|
We have added, cumulatively, figures from 13 references of
annual iatrogenic deaths. However, there is invariably some
degree of overlap and double counting that can occur in gathering
non-finite statistics.
Death numbers don't come with names and birth dates to prevent
duplication On the other hand, there are many missing statistics.
As we will show, only about 5 to 20% of iatrogenic incidents
are even recorded.16,24,25,33,34 And, our outpatient iatrogenic
statistics112 only include drug-related events and not surgical
cases, diagnostic errors, or therapeutic mishaps.
We have also been conservative in our inclusion of statistics
that were not reported in peer review journals or by government
institutions. For example, on July 23, 2002, The Chicago Tribune
analyzed records from patient databases, court cases, 5,810
hospitals, as well as 75 federal and state agencies and found
103,000 cases of death due to hospital infections, 75% of
which were preventable.152 We do not include this figure but
report the lower Weinstein figure of 88,000.9 Another figure
that we withheld, for lack of proper peer review was The National
Committee for Quality Assurance, September 2003 report which
found that at least 57,000 people die annually from lack of
proper care for commons diseases such as high blood pressure,
diabetes, or heart disease.153
Overlapping of statistics in Death by Medicine may occur
with the Institute of Medicine (IOM) paper that designates
"medical error" as including drugs, surgery, and
unnecessary procedures.6 Since we have also included other
statistics on adverse drug reactions, surgery and, unnecessary
procedures, perhaps a much as 50% of the IOM number could
be redundant. However, even taking away half the 98,000 IOM
number still leaves us with iatrogenic events as the number
one killer at 738,000 annual deaths.
MEDICAL AND SURGICAL PROCEDURES
It is instructive to know the mortality rate associated with
different medical and surgical procedures. Even though we
must sign release forms when we undergo any procedure, many
of us are in denial about the true risks involved. We seem
to hold a collective impression that since medical and surgical
procedures are so commonplace, they are both necessary and
safe. Unfortunately, partaking in allopathic medicine itself
is one of the highest causes of death as well as the most
expensive way to die.
Shouldn’t the daily death rate of iatrogenesis in hospitals,
out of hospitals, in nursing homes, and psychiatric residences
be reported like the pollen count or the smog index? Let’s
stop hiding the truth from ourselves. It’s only when
we focus on the problem and ask the right questions that we
can hope to find solutions.
Perhaps the words "health care" give us the illusion
that medicine is about health. Allopathic medicine is not
a purveyor of healthcare but of disease-care. Studying the
mortality figures in the Healthcare Cost and Utilization Project
(HCUP) within the U.S. government’s Agency for Healthcare
Research and Quality, we found many points of interest.13
The HCUP computer program that calculates the annual mortality
statistics for all U.S. hospital discharges is only as good
as the codes that are put into the system.
In an e-mail correspondence with HCUP, we were told that
the mortality rates that were indicated in tables and charts
for each procedure were not necessarily due to the procedure
but only indicated that someone who received that procedure
died either from their original disease or from the procedure.
Therefore there is no way of knowing exactly how many people
died from a particular procedure. There are also no codes
for adverse drug side effects, none for surgical mishap, and
none for medical error. Until there are codes for medical
error, statistics of those people who are dying from various
types of medical error will be buried in the general statistics.
There is a code for "poisoning & toxic effects of
drugs" and a code for "complications of treatment."
However, the mortality figures registered in these categories
are very low and don’t compare with what we know from
studies such as the JAMA 1998 study1 that said there were
an average of 106,000 prescription medication deaths per year.
WHY AREN’T MEDICAL AND SURGICAL PROCEDURES STUDIED?
