Death By Medicine
By: Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD;
Debora Rasio, MD; and Dorothy Smith, PhD, 2004
What you are about to read is a stunning compilation of facts that documents
that those who seek to abolish consumer access to natural therapies are
misleading the public.
Nearly 800,000 Americans die each year at the hands of government-
sanctioned medicine, while the FDA and other government agencies pretend
to protect the public by harassing those who offer safe alternatives.
A definitive review of medical peer-reviewed journals and government health
statistics shows that American medicine frequently causes more harm than
Each year approximately 2.2 million US hospital patients experience adverse
drug reactions (ADRs) to prescribed medications.
In 1995, Dr. Richard Besser of the federal Center for Disease Control and
Prevention (CDC) estimated the number of unnecessary antibiotics prescribed
annually for viral infections to be 20 million; in 2003, Dr. Besser spoke in terms
of tens of millions of unnecessary antibiotics prescribed annually.
Approximately 7.5 million unnecessary medical and surgical procedures are
performed annually in the US, while approximately 8.9 million Americans are
The estimated total number of iatrogenic deaths—that is, deaths induced
inadvertently by a physician or surgeon or by medical treatment or diagnostic
procedures—in the US annually is 783,936.
It is evident that the American medical system is itself the leading cause of
death and injury in the US. By comparison, approximately 699,697 Americans
died of heart disease in 2001, while 553,251 died of cancer.
Using Dr. Lucian L. Leape’s 1997 medical and drug error rate of 3 million
multiplied by the 14% fatality rate he used in 1994 produces an annual death
rate of 420,000 for drug errors and medical errors combined.
Using this number instead of Lazarou’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.
The enumeration 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.
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.
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.
Never before have 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. 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:
Stress and how it adversely affects the immune system and life processes.
Excessive calorie intake.
Highly processed and denatured foods grown in denatured and chemically
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.
As few as 5% and no more than 20% of iatrogenic events are ever reported.
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. Our
considerably higher figure is equivalent to six jumbo jets falling out of the sky
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
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 (IRBs) to advise on clinical trial research
also serve as consultants to the pharmaceutical industry.
The study authors were concerned that such representation could cause
potential conflicts of interest. In a news release, Dr. Erik Campbell, the lead
“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.”
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.”
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 wrote that growing conflicts of interest are tainting science and
called for stronger restrictions on pharmaceutical stock ownership and other
financial incentives for researchers:
“When the boundaries between industry and academic medicine become as
blurred as they are now,” Angell wrote, “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. 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, in 1996 published
Tainted Truth: The Manipulation of Fact in America, a book about the
widespread practice of lying with statistics. 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 1981, the drug industry
“gave” $292 million to colleges and universities for research. By 1991, this
figure had risen to $2.1 billion.
The First Iatrogenic Study
Dr. Lucian L. Leape opened medicine’s Pandora’s box in his 1994 paper,
“Error in Medicine” which appeared in the Journal of the American Medical
He found that Schimmel reported in 1964 that 20% of hospital patients suffered
iatrogenic injury, with a 20% fatality rate. In 1981, Steel reported that 36% of
hospitalized patients experienced iatrogenesis, with a 25% fatality rate, and
adverse drug reactions were involved in 50% of the injuries.
In 1991, Bedell reported that 64% of acute heart attacks in one hospital were
preventable and were mostly due to adverse drug reactions.
Leape focused on the “Harvard Medical Practice Study” published in 1991,
which found a 4% iatrogenic injury rate for patients, with a 14% fatality rate, in
1984 in New York State. From the 98,609 patients injured and the 14% fatality
rate, he estimated that in the entire US, 180,000 people die each year partly as a
result of iatrogenic injury.
Why Leape chose to use the much lower figure of 4% injury for his analysis
remains in question. Using instead the average of the rates found in the three
studies he cites (36%, 20%, and 4%) would have produced a 20% medical
error rate. The number of iatrogenic deaths using an average rate of injury and
his 14% fatality rate would be 1,189,576.
Leape acknowledged that the literature on medical errors is sparse and
represents only the tip of the iceberg, noting that when errors are specifically
sought out, reported rates are “distressingly high.” He cited several autopsy
studies with rates as high as 35-40% of missed diagnoses causing death. He
also noted that an intensive care unit reported an average of 1.7 errors per day
per patient, and 29% of those errors were potentially serious or fatal.
In trying to determine why there are so many medical errors, Leape
acknowledged the lack of reporting of medical errors. Medical errors occur in
thousands of different locations and are perceived as isolated and unusual
But the most important reason that the problem of medical errors is
unrecognized and growing, according to Leape, is that doctors and nurses are
unequipped to deal with human error because of the culture of medical
training and practice. Doctors are taught that mistakes are unacceptable.
Medical mistakes are therefore viewed as a failure of character and any error
No one is taught what to do when medical errors do occur. Leape cites
McIntyre and Popper, who said the “infallibility model” of medicine leads to
intellectual dishonesty with a need to cover up mistakes rather than admit
There are no Grand Rounds on medical errors, no sharing of failures among
doctors, and no one to support them emotionally when their error harms a
Leape hoped his paper would encourage medical practitioners “to
fundamentally change the way they think about errors and why they occur.” It
has been almost a decade since this groundbreaking work, but the mistakes
continue to soar.
In 1995, a JAMA report noted:
“Over a million patients are injured in US hospitals each year, and
approximately 280,000 die annually as a result of these injuries. Therefore, the
iatrogenic death rate dwarfs the annual automobile accident mortality rate of
45,000 and accounts for more deaths than all other accidents combined.”
At a 1997 press conference, Leape released a nationwide poll on patient
iatrogenesis conducted by the National Patient Safety Foundation (NPSF),
which is sponsored by the American Medical Association (AMA). Leape is a
founding member of NPSF.
The survey found that more than 100 million Americans have been affected
directly or indirectly by a medical mistake. Forty-two percent were affected
directly and 84% personally knew of someone who had experienced a medical
At this press conference, Leape updated his 1994 statistics, noting that as of
1997, medical errors in inpatient hospital settings nationwide could be as high
as 3 million and could cost as much as $200 billion.
Leape used a 14% fatality rate to determine a medical error death rate of
180,000 in 1994. In 1997, using Leape’s base number of 3 million errors, the
annual death rate could be as high as 420,000 for hospital inpatients alone.
Only a Fraction of Medical Errors Are Reported
In 1994, Leape said he was well aware that medical errors were not being
reported. A study conducted in two obstetrical units in the UK found that only
about one quarter of adverse incidents were ever reported, to protect staff,
preserve reputations, or for fear of reprisals, including lawsuits.
An analysis by Wald and Shojania found that only 1.5% of all adverse events
result in an incident report, and only 6% of adverse drug events are identified
The authors learned that the American College of Surgeons estimates that
surgical incident reports routinely capture only 5-30% of adverse events. In
one study, only 20% of surgical complications resulted in discussion at
morbidity and mortality rounds. From these studies, it appears that all the
statistics gathered on medical errors may substantially underestimate the
number of adverse drug and medical therapy incidents.
