Death by Medicine

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Death by Medicine - 3

Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD

Debora Rasio MD, Dorothy Smith PhD

October 2003

 

Note: The information on this website is not a substitute for

diagnosis and treatment by a qualified, licensed professional.

 

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INTRODUCTION

 

Never before have the complete statistics on the multiple causes of iatrogenesis

been combined in one paper. Medical science amasses tens of thousands of papers

annually - each one a tiny fragment of the whole picture. To look at only one

piece and try to understand the benefits and risks is to stand one inch away

from an elephant and describe everything about it. You have to pull back to

reveal the complete picture, such as we have done here. Each specialty, each

division of medicine, keeps their own records and data on morbidity and

mortality like pieces of a puzzle. But the numbers and statistics were always

hiding in plain sight. We have now completed the painstaking work of reviewing

thousands and thousands of studies. Finally putting the puzzle together we came

up with some disturbing answers.

 

Is American Medicine Working?

 

At 14% of the Gross National Product, healthcare spending reached $1.6 trillion

in 2003.15 Considering this enormous expenditure, we should have the best

medicine in the world. We should be reversing disease, preventing disease, and

doing minimal harm. However, careful and objective review shows the opposite.

Because of the extraordinary narrow context of medical technology through which

contemporary medicine examines the human condition, we are completely missing

the full picture. Medicine is not taking into consideration the following

monumentally important aspects of a healthy human organism: (a) stress and how

it adversely affects the immune system and life processes; (b) insufficient

exercise; © excessive caloric intake; (d) highly-processed and denatured foods

grown in denatured and chemically-damaged soil; and (e) exposure to tens of

thousands of environmental toxins. Instead of minimizing these disease-causing

factors, we actually cause more illness through medical

technology, diagnostic testing, overuse of medical and surgical procedures, and

overuse of pharmaceutical drugs. The huge disservice of this therapeutic

strategy is the result of little effort or money being appropriated for

preventing disease.

 

Under-reporting of Iatrogenic Events

 

As few as 5% and only up to 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 a much higher annual iatrogenic death rate

than 783,936. Dr. Leape, in 1994, said his figure of 180,000 medical mistakes

annually was equivalent to three jumbo-jet crashes every two days.16 Our report

shows that 6 jumbo jets are falling out of the sky each and every day.

 

Correcting a Compromised System

 

What we must deduce from this report is that medicine is in need of complete and

total reform: from the curriculum in medical schools to protecting patients from

excessive medical intervention. It is quite obvious that we can’t change

anything if we are not honest about what needs to be changed. This report simply

shows the degree to which change is required. We are fully aware that what

stands in the way of change are powerful pharmaceutical companies, medical

technology companies, and special interest groups with enormous vested interests

in the business of medicine. They fund medical research, support medical schools

and hospitals, and advertise in medical journals. With deep pockets they entice

scientists and academics to support their efforts. Such funding can sway the

balance of opinion from professional caution to uncritical acceptance of a new

therapy or drug. You only have to look at the number of invested people on

hospital, medical, and government health advisory boards to

see conflict of interest. The public is mostly unaware of these interlocking

interests. For example, a 2003 study found that nearly half of medical school

faculty, who serve on Institutional Review Boards (IRB) to advise on clinical

trial research, also serve as consultants to the pharmaceutical industry.17 The

authors were concerned that such representation could cause potential conflicts

of interest. A news release by Dr. Erik Campbell, the lead author, said, " Our

previous research with faculty has shown us that ties to industry can affect

scientific behavior, leading to such things as trade secrecy and delays in

publishing research. It's possible that similar relationships with companies

could affect IRB members' activities and attitudes.”18

 

Medical Ethics and Conflict of Interest in Scientific Medicine

 

Jonathan Quick, Director of Essential Drugs and Medicines Policy for the World

Health Organization wrote in a recent WHO Bulletin: " If clinical trials become a

commercial venture in which self-interest overrules public interest and desire

overrules science, then the social contract which allows research on human

subjects in return for medical advances is broken. " 19

 

Former editor of the New England Journal of Medicine (NEJM), Dr. Marcia Angell,

struggled to bring the attention of the world to the problem of commercializing

scientific research in her outgoing editorial titled “Is Academic Medicine for

Sale?”20 Angell called for stronger restrictions on pharmaceutical stock

ownership and other financial incentives for researchers. She said that growing

conflicts of interest are tainting science. She warned that, “When the

boundaries between industry and academic medicine become as blurred as they are

now, the business goals of industry influence the mission of medical schools in

multiple ways.” She did not discount the benefits of research but said a

Faustian bargain now existed between medical schools and the pharmaceutical

industry.

