The state of medicine?

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The state of medicine?

Postby kenneth delves on Sat May 24, 2008 8:56 pm

Death by Medicine
By Gary Null, Ph.D., PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
[back] Extracts

ABSTRACT
Table 1: Estimated Annual Mortality and Economic Cost of Medical Intervention
Table 2: Estimated Annual Mortality and Economic Cost of Medical Intervention
Table 3: Estimated 10-Year Death Rates from Medical Intervention
Table 4: Estimated 10-Year Unnecessary Medical Events
INTRODUCTION
Is American Medicine Working?
Underreporting of Iatrogenic Events
Medical Ethics and Conflict of Interest in Scientific Medicine
THE FIRST IATROGENIC STUDY
ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED
PUBLIC SUGGESTIONS ON IATROGENESIS
DRUG IATROGENESIS
Medication Errors
Recent Adverse Drug Reactions
Medicating Our Feelings
Television Diagnosis
How Do We Know Drugs Are Safe?
Specific Drug Iatrogenesis: Antibiotics
The Problem with Antibiotics
Cesarean Section
NEVER ENOUGH STUDIES
ADVERSE DRUG REACTIONS
BEDSORES
MALNUTRITION IN NURSING HOMES
Nosocomial Infections
Outpatient Iatrogenesis
Unnecessary Surgeries
MEDICAL ERRORS: A GLOBAL ISSUE
HEALTH INSURANCE
WAREHOUSING OUR ELDERS
Overmedicating Seniors
WHAT REMAINS TO BE UNCOVERED
Appendix: OFFICE OF TECHNOLOGY ASSESSMENT (OTA)
General Facts
Hospitals
Health-Related Research and Development
Pharmaceutical and Medical-Device Industries
Health Care Technology Assessment
Examples of Lack of Proper Management of HealthCare
Treatments for Coronary Artery Disease
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Laparoscopic Surgery
Infant Mortality
Screening for Breast Cancer
Summary
References

ABSTRACT
A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million.1 Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics.2, 2a

The number of unnecessary medical and surgical procedures performed annually is 7.5 million.3 The number of people exposed to unnecessary hospitalization annually is 8.9 million.4 The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251.5

Table 1: Estimated Annual Mortality and Economic Cost of Medical Intervention

Condition Deaths Cost Author
Adverse Drug Reactions 106,000 $12 billion Lazarou(1), Suh (49)
Medical error 98,000 $2 billion IOM(6)
Bedsores 115,000 $55 billion Xakellis(7), Barczak (8)
Infection 88,000 $5 billion Weinstein(9), MMWR (10)
Malnutrition 108,800 ----------- Nurses Coalition(11)
Outpatients 199,000 $77 billion Starfield(12), Weingart(112)
Unnecessary Procedures 37,136 $122 billion HCUP(3,13)
Surgery-Related 32,000 $9 billion AHRQ(85)
Total 783,936 $282 billion


Using Leape's 1997 medical and drug error rate of 3 million(14) multiplied by the 14% fatality rate he used in 1994(16) produces an annual death rate of 420,000 for drug errors and medical errors combined. Using this number instead of Lazorou's 106,000 drug errors and the Institute of Medicine 's (IOM) estimated 98,000 annual medical errors would add another 216,000 deaths, for a total of 999,936 deaths annually.

Table 2: Estimated Annual Mortality and Economic Cost of Medical Intervention

Condition Deaths Cost Author
ADR/med error 420,000 $200 billion Leape(14)
Bedsores 115,000 $55 billion Xakellis(7), Barczak (8)
Infection 88,000 $5 billion Weinstein(9), MMWR (10)
Malnutrition 108,800 ----------- Nurses Coalition(11)
Outpatients 199,000 $77 billion Starfield(12), Weingart(112)
Unnecessary Procedures 37,136 $122 billion HCUP(3,13)
Surgery-Related 32,000 $9 billion AHRQ(85)
Total 999,936


