleeding and blood clots (haematoma), direct damage to the nerves
(needle injury or chemical injury) and poor blood supply to the spinal
cord (ischaemia). All can cause permanent nerve injury including
paralysis. A further complication occurs when a 'drug switch' or 'route
switch' occurs: either the wrong dug is delivered as an epidural or
spinal (drug switch) or a drug that should have been administered
intravenously is used in as an epidural or spinal, or vice versa (route
26
switch). The sensitivity of the nervous system and the type of drugs
used means these mistakes can be fatal. 47d
?"Although anesthesia is considered very safe, it is not risk free. . . .
Uncommon complications include chest infections and difficulty breathing,
damage to teeth, lips or tongue, and awareness under general anesthesia. . . .
The rare and very rare complications of anesthesia include damage to the
eyes, serious allergic reactions to medications, nerve damage, equipment
failure and death.?" 47e
?"Deaths caused solely by anesthesia are very rare, and are usually the result
of several serious complications together,?" such as allergies, ?"your previous
medical conditions, your body size, your surgical procedure, and your habits
like smoking,?" all of which may ?"influence the risks of certain
complications.?" ?"Risk cannot be completely avoided, but the combination
of your anesthesia professional's training, modern [sterilized] equipment
used to deliver anesthesia and monitor your condition, and modern
medications have made anesthesia a much safer procedure in recent
years.?"47e
MEDICATION ERRORS
A survey of a 1992 national pharmacy database found a total of 429,827
medication errors in 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.48
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-bed hospital, the number of errors per
day was 40.49 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 417,908.50
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
27
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%.6
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 2002.51 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.?"52
William Tierney, who editorialized on the New England Journal study,
wrote, ?"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 calciumchannel
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.
In 2004, the world pharmaceutical market did $550 billion in sales; the
U.S.market accounted for 48% of that total, which was $248 billion. The
U.S. sold nearly half of the world?'s total of prescription drugs. 52a
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.
28
Moreover, a whole generation of antidepressant users has been created from
young people growing up on Ritalin®. Medicating young people 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.?"53 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.
You cannot turn on T.V. without hearing a pitch for drugs for social anxiety,
depression, or lethargy. Note that when they tell you the side effects, they
often show a pastoral scene of beauty, or a joyful activity, at the same time,
so you will equate the obligatory warning of danger with a pleasant memory.
Doctors (not just consumers) are bombarded with psychoactive
pharmaceutical propaganda, so they will prescribe certain drug products:
In 2006 money from the pharmaceutical industry accounted for about
30 percent of the [American Psychiatric] association?'s $62.5 million
in financing. About half of that money went to drug advertisements in
psychiatric journals and exhibits at the annual meeting, and the other
half to sponsor fellowships, conferences and industry symposiums at
the annual meeting. 5d
TELEVISION DIAGNOSIS
To reach the widest audience possible, drug companies no longer just target
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.54 This $2.5 billion represents only 15% of the
total pharmaceutical advertising budget.
29
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.55 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.?"55
?"In 2004, pharmaceutical manufacturers spent an estimated $4.15 billion on
direct-to-consumer advertising, according to IMS Health.?"55a There are
those who surmise that consumers are paying for these expensive ads when
they buy medications that cost much more than they are worth.
A finding of a national survey of 643 physicians by Harvard?'s Dr. Joel
Weissman, et al. found that ?"direct-to-consumer advertising (DTCA) led
patients to seek unnecessary treatments.?" 55b
In 2004, Americans spent $188.5 billion on prescription medications, which
was more than 4 ½ times the $40.3 billion spent in 1990. 55c
Dr. David Graham of the FDA?'s Center for Drug Evaluation and Research
warns, ?"Direct-to-consumer advertising in general is a great disservice to the
American people. We see wonderful ads of people demonstrating their
health, whether they're skating across the ice or doing their Tai Chi. Madison
Avenue knows that a picture is worth a thousand words, so they convey an
image, a message, and it makes an impression on patients and on physicians.
It creates needs or desires where there really isn't a need or a desire.?"5j
?"There was a recent study in The Journal of The American Medical
Association that showed that if patients mentioned a drug that they've seen
on television to their physician they were much more likely to be prescribed
that drug by the doctor. Drug companies know this. That's why they do it.
. . .Clearly, direct-to-consumer advertising does not serve the American
people well.?"5j
30
HOW DO WE KNOW DRUGS ARE SAFE?
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.?"56
NBC News?' 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.57
The leading causes of adverse drug reactions are antibiotics (17%),
cardiovascular drugs (17%), chemotherapy (15%), and analgesics and antiinflammatory
agents (15%).11
SPECIFIC DRUG IATROGENESIS: ANTIBIOTICS
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.58 Of this
31
amount, 25 million pounds are used in animal husbandry and 23 million
pounds are used to try to prevent disease and promote growth. Only 2
million pounds are given for specific animal infections. Dr. Agger 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.
Agger contends that overuse of antibiotics results in food-borne infections
that are 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 antisalmonella 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. Agger 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. Agger says that exposure to a steady stream of antibiotics has altered
pathogens such as Streptococcus pneumoniae, Staphylococcus aureus, and
entercocci, to name a few.
Almost half of patients with upper respiratory tract infections in the US still
receive antibiotics from their doctors,59 which is inappropriate in most
cases. In Germany, the prevalence of systemic antibiotic use in children aged
0-6 years was 42.9%.60
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.
32
Antibiotic use in children aged 3 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.61 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 broadspectrum
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.62 Antibiotics being prescribed in 73% of sore-throat cases
instead of the recommended 10% resulted in a total of 4.2 million
unnecessary antibiotic prescriptions for sore throats alone from 1989 to
1999.
THE PROBLEM WITH ANTIBIOTICS
In September 2003, the CDC re-launched a program started in 1995 called
?"Get Smart: Know When Antibiotics Work.?"63 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 prescriptions for antibiotics written each
year in physicians?' offices are inappropriate.7,8 Using antibiotics when not
needed can lead to the development of deadly strains of bacteria that are
resistant to drugs.16
33
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, then head of the ?"Get Smart?" program to
educate patients about proper antibiotic use, ?"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.?"64
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 garlic, vitamin C, lactoferrin, elderberry,
vitamin A, zinc, or DHEA? 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.65 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, or to the thousands of journal articles that support this
approach. This tunnel vision and refusal to recommend the available nondrug
alternatives is unfortunate when the CDC is desperately trying to curb
the overuse of antibiotics.
