If
you ever wanted to live your own fairy-tale, you may want to consider
moving to the village Giethoorn. Also known as “Venice of the
Netherlands”, this magical village founded around 1230 is the kind most
people could only dream of…
It has no roads or any modern transportation
at all, only canals. Well, and 176 bridges too. Tourists have to leave
their cars outside of the village and travel here by foot or boat by
(usually by “whisper boats”, which have noiseless engines). So you can
probably imagine how peaceful it is here (well, when it isn’t flooded
with tourists, of course)… Even the village’s website says that “the
loudest sound you can normally hear is the quacking of a duck or the
noise made by other birds”. It’s like something out of a storybook.
Cet épisode 63 de l'Actu au Scalpel revient sur l'affaire du coronavirus. Il sera question ici aussi bien de l'épidémie que du traitement médiatique assez lamentable de cette affaire. On reviendra également sur certains points de l'histoire qui vont nous aider à mieux comprendre ce qui se passe.
Coronavirus : Le bilan tragique au stade 3 : "MALHEUR À TOI, PAYS DONT LE ROI EST UN ENFANT !"
292,240 views
•17 Mar 2020
Bill Gates Talks about Coronavirus-Like Epidemic in 2019 Netflix Documentary
Updated on
Jan 31, 2020 at 8:11 am UTC by Teuta Franjkovic · 4 min read Photo: Netflix
In
November Netflix released a documentary about the coronavirus-like
epidemic and Bill Gates spoke there like a real Nostradamus. He said we
should invest more in the development of vaccines against such diseases.
When last year in November, a documentary series episode from Netflix
called “The Next Pandemic” came out – nobody actually didn’t give it
too much importance. However, only a month after – boy, how it started
to be popular. The episode describes the ways how viruses are spreading
and evolving into epidemic situations. The story starts with
traveling across India, Egypt, the Democratic Republic of Congo, the
United States and explains historical cases of pandemics like it was the
Spanish flu of 1918 or Ebola and the bird flu.
Chinese Wet Markets are Batch of Disease
The
point is that the documentary says that in wet markets in China, people
are trading with various live animals who are then being slaughtered on
sight by vendors who then sell meat to consumers. And, just to
explain a bit. The author of this article has been traveling through
Asia a lot. And I love food. And I’ve seen wet markets in Hong Kong,
Singapore, Bali, Taiwan – and they are all pretty normal and decent.
Maybe a little bit dirtier because of the climate there, but nothing
special. But I couldn’t go to mainland China wet markets. Wushu,
Shenzhen and even Shanghai seem to be another culture.
In Humid Conditions the Virus Evolves
From
eating pigeons and dogs and rats and lizards and bats – to not giving a
damn about any hygiene, not to talk about any humanity when killing
those animals at the spot. So yes. When Netflix describes the wet
markets as a disease X factory – they couldn’t be more right. When you
have such conditions (humidity, dirt, no water, no soap, blood, sun)
it’s easy for any virus to mutate and spares to humans. The documentary says:
“This
is a wet market in the Lianghua, China. Unlike markets in much of the
West, where animals are already dead when they arrive, this wet market
sells meat that’s very fresh. It’s killed on sight. That’s what makes it
a disease X factory. Many different animal species are stacked on top
of each other, their blood and meat mixed, before being passed from
human to human. All the while, their viruses are mixing and mutating,
increasing the odds that one finds its way to humans.”
The wet market from Netflix’s story is in fact totally similar to the seafood market in Wuhan where coronavirus evolved.
Snakes and Bats – the Main Culprits
Scientists
believe that the coronavirus (2019-nCoV) comes from snakes and bats.
Both animals were sold live in the Wuhan seafood market, which made
humans vulnerable to the respiratory disease. Bats were “guilty”
as well in the SARS outbreak in 2003. After several people were
infected, it then transferred from humans to humans, causing a pandemic.
On Thursday the newest information
was that at least 170 people are dead and more than 7,000 cases have
been confirmed in mainland China, as the Wuhan coronavirus spreads
across Asia and the rest of the world. The coronavirus is
spreading rapidly and scientists across the globe are rushing to find a
vaccine for it. The latest news says that Russia will join China’s
efforts to develop a vaccine for the deadly novel coronavirus in an
effort to stop spreading the disease. A group of virologists in
Australia also managed to replicate the coronavirus outside of China to
help with diagnosis and help with efficient testing.
Bill Gates as Nostradamus
But, one player in Netflix’s documentary is a well-known billionaire Bill Gates
who now sounds like a real live Nostradamus. He said that when a
pandemic that the world has not seen before emerges, no matter the size,
people regret not investing more for vaccines. Gates said:
“If
a disease comes along that we haven’t seen before, typically it would
take four or five years to come up with a vaccine against that disease.
And new technologies might shorten those times.”
When a pandemic comes along of any size, we always look back and wish we invested more. The
coronavirus, with its roots in Wuhan’s seafood market, eerily
replicates previous virus outbreaks like the SARS virus that was also
caused by live animal markets. The number of people that have been
confirmed as infected by coronavirus has risen to well over 8,000,
surpassing the SARS outbreak from 2002-2003 in that respect, but still
with less reported deaths. The question remains on should
scientists and institutions thought before on investing more in order to
prepare for potential outbreaks modeled after SARS, and would that
lessened the impact of the coronavirus outbreak. Business, News, Personal Finance
Author: Teuta FranjkovicExperienced
creative professional focusing on financial and political analysis,
editing daily newspapers and news sites, economical and political
journalism, consulting, PR and Marketing. Teuta’s passion is to create
new opportunities and bring people together.
https://www.youtube.com/watch?v=OQD_-2KI244
Coronavirus : la Chine en quarantaine | ARTE Reportage
The Most DISGUSTING Marketing in the World - Wuhan Market (Corona Virus)
https://www.youtube.com/watch?v=G9oqvJ3iXGI
Connor Reed, a British man who works at a school in Wuhan, explains how it felt to have the Covid-19 coronavirus, discusses what life is like after 40 days in lockdown and how he thinks people in the UK would cope in similar circumstances.
https://www.youtube.com/watch?v=okg7uq_HrhQ
How Coronavirus Kills: Acute Respiratory Distress Syndrome (ARDS) & Treatment
Doctors Kill 1,000,000 People Each Year In the U.S. Alone – Shocking Health Statistics
TLB Editors Note:
The article you are about to read was originally published in 2015, but
has not received the attention it surely needs. One of our pastimes
here is to go through older publications, studies and articles to find
the gems like this that truly need more daylight … thus we present this
in the hopes it will awaken many to the dangers of modern medicine,
dangers you would never be aware of if it were not for these great
doctors, researchers and authors, as well as TLB’s propensity to go
looking for forgotten gems of knowledge. The vital question to be
answered is … if it was known to be this bad five years ago, what the
heck is it like now … ??? Please read on!
Death by Medicine
By: Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD
Something
is wrong when regulatory agencies pretend that vitamins are dangerous,
yet ignore published statistics showing that government-sanctioned
medicine is the real hazard.
Until now, Life
Extension could cite only isolated statistics to make its case about the
dangers of conventional medicine. No one had ever analyzed and combined
ALL of the published literature dealing with injuries and deaths caused
by government-protected medicine. That has now changed.
A
group of researchers meticulously reviewed the statistical evidence and
their findings are absolutely shocking.4 These researchers have
authored a paper titled “Death by Medicine” that presents compelling
evidence that today’s system frequently causes more harm than good.
This
fully referenced report shows the number of people having in-hospital,
adverse reactions to prescribed drugs to be 2.2 million per year. The
number of unnecessary antibiotics prescribed annually for viral
infections is 20 million per year. The number of unnecessary medical and
surgical procedures performed annually is 7.5 million per year. The
number of people exposed to unnecessary hospitalization annually is 8.9
million per year.
The most stunning statistic,
however, is that the total number of deaths caused by conventional
medicine is an astounding 783,936 per year. It is now evident that the
American medical system is the leading cause of death and injury in the
US. (By contrast, the number of deaths attributable to heart disease in
2001 was 699,697, while the number of deaths attributable to cancer was
553,251.5)
We had intended to publish the entire
text of “Death By Medicine” in this month’s issue. The article uncovered
so many problems with conventional medicine however, that it became too
long to fit within these pages. We have instead put it on our website (www.lef.org).
We
placed this article on our website to memorialize the failure of the
American medical system. By exposing these gruesome statistics in
painstaking detail, we provide a basis for competent and compassionate
medical professionals to recognize the inadequacies of today’s system
and at least attempt to institute meaningful reforms.
Natural
medicine is under siege, as pharmaceutical company lobbyists urge
lawmakers to deprive Americans of the benefits of dietary supplements.
Drug-company front groups have launched slanderous media campaigns to
discredit the value of healthy lifestyles. The FDA continues to
interfere with those who offer natural products that compete with
prescription drugs.
These attacks against natural
medicine obscure a lethal problem that until now was buried in thousands
of pages of scientific text. In response to these baseless challenges
to natural medicine, the Nutrition Institute of America commissioned an
independent review of the quality of “government-approved” medicine. The
startling findings from this meticulous study indicate that
conventional medicine is “the leading cause of death” in the United
States .
The Nutrition Institute of America is a
nonprofit organization that has sponsored independent research for the
past 30 years. To support its bold claim that conventional medicine is
America ‘s number-one killer, the Nutritional Institute of America
mandated that every “count” in this “indictment” of US medicine be
validated by published, peer-reviewed scientific studies.
What you are about to read is a stunning compilation of facts that
documents that those who seek to abolish consumer access to natural
therapies are misleading the public. Over 700,000 Americans die each
year at the hands of government-sanctioned medicine, while the FDA and
other government agencies pretend to protect the public by harassing
those who offer safe alternatives.
A definitive
review of medical peer-reviewed journals and government health
statistics shows that American medicine frequently causes more harm than
good.
Each year approximately 2.2 million US
hospital patients experience adverse drug reactions (ADRs) to prescribed
medications.(1) In 1995, Dr. Richard Besser of the federal Centers for
Disease Control and Prevention (CDC) estimated the number of unnecessary
antibiotics prescribed annually for viral infections to be 20 million;
in 2003, Dr. Besser spoke in terms of tens of millions of unnecessary
antibiotics prescribed annually.(2, 2a) Approximately 7.5 million
unnecessary medical and surgical procedures are performed annually in
the US,(3) while approximately 8.9 million Americans are hospitalized
unnecessarily.(4)
Iatrogenic: “Induced by a physician’s words or therapy (used especially of a complication resulting from treatment)”
As
shown in the following table, the estimated total number of iatrogenic
deaths—that is, deaths induced inadvertently by a physician or surgeon
or by medical treatment or diagnostic procedures— in the US annually is
783,936. It is evident that the American medical system is itself the
leading cause of death and injury in the US . By comparison,
approximately 699,697 Americans died of heart in 2001, while 553,251
died of cancer.(5)
Table 1: Estimated Annual Mortality and Economic Cost of Medical Intervention
Condition
Deaths
Cost
Author
Adverse Drug Reactions
106,000
$12 billion
Lazarou (1), Suh (49)
Medical Error
98,000
$2 billion
IOM(6)
Bedsores
115,000
$55 billion
Zakellis(7), Barczak(8)
Infection
88,000
$5 billion
Weinstein(9), MMWR(10)
Malnutrition
108,800
–
Nurses Coalition(11)
Outpatients
199,000
$77 billion
Starfield(12), Weingart(112)
Unnecessary Procedures
37,136
$122 billion
HCUP(3,13)
Surgery-Related
32,000
$9 billion
AHRQ(85)
Total
783,936
$282 billion
Using
Leape’s 1997 medical and drug error rate of 3 million(14) multiplied by
the 14% fatality rate he used in 1994(16) produces an annual death rate
of 420,000 for drug errors and medical errors combined. Using this
number instead of Lazorou’s 106,000 drug errors and the Institute of
Medicine ‘s (IOM) estimated 98,000 annual medical errors would add
another 216,000 deaths, for a total of 999,936 deaths annually.
Table 2: Estimated Annual Mortality and Economic Cost of Medical Intervention
Condition
Deaths
Cost
Author
ADR/Medical error
420,000
$200 billion
Leap(14)
Bedsores
115,000
$55 billion
Zakesslis(7), Barczak(8)
Infection
88,000
$5 billion
Weinstein(9), MMWR(1o)
Malnutrition
108,800
—
Nurses Coalition(11)
Outpatients
199,000
$77 billion
Starfield(12), Weingart(112)
Unnecessary Procedures
37,136
$122 billion
HCUP(3,13)
Surgery-Related
32,000
$9 billion
AHRQ(85)
Total
999,936
$468 billion
(Webmaster’s Note: I rounded off the above figure of 999,936 to 1,000,000 for the title of this article).
