Death By Physician Part Four
- From: "DoctorShame" <catscratchfiber@xxxxxxxxxxxxx>
- Date: 18 Oct 2005 12:47:20 -0700
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 SURGICAL 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 U.S. at a hospital cost
of $11,000 per patient, the total number of unnecessary back surgeries
each year in the U.S. 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 nine 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, and 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.
[ Part I, Ref. I, Part II, Ref. II, Appendix ] Next >>
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