In 1978, the U.S. Office of Technology Assessment (OTA) reported
that, "Only 10 percent to 20 percent of all procedures
currently used in medical practice have been shown to be efficacious
by controlled trial."83 In 1995, the OTA compared medical
technology in eight countries (Australia, Canada, France,
Germany, Netherlands, Sweden, United Kingdom, and the United
States) and again noted that few medical procedures in the
United States had been subjected to clinical trial. It also
reported that infant mortality was high and life expectancy
was low compared to other developed countries.84
Although almost 10 years old, much of what was said in this
report holds true today. The report lays the blame for the
high cost of medicine squarely at the feet of the medical
free-enterprise system and the fact that there is no national
health care policy. It describes the failure of government
attempts to control health care costs due to market incentive
and profit motive in the financing and organization of health
care including private insurance, hospital system, physician
services, and drug and medical device industries.
Whereas we may want to expand health-care, expansion of disease-care
is the goal of free enterprise. "Health Care Technology
and Its Assessment in Eight Countries" is also the last
report prepared by the OTA, which was shut down in 1995. It’s
also, perhaps, the last honest, in-depth look at modern medicine.
Because of the importance of this 60-page report, we enclose
a summary in the Appendix.
SURGICAL ERRORS FINALLY REPORTED
Just hours before completion of this paper, statistics on
surgical-related deaths became available. An October 8, 2003
JAMA study from the U.S. government’s Agency for Healthcare
Research and Quality (AHRQ) documented 32,000 mostly surgery-related
deaths costing $9 billion and accounting for 2.4 million extra
days in the hospital in 2000.85 In a press release accompanying
the JAMA study, the AHRQ director, Carolyn M. Clancy, M.D.,
admitted, "This study gives us the first direct evidence
that medical injuries pose a real threat to the American public
and increase the costs of health care." 86
Hospital administrative data from 20 percent of the nation’s
hospitals were analyzed for eighteen different surgical complications
including postoperative infections, foreign objects left in
wounds, surgical wounds reopening, and post-operative bleeding.
In the same press release the study’s authors said that,
"The findings greatly underestimate the problem, since
many other complications happen that are not listed in hospital
administrative data." They also felt that, "The
message here is that medical injuries can have a devastating
impact on the health care system. We need more research to
identify why these injuries occur and find ways to prevent
them from happening."
One of the authors, Dr. Zhan said that improved medical practices,
including an emphasis on better hand-washing, might help reduce
the morbidity and mortality rates. An accompanying JAMA editorial
by health-risk researcher Dr. Saul Weingart of Harvard’s
Beth Israel Deaconess Medical Center said, "Given their
staggering magnitude, these estimates are clearly sobering."87
UNNECESSARY X-RAYS
When X-rays were discovered, no one knew the long-term effects
of ionizing radiation. In the 1950s monthly fluoroscopic exams
at the doctor’s office were routine. You could even walk
into most shoe stores and see your foot bones; looking at
bones was an amusing novelty. We still don’t know the
ultimate outcome of our initial escapade with X-rays.
It was common practice to use X-rays in pregnant women to
measure the size of the pelvis, and make a diagnosis of twins.
Finally, a study of 700,000 children born between 1947 and
1964 was conducted in 37 major maternity hospitals. The children
of mothers who had received pelvic X-rays during pregnancy
were compared with the children of mothers who had not been
X-rayed. Cancer mortality was 40 percent higher among the
children with X-rayed mothers.88
In present-day medicine, coronary angiography combines an
invasive surgical procedure of snaking a tube through a blood
vessel in the groin up to the heart. To get any useful information
during the angiography procedure X-rays are taken almost continuously
with minimum dosage ranges between 460 and 1,580 mrem. The
minimum radiation from a routine chest X-ray is 2 mrem. X-ray
radiation accumulates in the body and it is well-known that
ionizing radiation used in X-ray procedures causes gene mutation.
We can only obtain guesstimates as to its impact on health
from this high level of radiation. Experts manage to obscure
the real effects in statistical jargon such as, "The
risk for lifetime fatal cancer due to radiation exposure is
estimated to be four in 1 million per 1,000 mrem."89
However, Dr. John Gofman, who has been studying the effects
of radiation on human health for 45 years, is prepared to
tell us exactly what diagnostic X-rays are doing to our health.