The
enumerating of unnecessary medical events is very important in our
analysis. Any invasive, unnecessary medical procedure must be considered
as part of the larger iatrogenic picture. Unfortunately, cause and
effect go unmonitored. The figures on unnecessary events represent
people who are thrust into a dangerous health care system. Each of these
16.4 million lives is being affected in ways that could have fatal
consequences. Simply entering a hospital could result in the following:
In 16.4 million people, a 2.1% chance (affecting 186,000) of a serious adverse drug reaction(1)
In 16.4 million people, a 5-6% chance (affecting 489,500) of acquiring a nosocomial* infection(9)
In
16.4 million people, a 4-36% chance (affecting 1.78 million) of having
an iatrogenic injury (medical error and adverse drug reactions).(16)
In 16.4 million people, a 17% chance (affecting 1.3 million) of a procedure error.(40)
Noscocomial: Taking place or originating in a hospital.
These
statistics represent a one-year time span. Working with the most
conservative figures from our statistics, we project the following
10-year death rates.
Table 3: Estimated 10-Year Death Rates from Medical Intervention
Condition
10-Year Deaths
Author
Adverse Drug Reaction
1.06 million
(1)
Medical error
0.98 million
(6)
Bedsores
1.15 million
(7,8)
Nosocomial Infection
0.88 million
(9,10)
Malnutrition
1.09 million
(11)
Outpatients
1.99 million
(12,112)
Unnecessary Procedures
371,360
(3,13)
Surgery-related
320,000
(85)
Total
7,841,360
Our
estimated 10-year total of 7.8 million iatrogenic deaths is more than
all the casualties from all the wars fought by the US throughout its
entire history.
Our projected figures for unnecessary medical events occurring over a 10-year period also are dramatic.
Table 4: Estimated 10-Year Unnecessary Medical Events
Unnecessary Events
10-year Number
Iatrogenic Events
Hospitalization
89 million (4)
17 million
Procedures
75 million (3)
15 million
Total
163 million
These
figures show that an estimated 164 million people—more than half of the
total US population—receive unneeded medical treatment over the course
of a decade.
INTRODUCTION
Never
before have the complete statistics on the multiple causes of
iatrogenesis been combined in one article. Medical science amasses tens
of thousands of papers annually, each representing a tiny fragment of
the whole picture. To look at only one piece and try to understand the
benefits and risks is like standing an inch away from an elephant and
trying to describe everything about it. You have to step back to see the
big picture, as we have done here. Each specialty, each division of
medicine keeps its own records and data on morbidity and mortality. We
have now completed the painstaking work of reviewing thousands of
studies and putting pieces of the puzzle together.
IS AMERICAN MEDICINE WORKING?
US
health care spending reached $1.6 trillion in 2003, representing 14% of
the nation’s gross national product.(15) Considering this enormous
expenditure, we should have the best medicine in the world. We should be
preventing and reversing disease, and doing minimal harm. Careful and
objective review, however, shows we are doing the opposite. Because of
the extraordinarily narrow, technologically driven context in which
contemporary medicine examines the human condition, we are completely
missing the larger picture.
Medicine is not taking
into consideration the following critically important aspects of a
healthy human organism: (a) stress and how it adversely affects the
immune system and life processes; (b) insufficient exercise; (c)
excessive caloric intake; (d) highly processed and denatured foods grown
in denatured and chemically damaged soil; and (e) exposure to tens of
thousands of environmental toxins. Instead of minimizing these
disease-causing factors, we cause more illness through medical
technology, diagnostic testing, overuse of medical and surgical
procedures, and overuse of pharmaceutical drugs. The huge disservice of
this therapeutic strategy is the result of little effort or money being
spent on preventing disease.
UNDERREPORTING OF IATROGENIC EVENTS
As few as 5% and no more than 20% of iatrogenic acts are ever reported.(16,24,25,33,34)
This
implies that if medical errors were completely and accurately reported,
we would have an annual iatrogenic death toll much higher than 783,936.
In 1994, Leape said his figure of 180,000 medical mistakes resulting in
death annually was equivalent to three jumbo-jet crashes every two
days.(16) Our considerably higher figure is equivalent to six jumbo jets are falling out of the sky each day.
What
we must deduce from this report is that medicine is in need of complete
and total reform—from the curriculum in medical schools to protecting
patients from excessive medical intervention. It is obvious that we
cannot change anything if we are not honest about what needs to be
changed. This report simply shows the degree to which change is
required.
We are fully aware of what stands in the
way of change: powerful pharmaceutical and medical technology
companies, along with other powerful groups with enormous vested
interests in the business of medicine. They fund medical research,
support medical schools and hospitals, and advertise in medical
journals. With deep pockets, they entice scientists and academics to
support their efforts. Such funding can sway the balance of opinion from
professional caution to uncritical acceptance of new therapies and
drugs. You have only to look at the people who make up the hospital,
medical, and government health advisory boards to see conflicts of
interest. The public is mostly unaware of these interlocking interests.
For
example, a 2003 study found that nearly half of medical school faculty
who serve on institutional review boards (IRB) to advise on clinical
trial research also serve as consultants to the pharmaceutical
industry.(17) The study authors were concerned that such representation
could cause potential conflicts of interest. A news release by Dr. Erik
Campbell, the lead author, said, “Our previous research with faculty has
shown us that ties to industry can affect scientific behavior, leading
to such things as trade secrecy and delays in publishing research. It’s
possible that similar relationships with companies could affect IRB
members’ activities and attitudes.”(18)
MEDICAL ETHICS AND CONFLICT OF INTEREST IN SCIENTIFIC MEDICINE
Jonathan
Quick, director of essential drugs and medicines policy for the World
Health Organization (WHO), wrote in a recent WHO bulletin: “If clinical
trials become a commercial venture in which self-interest overrules
public interest and desire overrules science, then the social contract
which allows research on human subjects in return for medical advances
is broken.”(19)
As former editor of the New England Journal of Medicine,
Dr. Marcia Angell struggled to bring greater attention to the problem
of commercializing scientific research. In her outgoing editorial
entitled “Is Academic Medicine for Sale?”
Angell
said that growing conflicts of interest are tainting science and called
for stronger restrictions on pharmaceutical stock ownership and other
financial incentives for researchers:(20) “When the boundaries between
industry and academic medicine become as blurred as they are now, the
business goals of industry influence the mission of medical schools in
multiple ways.” She did not discount the benefits of research but said a
Faustian bargain now existed between medical schools and the
pharmaceutical industry.
Angell left the New England Journal in
June 2000. In June 2002, the New England Journal of Medicine announced
that it would accept journalists who accept money from drug companies
because it was too difficult to find ones who have no ties. Another
former editor of the journal, Dr. Jerome Kassirer, said that was not the
case and that plenty of researchers are available who do not work for
drug companies.(21) According to an ABC news report, pharmaceutical
companies spend over $2 billion a year on over 314,000 events attended
by doctors.
The ABC news report also noted that a
survey of clinical trials revealed that when a drug company funds a
study, there is a 90% chance that the drug will be perceived as
effective whereas a non-drug-company-funded study will show favorable
results only 50% of the time. It appears that money can’t buy you love
but it can buy any “scientific” result desired.
Cynthia Crossen, a staffer for the Wall Street Journal, in 1996 published Tainted Truth : The Manipulation of Fact in America ,
a book about the widespread practice of lying with statistics.(22)
Commenting on the state of scientific research, she wrote: “The road to
hell was paved with the flood of corporate research dollars that eagerly
filled gaps left by slashed government research funding.” Her data on
financial involvement showed that in l981 the drug industry “gave” $292
million to colleges and universities for research. By l991, this figure
had risen to $2.1 billion.
THE FIRST IATROGENIC STUDY
Dr. Lucian L. Leape opened medicine’s Pandora’s box in his 1994 paper, “Error in Medicine,” which appeared in the Journal of the American Medical Association (JAMA).(16)
He found that Schimmel reported in 1964 that 20% of hospital patients
suffered iatrogenic injury, with a 20% fatality rate. In 1981 Steel
reported that 36% of hospitalized patients experienced iatrogenesis with
a 25% fatality rate, and adverse drug reactions were involved in 50% of
the injuries. In 1991, Bedell reported that 64% of acute heart attacks
in one hospital were preventable and were mostly due to adverse drug
reactions.
Leape focused on the “Harvard Medical
Practice Study” published in 1991, (16a) which found a 4% iatrogenic
injury rate for patients, with a 14% fatality rate, in 1984 in New York
State. From the 98,609 patients injured and the 14% fatality rate, he
estimated that in the entire U.S. 180,000 people die each year partly as
a result of iatrogenic injury.
Why Leape chose to
use the much lower figure of 4% injury for his analysis remains in
question. Using instead the average of the rates found in the three
studies he cites (36%, 20%, and 4%) would have produced a 20% medical
error rate. The number of iatrogenic deaths using an average rate of
injury and his 14% fatality rate would be 1,189,576.
Leape
acknowledged that the literature on medical errors is sparse and
represents only the tip of the iceberg, noting that when errors are
specifically sought out, reported rates are “distressingly high.” He
cited several autopsy studies with rates as high as 35-40% of missed
diagnoses causing death. He also noted that an intensive care unit
reported an average of 1.7 errors per day per patient, and 29% of those
errors were potentially serious or fatal.
Leape
calculated the error rate in the intensive care unit study. First, he
found that each patient had an average of 178 “activities”
(staff/procedure/medical interactions) a day, of which 1.7 were errors,
which means a 1% failure rate. This may not seem like much, but Leape
cited industry standards showing that in aviation, a 0.1% failure rate
would mean two unsafe plane landings per day at Chicago’s O’Hare
International Airport; in the US Postal Service, a 0.1% failure rate
would mean 16,000 pieces of lost mail every hour; and in the banking
industry, a 0.1% failure rate would mean 32,000 bank checks deducted
from the wrong bank account.
In trying to
determine why there are so many medical errors, Leape acknowledged the
lack of reporting of medical errors. Medical errors occur in thousands
of different locations and are perceived as isolated and unusual events.
But the most important reason that the problem of medical errors is
unrecognized and growing, according to Leape, is that doctors and nurses
are unequipped to deal with human error because of the culture of
medical training and practice.
Doctors are taught
that mistakes are unacceptable. Medical mistakes are therefore viewed as
a failure of character and any error equals negligence. No one is
taught what to do when medical errors do occur. Leape cites McIntyre and
Popper, who said the “infallibility model” of medicine leads to
intellectual dishonesty with a need to cover up mistakes rather than
admit them. There are no Grand Rounds on medical errors, no sharing of
failures among doctors, and no one to support them emotionally when
their error harms a patient.
Leape hoped his paper
would encourage medical practitioners “to fundamentally change the way
they think about errors and why they occur.” It has been almost a decade
since this groundbreaking work, but the mistakes continue to soar.
In
1995, a JAMA report noted, “Over a million patients are injured in US
hospitals each year, and approximately 280,000 die annually as a result
of these injuries. Therefore, the iatrogenic death rate dwarfs the
annual automobile accident mortality rate of 45,000 and accounts for
more deaths than all other accidents combined.”(23)
At
a 1997 press conference, Leape released a nationwide poll on patient
iatrogenesis conducted by the National Patient Safety Foundation (NPSF),
which is sponsored by the American Medical Association (AMA). Leape is a
founding member of NPSF. The survey found that more than 100 million
Americans have been affected directly or indirectly by a medical
mistake. Forty-two percent were affected directly and 84% personally
knew of someone who had experienced a medical mistake.(14)
At
this press conference, Leape updated his 1994 statistics, noting that
as of 1997, medical errors in inpatient hospital settings nationwide
could be as high as 3 million and could cost as much as $200 billion .
Leape used a 14% fatality rate to determine a medical error death rate
of 180,000 in 1994.(16) In 1997, using Leape’s base number of 3 million
errors, the annual death rate could be as high as 420,000 for hospital
inpatients alone.
ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED
In
1994, Leape said he was well aware that medical errors were not being
reported.(16) A study conducted in two obstetrical units in the UK found
that only about one-quarter of adverse incidents were ever reported, to
protect staff, preserve reputations, or for fear of reprisals,
including lawsuits.(24). An analysis by Wald and Shojania found that
only 1.5% of all adverse events result in an incident report, and only
6% of adverse drug events are identified properly.
The
authors learned that the American College of Surgeons estimates that
surgical incident reports routinely capture only 5-30% of adverse
events. In one study, only 20% of surgical complications resulted in
discussion at morbidity and mortality rounds.(25) From these studies, it
appears that all the statistics gathered on medical errors may
substantially underestimate the number of adverse drug and medical
therapy incidents. They also suggest that our statistics concerning
mortality resulting from medical errors may be in fact be conservative
figures.
An article in Psychiatric Times (April
2000) outlines the stakes involved in reporting medical errors.(26) The
authors found that the public is fearful of suffering a fatal medical
error, and doctors are afraid they will be sued if they report an error.
This brings up the obvious question: who is reporting medical errors?
Usually it is the patient or the patient’s surviving family. If no one
notices the error, it is never reported.