The AHRQ reports that currently, ?"The most common HAI [Health careassociated
infection] agent is methicillin-resistant Staphylococcus aureus
(MRSA).?"65a
DRUGS POLLUTE OUR WATER SUPPLY
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
34
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.66-74
SPECIFIC DRUG IATROGENESIS: NSAIDS
It is not only 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 in serious
adverse reactions among commonly prescribed drugs. The study results
suggest that GPs do not have adequate knowledge of these drugs and are
unable to effectively manage the adverse reactions.75
A cross-sectional survey of 125 patients attending specialty pain clinics in
South London found that possible iatrogenic factors such as ?"overinvestigation,
inappropriate information, and advice given to patients as well
as misdiagnosis, over-treatment, and inappropriate prescription of
medication were common.?"76
In 2003, J.S. Hochman, M.D., Executive Director of the National
Foundation for the Treatment of Pain, referring to NSAID-related deaths as
a ?"silent epidemic,?" wrote:
It has been estimated conservatively that 16,500 NSAID-related
deaths occur among patients with rheumatoid arthritis or osteoarthritis
every year in the United States. This figure is similar to the number
of deaths from the acquired immunodeficiency syndrome and
considerably greater than the number of deaths from multiple
myeloma, asthma, cervical cancer, or Hodgkin?'s disease. 76a
66,000 people were killed over a 10-year period during the Viet Nam War.
More people are killed by NSAIDs in one year (16,500 deaths) than were
killed in any two years of the Viet Nam War. In ten years, NSAIDS kills
165,000 people. NSAIDS kills 2.5 times as many people in a 10-year period
as were killed in the ten years of the Viet NamWar.
35
In 2003, the British Medical Journal 76b warned that women who took
NSAIDs ?"--painkillers like Advil, Motrin and Naprosyn ?– had an 80 percent
higher risk of miscarriage than women who avoided these
medications,?"76b,76c ?"The risk increased if such painkillers were taken
shortly before or after conception, or for longer than one week.?" 76c
On September 30, 2004, Merck announced ?"a voluntary worldwide
withdrawal of VIOXX (rofecoxib), its arthritis and acute pain medication.?"
Merck announces voluntary worldwide withdrawal of VIOXX.76d ?"due to
safety concerns of an increased risk of cardiovascular events (including heart
attack and stroke) in patients on rofecoxib. Rofecoxib is a prescription
COX-2 selective, non-steroidal anti-inflammatory drug (NSAID) that was
approved by the FDA in May 1999.?"76d ?"It was later approved for the
relief of the signs and symptoms of rheumatoid arthritis in adults and
children.?" 76e This means that children were exposed to this dangerous
drug.
The Lancet carried the following article in its first issue of December 2004,
?"Risk of cardiovascular events and rofecoxib: cumulative meta-analysis,?"
which finds that ?"rofecoxib should have been withdrawn several years
earlier. The reasons why manufacturer and drug licensing authorities did
not continuously monitor and summarise the accumulating evidence need to
be clarified.?" 76f
The NSAID ?"Vioxx was withdrawn after evidence came to light that it
almost doubled the risk of heart attacks and stroke in people who had been
taking it for 18 months.?"76g FDA researcher Dr. David Graham,
testifying before the US Senate, estimated 88,000 to 138,000 Americans had
heart attacks or strokes as a side effect of Vioxx. 5b "Of these," Graham
said, ?"30-40% probably died.?"5b ?"That would be an estimated 27,000 to
55,000 preventable deaths attributed to Vioxx.?"76h
Dr. Graham continues his Senate testimony, ?"If there were an average of
150 to 200 people on an aircraft, this range of 88,000 to 138,000 would be
the rough equivalent of 500 to 900 aircraft dropping from the sky. This
translates to 2-4 aircraft every week, week in and week out, for the past 5
years.?"5b
36
SPECIFIC DRUG IATROGENESIS: CANCER CHEMOTHERAPY
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.77 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 most patients with advanced carcinoma.
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,78 with even a slightly lower survival rate for the
HDC/SCT group.
Serious adverse effects occurred more often in the HDC group than in 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 cancersurvival
statistics since 1989. In fact, research should be conducted to
37
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.
Until now, the extent to which chemotherapy tortures young patients,
formerly thought to be strong enough to withstand the toxicity, was
unknown. On August 16, 2006, Harvard Medical School-affiliated Drs.
Michael J. Hassett, A. James O?'Malley, Juliana R. Pakes, Joseph P.
Newhouse, and Craig C. Earle published, ?"Frequency and Cost of
Chemotherapy-Related Serious Adverse Effects in a Population Sample of
Women With Breast Cancer?" in the Journal of the National Cancer
Institute. 78a The authors acknowledge that ?"breast cancer is the most
common indication for chemotherapy among women in the United States,
and chemotherapy drugs are the leading cause of serious drug-related
adverse effects among women with breast cancer,?" 78a but the authors
suggest that studies in older women cannot be extrapolated to the general
population. 78a
This, therefore, is the first study of chemotherapy-related serious adverse
effects in a population-based sample of younger women with breast cancer.
12,239 women 63 years of age or younger with newly diagnosed breast
cancer participated in the study. (?"A drug-related serious adverse effect has
been defined as any untoward medical occurrence that is related to drug use
and results in death or significant disability/incapacity, requires hospital
admission or prolongation of existing hospital stay, or is life threatening.?")
Several of the adverse effects are: dehydration or electrolyte disorders
[potentially fatal]; fatigue; dizziness; nausea; diarrhea; emesis; bronchitis
[potentially fatal]; pnumonia [potentially fatal]; flu [potentially fatal]; kidney
infection [potentially fatal]; other infections [potentially fatal]; shock
[potentially fatal]; fever; malnutrition; anemias [potentially fatal]; deep-vein
thrombosis or pulmonary embolism [potentially fatal]; fractures and
dislocations; emphysema [potentially fatal]; asthma [potentially fatal]; renal
failure [potentially fatal]; thyroid disorders, including goiter [potentially
fatal]; and headaches, including migraines. 78a
Prior to this study, it was believed that women over age 65 could be
expected to have comorbid conditions that would make them more
susceptible to adverse side-effects of chemotherapy, but that the younger
population could survive the toxicity. The authors conclude that ?"breast
38
cancer chemotherapy may cause more patient suffering and higher health
care costs than previously estimated.?" 78a
They emphasize that clinical trials of new drugs are often inadequate to
accurately show experiences of the general population. They warn:
Although clinical trials of new drug therapies provide some
information regarding the number and nature of serious adverse
effects, reports of these complications are frequently inadequate and
may not accurately reflect the experiences of the general population.