Dr. Gofman has a PhD in nuclear and physical chemistry and
is a medical doctor. He worked on the Manhattan nuclear project,
discovered uranium-2323, was the first person to isolate plutonium,
and since 1960, he’s been studying the effects of radiation
on human health.
With five scientifically documented books totaling over 2,800
pages, Dr. Gofman provides strong evidence that medical technology,
specifically X-rays, CT scans, mammography, and fluoroscopy,
are a contributing factor to 75 percent of new cancers.
His 699-page report, updated in 2000, "Radiation from
Medical Procedures in the Pathogenesis of Cancer and Ischemic
Heart Disease: Dose-Response Studies with Physicians per 100,000
Population to here"90 shows that as the number of physicians
increases in a geographical area with an increase in the number
of X-ray diagnostic tests, there is an associated increase
in the rate of cancer and ischemic heart disease. Dr. Gofman
elaborates that it’s not X-rays alone that cause the
damage but a combination of health risk factors including:
poor diet, smoking, abortions, and the use of birth control
pills. Dr. Gofman predicts that 100 million premature deaths
over the next decade will be the result of ionizing radiation.
In his book, "Preventing Breast Cancer," Dr. Gofman
says that breast cancer is the leading cause of death among
American women between the ages of 44 and 55. Because breast
tissue is highly radiation-sensitive, mammograms can cause
cancer. The danger can be heightened by a woman’s genetic
makeup, preexisting benign breast disease, artificial menopause,
obesity, and hormonal imbalance.91
Even X-rays for back pain can lead someone into crippling
surgery. Dr. Sarno, a well-known New York orthopedic surgeon,
found that X-rays don’t always tell the truth. In his
books he cites studies on normal people without a trace of
back pain that have spinal abnormalities on X-ray. Other studies
have shown that some people with back pain have normal spines
on X-ray. So, Dr. Sarno says there is not necessarily any
association between back pain and spinal X-ray abnormality.92
However, if a person happens to have back pain and an incidental
abnormality on X-ray, they may be treated surgically, sometimes
with no change in back pain, or worsening of back pain, or
even permanent disability.
In addition, doctors often order X-rays as protection against
malpractice claims to give the impression that they are leaving
no stone unturned. It appears that doctors are putting their
own fears before the interests of their patients.
UNNECESSARY HOSPITALIZATION
Summary:
8.9 million (8,925,033) people were hospitalized unnecessarily
in 2001.4
In a study of inappropriate hospitalization 1,132 medical
records were reviewed by two doctors. Twenty-three percent
of all admissions were inappropriate and an additional 17
percent could have been handled in ambulatory out-patient
clinics. Thirty-four percent of all hospital days were also
inappropriate and could have been avoided.93 The rate of inappropriate
admissions in 1990 was 23.5 percent.94 In 1999, another study
confirmed the figure of 24 percent inappropriate admissions
indicating a consistent pattern from 1986 to 1999,95 showing
steady reporting of approximately 24 percent inappropriate
admissions each year.
Putting these figures into present-day terms using the HCUP
database, the total number of patient discharges from hospitals
in the U.S. in 2001 was 37,187,641.13 The above data indicate
that 24 percent of those hospitalizations need never have
occurred. It further means that 8,925,033 people were exposed
to unnecessary medical intervention in hospitals and therefore
represent almost 9 million potential iatrogenic episodes.4
WOMEN’S EXPERIENCE IN MEDICINE
Briefly, we will look at the medical iatrogenesis of women
in particular. Dr. Martin Charcot (1825-1893) was world-renowned,
the most celebrated doctor of his time. He practiced in the
Paris hospital La Salpetriere. He became an expert in hysteria
diagnosing an average of 10 hysterical women each day, transforming
them into ... "iatrogenic monsters," turning
simple ‘neurosis’ into hysteria.96 The number of
women diagnosed with hysteria and hospitalized rose from one
percent in 1841 to 17 percent in 1883.
