truth fairy + the real dragons , (sorry angel)

July 7, 2004

All the figures are in the documents. Please look closer, and even try to

disproove any of it. It is actually worse. The figures are the absolute

minimum. If the TCM community had that percentage of error, we'd be hung by the

neck and whipped to the seventh generation.

If doing good is a real motivation, then to help influence the system by saving

a million lives by creating awareness of lethal problems seems worthwhile to me.

I'm probably not going to accomplish that much in my clinic in my lifespan. I

don't really see many medical people talking at all about these things. And to

poo-poo all the problems as just somebody's opinion without even considering it,

I feel that is unbelievably ignorant or selfish. This is big kid stuff. Things

are moving quickly away from being able to be solved. In time we may not even

have the vocabulary for dealing with critcism of the Market Forces.

Would you want to eliminate the sources of cancer, or play around trying to

keep your patients alive for a couple more years, as you see younger and younger

less likely patients getting cancer or everything else? I don't know if they

lack the ability to see where things are going, or the strength to deal with it,

or don't want to bite the hand that feeds them, or all the above. Repeating

these kind of findings doesn't make anyone wealthy or popular,( I am active in

other areas beside medicine) my son said I should let it go cause nobody cares

and wouldn't believe it, and you'll just get depressed. That is sad. The

saddest thing to me is that the healthcare people, the ones that should see the

increases in disease suffering and their causes -don't. They can't believe it.

Not because many things aren't true, but because it threatens their professional

pride, and the comfort of some authority to proscribe treatment

protocols--whether or not they have disastrous effect down

the road. In a poetic sense, every tear on earth is polluted, each year more

toxic with profitable industrial effluent that pools and eats away at little

bodies and nobodys' seed is spared. How can you not care? We see the damage

better than almost anyone. I wish and pray and meditate for positive ways to

influence the situation. My qi, when I'm right, can flow and help maybe a

couple people ata time at most. That's not enough. We need to discuss and

dialog this stuff. Here in this group, I am almost the only one who brings up

these broad topics, I know I'm a pain and I'm sorry but, that is a shame. But it

isn't a big burden on the group. I hope I don't get tossed out of the group for

not pretending everything is just peachy in the High Dollar world of for profit

healthcare.

< wrote:

July 7, 2004

Chinese Medicine , mystir

<ykcul_ritsym> wrote:

> All the figures are in the documents. Please look closer, and even

try to disproove any of it.

(JAson) please, show me, as I showed in my last post the stats ARE NOT

there. I specifically quoted what was there and showed how it does not

match what is being said... Come on if you see just point me where,

instead of playing this game!

?It is actually worse. The figures are the absolute minimum. If the

TCM community had that percentage of error, we'd be hung by the neck

and whipped to the seventh generation.

> If doing good is a real motivation, then to help influence the

system by saving a million lives by creating awareness of lethal

problems seems worthwhile to me. I'm probably not going to accomplish

that much in my clinic in my lifespan. I don't really see many

medical people talking at all about these things.

(JAson) The original ideas and quotes are in medical journals. So I am

unclear what you are talking about

>And to poo-poo all the problems as just somebody's opinion without

even considering it, I feel that is unbelievably ignorant or selfish.

(JAson)Of course no one is poo pooing anything, My point is that

things are very overly exaggerated to prove certain points. This is

not reality. Trust me I have considered everything written here.

Show the facts and everyone will listen.

As far as the rest of this medical bashing (below) I won't even

comment... Yes I was there at one point, but IMO this attitude gets us

no where... I would like to remind everyone of the Neijing when Qi bo

asked huang di why we have all these 'crazy' health problems...

He says (paraphrased b/c I don't have the neijing in front of me) -

" People at one time lived at one with nature but now they have lost

their way, a sad state of affairs " - yes 2000 years ago...

-

This is big kid stuff. Things are moving quickly away from being able

to be solved. In time we may not even have the vocabulary for dealing

with critcism of the Market Forces.

> Would you want to eliminate the sources of cancer, or play

around trying to keep your patients alive for a couple more years, as

you see younger and younger less likely patients getting cancer or

everything else? I don't know if they lack the ability to see where

things are going, or the strength to deal with it, or don't want to

bite the hand that feeds them, or all the above. Repeating these kind

of findings doesn't make anyone wealthy or popular,( I am active in

other areas beside medicine) my son said I should let it go cause

nobody cares and wouldn't believe it, and you'll just get depressed.

That is sad. The saddest thing to me is that the healthcare people,

the ones that should see the increases in disease suffering and their

causes -don't. They can't believe it. Not because many things

aren't true, but because it threatens their professional pride, and

the comfort of some authority to proscribe treatment

protocols--whether or not they have disastrous effect down

> the road. In a poetic sense, every tear on earth is polluted,

each year more toxic with profitable industrial effluent that pools

and eats away at little bodies and nobodys' seed is spared. How can

you not care? We see the damage better than almost anyone. I wish and

pray and meditate for positive ways to influence the situation. My

qi, when I'm right, can flow and help maybe a couple people ata time

at most. That's not enough. We need to discuss and dialog this

stuff. Here in this group, I am almost the only one who brings up

these broad topics, I know I'm a pain and I'm sorry but, that is a

shame. But it isn't a big burden on the group. I hope I don't get

tossed out of the group for not pretending everything is just peachy

in the High Dollar world of for profit healthcare.

