Iatrogenic(doctor-related) causes and Prescription Drugs Are The Leading Cause of Hospitalization and Death in the US, Causing over 250,000 Hospital Related Deaths Every Year; Prescription Drugs are Responsible for over 100,000 Deaths Every Year (documentation provided)

While doctors provide needed treatment successfully for many patients and conditions, it is also well documented that doctor errors and adverse effects of doctor-prescribed drugs or treatments is one of the leading causes of hospitalizations, deaths, and other adverse health events(1-28). 14 % of the U.S. Gross National Product is related to medical and health care, but in spite of the much higher levels of spending on health care the U.S. ranks very poorly compared to other developed countries regarding health statistics and effectiveness of health care(18,etc.). Experts analyzing the basis for this have suggested that a profit driven medical system dominated by pharmaceutical companies and advertising result in over use of technology and pharmaceutical drugs and expensive procedures that have significant risk of adverse health effects(11,1,28).

The following hospitalization, death, and adverse annual effects statistics come from the medical literature, as referenced:

Hospital Events Annual Incidence Related Deaths

In-hospital adverse drug reactions(ADR): 2.2 million (3,4,10,11) over 100,000

Unnecessary surgery or medical procedures 7.5 million (8,5,11,23) over 30,000

Medical mistakes-surgery and other- over 400,000 (7,10,11,23) over 100, 000

Hospital medication errors (5% of patients) over 300,000 harmed, over 7,000(9,13) Infections and antibiotic-resistant infections ? over 80,000 (10,20)

Unnecessary hospitalizations 8.9 million (6) ?

Total hospital related adverse effects 300,000 to 700,000

Malnutrition/dehydration in nursing homes over 100,000 premature deaths (24)

Outpatient adverse drug effects(ADR) over 190,000 (25)

Unnecessary prescriptions of antibiotics Over 20 million (16) thousands

Significant levels of antibiotics and prescription drugs in water bodies and the food chain

Unnecessary X-rays or radiation procedures 70 % of all cancers; 250,000 (19)

Commentary by Dr. Mercola with snips from Gary Null:

These total to over 300,000 hospital deaths per year from iatrogenic causes!!

What does the word iatrogenic mean? This term is defined as induced in a patient by a physician's activity, manner, or therapy. Used especially of a complication of treatment.

The only more common causes are cancer and heart disease which result in 700,000 and 553,000 deaths annually(17). If the higher estimates are used, hospital related deaths due to iatrogenic causes would range from 230,000 to 400,000 per year and constitutes the third leading cause of death in the United States. With non-hospital related iatrogenic deaths added the total may be the largest factor in U.S. deaths.

The article that led to this compilation, Dr. Barbara Starfield’s study in the Journal

of the American Medical Association (JAMA), is the best article I have ever seen written in the published literature documenting the tragedy of the traditional medical paradigm^1,2. This information is a followup of the Institute of Medicine report which hit the papers in December of last year(7). Now such information is published in JAMA which is the most widely circulated medical periodical in the world. It should be noted that most of the estimates in the previous table are likely greatly understated, as it is well documented that medical mistakes are greatly under reported- with studies indicating that only 5 to 20 percent of medical mistakes are reported(28,4,11). Studies indicate that medical mistakes are not consistently or accurately reported by any of the health professional groups, for a number of well known reasons.

Dr. Starfield offers several warnings in interpreting these numbers:

_ First, most of the data are derived from studies in hospitalized patients.

_ Second, these estimates are for deaths only and do not include negative effects that are associated with disability or discomfort.

_ Third, the estimates of death due to error are lower than those in the IOM report.1

_ The drugs with the worst record of adverse effects were NSAIDS, SSRIs, calcium-channel blockers, antibiotics, cardiovascular drugs, and chemotherapy.

Another analysis concluded that between 4% and 18% of consecutive patients experience negative effects in outpatient settings,with:

_ 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 (15)

The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care.(15)

However, evidence from a few studies indicates that as many as 20% to 30% of patients receive inappropriate care. The treatment of the elderly appears to be even more problematic. Studies find that the elderly see multiple doctors and receive multiple drugs, greatly increasing the likelihood of adverse drug interactions and effects(11). The average senior receives 25 prescriptions per year and studies have determined there are millions of inappropriate and contraindicated prescriptions per year and millions of cases of dose errors. Many of the drug prescriptions were given without a documented diagnosis justifying there use and without consideration of interactions with other drugs. Studies also find seniors in pain seldom receive appropriate treatment.