Indeed, recent and widely publicized cases have demonstrated that
serious adverse effects that are not fully appreciated during early
clinical trials can appear after a drug is approved by the US Food and
Drug Administration (FDA) and used by the public. In fact, one study
of serious adverse effects identified after FDA approval found that
22 cancer drugs had been linked with 25 serious adverse effects
between 2000 and 2002. 78a
The authors conclude that their findings ?"have important implications for
quality of life and could affect decisions regarding [risks of] therapy.?" 78a
A 2004 pioneer overview study, ?"The Contribution of Cytotoxic
Chemotherapy to 5-year Survival in Adult Malignancies,?" by Drs. Graeme
Morgan, Robyn Ward, and Michael Barton in Clinical Oncology reports,
"The overall contribution of curative and adjuvant cytotoxic
chemotherapy to 5-year survival in adults was estimated to be ...2.1% in
the USA . . . It is clear that cytotoxic chemotherapy only makes a minor
contribution to cancer survival." 78b That is, only 2.1% of patients
treated with cytotoxic chemotherapy for various malignancies survive for 5
years as a result of chemotherapy. They note that their estimate of benefit is
statistically generous, using the ?"upper limit of effectiveness,?" and ?"the
benefit of cytotoxic chemotherapy may have been overestimated for cancers
of oesophagus, stomach, rectum and brain.?" The authors refer to ?"the
minimal impact of cytotoxic chemotherapy on 5-year survival, and the
lack of any major progress over the last 20 years.?"78b
DRUG COMPANIES FINED
39
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 fine to the FDA for quality-control problems at four of its
factories.79 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.
UNNECESSARY SURGICAL PROCEDURES
In 1974, 2.4 million unnecessary surgeries were performed, resulting in
11,900 deaths at a cost of $3.9 billion.80,81 In 2001, 7.5 million
unnecessary surgical procedures were performed, resulting in 37,136 deaths
at a cost of $30 billion (using 1974 dollars).9,10
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 implants81?—
are unnecessary.
40
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.80
According to the Healthcare Cost and Utilization Project within the Agency
for Healthcare Research and Quality,22 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 $30 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.82
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 into
thinking this route is safe and sexy.
Unnecessary surgeries have even been marketed on the Internet.83 A study
in Spain declares that 20-25% of total surgical practice represents
unnecessary operations.84 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.85
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
41
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%.86
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.87
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 painrelieving procedures.?"88
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.89
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.22
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.
Perhaps the most infamous often unnecessary surgical procedure is the
hysterectomy, especially when performed on women close to menopause,
after which many adverse symptoms, such as uterine bleeding, disappear
with the natural reduction of estrogen levels.
?"Since the 1960s, hysterectomy has been one of the most frequently
performed inpatient surgical procedures in the United States, with an
estimated 33% of women undergoing a hysterectomy by 60 years of age,?"
according to the CDC.22a It is clear from these statistics that until the late
42
1980s (or later), one-third of all women in the U.S. had hysterectomies. It is
probable that many more were told to have a hysterectomy (it was ?"in
fashion?"), but if they went for a second opinion to a more conservative
doctor, skilled at considering their case carefully on an individual basis, they
might be told to just go home. It is well known that many of these women
lived well into their eighties without the recommended surgery, according to
empirical evidence.
The hysterectomy is controversial to this day, but many doctors are more
cautious now before they perform these operations that project women into
premature menopause, and they will reserve this surgery for life-saving
purposes only, not for ?"comfort?" from pain or bleeding. This surgery may
place women at greater risk for disease, as it shifts hormonal balance
drastically.
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,22 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 study6 that estimated an average of
43
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 medical error will remain
buried in the general statistics.
?"A study supported by the Agency for Healthcare Research and Quality that
analyzed data from nearly 3 million operations between 1985 and 2004
found that 1 in 112,994 surgeries occurred at the wrong surgical site. Other
studies have reported incidence rates up to five times higher, and because
not all sentinel events are reported, these figures are likely underestimated.?"
22b
?"Wrong-site surgery results in devastating consequences for the patient in
terms of morbidity and mortality, as well as negative financial consequences
for surgeons and hospitals. For example, studies have shown that 79 percent
of wrong-site eye surgeries and 84 percent of wrong-site orthopedic
surgeries result in malpractice claims.?" 22b No surprises there.
?"Since 2004, surgeons have been required by The Joint Commission
[Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong
Person Surgery] to mark the surgical site while consulting with the
patient before surgery. Nevertheless, wrong-site surgeries persist at low but
unacceptable rates, leading to devastating consequences for those affected.
Wrong-site surgeries occur due to a lack of formal systems that ensure
compliance with surgical site marking requirements.?" 22b
The Joint Commission?'s Universal Protocol for Preventing Wrong Site,
Wrong Procedure, Wrong Person Surgery [updated version, effective
January 1, 2009] is available at
http://www.jointcommission.org/PatientSafety/UniversalProtocol/; accessed
February 1, 2009
Wrong site, wrong procedure, wrong person surgery is not the only
iatrogenic surgery that can induce death. The Office of the Chief Medical
Examiner of New York City had a mortuary museum started, in part, for the
purpose of medical education and iatrogenic reform by innovative N.Y.C.
Chief Medical Examiner Milton Helpern, M.D. (C.M.E. 1954-1973), based
on autopsies performed there. (This museum was later transferred to The
Armed Forces Institute of Pathology in Washington, D.C.).
44
There is a particularly chilling exhibit in this collection. It is simply a
surgical clamp and a large surgical gauze pad, with a descriptive case card.
