DEATH BY MEDICINE Part 5

[Guest guest]

DEATH BY MEDICINE Part 5

 

 

UNNECESSARY SURGICAL PROCEDURES

 

Summary:

 

1974: 2.4 million unnecessary surgeries performed

annually resulting in 11,900 deaths at an annual cost

of $3.9 billion.73,74

 

2001: 7.5 million unnecessary surgical procedures

resulting in 37,136 deaths at a cost of $122 billion

(using 1974 dollars).3

 

It’s very difficult to obtain accurate statistics when

studying unnecessary surgery. Dr. Leape in 1989 wrote

that perhaps 30% of controversial surgeries are

unnecessary. Controversial surgeries include Cesarean

section, tonsillectomy, appendectomy, hysterectomy,

gastrectomy for obesity, breast implants, and elective

breast implants.74

 

Almost thirty years ago, in 1974, the Congressional

Committee on Interstate and Foreign Commerce held

hearings on unnecessary surgery. They 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

 

In 2001, the top 50 medical and surgical procedures

totaled approximately 41.8 million. These figures were

taken from the Healthcare Cost and Utilization Project

within the Agency for Healthcare Research and

Quality.13 Using 17.6% from the 1974 U.S.

Congressional House Subcommittee Oversight

Investigation as the percentage of unnecessary

surgical procedures, and extrapolating from the death

rate in 1974, we come up with an unnecessary procedure

number of 7.5 million (7,489,718) and a death rate of

37,136, at a cost of $122 billion (using 1974

dollars).

 

Researchers performed a very similar analysis, using

the 1974 ‘unnecessary surgery percentage’ of 17.6, on

back surgery. In 1995, researchers testifying before

the Department of Veterans Affairs estimated that of

250,000 back surgeries in the U.S. at a hospital cost

of $11,000 per patient, the total number of

unnecessary back surgeries each year in the U.S. could

approach 44,000, costing as much as $484 million.75

 

The unnecessary surgery figures are escalating just as

prescription drugs driven by television advertising.

Media-driven surgery such as gastric bypass for

obesity " modeled " by Hollywood personalities seduces

obese people to think this route is safe and sexy.

There is even a problem of surgery being advertised on

the Internet.76 A study in Spain declares that between

20 and 25% of total surgical practice represents

unnecessary operations.77

 

According to data from the National Center for Health

Statistics from 1979 to 1984, there was a 9% increase

in the total number of surgical procedures, and the

number of surgeons grew by 20%. The author notes that

there has not been a parallel increase in the number

of surgeries despite a recent large increase in the

number of surgeons. There was concern that there would

be too many surgeons to share a small surgical

caseload.78

 

The previous author spoke too soon - there was no

cause to worry about a small surgical caseload. By

1994, there was an increase of 38% for a total of

7,929,000 cases for the top ten surgical procedures.

In 1983, surgical cases totaled 5,731,000. In 1994,

cataract surgery was number one with over two million

operations, and second was Cesarean section (858,000

procedures). Inguinal hernia operations were third

(689,000 procedures), and knee arthroscopy, in seventh

place, grew 153% (632,000 procedures) while prostate

surgery declined 29% (229,000 procedures).79

 

The list of iatrogenic diseases from surgery is as

long as the list of procedures themselves. In one

study epidural catheters were inserted to deliver

anesthetic into the epidural space around the spinal

nerves to block them for lower Cesarean section,

abdominal surgery, or prostate surgery. In some cases,

non-sterile technique, during catheter insertion,

resulted in serious infections, even leading to limb

paralysis.80

 

In one review of the literature, the authors

demonstrated " a significant rate of overutilization of

coronary angiography, coronary artery surgery, cardiac

pacemaker insertion, upper gastrointestinal

endoscopies, carotid endarterectomies, back surgery,

and pain-relieving procedures. " 81

 

A 1987 JAMA study found the following significant

levels of inappropriate surgery: 17% of cases for

coronary angiography, 32% for carotid endarterectomy,

and 17% for upper gastrointestinal tract endoscopy.82

Using the Healthcare Cost and Utilization Project

(HCUP) statistics provided by the government for 2001,

the number of people getting upper gastrointestinal

endoscopy, which usually entails biopsy, was 697,675;

the number getting endarterectomy was 142,401; and the

number having coronary angiography was 719,949.13

Therefore, according to the JAMA study 17%, or 118,604

people had an unnecessary endoscopy procedure.