They also suggest that our statistics concerning mortality resulting from
medical errors may be in fact conservative figures.
An article in Psychiatric Times (April 2000) outlines the stakes involved in
reporting medical errors. The authors found that the public is fearful of
suffering a fatal medical error, and doctors are afraid they will be sued if they
report an error. This brings up the obvious question: who is reporting medical
Usually it is the patient or the patient’s surviving family. If no one notices the
error, it is never reported.
Janet Heinrich, an associate director at the US General Accounting Office
responsible for health financing and public health issues, testified before a
House subcommittee hearing on medical errors that:
“The full magnitude of their threat to the American public is unknown” and
“gathering valid and useful information about adverse events is extremely
She acknowledged that the fear of being blamed, and the potential for legal
liability, played key roles in the underreporting of errors. The Psychiatric
Times noted that the AMA strongly opposes mandatory reporting of medical
If doctors are not reporting, what about nurses? A survey of nurses found that
they also fail to report medical mistakes for fear of retaliation.
Standard medical pharmacology texts admit that relatively few doctors ever
report adverse drug reactions to the FDA. The reasons range from not
knowing such a reporting system exists to fear of being sued.
Yet the public depends on this tremendously flawed system of voluntary
reporting by doctors to know whether a drug or a medical intervention is
Pharmacology texts also will tell doctors how hard it is to separate drug side
effects from disease symptoms. Treatment failure is most often attributed to
the disease and not the drug or doctor.
Doctors are warned: “Probably nowhere else in professional life are mistakes
so easily hidden, even from ourselves.” It may be hard to accept, but it is not
difficult to understand why only 1 in 20 side effects is reported to either
hospital administrators or the FDA.
If hospitals admitted to the actual number of errors for which they are
responsible, which is about 20 times what is reported; they would come under
intense scrutiny. Jerry Phillips, associate director of the FDA’s Office of Post
Marketing Drug Risk Assessment, confirms this number.
“In the broader area of adverse drug reaction data, the 250,000 reports received
annually probably represent only 5% of the actual reactions that occur.”
Dr. Jay Cohen, who has extensively researched adverse drug reactions, notes
that because only 5% of adverse drug reactions are reported, there are in fact
5 million medication reactions each year.
A 2003 survey is all the more distressing because there seems to be no
improvement in error reporting, even with all the attention given to this topic.
Dr. Dorothea Wild surveyed medical residents at a community hospital in
Connecticut and found that only half were aware that the hospital had a
medical error-reporting system, and that the vast majority did not use it at all.
Dr. Wild says this does not bode well for the future. If doctors do not learn
error reporting in their training, they will never use it. Wild adds that error
reporting is the first step in locating the gaps in the medical system and fixing
In a telephone survey, 1,207 adults ranked the effectiveness of the following
measures in reducing preventable medical errors that result in serious harm.
Following each measure is the percentage of respondents who ranked the
measure as “very effective.”
Giving doctors more time to spend with patients (78%).
Requiring hospitals to develop systems to avoid medical errors (74%).
Better training of health professionals (73%).
Using only doctors specially trained in intensive care medicine on intensive
care units (73%).
Requiring hospitals to report all serious medical errors to a state agency
Increasing the number of hospital nurses (69%).
Reducing the work hours of doctors in training to avoid fatigue (66%).
Encouraging hospitals to voluntarily report serious medical errors to a state
Prescription drugs constitute the major treatment modality of scientific
medicine. With the discovery of the “germ theory” medical scientists
convinced the public that infectious organisms were the cause of illness.
Finding the “cure” for these infections proved much harder than anyone
imagined. From the beginning, chemical drugs promised much more than
they delivered. But far beyond not working, the drugs also caused
incalculable side effects. The drugs themselves, even when properly
prescribed, have side effects that can be fatal, as Lazarou’s study showed.
But human error can make the situation even worse.
A survey of a 1992 national pharmacy database found a total of 429,827
medication errors in 1,081 hospitals. Medication errors occurred in 5.22% of
patients admitted to these hospitals each year.
The authors concluded that at least 90,895 patients annually were harmed by
medication errors in the US as a whole.
A 2002 study shows that 20% of hospital medications for patients had dosage
errors. Nearly 40% of these errors were considered potentially harmful to the
patient. In a typical 300-bed hospital, the number of errors per day was 40.
Problems involving patients’ medications were even higher the following
year. The error rate intercepted by pharmacists in this study was 24%, making
the potential minimum number of patients harmed by prescription drugs
Adverse Drug Reactions
More recent studies on adverse drug reactions show that the figures from
1994 published in Lazarou’s 1998 JAMA article may be increasing. A 2003
study followed 400 patients after discharge from a tertiary care hospital setting
(requiring highly specialized skills, technology, or support services).
Seventy-six patients (19%) had adverse events. Adverse drug events were the
most common, at 66% of all events. The next most common event was
procedure-related injuries, at 17%.
In a New England Journal of Medicine study, an alarming one in four patients
suffered observable side effects from the more than 3.34 billion prescription
drugs filled in 2002.
One of the doctors who produced the study was interviewed by Reuters and
“With these 10-minute appointments, it’s hard for the doctor to get into whether
the symptoms are bothering the patients.”
William Tierney, who editorialized on the New England Journal study, wrote:
“Given the increasing number of powerful drugs available to care for the aging
population, the problem will only get worse.”
The drugs with the worst record of side effects were selective serotonin
reuptake inhibitors (SSRIs), nonsteroidal anti-inflammatory drugs (NSAIDs),
and calcium-channel blockers.
Reuters also reported that prior research has suggested that nearly 5% of
hospital admissions (over 1 million per year) are the result of drug side effects.
But most of the cases are not documented as such.
The study found that one of the reasons for this failure is that in nearly two
thirds of the cases, doctors could not diagnose drug side effects or the side
effects persisted because the doctor failed to heed the warning signs.
Medicating Our Feelings
Patients seeking a more joyful existence and relief from worry, stress, and
anxiety often fall victim to the messages endlessly displayed on TV and
Often, instead of gaining relief, they fall victim to the myriad iatrogenic side
effects of antidepressant medication.
Moreover, a whole generation of antidepressant users has been created from
young people growing up on Ritalin. Medicating young people and modifying
their emotions must have some impact on how they learn to deal with their
feelings. They learn to equate coping with drugs rather than with their inner
resources. As adults, these medicated youth reach for alcohol, drugs, or even
street drugs to cope.
According to JAMA: “Ritalin acts much like cocaine.” Today’s marketing of
mood-modifying drugs such as Prozac and Zoloft makes them not only
socially acceptable, but almost a necessity in today’s stressful world.
To reach the widest audience possible, drug companies no longer just target
medical doctors with their marketing of antidepressants. By 1995, drug
companies had tripled the amount of money allotted to direct advertising of
prescription drugs to consumers.
