Death by MedicineMarch 2004
By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
What constitutes the “best care”? The CDC does not elaborate and ignores the latest research on the dozens of nutraceuticals that have been scientifically proven to treat viral infections and boost immune-system function. Will doctors recommend vitamin C, echinacea, elderberry, vitamin A, zinc, or homeopathic oscillococcinum? Probably not. The CDC's common-sense recommendations that most people follow anyway include getting proper rest, drinking plenty of fluids, and using a humidifier.
The pharmaceutical industry claims it supports limiting the use of antibiotics. The drug company Bayer sponsors a program called “Operation Clean Hands” through an organization called LIBRA.(57) The CDC also is involved in trying to minimize antibiotic resistance, but nowhere in its publications is there any reference to the role of nutraceuticals in boosting the immune system, nor to the thousands of journal articles that support this approach. This tunnel vision and refusal to recommend the available non-drug alternatives is unfortunate when the CDC is desperately trying to curb the overuse of antibiotics.
Drugs Pollute Our Water Supply
We have reached the point of saturation with prescription drugs. Every body of water tested contains measurable drug residues. The tons of antibiotics used in animal farming, which run off into the water table and surrounding bodies of water, are conferring antibiotic resistance to germs in sewage, and these germs also are found in our water supply. Flushed down our toilets are tons of drugs and drug metabolites that also find their way into our water supply. We have no way to know the long-term health consequences of ingesting a mixture of drugs and drug-breakdown products. These drugs represent another level of iatrogenic disease that we are unable to completely measure.(58-67)
Specific Drug Iatrogenesis: NSAIDs
It's not just the US that is plagued by iatrogenesis. A survey of more than 1,000 French general practitioners (GPs) tested their basic pharmacological knowledge and practice in prescribing NSAIDs, which rank first among commonly prescribed drugs for serious adverse reactions. The study results suggest that GPs do not have adequate knowledge of these drugs and are unable to effectively manage adverse reactions.(68)
A cross-sectional survey of 125 patients attending specialty pain clinics in South London found that possible iatrogenic factors such as “over-investigation, inappropriate information, and advice given to patients as well as misdiagnosis, over-treatment, and inappropriate prescription of medication were common.”(69)
Specific Drug Iatrogenesis: Cancer Chemotherapy
In 1989, German biostatistician Ulrich Abel, PhD, wrote a monograph entitled “Chemotherapy of Advanced Epithelial Cancer.” It was later published in shorter form in a peer-reviewed medical journal.(70) Abel presented a comprehensive analysis of clinical trials and publications representing over 3,000 articles examining the value of cytotoxic chemotherapy on advanced epithelial cancer. Epithelial cancer is the type of cancer with which we are most familiar, arising from epithelium found in the lining of body organs such as the breast, prostate, lung, stomach, and bowel. From these sites, cancer usually infiltrates adjacent tissue and spreads to the bone, liver, lung, or brain. With his exhaustive review, Abel concluded there is no direct evidence that chemotherapy prolongs survival in patients with advanced carcinoma; in small-cell lung cancer and perhaps ovarian cancer, the therapeutic benefit is only slight. According to Abel, “Many oncologists take it for granted that response to therapy prolongs survival, an opinion which is based on a fallacy and which is not supported by clinical studies.”
Over a decade after Abel's exhaustive review of chemotherapy, there seems no decrease in its use for advanced carcinoma. For example, when conventional chemotherapy and radiation have not worked to prevent metastases in breast cancer, high-dose chemotherapy (HDC) along with stem-cell transplant (SCT) is the treatment of choice. In March 2000, however, results from the largest multi-center randomized controlled trial conducted thus far showed that, compared to a prolonged course of monthly conventional-dose chemotherapy, HDC and SCT were of no benefit, (71) with even a slightly lower survival rate for the HDC/SCT group. Serious adverse effects occurred more often in the HDC group than the standard-dose group. One treatment-related death (within 100 days of therapy) was recorded in the HDC group, but none was recorded in the conventional chemotherapy group. The women in this trial were highly selected as having the best chance to respond.
Unfortunately, no all-encompassing follow-up study such as Dr. Abel's exists to indicate whether there has been any improvement in cancer-survival statistics since 1989. In fact, research should be conducted to determine whether chemotherapy itself is responsible for secondary cancers instead of progression of the original disease. We continue to question why well-researched alternative cancer treatments are not used.
Drug Companies Fined
Periodically, the FDA fines a drug manufacturer when its abuses are too glaring and impossible to cover up. In May 2002, The Washington Post reported that Schering-Plough Corp., the maker of Claritin, was to pay a $500 million dollar fine to the FDA for quality-control problems at four of its factories.(72) The indictment came after the Public Citizen Health Research Group, led by Dr. Sidney Wolfe, called for a criminal investigation of Schering-Plough, charging that the company distributed albuterol asthma inhalers even though it knew the units were missing the active ingredient.