This is a true medical history. A thirty-five-year-old woman entered a
hospital in New York for an appendectomy. Postoperative recovery was
unevenful, and she was discharged to go home on the eighth day after her
operation. The next morning she phoned her surgeon to complain about
abdominal cramps. He prescribed routine mild medication, reassuring her
that there was nothing to worry about. When the pain persisted, she
consulted a second doctor, who diagnosed an ?"acute intestinal obstruction,?"
and admitted her to another hospital as an emergency case. The second
hospital was far away from the first, and a different surgeon performing the
second operation discovered that the first surgeon had failed to remove a
surgical clamp from the patient?'s abdomen. Some coils of the small
intestine had become entwined with the clamp, resulting in gangrene. The
second surgeon removed the gangrenous section of intestine, sewed together
the two healthy ends, and closed that incision. 22c
The patient?'s postoperative course after the second surgery was marked by
failure of the incision wound to heal, with accompanying fever. A diagnosis
of peritonitis was made. The ?"wonder?" drugs were not yet in use; in two
days the patient was dead. The cause of death registered by the medical
examiner?'s office was ?"Septic peritonitis due to the presence of a foreign
body.?" The sutopsy had revealed that the second surgeon in the second
hospital had left a large surgical gauze pad in the abdominal cavity during
the operation that he was performing to remove the metal clamp that had
been left by the first negligent surgeon. 22c Surgical malpractice has been
documented for many years, but it has not been eliminated.
If you think that might just be a surgical horror story that cannot occur
today, then you may be unfamiliar with current medical malpractice case
law. The article ?"Virginia has special medical malpractice law on retained
surgical towels,?" published on January 22, 2009, states, ?"Obviously the
hospital and doctor are not supposed to leave things in you, but it is not
uncommon for these retained surgical device cases to arise.?" 22d
?"Often the patient will go months if not longer before coming to realize that
they have some medical equipment like a surgical towel or lap sponge still
inside their abdomen after an operation. What typically happens is that the
object becomes infected or blocks up some bodily function causing pain.
Eventually the patient will get an X-ray or other diagnostic test which will
45
show that something foreign is inside their body cavity. Realizing that there
was not a proper accounting of medical supplies done in the operating room
may take some time.?"22d
?"[T]he surgeon will typically blame the hospital staff for their failure to do
the towel and sponge count and they will in turn point the finger back at him
for being the captain of the ship who let something bad happen on his watch
and under his command. Both healthcare providers will try to say that maybe
the patient herself did something wrong or isn't as hurt as she claims despite
what is typically a very bad period of pain and the need for at least one more
operation to go in and remove the surgical towel or sponge from the patient's
body.?"22d
?"A medical team left behind an unwanted memento in Donald Gable's chest
. . .: A two-foot-long guide wire." I was flabbergasted," said Gable, who
developed a blood clot and had to be hospitalized again after the wire was
removed. "That thing could have penetrated my vein, and I could have bled
to death." 22e
?"Doctors reviewed the X-rays at least six times before his discharge and did
not spot the wire, according to Gable's suit. A doctor discovered the wire
when Gable returned for a routine follow-up.?" 22e
?"About 80 times a year in the Philadelphia region [alone], the tools of
surgery -- gauze, scalpels, needles, retractors and the like -- are found left
behind in patients.?"22e
A ?"woman set off an airport metal detector in 2002 because of a . . . rulerlength
instrument left inside her abdomen.?'There is absolutely no reason for
these to occur,?' said Philadelphia lawyer Paul Lauricella, who won a $2.5
million verdict in a foreign-body case against Frankford Hospital. . . . A 15-
inch-square towel had been left in his client's abdomen for three weeks.?"
?'All you have to do [to prevent these] is be able to count.?'"22e
?"Gauze pads that sop up blood -- the most common items left behind -- have
been tagged with a special strip since the mid-1950s, making them stand out
on X-rays. Several area surgeons said they call for such X-rays when counts
do not add up.?" 22e
?"But the system is far from fool-proof. Chunliu Zhan, a physician and
researcher for the federal Agency for Healthcare Research and Quality,
46
found that this mistake occurs 2,700 times a year in the United States
. . .While medical experts have been trying to do away with this error for
decades, regulators have been slow to collect cases and study them.?" 22e
?"Gauze pads ?– ?'sponges?' in medical lingo - were left behind twice as often
as surgical instruments. Gauze can trap fluid and lead to [potentially fatal]
infections, while instruments can puncture an organ. Nearly all require a
second operation to be removed,?" 22e unless the patient expires before the
problem is discovered.
The difficulty in tracing deaths resulting from failure to remove sponges and
instruments from body cavities is that if a patient who has had surgery due to
illness dies, particularly at home, an autopsy is often not required because
the death is attributed to the disease, not to an unsuspected foreign object.
These are the kinds of errors that are apparently not being reported by
hospitals. Josh Goldstein of The Philadelphia Inquirer laments, ?"?'Anybody
that is supposed to report close calls and has zero reports is clueless,?' said
James Bagian, head of the Department of Veterans Affairs?' National Center
for Patient Safety. ?'Management is asleep at the switch and just waiting until
they kill someone.?'?" 91b
There is a two-pronged Surgical Safety Checklist: pre-surgical, as well as
post-operative checklist procedures now help to prevent surgical
misadventure/death. While it is not an absolute guarantee of safety, it
appears to help.
Alex B. Haynes, M.D., M.P.H. of the Harvard School of Public Health and
Massachusetts General Hospital, and his colleagues state in their article, ?"A
Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global
Population,?" published in the January 29, 2009 issue of The New England
Journal of Medicine:: ?"Surgical complications are common and often
preventable. We hypothesized that a program to implement a 19-item
surgical safety checklist designed to improve team communication and
consistency of care would reduce complications and deaths associated with
surgery. ?" 22f
Haynes et al. state, ?"[S]urgical care and its attendant complications represent
a substantial burden of disease worthy of attention from the public health
47
community worldwide. Data suggest that at least half of all surgical
complications are avoidable.?" 22f
Haynes et al. report, ?"In 2008, the World Health Organization (WHO)
published guidelines identifying multiple recommended practices to ensure
the safety of surgical patients worldwide. On the basis of these guidelines,
we designed a 19-item checklist intended to be globally applicable and to
reduce the rate of major surgical complications.?" 22f
The New York Times reports in their article of January 14, 2009, ?"Checklist
Reduces Deaths in Surgery,?" by Eric Nagourney, that "a year after surgical
teams at eight hospitals adopted a 19-item checklist, the average patient
death rate fell more than 40 percent and the rate of complications fell by
about a third.?"22g
The checklist includes ?"a requirement that the nursing staff confirm that
everything has been sterilized and that all equipment needed is present.