>

> wrote:

July 7, 2004

Here's a copy of the article. I would reccomend everyone to read it, look up the

references and make your own determination of what is true.

You can also look up several studies in the medical journals ie; JAMA, BMJ,

Lancet and New England Journal of Medicine.

Below is a summary with the references to the above article " Death by Medicine "

This article was produced by Life Extension. I have been subscribing to this

magazine for several years and the information I read several years ago is

starting to be adopted by Western Medicine, although still slow in implementing,

The web site is www.lef.org

Brian N Hardy, DC, LAc, DACBN, CCN

OFFICE OF TECHNOLOGY ASSESSMENT (OTA)

Health Care Technology and Its Assessment in Eight Countries, 1995.

General Facts

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.

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.

Health status is correlated with socioeconomic status.

Health care is not universal.

Health care is based on the free market system with no fixed budget or

limitations on expansion.

Health care accounts for 14% of the US GNP ($800 billion in 1993).

The federal government does no central planning, though it is the major

purchaser of health care for older people and some poor people.

Americans are less satisfied with their health care system than people in

other developed countries.

US medicine specializes in expensive medical technology; some large US cities

have more magnetic resonance image (MRI) scanners than most countries.

Huge public and private investments in medical research and pharmaceutical

development drive this “technological arms race.”

Any efforts to restrain technological developments in health care are opposed

by policymakers concerned about negative impacts on medical-technology

industries.

Hospitals

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.

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.

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.

In 1991, government-run health care spending totaled $81 billion.

Total US health care spending rose to $752 billion in 1991 from $70 billion

in 1950. Spending grew five-fold per capita.

Reasons for increased healthcare spending include:

The high cost of defensive medicine, with an escalation in services solely

to avoid malpractice litigation.

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.

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.

The reasons government attempts to control health care costs have failed

include:

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.

Expansion is the goal of free enterprise.

Health-Related Research and Development

The US spends more than any other country on health-related R & D.

In 1989, the federal government spent $9.2 billion on R & D, while private

industry spent an additional $9.4 billion.

Total US R & D expenditures rose 50% from 1983 to 1992.

NIH receives about half of US government R & D funding.

NIH spent more on basic research ($4.1 billion in 1989) than for clinical

trials of medical treatments on humans ($519 million in 1989).

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.

In 1990, the NIH had just begun to do meta-analysis and cost-effectiveness

analysis.

Pharmaceutical and Medical-Device Industries

About two-thirds of the industry's $9.4 billion budget went to drug research;

device manufacturers spent the remaining one-third.

In addition to R & D, the medical industry spent 24% of total sales on

promoting their products and 15% of total sales on development.

Total marketing expenses in 1990 were over $5 billion.

Many products provide no benefit over existing products.

Public and private health care consumers buy these products.

If health care spending is perceived as a problem, a highly profitable drug

industry exacerbates the problem.

Controlling Health Care Technology

The FDA ensures the safety and efficacy of drugs, biologics, and medical

devices.

The FDA does not consider costs of therapy.

The FDA does not consider the effectiveness of a therapy.

The FDA does not compare a product to currently marketed products

The FDA does not consider nondrug alternatives for a given clinical problem.

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.

Such drugs should be subject to greater post-marketing surveillance

requirements. As of 1995, these provisions had not yet come into play.

Many argue that reductions in the pre-approval testing of drugs open the

possibility of significant undiscovered toxicities.

Health Care Technology Assessment

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%).

In 1978, Congress created the National Center for Health Care Technology

(NCHCT) to advise Medicare and Medicaid.

With an annual budget of $4 million, NCHCT published three broad assessments

of high-priority technologies and made about 75 coverage recommendations to

Medicare.

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 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.”

The medical device lobby also opposed government oversight by NCHCT.

Examples of Lack of Proper Management of HealthCare

Treatments for Coronary Artery Disease

Since the early 1970s, the number of coronary artery bypass surgeries (CABGS)

has risen rapidly without government regulation or clinical trials.

Angioplasty for single vessel disease was introduced in 1978. The first

published trial of angioplasty versus medical treatment was done in 1992.

Angioplasty did not reduce the number of CABGS, as was promoted.

Both procedures increase in number every year as the patient population grows

older and sicker.

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.

As of 1995, the NIH consensus program had not assessed CABGS since 1980 and

had never assessed angioplasty.

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.

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)

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 .

There is little information available on how CT scans improve or affect

patient outcomes

In some institutions, up to 90% of scans performed were negative.

Approval by the FDA was not required for CT scanners, nor was any evidence of

safety or efficacy.

