Doctors are the Third Leading Cause of Death Part II

By Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD, Debora Rasio MD, Dorothy Smith PhD

Drug Iatrogenesis
Drugs comprise 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 study1 shows. But human error can make the situation even worse.

Medication Errors
A survey of a 1992 national pharmacy database found a total of 429,827 medication errors from 1,081 hospitals. Medication errors occurred in 5.22 percent of patients admitted to these hospitals each year. The authors concluded that a minimum of 90,895 patients annually were harmed by medication errors in the country as a whole.37

A 2002 study shows that 20 percent of hospital medications for patients had dosage mistakes. Nearly 40 percent of these errors were considered potentially harmful to the patient. In a typical 300-patient hospital the number of errors per day were 40.38

Problems involving patients' medications were even higher the following year. The error rate intercepted by pharmacists in this study was 24 percent, making the potential minimum number of patients harmed by prescription drugs 417,908.39

Recent 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 (hospital care that requires highly specialized skills, technology or support services). Seventy-six patients (19 percent) had adverse events. Adverse drug events were the most common at 66 percent. The next most common events were procedure-related injuries at 17 percent.40

In a NEJM study an alarming one-in-four patients suffered observable side effects from the more than 3.34 billion prescription drugs filled in 2002.41 One of the doctors who produced the study was interviewed by Reuters and commented that:

"With these 10-minute appointments, it's hard for the doctor to get into whether the symptoms are bothering the patients."42
William Tierney, who editorialized on the NEJM study, said
" ... 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 the SSRIs, the NSAIDs, and calcium-channel blockers. Reuters also reported that prior research has suggested that nearly 5 percent 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 one of the reasons for this failure: in nearly two-thirds of the cases, doctors couldn't diagnose drug side effects or the side effects persisted because the doctor failed to heed the warning signs.

Medicating Our Feelings
We only need to look at the side effects of antidepressant drugs, which give hope to a depressed population. Patients seeking a more joyful existence and relief from worry, stress and anxiety, fall victim to the messages blatantly displayed on TV and billboards. Often, instead of relief, they also fall victim to a myriad of iatrogenic side effects of antidepressant medication.

Also, a whole generation of antidepressant users has resulted from young people growing up on Ritalin. Medicating youth and modifying their emotions must have some impact on how they learn to deal with their feelings. They learn to equate coping with drugs and not their inner resources. As adults, these medicated youth reach for alcohol, drugs, or even street drugs, to cope.

According to the Journal of the American Medical Association, "Ritalin acts much like cocaine."43 Today's marketing of mood-modifying drugs, such as Prozac or Zoloft, makes them not only socially acceptable but almost a necessity in today's stressful world.

Television Diagnosis
In order to reach the widest audience possible, drug companies are no longer just targeting medical doctors with their message about antidepressants. By 1995 drug companies had tripled the amount of money allotted to direct advertising of prescription drugs to consumers. The majority of the money is spent on seductive television ads. From 1996 to 2000, spending rose from $791 million to nearly $2.5 billion.44 Even though $2.5 billion may seem like a lot of money, the authors comment that it only represents 15 percent of the total pharmaceutical advertising budget.

According to medical experts "there is no solid evidence on the appropriateness of prescribing that results from consumers requesting an advertised drug." However, the drug companies maintain that direct-to-consumer advertising is educational. Dr. Sidney M. Wolfe, of the Public Citizen Health Research Group in Washington, D.C., argues that the public is often misinformed about these ads.45

People want what they see on television and are told to go to their doctor for a prescription.
Doctors in private practice either acquiesce to their patients' demands for these drugs or spend valuable clinic time trying to talk patients out of unnecessary drugs. 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."46

How Do We Know Drugs Are Safe?
Another aspect of scientific medicine that the public takes for granted is the testing of new drugs. Unlike the class of people that take drugs who are ill and need medication, in general, drugs are tested on individuals who are fairly healthy and not on other medications that can interfere with findings. But when they are declared "safe" and enter the drug prescription books, they are naturally going to be used by people on a variety of other medications and who also 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 General Accounting Office (an agency of the U.S. Government) "found that of the 198 drugs approved by the FDA between 1976 and 1985 ... 102 (or 51.5 percent) 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."47

