Death by Medicine
Thanks Kathi for the link!
Unfortunately, the same Front Groups
(quackwatch.com/acsh.org/junkscience.com) that are hired by
the silicone industry are hired by the pharmaceutical
industry too.) They are well represented on Usenet, many
found at this link.
www.humanticsfoundation.com/andysposse.htm
Dr. Mercola has been horribly harassed by the same groups,
in spite of the excellent work he produces and the help
he has been to his patients.
Ilena
~~~~~~~~~~~~~~~~~~~
mercola.comdeath by medicine.htmOpen ↗
Natural medicine has come under attack as pharmaceutical
company lobbyists push lawmakers to deprive Americans of the
benefits of dietary supplements. Drug-front groups have
implemented slanderous campaigns in attempts to undermine
the value of natural health lifestyles.
These attacks to natural medicine prompted an independent
review of government-approved medicine, which revealed that
conventional medicine was the leading cause of death in the
United States. This review of government health statistics
showed that in most cases, American medicine does more harm
than good. Compelling evidence from this study unveiled
astounding statistics on the 783,936 deaths per year that
have resulted from conventional medicine.
The purpose of this article was to memorialize the failure
of the American medical system by exposing the horrifying
statistics of the inadequacies of today’s health care
system with the goal of beginning some meaningful reform.
Highlights from the findings in the review:
U.S. health care spending has reached $1.6 trillion in 2003,
which represents 14 percent of the nation’s gross
national product.
In a 1992 survey, a national pharmacy database found a total
of 429,827 medication errors from 1,081 hospitals.
In 1974, 2.4 million unnecessary surgeries were performed
that resulted in 11,900 deaths compared to the year 2001,
where 7.5 million unnecessary surgeries were performed
resulting in 37,136 deaths.
A 1998 study reported an estimated 106,000 deaths from
prescription medications per year.
Nearly 9 million people were unnecessarily
hospitalized in 2001.
Here are additional reasons why the traditional paradigm
is flawed:
Studies have found that the 41 million Americans without
health insurance have an increased risk for dying
prematurely and not receiving appropriate medical care.
20 percent of all causes of death occur in nursing homes.
More than 30 percent of nursing homes in the United States
were cited for abuses, exceeding over 9,000 violations.
A study of a 100-bed sub-acute care hospital revealed that
only 8 percent of the patients were well nourished, 29
percent were malnourished and 63 percent were at risk of
malnutrition.
Life Extension Institute March 2004
Ds. Mercola's Comment:
This definitive review of the conventional health care
system is a must-read because it describes in detail the
failure of the traditional paradigm and provides us with
shocking statistics on the thousands and thousands of deaths
that resulted from unnecessary or incorrect medical
treatments.
The only problem I have with this article is that the
formatting is really terrible and makes it difficult to
follow. The Web site uses a type of frame and you need to
use the light blue bar on the immediate right of the text to
scroll down and reach the next page. However, despite the
formatting issue, I highly recommend reading this article.
This article acts as yet another huge wake-up call by
providing further substantial evidence that the health care
system is in desperate need of drastic reform. Too many
lives are being lost at the hands of conventional medicine.
The findings in this review also further reinforce my vision
and passion, which is to transform the medicine and surgery-
bombarded medical paradigm to one that focuses on treatment
and prevention of the underlying causes.
I view this review as a very positive step toward fulfilling
my vision because it specifically outlines the blatant
mistakes and failures of the traditional system.
The statistics from this review gives people even more
reasons to explore alternative and less evasive approaches
to health care--such as educating yourself with the
information in my Total Health Program--to find out what is
truly going on.
The increasing number of people visiting my Web site have
access to a constantly expanding database that they can use
as a tool to educate themselves on how to facilitate their
own healing.
mercola.comdeath by medicine.htmOpen ↗
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Death by Medicine, Part I
By Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD,
Debora Rasio MD, Dorothy Smith PhD
ABSTRACT
A definitive review and close reading of medical peer-review
journals, and government health statistics shows that
American medicine frequently causes more harm than good. The
number of people having in-hospital, adverse drug reactions
(ADR) to prescribed medicine is
2.2 million.1 Dr. Richard Besser, of the CDC, in 1995, said
the number of unnecessary antibiotics prescribed annually
for viral infections was 20 million. Dr. Besser, in 2003,
now refers to tens of millions of unnecessary
antibiotics.2, 2a
The number of unnecessary medical and surgical procedures
performed annually is 7.5 million.3 The number of people
exposed to unnecessary hospitalization annually is 8.9
million.4 The total number of iatrogenic deaths shown in the
following table is 783,936. It is evident that the American
medical system is the leading cause of death and injury in
the United States. The 2001 heart disease annual death rate
is 699,697; the annual cancer death rate, 553,251.5
TABLES AND FIGURES (see Section on Statistical Tables and
Figures, below, for exposition)
mercola.comdeath by medicine.htmOpen ↗
ANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL INTERVENTIONWe
could have an even higher death rate by using Dr. Lucien
Leape’s 1997 medical and drug error rate of 3 million.