Janet
Heinrich, an associate director at the U.S. General Accounting Office
responsible for health financing and public health issues, testified
before a House subcommittee hearing on medical errors that “the full
magnitude of their threat to the American public is unknown” and
“gathering valid and useful information about adverse events is
extremely difficult.” She acknowledged that the fear of being blamed,
and the potential for legal liability, played key roles in the
underreporting of errors. The Psychiatric Times noted that the AMA
strongly opposes mandatory reporting of medical errors.(26) If doctors
are not reporting, what about nurses? A survey of nurses found that they
also fail to report medical mistakes for fear of retaliation.(27)
Standard
medical pharmacology texts admit that relatively few doctors ever
report adverse drug reactions to the FDA.(28) The reasons range from not
knowing such a reporting system exists to fear of being sued.(29) Yet
the public depends on this tremendously flawed system of voluntary
reporting by doctors to know whether a drug or a medical intervention is
harmful.
Pharmacology texts also will tell
doctors how hard it is to separate drug side effects from disease
symptoms. Treatment failure is most often attributed to the disease and
not the drug or doctor. Doctors are warned, “Probably nowhere else in
professional life are mistakes so easily hidden, even from
ourselves.”(30) It may be hard to accept, but it is not difficult to
understand why only 1 in 20 side effects is reported to either hospital
administrators or the FDA.(31, 31a)
If hospitals
admitted to the actual number of errors for which they are responsible,
which is about 20 times what is reported, they would come under intense
scrutiny.(32) Jerry Phillips, associate director of the FDA’s Office of
Post Marketing Drug Risk Assessment, confirms this number. “In the
broader area of adverse drug reaction data, the 250,000 reports received
annually probably represent only 5% of the actual reactions that
occur.”(33) Dr. Jay Cohen, who has extensively researched adverse drug
reactions, notes that because only 5% of adverse drug reactions are
reported, there are in fact 5 million medication reactions each
year.(34)
A 2003 survey is all the more
distressing because there seems to be no improvement in error reporting,
even with all the attention given to this topic. Dr. Dorothea Wild
surveyed medical residents at a community hospital in Connecticut and
found that only half were aware that the hospital had a medical
error-reporting system, and that the vast majority did not use it at
all. Dr. Wild says this does not bode well for the future. If doctors
don’t learn error reporting in their training, they will never use it.
Wild adds that error reporting is the first step in locating the gaps in
the medical system and fixing them. Not even that first step has been
taken to date.(35)
PUBLIC SUGGESTIONS ON IATROGENESIS
In
a telephone survey, 1,207 adults ranked the effectiveness of the
following measures in reducing preventable medical errors that result in
serious harm.(36) (Following each measure is the percentage of
respondents who ranked the measure as “very effective.”)
Giving doctors more time to spend with patients (78%)
Requiring hospitals to develop systems to avoid medical errors (74%)
better training of health professionals (73%)
Using only doctors specially trained in intensive care medicine on intensive care units (73%)
Requiring hospitals to report all serious medical errors to a state agency (71%)
Increasing the number of hospital nurses (69%)
Reducing the work hours of doctors in training to avoid fatigue (66%)
encouraging hospitals to voluntarily report serious medical errors to a state agency (62%).
DRUG IATROGENESIS
Prescription
drugs constitute 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 study(1)
showed. 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% of patients admitted to these hospitals each year. The authors
concluded that at least 90,895 patients annually were harmed by
medication errors in the US as a whole.(37)
A 2002
study shows that 20% of hospital medications for patients had dosage
errors. Nearly 40% of these errors were considered potentially harmful
to the patient. In a typical 300-patient hospital, the number of errors
per day was 40.(38)
Problems involving patients’
medications were even higher the following year. The error rate
intercepted by pharmacists in this study was 24%, 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
setting (requiring highly specialized skills, technology, or support
services). Seventy-six patients (19%) had adverse events. Adverse drug
events were the most common, at 66% of all events. The next most common
event was procedure-related injuries, at 17%.(40)
In a New England Journal of Medicine 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, “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 New England Journal 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 selective serotonin
reuptake inhibitors ( SSRIs), nonsteroidal anti-inflammatory drugs
(NSAIDs), and calcium-channel blockers. Reuters also reported that prior
research has suggested that nearly 5% 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 that one of the
reasons for this failure is that in nearly two-thirds of the cases,
doctors could not diagnose drug side effects or the side effects
persisted because the doctor failed to heed the warning signs.
MEDICATING OUR FEELINGS
Patients
seeking a more joyful existence and relief from worry, stress, and
anxiety often fall victim to the messages endlessly displayed on TV and
billboards. Often, instead of gaining relief, they fall victim to the
myriad iatrogenic side effects of antidepressant medication.
Moreover,
a whole generation of antidepressant users has been created 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 rather than with their
inner resources. As adults, these medicated youth reach for alcohol,
drugs, or even street drugs to cope. According to JAMA , “Ritalin acts
much like cocaine.”(43) Today’s marketing of mood-modifying drugs such
as Prozac and Zoloft ® makes them not only socially acceptable but
almost a necessity in today’s stressful world.
TELEVISION DIAGNOSIS
To
reach the widest audience possible, drug companies are no longer just
targeting medical doctors with their marketing of antidepressants. By
1995, drug companies had tripled the amount of money allotted to direct
advertising of prescription drugs to consumers. The majority of this
money is spent on seductive television ads. From 1996 to 2000, spending
rose from $791 million to nearly $2.5 billion.(44) This $2.5 billion
represents only 15% of the total pharmaceutical advertising budget.
While
the drug companies maintain that direct-to-consumer advertising is
educational, Dr. Sidney M. Wolfe of the Public Citizen Health Research
Group in Washington, DC, argues that the public often is misinformed
about these ads.(45) People want what they see on television and are
told to go to their doctors for a prescription. Doctors in private
practice either acquiesce to their patients’ demands for these drugs or
spend valuable 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. Drugs generally are tested on individuals who are
fairly healthy and not on other medications that could interfere with
findings. But when these new drugs are declared “safe” and enter the
drug prescription books, they are naturally going to be used by people
who are on a variety of other medications and 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
federal government’s General Accounting Office “found that of the 198
drugs approved by the FDA between 1976 and 1985… 102 (or 51.5%) 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)
NBC
Television’s investigative show “Dateline” wondered if your doctor is
moonlighting as a drug company representative. After a yearlong
investigation, NBC 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 untested uses of
these medications, even though these drugs are approved only for the
specific indications for which they have been tested.(48)
The
leading causes of adverse drug reactions are antibiotics (17%),
cardiovascular drugs (17%), chemotherapy (15%), and analgesics and
anti-inflammatory agents (15%).(49)
SPECIFIC DRUG IATROGENESIS: ANTIBIOTICS
According
to William Agger, MD, director of microbiology and chief of infectious
disease at Gundersen Lutheran Medical Center in La Crosse, WI, 30
million pounds of antibiotics are used in America each year.(50) Of this
amount, 25 million pounds are used in animal husbandry, and 23 million
pounds are used to try to prevent disease and the stress of shipping, as
well as to promote growth. Only 2 million pounds are given for specific
animal infections. Dr. Agger reminds us that low concentrations of
antibiotics are measurable in many of our foods and in various waterways
around the world, much of it seeping in from animal farms.
Agger
contends that overuse of antibiotics results in food-borne infections
resistant to antibiotics. Salmonella is found in 20% of ground meat, but
the constant exposure of cattle to antibiotics has made 84% of
salmonella resistant to at least one anti-salmonella antibiotic.
Diseased animal food accounts for 80% of salmonellosis in humans, or 1.4
million cases per year. The conventional approach to countering this
epidemic is to radiate food to try to kill all organisms while
continuing to use the antibiotics that created the problem in the first
place. Approximately 20% of chickens are contaminated with Campylobacter jejuni,
an organism that causes 2.4 million cases of illness annually.
Fifty-four percent of these organisms are resistant to at least one
anti-campylobacter antimicrobial agent.
Denmark
banned growth-promoting antibiotics beginning in 1999, which cut their
use by more than half within a year, from 453,200 to 195,800 pounds. A
report from Scandinavia found that removing antibiotic growth promoters
had no or minimal effect on food production costs. Agger warns that the
current crowded, unsanitary methods of animal farming in the US support
constant stress and infection, and are geared toward high antibiotic
use.
In the US, 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. Agger 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 U.S.
still receive antibiotics from their doctor.(51) According to the CDC,
90% of upper respiratory infections are viral and should not be treated
with antibiotics. In Germany, the prevalence of systemic antibiotic use
in children aged 0-6 years was 42.9%.(52)
Data
obtained from nine US health insurers on antibiotic use in 25,000
children from 1996 to 2000 found that rates of antibiotic use decreased.
Antibiotic use in children aged three months to under 3 years decreased
24%, from 2.46 to 1.89 antibiotic prescriptions per patient per year.
For children aged 3 to under 6 years, there was a 25% 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% reduction from 0.85
to 0.69 antibiotic prescriptions per patient per year.(53) Despite these
reductions, 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, with penicillin and erythromycin the only
recommended treatment. Ninety percent of sore-throat cases, however, are
viral. Antibiotics were used in 73% of the estimated 6.7 million adult
annual visits for sore throat in the US between 1989 and 1999.
Furthermore, patients treated with antibiotics were prescribed
non-recommended broad-spectrum antibiotics in 68% of visits. This period
saw a significant increase in the use of newer, more expensive
broad-spectrum antibiotics and a decrease in use of the recommended
antibiotics penicillin and erythromycin.(54) A ntibiotics being
prescribed in 73% of sore-throat cases instead of the recommended 10%
resulted in a total of 4.2 million unnecessary antibiotic prescriptions
from 1989 to 1999.
THE PROBLEM WITH ANTIBIOTICS
In
September 2003, the CDC re-launched a program started in 1995 called
“Get Smart: Know When Antibiotics Work.”(55) This $1.6 million campaign
is designed to educate patients about the overuse and inappropriate use
of antibiotics. Most people involved with alternative medicine have
known about the dangers of antibiotic overuse for decades. Finally the
government is focusing on the problem, yet it is spending only a
miniscule amount of money on an iatrogenic epidemic that is costing
billions of dollars and thousands of lives.
The
CDC warns that 90% of upper respiratory infections, including children’s
ear infections, are viral and that antibiotics do not treat viral
infection. More than 40% of about 50 million prescriptions for
antibiotics written each year in physicians’ offices are
inappropriate.(2) 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) The CDC, however, seems to be blaming patients for
misusing antibiotics even though they are available only by prescription
from physicians.
According to Dr. Richard Besser,
head of “Get Smart”: “Programs that have just targeted physicians have
not worked. Direct-to-consumer advertising of drugs is to blame in some
cases.” 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)
What constitutes the “best
care”? The CDC does not elaborate and ignores the latest research on the
dozens of nutraceuticals that have been scientifically proven to treat
viral infections and boost immune-system function. Will doctors
recommend vitamin C, echinacea, elderberry, vitamin A, zinc, or
homeopathic oscillococcinum? Probably not. The CDC’s common-sense
recommendations that most people follow anyway include getting proper
rest, drinking plenty of fluids, and using a humidifier.
The
pharmaceutical industry claims it supports limiting the use of
antibiotics. The drug company Bayer sponsors a program called “Operation
Clean Hands” through an organization called LIBRA.(57) The CDC also is
involved in trying to minimize antibiotic resistance, but nowhere in its
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 tunnel vision and refusal to recommend
the available non-drug alternatives is unfortunate when the CDC is
desperately trying to curb the overuse of antibiotics.
DRUGS POLLUTE OUR WATER SUPPLY
We
have reached the point of saturation with prescription drugs. Every
body of water tested contains measurable drug residues. 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 also are 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 way to know the
long-term health consequences of ingesting a mixture of drugs and
drug-breakdown products. These drugs represent another level of
iatrogenic disease that we are unable to completely measure.(58-67)
SPECIFIC DRUG IATROGENESIS: NSAIDs
It’s
not just the US that is plagued by iatrogenesis. A survey of more than
1,000 French general practitioners (GPs) tested their basic
pharmacological knowledge and practice in prescribing NSAIDs, which rank
first among commonly prescribed drugs for serious adverse reactions.
The study results suggest that GPs do not 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, German biostatistician Ulrich Abel, PhD, wrote a monograph
entitled “Chemotherapy of Advanced Epithelial Cancer.” It was later
published in shorter form in a peer-reviewed medical journal.(70) 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 with which we are most familiar, arising from epithelium
found in the lining of body organs such as the breast, prostate, lung,
stomach, and bowel. From these sites, cancer usually infiltrates
adjacent tissue and spreads to the bone, liver, lung, or brain.
With
his exhaustive review, Abel concluded there is no direct evidence that
chemotherapy prolongs survival in patients with advanced carcinoma; in
small-cell lung cancer and perhaps ovarian cancer, the therapeutic
benefit is only slight. According to Abel, “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 Abel’s exhaustive review of chemotherapy, there seems no
decrease in its use for advanced carcinoma. For example, when
conventional chemotherapy and radiation have not worked to prevent
metastases in breast cancer, high-dose chemotherapy (HDC) along with
stem-cell transplant (SCT) is the treatment of choice. In March 2000,
however, 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) with even a slightly lower survival rate for the HDC/SCT group.
