Death by Medicine, Part I   References
Death by Medicine, Part II  References  Appendix
 

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

source: mercola.com

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)
 

ANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL INTERVENTION
 

Condition	Deaths	Cost	Author
Adverse Drug Reactions	106,000	$12 billion	Lazarou1 Suh49
Medical error	98,000	$2 billion	IOM6
Bedsores	115,000	$55 billion	Xakellis7 Barczak8
Infection	88,000	$5 billion	Weinstein9 MMWR10
Malnutrition	108,800	--------	Nurses Coalition11
Outpatients	199,000	$77 billion	Starfield12 Weingart112
Unnecessary Procedures	37,136	$122 billion	HCUP3,13
Surgery-Related	32,000	$9 billion	AHRQ85
TOTAL	783,936	$282 billion

We 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.
 

Condition	Deaths	Cost	Author
ADR/med error	420,000	$200 billion	Leape 199714
TOTAL	999,936

ANNUAL UNNECESSARY MEDICAL EVENTS STATISTICS
 

Unnecessary Events	People Affected	Iatrogenic Events
Hospitalization	8.9 million4	1.78 million16
Procedures	7.5 million3	1.3  million40
TOTAL	16.4 million	3.08 million

 

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:

In 16.4 million people, 2.1% chance of a serious adverse drug reaction,1
(186,000)

In 16.4 million people, 5-6% chance of acquiring a nosocomial infection,9
(489,500)

In16.4 million people, 4-36% chance of having an iatrogenic injury in
hospital (medical error and adverse drug reactions),16 (1.78 million)

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
 

Condition	10-Year Deaths	Author
Adverse Drug Reaction	1.06 million	(1)
Medical error	0.98 million	(6)
Bedsores	1.15 million	(7,8)
Nosocomial Infection	0.88 million	(9,10)
Malnutrition	1.09 million	(11)
Outpatients	1.99 million	(12, 112)
Unnecessary Procedures	371,360	(3,13)
Surgery-related	320,000	(85)
TOTAL	7,841,360  (7.8 million)

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
 

Unnecessary Events	10-year Number	Iatrogenic Events
Hospitalization	89 million4	17 million
Procedures	75 million3	15 million
TOTAL	164 million

 

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
 

Dr. 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. 

Dr. 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
 

Dr. 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 Dr.
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 sexy. There is even a problem of
surgery being advertised on the 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.
 
 

We have added, cumulatively, figures from 13 references of annual iatrogenic
deaths. However, there is invariably some degree of overlap and double
counting that can occur in gathering non-finite statistics.

Death numbers don't come with names and birth dates to prevent duplication
On the other hand, there are many missing statistics. As we will show, only
about 5 to 20% of iatrogenic incidents are even recorded.16,24,25,33,34 And,
our outpatient iatrogenic statistics112 only include drug-related events and
not surgical cases, diagnostic errors, or therapeutic mishaps.

We have also been conservative in our inclusion of statistics that were not
reported in peer review journals or by government institutions. For example,
on July 23, 2002, The Chicago Tribune analyzed records from patient
databases, court cases, 5,810 hospitals, as well as 75 federal and state
agencies and found 103,000 cases of death due to hospital infections, 75% of
which were preventable.152 We do not include this figure but report the
lower Weinstein figure of 88,000.9 Another figure that we withheld, for lack
of proper peer review was The National Committee for Quality Assurance,
September 2003 report which found that at least 57,000 people die annually
from lack of proper care for commons diseases such as high blood pressure,
diabetes, or heart disease.153

Overlapping of statistics in Death by Medicine may occur with the Institute
of Medicine (IOM) paper that designates "medical error" as including drugs,
surgery, and unnecessary procedures.6 Since we have also included other
statistics on adverse drug reactions, surgery and, unnecessary procedures,
perhaps a much as 50% of the IOM number could be redundant. However, even
taking away half the 98,000 IOM number still leaves us with iatrogenic
events as the number one killer at 738,000 annual deaths.

MEDICAL AND SURGICAL PROCEDURES

It is instructive to know the mortality rate associated with different
medical and surgical procedures. Even though we must sign release forms when
we undergo any procedure, many of us are in denial about the true risks
involved. We seem to hold a collective impression that since medical and
surgical procedures are so commonplace, they are both necessary and safe.
Unfortunately, partaking in allopathic medicine itself is one of the highest
causes of death as well as the most expensive way to die.

Shouldn’t the daily death rate of iatrogenesis in hospitals, out of
hospitals, in nursing homes, and psychiatric residences be reported like the
pollen count or the smog index? Let’s stop hiding the truth from ourselves.
It’s only when we focus on the problem and ask the right questions that we
can hope to find solutions.

Perhaps the words “health care” give us the illusion that medicine is about
health. Allopathic medicine is not a purveyor of healthcare but of
disease-care. Studying the mortality figures in the Healthcare Cost and
Utilization Project (HCUP) within the U.S. government’s Agency for
Healthcare Research and Quality, we found many points of interest.13 The
HCUP computer program that calculates the annual mortality statistics for
all U.S. hospital discharges is only as good as the codes that are put into
the system.

In an e-mail correspondence with HCUP, we were told that the mortality rates
that were indicated in tables and charts for each procedure were not
necessarily due to the procedure but only indicated that someone who
received that procedure died either from their original disease or from the
procedure.

Therefore there is no way of knowing exactly how many people died from a
particular procedure. There are also no codes for adverse drug side effects,
none for surgical mishap, and none for medical error. Until there are codes
for medical error, statistics of those people who are dying from various
types of medical error will be buried in the general statistics. There is a
code for “poisoning & toxic effects of drugs” and a code for “complications
of treatment.”