14 Multiplied by the fatality rate of 14% (that Leape used
in 199416 we arrive at an annual death rate of 420,000 for
drug errors and medical errors combined. If we put this
number in place of Lazorou’s 106,000 drug errors and
the Institute of Medicine’s (IOM) 98,000 medical
errors, we could add another 216,000 deaths making a total
of 999,936 deaths annually. ANNUAL UNNECESSARY MEDICAL
EVENTS STATISTICS
The enumerating of unnecessary medical events is very
important in our analysis. Any medical procedure that is
invasive and not necessary must be considered as part of the
larger iatrogenic picture. Unfortunately, cause and effect
go unmonitored. The figures on unnecessary events represent
people (“patients”) who are thrust into a
dangerous healthcare system. They are helpless victims. Each
one of these 16.4 million lives is being affected in a way
that could have a fatal consequence. Simply entering a
hospital could result in the following:
3.In 16.4 million people, 2.1% chance of a serious adverse
drug reaction,1 (186,000)
4.In 16.4 million people, 5-6% chance of acquiring a
nosocomial infection,9 (489,500)
4.Aa1.4 million people, 4-36% chance of having an iatrogenic
injury in hospital (medical error and adverse drug
reactions),16 (1.78 million)
5.In 16.4 million people, 17% chance of a procedure error,40
(1.3 million)
All the statistics above represent a one-year time span.
Imagine the numbers over a ten-year period. Working with the
most conservative figures from our statistics we project the
following 10-year death rates.
TEN-YEAR DEATH RATES FOR MEDICAL INTERVENTION
Our projected statistic of 7.8 million iatrogenic deaths is
more than all the casualties from wars that America has
fought in its entire history.
Our projected figures for unnecessary medical events
occurring over a 10-year period are also dramatic.
TEN-YEAR STATISTICS FOR UNNECESSARY INTERVENTION
These projected figures show that a total of 164 million
people, approximately 56% of the population of the
United States, have been treated unnecessarily by the
medical industry – in other words, nearly 50,000
people per day.
INTRODUCTION
Never before have the complete statistics on the multiple
causes of iatrogenesis been combined in one paper. Medical
science amasses tens of thousands of papers annually--each
one a tiny fragment of the whole picture. To look at only
one piece and try to understand the benefits and risks is to
stand one inch away from an elephant and describe everything
about it. You have to pull back to reveal the complete
picture, such as we have done here. Each specialty, each
division of medicine, keeps their own records and data on
morbidity and mortality like pieces of a puzzle. But the
numbers and statistics were always hiding in plain sight. We
have now completed the painstaking work of reviewing
thousands and thousands of studies. Finally putting the
puzzle together we came up with some disturbing answers.
Is American Medicine Working?
At 14 percent of the Gross National Product, health care
spending reached $1.6 trillion in 2003.15 Considering this
enormous expenditure, we should have the best medicine in
the world. We should be reversing disease, preventing
disease, and doing minimal harm. However, careful and
objective review shows the opposite. Because of the
extraordinary narrow context of medical technology through
which contemporary medicine examines the human condition, we
are completely missing the full picture.
Medicine is not taking into consideration the following
monumentally important aspects of a healthy human organism:
(a) stress and how it adversely affects the immune system
and life processes; (b) insufficient exercise; (c)
excessive caloric intake; (d) highly-processed and
denatured foods grown in denatured and chemically-damaged
soil; and (e) exposure to tens of thousands of
environmental toxins. Instead of minimizing these disease-
causing factors, we actually 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 appropriated for
preventing disease.
Under-reporting of Iatrogenic Events
As few as 5 percent and only up to 20 percent of iatrogenic
acts are ever reported.16,24,25,33,34 This implies that if
medical errors were completely and accurately reported, we
would have a much higher annual iatrogenic death rate than
783,936. Dr. Leape, in 1994, said his figure of 180,000
medical mistakes annually was equivalent to three jumbo-jet
crashes every two days.16 Our report shows that six jumbo
jets are falling out of the sky each and every day.
Correcting a Compromised System
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 quite obvious that we
can’t 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 that what stands in the way of change are
powerful pharmaceutical companies, medical technology
companies, and special interest groups with enormous vested
interests in the business of medicine. They fund medical
research, support medical schools and hospitals, and
advertise in medical journals. With deep pockets they entice
scientists and academics to support their efforts. Such
funding can sway the balance of opinion from professional
caution to uncritical acceptance of a new therapy or drug.
You only have to look at the number of invested people on
hospital, medical, and government health advisory boards
to see conflict of interest. The public is mostly unaware
of these interlocking interests. For example, a 2003
study found that nearly half of medical school faculty,
who serve on Institutional Review Boards (IRB) to advise
on clinical trial research, also serve as consultants to
the pharmaceutical industry.17 The authors were concerned
that such representation could cause potential conflicts
of interest.
A news release by Dr. Erik Campbell, the lead author, said,
"Our previous research with faculty has shown us that ties
to industry can affect scientific behavior, leading to such
things as trade secrecy and delays in publishing research.
It's possible that similar relationships with companies
could affect IRB members' activities and attitudes.”18
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
recent WHO Bulletin: "If clinical trials become a commercial
venture in which self-interest overrules public interest and
desire overrules science, then the social contract which
allows research on human subjects in return for medical
advances is broken."19
Former editor of the New England Journal of Medicine (NEJM),
Dr. Marcia Angell, struggled to bring the attention of the
world to the problem of commercializing scientific research
in her outgoing editorial titled “Is Academic Medicine
for Sale?”20 Angell called for stronger restrictions
on pharmaceutical stock ownership and other financial
incentives for researchers. She said that growing conflicts
of interest are tainting science.