Serious adverse effects occurred more often in the HDC group than the
standard-dose group. One treatment-related death (within 100 days of
therapy) was recorded in the HDC group, but none was recorded in the
conventional chemotherapy group. The women in this trial were highly
selected as having the best chance to respond.
Unfortunately,
no all-encompassing follow-up study such as Dr. Abel’s exists to
indicate whether there has been any improvement in cancer-survival
statistics since 1989. In fact, research should be conducted to
determine 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 are not used.
DRUG COMPANIES FINED
Periodically,
the FDA fines a drug manufacturer when its abuses are too glaring and
impossible to cover up. In May 2002, The Washington Post reported that
Schering-Plough Corp., the maker of Claritin, was to pay a $500 million
dollar fine to the FDA for quality-control problems at four of its
factories.(72) The indictment came after the Public Citizen Health
Research Group, led 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.
The FDA tabulated infractions
involving 125 products, or 90% of the drugs made by Schering-Plough
since 1998. Besides paying the fine, the company was forced to halt the
manufacture of 73 drugs or suffer another $175 million fine.
Schering-Plough’s news releases told another story, assuring consumers
that they should still feel confident in the company’s products.
This
large settlement served 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 has paid a $100 million fine for failing
to meet quality standards in the production of medical test kits, while
Wyeth Laboratories paid $30 million in 2000 to settle accusations of
poor manufacturing practices.
UNNECESSARY SURGICAL PROCEDURES
In
1974, 2.4 million unnecessary surgeries were performed, resulting in
11,900 deaths at a cost of $3.9 billion.(73,74) In 2001, 7.5 million
unnecessary surgical procedures were performed, resulting in 37,136
deaths at a cost of $122 billion (using 1974 dollars).(3)
It
is very difficult to obtain accurate statistics when studying
unnecessary surgery. In 1989, Leape wrote that perhaps 30% of
controversial surgeries—which include cesarean section, tonsillectomy,
appendectomy, hysterectomy, gastrectomy for obesity, breast implants,
and elective breast implants(74)— are unnecessary. In 1974, the
Congressional Committee on Interstate and Foreign Commerce held hearings
on unnecessary surgery. It found that 17.6% 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)
According to the
Healthcare Cost and Utilization Project within the Agency for Healthcare
Research and Quality(13), in 2001 the 50 most common medical and
surgical procedures were performed approximately 41.8 million times in
the US. Using the 1974 House Subcommittee on Oversight and
Investigations’ figure of 17.6% as the percentage of unnecessary
surgical procedures, and extrapolating from the death rate in 1974,
produces nearly 7.5 million (7,489,718) unnecessary procedures and a
death rate of 37,136, at a cost of $122 billion (using 1974 dollars).
In
1995, researchers conducted a similar analysis of back surgery
procedures, using the 1974 “unnecessary surgery percentage” of 17.6.
Testifying before the Department of Veterans Affairs, they estimated
that of the 250,000 back surgeries performed annually in the US at a
hospital cost of $11,000 per patient, the total number of unnecessary
back surgeries approaches 44,000, costing as much as $484 million.(75)
Like
prescription drug use driven by television advertising, unnecessary
surgeries are escalating. Media-driven surgery such as gastric bypass
for obesity “modeled” by Hollywood celebrities seduces obese people to
think this route is safe and sexy. Unnecessary surgeries have even been
marketed on the Internet.(76) A study in Spain declares that 20-25% of
total surgical practice represents unnecessary operations.(77)
According
to data from the National Center for Health Statistics for 1979 to
1984, the total number of surgical procedures increased 9% while the
number of surgeons grew 20%. The study notes that the large increase in
the number of surgeons was not accompanied by a parallel increase in the
number of surgeries performed, and expressed concern about an excess of
surgeons to handle the surgical caseload.(78)
From
1983 to 1994, however, the incidence of the 10 most commonly performed
surgical procedures jumped 38%, to 7,929,000 from 5,731,000 cases. By
1994, cataract surgery was the most common procedure with more than 2
million operations, followed by cesarean section (858,000 procedures)
and inguinal hernia operations (689,000 procedures). Knee arthroscopy
procedures increased 153% while prostate surgery declined 29%.(79)
The
list of iatrogenic complications from surgery is as long as the list of
procedures themselves. One study examined catheters that were inserted
to deliver anesthetic into the epidural space around the spinal nerves
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 found “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% of
coronary angiography procedures, 32% of carotid endarterectomy
procedures, and 17% of upper gastrointestinal tract endoscopy
procedures.(82) Based on the Healthcare Cost and Utilization Project
(HCUP) statistics provided by the government for 2001, 697,675 upper
gastrointestinal endoscopies (usually entailing biopsy) were performed,
as were 142,401 endarterectomies and 719,949 coronary angiographies.(13)
Extrapolating the JAMA study’s inappropriate surgery rates to 2001
produces 118,604 unnecessary endoscopy procedures, 45,568 unnecessary
endarterectomies, and 122,391 unnecessary coronary angiographies. These
are all forms of medical iatrogenesis.
MEDICAL AND SURGICAL PROCEDURES
It
is instructive to know the mortality rates associated with various
medical and surgical procedures. Although we must sign release forms
when we undergo any procedure, many of us are in denial about the true
risks involved; because medical and surgical procedures are so
commonplace, they often are seen as both necessary and safe.
Unfortunately, allopathic medicine itself is a leading cause of death,
as well as the most expensive way to die.
Perhaps the words “health care” confer the illusion that medicine is about health. Allopathic medicine is not a purveyor of health care but of disease care. The
HCUP figures are instructive,(13) but the computer program that
calculates annual mortality statistics for all US hospital discharges is
only as good as the codes entered into the system. In email
correspondence, HCUP indicated that the mortality rates for each
procedure indicated only that someone undergoing that procedure died
either from the procedure or from some other cause.
Thus
there is no way of knowing exactly how many people die from a
particular procedure. While codes for “poisoning & toxic effects of
drugs” and “complications of treatment” do exist, the mortality figures
registered in these categories are very low and do not correlate with
what is known from research such as the 1998 JAMA study(1) that
estimated an average of 106,000 prescription medication deaths per year.
No codes exist for adverse drug side effects, surgical mishaps, or
other types of medical error. Until such codes exist, the true mortality
rates tied to of medical error will remain buried in the general
statistics.
AN HONEST LOOK AT U.S. HEALTH CARE
In
1978, the US Office of Technology Assessment (OTA) reported: “Only
10-20% 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, the Netherlands, Sweden, the UK, and the US ) and again
noted that few medical procedures in the US have been subjected to
clinical trial. It also reported that US infant mortality was high and
life expectancy low compared to other developed countries.(84)
Although
almost 10 years old, much of what was written in the OTA report holds
true today. The report blames the high cost of American medicine on the
medical free-enterprise system and failure to create a national health
care policy. It attributes the government’s failure to control health
care costs to market incentives and profit motives inherent in the
current financing and organization of health care, which includes such
interests as private health insurers, hospital systems, physicians, and
the drug and medical-device industries. “Health Care Technology and Its
Assessment in Eight Countries” is the last report prepared by the OTA,
which was disbanded in 1995. It also is perhaps the US government’s last
honest, detailed examination of the nation’s health care system. An
appendix summarizing this 60-page report follows this article.
SURGICAL ERRORS FINALLY REPORTED
An
October 2003 JAMA study from the US 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 hospital
days in 2000.(85) Data from 20% of the nation’s hospitals were analyzed
for 18 different surgical complications, including postoperative
infections, foreign objects left in wounds, surgical wounds reopening,
and post-operative bleeding.
In a press release
accompanying the study, AHRQ director Carolyn M. Clancy, MD, noted:
“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) According to the study’s authors, “The findings
greatly underestimate the problem, since many other complications happen
that are not listed in hospital administrative data.” They added: “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.” The study
authors said that improved medical practices, including an emphasis on
better hand washing, might help reduce morbidity and mortality rates. In
an accompanying JAMA editorial, health-risk researcher Dr. Saul
Weingart of Harvard’s Beth Israel-Deaconess Medical Center wrote, “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, and you could even walk into most shoe stores and
see x-rays of your foot bones. We still do not know the ultimate outcome
of our initial fascination with x-rays.
In those
days, it was common practice to x-ray pregnant women to measure their
pelvises and make a diagnosis of twins. Finally, a study of 700,000
children born between 1947 and 1964 in 37 major maternity hospitals
compared the children of mothers who had received pelvic x-rays during
pregnancy to those of mothers who did not. It found that cancer
mortality was 40% higher among children whose mothers had been
x-rayed.(88)
In present-day medicine, coronary
angiography is an invasive surgical procedure that involves snaking a
tube through a blood vessel in the groin up to the heart. To obtain
useful information, X-rays are taken almost continuously, with minimum
dosages ranging from 460 to 1,580 mrem. The minimum radiation from a
routine chest x-ray is 2 mrem. X-ray radiation accumulates in the body,
and ionizing radiation used in X-ray procedures has been shown to cause
gene mutation. The health impact of this high level of radiation is
unknown, and often obscured in statistical jargon such as, “The risk for
lifetime fatal cancer due to radiation exposure is estimated to be 4 in
one million per 1,000 mrem.”(89)
Dr. John Gofman
has studied the effects of radiation on human health for 45 years. A
medical doctor with a PhD in nuclear and physical chemistry, Gofman
worked on the Manhattan Project, discovered uranium-233, and was the
first person to isolate plutonium. In five scientifically documented
books, Gofman provides strong evidence that medical
technology—specifically x-rays, CT scans, and mammography and
fluoroscopy devices—are a contributing factor to 75% of new cancers.
In
a nearly 700-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,”(90)
Gofman shows that as the number of physicians increases in a
geographical area along with an increase in the number of x-ray
diagnostic tests performed, the rate of cancer and ischemic heart
disease also increases. Gofman elaborates that it is not x-rays alone
that cause the damage but a combination of health risk factors that
include poor diet, smoking, abortions, and the use of birth control
pills. Dr. Gofman predicts that ionizing radiation will be responsible
for 100 million premature deaths over the next decade.
In his book, Preventing Breast Cancer,
Dr. Gofman notes that breast cancer is the leading cause of death among
American women between the ages of 44 and 55. Because breast tissue is
highly sensitive to radiation, mammograms can cause cancer. The danger
can be heightened other factors including 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. John E. Sarno, a well-known
New York orthopedic surgeon, found that there is not necessarily any
association between back pain and spinal x-ray abnormality. He cites
studies of normal people without a trace of back pain whose x-rays
indicate spinal abnormalities and of people with back pain whose spines
appear to be normal on x-ray.(92) People who happen to have back pain
and show an abnormality on x-ray may be treated surgically, sometimes
with no change in back pain, worsening of back pain, or even permanent
disability. Moreover, doctors often order x-rays as protection against
malpractice claims, to give the impression of leaving no stone unturned.
It appears that doctors are putting their own fears before the
interests of their patients.
UNNECESSARY HOSPITALIZATION
Nearly
9 million (8,925,033) people were hospitalized unnecessarily in
2001.(4) In a study of inappropriate hospitalization, two doctors
reviewed 1,132 medical records. They concluded that 23% of all
admissions were inappropriate and an additional 17% could have been
handled in outpatient clinics. Thirty-four percent of all hospital days
were deemed inappropriate and could have been avoided.(93) The rate of
inappropriate hospital admissions in 1990 was 23.5%.(94) In 1999,
another study also found an inappropriate admissions rate of 24%,
indicating a consistent pattern from 1986 to 1999.(95) The HCUP database
indicates that the total number of patient discharges from US hospitals
in 2001 was 37,187,641,(13) meaning that almost 9 million people were
exposed to unnecessary medical intervention in hospitals and therefore
represent almost 9 million potential iatrogenic episodes.(4)
WOMEN’S EXPERIENCE IN MEDICINE
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” and turning
simple “neurosis” into hysteria.(96) The number of women diagnosed with
hysteria and hospitalized rose from 1% in 1841 to 17% in 1883. Hysteria
is derived from the Latin “hystera” meaning uterus.
According
to Dr. Adriane Fugh-Berman, US medicine has a tradition of excessive
medical and surgical interventions on women. Only 100 years ago, male
doctors believed 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. Fugh-Berman notes that US doctors eventually disabused
themselves of that notion but have continued to treat women very
differently than they treat men.(97) She cites the following statistics:
Thousands of prophylactic mastectomies are performed annually.
One-third of US 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 a 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, but does increase the risk of breast cancer, heart disease,
stroke, and gall bladder attack.(100)
As
many as one-third of postmenopausal women use HRT.(101,102) This number
is important in light of the much-publicized Women’s Health Initiative
Study, which was halted 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% of live births) were performed in
the US, making it the nation’s most common obstetric-gynecologic
(OB/GYN) surgical procedure. The second most common OB/GYN operation was
hysterectomy (673,000), followed by diagnostic dilation and curettage
of the uterus (632,000). In 1983, OB/GYN procedures represented 23% of
all surgery completed in the US.(104)
In 2001,
cesarean section is still the most common OB/GYN surgical procedure.