Magnetic Resonance Imaging (MRI)

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.

A definitive review published in 1994 found less than 30 studies of 5,000

that were prospective comparisons of diagnostic accuracy or therapeutic choice.

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.

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

Laparoscopic cholecystectomy was introduced at a professional surgical

society meeting in late 1989. By 1992, 85% of all cholecystectomies were

performed laparoscopically.

There was an associated increase of 30% in the number of cholecystectomies

performed.

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.

The mortality rate for gall bladder surgeries did not decline as a result of

the lower risk because so many more were performed.

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.

Patient demand, fueled by substantial media attention, was a major force in

promoting rapid adoption of these procedures.

The major manufacturer of laparoscopic equipment produced the video that

introduced the procedure in 1989.

Doctors were given two-day training seminars before performing the surgery on

patients.

Infant Mortality

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.

US black infant mortality is 18.6 per 1,000 live births, compared to 8.8 for

whites.

Screening for Breast Cancer

Mammography screening in women under 50 has always been a subject of debate.

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.

The National Cancer Institute (NCI) refused to change its recommendations on

mammography.

The American Cancer Society decided to wait for more studies on mammography.

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

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.

References

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in

hospitalized patients: a meta-analysis of prospective studies. JAMA . 1998 Apr

15;279(15):1200-5.

Rabin R. Caution about overuse of antibiotics. Newsday . September 18, 2003 .

2a. Centers for Disease Control and Prevention. CDC antimicrobial resistance and

antibiotic resistance—general information. Available at:

http://www.cdc.gov/drugresistance/community/. Accessed December 13, 2003 .

For calculations detail, see “Unnecessary Surgery.” Sources: HCUPnet,

Healthcare Cost and Utilization Project. Agency for Healthcare Research and

Quality, Rockville , MD. Available at: http://www.ahrq.gov/data/hcup/hcupnet.htm

.. Accessed December 18, 2003 . US Congressional House Subcommittee Oversight

Investigation. Cost and Quality of Health Care: Unnecessary Surgery . Washington

, DC : Government Printing Office;1976. Cited in: McClelland GB, Foundation for

Chiropractic Education and Research. Testimony to the Department of Veterans

Affairs' Chiropractic Advisory Committee. March 25, 2003 .

For calculations detail, see “Unnecessary Hospitalization.” Sources: HCUPnet,

Healthcare Cost and Utilization Project. Agency for Healthcare Research and

Quality, Rockville , MD. Available at: http://www.ahrq.gov/data/hcup/hcupnet.htm

.. Accessed December 18, 2003 . Siu AL, Sonnenberg FA, Manning WG, et al.

Inappropriate use of hospitals in a randomized trial of health insurance plans.

N Engl J Med . 1986 Nov 13;315(20):1259-66. Siu AL, Manning WG, Benjamin B.

Patient, provider and hospital characteristics associated with inappropriate

hospitalization. Am J Public Health . 1990 Oct;80(10):1253-6. Eriksen BO,

Kristiansen IS, Nord E, et al. The cost of inappropriate admissions: a study of

health benefits and resource utilization in a department of internal medicine. J

Intern Med . 1999 Oct;246(4):379-87.

U.S. National Center for Health Statistics. National Vital Statistics Report,

vol. 51, no. 5, March 14, 2003 .

Thomas, EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse

events and negligent care in Utah and Colorado. Med Care. 2000 Mar;38(3):261-71.

Thomas, EJ, Studdert DM, Newhouse JP, et al. Costs of medical injuries in Utah

and Colorado . Inquiry . 1999 Fall;36(3):255-64. [Two references.]

Xakellis GC, Frantz R, Lewis A. Cost of pressure ulcer prevention in

long-term care. Am Geriatr Soc . 1995 May;43(5):496-501.

Barczak CA, Barnett RI, Childs EJ, Bosley LM. Fourth national pressure ulcer

prevalence survey. Adv Wound Care . 1997 Jul-Aug;10(4):18-26.

Weinstein RA. Nosocomial Infection Update. Emerg Infect Dis . 1998

Jul-Sep;4(3):416-20.

Fourth Decennial International Conference on Nosocomial and

Healthcare-Associated Infections. Morbidity and Mortality Weekly Report.

February 25, 2000 , Vol. 49, No. 7, p.138.

Burger SG, Kayser-Jones J, Bell JP. Malnutrition and dehydration in nursing

homes: key issues in prevention and treatment. National Citizens' Coalition for

Nursing Home Reform. June 2000. Available at:

http://www.cmwf.org/programs/elders/burger_mal_386.asp. Accessed December 13,

2003 .

Starfield B. Is US health really the best in the world? JAMA . 2000 Jul

26;284(4):483-5. Starfield B. Deficiencies in US medical care. JAMA . 2000 Nov

1;284(17):2184-5.