She warned that, “When the boundaries between industry
and academic medicine become as blurred as they are now, the
business goals of industry influence the mission of medical
schools in multiple ways.” She did not discount the
benefits of research but said a Faustian bargain now existed
between medical schools and the pharmaceutical industry.
Angell left the NEMJ in June 2000. Two years later, in
June 2002, the NEJM announced that it would now accept
biased journalists (those who accept money from drug
companies) because it is too difficult to find ones who
have no ties. Another former editor of the journal, Dr.
Jerome Kassirer, said that was just not the case, that
there are plenty of researchers who don’t work for
drug companies.21 The ABC report said that one measurable
tie between pharmaceutical companies and doctors amounts
to over $2 billion a year spent for over 314,000 events
that doctors attend.
The ABC report also noted that a survey of clinical trials
revealed that when a drug company funds a study, there is a
90 percent chance that the drug will be perceived as
effective whereas a non-drug company-funded study will show
favorable results 50 percent of the time. It appears that
money can’t buy you love but it can buy you any
"scientific" result you want. The only safeguard to
reporting these studies was if the journal writers remained
unbiased. That is no longer the case.
Cynthia Crossen, writer for the Wall Street Journal in 1996,
published Tainted Truth: The Manipulation of Fact in
America, a book about the widespread practice of lying with
statistics.22 Commenting on the state of scientific research
she said that, “The road to hell was paved with the
flood of corporate research dollars that eagerly filled gaps
left by slashed government research funding.” Her data
on financial involvement showed that in l981 the drug
industry “gave” $292 million to colleges and
universities for research. In l991 it “gave”
$2.1 billion.
THE FIRST IATROGENIC STUDY
Dt. Lucian L. Leape opened medicine’s Pandora’s
box in his 1994 JAMA paper, “Error in
Medicine”.16 He began the paper by reminiscing
about Florence Nightingale’s maxim--“first
do no harm.” But he found evidence of the opposite
happening in medicine. He found that Schimmel reported
in 1964 that 20 percent of hospital patients suffered
iatrogenic injury, with a 20 percent fatality rate.
Steel in 1981 reported that 36 percent of hospitalized
patients experienced iatrogenesis with a 25 percent
fatality rate and adverse drug reactions were involved
in 50 percent of the injuries. Bedell in 1991 reported
that 64 percent of acute heart attacks in one hospital
were preventable and were mostly due to adverse drug
reactions.
However, Leape focused on his and Brennan’s
“Harvard Medical Practice Study” published in
1991.16a They found that in 1984, in New York State, there
was a 4 percent iatrogenic injury rate for patients with a
14 percent fatality rate. From the 98,609 patients injured
and the 14 percent fatality rate, he estimated that in the
whole of the U.S. 180,000 people die each year, partly as a
result of iatrogenic injury. Leape compared these deaths to
the equivalent of three jumbo-jet crashes every two days.
Why Leape chose to use the much lower figure of four percent
injury for his analysis remains in question. Perhaps he
wanted to tread lightly. If Leape had, instead, calculated
the average rate among the three studies he cites (36
percent, 20 percent, and 4 percent), he would have come up
with a 20 percent medical error rate. The number of
fatalities that he could have presented, using an average
rate of injury and his 14 percent fatality, is an annual
1,189,576 iatrogenic deaths, or over ten jumbo jets crashing
every day.
Leape acknowledged that the literature on medical error is
sparse and we are only seeing the tip of the iceberg. He
said that when errors are specifically sought out, reported
rates are “distressingly high”. He cited several
autopsy studies with rates as high as 35 percent to 40
percent of missed diagnoses causing death. He also commented
that an intensive care unit reported an average of 1.7
errors per day per patient, and 29 percent of those errors
were potentially serious or fatal. We wonder: what is the
effect on someone who daily gets the wrong medication, the
wrong dose, the wrong procedure; how do we measure the
accumulated burden of injury; and when the patient finally
succumbs after the tenth error that week, what is entered on
the death certificate?
Leape calculated the rate of error in the intensive care
unit. 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 percent failure rate. To some this may not seem like much,
but putting this into perspective, Leape cited industry
standards where in aviation a 0.1 percent failure rate would
mean 2 unsafe plane landings per day at O’Hare
airport; in the U.S. Mail, 16,000 pieces of lost mail every
hour; or in banking, 32,000 bank checks deducted from the
wrong bank account every hour.
Analyzing why there is so much medical error Leape
acknowledged the lack of reporting. Unlike a jumbo-jet
crash, which gets instant media coverage, hospital errors
are spread out over the country in thousands of different
locations. They are also perceived as isolated and unusual
events. However, the most important reason that medical
error is unrecognized and growing, according to Leape, was,
and still is, that doctors and nurses are unequipped to
deal with human error, due to 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. We can see how a great deal of
sweeping under the rug takes place since nobody is taught
what to do when medical error does occur. Leape cited
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 medicine “to
fundamentally change the way they think about errors and why
they occur”. It’s been almost a decade since
this groundbreaking work, but the mistakes continue to soar.