Hysteria is derived from the Latin "hystera," meaning
uterus. Dr. Adriane Fugh-Berman stated very clearly in her
paper that there is a tradition in U.S. medicine of excessive
medical and surgical interventions on women. Only 100 years
ago male doctors decided that female psychological imbalance
originated in the uterus. When surgery to remove the uterus
was perfected it became the "cure" for mental instability,
effecting a physical and psychological castration. Dr. Fugh-Berman
noted that U.S. doctors eventually disabused themselves of
that notion but have continued to treat women very differently
than they treat men.97 She cites the following:
- Thousands of prophylactic mastectomies are performed annually.
- One-third of U.S. 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.98 It confines women to a hospital bed and may
result in higher incidence of cesarean section.99
- Normal processes such as menopause and childbirth have
been heavily medicalized.
- Synthetic hormone replacement therapy (HRT) does not prevent
heart disease or dementia. It does increase the risk of
breast cancer, heart disease, stroke, and gall bladder attack.100
We would add that as many as one-third of postmenopausal
women use HRT.101,102 These numbers are important in light
of the much-publicized Women’s Health Initiative Study,
which was forced to stop before its completion because of
a higher death rate in the synthetic estrogen-progestin (HRT)
group.103
Cesarean Section
In 1983, 809,000 cesarean sections (21 percent of live births)
were performed, making it the most common obstetric and gynecologic
(OB/GYN) surgical procedure. The second most common OB/GYN
operation was hysterectomy (673,000), and diagnostic dilation
and curettage of the uterus (632,000) was third. In 1983,
OB/GYN operations represented 23 percent of all surgery completed
in this country.104
In 2001, Cesarean section is still the most common OB/GYN
surgical procedure. Approximately 4 million births occur annually,
with a 24 percent C-Section rate, i.e., 960,000 operations.
In the Netherlands only eight percent of babies are delivered
by Cesarean section. Assuming human babies are similar in
the United States and in the Netherlands, we are performing
640,000 unnecessary C-Sections in the United States with its
three to four times higher mortality and 20 times greater
morbidity than vaginal delivery.105
The cesarean section rate was only 4.5 percent in the United
States in 1965. By 1986 it had climbed to 24.1 percent. The
author states that obviously an "uncontrolled pandemic
of medically unnecessary cesarean births is occurring."106
VanHam reported a cesarean section postpartum hemorrhage rate
of seven percent, a hematoma formation rate of 3.5 percent,
a urinary tract infection rate of three percent, and a combined
postoperative morbidity rate of 35.7 percent in a high-risk
population undergoing cesarean section.107
NEVER ENOUGH STUDIES
Scientists used the excuse that there were never enough studies
revealing the dangers of DDT and other dangerous pesticides
to ban them. They also used this excuse around the issue of
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
results of tobacco research. In 1964, the Surgeon General's
report condemned smoking, however the AMA refused to endorse
it. What was their reason? They needed more research. Actually
what they really wanted was more money and they got it from
a consortium of tobacco companies who paid the AMA $18 million
over the next nine years, during which the AMA said nothing
about the dangers of smoking.108
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 Chesterfield
ads claiming that 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 public health."109 Today, scientists
continue to use the excuse that they need more studies before
they will lend their support to restrict the inordinate use
of drugs.
OVERVIEW OF STATISTICAL TABLES AND FIGURES
Adverse Drug Reactions
The Lazarou study1 was based on statistical analysis of 33
million U.S. hospital admissions in 1994. Hospital records
for prescribed medications were analyzed. The number of serious
injuries due to prescribed drugs was 2.2 million; 2.1 percent
of in-patients experienced a serious adverse drug reaction;
4.7 percent of all hospital admissions were due to a serious
adverse drug reaction; and fatal adverse drug reactions occurred
in 0.19 percent of in-patients and 0.13 percent of admissions.
The authors concluded that a projected 106,000 deaths occur
annually due to adverse drug reactions.