HCUPnet, Healthcare Cost and Utilization Project. Agency for Healthcare

Research and Quality, Rockville , MD. Available at:

http://www.ahrq.gov/data/hcup/hcupnet.htm . Accessed December 18, 2003 .

Nationwide poll on patient safety: 100 million Americans see medical mistakes

directly touching them [press release]. McLean , VA : National Patient Safety

Foundation; October 9, 1997 .

The Society of Actuaries Health Benefit Systems Practice Advancement

Committee. The Troubled Healthcare System in the US . September 13, 2003 .

Available at: http://www.soa.org/sections/troubled_healthcare.pdf. Accessed

December 18, 2003 .

Leape LL. Error in medicine. JAMA . 1994 Dec 21;272(23):1851-7.

a.Brennan TA, Leape LL, Laird NM , et al. Incidence of adverse events and

negligence in hospitalized patients. Results of the Harvard Medical Practice

Study I. N Engl J Med . 1991 Feb 7;324(6):370-6.

Campbell EG, Weissman JS, Clarridge B, Yucel R, Causino N, Blumenthal D.

Characteristics of medical school faculty members serving on institutional

review boards: results of a national survey. Acad Med . 2003 Aug;78(8):831-6.

Possible conflict of interest within medical profession. HealthDayNews.

August 15, 2003 .

World Health Organization. Press Release Bulletin #9. December 17, 2001 .

Angell M. Is academic medicine for sale? N Engl J Med . 2000 May

18;342(20):1516-8.

McKenzie J. Conflict of interest? Medical journal changes policy of finding

independent doctors [transcript]. ABC News. June 12, 2002 .

Crossen C. Tainted Truth: The Manipulation of Fact in America . New York , NY

: Simon & Schuster; 1994.

Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and

potential adverse drug events. Implications for prevention. ADE Prevention Study

Group. JAMA . 1995 Jul 5;274(1):29-34.

Vincent C, Stanhope N, Crowley-Murphy M. Reasons for not reporting adverse

incidents: an empirical study. J Eval Clin Pract . 1999 Feb;5(1):13-21.

Wald H, Shojania KG. Incident reporting. In: Shojania KG, Duncan BW, McDonald

KM, et al, eds. Making Health Care Safer: A Critical Analysis of Patient Safety

Practices . Rockville , MD : Agency for Healthcare Research and Quality;

2001:chap 4. Evidence Report/Technology Assessment No. 43. AHRQ publication

01-E058.

Grinfeld MJ. The debate over medical error reporting. Psychiatric Times .

April 2000.

King G III, Hermodson A. Peer reporting of coworker wrongdoing: A qualitative

analysis of observer attitudes in the decision to report versus not report

unethical behavior. Journal of Applied Communication Research . 2000;(28),

309-29.

Gilman AG, Rall TW, Nies AS , Taylor P. Goodman and Gilman's The

Pharmacological Basis of Therapeutics. New York , NY : Pergamon Press; 1996.

Kolata G. New York Times News Service. Who cares when our drugs fail? San

Diego Union-Tribune . October 15, 1997 :E-1,5.

Melmon KL, Morrelli HF, Hoffman BB, Nierenberg DW, eds. Melmon and Morrelli's

Clinical Pharmacology: Basic Principles in Therapeutics . 3rd ed. New York , NY

: McGraw-Hill, Inc., 1992.

Moore TJ, Psaty BM, Furberg CD. Time to act on drug safety . JAMA . 1998 May

20, 279 (19):1571-3.

32 a.Cullen DJ, Bates DW, Small SD, Cooper JB, Nemeskal AR , Leape LL. The

incident reporting system does not detect adverse drug events: a problem for

quality improvement. Jt Comm J Qual Improv . 1995 Oct;21(10):541-8.

Bates DW. Drugs and adverse drug reactions: how worried should we be? JAMA .

1998 Apr 15;279(15):1216-7.

Dickinson, JG. FDA seeks to double effort on confusing drug names. Dickinson

's FDA Review . 2000 Mar;7(3):13-4.

Cohen JS. Overdose: The Case Against the Drug Companies . New York , NY :

Tarcher-Putnum; 2001.

Stenson J. Few residents report medical errors, survey finds. Reuters Health.

February 21, 2003 .

Survey by Henry J. Kaiser Family Foundation, Harvard School of Public Health.

Methodology: Fieldwork conducted by ICR - International Communications Research,

April 11- June 11, 2002

Bond CA, Raehl CL, Franke T. Clinical pharmacy services, hospital pharmacy

staffing, and medication errors in United States hospitals. Pharmacotherapy .

2002 Feb;22(2):134-47.

Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors

observed in 36 health care facilities. Arch Intern Med . 2002 Sep

9;162(16):1897-903.

LaPointe NM , Jollis JG. Medication errors in hospitalized cardiovascular

patients. Arch Intern Med . 2003 Jun 23;163(12):1461-6.

Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and

severity of adverse events affecting patients after discharge from the hospital.

Ann Intern Med . 2003 Feb 4;138(3):161-7.

Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory

care. N Engl J Med . 2003 Apr 17;348(16):1556-64.

Medication side effects strike 1 in 4. Reuters. April 17, 2003 .

Vastag B. Pay attention: ritalin acts much like cocaine. JAMA . 2001 Aug

22-29;286(8):905-6.

Rosenthal MB, Berndt ER, Donohue JM, Frank RG, Epstein AM. Promotion of

prescription drugs to consumers. N Engl J Med . 2002 Feb 14;346(7):498-505.

Wolfe SM. Direct-to-consumer advertising—education or emotion promotion? N

Engl J Med . 2002 Feb 14;346(7):524-6.

Ibid.

US General Accounting Office. Report to the Chairman, Subcommittee on Human

Resources and Intergovernmental Relations, Committee on Government Operations,

House of Representatives: FDA Drug Review Postapproval Risks 1976-85 .

Washington , DC : US General Accounting Office; 1990:3.

Drug giant accused of false claims. MSNBC News. July 11, 2003 . Available at:

http://msnbc.com/news/937302.asp?0sl=-42 & cp1=1. Accessed December 17,2003 .

Suh DC , Woodall BS, Shin SK , Hermes-De Santis ER. Clinical and economic

impact of adverse drug reactions in hospitalized patients. Ann Pharmacother .

2000 Dec;34(12):1373-9.

Agger WA. Antibiotic resistance: unnatural selection in the office and on the

farm. Wisconsin Medical Journal . August 2002.

Nash DR, Harman J, Wald ER, Kelleher KJ. Antibiotic prescribing by primary

care physicians for children with upper respiratory tract infections. Arch

Pediatr Adolesc Med . 2002 Nov;156(11):1114-9.

Schindler C, Krappweis J, Morgenstern I, Kirch W. Prescriptions of systemic

antibiotics for children in Germany aged between 0 and 6 years.

Pharmacoepidemiol Drug Saf . 2003 Mar;12(2):113-20.

Finkelstein JA, Stille C, Nordin J, et al. Reduction in antibiotic use among

US children, 1996-2000. Pediatrics . 2003 Sep;112(3 Pt 1):620-7.

Linder JA, Stafford RS. Antibiotic treatment of adults with sore throat by

community primary care physicians: a national survey, 1989-1999. JAMA . 2001 Sep

12;286(10):1181-6.

Drug resistance page. Centers for Disease Control and Prevention website.

Available at: http://www.cdc.gov/drugresistance/community/. Accessed December

17, 2003 .

Available at: http://www.health.state.ok.us/program/cdd/ar/. Accessed

December 17, 2003 .

Available at: http://www.librainitiative.com/life/en/libra_initiative.html.

Accessed December 17, 2003 .

Ohlsen K, Ternes T, Werner G, et al. Impact of antibiotics on conjugational

resistance gene transfer in Staphylococcus aureus in sewage. Environ Microbiol .

2003 Aug;5(8):711-6.

Pawlowski S, Ternes T, Bonerz M, et al. Combined in situ and in vitro

assessment of the estrogenic activity of sewage and surface water samples.

Toxicol Sci . 2003 Sep;75(1):57-65. Epub 2003 Jun 12.

Ternes TA, Stuber J, Herrmann N, et al. Ozonation: a tool for removal of

pharmaceuticals, contrast media and musk fragrances from wastewater? Water Res .

2003 Apr;37(8):1976-82.

Ternes TA, Meisenheimer M, McDowell D, et al. Removal of pharmaceuticals

during drinking water treatment. Environ Sci Technol . 2002 Sep

1;36(17):3855-63.

Ternes T, Bonerz M, Schmidt T. Determination of neutral pharmaceuticals in

wastewater and rivers by liquid chromatography-electrospray tandem mass

spectrometry. J Chromatogr A . 2001 Dec 14;938(1-2):175-85.

Golet EM, Alder AC, Hartmann A, Ternes TA, Giger W. Trace determination of

fluoroquinolone antibacterial agents in urban wastewater by solid-phase

extraction and liquid chromatography with fluorescence detection. Anal Chem .

2001 Aug 1;73(15):3632-8.

Daughton CG, Ternes TA. Pharmaceuticals and personal care products in the

environment: agents of subtle change? Environ Health Perspect . 1999 Dec;107

Suppl 6:907-38.

Hirsch R, Ternes T, Haberer K, Kratz KL. Occurrence of antibiotics in the

aquatic environment. Sci Total Environ . 1999 Jan 12;225(1-2):109-18.

Ternes TA, Stumpf M, Mueller J, Haberer K, Wilken RD , Servos M. Behavior and

occurrence of estrogens in municipal sewage treatment plants—I. Investigations

in Germany , Canada and Brazil . Sci Total Environ . 1999 Jan 12;225(1-2):81-90.

Hirsch R, Ternes TA, Haberer K, Mehlich A, Ballwanz F, Kratz KL.

