http://www.lef.

org/
Death by Medicine
By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
Something is wrong when regulatory agencies pretend that vitamins are dangerous, yet ignore published statistics showing that
government-sanctioned medicine is the real hazard.
Until now, Life Extension could cite only isolated statistics to make its case about the dangers of conventional medicine. No one
had ever analyzed and combined ALL of the published literature dealing with injuries and deaths caused by government-protected
medicine. That has now changed.
A group of researchers meticulously reviewed the statistical evidence and their findings are absolutely shocking.4 These
researchers have authored a paper titled Death by Medicine that presents compelling evidence that todays system frequently
causes more harm than good.
This fully referenced report shows the number of people having in-hospital, adverse reactions to prescribed drugs to be 2.2 million
per year. The number of unnecessary antibiotics prescribed annually for viral infections is 20 million per year. The number of
unnecessary medical and surgical procedures performed annually is 7.5 million per year. The number of people exposed to
unnecessary hospitalization annually is 8.9 million per year.
The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding
783,936 per year. It is now evident that the American medical system is the leading cause of death and injury in the US. (By
contrast, the number of deaths attributable to heart disease in 2001 was 699,697, while the number of deaths attributable to
cancer was 553,251.5)
We placed this article on our website to memorialize the failure of the American medical system. By exposing these gruesome
statistics in painstaking detail, we provide a basis for competent and compassionate medical professionals to recognize the
inadequacies of todays system and at least attempt to institute meaningful reforms.
Death by Medicine
By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
Natural medicine is under siege, as pharmaceutical company lobbyists urge lawmakers to deprive Americans of the benefits of
dietary supplements. Drug-company front groups have launched slanderous media campaigns to discredit the value of healthy
lifestyles. The FDA continues to interfere with those who offer natural products that compete with prescription drugs.
These attacks against natural medicine obscure a lethal problem that until now was buried in thousands of pages of scientific
text. In response to these baseless challenges to natural medicine, the Nutrition Institute of America commissioned an
independent review of the quality of government-approved medicine. The startling findings from this meticulous study indicate
that conventional medicine is the leading cause of death in the United States .
The Nutrition Institute of America is a nonprofit organization that has sponsored independent research for the past 30 years. To
support its bold claim that conventional medicine is America 's number-one killer, the Nutritional Institute of America mandated
that every count in this indictment of US medicine be validated by published, peer-reviewed scientific studies.
What you are about to read is a stunning compilation of facts that documents that those who seek to abolish consumer access
to natural therapies are misleading the public. Over 700,000 Americans die each year at the hands of government-sanctioned
medicine, while the FDA and other government agencies pretend to protect the public by harassing those who offer safe
alternatives.
A definitive review of medical peer-reviewed journals and government health statistics shows that American medicine frequently
causes more harm than good.
Each year approximately 2.2 million US hospital patients experience adverse drug reactions (ADRs) to prescribed medications.(1)
In 1995, Dr. Richard Besser of the federal Centers for Disease Control and Prevention (CDC) estimated the number of
unnecessary antibiotics prescribed annually for viral infections to be 20 million; in 2003, Dr. Besser spoke in terms of tens of
millions of unnecessary antibiotics prescribed annually.(2, 2a) Approximately 7.5 million unnecessary medical and surgical
procedures are performed annually in the US,(3) while approximately 8.9 million Americans are hospitalized unnecessarily.(4)
As shown in the following table, the estimated total number of iatrogenic deathsthat is, deaths induced inadvertently by a
physician or surgeon or by medical treatment or diagnostic procedures in the US annually is 783,936. It is evident that the
American medical system is itself the leading cause of death and injury in the US . By comparison, approximately 699,697
Americans died of heart in 2001, while 553,251 died of cancer.(5)
Using Leape's 1997 medical and drug error rate of 3 million(14) multiplied by the 14% fatality rate he used in 1994(16) produces an
annual death rate of 420,000 for drug errors and medical errors combined. Using this number instead of Lazorou's 106,000 drug
errors and the Institute of Medicine 's (IOM) estimated 98,000 annual medical errors would add another 216,000 deaths, for a
total of 999,936 deaths annually.
TABLE 1: ESTIMATED ANNUAL MORTALITY AND ECONOMIC COST OF MEDICAL INTERVENTION
Condition Deaths Cost Author
Adverse Drug Reactions 106,000 $12 billion Lazarou(1), Suh (49)
Medical error 98,000 $2 billion IOM(6)
Bedsores 115,000 $55 billion Xakellis(7), Barczak (8)
Infection 88,000 $5 billion Weinstein(9), MMWR (10)
Malnutrition 108,800 ----------- Nurses Coalition(11)
Outpatients 199,000 $77 billion Starfield(12), Weingart(112)
Unnecessary Procedures 37,136 $122 billion HCUP(3,13)
Surgery-Related 32,000 $9 billion AHRQ(85)
Total 783,936 $282 billion
The enumerating of unnecessary medical events is very important in our analysis. Any invasive, unnecessary medical procedure
must be considered as part of the larger iatrogenic picture. Unfortunately, cause and effect go unmonitored. The figures on
unnecessary events represent people who are thrust into a dangerous health care system. Each of these 16.4 million lives is
being affected in ways that could have fatal consequences. Simply entering a hospital could result in the following:
I In 16.4 million people, a 2.1% chance (affecting 186,000) of a serious adverse drug reaction(1)
I In 16.4 million people, a 5-6% chance (affecting 489,500) of acquiring a nosocomial infection(9)
I In16.4 million people, a 4-36% chance (affecting 1.78 million) of having an iatrogenic injury (medical error and adverse drug
reactions).(16)
I In 16.4 million people, a 17% chance (affecting 1.3 million) of a procedure error.(40)
These statistics represent a one-year time span. Working with the most conservative figures from our statistics, we project the
following 10-year death rates.
Our estimated 10-year total of 7.8 million iatrogenic deaths is more than all the casualties from all the wars fought by the US
throughout its entire history.
Our projected figures for unnecessary medical events occurring over a 10-year period also are dramatic.
TABLE 2: ESTIMATED ANNUAL MORTALITY AND ECONOMIC COST OF MEDICAL INTERVENTION
Condition Deaths Cost Author
ADR/med error 420,000 $200 billion Leape(14)
Bedsores 115,000 $55 billion Xakellis(7), Barczak (8)
Infection 88,000 $5 billion Weinstein(9), MMWR (10)
Malnutrition 108,800 ----------- Nurses Coalition(11)
Outpatients 199,000 $77 billion Starfield(12), Weingart(112)
Unnecessary Procedures 37,136 $122 billion HCUP(3,13)
Surgery-Related 32,000 $9 billion AHRQ(85)
Total 999,936
TABLE 3: ESTIMATED 10-YEAR DEATH RATES FROM 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
These figures show that an estimated 164 million peoplemore than half of the total US populationreceive unneeded medical
treatment over the course of a decade.
INTRODUCTION
Never before have the complete statistics on the multiple causes of iatrogenesis been combined in one article. Medical science
amasses tens of thousands of papers annually, each representing a tiny fragment of the whole picture. To look at only one piece
and try to understand the benefits and risks is like standing an inch away from an elephant and trying to describe everything
about it. You have to step back to see the big picture, as we have done here. Each specialty, each division of medicine keeps its
own records and data on morbidity and mortality. We have now completed the painstaking work of reviewing thousands of studies
and putting pieces of the puzzle together.
Is American Medicine Working?
