How dangerous is conventional medicine?

[Guest guest]

This is an article from The South African Journal of Natural Medicine:

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Dr Bernard Brom - Editor

MB ChB (UCT), CEDH (France), Dip Acup

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As a medical doctor I am constantly aware of the incredible benefits of modern

medicine. At the

same time I am very conscious of my responsibility to ensure that my patients

understand the risks

involved. These risks are not to be underestimated. While doctor-induced disease

(iatrogenic

disorder) is generally regarded as the fourth most common cause of ill health

after cancer, heart

disease and stroke, some recent evidence suggests that it is even higher up on

the list and may in

fact be the most common cause of ill health. While doctors generally like to

remind everyone that

the benefits are worth the risks, they themselves are generally not the greatest

patients and

avoid investigations and surgery whenever possible.

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Iatrogenic disorder is defined in Taber's medical dictionary as 'any adverse

mental or physical

condition induced in a patient by effects of treatment by a physician or

surgeon'. The term

implies that such effects could have been avoided by proper and judicious care

on the part of the

physician, surgeon or dentist. Most of the figures quoted come from the USA and

tend to be very

conservative. It has been suggested that only about 5 - 20% of iatrogenic

incidents are recorded.

This is not surprising because of medico-legal implications.

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Hospitals tend to downplay the incidence and doctors and staff generally don't

like to report when

something goes wrong due to improper handling. Iatrogenic disorders include

diagnostic errors,

drug-related events, surgical mishaps, investigational procedures that go wrong

because of poor

technique, hospital infections that could have been prevented, and poor nursing

procedures.

-

According to one source the number of

people killed by iatrogenic events is in the order of over 700 000 every year,

making it the

number one killer in America. While these figures may seem shocking they should

not really

surprise anyone. In recent years, for example, there has been a steady and

progressive increase in

caesarian section delivery worldwide; in the USA the rate has increased from

5.5% in the 1970s to

21% in 2000. With this increase comes an increase in complications, including

maternal death. In

South Africa the caesarian section rate in the public sector is between 10% and

20% depending on

the area, while in the private sector the rate is over 50% in some areas. This

high rate in the

private sector is not only due to pressure from gynaecologists, but also

pressure from mothers who

would prefer the easier way no matter what the risk. There are more maternal

deaths from caesarian

section delivery (9/100 000) than from vaginal births (2/100 000).

-

The number of unnecessary medical and surgical procedures performed annually in

America is 7.5

million, and the number of people exposed to unnecessary hospitalisation

annually is 8.9 million.

A JAMA study published in 2003 on surgically related complications and deaths

reported 32 000

deaths costing $9 billion and accounting for 2.4 million extra days in hospitals

in 2000.1

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One can easily understand therefore why the rate of iatrogenic conditions has

increased and will

continue to increase. The truth is that everyone has his or her own bias. If one

has a hammer in

one's hand one tends to see nails everywhere. Surgeons will always be biased

towards surgery,

gynaecologists towards caesarian sections, oncologists towards chemo-therapy,

dermatologists

towards cortisone creams, etc. In addition, clinical decision making is often

difficult, which

makes it easy to move the patient in the direction of one's bias. This

difficulty also accounts

for the wide difference in 'expert opinions'. In one study, expert opinions on

colon cancer

screening varied from 5% to 95%, and specialist opinions on outcomes in their

own field varied by

up to 100%.2

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In his introduction to Limits to Medicine published in 1976, Ivan Illich was

already saying: 'The

medical establishment has become a major threat to health. The disabling impact

of professional

control over medicine has reached the proportions of an epidemic'.3 Thomas

McKeown, Emeritus

Professor of Social Medicine Emeritus at the University of Birmingham in

England, stated: 'Doctors

have always tended to overestimate the effectiveness of their intervention and

to underestimate

the risks'. 4

-

The public may well ask what is going on. It appears that there is a real

conflict of interests

occuring across the board. Too many investigators and scientists are directly or

indirectly being

paid by the huge pharmaceutical industry. This vast industry is big business and

spends increasing

amounts of money on advertising, research and ensuring that there is a return on

their investment.

Trials sponsored by drug companies are more likely to report favourably on the

treatment being

tested. Stelfox and associates5 reviewed 70 articles on the safety of a

particular drug:

publications where there was financial relationship with the drug manufacturers

showed 96%

support, while in publications without this association there was only 60% and

30% support.