The majority of this money is spent on seductive television ads. From 1996 to
2000, spending rose from $791 million to nearly $2.5 billion. This $2.5 billion
represents only 15% of the total pharmaceutical advertising budget.
While the drug companies maintain that direct-to-consumer advertising is
educational, Dr. Sidney M. Wolfe of the Public Citizen Health Research Group in
Washington, DC, argues that the public often is misinformed about these ads.
People want what they see on television and are told to go to their doctors for
a prescription. Doctors in private practice either acquiesce to their patients’
demands for these drugs or spend valuable time trying to talk patients out of
Dr. Wolfe remarks that one important study found that people mistakenly
believe that the “FDA reviews all ads before they are released and allows only
the safest and most effective drugs to be promoted directly to the public.”
How Do We Know Drugs Are Safe?
Another aspect of scientific medicine that the public takes for granted is the
testing of new drugs. Drugs generally are tested on individuals who are fairly
healthy and not on other medications that could interfere with findings.
But when these new drugs are declared “safe” and enter the drug prescription
books, they are naturally going to be used by people who are on a variety of
other medications and have a lot of other health problems.
Then a new phase of drug testing called “post-approval” comes into play,
which is the documentation of side effects once drugs hit the market. In one
very telling report, the federal government’s General Accounting Office found
“Of the 198 drugs approved by the FDA between 1976 and 1985, 102 (or 51.5%)
had serious post-approval risks, the serious post-approval risks (included)
heart failure, myocardial infarction, anaphylaxis, respiratory depression and
arrest, seizures, kidney and liver failure, severe blood disorders, birth defects
and fetal toxicity, and blindness.”
NBC News’ investigative show “Dateline” wondered if your doctor is
moonlighting as a drug company representative. After a yearlong
investigation, NBC reported that because doctors can legally prescribe any
drug to any patient for any condition, drug companies heavily promote “off
label” and frequently inappropriate and untested uses of these medications,
even though these drugs are approved only for the specific indications for
which they have been tested.
The leading causes of adverse drug reactions are antibiotics (17%),
cardiovascular drugs (17%), chemotherapy (15%), and analgesics and anti-
inflammatory agents (15%).
Specific Drug Iatrogenesis: Antibiotics
According to William Agger, MD, director of microbiology and chief of
infectious disease at Gundersen Lutheran Medical Center in La Crosse, WI, 30
million pounds of antibiotics are used in America each year.
Of this amount, 25 million pounds are used in animal husbandry and 23 million
pounds are used to try to prevent disease and promote growth. Only 2 million
pounds are given for specific animal infections. Dr. Agger reminds us that low
concentrations of antibiotics are measurable in many of our foods and in
various waterways around the world, much of it seeping in from animal farms.
Agger contends that overuse of antibiotics results in food-borne infections
that are resistant to antibiotics. Salmonella is found in 20% of ground meat,
but the constant exposure of cattle to antibiotics has made 84% of salmonella
resistant to at least one anti-salmonella antibiotic.
Diseased animal food accounts for 80% of salmonellosis in humans, or 1.4
million cases per year. The conventional approach to countering this
epidemic is to radiate food to try to kill all organisms while continuing to use
the antibiotics that created the problem in the first place.
Approximately 20% of chickens are contaminated with Campylobacter jejuni,
an organism that causes 2.4 million cases of illness annually. Fifty-four
percent of these organisms are resistant to at least one anti-Campylobacter
Denmark banned growth-promoting antibiotics beginning in 1999, which cut
their use by more than half within a year, from 453,200 to 195,800 pounds. A
report from Scandinavia found that removing antibiotic growth promoters had
no or minimal effect on food production costs.
Agger warns that the current crowded, unsanitary methods of animal farming
in the US support constant stress and infection, and are geared toward high
In the US, over 3 million pounds of antibiotics are used every year on humans.
With a population of 284 million Americans, this amount is enough to give
every man, woman, and child 10 teaspoons of pure antibiotics per year.
Agger says that exposure to a steady stream of antibiotics has altered
pathogens such as Streptococcus pneumoniae, Staplococcus aureus, and
entercocci, to name a few.
Almost half of patients with upper respiratory tract infections in the US still
receive antibiotics from their doctors. According to the CDC, 90% of upper
respiratory infections are viral and should not be treated with antibiotics. In
Germany, the prevalence of systemic antibiotic use in children aged 0-6 years
Data obtained from nine US health insurers on antibiotic use in 25,000 children
from 1996 to 2000 found that rates of antibiotic use decreased. Antibiotic use
in children aged 3 months to under 3 years decreased 24%, from 2.46 to 1.89
antibiotic prescriptions per patient per year.
For children aged 3 to under 6 years, there was a 25% reduction, from 1.47 to
1.09 antibiotic prescriptions per patient per year. And for children aged 6 to
under 18 years, there was a 16% reduction, from 0.85 to 0.69 antibiotic
prescriptions per patient per year. Despite these reductions, the data indicate
that on average, every child in America receives 1.22 antibiotic prescriptions
Group A, beta-hemolytic streptococci is the only common cause of sore throat
that requires antibiotics, with penicillin and erythromycin the only
recommended treatment. Ninety percent of sore-throat cases, however, are
viral. Antibiotics were used in 73% of the estimated 6.7 million adult annual
visits for sore throat in the US between 1989 and 1999.
Furthermore, patients treated with antibiotics were prescribed non-
recommended broad-spectrum antibiotics in 68% of visits. This period saw a
significant increase in the use of newer, more expensive broad-spectrum
antibiotics and a decrease in use of the recommended antibiotics penicillin
Antibiotics being prescribed in 73% of sore-throat cases instead of the
recommended 10% resulted in a total of 4.2 million unnecessary antibiotic
prescriptions from 1989 to 1999.
The Problem with Antibiotics
In September 2003, the CDC re-launched a program started in 1995 called “Get
Smart: Know When Antibiotics Work.” This $1.6 million campaign is designed
to educate patients about the overuse and inappropriate use of antibiotics.
Most people involved with alternative medicine have known about the dangers
of antibiotic overuse for decades. Finally, the government is focusing on the
problem, yet it is spending only a miniscule amount of money on an iatrogenic
epidemic that is costing billions of dollars and thousands of lives.
The CDC warns that 90% of upper respiratory infections, including children’s
ear infections, are viral and that antibiotics do not treat viral infection.
More than 40% of about 50 million prescriptions for antibiotics written each
year in physicians’ offices are inappropriate. Using antibiotics when not
needed can lead to the development of deadly strains of bacteria that are
resistant to drugs and cause more than 88,000 deaths due to hospital-acquired
The CDC, however, seems to be blaming patients for misusing antibiotics even
though they are available only by prescription from physicians. According to
Dr. Richard Besser, head of the “Get Smart” program to educate patients about
proper antibiotic use, says:
“Programs that have just targeted physicians have not worked. Direct-to-
consumer advertising of drugs is to blame in some cases.”