An estimated 44,000 to 98,000 among them die each year as a result of medical errors.2

This might be tolerated if it resulted in better health, but does it? Of 13 countries in a recent comparison (18), the United States ranks an average of 12th (second from the bottom) for 16 available health indicators. More specifically, the ranking of the US on several indicators was:

_ 13th (last) for low-birth-weight percentages

_ 13th for neonatal mortality and infant mortality overall 14

_ 11th for postneonatal mortality

_ 13th for years of potential life lost (excluding external causes)

_ 11th for life expectancy at 1 year for females, 12th for males

_ 10th for life expectancy at 15 years for females, 12th for males

_ 10th for life expectancy at 40 years for females, 9th for males

_ 7th for life expectancy at 65 years for females, 7th for males

_ 3rd for life expectancy at 80 years for females, 3rd for males

_ 10th for age-adjusted mortality

The poor performance of the US was recently confirmed by a World Health Organization study, which used different data and ranked the United States as 15th among 25 industrialized countries.

There is a perception that the American public "behaves badly" by smoking, drinking, and perpetrating violence." However the data does not support this assertion.

_ The proportion of females who smoke ranges from 14% in Japan to 41% in Denmark; in the United States, it is 24% (fifth best). For males, the range is from 26% in Sweden to 61% in Japan; it is 28% in the United States (third best).

_ The US ranks fifth best for alcoholic beverage consumption.

_ The US has relatively low consumption of animal fats (fifth lowest in men aged 55-64 years in 20 industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among 13 industrialized countries.

Lack of technology is certainly not a contributing factor to the US's low ranking.

_ Among 29 countries, the United States is second only to Japan in the availability of magnetic resonance imaging units and computed tomography scanners per million population. 17

_ Japan, however, ranks highest on health, whereas the US ranks among the lowest.

_ It is possible that the high use of technology in Japan is limited to diagnostic technology not matched by high rates of treatment, whereas in the US, high use of diagnostic technology may be linked to more treatment.

_ Supporting this possibility are data showing that the number of employees per bed (full-time equivalents) in the United States is highest among the countries ranked, whereas they are very low in Japan, far lower than can be accounted for by the common practice of having family members rather than hospital staff provide the amenities of hospital care.

Antibiotic use has increased dramatically over the last 2 decades, with a likewise

serious dramatic increase in antibiotic resistance among harmful bacteria types.

Over 30 million pounds of antibiotics are used each year in the U.S., with over 25

million pounds of this in animal husbandry to promote growth and prevent bacterial

outbreaks in animals kept in close quarters(21). The high use of agricultural

antibiotics is resulting in significant amounts of antibiotics in water bodies and the

food chain, resulting in significant increases in antibiotic resistance. Salmonella is

found in 20% of ground meat, with 84% of salmonella resistance to some antibiotics.

Approx. 20% of chickens and eggs are contaminated with salmonella or

campylobacter, with over 50% of campylobacter resistant to some antibiotics. Meat

borne bacteria is responsible for millions of human cases per year.

The approx. 3 million pounds of antibiotics used on humans in the U.S. amounts

to about 10 teaspoons per person. Although according to the CDC over 90% of

upper respiratory infections are viral and sinus infections are fungal, with antibiotics

contraindicated, approx. 50% of treated patients receive antibiotics(22). Likewise

Group A beta-hemolytic streptococci is the only common cause of sore throat that

responds to antibiotics, with over 90% of sore throats being viral or other. But it is

estimated that 73% of doctor visits for sore throat result in antibiotic prescriptions

(22,16). A National Cancer Institute found a strong relation between level of

antibiotic use and breast cancer(12).

Some doctor’s state that women are treated more aggressively and differently than men, resulting in more iatrogenic effects affecting women(26,11). One doctor notes that:

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; more 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

since it confines women to a hospital bed and may result in higher incidence of

Caesarean section; normal processes such as menopause and childbirth have been

highly medicinized; synthetic hormone replacement therapy has been actively

promoted though it does not prevent the conditions it was promoted for and does

increase the risk of breast cancer, heart disease, stroke, and gall bladder attack.