However, the mortality figures registered in these categories are very low
and don’t compare with what we know from studies such as the JAMA 1998
study1 that said there were an average of 106,000 prescription medication
deaths per year.

WHY AREN’T MEDICAL AND SURGICAL PROCEDURES STUDIED?

In 1978, the U.S. Office of Technology Assessment (OTA) reported that, “Only
10 percent to 20 percent of all procedures currently used in medical
practice have been shown to be efficacious by controlled trial."83 In 1995,
the OTA compared medical technology in eight countries (Australia, Canada,
France, Germany, Netherlands, Sweden, United Kingdom, and the United States)
and again noted that few medical procedures in the United States had been
subjected to clinical trial. It also reported that infant mortality was high
and life expectancy was low compared to other developed countries.84

Although almost 10 years old, much of what was said in this report holds
true today. The report lays the blame for the high cost of medicine squarely
at the feet of the medical free-enterprise system and the fact that there is
no national health care policy. It describes the failure of government
attempts to control health care costs due to market incentive and profit
motive in the financing and organization of health care including private
insurance, hospital system, physician services, and drug and medical device
industries.

Whereas we may want to expand health-care, expansion of disease-care is the
goal of free enterprise. “Health Care Technology and Its Assessment in Eight
Countries” is also the last report prepared by the OTA, which was shut down
in 1995. It’s also, perhaps, the last honest, in-depth look at modern
medicine. Because of the importance of this 60-page report, we enclose a
summary in the Appendix.

SURGICAL ERRORS FINALLY REPORTED

Just hours before completion of this paper, statistics on surgical-related
deaths became available. An October 8, 2003 JAMA study from the U.S.
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 days in the hospital in 2000.85 In a press release
accompanying the JAMA study, the AHRQ director, Carolyn M. Clancy, M.D.,
admitted, “This study gives us the first direct evidence that medical
injuries pose a real threat to the American public and increase the costs of
health care.” 86

Hospital administrative data from 20 percent of the nation’s hospitals were
analyzed for eighteen different surgical complications including
postoperative infections, foreign objects left in wounds, surgical wounds
reopening, and post-operative bleeding. In the same press release the study’
s authors said that, “The findings greatly underestimate the problem, since
many other complications happen that are not listed in hospital
administrative data.” They also felt that, "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."

One of the authors, Dr. Zhan said that improved medical practices, including
an emphasis on better hand-washing, might help reduce the morbidity and
mortality rates. An accompanying JAMA editorial by health-risk researcher
Dr. Saul Weingart of Harvard’s Beth Israel Deaconess Medical Center said,
“Given their staggering magnitude, these estimates are clearly sobering.”87

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. You could even walk into most shoe stores and see your foot
bones; looking at bones was an amusing novelty. We still don’t know the
ultimate outcome of our initial escapade with X-rays.

It was common practice to use X-rays in pregnant women to measure the size
of the pelvis, and make a diagnosis of twins. Finally, a study of 700,000
children born between 1947 and 1964 was conducted in 37 major maternity
hospitals. The children of mothers who had received pelvic X-rays during
pregnancy were compared with the children of mothers who had not been
X-rayed. Cancer mortality was 40 percent higher among the children with
X-rayed mothers.88

In present-day medicine, coronary angiography combines an invasive surgical
procedure of snaking a tube through a blood vessel in the groin up to the
heart. To get any useful information during the angiography procedure X-rays
are taken almost continuously with minimum dosage ranges between 460 and
1,580 mrem. The minimum radiation from a routine chest X-ray is 2 mrem.
X-ray radiation accumulates in the body and it is well-known that ionizing
radiation used in X-ray procedures causes gene mutation. We can only obtain
guesstimates as to its impact on health from this high level of radiation.
Experts manage to obscure the real effects in statistical jargon such as,
“The risk for lifetime fatal cancer due to radiation exposure is estimated
to be four in 1 million per 1,000 mrem.”89

However, Dr. John Gofman, who has been studying the effects of radiation on
human health for 45 years, is prepared to tell us exactly what diagnostic
X-rays are doing to our health. Dr. Gofman has a PhD in nuclear and physical
chemistry and is a medical doctor. He worked on the Manhattan nuclear
project, discovered uranium-2323, was the first person to isolate plutonium,
and since 1960, he’s been studying the effects of radiation on human health.

With five scientifically documented books totaling over 2,800 pages, Dr.
Gofman provides strong evidence that medical technology, specifically
X-rays, CT scans, mammography, and fluoroscopy, are a contributing factor to
75 percent of new cancers.

His 699-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 to here”90 shows that as the number
of physicians increases in a geographical area with an increase in the
number of X-ray diagnostic tests, there is an associated increase in the
rate of cancer and ischemic heart disease. Dr. Gofman elaborates that it’s
not X-rays alone that cause the damage but a combination of health risk
factors including: poor diet, smoking, abortions, and the use of birth
control pills. Dr. Gofman predicts that 100 million premature deaths over
the next decade will be the result of ionizing radiation.

