DEATH BY MEDICINE Part 7

[Guest guest]

DEATH BY MEDICINE Part 7

 

 

 

WHAT REMAINS TO BE UNCOVERED

 

Our ongoing research will continue to quantify the

iatrogenic morbidity, mortality, and financial loss in

outpatient clinics, transitional care, long-term care,

rehabilitative care, home care, private practitioners

offices, as well as hospitals, due to:

 

1. X-ray exposures: mammography, fluoroscopy, CT

scans.

 

2. Overuse of antibiotics in all conditions.

 

3. Drugs that are carcinogenic: hormone replacement

therapy (*see below), immunosuppressive drugs,

prescription drugs.

 

4. Cancer chemotherapy: If it doesn’t extend life, is

it shortening life?70

 

5. Surgery and surgical procedures.

 

6. Unnecessary surgery: Cesarean section, radical

mastectomy, preventive mastectomy, radical

hysterectomy, prostatectomy, cholecystectomies,

cosmetic surgery, arthroscopy, etc.

 

7. Medical procedures and therapies.

 

8. Discredited, unnecessary, and unproven medical

procedures and therapies.

 

9. Doctors themselves: when doctors go on strike, it

appears the mortality rate goes down.

 

10. Missed diagnoses.

 

*Part of our ongoing research will be to quantify the

mortality and morbidity caused by hormone replacement

therapy (HRT) since the mid-1940’s. 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 U.S.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 and little evidence of osteoporosis reduction

or prevention of dementia. WHI researchers, who

usually never give recommendations, other than

demanding more studies, are advising 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 U.K were published in the Lancet,

August, 2003. Lead author, Professor Valerie Beral, of the Cancer Research UK Epidemiology Unit,

is very open about the damage HRT has caused. She

said, " 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, oestrogen-progestagen

(combination) therapy accounting for 15,000 of

these. " 151 However, we were not able to find the

statistics on breast cancer, stroke, uterine cancer,

or heart disease due to HRT used by American women.

The population of America is roughly six times that of

the U.K. Therefore, it is possible that 120,000 cases

of breast cancer have been caused by HRT in the past

decade.

 

CONCLUSION

 

When the number one killer in a society is the

healthcare system, then, that system has no excuse

except to address its own urgent shortcomings. It’s a

failed system in need of immediate attention. What we

have outlined in this paper are insupportable aspects

of our contemporary medical system that need to be

changed - beginning at its very foundations.

 

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APPENDIX

 

OFFICE OF TECHNOLOGY ASSESSMENT (OTA)

 

Health Care Technology and Its Assessment in Eight

Countries, 1995.

 

General Facts

 

1. In 1990 life expectancy in the U.S. was 71.8 years

for men and 78.8 for women, among the lowest of the

developed countries.

 

2. The 1990 infant mortality rate was 9.2 per 1,000

live births. This was in the bottom half of the

distribution among all developed countries. (OTA

comments on the frustration of poor statistics and

high healthcare spending.)

 

3. Health status is correlated with socioeconomic

status.

 

4. Healthcare is not universal.

 

5. Healthcare is based on the free market system with

no fixed budget or limitations on expansion.

 

6. Healthcare accounts for 14% of the U.S. GNP, which

was over $800 billion in 1993.

 

7. The federal government does no central planning. It

is the major purchaser of health care for older people

and some poor people.

 

8. Americans have a lower level of satisfaction with

their healthcare system than people in other developed

countries.

 

9. U.S. medicine specializes in expensive medical

technology. Some major U.S. cities have more MRI

scanners than most countries.

 

10. Huge public and private investment in medical

research and pharmaceutical development drives this

" technological arms race. "

 

11. Any efforts to restrain technological developments

in healthcare are opposed by policy makers concerned

about negative impacts on medical-technology

industries.

 

Hospitals

 

12. In 1990 there were: 5,480 acute-care hospitals,

880 specialty hospitals (psychiatric, long-term care,

rehab) and 340 federal hospitals (military, vets and

Native Americans) providing 2.7 hospitals per 100,000

population.

 

13. In 1990 the average length of stay for an annual

33 million admissions was 9.2 days. Bed occupancy rate

was 66%. Lengths of stay were shorter and admission

rates lower than other countries.