Besser says the program:
“Teaches patients and the general public that antibiotics are precious resources
that must be used correctly if we want to have them around when we need
them. Hopefully, as a result of this campaign, patients will feel more
comfortable asking their doctors for the best care for their illnesses, rather than
asking for antibiotics.”
What constitutes the “best care”? The CDC does not elaborate and ignores
the latest research on the dozens of nutraceuticals that have been
scientifically proven to treat viral infections and boost immune-system
Will doctors recommend garlic, vitamin C, lactoferrin, elderberry, vitamin A,
zinc, or DHEA? Probably not.
The CDC’s common-sense recommendations that most people follow anyway
include getting proper rest, drinking plenty of fluids, and using a humidifier.
The pharmaceutical industry claims it supports limiting the use of antibiotics.
The drug company Bayer sponsors a program called “Operation Clean Hands”
through an organization called LIBRA.
The CDC also is involved in trying to minimize antibiotic resistance, but
nowhere in its publications is there any reference to the role of nutraceuticals
in boosting the immune system, or to the thousands of journal articles that
support this approach.
This tunnel vision and refusal to recommend the available non-drug
alternatives is unfortunate when the CDC is desperately trying to curb the
overuse of antibiotics.
Drugs Pollute Our Water Supply
We have reached the point of saturation with prescription drugs. Every body
of water tested contains measurable drug residues. The tons of antibiotics
used in animal farming, which run off into the water table and surrounding
bodies of water, are conferring antibiotic resistance to germs in sewage, and
these germs also are found in our water supply.
Flushed down our toilets are tons of drugs and drug metabolites that also find
their way into our water supply. We have no way to know the long-term health
consequences of ingesting a mixture of drugs and drug-breakdown products.
These drugs represent another level of iatrogenic disease that we are unable
to completely measure.
Specific Drug Iatrogenesis: NSAIDs
It is not only the US that is plagued by iatrogenesis. A survey of more than
1,000 French general practitioners (GPs) tested their basic pharmacological
knowledge and practice in prescribing NSAIDs, which rank first among
commonly prescribed drugs for serious adverse reactions.
The study results suggest that GPs do not have adequate knowledge of these
drugs and are unable to effectively manage adverse reactions.
A cross-sectional survey of 125 patients attending specialty pain clinics in
South London found that possible iatrogenic factors such as:
“Over-investigation, inappropriate information, and advice given to patients as
well as misdiagnosis, over-treatment, and inappropriate prescription of
medication were common.”
Specific Drug Iatrogenesis: Cancer Chemotherapy
In 1989, German biostatistician Ulrich Abel, PhD, wrote a monograph entitled
“Chemotherapy of Advanced Epithelial Cancer.” It was later published in
shorter form in a peer-reviewed medical journal.
Abel presented a comprehensive analysis of clinical trials and publications
representing over 3,000 articles examining the value of cytotoxic
chemotherapy on advanced epithelial cancer.
Epithelial cancer is the type of cancer with which we are most familiar, arising
from epithelium found in the lining of body organs such as the breast,
prostate, lung, stomach, and bowel. From these sites, cancer usually
infiltrates adjacent tissue and spreads to the bone, liver, lung, or brain.
With his exhaustive review, Abel concluded there is no direct evidence that
chemotherapy prolongs survival in most patients with advanced carcinoma.
According to Abel:
“Many oncologists take it for granted that response to therapy prolongs
survival, an opinion which is based on a fallacy and which is not supported by
Over a decade after Abel’s exhaustive review of chemotherapy, there seems
no decrease in its use for advanced carcinoma. For example, when
conventional chemotherapy and radiation have not worked to prevent
metastases in breast cancer, high-dose chemotherapy (HDC) along with
stem-cell transplant (SCT) is the treatment of choice.
In March 2000, however, results from the largest multi-center randomized
controlled trial conducted thus far showed that, compared to a prolonged
course of monthly conventional-dose chemotherapy, HDC and SCT were of
no benefit, with even a slightly lower survival rate for the HDC/SCT group.
Serious adverse effects occurred more often in the HDC group than in the
standard-dose group. One treatment-related death (within 100 days of
therapy) was recorded in the HDC group, but none was recorded in the
conventional chemotherapy group. The women in this trial were highly
selected as having the best chance to respond.
Unfortunately, no all-encompassing follow-up study such as Dr. Abel’s exists
to indicate whether there has been any improvement in cancer-survival
statistics since 1989.
In fact, research should be conducted to determine whether chemotherapy
itself is responsible for secondary cancers instead of progression of the
original disease. We continue to question why well-researched alternative
cancer treatments are not used.
Drug Companies Fined
Periodically, the FDA fines a drug manufacturer when its abuses are too
glaring and impossible to cover up. In May 2002, the Washington Post
reported that Schering-Plough Corp., the maker of Claritin, was to pay a $500
million fine to the FDA for quality-control problems at four of its factories. The
indictment came after the Public Citizen Health Research Group, led by
Dr. Sidney Wolfe, called for a criminal investigation of Schering-Plough,
charging that the company distributed albuterol asthma inhalers even though
it knew the units were missing the active ingredient.
The FDA tabulated infractions involving 125 products, or 90% of the drugs
made by Schering-Plough since 1998. Besides paying the fine, the company
was forced to halt the manufacture of 73 drugs or suffer another $175 million
fine. Schering-Plough’s news releases told another story, assuring
consumers that they should still feel confident in the company’s products.
This large settlement served as a warning to the drug industry about
maintaining strict manufacturing practices and has given the FDA more clout
in dealing with drug company compliance.
According to the Washington Post article, a federal appeals court ruled in 1999
that the FDA could seize the profits of companies that violate “good
Since that time, Abbott Laboratories has paid a $100 million fine for failing to
meet quality standards in the production of medical test kits, while Wyeth
Laboratories paid $30 million in 2000 to settle accusations of poor
Unnecessary Surgical Procedures
In 1974, 2.4 million unnecessary surgeries were performed, resulting in 11,900
deaths at a cost of $3.9 billion.
In 2001, 7.5 million unnecessary surgical procedures were performed,
resulting in 37,136 deaths at a cost of $122 billion (using 1974 dollars).
It is very difficult to obtain accurate statistics when studying unnecessary
surgery. In 1989, Leape wrote that perhaps 30% of controversial surgeries—
which include cesarean section, tonsillectomy, appendectomy, hysterectomy,
gastrectomy for obesity, breast implants, and elective breast implants— are
In 1974, the Congressional Committee on Interstate and Foreign Commerce
held hearings on unnecessary surgery. It 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.
According to the Healthcare Cost and Utilization Project within the Agency for
Healthcare Research and Quality, in 2001 the 50 most common medical and
surgical procedures were performed approximately 41.8 million times in the
Using the 1974 House Subcommittee on Oversight and Investigations’ figure
of 17.6% as the percentage of unnecessary surgical procedures, and
extrapolating from the death rate in 1974, produces nearly 7.5 million
(7,489,718) unnecessary procedures and a death rate of 37,136, at a cost of
$122 billion (using 1974 dollars).