DR .MERCOLA'S COMMENT:

Folks, this is what they call a "Landmark Article". Only several ones like this are published every year. One of the major reasons it is so huge as that it is published in JAMA which is the largest and one of the most respected medical journals in the entire world.

I did find it most curious that the best wire service in the world, Reuter's, did

not pick up this article. I have no idea why they let it slip by.

These statistics prove very clearly that the system is just not working. It is

broken and is in desperate need of repair.

I was previously fond of saying that drugs are the fourth leading cause of death in this country. However, this article makes it quite clear that the more powerful number is that doctors and drugs are the third leading cause of death in this country killing over a quarter million people a year. The only more common causes are cancer and heart disease which result in 700,000 and 553,000 deaths annually(17).

This statistic is likely to be seriously underestimated as much of the coding only describes the cause of organ failure and does not address iatrogenic causes at all.

Japan seems to have benefitted from recognizing that technology is wonderful, but just because you diagnose something with it, one should not be committed to undergoing treatment in the traditional paradigm. Their health statistics reflect this aspect of their philosophy as much of their treatment is not treatment at all, but loving care rendered in the home.

Care, not treatment, is the answer. Drugs, surgery and hospitals are rarely the answer to chronic health problems. Facilitating the God-given healing capacity that all of us have is the key. Improving the diet, exercise, and lifestyle are basic.

Effective interventions for the underlying emotional and spiritual wounding behind most chronic illness are also important clues to maximizing health and reducing disease.

1. Dr. Barbara Starfield, Johns Hopkins School of Hygiene and Public Health,

Journal American Medical Association(JAMA); July 26, 2000;284(4):483-5

www.mercola.com/2000/jul/30/doctors_death.htm

2. Schuster MA, McGlynn EA, Brook RH. How good is the quality of health care in the United States? Milbank Q. 1998;76(4):517-63, 509;

3. Drug-Induced Disorders, E. G. Holland, PHARM.D., and F. V. Degruy, M.D. University of South Alabama College of Medicine, Mobile, Alabama

American Family Physician, 76(7), 1997; www.aafp.org/afp/971101ap/holland.html

4. Leape LL. Error in Medicine, JAMA, 1994, Dec 21; 272(23): 1851-7; & Bates DW et al, Incidence of adverse drug related events, ADE Prevention Study Group, JAMA, 1995, 274(1): 29-34.

5. Calculations detailed in Unnecessary Surgery Section or Instant Tables: 2001 prerun tables: most common procedures, http://hcup.ahrq.gov/HCUPnet.asp and U.S. Congressional House Subcommittee Oversight Investigation, Cost and Quality of Health Care: Unnecessary Surgery. Washington, D.C: Government Printing Office, 1976.

6. Calculations from 4 sources: (5) & Brook RH et al, Inappropriate use of hospitals in a randomized trial of health insurance plans, NEJM, 1986, 315(20):1259-66; & Siu AL et al, Patient, provider, and hospital characteristics associated with inappropriate hospitalization, Am J Public Health, 1990, 80(10):1253-6; & Eriksen BO et al, The cost of inappropriate admissions: a study of health benefits and resource utilization in a department of internal medicine. J Intern Med 1999, 246(4):370-87.

7. Kohn L, ed, Corrigan J, ed, Donaldson M, ed. Institute of Medicine, To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999

8. Leape LL. Unnecessary surgery. Annu Rev Public Health. 1992;13:363-83. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115.

9. Phillips DP, Christenfeld N, Glynn LM. Increase in US medication-error deaths between 1983 and 1993. Lancet. 1998 Feb 28;351(9103):643-4; &(b) Bond CA et al, Clinical pharmacy services, hospital pharmacy staffing, and medication errors in U.S. hospitals, Pharmacotherapy, 2002, 22(2):134-47; &(c) Barker KN et al, Medication errors observed in 36 health care facilities. Arch Intern Med, 2003 162(16):1897-1903; & (d) Lapointe NM et al, Medication errors in hospitalized cardiovascular patients, Arch Intern Med 2003, 163(12):1461-6.

10. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998 Apr 15;279(15):1200-5; & (b) Suh DC et al, Clinical and economic impact of adverse drug reactions in hospitalized patients, Ann Pharmacother. 2000, 34(12):1273-9.