In his book, “Preventing Breast Cancer,” Dr. Gofman says that breast cancer
is the leading cause of death among American women between the ages of 44
and 55. Because breast tissue is highly radiation-sensitive, mammograms can
cause cancer. The danger can be heightened by a woman’s genetic makeup,
preexisting benign breast disease, artificial menopause, obesity, and
hormonal imbalance.91

Even X-rays for back pain can lead someone into crippling surgery. Dr.
Sarno, a well-known New York orthopedic surgeon, found that X-rays don’t
always tell the truth. In his books he cites studies on normal people
without a trace of back pain that have spinal abnormalities on X-ray. Other
studies have shown that some people with back pain have normal spines on
X-ray. So, Dr. Sarno says there is not necessarily any association between
back pain and spinal X-ray abnormality.92 However, if a person happens to
have back pain and an incidental abnormality on X-ray, they may be treated
surgically, sometimes with no change in back pain, or worsening of back
pain, or even permanent disability.

In addition, doctors often order X-rays as protection against malpractice
claims to give the impression that they are leaving no stone unturned. It
appears that doctors are putting their own fears before the interests of
their patients.

UNNECESSARY HOSPITALIZATION

Summary:

8.9 million (8,925,033) people were hospitalized unnecessarily in 2001.4

In a study of inappropriate hospitalization 1,132 medical records were
reviewed by two doctors. Twenty-three percent of all admissions were
inappropriate and an additional 17 percent could have been handled in
ambulatory out-patient clinics. Thirty-four percent of all hospital days
were also inappropriate and could have been avoided.93 The rate of
inappropriate admissions in 1990 was 23.5 percent.94 In 1999, another study
confirmed the figure of 24 percent inappropriate admissions indicating a
consistent pattern from 1986 to 1999,95 showing steady reporting of
approximately 24 percent inappropriate admissions each year.

Putting these figures into present-day terms using the HCUP database, the
total number of patient discharges from hospitals in the U.S. in 2001 was
37,187,641.13 The above data indicate that 24 percent of those
hospitalizations need never have occurred. It further means that 8,925,033
people were exposed to unnecessary medical intervention in hospitals and
therefore represent almost 9 million potential iatrogenic episodes.4

WOMEN’S EXPERIENCE IN MEDICINE

Briefly, we will look at the medical iatrogenesis of women in particular.
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,” turning simple
‘neurosis’ into hysteria.96 The number of women diagnosed with hysteria and
hospitalized rose from one percent in 1841 to 17 percent in 1883.

Hysteria is derived from the Latin “hystera,” meaning uterus. Dr. Adriane
Fugh-Berman stated very clearly in her paper that there is a tradition in
U.S. medicine of excessive medical and surgical interventions on women. Only
100 years ago male doctors decided 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. Dr. Fugh-Berman noted that U.S. doctors eventually
disabused themselves of that notion but have continued to treat women very
differently than they treat men.97 She cites the following:

Thousands of prophylactic mastectomies are performed annually.
One-third of U.S. 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.98
It confines women to a hospital bed and may result in higher incidence of
cesarean section.99
Normal processes such as menopause and childbirth have been heavily
medicalized.
Synthetic hormone replacement therapy (HRT) does not prevent heart disease
or dementia. It does increase the risk of breast cancer, heart disease,
stroke, and gall bladder attack.100

We would add that as many as one-third of postmenopausal women use
HRT.101,102 These numbers are important in light of the much-publicized
Women’s Health Initiative Study, which was forced to stop before its
completion because of a higher death rate in the synthetic
estrogen-progestin (HRT) group.103

Cesarean Section

In 1983, 809,000 cesarean sections (21 percent of live births) were
performed, making it the most common obstetric and gynecologic (OB/GYN)
surgical procedure. The second most common OB/GYN operation was hysterectomy
(673,000), and diagnostic dilation and curettage of the uterus (632,000) was
third. In 1983, OB/GYN operations represented 23 percent of all surgery
completed in this country.104

In 2001, Cesarean section is still the most common OB/GYN surgical
procedure. Approximately 4 million births occur annually, with a 24 percent
C-Section rate, i.e., 960,000 operations. In the Netherlands only eight
percent of babies are delivered by Cesarean section. Assuming human babies
are similar in the United States and in the Netherlands, we are performing
640,000 unnecessary C-Sections in the United States with its three to four
times higher mortality and 20 times greater morbidity than vaginal
delivery.105

The cesarean section rate was only 4.5 percent in the United States in 1965.
By 1986 it had climbed to 24.1 percent. The author states that obviously an
“uncontrolled pandemic of medically unnecessary cesarean births is
occurring.”106 VanHam reported a cesarean section postpartum hemorrhage rate
of seven percent, a hematoma formation rate of 3.5 percent, a urinary tract
infection rate of three percent, and a combined postoperative morbidity rate
of 35.7 percent in a high-risk population undergoing cesarean section.107

NEVER ENOUGH STUDIES

Scientists used the excuse that there were never enough studies revealing
the dangers of DDT and other dangerous pesticides to ban them. They also
used this excuse around the issue of 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 results of tobacco research. In 1964, the Surgeon General's
report condemned smoking, however the AMA refused to endorse it. What was
their reason? They needed more research. Actually what they really wanted
was more money and they got it from a consortium of tobacco companies who
paid the AMA $18 million over the next nine years, during which the AMA said
nothing about the dangers of smoking.108

The Journal of the American Medical Association (JAMA), "after careful
consideration of the extent to which cigarettes were used by physicians in
practice," began accepting tobacco advertisements and money in 1933. State
journals such as the New York State Journal of Medicine also began to run
Chesterfield ads claiming that cigarettes are, "Just as pure as the water
you drink … and practically untouched by human hands."

In 1948, JAMA argued "more can be said in behalf of smoking as a form of
escape from tension than against it … there does not seem to be any
preponderance of evidence that would indicate the abolition of the use of
tobacco as a substance contrary to the public health."109 Today, scientists
continue to use the excuse that they need more studies before they will lend
their support to restrict the inordinate use of drugs.