We used a cost analysis from a 2000 study in which the increase
in hospitalization costs per patient suffering an adverse
drug reaction was $5,483. Therefore, costs for the Lazarou
study’s 2.2 million patients with serious drug reactions
amounted $12 billion.1,49
Serious adverse drug reactions commonly emerge after Food
and Drug Administration approval. The safety of new agents
cannot be known with certainty until a drug has been on the
market for many years.110
Bedsores
Over 1 million people develop bedsores in U.S. hospitals
every year. It’s a tremendous burden to patients and
family, and a $55 billion dollar health care burden.7 Bedsores
are preventable with proper nursing care. It is true that
50 percent of those affected are in a vulnerable age group
of over 70. In the elderly bedsores carry a four-fold increase
in the rate of death.
The mortality rate in hospitals for patients with bedsores
is between 23 percent and 37 percent.8 Even if we just take
the 50 percent of people over 70 with bedsores and the lowest
mortality at 23 percent, 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, gave citations to 20 percent of the nation's
17,000 nursing homes for violations between July 2000 and
January 2002. Many violations involved serious physical injury
and death.111
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 aren’t able to manage
a food tray by themselves.11 It is difficult to place a mortality
rate on malnutrition and dehydration. This Coalition report
states that malnourished residents, compared with well-nourished
hospitalized nursing home residents, have a five-fold increase
in mortality when they are admitted to hospital. So, if we
take one-third of the 1.6 million nursing home residents who
are malnourished and multiply that by a mortality rate of
20 percent,8,14 we find 108,800 premature deaths due to malnutrition
in nursing homes.
Nosocomial Infections
The rate of nosocomial infections per 1,000 patient days
has increased 36 percent - from 7.2 in 1975 to 9.8 in 1995.
Reports from more than 270 U.S. hospitals showed that the
nosocomial infection rate itself had remained stable over
the previous 20 years with approximately five to six hospital-acquired
infections occurring per 100 admissions, which is a rate of
5-6 percent. However, because of progressively shorter inpatient
stays and the increasing number of admissions, the actual
number of infections increased.
It is estimated that in 1995, nosocomial infections cost
$4.5 billion and contributed to more than 88,000 deaths -
one death every 6 minutes.9 The 2003 incidence of nosocomial
mortality is quite 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 1999.10 This is a $0.5 billion
increase in four years. The present cost of nosocomial infections
might now be in the order of $5.5 billion.
Outpatient Iatrogenesis
Dr. Barbara Starfield in a 2000 JAMA paper presents us with
well-documented facts that are both shocking and unassailable.12
- The U.S. ranks twelfth out of 13 countries in a total
of 16 health indicators. Japan, Sweden, and Canada were
first, second, and third.
- More than 40 million people have no health insurance.
- 20 percent to 30 percent of patients receive contraindicated
care.
Dr. Starfield warns that one cause of medical mistakes is
the overuse of technology, which may create a "cascade
effect" leading to more treatment. She urges the use
of ICD (International Classification of Diseases) codes that
have designations called: "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 says that, at present, deaths
actually due to medical error are likely to be coded according
to some other cause of death.
She concludes that against the backdrop of our abysmal health
report card compared to the rest of the Westernized 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" on outpatient iatrogenesis. And Weingart,
in turn, cites several authors and provides statistics showing
that between 4 percent to 18 percent of consecutive patients
in outpatient settings suffer an iatrogenic event leading
to:112
116 million extra physician visits
77 million extra prescriptions
17 million emergency department visits
8 million hospitalizations
3 million long-term admissions
199,000 additional deaths
$77 billion in extra costs
Unnecessary Surgeries
There are 12,000 deaths per year from unnecessary surgeries.