Approximately 4 million births occur annually, with 24% (960,000)
delivered by cesarean section. In the Netherlands, only 8% of births are
delivered by cesarean section. This suggests 640,000 unnecessary
cesarean sections—entailing three to four times higher mortality and 20
times greater morbidity than vaginal delivery(105)—are performed
annually in the US.
The US cesarean rate rose from
just 4.5% in 1965 to 24.1% in 1986. Sakala contends that an
“uncontrolled pandemic of medically unnecessary cesarean births is
occurring.”(106) VanHam reported a cesarean section postpartum
hemorrhage rate of 7%, a hematoma formation rate of 3.5%, a urinary
tract infection rate of 3%, and a combined postoperative morbidity rate
of 35.7% in a high-risk population undergoing cesarean section.(107)
NEVER ENOUGH STUDIES
Scientists
claimed there were never enough studies revealing the dangers of DDT
and other dangerous pesticides to ban them. They also used this argument
for 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 the results of
tobacco research. In 1964, when the Surgeon General’s report condemned
smoking, the AMA refused to endorse it, claiming a need for more
research. What they really wanted was more money, which they received
from a consortium of tobacco companies that 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 advertisements for Chesterfield cigarettes
that claimed 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 more studies are needed before they will support restricting the
inordinate use of drugs.
ADVERSE DRUG REACTIONS
The
Lazarou study(1) analyzed records for prescribed medications for 33
million US hospital admissions in 1994. It discovered 2.2 million
serious injuries due to prescribed drugs; 2.1% of inpatients experienced
a serious adverse drug reaction, 4.7% of all hospital admissions were
due to a serious adverse drug reaction, and fatal adverse drug reactions
occurred in 0.19% of inpatients and 0.13% of admissions. The authors
estimated that 106,000 deaths occur annually due to adverse drug
reactions.
Using a cost analysis from a 2000 study
in which the increase in hospitalization costs per patient suffering an
adverse drug reaction was $5,483, costs for the Lazarou study’s 2.2
million patients with serious drug reactions amounted to $12
billion.(1,49)
Serious adverse drug reactions
commonly emerge after FDA approval of the drugs involved. The safety of
new agents cannot be known with certainty until a drug has been on the
market for many years.(110)
BEDSORES
Over
one million people develop bedsores in U.S. hospitals every year. It’s a
tremendous burden to patients and family, and a $55 billion dollar
healthcare burden. (7) Bedsores are preventable with proper nursing
care. It is true that 50% of those affected are in a vulnerable age
group of over 70. In the elderly bedsores carry a fourfold increase in
the rate of death. The mortality rate in hospitals for patients with
bedsores is between 23% and 37%. (8) Even if we just take the 50% of
people over 70 with bedsores and the lowest mortality at 23%, 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, cited 20% 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 are not able to manage a
food tray by themselves.(11) It is difficult to place a mortality rate
on malnutrition and dehydration. The Coalition report states that
malnourished residents, compared with well-nourished hospitalized
nursing home residents, have a fivefold increase in mortality when they
are admitted to a hospital. Multiplying the one-third of 1.6 million
nursing home residents who are malnourished by a mortality rate of
20%(8,14) results in 108,800 premature deaths due to malnutrition in
nursing homes.
NOSOCOMIAL INFECTIONS
The
rate of nosocomial infections per 1,000 patient days rose from 7.2 in
1975 to 9.8 in 1995, a 36% jump in 20 years. Reports from more than 270
US 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, a rate of
5-6%. Due to progressively shorter inpatient stays and the increasing
number of admissions, however, the number of infections increased. It is
estimated that in 1995, nosocomial infections cost $4.5 billion and
contributed to more than 88,000 deaths, or 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) representing a $0.5
billion increase in just four years. At this rate of increase, the
current cost of nosocomial infections would be around $5.5 billion.
OUTPATIENT IATROGENESIS
In a 2000 JAMA article,
Dr. Barbara Starfield presents well-documented facts that are both
shocking and unassailable.(12) The U.S. ranks 12th of 13 industrialized
countries when judged by 16 health status indicators. Japan, Sweden, and
Canada were first, second, and third, respectively. More than 40
million people in the US have no health insurance, and 20-30% of
patients receive contraindicated care.
Starfield
warns that one cause of medical mistakes is overuse of technology, which
may create a “cascade effect” leading to still more treatment. She
urges the use of ICD (International Classification of Diseases) codes
that have designations such as “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
notes that many deaths attributable to medical error today are likely to
be coded to indicate some other cause of death. She concludes that
against the backdrop of our poor health report card compared to other
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,” as well as other authors to
suggest that between 4% and 18% of consecutive patients in outpatient
settings suffer an iatrogenic event leading to:
1. 116 million extra physician visits
2. 77 million extra prescriptions filled
3. 17 million emergency department visits
4. 8 million hospitalizations
5. 3 million long-term admissions
6. 199,000 additional deaths
7. $77 billion in extra costs(112)
UNNECESSARY SURGERIES
While
some 12,000 deaths occur each year from unnecessary surgeries, results
from the few studies that have measured unnecessary surgery directly
indicate that for some highly controversial operations, the proportion
of unwarranted surgeries could be as high as 30%.(74)
MEDICAL ERRORS: A GLOBAL ISSUE
A five-country survey published in the Journal of Health Affairs found
that 18-28% 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. The breakdown by country showed the percentages of
those suffering a medical or drug error were 18% in Britain, 23% in
Australia and in New Zealand, 25% in Canada, and 28% in the US.(113)
HEALTH INSURANCE
The
Institute of Medicine recently found that the 41 million Americans with
no health insurance have consistently worse clinical outcomes than
those who are insured, and are at increased risk for dying prematurely
(114).
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 US GAO estimated
that $12 billion dollars was lost to fraudulent or unnecessary claims in
1998, 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
One
way to measure the moral and ethical fiber of a society is by how it
treats its weakest and most vulnerable members. In some cultures,
elderly people lives out their lives in extended family settings that
enable them to continue participating in family and community affairs.
American nursing homes, where millions of our elders go to live out
their final days, represent the pinnacle of social isolation and medical
abuse.
In America, approximately 1.6 million elderly are confined to nursing homes. By 2050, that number could be 6.6 million.(11,116)
Twenty percent of all deaths from all causes occur in nursing homes.(117)
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)
Presenting
a report he sponsored entitled “Abuse of Residents is a Major Problem
in U.S. Nursing Homes” on July 30, 2001, Rep. Henry Waxman (D-CA) noted
that “as a society we will be judged by how we treat the elderly.” The
report found one-third of the nation’s approximately 17,000 nursing
homes were cited for an abuse violation in a two-year period from
January 1999 to January 2001.(116) According to Waxman, “the people who
cared for us deserve better.” The report suggests that this known abuse
represents only the “tip of the iceberg” and that much more abuse occurs
that we aware of or ignore.(116a) The report found:
Over 30% of US nursing homes were cited for abuses, totaling more than 9,000 violations.
10% of nursing homes had violations that caused actual physical harm to residents or worse.
Over 40% (3,800) of the abuse violations followed the filing of a formal complaint, 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. In 1990, Congress mandated an
exhaustive study of nurse-to-patient ratios in nursing homes. The study
was finally begun in 1998 and took four years to complete.(120) A
spokesperson for The National Citizens’ Coalition for Nursing Home
Reform commented on the study: “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) Although preventable with proper nursing care,
bedsores occur three times more commonly in nursing homes than in acute
care or veterans hospitals.(122).
Because many
nursing home patients suffer from chronic debilitating conditions, their
assumed cause of death often is unquestioned by physicians. Some
studies show that as many as 50% of deaths due to restraints, falls,
suicide, homicide, and choking in nursing homes may be covered
up.(123,124) It is possible that many nursing home deaths are instead
attributed to heart disease. 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 8-24%. In the elderly, the overreporting
of heart disease as a cause of death is as much as twofold.(125)
That
very few statistics exist concerning malnutrition in acute-care
hospitals and nursing homes demonstrates the lack of concern in this
area. While a survey of the literature turns up few US studies, one
revealing US study evaluated the nutritional status of 837 patients in a
100-bed subacute-care hospital over a 14-month period. The study found
only 8% of the patients were well nourished, while 29% were malnourished
and 63% were at risk of malnutrition. As a result, 25% of the
malnourished patients required readmission to an acute-care hospital,
compared to 11% of the well-nourished patients. The authors concluded
that malnutrition reached epidemic proportions in patients admitted to
this subacute-care facility.(126)
Many studies
conclude that physical restraints are an underreported and preventable
cause of death. Studies show that compared to no restraints, the use of
restraints carries a higher mortality rate and economic burden.(127-129)
Studies have found that physical restraints, including bedrails, are
the cause of at least 1 in every 1,000 nursing-home deaths.(130-132)
Deaths
caused by malnutrition, dehydration, and physical restraints, however,
are rarely recorded on death certificates. Several studies reveal that
nearly half of the listed causes of death on death certificates for
elderly people with chronic or multi-system disease are inaccurate.(133)
Even though 1 in 5 people die in nursing homes, an autopsy is performed
in less than 1% of these deaths.(134).
OVERMEDICATING SENIORS
Dr.
Robert Epstein, chief medical officer of Medco Health Solutions Inc. (a
unit of Merck & Co.), conducted a study in 2003 of drug trends
among the elderly.(135) He found that seniors are going to multiple
physicians, getting multiple prescriptions, and using multiple
pharmacies. Medco oversees drug-benefit plans for more than 60 million
Americans, including 6.3 million seniors who received more than 160
million prescriptions. According to the study, the average senior
receives 25 prescriptions each year. Among 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
seniors, 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 noted: “There are serious and systemic problems with
poor continuity of care in the United States .” He says this study
represents only “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% from 1999 to 2000, – from 7.1 to 7.5
prescriptions. The average number dispensed for Medicare members
increased 5.5%, from 18.1 to 19.1 prescriptions.(136) The total number
of prescriptions written in the US in 2000 was 2.98 billion, or 10.4
prescriptions for every man, woman, and child.(137)
In
a study of 818 residents of residential care facilities for the
elderly, 94% 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)
Seniors and
groups like the American Association for Retired Persons (AARP) are
demanding that prescription drug coverage be a basic right.(139) They
have accepted allopathic medicine’s overriding assumption that aging and
dying in America must be accompanied by drugs in nursing homes and
eventual hospitalization. Seniors are given the choice of either
high-cost patented drugs or low-cost generic drugs. Drug companies
attempt to keep the most expensive drugs on the shelves and suppress
access to generic drugs, despite facing stiff fines of hundreds of
millions of dollars levied by the federal government.(140,141) In 2001,
some of the world’s largest drug companies were fined a record $871
million for conspiring to increase the price of vitamins.(142)
Current
AARP recommendations for diet and nutrition assume that seniors are
getting all the nutrition they need in an average diet. At most, AARP
suggests adding extra calcium and a multivitamin and mineral
supplement.(143)
Ironically, studies also indicate
underuse of proper pain medication for patients who need it. One study
evaluated pain management in a group of 13,625 cancer patients, aged 65
and over, living in nursing homes. While almost 30% of the patients
reported pain, more than 25% received no pain relief medication, 16%
received a mild analgesic drug, 32% received a moderate analgesic drug,
and 26% received adequate pain-relieving morphine. The authors concluded
that older patients and minority patients were more likely to have
their pain untreated.(144)
WHAT REMAINS TO BE UNCOVERED
Our ongoing research will continue to quantify the morbidity, mortality, and financial loss due to:
3. Carcinogenic drugs (hormone replacement therapy,* immunosuppressive and prescription drugs).
4. Cancer chemotherapy(70)
5.
Surgery and unnecessary surgery (cesarean section, radical mastectomy,
preventive mastectomy, radical hysterectomy, prostatectomy,
cholecystectomies, cosmetic surgery, arthroscopy, etc.).
6. Discredited medical procedures and therapies.
7. Unproven medical therapies.
8. Outpatient surgery.
9. Doctors themselves.
*
Part of our ongoing research will be to quantify the mortality and
morbidity caused by hormone replacement therapy (HRT) since the 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 to 16 million women in the
US.(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, with little evidence of osteoporosis
reduction or dementia prevention. WHI researchers, who usually never
make recommendations except to suggest more studies, advised 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 UK were
published in medical journal The Lancet in August 2003. According to
lead author Prof. Valerie Beral, director of the Cancer Research UK
Epidemiology Unit: “We estimate that over the past decade, use of HRT by
UK women aged 50-64 has resulted in an extra 20,000 breast cancers,
estrogen-progestagen (combination) therapy accounting for 15,000 of
these.”(151) We were unable to find statistics on breast cancer, stroke,
uterine cancer, or heart disease caused by HRT used by American women.
Because the US population is roughly six times that of the UK, it is
possible that 120,000 cases of breast cancer have been caused by HRT in
the past decade.
OFFICE OF TECHNOLOGY ASSESSMENT (OTA)
Health Care Technology and Its Assessment in Eight Countries, 1995.
General Facts
1.
In 1990, US life expectancy was 71.8 years for men and 78.8 years for
women, among the lowest rates in the developed countries.
2.