OVERVIEW OF STATISTICAL TABLES AND FIGURES

Adverse Drug Reactions

The Lazarou study1 was based on statistical analysis of 33 million U.S.
hospital admissions in 1994. Hospital records for prescribed medications
were analyzed. The number of serious injuries due to prescribed drugs was
2.2 million; 2.1 percent of in-patients experienced a serious adverse drug
reaction; 4.7 percent of all hospital admissions were due to a serious
adverse drug reaction; and fatal adverse drug reactions occurred in 0.19
percent of in-patients and 0.13 percent of admissions. The authors concluded
that a projected 106,000 deaths occur annually due to adverse drug
reactions.

We used a cost analysis from a 2000 study in which the increase in
hospitalization costs per patient suffering an adverse drug reaction was
$5,483. Therefore, costs for the Lazarou study’s 2.2 million patients with
serious drug reactions amounted $12 billion.1,49

Serious adverse drug reactions commonly emerge after Food and Drug
Administration approval. The safety of new agents cannot be known with
certainty until a drug has been on the market for many years.110

Bedsores

Over 1 million people develop bedsores in U.S. hospitals every year. It’s a
tremendous burden to patients and family, and a $55 billion dollar health
care burden.7 Bedsores are preventable with proper nursing care. It is true
that 50 percent of those affected are in a vulnerable age group of over 70.
In the elderly bedsores carry a four-fold increase in the rate of death.

The mortality rate in hospitals for patients with bedsores is between 23
percent and 37 percent.8 Even if we just take the 50 percent of people over
70 with bedsores and the lowest mortality at 23 percent, that gives us a
death rate due to bedsores of 115,000. Critics will say that it was the
disease or advanced age that killed the patient, not the bedsore, but our
argument is that an early death, by denying proper care, deserves to be
counted. It is only after counting these unnecessary deaths that we can then
turn our attention to fixing the problem.

Malnutrition in Nursing Homes

The General Accounting Office (GAO), a special investigative branch of
Congress, gave citations to 20 percent of the nation's 17,000 nursing homes
for violations between July 2000 and January 2002. Many violations involved
serious physical injury and death.111

A report from the Coalition for Nursing Home Reform states that at least
one-third of the nation’s 1.6 million nursing home residents may suffer from
malnutrition and dehydration, which hastens their death. The report calls
for adequate nursing staff to help feed patients who aren’t able to manage a
food tray by themselves.11 It is difficult to place a mortality rate on
malnutrition and dehydration. This Coalition report states that malnourished
residents, compared with well-nourished hospitalized nursing home residents,
have a five-fold increase in mortality when they are admitted to hospital.
So, if we take one-third of the 1.6 million nursing home residents who are
malnourished and multiply that by a mortality rate of 20 percent,8,14 we
find 108,800 premature deaths due to malnutrition in nursing homes.

Nosocomial Infections

The rate of nosocomial infections per 1,000 patient days has increased 36
percent - from 7.2 in 1975 to 9.8 in 1995. Reports from more than 270 U.S.
hospitals showed that the nosocomial infection rate itself had remained
stable over the previous 20 years with approximately five to six
hospital-acquired infections occurring per 100 admissions, which is a rate
of 5-6 percent. However, because of progressively shorter inpatient stays
and the increasing number of admissions, the actual number of infections
increased.

It is estimated that in 1995, nosocomial infections cost $4.5 billion and
contributed to more than 88,000 deaths - one death every 6 minutes.9 The
2003 incidence of nosocomial mortality is quite probably higher than in 1995
because of the tremendous increase in antibiotic-resistant organisms.
Morbidity and Mortality Report found that nosocomial infections cost $5
billion annually in 1999.10 This is a $0.5 billion increase in four years.
The present cost of nosocomial infections might now be in the order of $5.5
billion.

Outpatient Iatrogenesis

Dr. Barbara Starfield in a 2000 JAMA paper presents us with well-documented
facts that are both shocking and unassailable.12

The U.S. ranks twelfth out of 13 countries in a total of 16 health
indicators. Japan, Sweden, and Canada were first, second, and third.
More than 40 million people have no health insurance.
20 percent to 30 percent of patients receive contraindicated care.
Dr. Starfield warns that one cause of medical mistakes is the overuse of
technology, which may create a "cascade effect" leading to more treatment.
She urges the use of ICD (International Classification of Diseases) codes
that have designations called: "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 says that, at present, deaths actually
due to medical error are likely to be coded according to some other cause of
death.

She concludes that against the backdrop of our abysmal health report card
compared to the rest of the Westernized countries, we should recognize that
the harmful effects of health care interventions account for a substantial
proportion of our excess deaths.

Starfield cites Weingart’s 2000 article, “Epidemiology of Medical Error” on
outpatient iatrogenesis. And Weingart, in turn, cites several authors and
provides statistics showing that between 4 percent to 18 percent of
consecutive patients in outpatient settings suffer an iatrogenic event
leading to:112

116 million extra physician visits
77 million extra prescriptions
17 million emergency department visits
8 million hospitalizations
3 million long-term admissions
199,000 additional deaths
$77 billion in extra costs

Unnecessary Surgeries

There are 12,000 deaths per year from unnecessary surgeries. However,
results from the few studies that have measured unnecessary surgery directly
indicate that for some highly controversial operations, the fraction that
are unwarranted could be as high as 30 percent.74

IT’S A GLOBAL ISSUE

A survey published in the Journal of Health Affairs pointed out that between
18 percent and 28 percent 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 in five different countries. The breakdown by country
showed 18 percent of those in Britain, 25 percent in Canada, 23 percent in
Australia, 23 percent in New Zealand, and the highest number was in the U.S.
at 28 percent.113