However, results from the few studies that have measured unnecessary
surgery directly indicate that for some highly controversial
operations, the fraction that are unwarranted could be as
high as 30 percent.74
IT’S A GLOBAL ISSUE
A survey published in the Journal of Health Affairs pointed
out that between 18 percent and 28 percent 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 in five different countries. The breakdown by country
showed 18 percent of those in Britain, 25 percent in Canada,
23 percent in Australia, 23 percent in New Zealand, and the
highest number was in the U.S. at 28 percent.113
HEALTH INSURANCE
A recent finding by the Institute of Medicine is that the
41 million Americans without health insurance have consistently
worse clinical outcomes than those who are insured, and are
at increased risk for dying prematurely.114
Insurance Fraud
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 U.S. General Accounting
Office (GAO) gave a 1998 figure of $12 billion lost to fraudulent
or unnecessary claims, 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.115
WAREHOUSING OUR ELDERS
It is only fitting that we end this report with acknowledgement
of our elders. The moral and ethical fiber of society can
be judged by the way it treats its weakest and most vulnerable
members. Some cultures honor and respect the wisdom of their
elders, keeping them at home--the better to continue participation
in their community. However, American nursing homes, where
millions of our elders die, represent the pinnacle of social
isolation and medical abuse.
Important Statistics about Nursing Homes
1. In America, at any one time, approximately 1.6 million
elderly are confined to nursing homes. By 2050 that number
could be 6.6 million.11,116
2. A total of 20 percent of all deaths from all causes
occur in nursing homes.117
3. Hip fractures are the single greatest reason for nursing
home admissions.118 Nursing homes represent a reservoir
for drug-resistant organisms due to overuse of antibiotics.119
Congressman Waxman reminded us that "as a society we
will be judged by how we treat the elderly" when he presented
a report that he sponsored, "Abuse of Residents is a
Major Problem in U.S. Nursing Homes," on July 30, 2001.
The report uncovered that one-third--5,283 of the nations’
17,000 nursing homes--were cited for an abuse violation in
the two-year period studied, January 1999 to January 2001.116
Waxman stated that "the people who cared for us, deserve
better." He also made it very clear that this was only
the tip of the iceberg and there is much more abuse occurring
that we don’t know about or ignore.116a
The major findings of "Abuse of Residents is a Major
Problem in U.S. Nursing Homes," were:
- Over 30 percent of nursing homes in the United States
were cited for abuses, totaling more than 9,000 abuse violations.
- 10 percent of nursing homes had violations that caused
actual physical harm to residents, or worse.
- Over 40 percent, or 3,800, abuse violations were only
discovered after a formal complaint was filed, usually by
concerned family members.
- Many verbal abuse violations were found.
- Occasions of sexual abuse.
- Incidents of physical abuse causing numerous injuries
such as fractured femur, hip, elbow, wrist, and other injuries.
Dangerously understaffed nursing homes lead to neglect, abuse,
overuse of medications, and physical restraints. An exhaustive
study of nurse-to-patient ratios in nursing homes was mandated
by Congress in 1990. The study was finally begun in 1998 and
took four years to complete.120 Commenting on the study, a
spokesperson for The National Citizens’ Coalition for
Nursing Home Reform said, "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 ‘insufficient.’"121
Bedsores occur three times more commonly in nursing homes
than in acute care or veterans’ hospitals.122 But we
know that bedsores can be prevented with proper nursing care.
It shouldn’t take four years for someone to find out
that proper care of bedsores requires proper staffing. In
spite of such urgent need in nursing homes where additional
staff could solve so many problems, we hear the familiar refrain
"not enough research"--one that merely buys time
for those in charge and relegates another smoldering crisis
to the back burner.
Since many nursing home patients suffer from chronic debilitating
conditions, their assumed cause of death is often unquestioned
by physicians. Some studies show that as many as 50 percent
of deaths due to restraints, falls, suicide, homicide, and
choking in nursing homes may be covered up.123,124 It is quite
possible that many nursing home deaths are attributed, instead,
to heart disease, which, until our report, was the number
one cause of death. 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 7.9 percent to
24.3 percent. In the elderly the over-reporting of heart disease
as a cause of death is as much as two-fold.125
When elucidating iatrogenesis in nursing homes, some critics
have asked, "To what extent did these elderly people
already have life-threatening diseases that led to their premature
deaths anyway?" Our response is that if a loved one dies
one day, one week, one year, a decade, or two decades prematurely,
thanks to some medical misadventure, that is still a premature,
iatrogenic death. In a legalistic sense perhaps more weight
is placed on the loss of many potential years compared to
an additional few weeks, but this attitude is not justified
in an ethical or moral sense.