The investigative show NBC's "Dateline" wondered if your doctor is moonlighting as a drug rep. After a year-long investigation they 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 non-tested uses of these medications in spite of the fact that these drugs are only approved for specific indications they have been tested for.48

The leading causes of adverse drug reactions are:

• Antibiotics (17 percent)
• Cardiovascular drugs (17 percent)
• Chemotherapy (15 percent)
• Analgesics and anti-inflammatory agents (15 percent) 49

Specific Drug Iatrogenesis: Antibiotics
Dr. Egger, in a recent editorial, wrote that after 50 years of increasing use of antibiotics, 30 million pounds of antibiotics are used in America per year.50 Twenty-five million pounds of this total are used in animal husbandry. The vast majority of this amount, 23 million pounds, is used to try to prevent disease, the stress of shipping, and to promote growth. Only 2 million pounds are given for specific animal infections.

Dr. Egger reminds us that low concentrations of antibiotics are measurable in many of our foods, rivers, and streams around the world. Much of this is seeping into bodies of water from animal farms.

Egger says overuse of antibiotics results in food-borne infections resistant to antibiotics. Salmonella is found in 20 percent of ground meat but constant exposure of cattle to antibiotics has made 84 percent of salmonella resistant to at least one anti-salmonella antibiotic. Diseased animal food accounts for 80 percent of salmonellosis in humans, or 1.4 million cases per year.

The conventional approach to dealing with this epidemic is to radiate food to try to kill all organisms but keep using the antibiotics that cause the original problem. Approximately 20 percent of chickens are contaminated with Campylobacter jejuni causing 2.4 million human cases of illness annually. Fifty-four percent of these organisms are resistant to at least one anti-campylobacter antimicrobial.

A ban on growth-promoting antibiotics in Denmark began in 1999, which led to a decrease from 453,200 pounds to 195,800 pounds within a year. Another report from Scandinavia found that taking away antibiotic growth promoters had no or minimal effect on food production costs. Egger further warns that in America the current crowded, unsanitary methods of animal farming support constant stress and infection, and are geared toward high antibiotic use. He says these conditions would have to be changed along with cutting back on antibiotic use.

In America, 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. Egger 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 United States still receive antibiotics from their doctor.51 According to the CDC, 90 percent of upper respiratory infections are viral and should not be treated with antibiotics. In Germany the prevalence for systemic antibiotic use in children aged 0 to 6 years was 42.9 percent.52
Data taken from nine U.S. health plans between 1996 and 2000 on antibiotic use in 25,000 children found that rates of antibiotic use decreased. Antibiotic use in children, aged 3 months to under 3 years, decreased 24 percent, from 2.46 to 1.89 antibiotic prescriptions per/patient per/year. For children, 3 years to under 6 years, there was a 25 percent 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 percent reduction from 0.85 to 0.69 antibiotic prescriptions per/patient /per year.53 Although there was a reduction in antibiotic use, the data indicate that on average every child in America receives 1.22 antibiotic prescriptions annually.

Group A beta-hemolytic streptococci is the only common cause of sore throat that requires antibiotics, penicillin and erythromycin being the only recommended treatment. However, 90 percent of sore throats are viral. The authors of this study estimated there were 6.7 million adult annual visits for sore throat between 1989 and 1999 in the United States. Antibiotics were used in 73 percent of visits. Furthermore, patients treated with antibiotics were given non-recommended broad-spectrum antibiotics in 68 percent of visits.

The authors noted, that from 1989 to 1999, there was a significant increase in the newer and more expensive broad-spectrum antibiotics and a decrease in use of penicillin and erythromycin, which are the recommended antibiotics.54 If antibiotics were given in 73 percent of visits and should have only been given in 10 percent, this represents 63 percent, or a total of 4.2 million visits for sore throat that ended in unnecessary antibiotic prescriptions between1989 and 1999. In 1995, Dr. Besser and the CDC cited 2003 cited much higher figures of 20 million unnecessary antibiotic prescriptions per year for viral infections.2 Neither of these figures takes into account the number of unnecessary antibiotics used for non-fatal conditions such as acne, intestinal infection, skin infections, ear infections, etc.