The enumerating of unnecessary medical events is very important in our analysis. Any invasive, unnecessary medical procedure must be considered as part of the larger iatrogenic picture. Unfortunately, cause and effect go unmonitored. The figures on unnecessary events represent people who are thrust into a dangerous health care system. Each of these 16.4 million lives is being affected in ways that could have fatal consequences. Simply entering a hospital could result in the following:

In 16.4 million people, a 2.1% chance (affecting 186,000) of a serious adverse drug reaction(1)
In 16.4 million people, a 5-6% chance (affecting 489,500) of acquiring a nosocomial infection(9)
In16.4 million people, a 4-36% chance (affecting 1.78 million) of having an iatrogenic injury (medical error and adverse drug reactions).(16)
In 16.4 million people, a 17% chance (affecting 1.3 million) of a procedure error.(40)
These statistics represent a one-year time span. Working with the most conservative figures from our statistics, we project the following 10-year death rates.

Table 3: Estimated 10-Year Death Rates from Medical Intervention

Condition 10-Year Deaths
Author
Adverse Drug Reaction 1.06 million (1)
Medical error 0.98 million (6)
Bedsores 1.15 million (7,8)
Nosocomial Infection 0.88 million (9,10)
Malnutrition 1.09 million (11)
Outpatients 1.99 million (12, 112)
Unnecessary Procedures 371,360 (3,13)
Surgery-related 320,000 (85)
Total 7,841,360


Our estimated 10-year total of 7.8 million iatrogenic deaths is more than all the casualties from all the wars fought by the US throughout its entire history.

Our projected figures for unnecessary medical events occurring over a 10-year period also are dramatic.

Table 4: Estimated 10-Year Unnecessary Medical Events

Unnecessary Events 10-year Number Iatrogenic Events
Hospitalization 89 million(4) 17 million
Procedures 75 million(3) 15 million
Total 164 million


These figures show that an estimated 164 million people—more than half of the total US population—receive unneeded medical treatment over the course of a decade.

INTRODUCTION
Never before have the complete statistics on the multiple causes of iatrogenesis been combined in one article. Medical science amasses tens of thousands of papers annually, each representing a tiny fragment of the whole picture. To look at only one piece and try to understand the benefits and risks is like standing an inch away from an elephant and trying to describe everything about it. You have to step back to see the big picture, as we have done here. Each specialty, each division of medicine keeps its own records and data on morbidity and mortality. We have now completed the painstaking work of reviewing thousands of studies and putting pieces of the puzzle together.

Is American Medicine Working?
US health care spending reached $1.6 trillion in 2003, representing 14% of the nation's gross national product.(15) Considering this enormous expenditure, we should have the best medicine in the world. We should be preventing and reversing disease, and doing minimal harm. Careful and objective review, however, shows we are doing the opposite. Because of the extraordinarily narrow, technologically driven context in which contemporary medicine examines the human condition, we are completely missing the larger picture.

Medicine is not taking into consideration the following critically important aspects of a healthy human organism: (a) stress and how it adversely affects the immune system and life processes; (b) insufficient exercise; (c) excessive caloric intake; (d) highly processed and denatured foods grown in denatured and chemically damaged soil; and (e) exposure to tens of thousands of environmental toxins. Instead of minimizing these disease-causing factors, we cause more illness through medical technology, diagnostic testing, overuse of medical and surgical procedures, and overuse of pharmaceutical drugs. The huge disservice of this therapeutic strategy is the result of little effort or money being spent on preventing disease.

Underreporting of Iatrogenic Events
As few as 5% and no more than 20% of iatrogenic acts are ever reported.(16,24,25,33,34) This implies that if medical errors were completely and accurately reported, we would have an annual iatrogenic death toll much higher than 783,936. In 1994, Leape said his figure of 180,000 medical mistakes resulting in death annually was equivalent to three jumbo-jet crashes every two days.(16) Our considerably higher figure is equivalent to six jumbo jets are falling out of the sky each day.