One year later, in 1995, a report in JAMA said that, "Over a
million patients are injured in U.S. hospitals each year,
and approximately 280,000 die annually as a result of these
injuries. Therefore, the iatrogenic death rate dwarfs the
annual automobile accident mortality rate of 45,000 and
accounts for more deaths than all other accidents
combined."23
At a press conference in 1997 Dr. Leape released a
nationwide poll on patient iatrogenesis conducted by the
National Patient Safety Foundation (NPSF), which is
sponsored by the American Medical Association. The survey
found that more than 100 million Americans have been
impacted directly and indirectly by a medical mistake. Forty-
two percent were directly affected and a total of 84 percent
personally knew of someone who had experienced a medical
mistake.14 Dr. Leape is a founding member of the NPSF.
Du. Leape at this press conference also updated his 1994
statistics saying that medical errors in inpatient
hospital settings nationwide, as of 1997, could be as
high as three million and could cost as much as $200
billion. Leape used a 14 percent fatality rate to
determine a medical error death rate of 180,000 in
1994.16 In 1997, using Leape’s base number of
three million errors, the annual deaths could be as much
as 420,000 for inpatients alone. This does not include
nursing home deaths, or people in the outpatient
community dying of drug side effects or as the result of
medical procedures.
ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED
Leape, in 1994, said that he was well aware that medical
errors were not being reported.16 According to a study in
two obstetrical units in the U.K., only about one quarter of
the adverse incidents on the units are ever reported for
reasons of protecting staff or preserving reputations, or
fear of reprisals, including law suits.24 An analysis by
Wald and Shojania found that only 1.5 percent of all adverse
events result in an incident report, and only 6 percent of
adverse drug events are identified properly.
The authors learned that the American College of Surgeons
gives a very broad guess that surgical incident reports
routinely capture only 5-30 percent of adverse events. In
one surgical study only 20 percent of surgical complications
resulted in discussion at Morbidity and Mortality Rounds.25
From these studies it appears that all the statistics that
are gathered may be substantially underestimating the number
of adverse drug and medical therapy incidents. It also
underscores the fact that our mortality statistics are
actually conservative figures.
An article in Psychiatric Times outlines the stakes involved
with reporting medical errors.26 They found that the public
is fearful of suffering a fatal medical error, and doctors
are afraid they will be sued if they report an error. This
brings up the obvious question: who is reporting medical
errors? Usually it is the patient or the patient’s
surviving family. If no one notices the error, it is never
reported. Janet Heinrich, an associate director at the U.S.
General Accounting Office responsible for health financing
and public health issues, testifying before a House
subcommittee about medical errors, said that, "The full
magnitude of their threat to the American public is
unknown.” She added, "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 under-
reporting of errors. The Psychiatric Times noted that the
American Medical Association is strongly opposed to
mandatory reporting of medical errors.26 If doctors
aren’t reporting, what about nurses? In a survey of
nurses, they also did not report medical mistakes for fear
of retaliation.27
Standard medical pharmacology texts admit that relatively
few doctors ever report adverse drug reactions to the FDA.28
The reasons range from not knowing such a reporting system
exists to fear of being sued because they prescribed a drug
that caused harm. 29 However, it is this tremendously flawed
system of voluntary reporting from doctors that we depend on
to know whether a drug or a medical intervention is harmful.
Pharmacology texts will also 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 the doctor. Doctors are warned, “Probably
nowhere else in professional life are mistakes so easily
hidden, even from ourselves.”30 It may be hard to
accept, but not difficult to understand, why only one in
twenty side effects is reported to either hospital
administrators or the FDA.31,31a
If hospitals admitted to the actual number of errors and
mistakes, which is about 20 times what is reported, they
would come under intense scrutiny.32 Jerry Phillips,
associate director of the Office of Post Marketing Drug Risk
Assessment at the FDA, confirms this number. “In the
broader area of adverse drug reaction data, the 250,000
reports received annually probably represent only five
percent of the actual reactions that occur.”33 Dr. Jay
Cohen, who has extensively researched adverse drug
reactions, comments that because only five percent of
adverse drug reactions are being reported, there are, in
reality, five million medication reactions each year.34
It remains that whatever figure you choose to believe about
the side effects from drugs, all the experts agree that you
have to multiply that by 20 to get a more accurate estimate
of what is really occurring in the burgeoning
“field” of iatrogenic medicine.
A 2003 survey is all the more distressing because there
seems to be no improvement in error-reporting even with all
the attention on this topic. Dr. Dorothea Wild surveyed
medical residents at a community hospital in Connecticut.
She found that only half of the residents were aware that
the hospital had a medical error-reporting system, and the
vast majority didn’t use it at all. Dr. Wild says this
does not bode well for the future. If doctors don’t
learn error-reporting in their training, they will never use
it. And she adds that error reporting is the first step in
finding out where the gaps in the medical system are and
fixing them. That first baby step has not even begun.35
PUBLIC SUGGESTIONS ON IATROGENESIS
In a telephone survey, 1,207 adults were asked to indicate
how effective they thought the following would be in
reducing preventable medical errors that resulted in
serious harm:36
giving doctors more time to spend with patients: very
effective 78 percent requiring hospitals to develop systems
to avoid medical errors: very effective 74 percent better
training of health professionals: very effective 73 percent
using only doctors specially trained in intensive care
medicine on intensive care units: very effective 73 percent
requiring hospitals to report all serious medical errors to
a state agency: very effective 71 percent increasing the
number of hospital nurses: very effective 69 percent
reducing the work hours of doctors-in-training to avoid
fatigue: very effective 66 percent encouraging hospitals to
voluntarily report serious medical errors to a state agency:
very effective 62 percent
DRUG IATROGENESIS
Drugs comprise 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 study1
shows. But human error can make the situation even worse.