The FDA tabulated infractions involving 125 products, or 90% of the drugs made by Schering-Plough since 1998. Besides paying the fine, the company was forced to halt the manufacture of 73 drugs or suffer another $175 million fine. Schering-Plough's news releases told another story, assuring consumers that they should still feel confident in the company's products.
This large settlement served as a warning to the drug industry about maintaining strict manufacturing practices and has given the FDA more clout in dealing with drug company compliance. According to The Washington Post article, a federal appeals court ruled in 1999 that the FDA could seize the profits of companies that violate "good manufacturing practices." Since that time, Abbott Laboratories has paid a $100 million fine for failing to meet quality standards in the production of medical test kits, while Wyeth Laboratories paid $30 million in 2000 to settle accusations of poor manufacturing practices.
UNNECESSARY SURGICAL PROCEDURES
In 1974, 2.4 million unnecessary surgeries were performed, resulting in 11,900 deaths at a cost of $3.9 billion.(73,74) In 2001, 7.5 million unnecessary surgical procedures were performed, resulting in 37,136 deaths at a cost of $122 billion (using 1974 dollars).(3)
It is very difficult to obtain accurate statistics when studying unnecessary surgery. In 1989, Leape wrote that perhaps 30% of controversial surgeries—which include cesarean section, tonsillectomy, appendectomy, hysterectomy, gastrectomy for obesity, breast implants, and elective breast implants(74)— are unnecessary. In 1974, the Congressional Committee on Interstate and Foreign Commerce held hearings on unnecessary surgery. It found that 17.6% of recommendations for surgery were not confirmed by a second opinion. The House Subcommittee on Oversight and Investigations extrapolated these figures and estimated that, on a nationwide basis, there were 2.4 million unnecessary surgeries performed annually, resulting in 11,900 deaths at an annual cost of $3.9 billion.(73)
According to the Healthcare Cost and Utilization Project within the Agency for Healthcare Research and Quality(13), in 2001 the 50 most common medical and surgical procedures were performed approximately 41.8 million times in the US. Using the 1974 House Subcommittee on Oversight and Investigations' figure of 17.6% as the percentage of unnecessary surgical procedures, and extrapolating from the death rate in 1974, produces nearly 7.5 million (7,489,718) unnecessary procedures and a death rate of 37,136, at a cost of $122 billion (using 1974 dollars).
In 1995, researchers conducted a similar analysis of back surgery procedures, using the 1974 “unnecessary surgery percentage” of 17.6. Testifying before the Department of Veterans Affairs, they estimated that of the 250,000 back surgeries performed annually in the US at a hospital cost of $11,000 per patient, the total number of unnecessary back surgeries approaches 44,000, costing as much as $484 million.(75)
Like prescription drug use driven by television advertising, unnecessary surgeries are escalating. Media-driven surgery such as gastric bypass for obesity “modeled” by Hollywood celebrities seduces obese people to think this route is safe and sexy. Unnecessary surgeries have even been marketed on the Internet.(76) A study in Spain declares that 20-25% of total surgical practice represents unnecessary operations.(77)
According to data from the National Center for Health Statistics for 1979 to 1984, the total number of surgical procedures increased 9% while the number of surgeons grew 20%. The study notes that the large increase in the number of surgeons was not accompanied by a parallel increase in the number of surgeries performed, and expressed concern about an excess of surgeons to handle the surgical caseload.(78)
From 1983 to 1994, however, the incidence of the 10 most commonly performed surgical procedures jumped 38%, to 7,929,000 from 5,731,000 cases. By 1994, cataract surgery was the most common procedure with more than 2 million operations, followed by cesarean section (858,000 procedures) and inguinal hernia operations (689,000 procedures). Knee arthroscopy procedures increased 153% while prostate surgery declined 29%.(79)
The list of iatrogenic complications from surgery is as long as the list of procedures themselves. One study examined catheters that were inserted to deliver anesthetic into the epidural space around the spinal nerves for lower cesarean section, abdominal surgery, or prostate surgery. In some cases, non-sterile technique during catheter insertion resulted in serious infections, even leading to limb paralysis.(80)
In one review of the literature, the authors found “a significant rate of overutilization of coronary angiography, coronary artery surgery, cardiac pacemaker insertion, upper gastrointestinal endoscopies, carotid endarterectomies, back surgery, and pain-relieving procedures.”(81)
A 1987 JAMA study found the following significant levels of inappropriate surgery: 17% of coronary angiography procedures, 32% of carotid endarterectomy procedures, and 17% of upper gastrointestinal tract endoscopy procedures.(82) Based on the Healthcare Cost and Utilization Project (HCUP) statistics provided by the government for 2001, 697,675 upper gastrointestinal endoscopies (usually entailing biopsy) were performed, as were 142,401 endarterectomies and 719,949 coronary angiographies.(13) Extrapolating the JAMA study's inappropriate surgery rates to 2001 produces 118,604 unnecessary endoscopy procedures, 45,568 unnecessary endarterectomies, and 122,391 unnecessary coronary angiographies. These are all forms of medical iatrogenesis.