 

Angell left the NEMJ in June, 2000. Two years later, in June, 2002, the NEJM

announced that it will now accept biased journalists (those who accept money

from drug companies) because it is too difficult to find ones that have no ties.

Another former editor of the journal, Dr. Jerome Kassirer, said that was just

not the case, that there are plenty of researchers who don’t work for drug

companies.21 The ABC report said that one measurable tie between pharmaceutical

companies and doctors amounts to over $2 billion a year spent for over 314,000

events that doctors attend.

 

The ABC report also noted that a survey of clinical trials revealed that when a

drug company funds a study, there is a 90% chance that the drug will be

perceived as effective whereas a non-drug company-funded study will show

favorable results 50% of the time. It appears that money can’t buy you love but

it can buy you any " scientific " result you want. The only safeguard to reporting

these studies was if the journal writers remained unbiased. That is no longer

the case.

Cynthia Crossen, writer for the Wall Street Journal in 1996, published Tainted

Truth: The Manipulation of Fact in America, a book about the widespread practice

of lying with statistics.22 Commenting on the state of scientific research she

said that, “The road to hell was paved with the flood of corporate research

dollars that eagerly filled gaps left by slashed government research funding.”

Her data on financial involvement showed that in l981 the drug industry “gave”

$292 million to colleges and universities for research. In l991 it “gave” $2.1

billion.

 

THE FIRST IATROGENIC STUDY

 

Dr. Lucian L. Leape opened medicine’s Pandora’s box in his 1994 JAMA paper,

“Error in Medicine”.16 He began the paper by reminiscing about Florence

Nightingale’s maxim – “first do no harm.” But he found evidence of the opposite

happening in medicine. He found that Schimmel reported in 1964 that 20% of

hospital patients suffered iatrogenic injury, with a 20% fatality rate. Steel in

1981 reported that 36% of hospitalized patients experienced iatrogenesis with a

25% fatality rate and adverse drug reactions were involved in 50% of the

injuries. Bedell in 1991 reported that 64% of acute heart attacks in one

hospital were preventable and were mostly due to adverse drug reactions.

However, Leape focused on his and Brennan’s “Harvard Medical Practice Study”

published in 1991.16a They found that in 1984, in New York State, there was a 4%

iatrogenic injury rate for patients with a 14% fatality rate. From the 98,609

patients injured and the 14% fatality rate, he estimated that in the whole of

the U.S. 180,000 people die each year, partly as a result of iatrogenic injury.

Leape compared these deaths to the equivalent of three jumbo-jet crashes every

two days.

 

Why Leape chose to use the much lower figure of 4% injury for his analysis

remains in question. Perhaps he wanted to tread lightly. If Leape had, instead,

calculated the average rate among the three studies he cites (36%, 20%, and 4%),

he would have come up with a 20% medical error rate. The number of fatalities

that he could have presented, using an average rate of injury and his 14%

fatality, is an annual 1,189,576 iatrogenic deaths, or over ten jumbo jets

crashing every day

 

Leape acknowledged that the literature on medical error is sparse and we are

only seeing the tip of the iceberg. He said that when errors are specifically

sought out, reported rates are “distressingly high”. He cited several autopsy

studies with rates as high as 35-40% of missed diagnoses causing death. He also

commented that an intensive care unit reported an average of 1.7 errors per day

per patient, and 29% of those errors were potentially serious or fatal. We

wonder: what is the effect on someone who daily gets the wrong medication, the

wrong dose, the wrong procedure; how do we measure the accumulated burden of

injury; and when the patient finally succumbs after the tenth error that week,

what is entered on the death certificate?