Endarterectomy occurred in 142,401 patients;

potentially 32% or 45,568 did not need this procedure.

And 17% of 719,949, or 122,391 people receiving

coronary angiography were subjected to this highly

invasive procedure unnecessarily. These are all forms

of medical iatrogenesis.

 

MEDICAL AND SURGICAL PROCEDURES

 

It is instructive to know the mortality rate

associated with different medical and surgical

procedures. Even though we must sign release forms

when we undergo any procedure, many of us are in

denial about the true risks involved. We seem to hold

a collective impression that since medical and

surgical procedures are so commonplace, they are both

necessary and safe. Unfortunately, partaking in

allopathic medicine itself is one of the highest

causes of death as well as the most expensive way to

die.

 

Shouldn’t the daily death rate of iatrogenesis in

hospitals, out of hospitals, in nursing homes, and

psychiatric residences be reported like the pollen

count or the smog index? Let’s stop hiding the truth

from ourselves. It’s only when we focus on the problem

and ask the right questions can we hope to find

solutions.

 

Perhaps the word " healthcare " gives us the illusion

that medicine is about health. Allopathic medicine is

not a purveyor of healthcare but of disease-care.

Studying the mortality figures in the Healthcare Cost

and Utilization Project (HCUP) within the U.S.

government’s Agency for Healthcare Research and

Quality, we found many points of interest.13 The HCUP

computer program that calculates the annual mortality

statistics for all U.S. hospital discharges is only as

good as the codes that are put into the system. In an

email correspondence with HCUP, we were told that the

mortality rates that were indicated in tables and

charts for each procedure were not necessarily due to

the procedure but only indicated that someone who

received that procedure died either from their

original disease or from the procedure.

 

Therefore there is no way of knowing exactly how many

people died from a particular procedure. There are

also no codes for adverse drug side effects, none for

surgical mishap, and none for medical error. Until

there are codes for medical error, statistics of those

people who are dying from various types of medical

error will be buried in the general statistics. There

is a code for " poisoning & toxic effects of drugs " and

a code for " complications of treatment. " However, the

mortality figures registered in these categories are

very low and don’t compare with what we know from

studies such as the JAMA 1998 study1 that said there

were an average of 106,000 prescription medication

deaths per year.

 

WHY AREN’T MEDICAL AND SURGICAL PROCEDURES STUDIED?

 

In 1978, the U.S. Office of Technology Assessment

(OTA) reported that, " Only 10%-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, Netherlands,

Sweden, United Kingdom, and the United States) and

again noted that few medical procedures in the U.S.

had been subjected to clinical trial. It also reported

that infant mortality was high and life expectancy was

low compared to other developed countries.84 Although

almost ten years old, much of what was said in this

report holds true today. The report lays the blame for

the high cost of medicine squarely at the feet of the

medical free-enterprise system and the fact that there

is no national health care policy. It describes the

failure of government attempts to control health care

costs due to market incentive and profit motive in the

financing and organization of health care including

private insurance, hospital system, physician

services, and drug and medical device industries.

Whereas we may want to expand health-care, expansion

of disease-care is the goal of free enterprise.

" Health Care Technology and Its Assessment in Eight

Countries " is also the last report prepared by the

OTA, which was shut down in 1995. It’s also, perhaps,

the last honest, in-depth look at modern medicine.

Because of the importance of this 60-page report, we

enclose a summary in the Appendix.

 

SURGICAL ERRORS FINALLY REPORTED

 

Just hours before completion of this paper, statistics

on surgical-related deaths became available. A October

8, 2003 JAMA study from the U.S. government’s Agency

for Healthcare Research and Quality (AHRQ) documented

32,000 mostly surgery-related deaths costing $9

billion and accounting for 2.4 million extra days in

the hospital in 2000.85 In a press release

accompanying the JAMA study, the AHRQ director,

Carolyn M. Clancy, M.D., admitted, " This study gives

us the first direct evidence that medical injuries

pose a real threat to the American public and increase

the costs of health care. " 86 Hospital administrative

data from 20% of the nation’s hospitals were analyzed

for eighteen different surgical complications

including postoperative infections, foreign objects

left in wounds, surgical wounds reopening, and

post-operative bleeding. In the same press release the

study’s authors said that, " The findings greatly

underestimate the problem, since many other

complications happen that are not listed in hospital

administrative data. " They also felt that, " The

message here is that medical injuries can have a

devastating impact on the health care system. We need

more research to identify why these injuries occur and

find ways to prevent them from happening. " One of the

authors, Dr. Zhan said that improved medical

practices, including an emphasis on better

hand-washing, might help reduce the morbidity and

mortality rates. An accompanying JAMA editorial by

health-risk researcher Dr. Saul Weingart of Harvard’s

Beth Israel Deaconess Medical Center said, " Given

their staggering magnitude, these estimates are

clearly sobering. " 87

 