HEALTH INSURANCE

A recent finding by the Institute of Medicine is that the 41 million
Americans without health insurance have consistently worse clinical outcomes
than those who are insured, and are at increased risk for dying
prematurely.114

Insurance Fraud

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 U.S. General Accounting Office (GAO) gave a 1998 figure of $12
billion lost to fraudulent or unnecessary claims, and reclaimed $480 million
in judgments in that year. In 2001, the federal government won or negotiated
more than $1.7 billion in judgments, settlements, and administrative
impositions in health care fraud cases and proceedings.115

WAREHOUSING OUR ELDERS

It is only fitting that we end this report with acknowledgement of our
elders. The moral and ethical fiber of society can be judged by the way it
treats its weakest and most vulnerable members. Some cultures honor and
respect the wisdom of their elders, keeping them at home--the better to
continue participation in their community. However, American nursing homes,
where millions of our elders die, represent the pinnacle of social isolation
and medical abuse.

Important Statistics about Nursing Homes

1. In America, at any one time, approximately 1.6 million elderly are
confined to nursing homes. By 2050 that number could be 6.6 million.11,116

2. A total of 20 percent of all deaths from all causes occur in nursing
homes.117

3. Hip fractures are the single greatest reason for nursing home
admissions.118 Nursing homes represent a reservoir for drug-resistant
organisms due to overuse of antibiotics.119

Congressman Waxman reminded us that “as a society we will be judged by how
we treat the elderly" when he presented a report that he sponsored, "Abuse
of Residents is a Major Problem in U.S. Nursing Homes," on July 30, 2001.
The report uncovered that one-third--5,283 of the nations’ 17,000 nursing
homes--were cited for an abuse violation in the two-year period studied,
January 1999 to January 2001.116 Waxman stated that “the people who cared
for us, deserve better." He also made it very clear that this was only the
tip of the iceberg and there is much more abuse occurring that we don’t know
about or ignore.116a

The major findings of "Abuse of Residents is a Major Problem in U.S. Nursing
Homes," were:

Over 30 percent of nursing homes in the United States were cited for abuses,
totaling more than 9,000 abuse violations.
10 percent of nursing homes had violations that caused actual physical harm
to residents, or worse.
Over 40 percent, or 3,800, abuse violations were only discovered after a
formal complaint was filed, usually by concerned family members.
Many verbal abuse violations were found.
Occasions of sexual abuse.
Incidents of physical abuse causing numerous injuries such as fractured
femur, hip, elbow, wrist, and other injuries.

Dangerously understaffed nursing homes lead to neglect, abuse, overuse of
medications, and physical restraints. An exhaustive study of
nurse-to-patient ratios in nursing homes was mandated by Congress in 1990.
The study was finally begun in 1998 and took four years to complete.120
Commenting on the study, a spokesperson for The National Citizens’ Coalition
for Nursing Home Reform said, “They compiled two reports of three volumes
each thoroughly documenting the number of hours of care residents must
receive from nurses and nursing assistants to avoid painful, even dangerous,
conditions such as bedsores and infections. Yet it took the Department of
Health and Human Services and Secretary Tommy Thompson only four months to
dismiss the report as ‘insufficient.’”121

Bedsores occur three times more commonly in nursing homes than in acute care
or veterans’ hospitals.122 But we know that bedsores can be prevented with
proper nursing care. It shouldn’t take four years for someone to find out
that proper care of bedsores requires proper staffing. In spite of such
urgent need in nursing homes where additional staff could solve so many
problems, we hear the familiar refrain “not enough research”--one that
merely buys time for those in charge and relegates another smoldering crisis
to the back burner.

Since many nursing home patients suffer from chronic debilitating
conditions, their assumed cause of death is often unquestioned by
physicians. Some studies show that as many as 50 percent of deaths due to
restraints, falls, suicide, homicide, and choking in nursing homes may be
covered up.123,124 It is quite possible that many nursing home deaths are
attributed, instead, to heart disease, which, until our report, was the
number one cause of death. 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 7.9 percent to 24.3 percent. In the elderly
the over-reporting of heart disease as a cause of death is as much as
two-fold.125

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 day, one week, one year, a decade, or two decades prematurely,
thanks to some medical misadventure, that is still a premature, 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.

The fact that there are very few statistics on malnutrition in acute-care
hospitals and nursing homes shows the lack of concern in this area. A survey
of the literature turns up very few American studies. Those that do appear
are foreign studies in Italy, Spain, and Brazil. However, there is one very
revealing American study conducted over a 14-month period that evaluated 837
patients in a 100-bed sub-acute-care hospital for their nutritional status.
Only eight percent of the patients were found to be well nourished.

Almost one-third (29 percent) were malnourished and almost two-thirds (63
percent) were at risk of malnutrition. The consequences of this state of
deficiency were that 25 percent of the malnourished patients required
readmission to an acute-care hospital compared to 11 percent of the
well-nourished patients. The authors concluded that malnutrition reached
epidemic proportions in patients admitted to this sub-acute-care
facility.126

Many studies conclude that physical restraints are an underreported and
preventable cause of death. Whereas administrators say they must use
restraints to prevent falls, in fact, they cause more injury and death
because people naturally fight against such imprisonment. Studies show that
compared to no restraints, the use of restraints carries a higher mortality
rate and economic burden.127-129 Studies found that physical restraints,
including bedrails, are the cause of at least one in every 1,000
nursing-home deaths.130-132

However, deaths caused by malnutrition, dehydration, and physical restraints
are rarely recorded on death certificates. Several studies reveal that
nearly half of the listed causes of death on death certificates for older
persons with chronic or multi-system disease are inaccurate.133 Even though
1-in-5 people die in nursing homes, the autopsy rate is only 0.8 percent.134
Thus, we have no way of knowing the true causes of death.