 

Leape calculated the rate of error in the intensive care unit. First, he found

that each patient had an average of 178 “activities” (staff/procedure/medical

interactions) a day, of which 1.7 were errors, which means a 1% failure rate. To

some this may not seem like much, but putting this into perspective, Leape cited

industry standards where in aviation a 0.1% failure rate would mean 2 unsafe

plane landings per day at O’Hare airport; in the U.S. Mail, 16,000 pieces of

lost mail every hour; or in banking, 32,000 bank checks deducted from the wrong

bank account every hour.

 

Analyzing why there is so much medical error Leape acknowledged the lack of

reporting. Unlike a jumbo-jet crash, which gets instant media coverage, hospital

errors are spread out over the country in thousands of different locations. They

are also perceived as isolated and unusual events. However, the most important

reason that medical error is unrecognized and growing, according to Leape, was,

and still is, that doctors and nurses are unequipped to deal with human error,

due to the culture of medical training and practice. Doctors are taught that

mistakes are unacceptable. Medical mistakes are therefore viewed as a failure of

character and any error equals negligence. We can see how a great deal of

sweeping under the rug takes place since nobody is taught what to do when

medical error does occur. Leape cited McIntyre and Popper who said the

“infallibility model” of medicine leads to intellectual dishonesty with a need

to cover up mistakes rather than admit them. There are no Grand

Rounds on medical errors, no sharing of failures among doctors and no one to

support them emotionally when their error harms a patient.

 

Leape hoped his paper would encourage medicine “to fundamentally change the way

they think about errors and why they occur”. It’s been almost a decade since

this groundbreaking work, but the mistakes continue to soar.

 

One year later, in 1995, a report in JAMA said that, " Over a million patients

are injured in U.S. hospitals each year, and approximately 280,000 die annually

as a result of these injuries. Therefore, the iatrogenic death rate dwarfs the

annual automobile accident mortality rate of 45,000 and accounts for more deaths

than all other accidents combined. " 23

 

At a press conference in 1997 Dr. Leape released a nationwide poll on patient

iatrogenesis conducted by the National Patient Safety Foundation (NPSF), which

is sponsored by the American Medical Association. The survey found that more

than 100 million Americans have been impacted directly and indirectly by a

medical mistake. Forty-two percent were directly affected and a total of 84%

personally knew of someone who had experienced a medical mistake.14 Dr. Leape is

a founding member of the NPSF.

 

Dr. Leape at this press conference also updated his 1994 statistics saying that

medical errors in inpatient hospital settings nationwide, as of 1997, could be

as high as three million and could cost as much as $200 billion. Leape used a

14% fatality rate to determine a medical error death rate of 180,000 in 1994.16

In 1997, using Leape’s base number of three million errors, the annual deaths

could be as much as 420,000 for inpatients alone. This does not include nursing

home deaths, or people in the outpatient community dying of drug side effects or

as the result of medical procedures.

 

ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED

 

Leape, in 1994, said that he was well aware that medical errors were not being

reported.16 According to a study in two obstetrical units in the U.K., only

about one quarter of the adverse incidents on the units are ever reported for

reasons of protecting staff or preserving reputations, or fear of reprisals,

including law suits.24 An analysis by Wald and Shojania found that only 1.5% 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 gives a very broad guess that surgical incident reports routinely

capture only 5-30% of adverse events. In one surgical study only 20% of surgical

complications resulted in discussion at Morbidity and Mortality Rounds.25 From

these studies it appears that all the statistics that are gathered may be

substantially underestimating the number of adverse drug and medical therapy

incidents. It also underscores the fact that our mortality

statistics are actually conservative figures.

 

An article in Psychiatric Times outlines the stakes involved with reporting

medical errors.26 They found that the public is fearful of suffering a fatal

medical error, and doctors are afraid they will be sued if they report an error.