The fact that there are very few statistics on malnutrition
in acute-care hospitals and nursing homes shows the lack of
concern in this area. A survey of the literature turns up
very few American studies. Those that do appear are foreign
studies in Italy, Spain, and Brazil. However, there is one
very revealing American study conducted over a 14-month period
that evaluated 837 patients in a 100-bed sub-acute-care hospital
for their nutritional status. Only eight percent of the patients
were found to be well nourished.
Almost one-third (29 percent) were malnourished and almost
two-thirds (63 percent) were at risk of malnutrition. The
consequences of this state of deficiency were that 25 percent
of the malnourished patients required readmission to an acute-care
hospital compared to 11 percent of the well-nourished patients.
The authors concluded that malnutrition reached epidemic proportions
in patients admitted to this sub-acute-care facility.126
Many studies conclude that physical restraints are an underreported
and preventable cause of death. Whereas administrators say
they must use restraints to prevent falls, in fact, they cause
more injury and death because people naturally fight against
such imprisonment. Studies show that compared to no restraints,
the use of restraints carries a higher mortality rate and
economic burden.127-129 Studies found that physical restraints,
including bedrails, are the cause of at least one in every
1,000 nursing-home deaths.130-132
However, deaths caused by malnutrition, dehydration, and
physical restraints are rarely recorded on death certificates.
Several studies reveal that nearly half of the listed causes
of death on death certificates for older persons with chronic
or multi-system disease are inaccurate.133 Even though 1-in-5
people die in nursing homes, the autopsy rate is only 0.8
percent.134 Thus, we have no way of knowing the true causes
of death.
Over-medicating Seniors
The CDC may be focused on reducing the number of prescriptions
for children but a 2003 study finds over-medication of our
elderly population. Dr. Robert Epstein, chief medical officer
of Medco Health Solutions Inc. (a unit of Merck & Co.),
conducted the study on drug trends.135 He found that seniors
are going to multiple physicians and getting multiple prescriptions
and using multiple pharmacies. Medco oversees drug-benefit
plans for more than 60 million Americans, including 6.3 million
senior citizens who received more than 160 million prescriptions.
According to the study, the average senior receives 25 prescriptions
annually.
In those 6.3 million seniors, a total of 7.9 million medication
alerts were triggered: less than one-half that number, 3.4
million, were detected in 1999. About 2.2 million of those
alerts indicated excessive dosages unsuitable for senior citizens,
and about 2.4 million alerts indicated clinically inappropriate
drugs for the elderly. Reuters interviewed Kasey Thompson,
director of the Center on Patient Safety at the American Society
of Health System Pharmacists, who said, "There are serious
and systemic problems with poor continuity of care in the
United States." He says this study shows "the tip
of the iceberg" of a national problem.
According to Drug Benefit Trends, the average number of prescriptions
dispensed per non-Medicare HMO member per year rose 5.6 percent
from 1999 to 2000--from 7.1 to 7.5 prescriptions. The average
number dispensed for Medicare members increased 5.5 percent--from
18.1 to 19.1 prescriptions.136 The number of prescriptions
in 2000 was 2.98 billion, with an average per person prescription
amount of 10.4 annually.137
In a study of 818 residents of residential care facilities
for the elderly, 94 percent 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.138
Unfortunately, seniors, and groups like the American Association
for Retired Persons (AARP), appear to be dependent on prescription
drugs and are demanding that coverage for drugs be a basic
right.139 They have accepted the overriding assumption from
allopathic medicine that aging and dying in America must be
accompanied by drugs in nursing homes and eventual hospitalization
with tubes coming out of every orifice.