The 1990 US infant mortality rate in the US was 9.2 per 1,000 live
births, in the bottom half of the distribution among all developed
countries.
3. Health status is correlated with socioeconomic status.
4. Health care is not universal.
5. Health care is based on the free market system with no fixed budget or limitations on expansion.
6. Health care accounts for 14% of the US GNP ($800 billion in 1993).
7.
The federal government does no central planning, though it is the major
purchaser of health care for older people and some poor people.
8. Americans are less satisfied with their health care system than people in other developed countries.
9.
US medicine specializes in expensive medical technology; some large US
cities have more magnetic resonance image (MRI) scanners than most
countries.
10. Huge public and private investments in medical research and pharmaceutical development drive this “technological arms race.”
11.
Any efforts to restrain technological developments in health care are
opposed by policymakers concerned about negative impacts on
medical-technology industries.
Hospitals
1.
In 1990, the US had 5,480 acute-care hospitals, 880 specialty
(psychiatric, long-term care, and rehabilitation) hospitals, and 340
federal (military, veterans, and Native American) hospitals, or 2.7
hospitals per 100,000 population.
2. In 1990, the
average length of stay for 33 million admissions was 9.2 days. The bed
occupancy rate was 66%. Lengths of stay were shorter and admission rates
lower than other countries.
3. In 1990, the US
had 615,000 physicians, or 2.4 per 1,000 population; 33% were primary
care (family medicine, internal medicine, and pediatrics) and 67% were
specialists.
4. In 1991, government-run health care spending totaled $81 billion.
5. Total US health care spending rose to $752 billion in 1991 from $70 billion in 1950. Spending grew five-fold per capita.
6. Reasons for increased healthcare spending include:
1. The high cost of defensive medicine, with an escalation in services solely to avoid malpractice litigation.
2.
US health care based on defensive medicine costs nearly $45 billion per
year, or about 5% of total health care spending, according to one
source.
3. The availability and use of new medical
technologies have contributed the most to increased health care
spending, argue many analysts. These costs are impossible to quantify.
7. The reasons government attempts to control health care costs have failed include:
1.
Market incentive and profit-motive involvement in the financing and
organization of health care, including private insurers, hospital
systems, physicians, and the drug and medical-device industries.
2. Expansion is the goal of free enterprise.
Health-Related Research and Development
1. The US spends more than any other country on health-related R&D.
2. In 1989, the federal government spent $9.2 billion on R&D, while private industry spent an additional $9.4 billion.
3. Total US R&D expenditures rose 50% from 1983 to 1992.
4. NIH receives about half of US government R&D funding.
5.
NIH spent more on basic research ($4.1 billion in 1989) than for
clinical trials of medical treatments on humans ($519 million in 1989).
6.
Most of the clinical trials evaluate new treatment protocols for cancer
and complications of AIDS, and do not study existing treatments, even
though their effectiveness is in many cases unknown and questionable.
7. In 1990, the NIH had just begun to do meta-analysis and cost-effectiveness analysis.
Pharmaceutical and Medical-Device Industries
1.
About two-thirds of the industry’s $9.4 billion budget went to drug
research; device manufacturers spent the remaining one-third.
2.
In addition to R&D, the medical industry spent 24% of total sales
on promoting their products and 15% of total sales on development.
3. Total marketing expenses in 1990 were over $5 billion.
4. Many products provide no benefit over existing products.
5. Public and private health care consumers buy these products.
6. If health care spending is perceived as a problem, a highly profitable drug industry exacerbates the problem.
Controlling Health Care Technology
1. The FDA ensures the safety and efficacy of drugs, biologics, and medical devices.
2. The FDA does not consider costs of therapy.
3. The FDA does not consider the effectiveness of a therapy.
4. The FDA does not compare a product to currently marketed products
5. The FDA does not consider nondrug alternatives for a given clinical problem.
6.
It costs $200 million in development costs to bring a new drug to
market. AIDS-drug interest groups forced new regulations that speed up
the approval process.
7. Such drugs should be
subject to greater post-marketing surveillance requirements. As of 1995,
these provisions had not yet come into play.
8. Many argue that reductions in the pre-approval testing of drugs open the possibility of significant undiscovered toxicities.
Health Care Technology Assessment
1.
Failure to evaluate technology was a focus of a 1978 report from OTA
with examples of many common medical practices supported by limited
published data (10-20%).
2. In 1978, Congress created the National Center for Health Care Technology (NCHCT) to advise Medicare and Medicaid.
3.
With an annual budget of $4 million, NCHCT published three broad
assessments of high-priority technologies and made about 75 coverage
recommendations to Medicare.
4. Congress disbanded
NCHCT in 1981. The medical profession opposed it from the beginning.
The AMA testified before Congress in 1981 that “clinical policy analysis
and judgments are better made—and are being responsibly made—within the
medical profession. Assessing risks and costs, as well as benefits, has
been central to the exercise of good medical judgment for decades.”
5. The medical device lobby also opposed government oversight by NCHCT.
Examples of Lack of Proper Management of HealthCare
Treatments for Coronary Artery Disease
1.
Since the early 1970s, the number of coronary artery bypass surgeries
(CABGS) has risen rapidly without government regulation or clinical
trials.
2.Angioplastyforsinglevesseldiseasewasintroducedin1978Thefirstpublishedtrialofangioplastyversus
medical treatment was done in 1992.
3. Angioplasty did not reduce the number of CABGS, as was promoted.
4. Both procedures increase in number every year as the patient population grows older and sicker.
5.
Rates of use are higher in white patients and private insurance
patients, and vary greatly by geographic region, suggesting that use of
these procedures is based on non-clinical factors.
6. As of 1995, the NIH consensus program had not assessed CABGS since 1980 and had never assessed angioplasty.
7.
RAND researchers evaluated CABGS in New York in 1990. They reviewed
1,300 procedures and found 2% were inappropriate, 90% were appropriate,
and 7% were uncertain. For 1,300 angioplasties, 4% were inappropriate
and 38% uncertain. Using RAND methodologies, a panel of British
physicians rated twice as many procedures “inappropriate” as did a US
panel rating the same clinical cases. The New York numbers are in
question because New York State limits the number of surgery centers,
and the per-capita supply of cardiac surgeons in New York is about
one-half of the national average.
8. The estimated
five-year cost is $33,000 for angioplasty and $40,000 for CABGS.
Angioplasty did not lower costs, due to its high failure rates.
Computed Tomography (CT)
1.
The first CT scanner in the US was installed at the Mayo Clinic in
1973. By 1992, the number of operational CT scanners in the US had grown
to 6,060. By comparison, in 1993 there were 216 CT units in Canada .
2. There is little information available on how CT scans improve or affect patient outcomes
3. In some institutions, up to 90% of scans performed were negative.
4. Approval by the FDA was not required for CT scanners, nor was any evidence of safety or efficacy.
Magnetic Resonance Imaging (MRI)
1.
MRIs were introduced in Great Britain in 1978 and in the US in 1980. By
1988, there were 1,230 units and by 1992 between 2,800 and 3,000.
2.
A definitive review published in 1994 found less than 30 studies of
5,000 that were prospective comparisons of diagnostic accuracy or
therapeutic choice.
3. The American College of
Physicians assessed MRI studies and rated 13 of 17 trials as “weak,”
i.e., lacking data concerning therapeutic impact or patient outcomes.
4.
The OTA concluded: “It is evident that hospitals,
physician-entrepreneurs, and medical device manufacturers have
approached MRI and CT as commodities with high-profit potential, and
decision-making on the acquisition and use of these procedures has been
highly influenced by this approach. Clinical evaluation, appropriate
patient selection, and matching supply to legitimate demand might be
viewed as secondary forces.”
Laparoscopic Surgery
1.
Laparoscopic cholecystectomy was introduced at a professional surgical
society meeting in late 1989. By 1992, 85% of all cholecystectomies were
performed laparoscopically.
2. There was an associated increase of 30% in the number of cholecystectomies performed.
3.
Because of the increased volume of gall bladder operations, their total
cost increased 11.4% between 1988 and 1992, despite a 25.1% drop in the
average cost per surgery.
4. The mortality rate
for gall bladder surgeries did not decline as a result of the lower risk
because so many more were performed.
5. When
studies were finally done on completed cases, the results showed that
laparoscopic cholecystectomy was associated with reduced inpatient
duration, decreased pain, and a shorter period of restricted activity.
But rates of bile duct and major vessel injury increased and it was
suggested that these rates were worse for people with acute
cholecystitis. No clinical trials had been done to clarify this issue.
6. Patient demand, fueled by substantial media attention, was a major force in promoting rapid adoption of these procedures.
7. The major manufacturer of laparoscopic equipment produced the video that introduced the procedure in 1989.
8. Doctors were given two-day training seminars before performing the surgery on patients.
Infant Mortality
1. In 1990, the US ranked 24th in infant mortality of 38 developed countries with a rate of 9.2 deaths per 1,000 live births.
2. US black infant mortality is 18.6 per 1,000 live births, compared to 8.8 for whites.
Screening for Breast Cancer
1. Mammography screening in women under 50 has always been a subject of debate.
2.
In 1992, the Canadian National Breast Cancer Study of 50,000 women
showed that mammography had no effect on mortality for women aged 40-50.
3. The National Cancer Institute (NCI) refused to change its recommendations on mammography.
4. The American Cancer Society decided to wait for more studies on mammography.
5.
In December 1993, NCI announced that women over 50 should have routine
screenings every one to two years but that younger women would derive no
benefit from mammography.
Summary
1.
The OTA concluded: “There are no mechanisms in place to limit
dissemination of technologies regardless of their clinical value.”
Shortly after the release of this report, the OTA was disbanded.
1.
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.
2. Rabin R. Caution about overuse of
antibiotics. Newsday . September 18, 2003 . 2a. Centers for Disease
Control and Prevention. CDC antimicrobial resistance and antibiotic
resistance—general information. Available at:
http://www.cdc.gov/drugresistance/community/. Accessed December 13, 2003
.
3. For calculations detail, see “Unnecessary Surgery.” Sources:
HCUPnet, Healthcare Cost and Utilization Project. Agency for Healthcare
Research and Quality, Rockville , MD. Available at:
http://www.ahrq.gov/data/hcup/hcupnet.htm . Accessed December 18, 2003 .
US Congressional House Subcommittee Oversight Investigation. Cost and
Quality of Health Care: Unnecessary Surgery . Washington , DC :
Government Printing Office;1976. Cited in: McClelland GB, Foundation for
Chiropractic Education and Research. Testimony to the Department of
Veterans Affairs’ Chiropractic Advisory Committee. March 25, 2003 .
4. For calculations detail, see “Unnecessary Hospitalization.” Sources:
HCUPnet, Healthcare Cost and Utilization Project. Agency for Healthcare
Research and Quality, Rockville , MD. Available at:
http://www.ahrq.gov/data/hcup/hcupnet.htm . Accessed December 18, 2003 .
Siu AL, Sonnenberg FA, Manning WG, et al. Inappropriate use of
hospitals in a randomized trial of health insurance plans. N Engl J Med .
1986 Nov 13;315(20):1259-66. Siu AL, Manning WG, Benjamin B. Patient,
provider and hospital characteristics associated with inappropriate
hospitalization. Am J Public Health . 1990 Oct;80(10):1253-6. Eriksen
BO, Kristiansen IS, Nord E, 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 Oct;246(4):379-87.
5. U.S. National Center for Health Statistics. National Vital Statistics Report, vol. 51, no. 5, March 14, 2003 .
6. Thomas, EJ, Studdert DM, Burstin HR, et al. Incidence and types of
adverse events and negligent care in Utah and Colorado. Med Care. 2000
Mar;38(3):261-71. Thomas, EJ, Studdert DM, Newhouse JP, et al. Costs of
medical injuries in Utah and Colorado . Inquiry . 1999
Fall;36(3):255-64. [Two references.] 7. Xakellis GC, Frantz R, Lewis A.
Cost of pressure ulcer prevention in long-term care. Am Geriatr Soc .
1995 May;43(5):496-501.
8. Barczak CA, Barnett RI, Childs EJ, Bosley
LM. Fourth national pressure ulcer prevalence survey. Adv Wound Care .
1997 Jul-Aug;10(4):18-26.
9. Weinstein RA. Nosocomial Infection Update. Emerg Infect Dis . 1998 Jul-Sep;4(3):416-20.
10. Fourth Decennial International Conference on Nosocomial and
Healthcare-Associated Infections. Morbidity and Mortality Weekly Report.
February 25, 2000 , Vol. 49, No. 7, p.138.
11. Burger SG,
Kayser-Jones J, Bell JP. Malnutrition and dehydration in nursing homes:
key issues in prevention and treatment. National Citizens’ Coalition for
Nursing Home Reform. June 2000. Available at:
http://www.cmwf.org/programs/elders/burger_mal_386.asp. Accessed
December 13, 2003 .
12. Starfield B. Is US health really the best in
the world? JAMA . 2000 Jul 26;284(4):483-5. Starfield B. Deficiencies
in US medical care. JAMA . 2000 Nov 1;284(17):2184-5.