This brings up the obvious question: who is reporting medical errors? Usually it

is the patient or the patient’s surviving family. If no one notices the error,

it is never reported. Janet Heinrich, an associate director at the U.S. General

Accounting Office responsible for health financing and public health issues,

testifying before a House subcommittee about medical errors, said that, " The

full magnitude of their threat to the American public is unknown.” She added,

" Gathering valid and useful information about adverse events is extremely

difficult. " She acknowledged that the fear of being blamed, and the potential

for legal liability, played key roles in the under-reporting of errors. The

Psychiatric Times noted that the American Medical Association is

strongly opposed to mandatory reporting of medical errors.26 If doctors aren’t

reporting, what about nurses? In a survey of nurses, they also did not report

medical mistakes for fear of retaliation.27

 

Standard medical pharmacology texts admit that relatively few doctors ever

report adverse drug reactions to the FDA.28 The reasons range from not knowing

such a reporting system exists to fear of being sued because they prescribed a

drug that caused harm. 29 However, it is this tremendously flawed system of

voluntary reporting from doctors that we depend on to know whether a drug or a

medical intervention is harmful.

 

Pharmacology texts will also tell doctors how hard it is to separate drug side

effects from disease symptoms. Treatment failure is most often attributed to the

disease and not the drug or the doctor. Doctors are warned, “Probably nowhere

else in professional life are mistakes so easily hidden, even from ourselves.”30

It may be hard to accept, but not difficult to understand, why only one in

twenty side effects is reported to either hospital administrators or the

FDA.31,31

 

If hospitals admitted to the actual number of errors and mistakes, which is

about 20 times what is reported, they would come under intense scrutiny.32 Jerry

Phillips, associate director of the Office of Post Marketing Drug Risk

Assessment at the FDA, confirms this number. “In the broader area of adverse

drug reaction data, the 250,000 reports received annually probably represent

only 5% of the actual reactions that occur.”33 Dr. Jay Cohen, who has

extensively researched adverse drug reactions, comments that because only 5% of

adverse drug reactions are being reported, there are, in reality, five million

medication reactions each year.34

 

It remains that whatever figure you choose to believe about the side effects

from drugs, all the experts agree that you have to multiply that by 20 to get a

more accurate estimate of what is really occurring in the burgeoning “field” of

iatrogenic medicine.

 

A 2003 survey is all the more distressing because there seems to be no

improvement in error-reporting even with all the attention on this topic. Dr.

Dorothea Wild surveyed medical residents at a community hospital in Connecticut.

She found that only half of the residents were aware that the hospital had a

medical error-reporting system, and the vast majority didn’t use it at all. Dr.

Wild says this does not bode well for the future. If doctors don’t learn

error-reporting in their training, they will never use it. And she adds that

error reporting is the first step in finding out where the gaps in the medical

system are and fixing them. That first baby step has not even begun.35

 

PUBLIC SUGGESTIONS ON IATROGENESIS

 

In a telephone survey, 1,207 adults were asked to indicate how effective they

thought the following would be in reducing preventable medical errors that

resulted in serious harm:36

 

 

giving doctors more time to spend with patients: very effective 78%

 

 

requiring hospitals to develop systems to avoid medical errors: very effective

74%

 

 

better training of health professionals: very effective 73%

 

 

using only doctors specially trained in intensive care medicine on intensive

care units: very effective 73%

 

 

requiring hospitals to report all serious medical errors to a state agency: very

effective 71%

 

 

increasing the number of hospital nurses: very effective 69%

 

 

reducing the work hours of doctors-in-training to avoid fatigue: very effective

66%

 

 

encouraging hospitals to voluntarily report serious medical errors to a state

agency: very effective 62%

 

 

DRUG IATROGENESIS

 

Drugs comprise the major treatment modality of scientific medicine. With the

discovery of the “Germ Theory” medical scientists convinced the public that

infectious organisms were the cause of illness. Finding the “cure” for these

infections proved much harder than anyone imagined. From the beginning, chemical

drugs promised much more than they delivered. But far beyond not working, the

drugs also caused incalculable side effects. The drugs themselves, even when

properly prescribed, have side effects that can be fatal, as Lazarou’s study1

shows. But human error can make the situation even worse.

 

Medication Errors

 

A survey of a 1992 national pharmacy database found a total of 429,827

medication errors from 1,081 hospitals. Medication errors occurred in 5.22% of

patients admitted to these hospitals each year. The authors concluded that a

minimum of 90,895 patients annually were harmed by medication errors in the

country as a whole.37

 

A 2002 study shows that 20% of hospital medications for patients had dosage

mistakes. Nearly 40% of these errors were considered potentially harmful to the

patient. In a typical 300-patient hospital the number of errors per day were

40.38

 

Problems involving patients’ medications were even higher the following year.