 

14. In 1990 there were 615,000 physicians, 2.4 per

1,000; 33% were primary care (family medicine,

internal medicine, and pediatrics) and 67% were

specialists.

 

15. In 1991 government-run healthcare spending was $81

billion.

 

16. Total healthcare spending was $752 billion in

1991, an increase from $70 billion in 1950. Spending

grew five-fold per capita.

 

17. Reasons for increased healthcare spending:

 

a. The high cost of defensive medicine, with an

escalation in services solely to avoid malpractice

litigation.

 

b. U.S. healthcare based on defensive medicine costs

nearly $45 billion per year, or about 5% of total

healthcare spending, according to one source.

 

c. The availability and use of new medical

technologies have contributed the most to increased

healthcare spending, argue many analysts. OTA admits

that these costs are impossible to quantify.

 

18. The reasons government attempts to control

healthcare costs have failed:

 

a. Market incentive and profit-motive involvement in

the financing and organization of healthcare including

private insurance, hospital system, physician

services, and drug and medical device industries.

 

b. Expansion is the goal of free enterprise.

 

Health-Related Research and Development

 

19. The U.S. spends more than any other country on R &

D.

 

20. $9.2 billion was spent in 1989 by the federal

government; U.S. industries spent an additional $9.4

billion.

 

21. There was a 50% rise in total national R & D

expenditures between 1983 and 1992.

 

22. NIH receives about half of the government funding.

 

23. NIH spent more on basic research ($4.1 billion in

1989) than for clinical trials of medical treatments

on humans ($519 million in 1989).

 

24. Most of the trials evaluate new cancer treatment

protocols and new treatments for complications of AIDS

and do not study existing treatments, even though the

effectiveness of many of them is unknown and

questioned.

 

25. The NIH in 1990 had just begun to do meta-analysis

and cost-effectiveness analysis.

 

Pharmaceutical and Medical Device Industry

 

26. About two-thirds of the industry’s $9.4 billion

budget went to drug research; the remaining one-third

was spent by device manufacturers.

 

27. In addition to R & D, the medical industry spent

24% of total sales on promoting their products and

only 15% of total sales on development.

 

28. Total marketing expenses in 1990 were over $5

billion.

 

29. Many products provide no benefit over existing

products.

 

30. Public and private healthcare consumers buy these

products.

 

31. If healthcare spending is perceived as a problem,

a highly profitable drug industry exacerbates the

problem.

 

Controlling Health Care Technology

 

32. The FDA ensures the safety and efficacy of drugs,

biologics, and medical devices.

 

33. The FDA does not consider costs of therapy.

 

34. The FDA does not consider the effectiveness of a

therapy.

 

35. The FDA does not compare a product to currently

marketed products

 

36. The FDA does not consider non-drug alternatives

for a given clinical problem.

 

37. Drug development costs $200 million to bring a new

drug to market. AIDS-drug interest groups forced new

regulations that speed up the approval process.

 

38. Such drugs should be subject to greater

post-marketing surveillance requirements. But as of

1995 these provisions had not yet come into play.

 

39. Many argue that reductions in the pre-approval

testing of drugs opens the possibility of significant

undiscovered toxicities.

 

Health Care Technology Assessment

 

40. 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%)

 

41. In 1978 congress created the National Center for

Health Care Technology (NCHCT) to advise Medicare and

Medicaid.

 

42. With an annual budget of $4 million NCHCT

published three broad assessments of high-priority

technologies and made about 75 coverage

recommendations to Medicare.

 

43. NCHCT was put out of business by Congress in

1981—a political casualty. The medical profession

opposed it from the beginning. The AMA testified

before Congress in 1981 that " clinical policy analysis

and judgments are better made—and are being

responsibly made—within the medical profession.

Assessing risks and costs, as well as benefits, has

been central to the exercise of good medical judgment

for decades. "

 

44. The medical device lobby also opposed government

oversight by NCHCT.

 

Examples of Lack of Proper Management of HealthCare

 

1. Treatments for Coronary Artery Disease

 

45. Since the early 1970’s the number of coronary

artery-bypass surgeries (CABGS) has risen rapidly

without government regulation and without clinical

trials.

 

46. Angioplasty for single vessel disease was

introduced in 1978. The first published trial of

angioplasty versus medical treatment was in 1992.