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These wide differences are generally the rule, i.e. if the incentive towards

getting particular

results is strong enough then scientists generally tend to get the results they

would like to see

and they tend to remember the statistics that support their own world view. Any

patient who has

sought more than one second opinion will be aware of the enormous difference

that can be present

between one specialist and another.

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Individuals need to understand that medicine is much more of an art than a

science. Sir William

Osler, the great physician of half a century ago asserted: 'The practice of

medicine is an art,

based on science. Working with science, for science, it has not reached, perhaps

never will, the

dignity of a complete science, with exact laws, like astronomy or engineering.

Is there no science

of medicine? Yes, but in parts only, such as anatomy and physiology'. 6

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Knowing this and with information related to the iatrogenic problems of medicine

it becomes

important that every potential patient and everyone moving through the corridors

of conventional

medicine take responsibility for the way their ill health is managed. It really

is not good enough

to hand oneself over to the care of a doctor expecting him or her to serve your

higher good. This

is not because the doctor is evil, but only because of his or her bias, narrow

perspective, and

reliance on information that is shaped by the pressures of sponsoring companies.

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I am surprised at how often people will allow their doctor to give them

injections without finding

out exactly what the doctor is giving and what the possible side-effects may be.

I am equally

surprised that many surgeons do not give patients sufficient information on what

they plan to do

during the operation and what the risks really are. An example is the

hysterectomy. Gynaecologists

often remove the ovaries as well as the uterus without informing the woman that

the former will be

removed. Similarly, women are often not informed that removal of the uterus can

cut the blood

supply to the ovaries so that hormone replacement will become necessary.

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Of course doctors are not the only ones responsible for the increasing level of

iatrogenic ill

health. Where people in earlier times took responsibility for their own health

and also had the

means and knowledge to deal with many simple daily conditions, we have what Ivan

Illich called the

'medicalisation' of life. Today the general public has been imbued with fear so

that every

temperature in a child must be dealt with at least by the general practitioner,

(although often

only the specialist is good enough), every baby must receive a range of

vaccinations that keep

increasing from year to year, and all the elderly and now even the healthy young

are told that

they should receive influenza vaccinations. It is the norm now for all

deliveries to be done in

hospital, and to avoid pain a caesarian section is often considered preferable

to home delivery by

a midwife. We are led to believe that sick people are better off in hospital

than at home, that

investigations are safe and that generally it is better to have them than not.

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This thinking on the part of the public has contributed to the increasing

incidence of iatrogenic

disease. Doctors are increasingly being warned not to give medication for every

temperature, and

home deliveries by midwives are the rule in Holland and other countries. Apart

from some clear-cut

exceptions, hospitalisation may not be the better option, especially with the

increasing incidence

of antibiotic-resistant organisms and the danger attached to many

investigations.

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In the end each person must have the information required to make an informed

decision. This is

not easy because of the way that conventional medicine has managed to disempower

people and create

the illusion of a medicine based on scientific facts, and the belief that every

illness will

eventually be beaten into submission. The real facts are that there are limits

to science, and

that in dealing with living systems and in particular dealing with individual

human beings,

medicine becomes less of a science and more an art. It is in this realm of art

that the doctor

needs far more humility and patients need much greater awareness in order to

avoid the pitfalls of

a medical system that is still in its adolescence, while behaving as if it is

all-powerful.

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Conventional medicine claims to have all the answers, but the statistics

mentioned at the

beginning of this article do not support this.

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References

1. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable

to medical

injuries during hospitalization. JAMA 2003; 290: 1868-1874.

2. Parr G. Screening for cancer in general practice. CME 1998; 7: 380.

3. Illich I. Limits to Medicine. Middlesex, England: Penguin, 1989: 11.

4. McKeown T. The Role of Medicine: Dream, Mirage, or Nemesis? Princeton, New

Jersey: Princeton

University Press, 1979.

5. Stelfox HT, Chua G, O'Rourke K, Detsky AS. Conflict in interest in the debate

over

calcium-channel antagonists. N Engl J Med 1998; 338: 101-106.

6. Osler W. Aequanimitas and Other Addresses. 3rd ed. Philadelphia: Blakiston,

1932.

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This article appeared in issue 13

http://www.naturalmedicine.co.za/sajnm_main/article.php?story=20040507111211887

 

 

 

 

 

 

 

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