The error rate intercepted by pharmacists in this study was 24%, 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 four hundred patients after discharge from a tertiary care hospital

(hospital care that requires highly specialized skills, technology, or support

services). Seventy-six patients (19%) had adverse events. Adverse drug events

were the most common at 66%. The next most common events were procedure-related

injuries at 17%.40

 

In a NEJM study an alarming one-in-four patients suffered observable side

effects from the more than 3.34 billion prescription drugs filled in 2002.41 One

of the doctors who produced the study was interviewed by Reuters and commented

that, " With these 10-minute appointments, it's hard for the doctor to get into

whether the symptoms are bothering the patients. " 42 William Tierney, who

editorialized on the NEJM study, said “… given the increasing number of powerful

drugs available to care for the aging population, the problem will only get

worse.” The drugs with the worst record of side effects were the SSRIs, the

NSAIDs, and calcium-channel blockers. Reuters also reported that prior research

has suggested that nearly 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 one of the reasons for this failure: in nearly two-thirds

of the cases, doctors couldn’t diagnose drug side effects

or the side effects persisted because the doctor failed to heed the warning

signs.

 

Medicating Our Feelings

 

We only need to look at the side effects of antidepressant drugs, which give

hope to a depressed population. Patients seeking a more joyful existence and

relief from worry, stress, and anxiety, fall victim to the messages blatantly

displayed on TV and billboards. Often, instead of relief, they also fall victim

to a myriad of iatrogenic side effects of antidepressant medication.

 

Also, a whole generation of antidepressant users has resulted from young people

growing up on Ritalin. Medicating youth and modifying their emotions must have

some impact on how they learn to deal with their feelings. They learn to equate

coping with drugs and not their inner resources. As adults, these medicated

youth reach for alcohol, drugs, or even street drugs, to cope. According to the

Journal of the American Medical Association, “Ritalin acts much like cocaine.”43

Today’s marketing of mood-modifying drugs, such as Prozac or Zoloft, makes them

not only socially acceptable but almost a necessity in today’s stressful world.

 

Television Diagnosis

 

In order to reach the widest audience possible, drug companies are no longer

just targeting medical doctors with their message about antidepressants. By 1995

drug companies had tripled the amount of money allotted to direct advertising of

prescription drugs to consumers. The majority of the money is spent on seductive

television ads. From 1996 to 2000, spending rose from $791 million to nearly

$2.5 billion.44 Even though $2.5 billion may seem like a lot of money, the

authors comment that it only represents 15% of the total pharmaceutical

advertising budget. According to medical experts “there is no solid evidence on

the appropriateness of prescribing that results from consumers requesting an

advertised drug.” However, the drug companies maintain that direct-to-consumer

advertising is educational. Dr. Sidney M. Wolfe, of the Public Citizen Health

Research Group in Washington, D.C., argues that the public is often misinformed

about these ads.45 People want what they see on television

and are told to go to their doctor for a prescription. Doctors in private

practice either acquiesce to their patients’ demands for these drugs or spend

valuable clinic time trying to talk patients out of unnecessary drugs. Dr. Wolfe

remarks that one important study found that people mistakenly believe that the

“FDA reviews all ads before they are released and allows only the safest and

most effective drugs to be promoted directly to the public.”46

 

How Do We Know Drugs Are Safe?