In 1995, researchers conducted a similar analysis of back surgery procedures,
using the 1974 “unnecessary surgery percentage” of 17.6%. Testifying before
the Department of Veterans Affairs, they estimated that of the 250,000 back
surgeries performed annually in the US at a hospital cost of $11,000 per
patient, the total number of unnecessary back surgeries approaches 44,000,
costing as much as $484 million.
Like prescription drug use driven by television advertising, unnecessary
surgeries are escalating. Media-driven surgery such as gastric bypass for
obesity “modeled” by Hollywood celebrities seduces obese people into
thinking this route is safe and sexy.
Unnecessary surgeries have even been marketed on the Internet. A study in
Spain declares that 20-25% of total surgical practice represents unnecessary
According to data from the National Center for Health Statistics for 1979 to
1984, the total number of surgical procedures increased 9% while the number
of surgeons grew 20%.
The study notes that the large increase in the number of surgeons was not
accompanied by a parallel increase in the number of surgeries performed, and
expressed concern about an excess of surgeons to handle the surgical
From 1983 to 1994, however, the incidence of the 10 most commonly
performed surgical procedures jumped 38%, to 7,929,000 from 5,731,000
cases. By 1994, cataract surgery was the most common procedure, with more
than 2 million operations, followed by cesarean section (858,000 procedures)
and inguinal hernia operations (689,000 procedures). Knee arthroscopy
procedures increased 153% while prostate surgery declined 29%.
The list of iatrogenic complications from surgery is as long as the list of
procedures themselves. One study examined catheters that were inserted to
deliver anesthetic into the epidural space around the spinal nerves 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.
In one review of the literature, the authors found:
“A significant rate of over utilization of coronary angiography, coronary artery
surgery, cardiac pacemaker insertion, upper gastrointestinal endoscopies,
carotid endarterectomies, back surgery, and pain-relieving procedures.”
A 1987 JAMA study found the following significant levels of inappropriate
surgery: 17% of coronary angiography procedures, 32% of carotid
endarterectomy procedures, and 17% of upper gastrointestinal tract
Based on the Healthcare Cost and Utilization Project (HCUP) statistics
provided by the government for 2001, 697,675 upper gastrointestinal
endoscopies (usually entailing biopsy) were performed, as were 142,401
endarterectomies and 719,949 coronary angiographies.
Extrapolating the JAMA study’s inappropriate surgery rates to 2001 produces
118,604 unnecessary endoscopy procedures, 45,568 unnecessary
endarterectomies, and 122,391 unnecessary coronary angiographies.
These are all forms of medical iatrogenesis.
Medical and Surgical Procedures
It is instructive to know the mortality rates associated with various medical and
Although we must sign release forms when we undergo any procedure, many
of us are in denial about the true risks involved; because medical and surgical
procedures are so commonplace, they often are seen as both necessary and
safe. Unfortunately, allopathic medicine itself is a leading cause of death, as
well as the most expensive way to die.
Perhaps the words “health care” confer the illusion that medicine is about
health. Allopathic medicine is not a purveyor of health care but of disease
care. The HCUP figures are instructive, but the computer program that
calculates annual mortality statistics for all US hospital discharges is only as
good as the codes entered into the system.
In email correspondence, HCUP indicated that the mortality rates for each
procedure indicated only that someone undergoing that procedure died either
from the procedure or from some other cause.
Thus, there is no way of knowing exactly how many people die from a
particular procedure. While codes for “poisoning & toxic effects of drugs” and
“complications of treatment” do exist, the mortality figures registered in these
categories are very low and do not correlate with what is known from research
such as the 1998 JAMA study that estimated an average of 106,000
prescription medication deaths per year.
No codes exist for adverse drug side effects, surgical mishaps, or other types
of medical error. Until such codes exist, the true mortality rates tied to medical
error will remain buried in the general statistics.
An Honest Look at US Health Care
In 1978, the US Office of Technology Assessment (OTA) reported: “Only 10-
20% of all procedures currently used in medical practice have been shown to be
efficacious by controlled trial.”
In 1995, the OTA compared medical technology in eight countries (Australia,
Canada, France, Germany, the Netherlands, Sweden, the UK, and the US) and
again noted that few medical procedures in the US have been subjected to
clinical trial. It also reported that US infant mortality was high and life
expectancy low compared to other developed countries.
Surgical Errors Finally Reported
An October 2003 JAMA study from the US 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 hospital
days in 2000.
Data from 20% of the nation’s hospitals were analyzed for 18 different surgical
complications, including post-operative infections; foreign objects left in
wounds, surgical wounds reopening, and post-operative bleeding.
In a press release accompanying the study, AHRQ director Carolyn M. Clancy,
“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.”
According to the study’s authors:
“The findings greatly underestimate the problem, since many other
complications happen that are not listed in hospital administrative data.”
They added, “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.”
The study authors said that improved medical practices, including an
emphasis on better hand washing, might help reduce morbidity and mortality
rates. In an accompanying JAMA editorial, health-risk researcher Dr. Saul
Weingart of Harvard’s Beth Israel-Deaconess Medical Center wrote, “Given
their staggering magnitude, these estimates are clearly sobering.”
When x-rays were discovered, no one knew the long-term effects of ionizing
radiation. In the 1950s, monthly fluoroscopic exams at the doctor’s office were
routine, and you could even walk into most shoe stores and see x-rays of your
foot bones. We still do not know the ultimate outcome of our initial fascination
In those days, it was common practice to x-ray pregnant women to measure
their pelvises and make a diagnosis of twins. Finally, a study of 700,000
children born between 1947 and 1964 in 37 major maternity hospitals
compared the children of mothers who had received pelvic x-rays during
pregnancy to those of mothers who did not. It found that cancer mortality was
40% higher among children whose mothers had been x-rayed.
In present-day medicine, coronary angiography is an invasive surgical
procedure that involves snaking a tube through a blood vessel in the groin up
to the heart.
To obtain useful information, x-rays are taken almost continuously, with
minimum dosages ranging from 460 to 1,580 mrem. The minimum radiation
from a routine chest x-ray is 2 mrem. X-ray radiation accumulates in the body,
and ionizing radiation used in x-ray procedures has been shown to cause
The health impact of this high level of radiation is unknown, and often
obscured in statistical jargon such as, “The risk for lifetime fatal cancer due to
radiation exposure is estimated to be 4 in 1 million per 1,000 mrem.”
Dr. John Gofman has studied the effects of radiation on human health for 45
years. A medical doctor with a PhD in nuclear and physical chemistry, Dr.
Gofman worked on the Manhattan Project, discovered uranium-233, and was
the first person to isolate plutonium.