Instead of choosing between drugs and a diet-lifestyle change,
seniors are given the choiceless option of either high-cost
patented drugs or low-cost generic drugs. Drug companies are
attempting to keep the most expensive drugs on the shelves
and to suppress access to generic drugs, in spite of stiff
fines of hundreds of millions of dollars from the government.140,141
In 2001 some of the world's biggest drug companies, including
Roche, were fined a record £523 million ($871 million)
for conspiring to increase the price of vitamins.142
We would urge AARP, especially, to become more involved in
prevention of disease and not to rely so heavily on drugs.
At present, the AARP recommendations for diet and nutrition
assume that seniors are getting all the nutrition they need
in an average diet. At most, they suggest extra calcium and
a multiple vitamin/mineral supplement.143 This is not enough,
and in our next report we will show how to live a healthier
life without unnecessary medical intervention.
We would like to send the same message to the Hemlock Society,
which offers euthanasia options to chronically ill people,
especially those in severe pain. What if some of these chronic
diseases are really lifestyle diseases caused by deficiency
of essential nutrients, lack of care, inappropriate medication,
or lack of love? This question is extremely important to consider
when you are depressed or in pain. We must look to healing
those conditions before offering up our lives.
Let’s also look at the irony of under use of proper
pain medication for patients that really need it. For example,
in one particular study pain management was evaluated in a
group of 13,625 cancer patients, aged 65 or over, living in
nursing homes. Overall, almost 30 percent, or 4,003 patients,
reported pain. However, more than 25 percent received absolutely
no pain relief medication; 16 percent received a World Health
Organization (WHO) level-one drug (mild analgesic); 32 percent
a WHO level-two drug (moderate analgesic); and only 26 percent
received adequate pain relieving morphine. The authors concluded
that older patients and minority patients were more likely
to have their pain untreated.144
The time has come to set a standard for caring for the vulnerable
among us--a standard that goes beyond making sure they are
housed and fed, and not openly abused. We must stop looking
the other way and we, as a society, must take responsibility
for the way in which we deal with those who are unable to
care for themselves.
WHAT REMAINS TO BE UNCOVERED
- Our ongoing research will continue to quantify the morbidity,
mortality, and financial loss due to:
- X-ray exposures: mammography, fluoroscopy, CT scans.
- Overuse of antibiotics in all conditions.
- Drugs that are carcinogenic: hormone replacement therapy
(*see below), immunosuppressive drugs, prescription drugs.
- Cancer chemotherapy: If it doesn’t extend life, is
it shortening life?70
- 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.
- Outpatient surgery.
- Doctors themselves: when doctors go on strike, it appears
the mortality rate goes down.
*Part of our ongoing research will be to quantify the mortality
and morbidity caused by hormone replacement therapy (HRT)
since the mid-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 million to 16 million women in
the United States.145
The aborted Women’s Health Initiative Study (WHI) of
2002 showed that women taking synthetic estrogen combined
with synthetic progesterone have a higher incidence of ovarian
cancer, breast cancer, stroke, and heart disease and little
evidence of osteoporosis reduction or prevention of dementia.
WHI researchers, who usually never give recommendations, other
than demanding more studies, are advising doctors to be very
cautious about prescribing HRT to their patients.100,146-150
Results of the "Million Women Study" on HRT and
breast cancer in the U.K were published in the Lancet, August
2003. Lead author, Professor Valerie Beral, director of the
Cancer Research UK Epidemiology Unit, is very open about the
damage HRT has caused. She said, "We estimate that over
the past decade, use of HRT by UK women aged 50 to 64 has
resulted in an extra 20,000 breast cancers, oestrogen-progestagen
(combination) therapy accounting for 15,000 of these."151
However, we were not able to find the statistics on breast
cancer, stroke, uterine cancer, or heart disease due to HRT
used by American women. The population of America is roughly
six times that of the U.K. Therefore, it is possible that
120,000 cases of breast cancer have been caused by HRT in
the past decade.
CONCLUSION
When the number one killer in a society is the health care
system, then that system has no excuse except to address its
own urgent shortcomings. It’s a failed system in need
of immediate attention. What we have outlined in this paper
are insupportable aspects of our contemporary medical system
that need to be changed--beginning at its very foundations.
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