 

Another aspect of scientific medicine that the public takes for granted is the

testing of new drugs. Unlike the class of people that take drugs who are ill and

need medication, in general, drugs are tested on individuals who are fairly

healthy and not on other medications that can interfere with findings. But when

they are declared “safe” and enter the drug prescription books, they are

naturally going to be used by people on a variety of other medications and who

also have a lot of other health problems. Then, a new Phase of drug testing

called Post-Approval comes into play, which is the documentation of side effects

once drugs hit the market. In one very telling report, the General Accounting

Office (an agency of the U.S. Government) " found that of the 198 drugs approved

by the FDA between 1976 and 1985... 102 (or 51.5%) had serious post-approval

risks... the serious post-approval risks (included) heart failure, myocardial

infarction, anaphylaxis, respiratory depression and arrest,

seizures, kidney and liver failure, severe blood disorders, birth defects and

fetal toxicity, and blindness. " 47

 

The investigative show NBC’s “Dateline” wondered if your doctor is moonlighting

as a drug rep. After a year-long investigation they reported that because

doctors can legally prescribe any drug to any patient for any condition, drug

companies heavily promote " off-label " and frequently inappropriate and

non-tested uses of these medications in spite of the fact that these drugs are

only approved for specific indications they have been tested for.48

 

The leading causes of adverse drug reactions are antibiotics (17%),

cardiovascular drugs (17%), chemotherapy (15%), and analgesics and

anti-inflammatory agents (15%).49

 

Specific Drug Iatrogenesis: Antibiotics

 

Dr. Egger, in a recent editorial, wrote that after fifty years of increasing use

of antibiotics, 30 million pounds of antibiotics are used in America per

year.50Twenty-five million pounds of this total are used in animal husbandry.

The vast majority of this amount, twenty-three million pounds, is used to try to

prevent disease, the stress of shipping, and to promote growth. Only 2 million

pounds are given for specific animal infections. Dr. Egger reminds us that low

concentrations of antibiotics are measurable in many of our foods, rivers, and

streams around the world. Much of this is seeping into bodies of water from

animal farms.

 

Egger says overuse of antibiotics results in food-borne infections resistant to

antibiotics. Salmonella is found in 20% of ground meat but 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 dealing with this epidemic is to radiate food to try to kill all

organisms but keep using the antibiotics that cause the original problem.

Approximately 20% of chickens are contaminated with Campylobacter jejuni causing

2.4 million human cases of illness annually. Fifty-four percent of these

organisms are resistant to at least one anti-campylobacter antimicrobial.

 

A ban on growth-promoting antibiotics in Denmark began in 1999, which led to a

decrease from 453,200 pounds to 195,800 pounds within a year. Another report

from Scandinavia found that taking away antibiotic growth promoters had no or

minimal effect on food production costs. Egger further warns that in America the

current crowded, unsanitary methods of animal farming support constant stress

and infection, and are geared toward high antibiotic use. He says these

conditions would have to be changed along with cutting back on antibiotic use.

 

In America, over 3 million pounds of antibiotics are used every year on humans.

With a population of 284 million Americans, this amount is enough to give every

man, woman and child 10 teaspoons of pure antibiotics per year. Egger says that

exposure to a steady stream of antibiotics has altered pathogens such as

Streptococcus pneumoniae, Staplococcus aureus, and entercocci, to name a few.

 

Almost half of patients with upper respiratory tract infections in the 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 for systemic antibiotic use in children

aged 0-6 years was 42.9%.52

 

Data taken from nine U.S. health plans between 1996-2000 on antibiotic use in

25,000 children found that rates of antibiotic use decreased. Antibiotic use in

children, aged 3 months to under 3 years, decreased 24%, from 2.46 to 1.89

antibiotic prescriptions per/patient per/year. For children, 3 years 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

Although there was a reduction in antibiotic use, the data indicate that on

average every child in America receives 1.22 antibiotic prescriptions annually.

 

Group A beta-hemolytic streptococci is the only common cause of sore throat that

requires antibiotics, penicillin and erythromycin being the only recommended

treatment. However, 90% of sore throats are viral. The authors of this study

estimated there were 6.7 million adult annual visits for sore throat between

1989 and 1999 in the U.S. Antibiotics were used in 73% of visits. Furthermore,

patients treated with antibiotics were given non-recommended broad-spectrum

antibiotics in 68% of visits. The authors noted, that from 1989 to 1999, there

was a significant increase in the newer and more expensive broad-spectrum

antibiotics and a decrease in use of penicillin and erythromycin, which are the

recommended antibiotics.54 If antibiotics were given in 73% of visits and should

have only been given in 10%, this represents 63%, or a total of 4.2 million

visits for sore throat that ended in unnecessary antibiotic prescriptions

between1989-1999. In 1995, Dr. Besser and the CDC cited 2003 cited

much higher figures of 20 million unnecessary antibiotic prescriptions per year

for viral infections.2 Neither of these figures takes into account the number of

unnecessary antibiotics used for non-fatal conditions such as acne, intestinal

infection, skin infections, ear infections, etc.