What we must deduce from this report is that medicine is in need of complete and total reform—from the curriculum in medical schools to protecting patients from excessive medical intervention. It is obvious that we cannot change anything if we are not honest about what needs to be changed. This report simply shows the degree to which change is required.

We are fully aware of what stands in the way of change: powerful pharmaceutical and medical technology companies, along with other powerful groups with enormous vested interests in the business of medicine. They fund medical research, support medical schools and hospitals, and advertise in medical journals. With deep pockets, they entice scientists and academics to support their efforts. Such funding can sway the balance of opinion from professional caution to uncritical acceptance of new therapies and drugs. You have only to look at the people who make up the hospital, medical, and government health advisory boards to see conflicts of interest. The public is mostly unaware of these interlocking interests.

For example, a 2003 study found that nearly half of medical school faculty who serve on institutional review boards (IRB) to advise on clinical trial research also serve as consultants to the pharmaceutical industry.(17) The study authors were concerned that such representation could cause potential conflicts of interest. A news release by Dr. Erik Campbell, the lead author, said, "Our previous research with faculty has shown us that ties to industry can affect scientific behavior, leading to such things as trade secrecy and delays in publishing research. It's possible that similar relationships with companies could affect IRB members' activities and attitudes.”(18)

Medical Ethics and Conflict of Interest in Scientific Medicine
Jonathan Quick, director of essential drugs and medicines policy for the World Health Organization (WHO), wrote in a recent WHO bulletin: "If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken."(19)

As former editor of the New England Journal of Medicine , Dr. Marcia Angell struggled to bring greater attention to the problem of commercializing scientific research. In her outgoing editorial entitled “ Is Academic Medicine for Sale?” Angell said that growing conflicts of interest are tainting science and called for stronger restrictions on pharmaceutical stock ownership and other financial incentives for researchers:(20) “When the boundaries between industry and academic medicine become as blurred as they are now, the business goals of industry influence the mission of medical schools in multiple ways.” She did not discount the benefits of research but said a Faustian bargain now existed between medical schools and the pharmaceutical industry.

Angell left the New England Journal in June 2000. In June 2002, the New England Journal of Medicine announced that it would accept journalists who accept money from drug companies because it was too difficult to find ones who have no ties. Another former editor of the journal, Dr. Jerome Kassirer, said that was not the case and that plenty of researchers are available who do not work for drug companies.(21) According to an ABC news report, pharmaceutical companies spend over $2 billion a year on over 314,000 events attended by doctors.

The ABC news report also noted that a survey of clinical trials revealed that when a drug company funds a study, there is a 90% chance that the drug will be perceived as effective whereas a non-drug-company-funded study will show favorable results only 50% of the time. It appears that money can't buy you love but it can buy any "scientific" result desired.

Cynthia Crossen, a staffer for the Wall Street Journal, i n 1996 published Tainted Truth : The Manipulation of Fact in America , a book about the widespread practice of lying with statistics.(22) Commenting on the state of scientific research, she wrote: “The road to hell was paved with the flood of corporate research dollars that eagerly filled gaps left by slashed government research funding.” Her data on financial involvement showed that in l981 the drug industry “gave” $292 million to colleges and universities for research. By l991, this figure had risen to $2.1 billion.
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Re: The state of medicine?

Postby Michael on Sun May 25, 2008 6:41 am

Not surprised at all. Got a linK?
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Re: The state of medicine?

Postby Darth Rock&Roll on Sun May 25, 2008 7:07 am

Those numbers seem a lot higher than they were before, but that can be accounted for with a growing population.

yes, people die in the hands of their doctors.

quite often so.

Not because of the doctors fault all the time, but rather people don't go see a doctor until their problem is so fucking acutre it is hard to deal with.

preventitive medicine and practice is so far off the radar in our societies it is ridiculous.

so, we as martial artists and such are probably going to be a lot more shocked by this stuff relating to our own experiences which is generally along the lines of taking care of oneself rather diligently.
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Re: The state of medicine?