US health care spending reached $1.6 trillion in 2003, representing 14% of the nation's gross national product.(15) Considering
this enormous expenditure, we should have the best medicine in the world. We should be preventing and reversing disease, and
doing minimal harm. Careful and objective review, however, shows we are doing the opposite. Because of the extraordinarily
narrow, technologically driven context in which contemporary medicine examines the human condition, we are completely
missing the larger picture.
Medicine is not taking into consideration the following critically important aspects of a healthy human organism: (a) stress and
how it adversely affects the immune system and life processes; (b) insufficient exercise; (c) excessive caloric intake; (d) highly
processed and denatured foods grown in denatured and chemically damaged soil; and (e) exposure to tens of thousands of
environmental toxins. Instead of minimizing these disease-causing factors, we cause more illness through medical technology,
diagnostic testing, overuse of medical and surgical procedures, and overuse of pharmaceutical drugs. The huge disservice of this
therapeutic strategy is the result of little effort or money being spent on preventing disease.
Underreporting of Iatrogenic Events
As few as 5% and no more than 20% of iatrogenic acts are ever reported.(16,24,25,33,34) This implies that if medical errors were
completely and accurately reported, we would have an annual iatrogenic death toll much higher than 783,936. In 1994, Leape
said his figure of 180,000 medical mistakes resulting in death annually was equivalent to three jumbo-jet crashes every two days.
(16) Our considerably higher figure is equivalent to six jumbo jets are falling out of the sky each day.
What we must deduce from this report is that medicine is in need of complete and total reformfrom the curriculum in medical
schools to protecting patients from excessive medical intervention. It is obvious that we cannot change anything if we are not
honest about what needs to be changed. This report simply shows the degree to which change is required.
We are fully aware of what stands in the way of change: powerful pharmaceutical and medical technology companies, along with
other powerful groups with enormous vested interests in the business of medicine. They fund medical research, support medical
schools and hospitals, and advertise in medical journals. With deep pockets, they entice scientists and academics to support
their efforts. Such funding can sway the balance of opinion from professional caution to uncritical acceptance of new therapies
and drugs. You have only to look at the people who make up the hospital, medical, and government health advisory boards to
see conflicts of interest. The public is mostly unaware of these interlocking interests.
For example, a 2003 study found that nearly half of medical school faculty who serve on institutional review boards (IRB) to advise
on clinical trial research also serve as consultants to the pharmaceutical industry.(17) The study authors were concerned that
such representation could cause potential conflicts of interest. A news release by Dr. Erik Campbell, the lead author, said, "Our
previous research with faculty has shown us that ties to industry can affect scientific behavior, leading to such things as trade
secrecy and delays in publishing research. It's possible that similar relationships with companies could affect IRB members'
activities and attitudes.(18)
TABLE 4: ESTIMATED 10-YEAR UNNECESSARY MEDICAL EVENTS
Unnecessary Events 10-year Number Iatrogenic Events
Hospitalization 89 million(4) 17 million
Procedures 75 million(3) 15 million
Total 164 million
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)
As former editor of the New England Journal of Medicine , Dr. Marcia Angell struggled to bring greater attention to the problem of
commercializing scientific research. In her outgoing editorial entitled Is Academic Medicine for Sale? Angell said that growing
conflicts of interest are tainting science and called for stronger restrictions on pharmaceutical stock ownership and other financial
incentives for researchers:(20) When the boundaries between industry and academic medicine become as blurred as they are
now, the business goals of industry influence the mission of medical schools in multiple ways. She did not discount the benefits
of research but said a Faustian bargain now existed between medical schools and the pharmaceutical industry.
Angell left the New England Journal in June 2000. In June 2002, the New England Journal of Medicine announced that it would
accept journalists who accept money from drug companies because it was too difficult to find ones who have no ties. Another
former editor of the journal, Dr. Jerome Kassirer, said that was not the case and that plenty of researchers are available who do
not work for drug companies.(21) According to an ABC news report, pharmaceutical companies spend over $2 billion a year on
over 314,000 events attended by doctors.
The ABC news report also noted that a survey of clinical trials revealed that when a drug company funds a study, there is a 90%
chance that the drug will be perceived as effective whereas a non-drug-company-funded study will show favorable results only
50% of the time. It appears that money can't buy you love but it can buy any "scientific" result desired.
Cynthia Crossen, a staffer for the Wall Street Journal, i n 1996 published Tainted Truth : The Manipulation of Fact in America , a
book about the widespread practice of lying with statistics.(22) Commenting on the state of scientific research, she wrote: The
road to hell was paved with the flood of corporate research dollars that eagerly filled gaps left by slashed government research
funding. Her data on financial involvement showed that in l981 the drug industry gave $292 million to colleges and universities
for research. By l991, this figure had risen to $2.1 billion.
Death by Medicine
By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
THE FIRST IATROGENIC STUDY
Dr. Lucian L. Leape opened medicine's Pandora's box in his 1994 paper, Error in Medicine, which appeared in the Journal of the
American Medical Association (JAMA).(16) He found that Schimmel reported in 1964 that 20% of hospital patients suffered
iatrogenic injury, with a 20% fatality rate. In 1981 Steel reported that 36% of hospitalized patients experienced iatrogenesis with
a 25% fatality rate, and adverse drug reactions were involved in 50% of the injuries. In 1991, Bedell reported that 64% of acute
heart attacks in one hospital were preventable and were mostly due to adverse drug reactions.
Leape focused on the Harvard Medical Practice Study published in 1991, (16a) which found a 4% iatrogenic injury rate for
patients, with a 14% fatality rate, in 1984 in New York State. From the 98,609 patients injured and the 14% fatality rate, he
estimated that in the entire U.S. 180,000 people die each year partly as a result of iatrogenic injury.
Why Leape chose to use the much lower figure of 4% injury for his analysis remains in question. Using instead the average of
the rates found in the three studies he cites (36%, 20%, and 4%) would have produced a 20% medical error rate. The number of
iatrogenic deaths using an average rate of injury and his 14% fatality rate would be 1,189,576.
Leape acknowledged that the literature on medical errors is sparse and represents only the tip of the iceberg, noting that when
errors are specifically sought out, reported rates are distressingly high. He cited several autopsy studies with rates as high as
35-40% of missed diagnoses causing death. He also noted that an intensive care unit reported an average of 1.7 errors per day
per patient, and 29% of those errors were potentially serious or fatal.
Leape calculated the error rate in the intensive care unit study. First, he found that each patient had an average of 178
activities (staff/procedure/medical interactions) a day, of which 1.7 were errors, which means a 1% failure rate. This may not
seem like much, but Leape cited industry standards showing that in aviation, a 0.1% failure rate would mean two unsafe plane
landings per day at Chicago's O'Hare International Airport; in the US Postal Service, a 0.1% failure rate would mean 16,000
pieces of lost mail every hour; and in the banking industry, a 0.1% failure rate would mean 32,000 bank checks deducted from
the wrong bank account.
In trying to determine why there are so many medical errors, Leape acknowledged the lack of reporting of medical errors. Medical
errors occur in thousands of different locations and are perceived as isolated and unusual events. But the most important reason
that the problem of medical errors is unrecognized and growing, according to Leape, is that doctors and nurses are unequipped
to deal with human error because of the culture of medical training and practice. Doctors are taught that mistakes are
unacceptable. Medical mistakes are therefore viewed as a failure of character and any error equals negligence. No one is taught
what to do when medical errors do occur. Leape cites McIntyre and Popper, who said the infallibility model of medicine leads to
intellectual dishonesty with a need to cover up mistakes rather than admit them. There are no Grand Rounds on medical errors,
no sharing of failures among doctors, and no one to support them emotionally when their error harms a patient.