Over-medicating Seniors

The CDC may be focused on reducing the number of prescriptions for children
but a 2003 study finds over-medication of our elderly population. Dr. Robert
Epstein, chief medical officer of Medco Health Solutions Inc. (a unit of
Merck & Co.), conducted the study on drug trends.135 He found that seniors
are going to multiple physicians and getting multiple prescriptions and
using multiple pharmacies. Medco oversees drug-benefit plans for more than
60 million Americans, including 6.3 million senior citizens who received
more than 160 million prescriptions. According to the study, the average
senior receives 25 prescriptions annually.

In those 6.3 million seniors, a total of 7.9 million medication alerts were
triggered: less than one-half that number, 3.4 million, were detected in
1999. About 2.2 million of those alerts indicated excessive dosages
unsuitable for senior citizens, 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 said, “There are serious and systemic
problems with poor continuity of care in the United States.” He says this
study shows “the tip of the iceberg” of a national problem.

According to Drug Benefit Trends, the average number of prescriptions
dispensed per non-Medicare HMO member per year rose 5.6 percent from 1999 to
2000--from 7.1 to 7.5 prescriptions. The average number dispensed for
Medicare members increased 5.5 percent--from 18.1 to 19.1 prescriptions.136
The number of prescriptions in 2000 was 2.98 billion, with an average per
person prescription amount of 10.4 annually.137

In a study of 818 residents of residential care facilities for the elderly,
94 percent were receiving at least one medication at the time of the
interview. The average intake of medications was five per resident; the
authors noted that many of these drugs were given without a documented
diagnosis justifying their use.138

Unfortunately, seniors, and groups like the American Association for Retired
Persons (AARP), appear to be dependent on prescription drugs and are
demanding that coverage for drugs be a basic right.139 They have accepted
the overriding assumption from allopathic medicine that aging and dying in
America must be accompanied by drugs in nursing homes and eventual
hospitalization with tubes coming out of every orifice.

Instead of choosing between drugs and a diet-lifestyle change, seniors are
given the choiceless option of either high-cost patented drugs or low-cost
generic drugs. Drug companies are attempting to keep the most expensive
drugs on the shelves and to suppress access to generic drugs, in spite of
stiff fines of hundreds of millions of dollars from the government.140,141
In 2001 some of the world's biggest drug companies, including Roche, were
fined a record £523 million ($871 million) for conspiring to increase the
price of vitamins.142

We would urge AARP, especially, to become more involved in prevention of
disease and not to rely so heavily on drugs. At present, the AARP
recommendations for diet and nutrition assume that seniors are getting all
the nutrition they need in an average diet. At most, they suggest extra
calcium and a multiple vitamin/mineral supplement.143 This is not enough,
and in our next report we will show how to live a healthier life without
unnecessary medical intervention.

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. What if some of these chronic diseases are really lifestyle diseases
caused by deficiency of essential nutrients, lack of care, inappropriate
medication, or lack of love? This question is extremely important to
consider when you are depressed or in pain. We must look to healing those
conditions before offering up our lives.

Let’s also look at the irony of under use of proper pain medication for
patients that really need it. For example, in one particular study pain
management was evaluated in a group of 13,625 cancer patients, aged 65 or
over, living in nursing homes. Overall, almost 30 percent, or 4,003
patients, reported pain. However, more than 25 percent received absolutely
no pain relief medication; 16 percent received a World Health Organization
(WHO) level-one drug (mild analgesic); 32 percent a WHO level-two drug
(moderate analgesic); and only 26 percent received adequate pain relieving
morphine. The authors concluded that older patients and minority patients
were more likely to have their pain untreated.144

The time has come to set a 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.

WHAT REMAINS TO BE UNCOVERED

Our ongoing research will continue to quantify the morbidity, mortality, and
financial loss due to:
X-ray exposures: mammography, fluoroscopy, CT scans.
Overuse of antibiotics in all conditions.
Drugs that are carcinogenic: hormone replacement therapy (*see below),
immunosuppressive drugs, prescription drugs.
Cancer chemotherapy: If it doesn’t extend life, is it shortening life?70
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: when doctors go on strike, it appears the mortality rate
goes down.

*Part of our ongoing research will be to quantify the mortality and
morbidity caused by hormone replacement therapy (HRT) since the mid-1940s.
In December 2000, a government scientific advisory panel recommended that
synthetic estrogen be added to the nation's list of cancer-causing agents.
HRT, either synthetic estrogen alone or combined with synthetic
progesterone, is used by an estimated 13.5 million to 16 million women in
the United States.145

The aborted Women’s Health Initiative Study (WHI) of 2002 showed that women
taking synthetic estrogen combined with synthetic progesterone have a higher
incidence of ovarian cancer, breast cancer, stroke, and heart disease and
little evidence of osteoporosis reduction or prevention of dementia. WHI
researchers, who usually never give recommendations, other than demanding
more studies, are advising doctors to be very cautious about prescribing HRT
to their patients.100,146-150

Results of the “Million Women Study” on HRT and breast cancer in the U.K
were published in the Lancet, August 2003. Lead author, Professor Valerie
Beral, director of the Cancer Research UK Epidemiology Unit, is very open
about the damage HRT has caused. She said, "We estimate that over the past
decade, use of HRT by UK women aged 50 to 64 has resulted in an extra 20,000
breast cancers, oestrogen-progestagen (combination) therapy accounting for
15,000 of these.”151 However, we were not able to find the statistics on
breast cancer, stroke, uterine cancer, or heart disease due to HRT used by
American women. The population of America is roughly six times that of the
U.K. Therefore, it is possible that 120,000 cases of breast cancer have been
caused by HRT in the past decade.