 

47. Angioplasty did not cut down on the number of

CABGS as was promoted.

 

48. Both procedures increase in number every year as

the patient population grows older and sicker.

 

49. Rates of use are higher in white patients, in

private insurance patients, and there is great

variation in different geographic regions. Such facts

imply that use of these procedures is based on

non-clinical factors.

 

50. At the time of this report, 1995, the NIH

consensus program had not assessed CABGS since 1980

and had never assessed angioplasty.

 

51. RAND researchers evaluated CABGS in New York in

1990. They reviewed 1,300 procedures and found 2% were

inappropriate, 90% appropriate, and 7% 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 U.S. 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 the national average.

 

52. The estimated five-year cost is $33,000 for

angioplasty and $40,000 for CABGS. So, angioplasty did

not lower costs. This was because of high failure

rates of angioplasty.

 

2. Computed Tomography CT

 

53. The first CT scanner in the U.S. was installed at

the Mayo Clinic in 1973. In 1992 the number of

operational CT scanners was 6,060. By comparison, in

1993 there were 216 CT units in Canada.

 

54. There is little information available on how CT

scan improves or affects patient outcome.

 

55. In some institutions up to 90% of scans performed

were negative.

 

56. Approval by the FDA was not required for CT

scanners. No evidence of safety or efficacy was

required.

 

3. MRI

 

57. The first MRI was introduced in 1978 in Great

Britain; the first U.S. scanner in 1980. By 1988 there

were 1,230 units; by 1992 between 2,800 and 3,000.

 

58. A definitive review published in 1994 found less

than 30 studies out of 5,000 that were prospective

comparisons of diagnostic accuracy or therapeutic

choice.

 

59. American College of Physicians assessed MRI

studies and rated 13 out of 17 trials as " weak " -

meaning the absence of any studies on therapeutic

impact or patient outcomes.

 

60. The OAT concludes that, " 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. "

 

4. Laparoscopic Surgery

 

61. Laparoscopic cholecystectomy was introduced at a

professional surgical society meeting in late 1989. In

1992, five years after introduction, 85% of all

cholecystectomies were performed laparoscopically.

 

62. There was an associated increase of 30% in the

number of cholecystectomies performed.

 

63. Because of the increased volume of gall bladder

operations, the total costs increased 11.4% between

1988 and 1992, in spite of a 25.1% drop in the average

cost per surgery.

 

64. The mortality rate for gall bladder surgeries also

did not decline as a result of the lower risk because

so many more were performed.

 

65. When studies were finally done on completed cases,

the results showed that laparoscopic cholecystectomy

was associated with reduced in-patient duration,

decreased pain, and shorter period of restricted

activity. But there were increased rates of bile duct

and major vessel injuries and a suggestion that these

rates were worse for people with acute cholecystitis.

There were still no clinical trials to clarify this

issue.

 

66. Patient demand, fueled by substantial media

attention, was a major force in promoting rapid

adoption.

 

67. The video, which introduced the procedure in 1989,

was produced by the major manufacturer of laparoscopic

equipment.

 

68. Doctors were given two-day training seminars

before performing the surgery on patients.

 

Infant Mortality

 

69. In 1990 the U.S. ranked twenty-fourth in infant

mortality out of 38 developed countries with a rate of

9.2 deaths per 1,000 live births.

 

70. U.S. black infant mortality is 18.6 per 1,000 live

births and 8.8 for whites.

 

Screening for Breast Cancer

 

71. There has always been a debate over mammography

screening in women under 50.

 

72. In 1992 the Canadian National Breast Cancer Study

of 50,000 women showed that mammography had no effect

on mortality for younger women, aged 40-50.

 

73. The National Cancer Institute (NCI) refused to

change its recommendations on mammography.

 

74. The American Cancer Society decided to wait for

more studies on mammography.

 

75. Then, in December 1993 NCI announced that women

over 50 should have routine screening every one to two

years but younger women would have no benefit from

having mammography.

 

Summary

 

76. The OTA concluded that, " There are no mechanisms

in place to limit dissemination of technologies

regardless of their clinical value. "

 

Shortly after this report, the OTA was disbanded.

 

(Reprinted with permission.)