Medication Errors
A survey of a 1992 national pharmacy database found a total
of 429,827 medication errors from 1,081 hospitals.
Medication errors occurred in
5.22 percent of patients admitted to these hospitals each
year. The authors concluded that a minimum of 90,895
patients annually were harmed by medication errors in the
country as a whole.37
A 2002 study shows that 20 percent of hospital medications
for patients had dosage mistakes. Nearly 40 percent of these
errors were considered potentially harmful to the patient.
In a typical 300-patient hospital the number of errors per
day were 40.38
Problems involving patients’ medications were even
higher the following year. The error rate intercepted by
pharmacists in this study was 24 percent, making the
potential minimum number of patients harmed by prescription
drugs 417,908.39
Recent Adverse Drug Reactions
More recent studies on adverse drug reactions show that the
figures from 1994 (published in Lazarou’s 1998 JAMA
article) may be increasing. A 2003 study followed 400
patients after discharge from a tertiary care hospital
(hospital care that requires highly specialized skills,
technology or support services). Seventy-six patients (19
percent) had adverse events. Adverse drug events were the
most common at 66 percent. The next most common events were
procedure-related injuries at 17 percent.40
In a NEJM study an alarming one-in-four patients suffered
observable side effects from the more than 3.34 billion
prescription drugs filled in 2002.41 One of the doctors who
produced the study was interviewed by Reuters and commented
that, "With these 10-minute appointments, it's hard for the
doctor to get into whether the symptoms are bothering the
patients."42 William Tierney, who editorialized on the NEJM
study, said “… given the increasing number of
powerful drugs available to care for the aging population,
the problem will only get worse.”
The drugs with the worst record of side effects were the
SSRIs, the NSAIDs, and calcium-channel blockers. Reuters
also reported that prior research has suggested that nearly
five percent 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 one of the
reasons for this failure: in nearly two-thirds of the cases,
doctors couldn’t diagnose drug side effects or the
side effects persisted because the doctor failed to heed the
warning signs.
Medicating Our Feelings
We only need to look at the side effects of antidepressant
drugs, which give hope to a depressed population. Patients
seeking a more joyful existence and relief from worry,
stress and anxiety, fall victim to the messages blatantly
displayed on TV and billboards. Often, instead of relief,
they also fall victim to a myriad of iatrogenic side effects
of antidepressant medication.
Also, a whole generation of antidepressant users has
resulted from young people growing up on Ritalin. Medicating
youth and modifying their emotions must have some impact on
how they learn to deal with their feelings. They learn to
equate coping with drugs and not their inner resources. As
adults, these medicated youth reach for alcohol, drugs, or
even street drugs, to cope. According to the Journal of the
American Medical Association, “Ritalin acts much like
cocaine.”43 Today’s marketing of mood-modifying
drugs, such as Prozac or Zoloft, makes them not only
socially acceptable but almost a necessity in today’s
stressful world.
Television Diagnosis
In order to reach the widest audience possible, drug
companies are no longer just targeting medical doctors with
their message about antidepressants. By 1995 drug companies
had tripled the amount of money allotted to direct
advertising of prescription drugs to consumers. The majority
of the money is spent on seductive television ads. From 1996
to 2000, spending rose from $791 million to nearly $2.5
billion.44 Even though $2.5 billion may seem like a lot of
money, the authors comment that it only represents 15
percent of the total pharmaceutical advertising budget.
According to medical experts “there is no solid
evidence on the appropriateness of prescribing that results
from consumers requesting an advertised drug.”
However, the drug companies maintain that direct-to-consumer
advertising is educational. Dr. Sidney M. Wolfe, of the
Public Citizen Health Research Group in Washington, D.C.,
argues that the public is often misinformed about these
ads.45 People want what they see on television and are told
to go to their doctor for a prescription.
Doctors in private practice either acquiesce to their
patients’ demands for these drugs or spend valuable
clinic time trying to talk patients out of unnecessary
drugs. Dr. Wolfe remarks that one important study found that
people mistakenly believe that the “FDA reviews all
ads before they are released and allows only the safest and
most effective drugs to be promoted directly to the
public.”46
How Do We Know Drugs Are Safe?
Another aspect of scientific medicine that the public takes
for granted is the testing of new drugs. Unlike the class of
people that take drugs who are ill and need medication, in
general, drugs are tested on individuals who are fairly
healthy and not on other medications that can interfere with
findings. But when they are declared “safe” and
enter the drug prescription books, they are naturally going
to be used by people on a variety of other medications and
who also 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
General Accounting Office (an agency of the U.S. Government)
"found that of the 198 drugs approved by the FDA between
1976 and 1985 … 102 (or 51.5 percent) had serious post-
approval risks … the serious post-approval risks
(included) heart failure, myocardial infarction,
anaphylaxis, respiratory depression and arrest, seizures,
kidney and liver failure, severe blood disorders, birth
defects and fetal toxicity, and blindness."47
The investigative show NBC’s “Dateline”
wondered if your doctor is moonlighting as a drug rep.