Leape hoped his paper would encourage medical practitioners to fundamentally change the way they think about errors and why
they occur. It has been almost a decade since this groundbreaking work, but the mistakes continue to soar.
In 1995, a JAMA report noted, "Over a million patients are injured in US hospitals each year, and approximately 280,000 die
annually as a result of these injuries. Therefore, the iatrogenic death rate dwarfs the annual automobile accident mortality rate of
45,000 and accounts for more deaths than all other accidents combined."(23)
At a 1997 press conference, Leape released a nationwide poll on patient iatrogenesis conducted by the National Patient Safety
Foundation (NPSF), which is sponsored by the American Medical Association (AMA). Leape is a founding member of NPSF. The
survey found that more than 100 million Americans have been affected directly or indirectly by a medical mistake. Forty-two
percent were affected directly and 84% personally knew of someone who had experienced a medical mistake.(14)
At this press conference, Leape updated his 1994 statistics, noting that as of 1997, medical errors in inpatient hospital settings
nationwide could be as high as 3 million and could cost as much as $200 billion . Leape used a 14% fatality rate to determine a
medical error death rate of 180,000 in 1994.(16) In 1997, using Leape's base number of 3 million errors, the annual death rate
could be as high as 420,000 for hospital inpatients alone.
ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED
In 1994, Leape said he was well aware that medical errors were not being reported.(16) A study conducted in two obstetrical units
in the UK found that only about one-quarter of adverse incidents were ever reported, to protect staff, preserve reputations, or for
fear of reprisals, including lawsuits.(24). An analysis by Wald and Shojania found that only 1.5% of all adverse events result in an
incident report, and only 6% of adverse drug events are identified properly. The authors learned that the American College of
Surgeons estimates that surgical incident reports routinely capture only 5-30% of adverse events. In one study, only 20% of
surgical complications resulted in discussion at morbidity and mortality rounds.(25) From these studies, it appears that all the
statistics gathered on medical errors may substantially underestimate the number of adverse drug and medical therapy incidents.
They also suggest that our statistics concerning mortality resulting from medical errors may be in fact be conservative figures.
An article in Psychiatric Times (April 2000) outlines the stakes involved in reporting medical errors.(26) The authors found that the
public is fearful of suffering a fatal medical error, and doctors are afraid they will be sued if they report an error. This brings up the
obvious question: who is reporting medical errors? Usually it is the patient or the patient's surviving family. If no one notices the
error, it is never reported. Janet Heinrich, an associate director at the U.S. General Accounting Office responsible for health
financing and public health issues, testified before a House subcommittee hearing on medical errors that "the full magnitude of
their threat to the American public is unknown and "gathering valid and useful information about adverse events is extremely
difficult." She acknowledged that the fear of being blamed, and the potential for legal liability, played key roles in the
underreporting of errors. The Psychiatric Times noted that the AMA strongly opposes mandatory reporting of medical errors.(26) If
doctors are not reporting, what about nurses? A survey of nurses found that they also fail to report medical mistakes for fear of
retaliation.(27)
Standard medical pharmacology texts admit that relatively few doctors ever report adverse drug reactions to the FDA.(28) The
reasons range from not knowing such a reporting system exists to fear of being sued.(29) Yet the public depends on this
tremendously flawed system of voluntary reporting by doctors to know whether a drug or a medical intervention is harmful.
Pharmacology texts also will tell doctors how hard it is to separate drug side effects from disease symptoms. Treatment failure is
most often attributed to the disease and not the drug or doctor. Doctors are warned, Probably nowhere else in professional life
are mistakes so easily hidden, even from ourselves.(30) It may be hard to accept, but it is not difficult to understand why only 1 in
20 side effects is reported to either hospital administrators or the FDA.(31, 31a)
If hospitals admitted to the actual number of errors for which they are responsible, which is about 20 times what is reported, they
would come under intense scrutiny.(32) Jerry Phillips, associate director of the FDA's Office of Post Marketing Drug Risk
Assessment, confirms this number. In the broader area of adverse drug reaction data, the 250,000 reports received annually
probably represent only 5% of the actual reactions that occur.(33) Dr. Jay Cohen, who has extensively researched adverse drug
reactions, notes that because only 5% of adverse drug reactions are reported, there are in fact 5 million medication reactions
each year.(34)
A 2003 survey is all the more distressing because there seems to be no improvement in error reporting, even with all the attention
given to this topic. Dr. Dorothea Wild surveyed medical residents at a community hospital in Connecticut and found that only half
were aware that the hospital had a medical error-reporting system, and that the vast majority did not use it at all. Dr. Wild says
this does not bode well for the future. If doctors don't learn error reporting in their training, they will never use it. Wild adds that
error reporting is the first step in locating the gaps in the medical system and fixing them. Not even that first step has been taken
to date.(35)
PUBLIC SUGGESTIONS ON IATROGENESIS
In a telephone survey, 1,207 adults ranked the effectiveness of the following measures in reducing preventable medical errors that
result in serious harm.(36) (Following each measure is the percentage of respondents who ranked the measure as very effective.)
I giving doctors more time to spend with patients (78%)
I requiring hospitals to develop systems to avoid medical errors (74%)
I better training of health professionals (73%)
I using only doctors specially trained in intensive care medicine on intensive care units (73%)
I requiring hospitals to report all serious medical errors to a state agency (71%)
I increasing the number of hospital nurses (69%)
I reducing the work hours of doctors in training to avoid fatigue (66%)
I encouraging hospitals to voluntarily report serious medical errors to a state agency (62%).
DRUG IATROGENESIS
Prescription drugs constitute the major treatment modality of scientific medicine. With the discovery of the germ theory,
medical scientists convinced the public that infectious organisms were the cause of illness. Finding the cure for these infections
proved much harder than anyone imagined. From the beginning, chemical drugs promised much more than they delivered. But far
beyond not working, the drugs also caused incalculable side effects. The drugs themselves, even when properly prescribed, have
side effects that can be fatal, as Lazarou's study(1) showed. 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% of patients admitted to these hospitals each year. The authors concluded that at least 90,895 patients
annually were harmed by medication errors in the US as a whole.(37)
A 2002 study shows that 20% of hospital medications for patients had dosage errors. Nearly 40% of these errors were
considered potentially harmful to the patient. In a typical 300-patient hospital, the number of errors per day was 40.(38)
Problems involving patients' medications were even higher the following year. The error rate intercepted by pharmacists in this
study was 24%, making the potential minimum number of patients harmed by prescription drugs 417,908.(39)
RECENT ADVERSE DRUG REACTIONS
More-recent studies on adverse drug reactions show that the figures from 1994 published in Lazarou's 1998 JAMA article may be
increasing. A 2003 study followed 400 patients after discharge from a tertiary care hospital setting (requiring highly specialized
skills, technology, or support services). Seventy-six patients (19%) had adverse events. Adverse drug events were the most
common, at 66% of all events. The next most common event was procedure-related injuries, at 17%.(40)
In a New England Journal of Medicine study, an alarming one in four patients suffered observable side effects from the more than
3.34 billion prescription drugs filled in 2002.(41) One of the doctors who produced the study was interviewed by Reuters and
commented, "With these 10-minute appointments, it's hard for the doctor to get into whether the symptoms are bothering the
patients."(42) William Tierney, who editorialized on the New England Journal study, said given the increasing number of
powerful drugs available to care for the aging population, the problem will only get worse. The drugs with the worst record of side
effects were selective serotonin reuptake inhibitors ( SSRIs), nonsteroidal anti-inflammatory drugs (NSAIDs), and calcium-
channel blockers. Reuters also reported that prior research has suggested that nearly 5% of hospital admissions (over 1 million
per year) are the result of drug side effects. But most of the cases are not documented as such. The study found that one of the
reasons for this failure is that in nearly two-thirds of the cases, doctors could not diagnose drug side effects or the side effects
persisted because the doctor failed to heed the warning signs.