13. HCUPnet,
Healthcare Cost and Utilization Project. Agency for Healthcare Research
and Quality, Rockville , MD. Available at:
http://www.ahrq.gov/data/hcup/hcupnet.htm . Accessed December 18, 2003 .
14. Nationwide poll on patient safety: 100 million Americans see
medical mistakes directly touching them [press release]. McLean , VA :
National Patient Safety Foundation; October 9, 1997 .
15. The
Society of Actuaries Health Benefit Systems Practice Advancement
Committee. The Troubled Healthcare System in the US . September 13, 2003
. Available at: http://www.soa.org/sections/troubled_healthcare.pdf.
Accessed December 18, 2003 .
16. Leape LL. Error in medicine. JAMA . 1994 Dec 21;272(23):1851-7.
17. a.Brennan TA, Leape LL, Laird NM , et al. Incidence of adverse
events and negligence in hospitalized patients. Results of the Harvard
Medical Practice Study I. N Engl J Med . 1991 Feb 7;324(6):370-6.
18. Campbell EG, Weissman JS, Clarridge B, Yucel R, Causino N,
Blumenthal D. Characteristics of medical school faculty members serving
on institutional review boards: results of a national survey. Acad Med .
2003 Aug;78(8):831-6.
19. Possible conflict of interest within medical profession. HealthDayNews. August 15, 2003 .
20. World Health Organization. Press Release Bulletin #9. December 17, 2001 .
21. Angell M. Is academic medicine for sale? N Engl J Med . 2000 May 18;342(20):1516-8.
22. McKenzie J. Conflict of interest? Medical journal changes policy of
finding independent doctors [transcript]. ABC News. June 12, 2002 .
23. Crossen C. Tainted Truth: The Manipulation of Fact in America . New York , NY : Simon & Schuster; 1994.
24. Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug
events and potential adverse drug events. Implications for prevention.
ADE Prevention Study Group. JAMA . 1995 Jul 5;274(1):29-34.
25.
Vincent C, Stanhope N, Crowley-Murphy M. Reasons for not reporting
adverse incidents: an empirical study. J Eval Clin Pract . 1999
Feb;5(1):13-21.
26. Wald H, Shojania KG. Incident reporting. In:
Shojania KG, Duncan BW, McDonald KM, et al, eds. Making Health Care
Safer: A Critical Analysis of Patient Safety Practices . Rockville , MD :
Agency for Healthcare Research and Quality; 2001:chap 4. Evidence
Report/Technology Assessment No. 43. AHRQ publication 01-E058.
27. Grinfeld MJ. The debate over medical error reporting. Psychiatric Times . April 2000.
28. King G III, Hermodson A. Peer reporting of coworker wrongdoing: A
qualitative analysis of observer attitudes in the decision to report
versus not report unethical behavior. Journal of Applied Communication
Research . 2000;(28), 309-29.
29. Gilman AG, Rall TW, Nies AS ,
Taylor P. Goodman and Gilman’s The Pharmacological Basis of
Therapeutics. New York , NY : Pergamon Press; 1996.
30. Kolata G. New York Times News Service. Who cares when our drugs fail? San Diego Union-Tribune . October 15, 1997 :E-1,5.
31. Melmon KL, Morrelli HF, Hoffman BB, Nierenberg DW, eds. Melmon and
Morrelli’s Clinical Pharmacology: Basic Principles in Therapeutics . 3rd
ed. New York , NY : McGraw-Hill, Inc., 1992.
32. Moore TJ, Psaty
BM, Furberg CD. Time to act on drug safety . JAMA . 1998 May 20, 279
(19):1571-3. 32 a.Cullen DJ, Bates DW, Small SD, Cooper JB, Nemeskal AR ,
Leape LL. The incident reporting system does not detect adverse drug
events: a problem for quality improvement. Jt Comm J Qual Improv . 1995
Oct;21(10):541-8.
33. Bates DW. Drugs and adverse drug reactions: how worried should we be? JAMA . 1998 Apr 15;279(15):1216-7.
34. Dickinson, JG. FDA seeks to double effort on confusing drug names. Dickinson ‘s FDA Review . 2000 Mar;7(3):13-4.
35. Cohen JS. Overdose: The Case Against the Drug Companies . New York , NY : Tarcher-Putnum; 2001.
36. Stenson J. Few residents report medical errors, survey finds. Reuters Health. February 21, 2003 .
37. Survey by Henry J. Kaiser Family Foundation, Harvard School of
Public Health. Methodology: Fieldwork conducted by ICR – International
Communications Research, April 11- June 11, 2002
38. Bond CA, Raehl
CL, Franke T. Clinical pharmacy services, hospital pharmacy staffing,
and medication errors in United States hospitals. Pharmacotherapy . 2002
Feb;22(2):134-47.
39. Barker KN, Flynn EA, Pepper GA, Bates DW,
Mikeal RL. Medication errors observed in 36 health care facilities. Arch
Intern Med . 2002 Sep 9;162(16):1897-903.
40. LaPointe NM , Jollis
JG. Medication errors in hospitalized cardiovascular patients. Arch
Intern Med . 2003 Jun 23;163(12):1461-6.
41. Forster AJ, Murff HJ,
Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse
events affecting patients after discharge from the hospital. Ann Intern
Med . 2003 Feb 4;138(3):161-7.
42. Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med . 2003 Apr 17;348(16):1556-64.
43. Medication side effects strike 1 in 4. Reuters. April 17, 2003 .
44. Vastag B. Pay attention: ritalin acts much like cocaine. JAMA . 2001 Aug 22-29;286(8):905-6.
45. Rosenthal MB, Berndt ER, Donohue JM, Frank RG, Epstein AM.
Promotion of prescription drugs to consumers. N Engl J Med . 2002 Feb
14;346(7):498-505.
46. Wolfe SM. Direct-to-consumer advertising—education or emotion promotion? N Engl J Med . 2002 Feb 14;346(7):524-6.
47. Ibid.
48. US General Accounting Office. Report to the Chairman, Subcommittee
on Human Resources and Intergovernmental Relations, Committee on
Government Operations, House of Representatives: FDA Drug Review
Postapproval Risks 1976-85 . Washington , DC : US General Accounting
Office; 1990:3.
49. Drug giant accused of false claims. MSNBC News.
July 11, 2003 . Available at:
http://msnbc.com/news/937302.asp?0sl=-42&cp1=1. Accessed December
17,2003 .
50. Suh DC , Woodall BS, Shin SK , Hermes-De Santis ER.
Clinical and economic impact of adverse drug reactions in hospitalized
patients. Ann Pharmacother . 2000 Dec;34(12):1373-9.
51. Agger WA.
Antibiotic resistance: unnatural selection in the office and on the
farm. Wisconsin Medical Journal . August 2002.
52. Nash DR, Harman
J, Wald ER, Kelleher KJ. Antibiotic prescribing by primary care
physicians for children with upper respiratory tract infections. Arch
Pediatr Adolesc Med . 2002 Nov;156(11):1114-9.
53. Schindler C,
Krappweis J, Morgenstern I, Kirch W. Prescriptions of systemic
antibiotics for children in Germany aged between 0 and 6 years.
Pharmacoepidemiol Drug Saf . 2003 Mar;12(2):113-20.
54. Finkelstein
JA, Stille C, Nordin J, et al. Reduction in antibiotic use among US
children, 1996-2000. Pediatrics . 2003 Sep;112(3 Pt 1):620-7.
55.
Linder JA, Stafford RS. Antibiotic treatment of adults with sore throat
by community primary care physicians: a national survey, 1989-1999. JAMA
. 2001 Sep 12;286(10):1181-6.
56. Drug resistance page. Centers for
Disease Control and Prevention website. Available at:
http://www.cdc.gov/drugresistance/community/. Accessed December 17, 2003
.
57. Available at: http://www.health.state.ok.us/program/cdd/ar/. Accessed December 17, 2003 .
58. Available at: http://www.librainitiative.com/life/en/libra_initiative.html. Accessed December 17, 2003 .
59. Ohlsen K, Ternes T, Werner G, et al. Impact of antibiotics on
conjugational resistance gene transfer in Staphylococcus aureus in
sewage. Environ Microbiol . 2003 Aug;5(8):711-6.
60. Pawlowski S,
Ternes T, Bonerz M, et al. Combined in situ and in vitro assessment of
the estrogenic activity of sewage and surface water samples. Toxicol Sci
. 2003 Sep;75(1):57-65. Epub 2003 Jun 12.
61. Ternes TA, Stuber J,
Herrmann N, et al. Ozonation: a tool for removal of pharmaceuticals,
contrast media and musk fragrances from wastewater? Water Res . 2003
Apr;37(8):1976-82.
62. Ternes TA, Meisenheimer M, McDowell D, et al.
Removal of pharmaceuticals during drinking water treatment. Environ Sci
Technol . 2002 Sep 1;36(17):3855-63.
63. Ternes T, Bonerz M,
Schmidt T. Determination of neutral pharmaceuticals in wastewater and
rivers by liquid chromatography-electrospray tandem mass spectrometry. J
Chromatogr A . 2001 Dec 14;938(1-2):175-85.
64. Golet EM, Alder AC,
Hartmann A, Ternes TA, Giger W. Trace determination of fluoroquinolone
antibacterial agents in urban wastewater by solid-phase extraction and
liquid chromatography with fluorescence detection. Anal Chem . 2001 Aug
1;73(15):3632-8.
65DhtCGTTAPhtildldtithittfbtlh?EiHlth
Perspect . 1999 Dec;107 Suppl 6:907-38.
66. Hirsch R, Ternes T, Haberer K, Kratz KL. Occurrence of antibiotics
in the aquatic environment. Sci Total Environ . 1999 Jan
12;225(1-2):109-18.
67. Ternes TA, Stumpf M, Mueller J, Haberer K,
Wilken RD , Servos M. Behavior and occurrence of estrogens in municipal
sewage treatment plants—I. Investigations in Germany , Canada and Brazil
. Sci Total Environ . 1999 Jan 12;225(1-2):81-90.
68. Hirsch R,
Ternes TA, Haberer K, Mehlich A, Ballwanz F, Kratz KL. Determination of
antibiotics in different water compartments via liquid
chromatography-electrospray tandem mass spectrometry. J Chromatogr A .
1998 Jul 31;815(2):213-23.
69. Coste J, Hanotin C, Leutenegger E.
Prescription of non-steroidal anti-inflammatory agents and risk of
iatrogenic adverse effects: a survey of 1072 French general
practitioners. Therapie . 1995 May-Jun;50(3):265-70.
70. Kouyanou K, Pither CE, Wessely S. Iatrogenic factors and chronic pain. Psychosom Med . 1997 Nov-Dec;59(6):597-604.
71. Abel U. Chemotherapy of advanced epithelial cancer—a critical review. Biomed Pharmacother . 1992;46(10):439-52.
72. Schulman KA, Stadtmauer EA, Reed SD , et al. Economic analysis of
conventional-dose chemotherapy compared with high-dose chemotherapy plus
autologous hematopoietic stem-cell transplantation for metastatic
breast cancer. Bone Marrow Transplant . 2003 Feb;31(3):205-10.
73.
Kaufman, M. Drugmaker to pay FDA $500 million. Manufacturing problems
found at schering-plough . The Washington Post . May 18, 2002 :A01.
74. US Congressional House Subcommittee Oversight Investigation. Cost
and Quality of Health Care: Unnecessary Surgery . Washington , DC :
Government Printing Office;1976. Cited in: McClelland GB, Foundation for
Chiropractic Education and Research. Testimony to the Department of
Veterans Affairs’ Chiropractic Advisory Committee. March 25, 2003 .
75. Leape LL. Unnecessary surgery. Health Serv Res . 1989 Aug;24(3):351-407.
76. McClelland GB, Foundation for Chiropractic Education and Research.
Testimony to the Department of Veterans Affairs’ Chiropractic Advisory
Committee. March 25, 2003 .
77. Coile RC Jr. Internet-driven surgery. Russ Coiles Health Trends . 2003 Jun;15(8):2-4.
78. Guarner V. Unnecessary operations in the exercise of surgery. A
topic of our times with serious implications in medical ethics. Gac Med
Mex . 2000 Mar-Apr;136(2):183-8.
79. Rutkow IM. Surgical operations in the United States : 1979 to 1984. Surgery . 1987 Feb;101(2):192-200.
80. Rutkow IM. Surgical operations in the United States . Then (1983) and now (1994). Arch Surg . 1997 Sep;132(9):983-90.
81. Linnemann MU, Bulow HH. Infections after insertion of epidural catheters. Ugeskr Laeger . 1993 Jul 26;155(30):2350-2
82. Seres JL, Newman RI . Perspectives on surgical indications. Implications for controls. Clin J Pain . 1989 Jun;5(2):131-6.
83. Chassin MR, Kosecoff J, Park RE, et al. Does inappropriate use
explain geographic variations in the use of health care services? A
study of three procedures. JAMA. 1987 Nov 13;258(18):2533-7.
84.