Team members must also confirm that the patient has been given antibiotics
ahead of the surgery, if called for, to reduce the chance of infection. The
checklist also requires team members to verify that there is enough blood on
hand if there is a risk of blood loss, that a piece of equipment that measures
blood oxygenation is working and that all the medical images needed are
present.?"22g
?"Before the operation begins, the checklist calls for the team to confirm the
identity of the patient and the nature of the procedure. Afterward, the doctors
and nurses are supposed to review what has been done, including discussing
any special steps that need to be taken to aid recovery and confirming no
equipment has been left in the patient.?"22g
?"The researchers reviewed the outcome of 7,688 patients who were
undergoing noncardiac surgery at the hospitals. About half the patients had
surgery before the checklists were adopted, and half after. At the end of the
study, the average death rate dropped to 0.8 percent from 1.5 percent, and
the average complication rate fell to 7 percent from 11 percent.?" 22g
48
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.?"90 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.91 Legally, the OTA could not be
censored, but it could be shut down.
?"The congressional Office of Technology Assessment (OTA) closed its
doors September 29, 1995. For 23 years, the nonpartisan analytical agency
assisted Congress with the complex and highly technical issues that
increasingly affect our society.?" 91a
Under President Bill Clinton, ?"The 104th Congress voted to withdraw
funding for OTA and its full-time staff of 143 persons, and cover only a
skeleton staff and the amount needed for the agency's final closeout.?" 91a
A January 30, 2009 headline reads, ?"Hospitals are Still Neglecting to Report
Serious Mistakes - . . .?" ?"Despite laws in New Jersey and Pennsylvania
requiring hospitals to report major medical errors, unanticipated
complications, and near misses to state agencies for the purpose of reducing
medical mistakes, experts say that hospitals in both states are neglecting to
report these kinds of incidents.?" 91b
?"In 2007, major medical errors in Pennsylvania included accidentally
leaving surgical equipment inside two separate patients at Fox Chase Cancer
Center. At Abington Memorial Hospital in 2005, a woman recovering from
hip surgery developed open bed sores after being left lying on a bedpan for
several hours. In a total violation of state law, none of these incidents was
reported by the hospitals responsible.?" 91b
?"These individual reporting failures are indicative of a larger trend across
Pennsylvania and New Jersey. In 2007, 5 out of the 80 hospitals in New
Jersey neglected to report a single preventable medical error to state
49
agencies. Similarly, a handful of Pennsylvania hospitals reported no serious
events and no near misses that could have hurt patients.?"91b
The northeast is not the only place in the nation failing to comply. ?"To put
this in perspective, James Conway, a quality expert at the Institute for
Healthcare Improvement in Cambridge, Mass., says that on average, 100
patient medical charts document about 40 instances of patient harm. When
we compare these statistics to the ones coming in from hospitals, it becomes
apparent that underreporting is both pervasive and profound.?" 91b
There is a ?"current climate of sloppy enforcement.?"91b It is imperative ?"to
make certain that hospitals and doctors are held responsible for serious
patient harm,?" 91b or more complications and deaths will occur.
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 2000.92 Data from 20% of the nation?'s hospitals were
analyzed for 18 different surgical complications, including post-operative
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.?"23 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
50
Weingart of Harvard?'s Beth Israel-Deaconess Medical Center wrote, ?"Given
their staggering magnitude, these estimates are clearly sobering.?"93
There are two initiatives under way now to address surgical errors directly.
They are pre-operative and post-operative.
UNNECESSARY X-RAYS
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.94
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 1 million per 1,000 mrem.?"95
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, Dr.
Gofman worked on the Manhattan Project, discovered uranium-233, and was
the first person to isolate plutonium.
In five scientifically documented books, Dr. Gofman provides strong
evidence that medical technology?—specifically x-rays, CT scans, and
51
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,?"96 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 by other factors, including a woman?'s genetic
makeup, preexisting benign breast disease, artificial menopause, obesity, and
hormone imbalance.97
The Journal of the National Cancer Institute published the following
statements in their 2004 paper, ?"Full-Body CT Screening: Preventing or
Producing Cancer??" by R. Twombly. ?"Full-body computed tomography
(CT) screening may constitute more of a cancer risk than a cancer foil, say
researchers who?…liken the radiation exposure during a single scan to that
experienced within miles of a World War II atom bomb explosion.?" 97a
The September 2004 issue of Radiology includes an article by David
Brenner, Ph.D., Professor of Radiation Oncology and Public Health at
Columbia University in New York.
[Brenner] estimated the dose of radiation to the lung or stomach from
a single full-body CT scan to be 14-21 milligrays (mGy, a unit of
absorbed radiation). That corresponds to a dose region?—about 1.5
miles from the blast of an atomic bomb?—for which there is direct
evidence of increased mortality among atomic bomb survivors,
Brenner said. The exposure is 'equal to 100 chest X-rays or 100
mammograms,' he said. 97a
52
In the last few years, independent companies offering full-body CT scans
has doubled. The CT scan is popular with the well-to-do middle-aged and
seniors ?"who are willing to pay an average of $1,000 to ensure that their
aging bodies are not harboring tumors or other incipient diseases.?" 97a They
do not know that they may well develop malignant neoplastic disease as a
result of the CT scan itself.
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.98 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.
UNNECESSARY HOSPITALIZATION
Nearly 9 million (8,925,033) people were hospitalized unnecessarily in
2001.1-4 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.2
The rate of inappropriate hospital admissions in 1990 was 23.5%.3 In 1999,
another study also found an inappropriate admissions rate of 24%, indicating
a consistent pattern from 1986 to 1999.4 The HCUP database indicates that
the total number of patient discharges from US hospitals in 2001 was
37,187,641,22 meaning that almost 9 million people were exposed to
53
unnecessary medical intervention in hospitals and therefore represent almost
9 million potential iatrogenic episodes.1-4
WOMEN'S EXPERIENCE IN MEDICINE
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.99 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 from the way in which they
treat men.100 She cites the following statistics:
? Thousands of prophylactic mastectomies are performed annually.
? One third of US women have had a hysterectomy before menopause.
? Women are prescribed drugs more frequently than are men.
? Women are given potent drugs for disease prevention, which results in
disease substitution due to side effects.
? Fetal monitoring is unsupported by studies and not recommended by
the CDC.101 It confines women to a hospital bed and may result in a
higher incidence of cesarean section.102 (Internal fetal monitor may
raise risk of infection.)
? Normal processes such as menopause and childbirth have been
heavily ?"medicalized.?"