MEDICATING OUR FEELINGS
Patients seeking a more joyful existence and relief from worry, stress, and anxiety often fall victim to the messages endlessly
displayed on TV and billboards. Often, instead of gaining relief, they fall victim to the myriad iatrogenic side effects of
antidepressant medication.
Moreover, a whole generation of antidepressant users has been created from young people growing up on Ritalin. Medicating
youth and modifying their emotions must have some impact on how they learn to deal with their feelings. They learn to equate
coping with drugs rather than with their inner resources. As adults, these medicated youth reach for alcohol, drugs, or even street
drugs to cope. According to JAMA , Ritalin acts much like cocaine.(43) Today's marketing of mood-modifying drugs such as
Prozac and Zoloft makes them not only socially acceptable but almost a necessity in today's stressful world.
Television Diagnosis
To reach the widest audience possible, drug companies are no longer just targeting medical doctors with their marketing of
antidepressants. By 1995, drug companies had tripled the amount of money allotted to direct advertising of prescription drugs to
consumers. The majority of this money is spent on seductive television ads. From 1996 to 2000, spending rose from $791 million
to nearly $2.5 billion.(44) This $2.5 billion represents only 15% of the total pharmaceutical advertising budget. While the drug
companies maintain that direct-to-consumer advertising is educational, Dr. Sidney M. Wolfe of the Public Citizen Health
Research Group in Washington, DC, argues that the public often is misinformed about these ads.(45) People want what they see
on television and are told to go to their doctors for a prescription. Doctors in private practice either acquiesce to their patients'
demands for these drugs or spend valuable time trying to talk patients out of unnecessary drugs. Dr. Wolfe remarks that one
important study found that people mistakenly believe that the FDA reviews all ads before they are released and allows only the
safest and most effective drugs to be promoted directly to the public.(46)
How Do We Know Drugs Are Safe?
Another aspect of scientific medicine that the public takes for granted is the testing of new drugs. Drugs generally are tested on
individuals who are fairly healthy and not on other medications that could interfere with findings. But when these new drugs are
declared safe and enter the drug prescription books, they are naturally going to be used by people who are on a variety of other
medications and have a lot of other health problems. Then a new phase of drug testing called post-approval comes into play,
which is the documentation of side effects once drugs hit the market. In one very telling report, the federal government's General
Accounting Office "found that of the 198 drugs approved by the FDA between 1976 and 1985... 102 (or 51.5%) had serious post-
approval risks... the serious post-approval risks (included) heart failure, myocardial infarction, anaphylaxis, respiratory depression
and arrest, seizures, kidney and liver failure, severe blood disorders, birth defects and fetal toxicity, and blindness."(47)
NBC Television's investigative show Dateline wondered if your doctor is moonlighting as a drug company representative. After a
yearlong investigation, NBC reported that because doctors can legally prescribe any drug to any patient for any condition, drug
companies heavily promote "off label" and frequently inappropriate and untested uses of these medications, even though these
drugs are approved only for the specific indications for which they have been tested.(48)
The leading causes of adverse drug reactions are antibiotics (17%), cardiovascular drugs (17%), chemotherapy (15%), and analgesics
and anti-inflammatory agents (15%).(49)
SPECIFIC DRUG IATROGENESIS: ANTIBIOTICS
According to William Agger, MD, director of microbiology and chief of infectious disease at Gundersen Lutheran Medical Center
in La Crosse, WI, 30 million pounds of antibiotics are used in America each year.(50) Of this amount, 25 million pounds are used
in animal husbandry, and 23 million pounds are used to try to prevent disease and the stress of shipping, as well as to promote
growth. Only 2 million pounds are given for specific animal infections. Dr. Agger reminds us that low concentrations of antibiotics
are measurable in many of our foods and in various waterways around the world, much of it seeping in from animal farms.
Agger contends that overuse of antibiotics results in food-borne infections resistant to antibiotics. Salmonella is found in 20% of
ground meat, but the constant exposure of cattle to antibiotics has made 84% of salmonella resistant to at least one anti-
salmonella antibiotic. Diseased animal food accounts for 80% of salmonellosis in humans, or 1.4 million cases per year. The
conventional approach to countering this epidemic is to radiate food to try to kill all organisms while continuing to use the
antibiotics that created the problem in the first place. Approximately 20% of chickens are contaminated with Campylobacter
jejuni, an organism that causes 2.4 million cases of illness annually. Fifty-four percent of these organisms are resistant to at
least one anti-campylobacter antimicrobial agent.
Denmark banned growth-promoting antibiotics beginning in 1999, which cut their use by more than half within a year, from
453,200 to 195,800 pounds. A report from Scandinavia found that removing antibiotic growth promoters had no or minimal effect
on food production costs. Agger warns that the current crowded, unsanitary methods of animal farming in the US support
constant stress and infection, and are geared toward high antibiotic use.
In the US, over 3 million pounds of antibiotics are used every year on humans. With a population of 284 million Americans, this
amount is enough to give every man, woman, and child 10 teaspoons of pure antibiotics per year. Agger says that exposure to a
steady stream of antibiotics has altered pathogens such as Streptococcus pneumoniae, Staplococcus aureus, and entercocci,
to name a few.
Almost half of patients with upper respiratory tract infections in the U.S. still receive antibiotics from their doctor.(51) According to
the CDC, 90% of upper respiratory infections are viral and should not be treated with antibiotics. In Germany, the prevalence of
systemic antibiotic use in children aged 0-6 years was 42.9%.(52)
Data obtained from nine US health insurers on antibiotic use in 25,000 children from 1996 to 2000 found that rates of antibiotic
use decreased. Antibiotic use in children aged three months to under 3 years decreased 24%, from 2.46 to 1.89 antibiotic
prescriptions per patient per year. For children aged 3 to under 6 years, there was a 25% reduction from 1.47 to 1.09 antibiotic
prescriptions per patient per year. And for children aged 6 to under 18 years, there was a 16% reduction from 0.85 to 0.69
antibiotic prescriptions per patient per year.(53) Despite these reductions, the data indicate that on average every child in America
receives 1.22 antibiotic prescriptions annually.
Group A beta-hemolytic streptococci is the only common cause of sore throat that requires antibiotics, with penicillin and
erythromycin the only recommended treatment. Ninety percent of sore-throat cases, however, are viral. Antibiotics were used in
73% of the estimated 6.7 million adult annual visits for sore throat in the US between 1989 and 1999. Furthermore, patients
treated with antibiotics were prescribed non-recommended broad-spectrum antibiotics in 68% of visits. This period saw a
significant increase in the use of newer, more expensive broad-spectrum antibiotics and a decrease in use of the recommended
antibiotics penicillin and erythromycin.(54) A ntibiotics being prescribed in 73% of sore-throat cases instead of the recommended
10% resulted in a total of 4.2 million unnecessary antibiotic prescriptions from 1989 to 1999.