CONCLUSION

When the number one killer in a society is the health care system, then that
system has no excuse except to address its own urgent shortcomings. It’s a
failed system in need of immediate attention. What we have outlined in this
paper are insupportable aspects of our contemporary medical system that need
to be changed--beginning at its very foundations.

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Part One
Part Two
References Part Two
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Death by Medicine - Appendix
 

OFFICE OF TECHNOLOGY ASSESSMENT (OTA)
Health Care Technology and Its Assessment in Eight Countries, 1995.

General Facts

1. In 1990 life expectancy in the U.S. was 71.8 years for men and 78.8 for
women, among the lowest of the developed countries.

2. The 1990 infant mortality rate was 9.2 per 1,000 live births. This was
in the bottom half of the distribution among all developed countries. (OTA
comments on the frustration of poor statistics and high healthcare spending.)

3. Health status is correlated with socioeconomic status.

4. Healthcare is not universal.

5. Healthcare is based on the free market system with no fixed budget or
limitations on expansion.

6. Healthcare accounts for 14% of the U.S. GNP, which was over $800 billion
in 1993.

7. The federal government does no central planning. It is the major
purchaser of health care for older people and some poor people.

8. Americans have a lower level of satisfaction with their healthcare
system than people in other developed countries.

9. U.S. medicine specializes in expensive medical technology. Some major
U.S. cities have more MRI scanners than most countries.

10. Huge public and private investment in medical research and
pharmaceutical development drives this "technological arms race."

11. Any efforts to restrain technological developments in healthcare are
opposed by policy makers concerned about negative impacts on
medical-technology industries.

Hospitals

12. In 1990 there were: 5,480 acute-care hospitals, 880 specialty hospitals
(psychiatric, long-term care, rehab) and 340 federal hospitals (military,
vets and Native Americans) providing 2.7 hospitals per 100,000 population.

13. In 1990 the average length of stay for an annual 33 million admissions
was 9.2 days. Bed occupancy rate was 66%. Lengths of stay were shorter and
admission rates lower than other countries.

14. In 1990 there were 615,000 physicians, 2.4 per 1,000; 33% were primary
care (family medicine, internal medicine, and pediatrics) and 67% were
specialists.

15. In 1991 government-run healthcare spending was $81 billion.

16. Total healthcare spending was $752 billion in 1991, an increase from
$70 billion in 1950. Spending grew five-fold per capita.

17. Reasons for increased healthcare spending:

a. The high cost of defensive medicine, with an escalation in services
solely to avoid malpractice litigation.

b. U.S. healthcare based on defensive medicine costs nearly $45 billion per
year, or about 5% of total healthcare spending, according to one source.

c. The availability and use of new medical technologies have contributed
the most to increased healthcare spending, argue many analysts. OTA admits
that these costs are impossible to quantify.

18. The reasons government attempts to control healthcare costs have failed:

a. Market incentive and profit-motive involvement in the financing and
organization of healthcare including private insurance, hospital system,
physician services, and drug and medical device industries.

b. Expansion is the goal of free enterprise.

Health-Related Research and Development

19. The U.S. spends more than any other country on R & D.

20. $9.2 billion was spent in 1989 by the federal government; U.S.
industries spent an additional $9.4 billion.

21. There was a 50% rise in total national R & D expenditures between 1983
and 1992.

22. NIH receives about half of the government funding.

23. NIH spent more on basic research ($4.1 billion in 1989) than for
clinical trials of medical treatments on humans ($519 million in 1989).

24. Most of the trials evaluate new cancer treatment protocols and new
treatments for complications of AIDS and do not study existing treatments,
even though the effectiveness of many of them is unknown and questioned.

25. The NIH in 1990 had just begun to do meta-analysis and
cost-effectiveness analysis.

Pharmaceutical and Medical Device Industry

26. About two-thirds of the industry's $9.4 billion budget went to drug
research; the remaining one-third was spent by device manufacturers.

27. In addition to R & D, the medical industry spent 24% of total sales on
promoting their products and only 15% of total sales on development.

28. Total marketing expenses in 1990 were over $5 billion.

29. Many products provide no benefit over existing products.

30. Public and private healthcare consumers buy these products.

31. If healthcare spending is perceived as a problem, a highly profitable
drug industry exacerbates the problem.

Controlling Health Care Technology

32. The FDA ensures the safety and efficacy of drugs, biologics, and
medical devices.

33. The FDA does not consider costs of therapy.

34. The FDA does not consider the effectiveness of a therapy.

35. The FDA does not compare a product to currently marketed products

36. The FDA does not consider non-drug alternatives for a given clinical
problem.

37. Drug development costs $200 million to bring a new drug to market.
AIDS-drug interest groups forced new regulations that speed up the approval
process.

38. Such drugs should be subject to greater post-marketing surveillance
requirements. But as of 1995 these provisions had not yet come into play.

39. Many argue that reductions in the pre-approval testing of drugs opens
the possibility of significant undiscovered toxicities.