In five scientifically documented books, Dr. Gofman provides strong evidence
that medical technology—specifically x-rays, CT scans, and mammography
and fluoroscopy devices—are a contributing factor to 75% of new cancers.
In a nearly 700-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” Gofman shows
that as the number of physicians increases in a geographical area along with
an increase in the number of x-ray diagnostic tests performed, the rate of
cancer and ischemic heart disease also increases.
Gofman elaborates that it is not x-rays alone that cause the damage but a
combination of health risk factors that include poor diet, smoking, abortions,
and the use of birth control pills. Dr. Gofman predicts that ionizing radiation
will be responsible for 100 million premature deaths over the next decade.
In his book, “Preventing Breast Cancer” Dr. Gofman notes that breast cancer
is the leading cause of death among American women between the ages of 44
and 55. Because breast tissue is highly sensitive to radiation, mammograms
can cause cancer.
The danger can be heightened by other factors, including a woman’s genetic
makeup, preexisting benign breast disease, artificial menopause, obesity, and
Even x-rays for back pain can lead someone into crippling surgery. Dr. John E.
Sarno, a well-known New York orthopedic surgeon, found that there is not
necessarily any association between back pain and spinal x-ray abnormality.
He cites studies of normal people without a trace of back pain whose x-rays
indicate spinal abnormalities and of people with back pain whose spines
appear to be normal on x-ray. People who happen to have back pain and
show an abnormality on x-ray may be treated surgically, sometimes with no
change in back pain, worsening of back pain, or even permanent disability.
Moreover, doctors often order x-rays as protection against malpractice claims,
to give the impression of leaving no stone unturned. It appears that doctors
are putting their own fears before the interests of their patients.
Nearly 9 million people were hospitalized unnecessarily in 2001. In a study of
inappropriate hospitalization, two doctors reviewed 1,132 medical records.
They concluded that 23% of all admissions were inappropriate and an
additional 17% could have been handled in outpatient clinics.
Thirty-four percent of all hospital days were deemed inappropriate and could
have been avoided. The rate of inappropriate hospital admissions in 1990 was
23.5%. In 1999, another study also found an inappropriate admissions rate of
24%, indicating a consistent pattern from 1986 to 1999.
The HCUP database indicates that the total number of patient discharges from
US hospitals in 2001 was 37,187,641,meaning that almost 9 million people were
exposed to unnecessary medical intervention in hospitals and therefore
represent almost 9 million potential iatrogenic episodes.
Women’s Experience in Medicine
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 10 hysterical women
each day, transforming them into “iatrogenic monsters” and turning simple
“neurosis” into hysteria.
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. According to
Dr. Adriane Fugh-Berman, US medicine has a tradition of excessive medical
and surgical interventions on women.
Only 100 years ago, male doctors believed 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
Fugh-Berman notes that US doctors eventually disabused themselves of that
notion but have continued to treat women very differently than they treat men.
She cites the following statistics:
Thousands of prophylactic mastectomies are performed annually.
One third of US women have had a hysterectomy before menopause.
Women are prescribed drugs more frequently than are men.
Women are given potent drugs for disease prevention, which results in
disease substitution due to side effects.
Fetal monitoring is unsupported by studies and not recommended by the
CDC. It confines women to a hospital bed and may result in a higher incidence
of cesarean section.
Normal processes such as menopause and childbirth have been heavily
Synthetic hormone replacement therapy (HRT) does not prevent heart disease
or dementia, but does increase the risk of breast cancer, heart disease, stroke,
and gall bladder attack.
As many as a third of postmenopausal women use HRT. This number is
important in light of the much-publicized Women’s Health Initiative study,
which was halted before its completion because of a higher death rate in the
synthetic estrogen-progestin (HRT) group.
In 1983, 809,000 cesarean sections (21% of live births) were performed in the
US, making it the nation’s most common obstetric-gynecologic (OB-GYN)
The second most common OB-GYN operation was hysterectomy (673,000),
followed by diagnostic dilation and curettage of the uterus (632,000). In 1983,
OB-GYN procedures represented 23% of all surgeries completed in the US.
In 2001, cesarean section was still the most common OB-GYN surgical
procedure. Approximately 4 million births occur annually, with 24% (960,000)
delivered by cesarean section.
In the Netherlands, only 8% of births are delivered by cesarean section. This
suggests 640,000 unnecessary cesarean sections—entailing three to four
times higher mortality and 20 times greater morbidity than vaginal delivery—
are performed annually in the US.
The US cesarean rate rose from just 4.5% in 1965 to 24.1% in 1986. Sakala
contends that an “uncontrolled pandemic of medically unnecessary cesarean
births is occurring.”
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.
Never Enough Studies
Scientists claimed there were never enough studies revealing the dangers of
DDT and other dangerous pesticides to ban them. They also used this
argument for tobacco, claiming that more studies were needed before they
could be certain that tobacco really caused lung cancer.
Even the American Medical Association (AMA) was complicit in suppressing
the results of tobacco research. In 1964, when the Surgeon General’s report
condemned smoking, the AMA refused to endorse it, claiming a need for more
What they really wanted was more money, which they received from a
consortium of tobacco companies that paid the AMA $18 million over the next
nine years, during which the AMA said nothing about the dangers of smoking.
The Journal of the American Medical Association (JAMA), “after careful
consideration of the extent to which cigarettes were used by physicians in
practice” began accepting tobacco advertisements and money in 1933.
State journals such as the New York State Journal of Medicine also began to
run advertisements for Chesterfield cigarettes that claimed cigarettes are “Just
as pure as the water you drink . . . and practically untouched by human hands.”
In 1948, JAMA argued:
“More can be said in behalf of smoking as a form of escape from tension than
against it, there does not seem to be any preponderance of evidence that would
indicate the abolition of the use of tobacco as a substance contrary to the
Today, scientists continue to use the excuse that more studies are needed
before they will support restricting the inordinate use of drugs.
Adverse Drug Reactions
The Lazarou study analyzed records for prescribed medications for 33 million
US hospital admissions in 1994. It discovered 2.2 million serious injuries due
to prescribed drugs; 2.1% of inpatients experienced a serious adverse drug
reaction, 4.7% of all hospital admissions were due to a serious adverse drug
reaction, and fatal adverse drug reactions occurred in 0.19% of inpatients and
0.13% of admissions.
The authors estimated that 106,000 deaths occur annually due to adverse drug
Using a cost analysis from a 2000 study in which the increase in
hospitalization costs per patient suffering an adverse drug reaction was
$5,483, costs for the Lazarou study’s 2.2 million patients with serious drug
reactions amounted to $12 billion.
Serious adverse drug reactions commonly emerge after FDA approval of the
drugs involved. The safety of new agents cannot be known with certainty until
a drug has been on the market for many years.
Over 1 million people develop bedsores in US hospitals every year. It is a
tremendous burden to patients and family, and a $55 billion health care
Bedsores are preventable with proper nursing care. It is true that 50% of those
affected are in a vulnerable age group of over 70. In the elderly, bedsores
carry a fourfold increase in the rate of death.