The Problem with Antibiotics
In September 2003, the CDC re-launched a program started in 1995 called Get Smart: Know When Antibiotics Work.(55) This
$1.6 million campaign is designed to educate patients about the overuse and inappropriate use of antibiotics. Most people
involved with alternative medicine have known about the dangers of antibiotic overuse for decades. Finally the government is
focusing on the problem, yet it is spending only a miniscule amount of money on an iatrogenic epidemic that is costing billions of
dollars and thousands of lives. The CDC warns that 90% of upper respiratory infections, including children's ear infections, are
viral and that antibiotics do not treat viral infection. More than 40% of about 50 million prescriptions for antibiotics written each
year in physicians' offices are inappropriate.(2) U sing antibiotics when not needed can lead to the development of deadly strains
of bacteria that are resistant to drugs and cause more than 88,000 deaths due to hospital-acquired infections.(9) The CDC,
however, seems to be blaming patients for misusing antibiotics even though they are available only by prescription from
physicians. According to Dr. Richard Besser, head of Get Smart: "Programs that have just targeted physicians have not
worked. Direct-to-consumer advertising of drugs is to blame in some cases. Besser says the program teaches patients and the
general public that antibiotics are precious resources that must be used correctly if we want to have them around when we need
them. Hopefully, as a result of this campaign, patients will feel more comfortable asking their doctors for the best care for their
illnesses, rather than asking for antibiotics."(56)
Death by Medicine
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 surgerieswhich 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)
UNNECESSARY X-RAYS
When x-rays were discovered, no one knew the long-term effects of ionizing radiation. In the 1950s, monthly fluoroscopic exams
at the doctor's office were routine, and you could even walk into most shoe stores and see x-rays of your foot bones. We still do
not know the ultimate outcome of our initial fascination with x-rays.
In those days, it was common practice to x-ray pregnant women to measure their pelvises and make a diagnosis of twins.
Finally, a study of 700,000 children born between 1947 and 1964 in 37 major maternity hospitals compared the children of
mothers who had received pelvic x-rays during pregnancy to those of mothers who did not. It found that cancer mortality was
40% higher among children whose mothers had been x-rayed.(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 technologyspecifically x-
rays, CT scans, and mammography and fluoroscopy devicesare 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.
UNNECESSARY HOSPITALIZATION
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:
1. Thousands of prophylactic mastectomies are performed annually.
2. One-third of US women have had a hysterectomy before menopause.
3. Women are prescribed drugs more frequently than are men.
4. Women are given potent drugs for disease prevention, which results in disease substitution due to side effects.
5. Fetal monitoring is unsupported by studies and not recommended by the CDC.(98) It confines women to a hospital bed and
may result in a higher incidence of cesarean section.(99)
6. Normal processes such as menopause and childbirth have been heavily medicalized.
7. Synthetic hormone replacement therapy (HRT) does not prevent heart disease or dementia, but does increase the risk of
breast cancer, heart disease, stroke, and gall bladder attack.(100)
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)
Death by Medicine
By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
CESAREAN SECTION
In 1983, 809,000 cesarean sections (21% of live births) were performed in the US, making it the nation's most common obstetric-
gynecologic (OB/GYN) surgical procedure. The second most common OB/GYN operation was hysterectomy (673,000), followed
by diagnostic dilation and curettage of the uterus (632,000). In 1983, OB/GYN procedures represented 23% of all surgery
completed in the US.(104)
In 2001, cesarean section is still the most common OB/GYN surgical procedure. Approximately 4 million births occur annually,
with 24% (960,000) delivered by cesarean section. In the Netherlands, only 8% of births are delivered by cesarean section. This
suggests 640,000 unnecessary cesarean sectionsentailing three to four times higher mortality and 20 times greater morbidity
than vaginal delivery(105)are performed annually in the US.
The US cesarean rate rose from just 4.5% in 1965 to 24.1% in 1986. Sakala contends that an uncontrolled pandemic of
medically unnecessary cesarean births is occurring.(106) VanHam reported a cesarean section postpartum hemorrhage rate of
7%, a hematoma formation rate of 3.5%, a urinary tract infection rate of 3%, and a combined postoperative morbidity rate of
35.7% in a high-risk population undergoing cesarean section.(107)
NEVER ENOUGH STUDIES
Scientists claimed there were never enough studies revealing the dangers of DDT and other dangerous pesticides to ban them.
They also used this argument for tobacco, claiming that more studies were needed before they could be certain that tobacco
really caused lung cancer. Even the American Medical Association (AMA) was complicit in suppressing the results of tobacco
research. In 1964, when the Surgeon General's report condemned smoking, the AMA refused to endorse it, claiming a need for
more research. What they really wanted was more money, which they received from a consortium of tobacco companies that
paid the AMA $18 million over the next nine years during which the AMA said nothing about the dangers of smoking.(108)
The Journal of the American Medical Association (JAMA), "after careful consideration of the extent to which cigarettes were used
by physicians in practice," began accepting tobacco advertisements and money in 1933. State journals such as the New York
State Journal of Medicine also began to run advertisements for Chesterfield cigarettes that claimed cigarettes are "Just as pure
as the water you drink and practically untouched by human hands." In 1948, JAMA argued "more can be said in behalf of
smoking as a form of escape from tension than against it there does not seem to be any preponderance of evidence that would
indicate the abolition of the use of tobacco as a substance contrary to the public health."(109) Today, scientists continue to use
the excuse that more studies are needed before they will support restricting the inordinate use of drugs.
ADVERSE DRUG REACTIONS
The Lazarou study(1) analyzed records for prescribed medications for 33 million US hospital admissions in 1994. It discovered 2.2
million serious injuries due to prescribed drugs; 2.1% of inpatients experienced a serious adverse drug reaction, 4.7% of all
hospital admissions were due to a serious adverse drug reaction, and fatal adverse drug reactions occurred in 0.19% of inpatients
and 0.13% of admissions. The authors estimated that 106,000 deaths occur annually due to adverse drug reactions.
Using a cost analysis from a 2000 study in which the increase in hospitalization costs per patient suffering an adverse drug
reaction was $5,483, costs for the Lazarou study's 2.2 million patients with serious drug reactions amounted to $12 billion.(1,49)
Serious adverse drug reactions commonly emerge after FDA approval of the drugs involved. The safety of new agents cannot be
known with certainty until a drug has been on the market for many years.(110)
BEDSORES
Over one million people develop bedsores in U.S. hospitals every year. It's a tremendous burden to patients and family, and a $55
billion dollar healthcare burden. (7) Bedsores are preventable with proper nursing care. It is true that 50% of those affected are in a
vulnerable age group of over 70. In the elderly bedsores carry a fourfold increase in the rate of death. The mortality rate in
hospitals for patients with bedsores is between 23% and 37%. (8) Even if we just take the 50% of people over 70 with bedsores
and the lowest mortality at 23%, that gives us a death rate due to bedsores of 115,000. Critics will say that it was the disease or
advanced age that killed the patient, not the bedsore, but our argument is that an early death, by denying proper care, deserves
to be counted. It is only after counting these unnecessary deaths that we can then turn our attention to fixing the problem.
MALNUTRITION IN NURSING HOMES
The General Accounting Office (GAO), a special investigative branch of Congress, cited 20% of the nation's 17,000 nursing homes
for violations between July 2000 and January 2002. Many violations involved serious physical injury and death.(111)
A report from the Coalition for Nursing Home Reform states that at least one-third of the nation's 1.6 million nursing home
residents may suffer from malnutrition and dehydration, which hastens their death. The report calls for adequate nursing staff to
help feed patients who are not able to manage a food tray by themselves.(11) It is difficult to place a mortality rate on malnutrition
and dehydration. The Coalition report states that malnourished residents, compared with well-nourished hospitalized nursing
home residents, have a fivefold increase in mortality when they are admitted to a hospital. Multiplying the one-third of 1.6 million
nursing home residents who are malnourished by a mortality rate of 20%(8,14) results in 108,800 premature deaths due to
malnutrition in nursing homes.