? Synthetic hormone replacement therapy (HRT) does not prevent heart
disease or dementia, but does increase the risk of breast cancer, heart
disease, stroke, and gall bladder attack.103
? As many as a third of postmenopausal women use HRT.104,105 This
number is important in light of the much-publicized Women?'s Health
54
Initiative study, which was halted before its completion because of a
higher death rate in the synthetic estrogen-progestin (HRT) group.106
CESAREAN SECTION
In 1983, 809,000 cesarean sections (21% of live births) were performed in
the US, making it the nation?'s most common obstetricgynecologic
(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 surgeries completed in the US.107
In 2001, cesarean section was 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 delivery108?—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.?"109 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.110
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
55
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.111
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.?'112 Today,
scientists continue to use the excuse that more studies are needed before they
will support restricting the inordinate use of drugs.
ADVERSE DRUG REACTIONS
The Lazarou study6 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.6,57
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.113
BEDSORES
56
Over 1 million people develop bedsores in US hospitals every year. It is a
tremendous burden to patients and family, and a $90 billion health care
burden.14 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%.15 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
17,160. Critics will say that it was the disease or advanced age that killed the
patient, not the bedsores, 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.114
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.18 It is difficult to place a mortality rate on
malnutrition and dehydration.
The coalition report states that compared with well-nourished hospitalized
nursing home residents, malnourished 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%15,24 results in 4,630 premature deaths due to malnutrition in nursing
homes.
NOSOCOMIAL INFECTIONS
57
The rate of nosocomial (in-hospital) 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 5-6 hospitalacquired
infections occurring per 100 admissions. Due to progressively
shorter inpatient stays and the increasing number of admissions, however,
the number of infections has 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 six minutes.16
The 2003 incidence of nosocomial mortality is 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 1999,17 representing a $0.5 billion increase in just four
years. At this rate of increase, the current cost of nosocomial infections
would be close to $6 billion, or more.
As mentioned before Table 1, the CDC reports that the number of deaths
from healthcare-associated infections in hospitals alone has risen to 99,000
per year. Some of these deaths may be due to poor hygiene on the part of
physicians. 17g, 17h
According to HealthGrades Second Annual Patient Safety in American
Hospitals Report, May 2005:
If American hospitals were to implement what we know works, many
costly complications could be avoided and lives would be saved. For
example, we know that washing hands before patient contact is a
simple and effective process that is proven to reduce hospital-acquired
infection rates. 17i
OUTPATIENT IATROGENESIS
In a 2000 JAMA article, Dr. Barbara Starfield presents well-documented
facts that are both shocking and unassailable.19,20 The US 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
58
40 million people in the US have no health insurance, and 20-30% of
patients receive contraindicated care.
Starfield warned 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
Western 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:
? 116 million extra physician visits
? 77 million extra prescriptions filled
? 17 million emergency department visits
? 8 million hospitalizations
? 3 million long-term admissions
? 199,000 additional deaths
? $77 billion in extra costs.21
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%.81
MEDICAL ERRORS: A GLOBAL ISSUE
59
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.115
HEALTH INSURANCE
The Institute of Medicine 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.116 As noted
earlier, The National Coalition on Health Care reports, ?"Nearly 46 million
Americans, or 18 percent of the population under the age of 65, were
without health insurance in 2007, the latest government data available.?" 26c
Health insurance fraud exists. 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 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.117
There is more on health insurance under ?"Is American Medicine Working??"
WAREHOUSING OUR ELDERS
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 live 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.18,118
? Twenty percent of all deaths from all causes occur in nursing
homes.119
60
? Hip fractures are the single greatest reason for nursing home
admissions.120
? Nursing homes represent a reservoir for drug-resistant organisms due
to overuse of antibiotics.16
? Presenting a report he sponsored entitled ?"Abuse of Residents Is a
Major Problem in US 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 2001.118
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 are not aware
of or ignore.118 The report found:
? Over 30% of US nursing homes were cited for abuses, totaling more
than 9,000 violations.
? Ten percent of nursing homes had violations that caused actual
physical harm to residents or worse.
? Over 40% (3,800) of the abuse violations followed the filing of a
formal complaint, usually by concerned family members.
? Many verbal abuse violations were found, as were occasions of sexual
abuse.
? Incidents of physical abuse causing numerous injuries, such as
fractured femurs, hips, elbows, and wrists, also were 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.121 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.?' ?"122 Although preventable with proper nursing care,
bedsores occur three times more commonly in nursing homes than in acute
care or veterans hospitals.123
61
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.124,125 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 over-reporting of
heart disease as a cause of death is as much as twofold.126
When elucidating iatrogenesis in nursing homes, some critics have asked,
?"To what extent did these elderly people already have life-threatening
diseases that led to their premature deaths anyway??" Our response is that if a
loved one dies one week, one year, a decade, two decades, or one day
prematurely as a result of some medical misadventure, that is still an
untimely iatrogenic death. In a legalistic sense perhaps more weight is
placed on the loss of many potential years compared to an additional few
weeks, but this attitude is not justified in an ethical or moral sense.
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.127
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.128-130
Studies have found that physical restraints, including bedrails, are the cause
of at least 1 in every 1,000 nursing-home deaths.131-133
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
62
inaccurate.134 Although one in five people dies in nursing homes, an
autopsy is performed in less than 1% of these deaths.135
OVERMEDICATING SENIORS
The CDC seems to be focusing on reducing the number of prescriptions to
children, but a 2003 study finds over-medication of U.S. elderly. 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.136 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 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 ?"the tip of the iceberg?" of a
national problem.136
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.137 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.138
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.139
63
Seniors and groups like the American Association of Retired Persons
(AARP) have accepted allopathic medicine?'s overriding assumption that
aging and dying in America must be accompanied by drugs in nursing
homes and eventual hospitalization.140 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.141,142 In 2001, some of the world?'s
largest drug companies were fined a record $871 million for conspiring to
increase the price of vitamins.143
What if some of these chronic diseases are really lifestyle diseases caused by
deficiency of essential nutrients, lack of care, inappropriate medication,
overmedication, and isolation? This question is extremely important to
consider, yet 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.144 We would urge AARP to become more involved in
prevention of disease, and not to rely so heavily on drugs. We would like to
send the same message to the Hemlock Society, which offers euthanasia
options to chronically ill people, especially those in severe pain, who may
have become depressed. We must look to healing, lifting pain, releasing
depression, instead of cashing in Granny?'s chips. Let?'s also look at the irony
of underuse of proper pain medication for patients who really need it.
Ironically, studies do indicate underuse of appropriate 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 painrelief
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.145
The time has come to set a generous standard for caring for the vulnerable
among us--a standard that goes beyond making sure they are housed and fed,
and not openly abused. We must stop looking the other way and we, as a
society, must take responsibility for the way in which we deal with those
who are unable to care for themselves.