UNNECESSARY X-RAYS

 

When X-rays were discovered, no one knew the long-term

effects of ionizing radiation. In the 1950’s monthly

fluoroscopic exams at the doctor’s office were

routine. You could even walk into most shoe stores and

see your foot bones; looking at bones was an amusing

novelty. We still don’t know the ultimate outcome of

our initial escapade with X-rays.

 

It was common practice to use X-rays in pregnant women

to measure the size of the pelvis, and make a

diagnosis of twins. Finally, a study of 700,000

children born between 1947 and 1964 was conducted in

thirty-seven major maternity hospitals. The children

of mothers who had received pelvic X-rays during

pregnancy were compared with the children of mothers

who had not been X-rayed. Cancer mortality was 40%

higher among the children with X-rayed mothers.88

 

In present-day medicine, coronary angiography combines

an invasive surgical procedure of snaking a tube

through a blood vessel in the groin up to the heart.

To get any useful information during the angiography

procedure X-rays are taken almost continuously with

minimum dosage ranges between 460 - 1,580 mrem. The

minimum radiation from a routine chest X-ray is 2

mrem. X-ray radiation accumulates in the body and it

is well-known that ionizing radiation used in X-ray

procedures causes gene mutation. We can only obtain

guesstimates as to its impact on health from this high

level of radiation. Experts manage to obscure the real

effects in statistical jargon such as, " The risk for

lifetime fatal cancer due to radiation exposure is

estimated to be 4 in one million per 1,000 mrem. " 89

 

However, Dr. John Gofman, who has been studying the

effects of radiation on human health for 45 years, is

prepared to tell us exactly what diagnostic X-rays are

doing to our health. Dr. Gofman has a PhD in nuclear

and physical chemistry and is a medical doctor. He

worked on the Manhattan nuclear project, discovered

uranium-233, was the first person to isolate

plutonium, and since 1960, he’s been studying the

effects of radiation on human health. With five

scientifically documented books totaling over 2800

pages, Dr. Gofman provides strong evidence that

medical technology, specifically X-rays, CT scans,

mammography, and fluoroscopy, are a contributing

factor to 75% of new cancers. His 699-page report,

updated in 2000, " Radiation from Medical Procedures in

the Pathogenesis of Cancer and Ischemic Heart Disease:

Dose-Response Studies with Physicians per 100,000

Population " 90 shows that as the number of physicians

increases in a geographical area with an increase in

the number of X-ray diagnostic tests, there is an

associated increase in the rate of cancer and ischemic

heart disease. Dr. Gofman elaborates that it’s not

X-rays alone that cause the damage but a combination

of health risk factors including: poor diet, smoking,

abortions, and the use of birth control pills. Dr.

Gofman predicts that 100 million premature deaths over

the next decade will be the result of ionizing

radiation.

 

In his book, " Preventing Breast Cancer, " Dr. Gofman

says that breast cancer is the leading cause of death

among American women between the ages of forty-four

and fifty-five. Because breast tissue is highly

radiation-sensitive, mammograms can cause cancer. The

danger can be heightened by a woman’s genetic makeup,

preexisting benign breast disease, artificial

menopause, obesity, and hormonal imbalance.91

 

Even X-rays for back pain can lead someone into

crippling surgery. Dr. Sarno, a well-known New York

orthopedic surgeon, found that X-rays don’t always

tell the truth. In his books he cites studies on

normal people without a trace of back pain that have

spinal abnormalities on X-ray. Other studies have

shown that some people with back pain have normal

spines on X-ray. So, Dr. Sarno says there is not

necessarily any association between back pain and

spinal X-ray abnormality.92 However, if a person

happens to have back pain and an incidental

abnormality on X-ray, they may be treated surgically,

sometimes with no change in back pain, or worsening of

back pain, or even permanent disability.