MEDICAL AND SURGICAL PROCEDURES
It is instructive to know the mortality rates associated with various medical and surgical procedures. Although we must sign release forms when we undergo any procedure, many of us are in denial about the true risks involved; because medical and surgical procedures are so commonplace, they often are seen as both necessary and safe. Unfortunately, allopathic medicine itself is a leading cause of death, as well as the most expensive way to die.
Perhaps the words “health care” confer the illusion that medicine is about health. Allopathic medicine is not a purveyor of health care but of disease care. The HCUP figures are instructive,(13) but the computer program that calculates annual mortality statistics for all US hospital discharges is only as good as the codes entered into the system. In email correspondence, HCUP indicated that the mortality rates for each procedure indicated only that someone undergoing that procedure died either from the procedure or from some other cause.
Thus there is no way of knowing exactly how many people die from a particular procedure. While codes for “poisoning & toxic effects of drugs” and “complications of treatment” do exist, the mortality figures registered in these categories are very low and do not correlate with what is known from research such as the 1998 JAMA study(1) that estimated an average of 106,000 prescription medication deaths per year. No codes exist for adverse drug side effects, surgical mishaps, or other types of medical error. Until such codes exist, the true mortality rates tied to of medical error will remain buried in the general statistics.
AN HONEST LOOK AT US HEALTH CARE
In 1978, the US Office of Technology Assessment (OTA) reported: “Only 10-20% of all procedures currently used in medical practice have been shown to be efficacious by controlled trial."(83) In 1995, the OTA compared medical technology in eight countries ( Australia , Canada, France, Germany, the Netherlands, Sweden, the UK, and the US ) and again noted that few medical procedures in the US have been subjected to clinical trial. It also reported that US infant mortality was high and life expectancy low compared to other developed countries.(84)
Although almost 10 years old, much of what was written in the OTA report holds true today. The report blames the high cost of American medicine on the medical free-enterprise system and failure to create a national health care policy. It attributes the government's failure to control health care costs to market incentives and profit motives inherent in the current financing and organization of health care, which includes such interests as private health insurers, hospital systems, physicians, and the drug and medical-device industries. “Health Care Technology and Its Assessment in Eight Countries” is the last report prepared by the OTA, which was disbanded in 1995. It also is perhaps the US government's last honest, detailed examination of the nation's health care system. An appendix summarizing this 60-page report follows this article.
SURGICAL ERRORS FINALLY REPORTED
An October 2003 JAMA study from the US government's Agency for Healthcare Research and Quality (AHRQ) documented 32,000 mostly surgery-related deaths costing $9 billion and accounting for 2.4 million extra hospital days in 2000.(85) Data from 20% of the nation's hospitals were analyzed for 18 different surgical complications, including postoperative infections, foreign objects left in wounds, surgical wounds reopening, and post-operative bleeding.
In a press release accompanying the study, AHRQ director Carolyn M. Clancy, MD, noted: “This study gives us the first direct evidence that medical injuries pose a real threat to the American public and increase the costs of health care.”(86) According to the study's authors, “The findings greatly underestimate the problem, since many other complications happen that are not listed in hospital administrative data.” They added: "The message here is that medical injuries can have a devastating impact on the health care system. We need more research to identify why these injuries occur and find ways to prevent them from happening." The study authors said that improved medical practices, including an emphasis on better hand washing, might help reduce morbidity and mortality rates. In an accompanying JAMA editorial, health-risk researcher Dr. Saul Weingart of Harvard's Beth Israel-Deaconess Medical Center wrote, “Given their staggering magnitude, these estimates are clearly sobering.”(87)
When x-rays were discovered, no one knew the long-term effects of ionizing radiation. In the 1950s, monthly fluoroscopic exams at the doctor's office were routine, and you could even walk into most shoe stores and see x-rays of your foot bones. We still do not know the ultimate outcome of our initial fascination with x-rays.