64
WHAT REMAINS TO BE UNCOVERED
Our ongoing research will continue to quantify the morbidity, mortality, and
financial loss due to:
? X-ray exposure (mammography, fluoroscopy, CT scans).
? Overuse of antibiotics for all conditions.
? Carcinogenic drugs (hormone replacement therapy,*
immunosuppressive and prescription drugs).
? Cancer chemotherapy
? Surgery and unnecessary surgery (cesarean section, radical
mastectomy, preventive mastectomy, radical hysterectomy,
prostatectomy, cholecystectomies, cosmetic surgery, arthroscopy,
etc.).
? Discredited medical procedures and therapies.
? Unproven medical therapies.
? Outpatient surgery.
? Doctors themselves.
* 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 cancercausing
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.146 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 blood clots, breast cancer, stroke,
and heart disease, with little evidence of osteoporosis reduction or dementia
prevention. WHI researchers, who do not usually make recommendations
except to suggest more studies, advised doctors to be very cautious about
prescribing HRT to their patients.102,147-151
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,
65
estrogen-progestagen (combination) therapy accounting for 15,000 of
these.?"152
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.
According to the article, ?"Breast Cancer Risk Remains After Stopping
HRT,?" published on March 5, 2008, ?"Women who took estrogen plus
progestin in the Women's Health Initiative (WHI) trial of hormone
replacement therapy (HRT) remain at higher risk of breast cancer three years
after the trial was stopped, compared with those who took placebo.?"152a
?"Dr Gerardo Heiss (University of North Carolina, Chapel Hill) and
colleagues report their findings in the March 5, 2008 issue of the Journal of
the American Medical Association. . . . ?'What was not anticipated was the
greater risk of malignancies overall . . .?" said Dr. Heiss. 152a
?"The WHI trial of estrogen plus progestin included 16,608 postmenopausal
women and set out to examine whether conjugated equine estrogens (CEE)
plus medroxyprogesterone acetate (MPA) prevented cardiovascular disease
and fractures and to examine any associated change in the risk of breast
cancer. The trial was stopped prematurely in 2002 when data indicated an
increased risk of breast cancer and unexpected, higher risks of stroke, MI,
and venous thromboembolism.?"
?"In the new analysis, Heiss and colleagues examined the risk/benefit balance
of 15,730 of the participants after the trial was stopped in July 2002 out to
March 2005. . . . The annualized event rates for the outcome "all cancers"
was higher during the postintervention follow-up for the HRT group (1.56%
per year) compared with the placebo group (1.26% per year). This was
primarily due to a greater risk of invasive breast cancer: 79 women who took
HRT developed breast cancer in the postintervention phase compared with
60 who got placebo. . . . "The hormones' effects on breast cancer appear to
linger," says Dr. Leslie Ford (National Cancer Institute, Bethesda, MD) . . .
[T]here is some evidence that HRT is associated with decreased survival in
women with lung cancer.?" 152a
66
Dr. Elizabeth G. Nabel (director, National Heart, Lung, and Blood Institute,
Bethesda, MD) also warns, "These findings also indicate that women who
take estrogen plus progestin continue to be at increased risk of breast cancer,
even years after stopping therapy. Today's report confirms the study's
primary conclusion that combination hormone therapy should not be used to
prevent disease in healthy, postmenopausal women." 152a
?"Heiss agrees: ?'The balance of the benefits and risks of estrogen plus
progestin therapy continues to be unfavorable after stopping therapy,?' he
explained to heartwire. ?'As such, these findings confirm the results of the
WHI study as originally published?—this is not a preparation that ought to be
used over long periods to prevent chronic disease. That's it in a nutshell.?'"
152a
"Overall, the summary of benefits and risks appears to be unfavorable,"
Heiss reiterates, "and this suggests that vigilance is required after the use of
these preparations. Women should take care of their health and lifestyle . . .?"
152a
?"The results of the WHI trial?" include ?"increased risks for myocardial
infarction, stroke, deep venous thrombosis, and breast cancer associated with
active treatment. A global index suggested that the overall risks for
hormone therapy outweighed any benefits.?" 152a
What has yet to be uncovered about this HRT is why the trials continued as
long as they did with the womens?' lives at stake. We do not recommend
synthetic hormone replacement therapy.
SUMMARY
The Office of Technology Assessment (OTA) was perhaps the US
government's last honest agency that critically reviewed the
state of the nation's health care system. The purpose of the OTA was to
provide Congress with objective and authoritative analysis of complex
scientific and technical issues. In its final critical report, the OTA concluded:
?"There are no mechanisms in place to limit dissemination of technologies,
regardless of their clinical value.?" Shortly after the OTA released a report
that exposed how entrenched financial interests manipulate health care
practice in the United States, Congress disbanded the OTA.
67
Someone has said that health care is the only business where you keep
paying whether you get good results or not. We do not tolerate poor service
in the non-medical marketplace, yet we have accepted it for years in health
care. For years, our nation has avoided responsibility for examining this
major health crisis, to our own mounting peril. Now, we have an iatrogenic
epidemic. More Americans are dying each year at the hands of medicine
than all of our American casualties in the First World War and the Civil War
combined.
Why would highly trained medical doctors continue to follow failing
protocols year after year, producing negative results? The chemotherapy
studies cited in this paper show that the cytotoxicity is damaging the quality
of life and often causing death.
The reason the medical establishment can continue to betray the public trust
is because there are no sufficient consequences for killing or maiming
patients. The physician is rewarded for his efforts, not for his results. It is
taken for granted that if you have chemotherapy, you will be maimed, and
possibly killed. The patient even signs away his or her rights before surgery,
so that the surgeon and hospital are protected even if they are negligent.
The proprietary interests connected with these approved protocols make
them attractive for physicians and hospitals to follow. The pharmaceutical
companies reward physicians who buy and use their drugs. Grants are
offered to hospitals for research. Many financial incentives pave the way for
acceptance of protocols that prove deadly and costly. Medical students are
even offered incentives through sponsorship by drug companies to prescribe
certain drugs as soon as they are able to do so.
The public has accepted the Faustian bargain that his physician has made
with the drug companies because the patient believes there is no other
choice. He must take ten different prescription drugs if he is over 60. He
must have invasive tests. He must have a CT scan with the power of 100
chest X-rays. He must respond to the direct-to-consumer pharmaceutical
advertising and ask his doctor to prescribe TV meds, despite the horrific
side-effects warnings. The public now receives television messages that
appear to be coming from avuncular doctors, but they are really coming
from Big Pharma to get your money.