Determination of antibiotics in different water compartments via liquid

chromatography-electrospray tandem mass spectrometry. J Chromatogr A . 1998 Jul

31;815(2):213-23.

Coste J, Hanotin C, Leutenegger E. Prescription of non-steroidal

anti-inflammatory agents and risk of iatrogenic adverse effects: a survey of

1072 French general practitioners. Therapie . 1995 May-Jun;50(3):265-70.

Kouyanou K, Pither CE, Wessely S. Iatrogenic factors and chronic pain.

Psychosom Med . 1997 Nov-Dec;59(6):597-604.

Abel U. Chemotherapy of advanced epithelial cancer—a critical review. Biomed

Pharmacother . 1992;46(10):439-52.

Schulman KA, Stadtmauer EA, Reed SD , et al. Economic analysis of

conventional-dose chemotherapy compared with high-dose chemotherapy plus

autologous hematopoietic stem-cell transplantation for metastatic breast cancer.

Bone Marrow Transplant . 2003 Feb;31(3):205-10.

Kaufman, M. Drugmaker to pay FDA $500 million. Manufacturing problems found

at schering-plough . The Washington Post . May 18, 2002 :A01.

US Congressional House Subcommittee Oversight Investigation. Cost and Quality

of Health Care: Unnecessary Surgery . Washington , DC : Government Printing

Office;1976. Cited in: McClelland GB, Foundation for Chiropractic Education and

Research. Testimony to the Department of Veterans Affairs' Chiropractic Advisory

Committee. March 25, 2003 .

Leape LL. Unnecessary surgery. Health Serv Res . 1989 Aug;24(3):351-407.

McClelland GB, Foundation for Chiropractic Education and Research. Testimony

to the Department of Veterans Affairs' Chiropractic Advisory Committee. March

25, 2003 .

Coile RC Jr. Internet-driven surgery. Russ Coiles Health Trends . 2003

Jun;15(8):2-4.

Guarner V. Unnecessary operations in the exercise of surgery. A topic of our

times with serious implications in medical ethics. Gac Med Mex . 2000

Mar-Apr;136(2):183-8.

Rutkow IM. Surgical operations in the United States : 1979 to 1984. Surgery .

1987 Feb;101(2):192-200.

Rutkow IM. Surgical operations in the United States . Then (1983) and now

(1994). Arch Surg . 1997 Sep;132(9):983-90.

Linnemann MU, Bulow HH. Infections after insertion of epidural catheters.

Ugeskr Laeger . 1993 Jul 26;155(30):2350-2

Seres JL, Newman RI . Perspectives on surgical indications. Implications for

controls. Clin J Pain . 1989 Jun;5(2):131-6.

Chassin MR, Kosecoff J, Park RE, et al. Does inappropriate use explain

geographic variations in the use of health care services? A study of three

procedures. JAMA. 1987 Nov 13;258(18):2533-7.

Office of Technology Assessment, US Congress. Assessing the Efficacy and

Safety of Medical Technologies. Washington DC : Office of Technology Assessment,

US Congress; 1978.

Tunis SR, Gelband H. Health care technology in the United States . Health

Policy . 1994 Oct-Dec;30(1-3):335-96.

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

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

Injuries in hospitals pose a significant threat to patients and a substantial

increase in health care charges [press release]. Rockville , MD : Agency for

Healthcare Research and Quality. October 7, 2003 .

http://www.ahrq.gov/news/ress/pr2003/injurypr.htm.

Weingart SN, Iezzoni LI. Looking for medical injuries where the light is

bright. JAMA . 2003 Oct 8 ;290(14):1917-9.

MacMahon B. Prenatal x-ray exposure and childhood cancer. J Natl Cancer Inst

.. 1962 May;28:1173-91.

Health Physics Society. Available at:

http://hps.org/publicinformation/ate/q1084.html. Accessed December 17, 2003 .

Gofman JW. Radiation from Medical Procedures in the Pathogenesis of Cancer

and Ischemic Heart Disease: Dose-Response Studies with Physicians per 100,000

Population. San Francisco , CA : CNR Books; 1999.

Gofman J W. Preventing Breast Cancer: The Story of a Major, Proven,

Preventable Cause of This Disease . 2nd ed. San Francisco , CA : CNR Books;

1996.

Sarno JE. Healing Back Pain: The Mind-Body Connection . Warner Books; 1991.

Siu AL, Sonnenberg FA, Manning WG, et al. Inappropriate use of hospitals in a

randomized trial of health insurance plans. N Engl J Med . 1986 Nov

13;315(20):1259-66.

Siu AL, Manning WG, Benjamin B. Patient, provider and hospital

characteristics associated with inappropriate hospitalization. Am J Public

Health . 1990 Oct;80(10):1253-6.

Eriksen BO, Kristiansen IS, Nord E, et al. The cost of inappropriate

admissions: a study of health benefits and resource utilization in a department

of internal medicine. J Intern Med . 1999 Oct;246(4):379-87.