In those days, it was common practice to x-ray pregnant women to measure their pelvises and make a diagnosis of twins. Finally, a study of 700,000 children born between 1947 and 1964 in 37 major maternity hospitals compared the children of mothers who had received pelvic x-rays during pregnancy to those of mothers who did not. It found that cancer mortality was 40% higher among children whose mothers had been x-rayed.(88)
In present-day medicine, coronary angiography is an invasive surgical procedure that involves snaking a tube through a blood vessel in the groin up to the heart. To obtain useful information, X-rays are taken almost continuously, with minimum dosages ranging from 460 to 1,580 mrem. The minimum radiation from a routine chest x-ray is 2 mrem. X-ray radiation accumulates in the body, and ionizing radiation used in X-ray procedures has been shown to cause gene mutation. The health impact of this high level of radiation is unknown, and often obscured in statistical jargon such as, “The risk for lifetime fatal cancer due to radiation exposure is estimated to be 4 in one million per 1,000 mrem.”(89)
Dr. John Gofman has studied the effects of radiation on human health for 45 years. A medical doctor with a PhD in nuclear and physical chemistry, Gofman worked on the Manhattan Project, discovered uranium-233, and was the first person to isolate plutonium. In five scientifically documented books, Gofman provides strong evidence that medical technology—specifically x-rays, CT scans, and mammography and fluoroscopy devices—are a contributing factor to 75% of new cancers. In a nearly 700-page report updated in 2000, “Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease: Dose-Response Studies with Physicians per 100,000 Population,”(90) Gofman shows that as the number of physicians increases in a geographical area along with an increase in the number of x-ray diagnostic tests performed, the rate of cancer and ischemic heart disease also increases. Gofman elaborates that it is not x-rays alone that cause the damage but a combination of health risk factors that include poor diet, smoking, abortions, and the use of birth control pills. Dr. Gofman predicts that ionizing radiation will be responsible for 100 million premature deaths over the next decade.
In his book, “Preventing Breast Cancer,” Dr. Gofman notes that breast cancer is the leading cause of death among American women between the ages of 44 and 55. Because breast tissue is highly sensitive to radiation, mammograms can cause cancer. The danger can be heightened other factors including a woman's genetic makeup, preexisting benign breast disease, artificial menopause, obesity, and hormonal imbalance.(91)
Even x-rays for back pain can lead someone into crippling surgery. Dr. John E. Sarno, a well-known New York orthopedic surgeon, found that there is not necessarily any association between back pain and spinal x-ray abnormality. He cites studies of normal people without a trace of back pain whose x-rays indicate spinal abnormalities and of people with back pain whose spines appear to be normal on x-ray.(92) People who happen to have back pain and show an abnormality on x-ray may be treated surgically, sometimes with no change in back pain, worsening of back pain, or even permanent disability. Moreover, doctors often order x-rays as protection against malpractice claims, to give the impression of leaving no stone unturned. It appears that doctors are putting their own fears before the interests of their patients.
Nearly 9 million (8,925,033) people were hospitalized unnecessarily in 2001.(4) In a study of inappropriate hospitalization, two doctors reviewed 1,132 medical records. They concluded that 23% of all admissions were inappropriate and an additional 17% could have been handled in outpatient clinics. Thirty-four percent of all hospital days were deemed inappropriate and could have been avoided.(93) The rate of inappropriate hospital admissions in 1990 was 23.5%.(94) In 1999, another study also found an inappropriate admissions rate of 24%, indicating a consistent pattern from 1986 to 1999.(95) The HCUP database indicates that the total number of patient discharges from US hospitals in 2001 was 37,187,641,(13) meaning that almost 9 million people were exposed to unnecessary medical intervention in hospitals and therefore represent almost 9 million potential iatrogenic episodes.(4)
WOMEN'S EXPERIENCE IN MEDICINE
Dr. Martin Charcot (1825-1893) was world-renowned, the most celebrated doctor of his time. He practiced in the Paris hospital La Salpetriere. He became an expert in hysteria, diagnosing an average of 10 hysterical women each day, transforming them into “iatrogenic monsters” and turning simple “neurosis” into hysteria.(96) The number of women diagnosed with hysteria and hospitalized rose from 1% in 1841 to 17% in 1883. Hysteria is derived from the Latin “hystera” meaning uterus. According to Dr. Adriane Fugh-Berman, US medicine has a tradition of excessive medical and surgical interventions on women. Only 100 years ago, male doctors believed that female psychological imbalance originated in the uterus. When surgery to remove the uterus was perfected, it became the “cure” for mental instability, effecting a physical and psychological castration. Fugh-Berman notes that US doctors eventually disabused themselves of that notion but have continued to treat women very differently than they treat men.(97) She cites the following statistics:
As many as one-third of postmenopausal women use HRT.(101,102) This number is important in light of the much-publicized Women's Health Initiative Study, which was halted before its completion because of a higher death rate in the synthetic estrogen-progestin (HRT) group.(103)