Doctors are the Third Leading Cause of Death Part III

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

The Problem with Antibiotics: They are Anti-Life
On September 17, 2003 the CDC relaunched a program, started in 1995, called "Get Smart: Know When Antibiotics Work."55 This is a $1.6 million campaign to educate patients about the overuse and inappropriate use of antibiotics. Most people involved with alternative medicine have known about the dangers of overuse of antibiotics for decades.
Finally the government is focusing on the problem, yet they are only putting a miniscule amount of money into an iatrogenic epidemic that is costing billions of dollars and thousands of lives.

The CDC warns that 90 percent of upper respiratory infections, including children's ear infections, are viral, and antibiotics don't treat viral infection. More than 40 percent of about 50 million prescriptions for antibiotics each year in physicians' offices were inappropriate.2 And 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 infections.9

However, the CDC seems to be blaming patients for misusing antibiotics even though they are only available on
prescription from a doctor who should know how to prescribe properly. Dr. Richard Besser, head of "Get Smart," says "Programs that have just targeted physicians have not worked. Direct-to-consumer advertising of drugs is to blame in some cases." Dr. 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."56

And what does the "best care" constitute? The CDC does not elaborate and patently avoids the latest research on the dozens of nutraceuticals scientifically proven to treat viral infections and boost the immune system. Will their doctors recommend vitamin C, echinacea, elderberry, vitamin A, zinc, or homeopathic oscillococcinum? No, they won't. The archaic solutions offered by the CDC include a radio ad, "Just Say No--Snort, sniffle, sneeze--No antibiotics please." Their commonsense recommendations, that most people do anyway, include resting, drinking plenty of fluids, and using a humidifier.

The pharmaceutical industry claims they are all for limiting the use of antibiotics. In order to make sure that happens, the drug company Bayer is sponsoring a program called, "Operation Clean Hands," through an organization called LIBRA.57 The CDC is also involved with trying to minimize antibiotic resistance, but nowhere in their publications is there any reference to the role of nutraceuticals in boosting the immune system nor to the thousands of journal articles that support this approach.

This recalcitrant tunnel vision and refusal to use available non-drug alternatives is absolutely inappropriate when the CDC is desperately trying to curb the nightmare of overuse of antibiotics. The CDC should also be called to task because it is only focusing on the overuse of antibiotics. There are similar nightmares for every class of drug being prescribed today.

Drugs Pollute Our Water Supply
We have reached the point of saturation with prescription drugs. We have arrived at the point where every body of water tested contains measurable drug residues. We are inundated with drugs. 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 are also 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 idea what the long-term consequences of ingesting a mixture of drugs and drug-breakdown products will do to our health. It's another level of iatrogenic disease that we are unable to completely measure.58-67

Specific Drug Iatrogenesis: NSAIDs
It's not just America that is plagued with iatrogenesis. A survey of 1,072 French general practitioners (GPs) tested their basic pharmacological knowledge and practice in prescribing NSAIDs. Non-steroidal anti-inflammatory drugs (NSAIDs) rank first among commonly prescribed drugs for serious adverse reactions. The results of the study suggested that GPs don't have adequate knowledge of these drugs and are unable to effectively manage adverse reactions.68

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."69

Specific Drug Iatrogenesis: Cancer Chemotherapy

In 1989, a German biostatistician, Ulrich Abel PhD, after publishing dozens of papers on cancer chemotherapy, wrote a monograph "Chemotherapy of Advanced Epithelial Cancer." It was later published in a shorter form in a peer-reviewed medical journal.70

Dr. 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 we are most familiar with. It arises from epithelium found in the lining of body organs such as breast, prostate, lung, stomach, or bowel.

From these sites cancer usually infiltrates into adjacent tissue and spreads to bone, liver, lung, or the brain. With his exhaustive review Dr. Abel concludes that there is no direct evidence that chemotherapy prolongs survival in patients with advanced carcinoma. He said that in small-cell lung cancer and perhaps ovarian cancer the therapeutic benefit is only slight. Dr. Abel goes on to say, "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 clinical studies."

Over a decade after Dr. Abel's exhaustive review of chemotherapy, there seems no decrease in its use for advanced carcinoma. For example, when conventional chemotherapy and radiation has not worked to prevent metastases in breast cancer, high-dose chemotherapy (HDC) along with stem-cell transplant (SCT) is the treatment of choice.
However, in March 2000, 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.71 There was even a slightly lower survival rate for the HDC/SCT group. And the authors noted that serious adverse effects occurred more often in the HDC group than the standard-dose group. There was one treatment-related death (within 100 days of therapy) in the HDC group, but none in the conventional chemotherapy group. The women in this trial were highly selected as having the best chance to respond.

There is also no all-encompassing follow-up study like Dr. Abel's that tells us if there is any improvement in cancer-survival statistics since 1989. In fact, we need to research 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 aren't used.

Drug Companies Fined
Periodically, a drug manufacturer is fined by the FDA when the abuses are too glaring and impossible to cover up. The May 2002 Washington Post reported that the maker of Claritin, Schering-Plough Corp., was to pay a $500 million fine to the FDA for quality-control problems at four of its factories.72 The FDA tabulated infractions that included 90 percent, or 125 of the drugs they made since 1998. Besides the fine, the company had to stop manufacturing 73 drugs or suffer another $175 million fine. PR statements by the company told another story. The company assured consumers that they should still feel confident in its products.