After a year-long investigation they 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 non-tested
uses of these medications in spite of the fact that these
drugs are only approved for specific indications they
have been tested for.48
The leading causes of adverse drug reactions are antibiotics
(17 percent), cardiovascular drugs (17 percent),
chemotherapy (15 percent), and analgesics and anti-
inflammatory agents (15 percent).49
Specific Drug Iatrogenesis: Antibiotics
Dv. Egger, in a recent editorial, wrote that after 50 years
of increasing use of antibiotics, 30 million pounds of
antibiotics are used in America per year.50 Twenty-five
million pounds of this total are used in animal
husbandry. The vast majority of this amount, 23 million
pounds, is used to try to prevent disease, the stress of
shipping, and to promote growth. Only 2 million pounds
are given for specific animal infections. Dr. Egger
reminds us that low concentrations of antibiotics are
measurable in many of our foods, rivers, and streams
around the world. Much of this is seeping into bodies of
water from animal farms.
Egger says overuse of antibiotics results in food-borne
infections resistant to antibiotics. Salmonella is found in
20 percent of ground meat but constant exposure of cattle to
antibiotics has made 84 percent of salmonella resistant to
at least one anti-salmonella antibiotic. Diseased animal
food accounts for 80 percent of salmonellosis in humans, or
1.4 million cases per year.
The conventional approach to dealing with this epidemic is
to radiate food to try to kill all organisms but keep using
the antibiotics that cause the original problem.
Approximately 20 percent of chickens are contaminated with
Campylobacter jejuni causing 2.4 million human cases of
illness annually. Fifty-four percent of these organisms are
resistant to at least one anti-campylobacter antimicrobial.
A ban on growth-promoting antibiotics in Denmark began in
1999, which led to a decrease from 453,200 pounds to 195,800
pounds within a year. Another report from Scandinavia found
that taking away antibiotic growth promoters had no or
minimal effect on food production costs. Egger further warns
that in America the current crowded, unsanitary methods of
animal farming support constant stress and infection, and
are geared toward high antibiotic use. He says these
conditions would have to be changed along with cutting back
on antibiotic use.
In America, over 3 million pounds of antibiotics are used
every year on humans. With a population of 284 million
Americans, this amount is enough to give every man, woman
and child 10 teaspoons of pure antibiotics per year. Egger
says that exposure to a steady stream of antibiotics has
altered pathogens such as Streptococcus pneumoniae,
Staplococcus aureus, and entercocci, to name a few.
Almost half of patients with upper respiratory tract
infections in the United States still receive antibiotics
from their doctor.51 According to the CDC, 90 percent of
upper respiratory infections are viral and should not be
treated with antibiotics. In Germany the prevalence for
systemic antibiotic use in children aged 0 to 6 years was
42.9 percent.52
Data taken from nine U.S. health plans between 1996 and 2000
on antibiotic use in 25,000 children found that rates of
antibiotic use decreased. Antibiotic use in children, aged 3
months to under 3 years, decreased 24 percent, from 2.46 to
1.89 antibiotic prescriptions per/patient per/year. For
children, 3 years to under 6 years, there was a 25 percent
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 percent reduction from 0.85 to 0.69
antibiotic prescriptions per/ patient /per year.53 Although
there was a reduction in antibiotic use, 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, penicillin and
erythromycin being the only recommended treatment. However,
90 percent of sore throats are viral. The authors of this
study estimated there were 6.7 million adult annual visits
for sore throat between 1989 and 1999 in the United States.
Antibiotics were used in 73 percent of visits. Furthermore,
patients treated with antibiotics were given non-recommended
broad-spectrum antibiotics in 68 percent of visits.
The authors noted, that from 1989 to 1999, there was a
significant increase in the newer and more expensive broad-
spectrum antibiotics and a decrease in use of penicillin and
erythromycin, which are the recommended antibiotics.54 If
antibiotics were given in 73 percent of visits and should
have only been given in 10 percent, this represents 63
percent, or a total of 4.2 million visits for sore throat
that ended in unnecessary antibiotic prescriptions
between1989 and 1999. In 1995, Dr. Besser and the CDC cited
2003 cited much higher figures of 20 million unnecessary
antibiotic prescriptions per year for viral infections.2
Neither of these figures takes into account the number of
unnecessary antibiotics used for non-fatal conditions such
as acne, intestinal infection, skin infections, ear
infections, etc.
The Problem with Antibiotics: They are Anti-Life
On September 17, 2003 the CDC relaunched a program, started
in 1995, called “Get Smart: Know When Antibiotics
Work.”55 This is a $1.6 million campaign to educate
patients about the overuse and inappropriate use of
antibiotics. Most people involved with alternative medicine
have known about the dangers of overuse of antibiotics for
decades. Finally the government is focusing on the problem,
yet they are only putting a miniscule amount of money into
an iatrogenic epidemic that is costing billions of dollars
and thousands of lives.
The CDC warns that 90 percent of upper respiratory
infections, including children’s ear infections, are
viral, and antibiotics don’t treat viral infection.