Postby Michael on Sun May 25, 2008 7:12 am

My favorite part of the report:

"Medicine is not taking into consideration the following critically important aspects of a healthy human organism: (a) stress and how it adversely affects the immune system and life processes; (b) insufficient exercise; (c) excessive caloric intake; (d) highly processed and denatured foods grown in denatured and chemically damaged soil; and (e) exposure to tens of thousands of environmental toxins. Instead of minimizing these disease-causing factors, we cause more illness through medical technology, diagnostic testing, overuse of medical and surgical procedures, and overuse of pharmaceutical drugs. The huge disservice of this therapeutic strategy is the result of little effort or money being spent on preventing disease."
"but we’re going to hunt down that last point-one percent and say: ‘you’ve gotta get inside, you gotta cut it out, and you gotta distance.’” —Mayor Garcetti
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Re: The state of medicine?

Postby kenneth delves on Sun May 25, 2008 9:24 am

Death By MedicineDeath by Medicine By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD. Something is wrong when regulatory ...
www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm
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Re: The state of medicine?

Postby Chanchu on Sun May 25, 2008 10:45 am

"Unnecessary Procedures 37,136 $122 billion HCUP(3,13)
Surgery-Related 32,000 $9 billion"

Yes medicine is in bad shape- elective non required surgury, and so on- patients are not told the facts about the long hard road of rehab- and that fact that the outcome may not be optimal " fix me syndrome" has a big effect on this.

Profit driven...

In the past military medicine* was disconected from this (I mean the profit aspect of it) Now the military medical system is intwined with civilian HMOs. This does not bode well for the troops.

Massive budget cuts closer of military hospitals and reductions in patient treatment medical staff- bean counters reign surpreme. Why was this done done? because they did not forsee future conflicts, saw the profit angle from the HMO's or what? No matter- no going back the current system is neither fish nor fowl.

American medical care over all is in trouble- pretty bad shape.

* Of course there were were big problems under the old military medical care system as well.

another factor is- Many good people are being driven out of medicine- tired of being unjustly sued and HMO strangulation.

"Medicine is not taking into consideration the following critically important aspects of a healthy human organism: (a) stress and how it adversely affects the immune system and life processes; (b) insufficient exercise; (c) excessive caloric intake; (d) highly processed and denatured foods grown in denatured and chemically damaged soil; and (e) exposure to tens of thousands of environmental toxins. Instead of minimizing these disease-causing factors, we cause more illness through medical technology, diagnostic testing, overuse of medical and surgical procedures, and overuse of pharmaceutical drugs. The huge disservice of this therapeutic strategy is the result of little effort or money being spent on preventing disease."

Yes thats the key right there- no profit in teaching people how to exercise. Stress- If a patient has a negative reaction to undue stress- they send the patient to a psy. doctor. Instead of reducing or mitigating the stress factors.

Put them on drugs more profit.
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Re: The state of medicine?

Postby qiphlow on Sun May 25, 2008 11:52 am

besides all the obvious "we should teach more prevention" stuff, the number one obstacle to fixing the healthcare system is getting over the idea that healthcare is a commodity. i've been in healthcare now for about 20 years. everything started it's downward spiral when this idea of managed care came into play. granted, at the time it seemed to be a wonderful idea: "hey doc, how's about you let us insurance companies and business folks worry about your billing and stuff? we're good at it, and you can spend your time doctoring!" unfortunately, what ended up happening was what we see today: money becomes the deciding factor in a patient's treatment. while hospitals need money to function (equipment, supplies, staff salaries, keep the lights on, etc.), too often necessary treatments are not given to patients because they can't afford to pay or the patient's insurance company has decided that it won't pay for the treatment. it's fucked up for sure. there's no easy solution.
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Re: The state of medicine?

Postby Darth Rock&Roll on Sun May 25, 2008 6:45 pm

true.

i think it should be part of the education system that it is imperative that we take care of ourselves as individuals.
Also, the outlawing of deliberately advertsing bad habit food to young impressionable minds would be a good thing.