 

In addition, doctors often order X-rays as protection

against malpractice claims to give the impression that

they are leaving no stone unturned. It appears that

doctors are putting their own fears before the

interests of their patients.

 

UNNECESSARY HOSPITALIZATION

 

Summary:

 

8.9 million (8,925,033) people were hospitalized

unnecessarily in 2001.4

 

In a study of inappropriate hospitalization 1,132

medical records were reviewed by two doctors.

Twenty-three percent of all admissions were

inappropriate and an additional 17% could have been

handled in ambulatory out-patient clinics. Thirty-four

percent of all hospital days were also inappropriate

and could have been avoided.93 The rate of

inappropriate admissions in 1990 was 23.5%.94 In 1999,

another study confirmed the figure of 24%

inappropriate admissions indicating a consistent

pattern from 1986 to 1999,95 showing steady reporting

of approximately 24% inappropriate admissions each

year. Putting these figures into present-day terms

using the HCUP database, the total number of patient

discharges from hospitals in the U.S. in 2001 was

37,187,641.13 The above data indicate that 24% of

those hospitalizations need never have occurred. It

further means that 8,925,033 people were exposed to

unnecessary medical intervention in hospitals and

therefore represent almost 9 million potential

iatrogenic episodes.4

 

WOMEN’S EXPERIENCE IN MEDICINE

 

Briefly, we will look at the medical iatrogenesis of

women in particular. Dr. Martin Charcot (1825-1893)

was world-renowned, the most celebrated doctor of his

time. He practiced in the Paris hospital La

Salpetriere. He became an expert in hysteria

diagnosing an average of ten hysterical women each

day, transforming them into… " iatrogenic monsters, "

turning simple ‘neurosis’ into hysteria.96 The number

of women diagnosed with hysteria and hospitalized rose

from 1% in 1841 to 17% in 1883. Hysteria is derived

from the Latin " hystera " meaning uterus. Dr. Adriane

Fugh-Berman stated very clearly in her paper that

there is a tradition in U.S. medicine of excessive

medical and surgical interventions on women. Only one

hundred years ago male doctors decided that female

psychological imbalance originated in the uterus. When

surgery to remove the uterus was perfected it became

the " cure " for mental instability, effecting a

physical and psychological castration. Dr. Fugh-Berman

noted that U.S. doctors eventually disabused

themselves of that notion but have continued to treat

women very differently than they treat men.97 She

cites the following:

 

1. Thousands of prophylactic mastectomies are

performed annually.

 

2. One-third of U.S. 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 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. It does

increase the risk of breast cancer, heart disease,

stroke, and gall bladder attack.100

 

We would add that as many as one-third of

postmenopausal women use HRT.101,102 These numbers are

important in light of the much-publicized Women’s

Health Initiative Study, which was forced to stop

before its completion because of a higher death rate

in the synthetic estrogen-progestin (HRT) group.103

 

Cesarean Section

 

In 1983, 809,000 Cesarean sections (21% of live

births) were performed, making it the most common

obstetric and gynecologic (OB/GYN) surgical procedure.

The second most common OB/GYN operation was

hysterectomy (673,000), and diagnostic dilation and

curettage of the uterus (632,000) was third. In 1983,

OB/GYN operations represented 23% of all surgery

completed in this country.104

 

In 2001, Cesarean section is still the most common

OB/GYN surgical procedure. Approximately 4 million

births occur annually, with a 24% C-Section rate,

i.e., 960,000 operations. In the Netherlands only 8%

of babies are delivered by Cesarean section. Assuming

human babies are similar in the U.S. and in the

Netherlands, we are performing 640,000 unnecessary

C-Sections in the U.S. with its three to four times

higher mortality and 20 times greater morbidity than

vaginal delivery.105

DEATH BY MEDICINE Part 5

 

The Cesarean section rate was only 4.5% in the U.S. in

1965. By 1986 it had climbed to 24.1%. The author

states that obviously an " uncontrolled pandemic of

medically unnecessary Cesarean births is

occurring. " 106 VanHam reported a Cesarean section

postpartum hemorrhage rate of 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

 

The greatest cause of morbidity in vaginal births is

anorectal tearing. In a study of 20,500 women, 5%

required an episiotomy and 67 patients (.0033%)

experienced wound disruption that required surgical

correction resulting in a " satisfactory outcome " .107a