11. M.Feldman(MD),C.Dean(MD),D.Rasio(MD),G. Null(PhD),D Smith(Phd), Death by Medicine, Dec 2003, www.garynull.com/documents/iatrogenic/deathbymedicine/DeathByMedicine.pdf

12. study at Henry Ford Health System, Epidemiol Rev 2002, 24(2):154-75; & European Respiratory Society's annual conference in Vienna; & (b)J. H. J. Droste and colleagues in Clinical & Experimental Allergy, Nov 2000; &(c) American Academy of Allergy, Asthma, and Immunology(AAAAI), 2002, Selected Articles from the Recent Literature, Summary www.aaaai.org/aadmc/currentliterature/selectedarticles/2002archive/adverse_effects.html

& (d) S. Taplin et al, National Cancer Institute, JAMA, Feb 18, 2004.

13. Gandhi TK et al, Adverse drug events in ambulatory care, NEJM, 2003, 348(16):1556-64; & (b) Dr. William Tierney, Medication side effects strike 1 in 4, April 17, 2003, Reuters; & (c) Forster AJ et al, The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 2003 138(3):161-7.

14. Annual summary of vital statistics--1998. Guyer B, Hoyert DL, Martin JA, Ventura SJ, MacDorman MF, Strobino DM. Department of Population and Family Health Sciences, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205, USA.Pediatrics. 1999 Dec;104(6):1229-46.

15. The New England Journal of Medicine January 7, 1999;340:48, 70-76.

16. Rabin R. Caution about overuse of antibiotics, Newsday, Sept. 18, 2003,

(a) www.cdc.gov/drugresistance/community/

17. National Vital Statistics Reports, 51(5), March 14, 2003.

18.World Health Organization, www.who.int/whr/2000/en/report.htm; & (b)U.S. Congress, Office of Technology Assessment(OTA), Health Care Technology and its Assessment in Eight Countries, 1995.

19. Dr. John Gofman, Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease: Dose-Response Studies with Physicians per 100,000 Population, 2000, CNR Books.

20. Weinstein RA, Nosocomial Infection Update. Special Issue. Emerging Infectious Diseases. Vol 4, No. 3, July/Sept 1998.

21. Egger WA, Antibiotic Resistance: Unnatural Selection in the Office and on the Farm. Wisconsin Medical Journal, Aug 2002.

22. Nash DR et al, Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Arch Pediatr Adolesc Med 2002, 156(11): 1114-9; & Linder JA et al, Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999. JAMA, 2001, 286(10): 1181-6.

23. Zahn C, Miller M. Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization, JAMA, 2003, 290: 1868-74.

24. Greene-Burger S, Kayser-Jones J, Prince-Bell J, Malnutrition and Dehydration in Nursing homes, National Citizens Coalition for Nursing Home Reform, June 2000,

www.cmwf.org/programs/elders/burger_mal_386.asp

25. Starfield B. Is US health really the best in the world? JAMA, 2000 284(4):483-5; & Starfield B. Deficiencies in U.S. medical care. JAMA, 2000, 284(17):2184-5; &

Weingart SN et al, Epideomology of medical error, West J Med 2000, 172(6):390-

26. Fugh-Berman A, Reader’s Companion to U.S. Women’s History. Houghton Mifflin,

http://college.hmco.com/history/readerscomp/women/html/wh_001200_alternativeh.htm

27. Dr. Robert Epstein, chief medical officer of Medco Health Solutions(Merck),

Overmedication of U.S. Seniors, Reuters Health, May 21, 2003.

28. Vincent C, et al, Reasons for not reporting adverse incidents: en empirical study. J Eval Clin Pract 1999, 5(1):13-21; & Wald H, et al, Incident Reporting in Making Health Care Safer, Agency for Healthcare Research and Quality(AHRQ), 2001; &

Dickinson JG. Dickinson’s FDA Review, Mar 2000, 7(3):13-14; & Cohen JS. Overdose: the Case Against Drug Companies, 2001, Tarcher-Putnam, NY; & Stenson J. Few Residents Report Medical Errors- Survey Finds, Reuters Health, Feb 21, 2003.

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National Istitute of Health(NIH), special interest ties of officials , several received over $500,000 in fees from pharmaceuticals they have regulatory control over, several instances of health harm and death in trials have been overlooked in products of compancies they received fees from. Smart Publications: Health and Wellness Update, Vol 141, p16,17.