Such a large settlement serves 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 manufacturing practices." Since that time Abbott Laboratories Inc. paid $100 million for failing to meet quality standards in the production of medical test kits, and Wyeth Laboratories Inc. paid $30 million in 2000 to settle accusations of poor manufacturing practices.

The indictment against Schering-Plough came after the Public Citizen Health Research Group, lead 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.

Unnecessary Surgery Procedures
Summary:
1974: 2.4 million unnecessary surgeries performed annually resulting in 11,900 deaths at an annual cost of $3.9 billion.73,74
2001: 7.5 million unnecessary surgical procedures resulting in 37,136 deaths at a cost of $122 billion (using 1974 dollars).3
It's very difficult to obtain accurate statistics when studying unnecessary surgery. Dr. Leape in 1989 wrote that perhaps 30 percent of controversial surgeries are unnecessary. Controversial surgeries include:
? Cesarean section
? Tonsillectomy
? Appendectomy
? Hysterectomy
? Gastrectomy for obesity
? Breast implants and elective breast implants 74

Almost 30 years ago, in 1974, the Congressional Committee on Interstate and Foreign Commerce held hearings on unnecessary surgery. They found that 17.6 percent 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.73

In 2001, the top 50 medical and surgical procedures totaled approximately 41.8 million. These figures were taken from the Healthcare Cost and Utilization Project within the Agency for Healthcare Research and Quality.13 Using 17.6 percent from the 1974 U.S. Congressional House Subcommittee Oversight Investigation as the percentage of unnecessary surgical procedures, and extrapolating from the death rate in 1974, we come up with an unnecessary procedure number of 7.5 million (7,489,718) and a death rate of 37,136, at a cost of $122 billion (using 1974 dollars).

Researchers performed a very similar analysis, using the 1974 'unnecessary surgery percentage' of 17.6, on back surgery. In 1995, researchers testifying before the Department of Veterans Affairs estimated that of 250,000 back surgeries in the United States at a hospital cost of $11,000 per patient, the total number of unnecessary back surgeries each year in the United Staes could approach 44,000, costing as much as $484 million.75

The unnecessary surgery figures are escalating just as prescription drugs driven by television advertising. Media-driven surgery such as gastric bypass for obesity "modeled" by Hollywood personalities seduces obese people to think this route is safe and sexy. There is even a problem of surgery being advertised on the Internet.76 A study in Spain declares that between 20 percent and 25 percent of total surgical practice represents unnecessary operations.77

According to data from the National Center for Health Statistics from 1979 to 1984, there was a 9 percent increase in the total number of surgical procedures, and the number of surgeons grew by 20 percent. The author notes that there has not been a parallel increase in the number of surgeries despite a recent large increase in the number of surgeons. There was concern that there would be too many surgeons to share a small surgical caseload.78

The previous author spoke too soon--there was no cause to worry about a small surgical caseload. By 1994, there was an increase of 38 percent for a total of 7,929,000 cases for the top ten surgical procedures. In 1983, surgical cases totaled 5,731,000. In 1994, cataract surgery was number one with over two million operations, and second was Cesarean section (858,000 procedures). Inguinal hernia operations were third (689,000 procedures), and knee arthroscopy, in seventh place, grew 153 percent (632,000 procedures) while prostate surgery declined 29 percent (229,000 procedures).79

The list of iatrogenic diseases from surgery is as long as the list of procedures themselves. In one study epidural catheters were inserted to deliver anesthetic into the epidural space around the spinal nerves to block them 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.80

In one review of the literature, the authors demonstrated:
"a significant rate of overutilization of coronary angiography, coronary artery surgery, cardiac pacemaker insertion, upper gastrointestinal endoscopies, carotid endarterectomies, back surgery, and pain-relieving procedures."81
A 1987 JAMA study found the following significant levels of inappropriate surgery:
? 17 percent of cases for coronary angiography
? 32 percent for carotid endarterectomy
? 17 percent for upper gastrointestinal tract endoscopy 82

Using the Healthcare Cost and Utilization Project (HCUP) statistics provided by the government for 2001, the number of people getting upper gastrointestinal endoscopy, which usually entails biopsy, was 697,675; the number getting endarterectomy was 142,401; and the number having coronary angiography was 719,949.13

Therefore, according to the JAMA study 17 percent, or 118,604 people had an unnecessary endoscopy procedure.
Endarterectomy occurred in 142,401 patients; potentially 32 percent or 45,568 did not need this procedure. And 17 percent of 719,949, or 122,391 people receiving coronary angiography were subjected to this highly invasive procedure unnecessarily. These are all forms of medical iatrogenesis.

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 percent to 20 percent of iatrogenic incidents are even recorded.16,24,25,33,34 And, our outpatient iatrogenic statistics 112 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 percent 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 common diseases such as:
? High blood pressure
? Diabetes
? Heart disease 153

Overlapping of statistics in this article 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 percent 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.