 

The Problem with Antibiotics: They are Anti-Life

 

On September 17, 2003 the CDC relaunched a program, started in 1995, called “Get

Smart: Know When Antibiotics Work.”55 This is a $1.6 million campaign to educate

patients about the overuse and inappropriate use of antibiotics. Most people

involved with alternative medicine have known about the dangers of overuse of

antibiotics for decades. Finally the government is focusing on the problem, yet

they are only putting a miniscule amount of money into an iatrogenic epidemic

that is costing billions of dollars and thousands of lives. The CDC warns that

90% of upper respiratory infections, including children’s ear infections, are

viral, and antibiotics don’t treat viral infection. More than 40% of about 50

million prescriptions for antibiotics each year in physicians' offices were

inappropriate.2 And using antibiotics, when not needed, can lead to the

development of deadly strains of bacteria that are resistant to drugs and cause

more than 88,000 deaths due to hospital-acquired

infections.9 However, the CDC seems to be blaming patients for misusing

antibiotics even though they are only available on prescription from a doctor

who should know how to prescribe properly. Dr. Richard Besser, head of “Get

Smart,” says " Programs that have just targeted physicians have not worked.

Direct-to-consumer advertising of drugs is to blame in some cases.” Dr. Besser

says the program “teaches patients and the general public that antibiotics are

precious resources that must be used correctly if we want to have them around

when we need them. Hopefully, as a result of this campaign, patients will feel

more comfortable asking their doctors for the best care for their illnesses,

rather than asking for antibiotics. " 56

 

And what does the “best care” constitute? The CDC does not elaborate and

patently avoids the latest research on the dozens of nutraceuticals

scientifically proven to treat viral infections and boost the immune system.

Will their doctors recommend vitamin C, echinacea, elderberry, vitamin A, zinc,

or homeopathic oscillococcinum? No, they won’t. The archaic solutions offered by

the CDC include a radio ad, “Just Say No - Snort, sniffle, sneeze - No

antibiotics please. " Their commonsense recommendations, that most people do

anyway, include resting, drinking plenty of fluids, and using a humidifier.

 

The pharmaceutical industry claims they are all for limiting the use of

antibiotics. In order to make sure that happens, the drug company Bayer is

sponsoring a program called, “Operation Clean Hands”, through an organization

called LIBRA.57 The CDC is also involved with trying to minimize antibiotic

resistance, but nowhere in their publications is there any reference to the role

of nutraceuticals in boosting the immune system nor to the thousands of journal

articles that support this approach. This recalcitrant tunnel vision and refusal

to use available non-drug alternatives is absolutely inappropriate when the CDC

is desperately trying to curb the nightmare of overuse of antibiotics. The CDC

should also be called to task because it is only focusing on the overuse of

antibiotics. There are similar nightmares for every class of drug being

prescribed today.

 

Drugs Pollute Our Water Supply

 

We have reached the point of saturation with prescription drugs. We have arrived

at the point where every body of water tested contains measurable drug residues.

We are inundated with drugs. The tons of antibiotics used in animal farming,

which run off into the water table and surrounding bodies of water, are

conferring antibiotic resistance to germs in sewage, and these germs are also

found in our water supply. Flushed down our toilets are tons of drugs and drug

metabolites that also find their way into our water supply. We have no idea what

the long-term consequences of ingesting a mixture of drugs and drug-breakdown

products will do to our health. It’s another level of iatrogenic disease that we

are unable to completely measure.58-67

 

Specific Drug Iatrogenesis: NSAIDs

 

It’s not just America that is plagued with iatrogenesis. A survey of 1072 French

general practitioners (GPs) tested their basic pharmacological knowledge and

practice in prescribing NSAIDs. Non-steroidal anti-inflammatory drugs (NSAIDs)

rank first among commonly prescribed drugs for serious adverse reactions. The

results of the study suggested that GPs don’t have adequate knowledge of these

drugs and are unable to effectively manage adverse reactions.68

 