In Canuckistan, tobacco and alcohol advertising are extremely limited, but over saturated fats and foods that are shown to lead to obesity and ultimately diabetes and untimely death are not restricted in their advertising despite the facts that we now know about shit food such as mcdonalds and burgers king and wendys and other shit food distributors who are contributing to the terrible daily living practices by capitalizing on inherent weaknesses.

there needs to be social changes that eradicate that style of food and replace it with better fare. I think some small steps have been taken towards that, but still not enough. This would also trickle back up into how much environmental damage is done by the deforestation of say south america to make way for ranches that produce the beef that goes into burgers all over the world.

anyway...
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Re: The state of medicine?

Postby Michael on Mon May 26, 2008 5:19 am

Hey, I think you're right and there is a big picture of huge agro-business leading us into eating stuff that has the highest profit margin. Diet and nutrition is sofa king important, but it's likely that the vast majority of calories ingested in the USA are fast food and junk food that needs heavy advertising and marketing to get people used to it at an early age: cartoons and happy meals.
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Re: The state of medicine?

Postby Darth Rock&Roll on Mon May 26, 2008 5:30 am

yes, if we track the average american, the poor slob is getting worse and worse every year.

he's putting on weight and getting more diseased as time goes.

with over 60% of the population in the 25lbs over and obese category, I'd say America has a weight problem and a health problem.

the fact that more than 45% of Americans can't afford or don't have health insurance or reasonable access is another pitfall that will have to be overcome.

Canada is tracking a similar path for the last 10 years. We have our problems too.

I'd say that the self inflicted health problems are at their height in "have" nations and i would also say that people display these tendencies to pollute themselves because we are inherently lazy, greedy, self interested and willfully ignorant all too often.

just mind your own shit and you'll be ok and besides, when it comes to your health, that's all you can do anyway. :)
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Re: The state of medicine?

Postby Steve James on Mon May 26, 2008 5:52 am

Well, a person is already in trouble when he has to go to the hospital :)
And, if he comes out worse than he went in, who's fault is it? Society does seem to depend on the medical establishment to solve its problems.

However, this is also a debate between different medical world views on how to treat illness and how to promote wellness. So, we end up with overly broad statements about one or the other, and both sides trying to "sell" their own version of health.

It is kind of funny. Nowadays, everything is a disease. Are you tired? Do your eyes get red? Do you ever get head aches? Does your stomach ever feel queasy? Would you like to shorten your menstrual cycle and make it less severe? How's your breath? At any rate, you choices; you can either eat the right foods, take the right vitamins, take the right medications or go to the hospital. Any way you choose will cost you, though :)
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Re: The state of medicine?

Postby Michael on Mon May 26, 2008 6:05 am

It was the medical establishment that touted itself as the answer to our problems and participated in the marketing for much of the stuff that makes us sick. Remember the TV ad's of MD's smoking and telling us how good it was?
"but we’re going to hunt down that last point-one percent and say: ‘you’ve gotta get inside, you gotta cut it out, and you gotta distance.’” —Mayor Garcetti
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Re: The state of medicine?

Postby Steve James on Mon May 26, 2008 6:38 am

Michael wrote:It was the medical establishment that touted itself as the answer to our problems and participated in the marketing for much of the stuff that makes us sick. Remember the TV ad's of MD's smoking and telling us how good it was?


Yeah, I remember. however, those doctors were also smokers. They'd smoke in their offices.

No one can argue that cigarette companies have not knowingly promoted unhealthy activities. Then, again, so have the producers of liquors and the bakers of white bread. Milk and sugar aren't so hot, either. But, in none of these cases, imo, is it reasonable to suggest that the medical establishment has produced or caused the problem.

Imo, it's also true that the medical establishment has, on the whole, been resistant to alternatives. But, all establishments are conservative. The parts of the medical establishment that are connected with the cost of medical care are one thing. We all would like to be able to afford it. Otoh, that means that somewhere along the line someone is going to make a profit. When it comes to pharmaceuticals that people need, it will always seems unfair. When companies patent medicines, it seems unjust.

Those are different from the "western medicine is bad" argument. It is just people.
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