More than 40 percent of about 50 million prescriptions for
antibiotics each year in physicians' offices were
inappropriate.2 And using antibiotics, when not needed, can
lead to the development of deadly strains of bacteria that
are resistant to drugs and cause more than 88,000 deaths due
to hospital-acquired infections.9
However, the CDC seems to be blaming patients for misusing
antibiotics even though they are only available on
prescription from a doctor who should know how to prescribe
properly. Dr. Richard Besser, head of “Get
Smart,” says "Programs that have just targeted
physicians have not worked. Direct-to-consumer advertising
of drugs is to blame in some cases.” Dr. Besser says
the program “teaches patients and the general public
that antibiotics are precious resources that must be used
correctly if we want to have them around when we need them.
Hopefully, as a result of this campaign, patients will feel
more comfortable asking their doctors for the best care for
their illnesses, rather than asking for antibiotics."56
And what does the “best care” constitute? The
CDC does not elaborate and patently avoids the latest
research on the dozens of nutraceuticals scientifically
proven to treat viral infections and boost the immune
system. Will their doctors recommend vitamin C, echinacea,
elderberry, vitamin A, zinc, or homeopathic oscillococcinum?
No, they won’t. The archaic solutions offered by the
CDC include a radio ad, “Just Say No--Snort, sniffle,
sneeze--No antibiotics please." Their commonsense
recommendations, that most people do anyway, include
resting, drinking plenty of fluids, and using a humidifier.
The pharmaceutical industry claims they are all for limiting
the use of antibiotics. In order to make sure that happens,
the drug company Bayer is sponsoring a program called,
“Operation Clean Hands,” through an organization
called LIBRA.57 The CDC is also involved with trying to
minimize antibiotic resistance, but nowhere in their
publications is there any reference to the role of
nutraceuticals in boosting the immune system nor to the
thousands of journal articles that support this approach.
This recalcitrant tunnel vision and refusal to use available
non-drug alternatives is absolutely inappropriate when the
CDC is desperately trying to curb the nightmare of overuse
of antibiotics. The CDC should also be called to task
because it is only focusing on the overuse of antibiotics.
There are similar nightmares for every class of drug being
prescribed today.
Drugs Pollute Our Water Supply
We have reached the point of saturation with prescription
drugs. We have arrived at the point where every body of
water tested contains measurable drug residues. We are
inundated with drugs. The tons of antibiotics used in
animal farming, which run off into the water table and
surrounding bodies of water, are conferring antibiotic
resistance to germs in sewage, and these germs are also
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 idea what the long-term consequences of ingesting
a mixture of drugs and drug-breakdown products will do to
our health. It’s another level of iatrogenic disease
that we are unable to completely measure.58-67
Specific Drug Iatrogenesis: NSAIDs
It’s not just America that is plagued with
iatrogenesis. A survey of 1,072 French general practitioners
(GPs) tested their basic pharmacological knowledge and
practice in prescribing NSAIDs. Non-steroidal anti-
inflammatory drugs (NSAIDs) rank first among commonly
prescribed drugs for serious adverse reactions. The results
of the study suggested that GPs don’t have adequate
knowledge of these drugs and are unable to effectively
manage adverse reactions.68
A cross-sectional survey of 125 patients attending specialty
pain clinics in South London found that possible iatrogenic
factors such as “over-investigation, inappropriate
information, and advice given to patients as well as
misdiagnosis, over-treatment, and inappropriate prescription
of medication were common.”69
Specific Drug Iatrogenesis: Cancer Chemotherapy
In 1989, a German biostatistician, Ulrich Abel PhD, after
publishing dozens of papers on cancer chemotherapy, wrote a
monograph “Chemotherapy of Advanced Epithelial
Cancer.” It was later published in a shorter form in a
peer-reviewed medical journal.70 Dr. 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 we are most familiar
with. It arises from epithelium found in the lining of body
organs such as breast, prostate, lung, stomach, or bowel.
From these sites cancer usually infiltrates into adjacent
tissue and spreads to bone, liver, lung, or the brain. With
his exhaustive review
Dw. Abel concludes that there is no direct evidence that
chemotherapy prolongs survival in patients with advanced
carcinoma. He said that in small-cell lung cancer and
perhaps ovarian cancer the therapeutic benefit is only
slight. Dr. Abel goes on to say, “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 Dr. Abel’s exhaustive review of
chemotherapy, there seems no decrease in its use for
advanced carcinoma. For example, when conventional
chemotherapy and radiation has not worked to prevent
metastases in breast cancer, high-dose chemotherapy (HDC)
along with stem-cell transplant (SCT) is the treatment of
choice. However, in March 2000, results from the largest multi-
center randomized controlled trial conducted thus far showed
that, compared to a prolonged course of monthly conventional-
dose chemotherapy, HDC and SCT were of no benefit.71 There
was even a slightly lower survival rate for the HDC/SCT
group. And the authors noted that serious adverse effects
occurred more often in the HDC group than the standard-dose
group. There was one treatment-related death (within 100
days of therapy) in the HDC group, but none in the
conventional chemotherapy group. The women in this trial
were highly selected as having the best chance to respond.
There is also no all-encompassing follow-up study like Dr.
Abel’s that tells us if there is any improvement in
cancer-survival statistics since 1989. In fact, we need to
research 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 aren’t used.
Drug Companies Fined
Periodically, a drug manufacturer is fined by the FDA when
the abuses are too glaring and impossible to cover up. The
May 2002 Washington Post reported that the maker of
Claritin, Schering-Plough Corp., was to pay a $500 million
fine to the FDA for quality-control problems at four of its
factories.72 The FDA tabulated infractions that included 90
percent, or 125 of the drugs they made since 1998. Besides
the fine, the company had to stop manufacturing 73 drugs or
suffer another $175 million fine. PR statements by the
company told another story. The company assured consumers
that they should still feel confident in its products.