Showalter E. Hystories: Hysterical Epidemics and Modern Media . New York , NY

: Columbia University Press; 1997.

Fugh-Berman A. Alternative healing. In: Smith B, Steinem G, Mink G, Navarro

M, and Mankiller W, eds. The Reader's Companion to U.S. Women's History. New

York , NY : Houghton Mifflin; 1998. Available at:

http://college.hmco.com/history/readerscomp/women/html/wh_001200_alternativeh.ht\

m .

Thacker SB, Stroup D, Chang M. Continuous electronic heart rate monitoring

for fetal assessment during labor (Cochrane Review). In: The Cochrane Library,

issue 1, 2003. Oxford : Update Software.

Cole C. Admission electronic fetal monitoring does not improve neonatal

outcomes . J Fam Pract . 2003 Jun;52(6):443-4.

Nelson HD, Humphrey LI, Nygren P, Teutsch SM, Allan JD. Postmenopausal

hormone replacement therapy: scientific review. JAMA . 2002 Aug

21;288(7):872–81.

Nelson HD. Assessing benefits and harms of hormone replacement therapy:

clinical applications. JAMA . 2002 Aug 21;288(7):882-4

Fletcher SW, Colditz GA. Failure of estrogen plus progestin therapy for

prevention. JAMA . 2002 Jul 17;288(3):366-8.

Rossouw JE, Anderson GL, Prentice RL, et al; Writing Group for the Women's

Health Initiative Investigators. Risks and benefits of estrogen plus progestin

in healthy postmenopausal women: principal results from the Women's Health

Initiative randomized controlled trial. JAMA . 2002 Jul 17;288(3):321-33.

Rutkow IM. Obstetric and gynecologic operations in the United States , 1979

to 1984. Obstet Gynecol . 1986 Jun;67(6):755-9.

Family Practice News . February 15, 1995 : 29.

Sakala C. Medically unnecessary cesarean section births: introduction to a

symposium. Soc Sci Med . 1993 Nov;37(10):1177-98.

VanHam MA, van Dongen PW, Mulder J. Maternal consequences of cesarean

section. A retrospective study of intra-operative and postoperative maternal

complications of cesarean section during a 10-year period. Eur J Obstet Reprod

Biol . 1997 Jul;74(1):1-6.

Weiner J. Smoking and cancer: the cigarette papers: how the industry is

trying to smoke us all . The Nation . January 1, 1996 :11-18.

Tobacco.org. Tobacco timeline. Available at:

http://www.tobacco.org/resources/history/tobacco_history.html. Acccessed

December 16, 2003 .

Lasser KE, Allen PD, Woolhandler SJ, Himmelstein DU, Wolfe SM, Bor DH. 2002.

Timing of new black box warnings and withdrawals for prescription medications.

JAMA . 2002 May 1;287(17):2215-20.

Injuryboard.com. General Accounting Office study sheds light on nursing home

abuse. July 17, 2003 . Available at:

http://www.injuryboard.com/view.cfm/Article=3005. Accessed December 17, 2003 .

Weingart SN, McL Wilson R, Gibberd RW, Harrison B. Epidemiology of medical

error. West J Med . 2000 Jun;172(6):390-3.

Blendon R, Schoen C, et al. Five nation survey exposes flaws in the U.S.

health care system. Health Affairs . May/June 2002.

Institute of Medicine . Care Without Coverage: Too Little, Too Late . May 21,

2002 . A Shared Destiny: Community Effects of Uninsurance . March 6, 2003 .

US Department of Health and Human Services and US Department of Justice.

Health Care Fraud and Abuse Control Program Annual Report for FY 1998. April

1999. Health Care Fraud and Abuse Control Program Annual Report for FY 2001.

April 2002.

Abuse of residents is a major problem in U.S. nursing homes [transcript]. CNN

television. July 30, 2001

117 a. Available at: http://www.house.gov/waxman. Accessed December 17, 2003 .

Mitka M. Unacceptable nursing home deaths unautopsied. JAMA . 1998 Sep

23-30;280(12):1038-9

New data is in on North Carolina 's nursing home residents. Medical Review of

North Carolina, Inc. July 21, 2003 .

Weinstein RA. Nosocomial infection update. Emerg Infect Dis . 1998

Jul-Sep;4(3):416-20.

Centers for Medicare & Medicaid Services. Report to Congress: Appropriateness

of Minimum Nurse Staffing Ratios In Nursing Homes: Phase II Final Report .

December 24, 2001 .

Consumer group criticizes Thompson letter dismissing report on dangerous

staffing levels in nursing homes [news release]. Washington , DC : National

Citizens' Coalition for Nursing Home Reform. March 22, 2002 .

Bergstrom N, Braden B, Kemp M, Champagne M, Ruby E. Multi-site study of

incidence of pressure ulcers and the relationship between risk level,

demographic characteristics, diagnoses and prescription of preventive

interventions . J Am Geriatr Soc . 1996 Jan;44(1):22-30.