The mortality rate in hospitals for patients with bedsores is between 23% and
37%. Even if we just take the 50% of people over 70 with bedsores and the
lowest mortality at 23%, that gives us a death rate due to bedsores of 115,000.
Critics will say that it was the disease or advanced age that killed the patient,
not the bedsore, but our argument is that an early death, by denying proper
care, deserves to be counted. It is only after counting these unnecessary
deaths that we can then turn our attention to fixing the problem.
Malnutrition in Nursing Homes
The General Accounting Office (GAO), a special investigative branch of
Congress, cited 20% of the nation’s 17,000 nursing homes for violations
between July 2000 and January 2002. Many violations involved serious
physical injury and death.
A report from the Coalition for Nursing Home Reform states that at least one
third of the nation’s 1.6 million nursing home residents may suffer from
malnutrition and dehydration, which hastens their death.
The report calls for adequate nursing staff to help feed patients who are not
able to manage a food tray by themselves. It is difficult to place a mortality rate
on malnutrition and dehydration. The coalition report states that compared
with well-nourished hospitalized nursing home residents, malnourished
residents have a fivefold increase in mortality when they are admitted to a
Multiplying the one third of 1.6 million nursing home residents who are
malnourished by a mortality rate of 20% results in 108,800 premature deaths
due to malnutrition in nursing homes.
The rate of nosocomial (in-hospital) infections per 1,000 patient days rose from
7.2 in 1975 to 9.8 in 1995, a 36% jump in 20 years.
Reports from more than 270 US hospitals showed that the nosocomial
infection rate itself had remained stable over the previous 20 years, with
approximately 5-6 hospital-acquired infections occurring per 100 admissions.
Due to progressively shorter inpatient stays and the increasing number of
admissions, however, the number of infections has increased. It is estimated
that in 1995, nosocomial infections cost $4.5 billion and contributed to more
than 88,000 deaths, or one death every six minutes.
The 2003 incidence of nosocomial mortality is probably higher than in 1995
because of the tremendous increase in antibiotic-resistant organisms.
Morbidity and Mortality Report found that nosocomial infections cost $5 billion
annually in 1999, representing a $0.5 billion increase in just four years. At this
rate of increase, the current cost of nosocomial infections would be close to $6
In a 2000 JAMA article, Dr. Barbara Starfield presents well-documented facts
that are both shocking and unassailable.
The US ranks 12th of 13 industrialized countries when judged by 16 health
status indicators. Japan, Sweden, and Canada were first, second, and third,
More than 40 million people in the US have no health insurance, and 20-30% of
patients receive contraindicated care.
Starfield warned that one cause of medical mistakes is overuse of technology,
which may create a “cascade effect” leading to still more treatment. She urges
the use of ICD (International Classification of Diseases) codes that have
designations such as “Drugs, Medicinal, and Biological Substances Causing
Adverse Effects in Therapeutic Use” and “Complications of Surgical and
Medical Care” to help doctors quantify and recognize the magnitude of the
medical error problem.
Starfield notes that many deaths attributable to medical error today are likely to
be coded to indicate some other cause of death. She concludes that against
the backdrop of our poor health report card compared to other Western
countries, we should recognize that the harmful effects of health care
interventions account for a substantial proportion of our excess deaths.
Starfield cites Weingart’s 2000 article, “Epidemiology of Medical Error” as well
as other authors to suggest that between 4% and 18% of consecutive patients
in outpatient settings suffer an iatrogenic event leading to:
116 million extra physician visits.
77 million extra prescriptions filled.
17 million emergency department visits.
8 million hospitalizations.
3 million long-term admissions.
199,000 additional deaths.
$77 billion in extra costs.
While some 12,000 deaths occur each year from unnecessary surgeries,
results from the few studies that have measured unnecessary surgery directly
indicate that for some highly controversial operations, the proportion of
unwarranted surgeries could be as high as 30%.
Medical Errors: A Global Issue
A five-country survey published in the Journal of Health Affairs found that 18-
28% of people who were recently ill had suffered from a medical or drug error
in the previous two years.
The study surveyed 750 recently ill adults. The breakdown by country showed
the percentages of those suffering a medical or drug error were 18% in Britain,
23% in Australia and in New Zealand, 25% in Canada, and 28% in the US.
The Institute of Medicine recently found that the 41 million Americans with no
health insurance have consistently worse clinical outcomes than those who
are insured, and are at increased risk for dying prematurely.
When doctors bill for services they do not render, advise unnecessary tests, or
screen everyone for a rare condition, they are committing insurance fraud.
The US GAO estimated that $12 billion was lost to fraudulent or unnecessary
claims in 1998, and reclaimed $480 million in judgments in that year.
In 2001, the federal government won or negotiated more than $1.7 billion in
judgments, settlements, and administrative impositions in health care fraud
cases and proceedings.
Warehousing Our Elders
One way to measure the moral and ethical fiber of a society is by how it treats
its weakest and most vulnerable members. In some cultures, elderly people
live out their lives in extended family settings that enable them to continue
participating in family and community affairs.
American nursing homes, where millions of our elders go to live out their final
days, represent the pinnacle of social isolation and medical abuse.
In America, approximately 1.6 million elderly are confined to nursing homes.
By 2050, that number could be 6.6 million.
Twenty percent of all deaths from all causes occur in nursing homes.
Hip fractures are the single greatest reason for nursing home admissions.
Nursing homes represent a reservoir for drug-resistant organisms due to
overuse of antibiotics.
Presenting a report he sponsored entitled “Abuse of Residents Is a Major
Problem in US Nursing Homes” on July 30, 2001, Rep. Henry Waxman (D-CA)
noted that: “as a society we will be judged by how we treat the elderly.” The
report found one third of the nation’s approximately 17,000 nursing homes
were cited for an abuse violation in a two-year period from January 1999 to
According to Waxman, “the people who cared for us deserve better.” The
report suggests that this known abuse represents only the “tip of the iceberg”
and that much more abuse occurs that we are not aware of or ignore.
The report found:
Over 30% of US nursing homes were cited for abuses, totaling more than 9,000
Ten percent of nursing homes had violations that caused actual physical harm
to residents or worse.
Over 40% (3,800) of the abuse violations followed the filing of a formal
complaint, usually by concerned family members.
Many verbal abuse violations were found, as were occasions of sexual abuse.
Incidents of physical abuse causing numerous injuries, such as fractured
femurs, hips, elbows, and wrists, also were found.
Dangerously understaffed nursing homes lead to neglect, abuse, overuse of
medications, and physical restraints. In 1990, Congress mandated an
exhaustive study of nurse-to-patient ratios in nursing homes.