Nosocomial Infections
The rate of nosocomial infections per 1,000 patient days rose from 7.2 in 1975 to 9.8 in 1995, a 36% jump in 20 years. Reports
from more than 270 US hospitals showed that the nosocomial infection rate itself had remained stable over the previous 20 years,
with approximately five to six hospital-acquired infections occurring per 100 admissions, a rate of 5-6%. Due to progressively
shorter inpatient stays and the increasing number of admissions, however, the number of infections increased. It is estimated
that in 1995, nosocomial infections cost $4.5 billion and contributed to more than 88,000 deaths, or one death every 6 minutes.(9)
The 2003 incidence of nosocomial mortality is quite probably higher than in 1995 because of the tremendous increase in
antibiotic-resistant organisms. Morbidity and Mortality Report found that nosocomial infections cost $5 billion annually in 1999,(10)
representing a $0.5 billion increase in just four years. At this rate of increase, the current cost of nosocomial infections would be
around $5.5 billion.
Outpatient Iatrogenesis
In a 2000 JAMA article, Dr. Barbara Starfield presents well-documented facts that are both shocking and unassailable.(12) The
U.S. ranks 12th of 13 industrialized countries when judged by 16 health status indicators. Japan, Sweden, and Canada were first,
second, and third, respectively. More than 40 million people in the US have no health insurance, and 20-30% of patients receive
contraindicated care.
Starfield warns that one cause of medical mistakes is overuse of technology, which may create a "cascade effect" leading to still
more treatment. She urges the use of ICD (International Classification of Diseases) codes that have designations such as
"Drugs, Medicinal, and Biological Substances Causing Adverse Effects in Therapeutic Use" and "Complications of Surgical and
Medical Care" to help doctors quantify and recognize the magnitude of the medical error problem. Starfield notes that many
deaths attributable to medical error today are likely to be coded to indicate some other cause of death. She concludes that
against the backdrop of our poor health report card compared to other Westernized countries, we should recognize that the
harmful effects of health care interventions account for a substantial proportion of our excess deaths.
Starfield cites Weingart's 2000 article, Epidemiology of Medical Error, as well as other authors to suggest that between 4% and
18% of consecutive patients in outpatient settings suffer an iatrogenic event leading to:
1. 116 million extra physician visits
2. 77 million extra prescriptions filled
3. 17 million emergency department visits
4. 8 million hospitalizations
5. 3 million long-term admissions
6. 199,000 additional deaths
7. $77 billion in extra costs(112)
Unnecessary Surgeries
While some 12,000 deaths occur each year from unnecessary surgeries, results from the few studies that have measured
unnecessary surgery directly indicate that for some highly controversial operations, the proportion of unwarranted surgeries could
be as high as 30%.(74)
MEDICAL ERRORS: A GLOBAL ISSUE
A five-country survey published in the Journal of Health Affairs found that 18-28% of people who were recently ill had suffered
from a medical or drug error in the previous two years. The study surveyed 750 recently ill adults. The breakdown by country
showed the percentages of those suffering a medical or drug error were 18% in Britain, 23% in Australia and in New Zealand,
25% in Canada, and 28% in the US.(113)
HEALTH INSURANCE
The Institute of Medicine recently found that the 41 million Americans with no health insurance have consistently worse clinical
outcomes than those who are insured, and are at increased risk for dying prematurely (114).
When doctors bill for services they do not render, advise unnecessary tests, or screen everyone for a rare condition, they are
committing insurance fraud. The US GAO estimated that $12 billion dollars was lost to fraudulent or unnecessary claims in 1998,
and reclaimed $480 million in judgments in that year. In 2001, the federal government won or negotiated more than $1.7 billion in
judgments, settlements, and administrative impositions in health care fraud cases and proceedings.(115)
WAREHOUSING OUR ELDERS
One way to measure the moral and ethical fiber of a society is by how it treats its weakest and most vulnerable members. In
some cultures, elderly people lives out their lives in extended family settings that enable them to continue participating in family
and community affairs. American nursing homes, where millions of our elders go to live out their final days, represent the
pinnacle of social isolation and medical abuse.
I In America, approximately 1.6 million elderly are confined to nursing homes. By 2050, that number could be 6.6 million.
(11,116)
I Twenty percent of all deaths from all causes occur in nursing homes.(117)
I Hip fractures are the single greatest reason for nursing home admissions.(118)
I Nursing homes represent a reservoir for drug-resistant organisms due to overuse of antibiotics.(119)
Presenting a report he sponsored entitled "Abuse of Residents is a Major Problem in U.S. Nursing Homes" on July 30, 2001,
Rep. Henry Waxman (D-CA) noted that as a society we will be judged by how we treat the elderly." The report found one-third of
the nation's approximately 17,000 nursing homes were cited for an abuse violation in a two-year period from January 1999 to
January 2001.(116) According to Waxman, the people who cared for us deserve better." The report suggests that this known
abuse represents only the tip of the iceberg and that much more abuse occurs that we aware of or ignore.(116a) The report found:
I Over 30% of US nursing homes were cited for abuses, totaling more than 9,000 violations.
I 10% of nursing homes had violations that caused actual physical harm to residents or worse.
I Over 40% (3,800) of the abuse violations followed the filing of a formal complaint, usually by concerned family members.
I Many verbal abuse violations were found.
I Occasions of sexual abuse.
I 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. In 1990,
Congress mandated an exhaustive study of nurse-to-patient ratios in nursing homes. The study was finally begun in 1998 and
took four years to complete.(120) A spokesperson for The National Citizens' Coalition for Nursing Home Reform commented on the
study: They compiled two reports of three volumes each thoroughly documenting the number of hours of care residents must
receive from nurses and nursing assistants to avoid painful, even dangerous, conditions such as bedsores and infections. Yet it
took the Department of Health and Human Services and Secretary Tommy Thompson only four months to dismiss the report as
insufficient.'(121) Although preventable with proper nursing care, bedsores occur three times more commonly in nursing homes
than in acute care or veterans hospitals.(122).
Because many nursing home patients suffer from chronic debilitating conditions, their assumed cause of death often is
unquestioned by physicians.Some studies show that as many as 50% of deaths due to restraints, falls, suicide, homicide, and
choking in nursing homes may be covered up.(123,124) It is possible that many nursing home deaths are instead attributed to heart
disease. In fact, researchers have found that heart disease may be over-represented in the general population as a cause of
death on death certificates by 8-24%. In the elderly, the overreporting of heart disease as a cause of death is as much as
twofold.(125)
That very few statistics exist concerning malnutrition in acute-care hospitals and nursing homes demonstrates the lack of
concern in this area. While a survey of the literature turns up few US studies, one revealing US study evaluated the nutritional
status of 837 patients in a 100-bed subacute-care hospital over a 14-month period. The study found only 8% of the patients were
well nourished, while 29% were malnourished and 63% were at risk of malnutrition. As a result, 25% of the malnourished patients
required readmission to an acute-care hospital, compared to 11% of the well-nourished patients. The authors concluded that
malnutrition reached epidemic proportions in patients admitted to this subacute-care facility.(126)
Many studies conclude that physical restraints are an underreported and preventable cause of death. Studies show that
compared to no restraints, the use of restraints carries a higher mortality rate and economic burden.(127-129) Studies have found
that physical restraints, including bedrails, are the cause of at least 1 in every 1,000 nursing-home deaths.(130-132)
Deaths caused by malnutrition, dehydration, and physical restraints, however, are rarely recorded on death certificates. Several
studies reveal that nearly half of the listed causes of death on death certificates for elderly people with chronic or multi-system
disease are inaccurate.(133) Even though 1 in 5 people die in nursing homes, an autopsy is performed in less than 1% of these
deaths.(134).