Health Care Technology Assessment

40. Failure to evaluate technology was a focus of a 1978 report from OTA
with examples of many common medical practices supported by limited
published data. (10-20%)

41. In 1978 congress created the National Center for Health Care Technology
(NCHCT) to advise Medicare and Medicaid.

42. With an annual budget of $4 million NCHCT published three broad
assessments of high-priority technologies and made about 75 coverage
recommendations to Medicare.

43. NCHCT was put out of business by Congress in 1981-a political casualty.
The medical profession opposed it from the beginning. The AMA testified
before Congress in 1981 that "clinical policy analysis and judgments are
better made-and are being responsibly made-within the medical profession.
Assessing risks and costs, as well as benefits, has been central to the
exercise of good medical judgment for decades."

44. The medical device lobby also opposed government oversight by NCHCT.

Examples of Lack of Proper Management of HealthCare

1. Treatments for Coronary Artery Disease

45. Since the early 1970's the number of coronary artery-bypass surgeries
(CABGS) has risen rapidly without government regulation and without
clinical trials.

46. Angioplasty for single vessel disease was introduced in 1978. The first
published trial of angioplasty versus medical treatment was in 1992.

47. Angioplasty did not cut down on the number of CABGS as was promoted.

48. Both procedures increase in number every year as the patient population
grows older and sicker.

49. Rates of use are higher in white patients, in private insurance
patients, and there is great variation in different geographic regions.
Such facts imply that use of these procedures is based on non-clinical
factors.

50. At the time of this report, 1995, the NIH consensus program had not
assessed CABGS since 1980 and had never assessed angioplasty.

51. RAND researchers evaluated CABGS in New York in 1990. They reviewed
1,300 procedures and found 2% were inappropriate, 90% appropriate, and 7%
uncertain. For 1,300 angioplasties, 4% were inappropriate and 38%
uncertain. Using RAND methodologies a panel of British physicians rated
twice as many procedures "inappropriate" as did a U.S. panel rating the
same clinical cases. The New York numbers are in question because New York
State limits the number of surgery centers, and the per-capita supply of
cardiac surgeons in New York is about one-half the national average.

52. The estimated five-year cost is $33,000 for angioplasty and $40,000 for
CABGS. So, angioplasty did not lower costs. This was because of high
failure rates of angioplasty.

2. Computed Tomography CT

53. The first CT scanner in the U.S. was installed at the Mayo Clinic in
1973. In 1992 the number of operational CT scanners was 6,060. By
comparison, in 1993 there were 216 CT units in Canada.

54. There is little information available on how CT scan improves or
affects patient outcome.

55. In some institutions up to 90% of scans performed were negative.

56. Approval by the FDA was not required for CT scanners. No evidence of
safety or efficacy was required.

3. MRI

57. The first MRI was introduced in 1978 in Great Britain; the first U.S.
scanner in 1980. By 1988 there were 1,230 units; by 1992 between 2,800 and
3,000.

58. A definitive review published in 1994 found less than 30 studies out of
5,000 that were prospective comparisons of diagnostic accuracy or
therapeutic choice.

59. American College of Physicians assessed MRI studies and rated 13 out of
17 trials as "weak" - meaning the absence of any studies on therapeutic
impact or patient outcomes.

60. The OAT concludes that, "It is evident that hospitals,
physician-entrepreneurs, and medical device manufacturers have approached
MRI and CT as commodities with high-profit potential, and decision-making
on the acquisition and use of these procedures has been highly influenced
by this approach. Clinical evaluation, appropriate patient selection, and
matching supply to legitimate demand might be viewed as secondary forces."

4. Laparoscopic Surgery

61. Laparoscopic cholecystectomy was introduced at a professional surgical
society meeting in late 1989. In 1992, five years after introduction, 85%
of all cholecystectomies were performed laparoscopically.

62. There was an associated increase of 30% in the number of
cholecystectomies performed.

63. Because of the increased volume of gall bladder operations, the total
costs increased 11.4% between 1988 and 1992, in spite of a 25.1% drop in
the average cost per surgery.

64. The mortality rate for gall bladder surgeries also did not decline as a
result of the lower risk because so many more were performed.

65. When studies were finally done on completed cases, the results showed
that laparoscopic cholecystectomy was associated with reduced in-patient
duration, decreased pain, and shorter period of restricted activity. But
there were increased rates of bile duct and major vessel injuries and a
suggestion that these rates were worse for people with acute cholecystitis.
There were still no clinical trials to clarify this issue.

66. Patient demand, fueled by substantial media attention, was a major
force in promoting rapid adoption.

67. The video, which introduced the procedure in 1989, was produced by the
major manufacturer of laparoscopic equipment.

68. Doctors were given two-day training seminars before performing the
surgery on patients.
Infant Mortality

69. In 1990 the U.S. ranked twenty-fourth in infant mortality out of 38
developed countries with a rate of 9.2 deaths per 1,000 live births.

70. U.S. black infant mortality is 18.6 per 1,000 live births and 8.8 for
whites.

Screening for Breast Cancer

71. There has always been a debate over mammography screening in women
under 50.

72. In 1992 the Canadian National Breast Cancer Study of 50,000 women
showed that mammography had no effect on mortality for younger women, aged
40-50.

73. The National Cancer Institute (NCI) refused to change its
recommendations on mammography.

74. The American Cancer Society decided to wait for more studies on
mammography.

75. Then, in December 1993 NCI announced that women over 50 should have
routine screening every one to two years but younger women would have no
benefit from having mammography.

Summary

76. The OTA concluded that, "There are no mechanisms in place to limit
dissemination of technologies regardless of their clinical value."

Shortly after this report, the OTA was disbanded.

End of appendix.

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