68
When it comes to choosing between prevention of disease, at least where a
condition could be prevented, or treatment of disease, it is advantageous to
the allopathic doctor to choose treatment. There is reward in choosing
treatment because the drug companies offer incentives to doctors who buy
their products. Prevention is more about vitamins and supplements and they
are far less lucrative for pharmaceutical companies. There is now a
campaign to raise the prices of these natural products that have few, if any,
side effects. A prescription may be necessary soon to obtain the vitamins
that are now so readily available at reasonable prices. We have the drug
companies to thank for this.
For example, if an honest journalist wishes to do an article on the benefits of
St. John?'s Wort for minor depression, he may call several government
agencies for a story. If the journalist presents evidence that St. John?'s Wort
is helpful, the FDA and the CDC may encourage the journalist to promote
more proven therapies, such as expensive prescription anti-depressants.
They may encourage or even pay the journalist to downplay any merits of
St. John?'s Wort. This is where the drug companies interfere with the
public?'s education about natural remedies. The far-reaching arm of the
pharmaceutical company?'s influence even extends to the falsification of
nutrient studies, in order to promote prescription drugs instead. There is
currently a systematic program to defame every natural vitamin, supplement,
and health food throughout the world.
Corruption is rampant when legislators pay journalists to do a hatchet job on
natural preventive remedies, so that the public will buy prescription drugs.
Where honest scientists do exist, they have no power to override the
corruption. The price they would pay for writing or speaking the truth
about the drug company invasion into modern medicine, or for censuring a
colleague for cause, is that the doctor or researcher would be alienated,
unable to get grants, unable to publish, possibly even unable to work. That
rare courageous doctor would have his career destroyed, though his good
character would be intact.
The medical environment has become a labyrinth of interlocking corporate,
hospital, and governmental boards of directors and advisors, infiltrated by
the drug companies. There are even ghost writers who are drug company
representatives who write glowing articles about pharmaceuticals, then they
are signed by well-known physicians who are paid handsomely for their
cooperation, though they may not know all of the adverse side-effects of the
69
drugs they promote. The physicians are paid to give positive reviews of
drug company studies; they are paid to endorse chemicals that may harm
patients because there is a rush to get the drugs on the market. The most
toxic substances are often approved first. Milder alternatives may be
ignored for financial reasons.
Drug companies now control the dissemination of continuing education
courses to doctors, and there may be some brain-washing going on; ads in
medical publications are controlled by drug companies; information given to
the FDA to promote is influenced by drug companies; drug companies may
pay the FDA to review their studies favorably. Influence is for sale.
There are astronomical profits in cooperating with the drug companies.
Drug companies are behind Medicare, so that people remain overmedicated;
or they receive the proper medications at higher doses to sell more, with
injury or death as a consequence.
Drug companies pay our legislators, our scientists, the NAS. Drug
companies have propaganda campaigns launched through the CDC, such as
a rush to vaccinate the moment a ?"bird flu?" appears on the horizon.
Vaccinate infants, children, teens, adults, elders, each one a potentially
lucrative marketing niche, even an opportunity to sell drugs to otherwise
healthy people. Why not make these vaccinations mandatory? Force us to
pay for possible side effects, ?"for our own good.?" Fright tactics are used to
petrify the public into rushing to pay for vaccines that may prove debilitating
or worse.
All of this is done with a wink and a nod. Not a cent is spent on prevention
(except pseudo-prevention through toxic inoculations that do not really
prevent disease, and may cause harm); instead, every dollar goes for
treatment.
The media, scientists, professors, universities, hospitals, governmental
agencies, such as the FDA, the EPA, and the CDC, are all having a banquet
at the pharmaceutical table. This is not the way to practice medicine. Every
so often, brave physicians like Drs. Graeme Morgan, Robyn Ward, and
Michael Barton stand up and tell the truth, about cytotoxic chemotherapy, in
this case, as in their article in Clinical Oncology, ?"The Contribution of
Cytotoxic Chemotherapy to 5-year Survival in Adult Malignancies.?" This
pioneer study demonstrates that curative and adjuvant cytotoxic
70
chemotherapy in America is only 2.1% effective at best, of ?"minimal
impact?" on cancer survival; with a ?"lack of any major progress?" in the field
?"over the last 20 years.?" 78b
There are also a few thousand complementary physicians who are helping
patients. Many complementary health care providers are denied publication
through the intervention of pharmaceutical companies. If they, or their
allopathic colleagues, do manage to speak out against corruption in the
establishment, they are considered traitors to the medical brotherhood. This
is not a scientific community; instead of objectivity and compassion, our
medical system is powered by weakness, greed, envy, and fear. There are
exceptions, such as Dr. David Graham of the FDA.
Medicine also has many spectacular breakthroughs and modalities for
helping people to heal and survive?—but let us continue to determine what
does not work and request that improvements be made. Let us be honest
about the causes of our illnesses. Your average doctor is not telling you that
your lifestyle may be making you ill, and that you can do something
economical to improve your health, and possibly reduce the need for costly
medication he prescribes; you are your doctor?'s ?"client.?" (Never change your
medication dosage without your doctor?'s approval).
The cumulative daily effects of steaks, colas, pizzas, pollution, computers,
cell phones, and pesticides place us in a toxic soup environment. Instead of
cleaning this up, many turn to medication for help. Drug companies are
paying our legislators, television and radio stations, schools, and news
outlets to keep this information from you. You are Big Pharma?'s ?"client.?"
BP wants your ?"account.?" And they pay the quack busters to attack anyone
who tells you the truth about what is really making you sick enough to seek
expensive ?"care?" from the number one source of fatalities in America, care
that might readily kill you and your loved ones: death by medicine.
71
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All Contents Copyright © 1995-2009 Life Extension Foundation All rights
reserved.

These statistics contained in this report confirm that American
Medicine is the number one cause of death in the United States.
Death by Medicine
by Gary Null, PhD;, ND; Martin Feldman, MD; Debora Rasio, MD;
Dorothy Smith, PhD, Carolyn Dean
Conventional Medicine's Lethal Dark Side
Something is drastically wrong when regulatory agencies pretend that
natural hormones and nutritional supplements are dangerous, yet ignore
published statistics showing that government-sanctioned medicine is the real
hazard. The statistics in this report show American medicine is the number