OVERMEDICATING SENIORS
Dr. Robert Epstein, chief medical officer of Medco Health Solutions Inc. (a unit of Merck & Co.), conducted a study in 2003 of
drug trends among the elderly.(135) He found that seniors are going to multiple physicians, getting multiple prescriptions, and
using multiple pharmacies. Medco oversees drug-benefit plans for more than 60 million Americans, including 6.3 million seniors
who received more than 160 million prescriptions. According to the study, the average senior receives 25 prescriptions each year.
Among those 6.3 million seniors, a total of 7.9 million medication alerts were triggered: less than one-half that number, 3.4
million, were detected in 1999. About 2.2 million of those alerts indicated excessive dosages unsuitable for seniors, and about
2.4 million alerts indicated clinically inappropriate drugs for the elderly. Reuters interviewed Kasey Thompson, director of the
Center on Patient Safety at the American Society of Health System Pharmacists, who noted: There are serious and systemic
problems with poor continuity of care in the United States . He says this study represents only the tip of the iceberg of a
national problem.
According to Drug Benefit Trends , the average number of prescriptions dispensed per non-Medicare HMO member per year rose
5.6% from 1999 to 2000, - from 7.1 to 7.5 prescriptions. The average number dispensed for Medicare members increased 5.5%,
from 18.1 to 19.1 prescriptions.(136) The total number of prescriptions written in the US in 2000 was 2.98 billion, or 10.4
prescriptions for every man, woman, and child.(137)
In a study of 818 residents of residential care facilities for the elderly, 94% were receiving at least one medication at the time of
the interview. The average intake of medications was five per resident; the authors noted that many of these drugs were given
without a documented diagnosis justifying their use.(138)
Seniors and groups like the American Association for Retired Persons (AARP) are demanding that prescription drug coverage be a
basic right.(139) They have accepted allopathic medicine's overriding assumption that aging and dying in America must be
accompanied by drugs in nursing homes and eventual hospitalization. Seniors are given the choice of either high-cost patented
drugs or low-cost generic drugs. Drug companies attempt to keep the most expensive drugs on the shelves and suppress
access to generic drugs, despite facing stiff fines of hundreds of millions of dollars levied by the federal government.(140,141) In
2001, some of the world's largest drug companies were fined a record $871 million for conspiring to increase the price of vitamins.
(142)
Current AARP recommendations for diet and nutrition assume that seniors are getting all the nutrition they need in an average
diet. At most, AARP suggests adding extra calcium and a multivitamin and mineral supplement.(143)
Ironically, studies also indicate underuse of proper pain medication for patients who need it. One study evaluated pain
management in a group of 13,625 cancer patients, aged 65 and over, living in nursing homes. While almost 30% of the patients
reported pain, more than 25% received no pain relief medication, 16% received a mild analgesic drug, 32% received a moderate
analgesic drug, and 26% received adequate pain-relieving morphine. The authors concluded that older patients and minority
patients were more likely to have their pain untreated.(144)
WHAT REMAINS TO BE UNCOVERED
Our ongoing research will continue to quantify the morbidity, mortality, and financial loss due to:
1. X-ray exposures (mammography, fluoroscopy, CT scans).
2. Overuse of antibiotics for all conditions.
3. Carcinogenic drugs (hormone replacement therapy,* immunosuppressive and prescription drugs).
4. Cancer chemotherapy(70)
5. Surgery and unnecessary surgery (cesarean section, radical mastectomy, preventive mastectomy, radical hysterectomy,
prostatectomy, cholecystectomies, cosmetic surgery, arthroscopy, etc.).
6. Discredited medical procedures and therapies.
7. Unproven medical therapies.
8. Outpatient surgery.
9. Doctors themselves.
* Part of our ongoing research will be to quantify the mortality and morbidity caused by hormone replacement therapy (HRT)
since the 1940s. In December 2000, a government scientific advisory panel recommended that synthetic estrogen be added to
the nation's list of cancer-causing agents. HRT, either synthetic estrogen alone or combined with synthetic progesterone, is used
by an estimated 13.5 to 16 million women in the US.(145) The aborted Women's Health Initiative Study (WHI) of 2002 showed that
women taking synthetic estrogen combined with synthetic progesterone have a higher incidence of ovarian cancer, breast
cancer, stroke, and heart disease, with little evidence of osteoporosis reduction or dementia prevention. WHI researchers, who
usually never make recommendations except to suggest more studies, advised doctors to be very cautious about prescribing
HRT to their patients.(100,146-150)
Results of the Million Women Study on HRT and breast cancer in the UK were published in medical journal The Lancet in
August 2003. According to lead author Prof. Valerie Beral, director of the Cancer Research UK Epidemiology Unit: "We estimate
that over the past decade, use of HRT by UK women aged 50-64 has resulted in an extra 20,000 breast cancers, estrogen-
progestagen (combination) therapy accounting for 15,000 of these.(151) We were unable to find statistics on breast cancer,
stroke, uterine cancer, or heart disease caused by HRT used by American women. Because the US population is roughly six
times that of the UK, it is possible that 120,000 cases of breast cancer have been caused by HRT in the past decade.
Death by Medicine (Appendix)
By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
OFFICE OF TECHNOLOGY ASSESSMENT (OTA)
Health Care Technology and Its Assessment in Eight Countries, 1995.
General Facts
1. In 1990, US life expectancy was 71.8 years for men and 78.8 years for women, among the lowest rates in the developed
countries.
2. The 1990 US infant mortality rate in the US was 9.2 per 1,000 live births, in the bottom half of the distribution among all
developed countries.
3. Health status is correlated with socioeconomic status.
4. Health care is not universal.
5. Health care is based on the free market system with no fixed budget or limitations on expansion.
6. Health care accounts for 14% of the US GNP ($800 billion in 1993).
7. The federal government does no central planning, though it is the major purchaser of health care for older people and some
poor people.
8. Americans are less satisfied with their health care system than people in other developed countries.
9. US medicine specializes in expensive medical technology; some large US cities have more magnetic resonance image
(MRI) scanners than most countries.
10. Huge public and private investments in medical research and pharmaceutical development drive this technological arms
race.
11. Any efforts to restrain technological developments in health care are opposed by policymakers concerned about negative
impacts on medical-technology industries.
Hospitals
1. In 1990, the US had 5,480 acute-care hospitals, 880 specialty (psychiatric, long-term care, and rehabilitation) hospitals,
and 340 federal (military, veterans, and Native American) hospitals, or 2.7 hospitals per 100,000 population.
2. In 1990, the average length of stay for 33 million admissions was 9.2 days. The bed occupancy rate was 66%. Lengths of
stay were shorter and admission rates lower than other countries.
3. In 1990, the US had 615,000 physicians, or 2.4 per 1,000 population; 33% were primary care (family medicine, internal
medicine, and pediatrics) and 67% were specialists.
4. In 1991, government-run health care spending totaled $81 billion.
5. Total US health care spending rose to $752 billion in 1991 from $70 billion in 1950. Spending grew five-fold per capita.