Such a large settlement serves 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 Inc. paid $100 million for failing to meet
quality standards in the production of medical test kits,
and Wyeth Laboratories Inc. paid $30 million in 2000 to
settle accusations of poor manufacturing practices.
The indictment against Schering-Plough came after the Public
Citizen Health Research Group, lead 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.
UNNECESSARY SURGICAL PROCEDURES
Summary:
1974: 2.4 million unnecessary surgeries performed annually
resulting in 11,900 deaths at an annual cost of $3.9
billion.73,74
2001: 7.5 million unnecessary surgical procedures resulting
in 37,136 deaths at a cost of $122 billion (using 1974
dollars).3
It’s very difficult to obtain accurate statistics when
studying unnecessary surgery. Dr. Leape in 1989 wrote that
perhaps 30 percent of controversial surgeries are
unnecessary. Controversial surgeries include Cesarean
section, tonsillectomy, appendectomy, hysterectomy,
gastrectomy for obesity, breast implants, and elective
breast implants.74
Almost 30 years ago, in 1974, the Congressional Committee on
Interstate and Foreign Commerce held hearings on unnecessary
surgery. They found that 17.6 percent of recommendations for
surgery were not confirmed by a second opinion. The House
Subcommittee on Oversight and Investigations extrapolated
these figures and estimated that, on a nationwide basis,
there were 2.4 million unnecessary surgeries performed
annually, resulting in 11,900 deaths at an annual cost of
$3.9 billion.73
In 2001, the top 50 medical and surgical procedures totaled
approximately 41.8 million. These figures were taken from
the Healthcare Cost and Utilization Project within the
Agency for Healthcare Research and Quality.13 Using 17.6
percent from the 1974 U.S. Congressional House Subcommittee
Oversight Investigation as the percentage of unnecessary
surgical procedures, and extrapolating from the death rate
in 1974, we come up with an unnecessary procedure number of
7.5 million (7,489,718) and a death rate of 37,136, at a
cost of $122 billion (using 1974 dollars).
Researchers performed a very similar analysis, using the
1974 ‘unnecessary surgery percentage’ of 17.6,
on back surgery. In 1995, researchers testifying before the
Department of Veterans Affairs estimated that of 250,000
back surgeries in the U.S. at a hospital cost of $11,000 per
patient, the total number of unnecessary back surgeries each
year in the U.S. could approach 44,000, costing as much as
$484 million.75
The unnecessary surgery figures are escalating just as
prescription drugs driven by television advertising. Media-
driven surgery such as gastric bypass for obesity
“modeled” by Hollywood personalities seduces
obese people to think this route is safe and
Internet.76 A study in Spain declares that between 20
percent and 25 percent of total surgical practice represents
unnecessary operations.77
According to data from the National Center for Health
Statistics from 1979 to 1984, there was a nine percent
increase in the total number of surgical procedures, and the
number of surgeons grew by 20 percent. The author notes that
there has not been a parallel increase in the number of
surgeries despite a recent large increase in the number of
surgeons. There was concern that there would be too many
surgeons to share a small surgical caseload.78
The previous author spoke too soon--there was no cause to
worry about a small surgical caseload. By 1994, there was an
increase of 38 percent for a total of 7,929,000 cases for
the top ten surgical procedures. In 1983, surgical cases
totaled 5,731,000. In 1994, cataract surgery was number one
with over two million operations, and second was Cesarean
section (858,000 procedures). Inguinal hernia operations
were third (689,000 procedures), and knee arthroscopy, in
seventh place, grew 153 percent (632,000 procedures) while
prostate surgery declined 29 percent (229,000 procedures).79
The list of iatrogenic diseases from surgery is as long as
the list of procedures themselves. In one study epidural
catheters were inserted to deliver anesthetic into the
epidural space around the spinal nerves to block them for
lower Cesarean section, abdominal surgery, or prostate
surgery. In some cases, non-sterile technique, during
catheter insertion, resulted in serious infections, even
leading to limb paralysis.80
In one review of the literature, the authors demonstrated
“a significant rate of overutilization of coronary
angiography, coronary artery surgery, cardiac pacemaker
insertion, upper gastrointestinal endoscopies, carotid
endarterectomies, back surgery, and pain-relieving
procedures.”81
A 1987 JAMA study found the following significant levels of
inappropriate surgery: 17 percent of cases for coronary
angiography, 32 percent for carotid endarterectomy, and 17
percent for upper gastrointestinal tract endoscopy.82 Using
the Healthcare Cost and Utilization Project (HCUP)
statistics provided by the government for 2001, the number
of people getting upper gastrointestinal endoscopy, which
usually entails biopsy, was 697,675; the number getting
endarterectomy was 142,401; and the number having coronary
angiography was 719,949.13 Therefore, according to the JAMA
study 17 percent, or 118,604 people had an unnecessary
endoscopy procedure. Endarterectomy occurred in 142,401
patients; potentially 32 percent or 45,568 did not need this
procedure. And 17 percent of 719,949, or 122,391 people
receiving coronary angiography were subjected to this highly
invasive procedure unnecessarily. These are all forms of
medical iatrogenesis.