A cross-sectional survey of 125 patients attending specialty pain clinics in

South London found that possible iatrogenic factors such as “over-investigation,

inappropriate information, and advice given to patients as well as misdiagnosis,

over-treatment, and inappropriate prescription of medication were common.”69

 

Specific Drug Iatrogenesis: Cancer Chemotherapy

 

In 1989, a German biostatistician, Ulrich Abel PhD, after publishing dozens of

papers on cancer chemotherapy, wrote a monograph “Chemotherapy of Advanced

Epithelial Cancer”. It was later published in a shorter form in a peer-reviewed

medical journal.70 Dr. Abel presented a comprehensive analysis of clinical

trials and publications representing over 3,000 articles examining the value of

cytotoxic chemotherapy on advanced epithelial cancer. Epithelial cancer is the

type of cancer we are most familiar with. It arises from epithelium found in the

lining of body organs such as breast, prostate, lung, stomach, or bowel. From

these sites cancer usually infiltrates into adjacent tissue and spreads to bone,

liver, lung, or the brain. With his exhaustive review Dr. Abel concludes that

there is no direct evidence that chemotherapy prolongs survival in patients with

advanced carcinoma. He said that in small-cell lung cancer and perhaps ovarian

cancer the therapeutic benefit is only slight. Dr.

Abel goes on to say, “Many oncologists take it for granted that response to

therapy prolongs survival, an opinion which is based on a fallacy and which is

not supported by clinical studies.”

 

Over a decade after Dr. Abel’s exhaustive review of chemotherapy, there seems no

decrease in its use for advanced carcinoma. For example, when conventional

chemotherapy and radiation has not worked to prevent metastases in breast

cancer, high-dose chemotherapy (HDC) along with stem-cell transplant (SCT) is

the treatment of choice. However, in March 2000, results from the largest

multi-center randomized controlled trial conducted thus far showed that,

compared to a prolonged course of monthly conventional-dose chemotherapy, HDC

and SCT were of no benefit.71 There was even a slightly lower survival rate for

the HDC/SCT group. And the authors noted that serious adverse effects occurred

more often in the HDC group than the standard-dose group. There was one

treatment-related death (within 100 days of therapy) in the HDC group, but none

in the conventional chemotherapy group. The women in this trial were highly

selected as having the best chance to respond.

 

There is also no all-encompassing follow-up study like Dr. Abel’s that tells us

if there is any improvement in cancer-survival statistics since 1989. In fact,

we need to research whether chemotherapy itself is responsible for secondary

cancers instead of progression of the original disease. We continue to question

why well-researched alternative cancer treatments aren’t used.

 

Drug Companies Fined

 

Periodically, a drug manufacturer is fined by the FDA when the abuses are too

glaring and impossible to cover up. The May 2002 Washington Post reported that

the maker of Claritin, Schering-Plough Corp., was to pay a $500 million dollar

fine to the FDA for quality-control problems at four of its factories.72 The FDA

tabulated infractions that included 90%, or 125 of the drugs they made since

1998. Besides the fine, the company had to stop manufacturing 73 drugs or suffer

another $175 million dollar fine. PR statements by the company told another

story. The company assured consumers that they should still feel confident in

its products.

 

Such a large settlement serves as a warning to the drug industry about

maintaining strict manufacturing practices and has given the FDA more clout in

dealing with drug company compliance. According to the Washington Post article,

a federal appeals court ruled in 1999 that the FDA could seize the profits of

companies that violate " good manufacturing practices. " Since that time Abbott

Laboratories Inc. paid $100 million for failing to meet quality standards in the

production of medical test kits, and Wyeth Laboratories Inc. paid $30 million in

2000 to settle accusations of poor manufacturing practices.

 

The indictment against Schering-Plough came after the Public Citizen Health

Research Group, lead by Dr. Sidney Wolfe, called for a criminal investigation of

Schering-Plough, charging that the company distributed albuterol asthma inhalers

even though it knew the units were missing the active ingredient.

 

 

 

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