Miles SH. Concealing accidental nursing home deaths. HEC Forum . 2002

Sep;14(3):224-34.

Corey TS, Weakley-Jones B, Nichols GR 2nd, Theuer HH. Unnatural deaths in

nursing home patients. J Forensic Sci . 1992 Jan;37(1):222-7.

Lloyd-Jones DM, Martin DO, Larson MG, Levy D. Accuracy of death certificates

for coding coronary heart disease as the cause of death. Ann Intern Med . 1998

Dec 15;129(12):1020-6.

Thomas DR , Zdrowski CD, Wilson MM, et al. Malnutrition in subacute care. Am

J Clin Nutr . 2002 Feb;75(2):308-13.

Robinson BE. Death by destruction of will. Lest we forget. Arch Intern Med .

1995 Nov 13;155(20):2250-1.

Capezuti E, Strumpf NE, Evans LK, Grisso JA, Maislin G. The relationship

between physical restraint removal and falls and injuries among nursing home

residents . J Gerontol A Biol Sci Med Sci . 1998 Jan;53(1):M47-52.

Phillips CD, Hawes C, Fries BE. Reducing the use of physical restraints in

nursing homes: will it increase costs? Am J Public Health . 1993

Mar;83(3):342-8.

Miles SH, Irvine P. Deaths caused by physical restraints. Gerontologist .

1992 Dec;32(6):762-6.

Annas GJ. The last resort—the use of physical restraints in medical

emergencies. N Engl J Med . 1999 Oct 28;341(18):1408-12.

Parker K, Miles SH. Deaths caused by bedrails. J Am Geriatr Soc . 1997

Jul;45(7):797-802.

Miles SH. Concealing accidental nursing home deaths. HEC Forum . 2002

Sep;14(3):224-34.

Katz PR, Seidel G. Nursing home autopsies. Survey of physician attitudes and

practice patterns. Arch Pathol Lab Med . 1990 Feb;114(2):145-7.

Overmedication of U.S. seniors. Reuters Health. May 21, 2003 .

Average number of prescriptions by HMOs increases. Drug Benefit Trends . 2002

Sep 12;14(8).

Kaiser Family Foundation. Prescription Drug Trends . November 2001.

Williams BR, Nichol MB, Lowe B, Yoon PS, McCombs JS, Margolies J. Medication

use in residential care facilities for the elderly. Ann Pharmacother . 1999

Feb;33(2):149-55.

AARP. Medicare and prescription drugs. Available at:

http://www.aarp.org/prescriptiondrugs. Accessed December 16, 2003 .

California reaches $100 million multi-state settlement with drug giant Mylan

over alleged price-fixing scheme [press release]. Sacramento , CA : Office of

the Attorney General, Department of Justice, State of California ; July 12, 2000

..

Attorney general reaches settlement with drug giant. WRAL News. March 7, 2003

.. Available at: . http://www.wral.com/money/2026364/detail.html . Accessed

December 16, 2003 .

Blowing the final whistle. The Observer. November 25, 2001 . Available at:

http://education.guardian.co.uk/businessofresearch/comment/0,9976,606260,00.html\

.. Accessed December 16, 2003 .

AARP. Are food supplements for me. Available at:

http://www.aarp.org/Articles/a2003-03-07-supplements.html. Accessed December

16,2003 .

Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly

patients with cancer. SAGE study group. Systematic assessment of geriatric drug

use via epidemiology. JAMA . 1998 Jun 17;279(23):1877-82.

Associated Press. Panel names estrogen as carcinogen. The Washington Post .

December 16, 2000 :A05.

Estrogen hikes ovarian cancer risk. MSNBC staff and wire reports. July 16,

2002 . Grady D. Study recommends NOT using hormone therapy for bone loss. New

York Times . October 1, 2003 .

Anderson GL, Judd HL, Kaunitz AM, et al. Effects of estrogen plus progestin

on gynecologic cancers and associated diagnostic procedures: the Women's Health

Initiative randomized trial. JAMA . 2003 Oct 1;290(13):1739-48.

Chlebowski RT, Hendrix SL, Langer RD , et al. Influence of estrogen plus

progestin on breast cancer and mammography in healthy postmenopausal women: the

Women's Health Initiative randomized trial. JAMA . 2003 Jun 25;289(24):3243-53.

Wassertheil-Smoller S, Hendrix SL, Limacher M, et al . Effect of estrogen

plus progestin on stroke in postmenopausal women: the Women's Health Initiative:

a randomized trial. JAMA . 2003 May 28;289(20):2673-84.

Shumaker SA, Legault C, Rapp SR, et al. Estrogen plus progestin and the

incidence of dementia and mild cognitive impairment in postmenopausal women: the

Women's Health Initiative memory study: a randomized controlled trial. JAMA

2003;289:2651-62 .

Beral V; Million Women Study Collaborators. Breast cancer and

hormone-replacement therapy in the Million Women Study. Lancet . 2003 Aug

9;362(9382):419-27.