6. Reasons for increased healthcare spending include:
1. The high cost of defensive medicine, with an escalation in services solely to avoid malpractice litigation.
2. US health care based on defensive medicine costs nearly $45 billion per year, or about 5% of total health care
spending, according to one source.
3. The availability and use of new medical technologies have contributed the most to increased health care spending,
argue many analysts. These costs are impossible to quantify.
7. The reasons government attempts to control health care costs have failed include:
1. Market incentive and profit-motive involvement in the financing and organization of health care, including private
insurers, hospital systems, physicians, and the drug and medical-device industries.
2. Expansion is the goal of free enterprise.
Health-Related Research and Development
1. The US spends more than any other country on health-related R&D.
2. In 1989, the federal government spent $9.2 billion on R&D, while private industry spent an additional $9.4 billion.
3. Total US R&D expenditures rose 50% from 1983 to 1992.
4. NIH receives about half of US government R&D funding.
5. NIH spent more on basic research ($4.1 billion in 1989) than for clinical trials of medical treatments on humans ($519
million in 1989).
6. Most of the clinical trials evaluate new treatment protocols for cancer and complications of AIDS, and do not study
existing treatments, even though their effectiveness is in many cases unknown and questionable.
7. In 1990, the NIH had just begun to do meta-analysis and cost-effectiveness analysis.
Pharmaceutical and Medical-Device Industries
1. About two-thirds of the industry's $9.4 billion budget went to drug research; device manufacturers spent the remaining one-
third.
2. In addition to R&D, the medical industry spent 24% of total sales on promoting their products and 15% of total sales on
development.
3. Total marketing expenses in 1990 were over $5 billion.
4. Many products provide no benefit over existing products.
5. Public and private health care consumers buy these products.
6. If health care spending is perceived as a problem, a highly profitable drug industry exacerbates the problem.
Controlling Health Care Technology
1. The FDA ensures the safety and efficacy of drugs, biologics, and medical devices.
2. The FDA does not consider costs of therapy.
3. The FDA does not consider the effectiveness of a therapy.
4. The FDA does not compare a product to currently marketed products
5. The FDA does not consider nondrug alternatives for a given clinical problem.
6. It costs $200 million in development costs to bring a new drug to market. AIDS-drug interest groups forced new
regulations that speed up the approval process.
7. Such drugs should be subject to greater post-marketing surveillance requirements. As of 1995, these provisions had not
yet come into play.
8. Many argue that reductions in the pre-approval testing of drugs open the possibility of significant undiscovered toxicities.
Health Care Technology Assessment
1. 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%).
2. In 1978, Congress created the National Center for Health Care Technology (NCHCT) to advise Medicare and Medicaid.
3. With an annual budget of $4 million, NCHCT published three broad assessments of high-priority technologies and made
about 75 coverage recommendations to Medicare.
4. Congress disbanded NCHCT in 1981. The medical profession opposed it from the beginning. The AMA testified before
Congress in 1981 that clinical policy analysis and judgments are better madeand are being responsibly madewithin
the medical profession. Assessing risks and costs, as well as benefits, has been central to the exercise of good medical
judgment for decades.
5. The medical device lobby also opposed government oversight by NCHCT.
EXAMPLES OF LACK OF PROPER MANAGEMENT OF HEALTHCARE
Treatments for Coronary Artery Disease
1. Since the early 1970s, the number of coronary artery bypass surgeries (CABGS) has risen rapidly without government
regulation or clinical trials.
2. Angioplasty for single vessel disease was introduced in 1978. The first published trial of angioplasty versus medical
treatment was done in 1992.
3. Angioplasty did not reduce the number of CABGS, as was promoted.
4. Both procedures increase in number every year as the patient population grows older and sicker.
5. Rates of use are higher in white patients and private insurance patients, and vary greatly by geographic region, suggesting
that use of these procedures is based on non-clinical factors.
6. As of 1995, the NIH consensus program had not assessed CABGS since 1980 and had never assessed angioplasty.
7. RAND researchers evaluated CABGS in New York in 1990. They reviewed 1,300 procedures and found 2% were
inappropriate, 90% were appropriate, and 7% were uncertain. For 1,300 angioplasties, 4% were inappropriate and 38%
uncertain. Using RAND methodologies, a panel of British physicians rated twice as many procedures inappropriate as
did a US panel rating the same clinical cases. The New York numbers are in question because New York State limits the
number of surgery centers, and the per-capita supply of cardiac surgeons in New York is about one-half of the national
average.
8. The estimated five-year cost is $33,000 for angioplasty and $40,000 for CABGS. Angioplasty did not lower costs, due to
its high failure rates.
Computed Tomography (CT)
1. The first CT scanner in the US was installed at the Mayo Clinic in 1973. By 1992, the number of operational CT scanners
in the US had grown to 6,060. By comparison, in 1993 there were 216 CT units in Canada .
2. There is little information available on how CT scans improve or affect patient outcomes
3. In some institutions, up to 90% of scans performed were negative.
4. Approval by the FDA was not required for CT scanners, nor was any evidence of safety or efficacy.
Magnetic Resonance Imaging (MRI)
1. MRIs were introduced in Great Britain in 1978 and in the US in 1980. By 1988, there were 1,230 units and by 1992
between 2,800 and 3,000.
2. A definitive review published in 1994 found less than 30 studies of 5,000 that were prospective comparisons of diagnostic
accuracy or therapeutic choice.
3. The American College of Physicians assessed MRI studies and rated 13 of 17 trials as weak, i.e., lacking data
concerning therapeutic impact or patient outcomes.
4. The OTA concluded: 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.
Laparoscopic Surgery
1. Laparoscopic cholecystectomy was introduced at a professional surgical society meeting in late 1989. By 1992, 85% of
all cholecystectomies were performed laparoscopically.
2. There was an associated increase of 30% in the number of cholecystectomies performed.
3. Because of the increased volume of gall bladder operations, their total cost increased 11.4% between 1988 and 1992,
despite a 25.1% drop in the average cost per surgery.
4. The mortality rate for gall bladder surgeries did not decline as a result of the lower risk because so many more were
performed.
5. When studies were finally done on completed cases, the results showed that laparoscopic cholecystectomy was
associated with reduced inpatient duration, decreased pain, and a shorter period of restricted activity. But rates of bile
duct and major vessel injury increased and it was suggested that these rates were worse for people with acute
cholecystitis. No clinical trials had been done to clarify this issue.
6. Patient demand, fueled by substantial media attention, was a major force in promoting rapid adoption of these procedures.
7. The major manufacturer of laparoscopic equipment produced the video that introduced the procedure in 1989.
8. Doctors were given two-day training seminars before performing the surgery on patients.
Infant Mortality
1. In 1990, the US ranked 24th in infant mortality of 38 developed countries with a rate of 9.2 deaths per 1,000 live births.
2. US black infant mortality is 18.6 per 1,000 live births, compared to 8.8 for whites.
Screening for Breast Cancer
1. Mammography screening in women under 50 has always been a subject of debate.
2. In 1992, the Canadian National Breast Cancer Study of 50,000 women showed that mammography had no effect on
mortality for women aged 40-50.
3. The National Cancer Institute (NCI) refused to change its recommendations on mammography.
4. The American Cancer Society decided to wait for more studies on mammography.
5. In December 1993, NCI announced that women over 50 should have routine screenings every one to two years but that
younger women would derive no benefit from mammography.
SUMMARY
1. The OTA concluded: There are no mechanisms in place to limit dissemination of technologies regardless of their clinical
value.
Shortly after the release of this report, the OTA was disbanded.
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