The study was finally begun in 1998 and took four years to complete. A
spokesperson for the National Citizens’ Coalition for Nursing Home Reform
commented on the study:
“They compiled two reports of three volumes, each thoroughly documenting
the number of hours of care residents must receive from nurses and nursing
assistants to avoid painful, even dangerous, conditions such as bedsores and
infections. Yet it took the Department of Health and Human Services and
Secretary Tommy Thompson only four months to dismiss the report as
Although preventable with proper nursing care, bedsores occur three times
more commonly in nursing homes than in acute care or veterans hospitals.
Because many nursing home patients suffer from chronic debilitating
conditions, their assumed cause of death often is unquestioned by
physicians. Some studies show that as many as 50% of deaths due to
restraints, falls, suicide, homicide, and choking in nursing homes may be
It is possible that many nursing home deaths are instead attributed to heart
disease. In fact, researchers have found that heart disease may be over-
represented in the general population as a cause of death on death certificates
by 8-24%. In the elderly, the over-reporting of heart disease as a cause of
death is as much as twofold.
That very few statistics exist concerning malnutrition in acute care hospitals
and nursing homes demonstrates the lack of concern in this area. While a
survey of the literature turns up few US studies, one revealing US study
evaluated the nutritional status of 837 patients in a 100-bed subacute care
hospital over a 14-month period.
The study found only 8% of the patients were well nourished, while 29% were
malnourished and 63% were at risk of malnutrition. As a result, 25% of the
malnourished patients required readmission to an acute care hospital,
compared to 11% of the well-nourished patients. The authors concluded that
malnutrition reached epidemic proportions in patients admitted to this
subacute care facility.
Many studies conclude that physical restraints are an underreported and
preventable cause of death. Studies show that compared to no restraints, the
use of restraints carries a higher mortality rate and economic burden.
Studies have found that physical restraints, including bedrails, are the cause
of at least 1 in every 1,000 nursing-home deaths.
Deaths caused by malnutrition, dehydration, and physical restraints, however,
are rarely recorded on death certificates. Several studies reveal that nearly
half of the listed causes of death on death certificates for elderly people with
chronic or multi-system disease are inaccurate. Although one in five people
dies in nursing homes, an autopsy is performed in less than 1% of these
Dr. Robert Epstein, chief medical officer of Medco Health Solutions Inc. (a unit
of Merck & Co.), conducted a study in 2003 of drug trends among the elderly.
He found that seniors are going to multiple physicians, getting multiple
prescriptions, and using multiple pharmacies. Medco oversees drug-benefit
plans for more than 60 million Americans, including 6.3 million seniors who
received more than 160 million prescriptions.
According to the study, the average senior receives 25 prescriptions each
year. Among those 6.3 million seniors, a total of 7.9 million medication alerts
were triggered: less than half that number, 3.4 million, was detected in 1999.
About 2.2 million of those alerts indicated excessive dosages unsuitable for
seniors, and about 2.4 million alerts indicated clinically inappropriate drugs for
Reuters interviewed Kasey Thompson, director of the Center on Patient Safety
at the American Society of Health System Pharmacists, who noted:
“There are serious and systemic problems with poor continuity of care in the
United States.” He says this study represents “the tip of the iceberg” of a
According to Drug Benefit Trends, the average number of prescriptions
dispensed per non-Medicare HMO member per year rose 5.6% from 1999 to
2000, from 7.1 to 7.5 prescriptions. The average number dispensed for
Medicare members increased 5.5%, from 18.1 to 19.1 prescriptions.
The total number of prescriptions written in the US in 2000 was 2.98 billion, or
10.4 prescriptions for every man, woman, and child.
In a study of 818 residents of residential care facilities for the elderly, 94% were
receiving at least one medication at the time of the interview. The average
intake of medications was five per resident; the authors noted that many of
these drugs were given without a documented diagnosis justifying their use.
Seniors and groups like the American Association of Retired Persons (AARP)
have accepted allopathic medicine’s overriding assumption that aging and
dying in America must be accompanied by drugs in nursing homes and
Seniors are given the choice of either high-cost patented drugs or low-cost
generic drugs. Drug companies attempt to keep the most expensive drugs on
the shelves and suppress access to generic drugs, despite facing stiff fines of
hundreds of millions of dollars levied by the federal government.
In 2001, some of the world’s largest drug companies were fined a record $871
million for conspiring to increase the price of vitamins.
Current AARP recommendations for diet and nutrition assume that seniors are
getting all the nutrition they need in an average diet. At most, AARP suggests
adding extra calcium and a multivitamin and mineral supplement.
Ironically, studies also indicate underuse of proper pain medication for
patients who need it. One study evaluated pain management in a group of
13,625 cancer patients, aged 65 and over, living in nursing homes.
While almost 30% of the patients reported pain, more than 25% received no
pain-relief medication, 16% received a mild analgesic drug, 32% received a
moderate analgesic drug, and 26% received adequate pain-relieving
The authors concluded that older patients and minority patients were more
likely to have their pain untreated.
What Remains to Be Uncovered
Our ongoing research will continue to quantify the morbidity, mortality, and
financial loss due to:
X-ray exposure (mammography, fluoroscopy, CT scans).
Overuse of antibiotics for all conditions.
Carcinogenic drugs (hormone replacement therapy, immunosuppressive and
Surgery and unnecessary surgery (cesarean section, radical mastectomy,
preventive mastectomy, radical hysterectomy, prostatectomy,
cholecystectomies, cosmetic surgery, arthroscopy, etc.).
Discredited medical procedures and therapies.
Unproven medical therapies.
Part of our ongoing research will be to quantify the mortality and morbidity
caused by hormone replacement therapy (HRT) since the 1940s. 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 US.
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 blood clots, breast cancer, stroke, and heart disease,
with little evidence of osteoporosis reduction or dementia prevention.
WHI researchers, who usually never make recommendations except to
suggest more studies, advised doctors to be very cautious about prescribing
HRT to their patients.
Results of the “Million Women Study” on HRT and breast cancer in the UK
were published in the medical journal The Lancet in August 2003. According
to lead author Prof. Valerie Beral, director of the Cancer Research UK
“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, estrogen-progestagen
(combination) therapy accounting for 15,000 of these.”
We were unable to find statistics on breast cancer, stroke, uterine cancer, or
heart disease caused by HRT used by American women. Because the US
population is roughly six times that of the UK, it is possible that 120,000 cases
of breast cancer have been caused by HRT in the past decade.
The Office of Technology Assessment (OTA) was perhaps the US
government's last honest agency that critically reviewed the state of the
nation's health care system. The purpose of the OTA was to provide Congress
with objective and authoritative analysis of complex scientific and technical
issues. In its final critical report, the OTA concluded:
“There are no mechanisms in place to limit dissemination of technologies,
regardless of their clinical value.”
Shortly after the OTA released a report that exposed how entrenched financial
interests manipulate health care practice in the United States, Congress
disbanded the OTA.
By: Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD;
Debora Rasio, MD; and Dorothy Smith, PhD www.garynull.com
Full Article: Death By Medicine