Office of Technology Assessment, US Congress. Assessing the Efficacy and
Safety of Medical Technologies. Washington DC : Office of Technology
Assessment, US Congress; 1978.
85. Tunis SR, Gelband H. Health care technology in the United States . Health Policy . 1994 Oct-Dec;30(1-3):335-96.
86. Zhan C, Miller M. Excess length of stay, charges, and mortality
attributable to medical injuries during hospitalization. JAMA .
2003;290:1868-1874.
87. Injuries in hospitals pose a significant
threat to patients and a substantial increase in health care charges
[press release]. Rockville , MD : Agency for Healthcare Research and
Quality. October 7, 2003 .
http://www.ahrq.gov/news/ress/pr2003/injurypr.htm.
88. Weingart SN, Iezzoni LI. Looking for medical injuries where the light is bright. JAMA . 2003 Oct 8 ;290(14):1917-9.
89. MacMahon B. Prenatal x-ray exposure and childhood cancer. J Natl Cancer Inst . 1962 May;28:1173-91.
90. Health Physics Society. Available at: http://hps.org/publicinformation/ate/q1084.html. Accessed December 17, 2003 .
91. Gofman JW. Radiation from Medical Procedures in the Pathogenesis of
Cancer and Ischemic Heart Disease: Dose-Response Studies with
Physicians per 100,000 Population. San Francisco , CA : CNR Books; 1999.
92. Gofman J W. Preventing Breast Cancer: The Story of a Major, Proven,
Preventable Cause of This Disease . 2nd ed. San Francisco , CA : CNR
Books; 1996.
93. Sarno JE. Healing Back Pain: The Mind-Body Connection . Warner Books; 1991.
94. Siu AL, Sonnenberg FA, Manning WG, et al. Inappropriate use of
hospitals in a randomized trial of health insurance plans. N Engl J Med .
1986 Nov 13;315(20):1259-66.
95. Siu AL, Manning WG, Benjamin B.
Patient, provider and hospital characteristics associated with
inappropriate hospitalization. Am J Public Health . 1990
Oct;80(10):1253-6.
96. Eriksen BO, Kristiansen IS, Nord E, 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 Oct;246(4):379-87.
97. Showalter E. Hystories: Hysterical Epidemics and Modern Media . New York , NY : Columbia University Press; 1997.
98. Fugh-Berman A. Alternative healing. In: Smith B, Steinem G, Mink G,
Navarro M, and Mankiller W, eds. The Reader’s Companion to U.S. Women’s
History. New York , NY : Houghton Mifflin; 1998. Available at:
http://college.hmco.com/history/readerscomp/women/html/wh_001200_alternativeh.htm
.
99. Thacker SB, Stroup D, Chang M. Continuous electronic heart
rate monitoring for fetal assessment during labor (Cochrane Review). In:
The Cochrane Library, issue 1, 2003. Oxford : Update Software.
100. Cole C. Admission electronic fetal monitoring does not improve neonatal outcomes . J Fam Pract . 2003 Jun;52(6):443-4.
101. Nelson HD, Humphrey LI, Nygren P, Teutsch SM, Allan JD.
Postmenopausal hormone replacement therapy: scientific review. JAMA .
2002 Aug 21;288(7):872–81.
102. Nelson HD. Assessing benefits and
harms of hormone replacement therapy: clinical applications. JAMA . 2002
Aug 21;288(7):882-4
103. Fletcher SW, Colditz GA. Failure of estrogen plus progestin therapy for prevention. JAMA . 2002 Jul 17;288(3):366-8.
104. Rossouw JE, Anderson GL, Prentice RL, et al; Writing Group for the
Women’s Health Initiative Investigators. Risks and benefits of estrogen
plus progestin in healthy postmenopausal women: principal results from
the Women’s Health Initiative randomized controlled trial. JAMA . 2002
Jul 17;288(3):321-33.
105. Rutkow IM. Obstetric and gynecologic
operations in the United States , 1979 to 1984. Obstet Gynecol . 1986
Jun;67(6):755-9.
106. Family Practice News . February 15, 1995 : 29.
107. Sakala C. Medically unnecessary cesarean section births:
introduction to a symposium. Soc Sci Med . 1993 Nov;37(10):1177-98.
108. VanHam MA, van Dongen PW, Mulder J. Maternal consequences of
cesarean section. A retrospective study of intra-operative and
postoperative maternal complications of cesarean section during a
10-year period. Eur J Obstet Reprod Biol . 1997 Jul;74(1):1-6.
109.
Weiner J. Smoking and cancer: the cigarette papers: how the industry is
trying to smoke us all . The Nation . January 1, 1996 :11-18.
110.
Tobacco.org. Tobacco timeline. Available at:
http://www.tobacco.org/resources/history/tobacco_history.html. Acccessed
December 16, 2003 .
111. Lasser KE, Allen PD, Woolhandler SJ,
Himmelstein DU, Wolfe SM, Bor DH. 2002. Timing of new black box warnings
and withdrawals for prescription medications. JAMA . 2002 May
1;287(17):2215-20.
112. Injuryboard.com. General Accounting Office
study sheds light on nursing home abuse. July 17, 2003 . Available at:
http://www.injuryboard.com/view.cfm/Article=3005. Accessed December 17,
2003 .
113. Weingart SN, McL Wilson R, Gibberd RW, Harrison B. Epidemiology of medical error. West J Med . 2000 Jun;172(6):390-3.
114. Blendon R, Schoen C, et al. Five nation survey exposes flaws in
the U.S. health care system. Health Affairs . May/June 2002.
115.
Institute of Medicine . Care Without Coverage: Too Little, Too Late .
May 21, 2002 . A Shared Destiny: Community Effects of Uninsurance .
March 6, 2003 .
116. US Department of Health and Human Services and
US Department of Justice. Health Care Fraud and Abuse Control Program
Annual Report for FY 1998. April 1999. Health Care Fraud and Abuse
Control Program Annual Report for FY 2001. April 2002.
117. Abuse of
residents is a major problem in U.S. nursing homes [transcript]. CNN
television. July 30, 2001 117 a. Available at:
http://www.house.gov/waxman. Accessed December 17, 2003 .
118. Mitka M. Unacceptable nursing home deaths unautopsied. JAMA . 1998 Sep 23-30;280(12):1038-9
119. New data is in on North Carolina ‘s nursing home residents. Medical Review of North Carolina, Inc. July 21, 2003 .
120. Weinstein RA. Nosocomial infection update. Emerg Infect Dis . 1998 Jul-Sep;4(3):416-20.
121. Centers for Medicare & Medicaid Services. Report to Congress:
Appropriateness of Minimum Nurse Staffing Ratios In Nursing Homes: Phase
II Final Report . December 24, 2001 .
122. Consumer group
criticizes Thompson letter dismissing report on dangerous staffing
levels in nursing homes [news release]. Washington , DC : National
Citizens’ Coalition for Nursing Home Reform. March 22, 2002 .
123.
Bergstrom N, Braden B, Kemp M, Champagne M, Ruby E. Multi-site study of
incidence of pressure ulcers and the relationship between risk level,
demographic characteristics, diagnoses and prescription of preventive
interventions . J Am Geriatr Soc . 1996 Jan;44(1):22-30.
124. Miles SH. Concealing accidental nursing home deaths. HEC Forum . 2002 Sep;14(3):224-34.
125. Corey TS, Weakley-Jones B, Nichols GR 2nd, Theuer HH. Unnatural
deaths in nursing home patients. J Forensic Sci . 1992 Jan;37(1):222-7.
126. Lloyd-Jones DM, Martin DO, Larson MG, Levy D. Accuracy of death
certificates for coding coronary heart disease as the cause of death.
Ann Intern Med . 1998 Dec 15;129(12):1020-6.
127. Thomas DR , Zdrowski CD, Wilson MM, et al. Malnutrition in subacute care. Am J Clin Nutr . 2002 Feb;75(2):308-13.
128. Robinson BE. Death by destruction of will. Lest we forget. Arch Intern Med . 1995 Nov 13;155(20):2250-1.
129. Capezuti E, Strumpf NE, Evans LK, Grisso JA, Maislin G. The
relationship between physical restraint removal and falls and injuries
among nursing home residents . J Gerontol A Biol Sci Med Sci . 1998
Jan;53(1):M47-52.
130. Phillips CD, Hawes C, Fries BE. Reducing the
use of physical restraints in nursing homes: will it increase costs? Am J
Public Health . 1993 Mar;83(3):342-8.
131. Miles SH, Irvine P. Deaths caused by physical restraints. Gerontologist . 1992 Dec;32(6):762-6.
132. Annas GJ. The last resort—the use of physical restraints in
medical emergencies. N Engl J Med . 1999 Oct 28;341(18):1408-12.
133. Parker K, Miles SH. Deaths caused by bedrails. J Am Geriatr Soc . 1997 Jul;45(7):797-802.
134. Miles SH. Concealing accidental nursing home deaths. HEC Forum . 2002 Sep;14(3):224-34.
135. Katz PR, Seidel G. Nursing home autopsies. Survey of physician
attitudes and practice patterns. Arch Pathol Lab Med . 1990
Feb;114(2):145-7.
136. Overmedication of U.S. seniors. Reuters Health. May 21, 2003 .
137. Average number of prescriptions by HMOs increases. Drug Benefit Trends . 2002 Sep 12;14(8).
138. Kaiser Family Foundation. Prescription Drug Trends . November 2001.
139. Williams BR, Nichol MB, Lowe B, Yoon PS, McCombs JS, Margolies J.
Medication use in residential care facilities for the elderly. Ann
Pharmacother . 1999 Feb;33(2):149-55.
140. AARP. Medicare and prescription drugs. Available at: http://www.aarp.org/prescriptiondrugs. Accessed December 16, 2003 .
141. California reaches $100 million multi-state settlement with drug
giant Mylan over alleged price-fixing scheme [press release]. Sacramento
, CA : Office of the Attorney General, Department of Justice, State of
California ; July 12, 2000 .
142. Attorney general reaches
settlement with drug giant. WRAL News. March 7, 2003 . Available at: .
http://www.wral.com/money/2026364/detail.html . Accessed December 16,
2003 .
143. Blowing the final whistle. The Observer. November 25,
2001 . Available at:
http://education.guardian.co.uk/businessofresearch/comment/0,9976,606260,00.html.
Accessed December 16, 2003 .
144. AARP. Are food supplements for
me. Available at:
http://www.aarp.org/Articles/a2003-03-07-supplements.html. Accessed
December 16,2003 .
145. Bernabei R, Gambassi G, Lapane K, et al.
Management of pain in elderly patients with cancer. SAGE study group.
Systematic assessment of geriatric drug use via epidemiology. JAMA .
1998 Jun 17;279(23):1877-82.
146. Associated Press. Panel names estrogen as carcinogen. The Washington Post . December 16, 2000 :A05.
147. Estrogen hikes ovarian cancer risk. MSNBC staff and wire reports.
July 16, 2002 . Grady D. Study recommends NOT using hormone therapy for
bone loss. New York Times . October 1, 2003 .
148. Anderson GL, Judd
HL, Kaunitz AM, et al. Effects of estrogen plus progestin on
gynecologic cancers and associated diagnostic procedures: the Women’s
Health Initiative randomized trial. JAMA . 2003 Oct 1;290(13):1739-48.
149. Chlebowski RT, Hendrix SL, Langer RD , et al. Influence of
estrogen plus progestin on breast cancer and mammography in healthy
postmenopausal women: the Women’s Health Initiative randomized trial.
JAMA . 2003 Jun 25;289(24):3243-53.
150. Wassertheil-Smoller S,
Hendrix SL, Limacher M, et al . Effect of estrogen plus progestin on
stroke in postmenopausal women: the Women’s Health Initiative: a
randomized trial. JAMA . 2003 May 28;289(20):2673-84.
151. Shumaker
SA, Legault C, Rapp SR, et al. Estrogen plus progestin and the incidence
of dementia and mild cognitive impairment in postmenopausal women: the
Women’s Health Initiative memory study: a randomized controlled trial.
JAMA 2003;289:2651-62 .
152. Beral V; Million Women Study
Collaborators. Breast cancer and hormone-replacement therapy in the
Million Women Study. Lancet . 2003 Aug 9;362(9382):419-27.
The Liberty Beacon Project
is now expanding at a near exponential rate, and for this we are
grateful and excited! But we must also be practical. For 7 years we have
not asked for any donations, and have built this project with our own
funds as we grew. We are now experiencing ever increasing growing pains
due to the large number of websites and projects we represent. So we
have just installed donation buttons on our websites and ask that you
consider this when you visit them. Nothing is too small. We thank you
for all your support and your considerations … (TLB)
••••
Comment Policy:
As a privately owned web site, we reserve the right to remove comments
that contain spam, advertising, vulgarity, threats of violence, racism,
or personal/abusive attacks on other users. This also applies to
trolling, the use of more than one alias, or just intentional mischief.
Enforcement of this policy is at the discretion of this websites
administrators. Repeat offenders may be blocked or permanently banned
without prior warning.
••••
Disclaimer:
TLB websites contain copyrighted material the use of which has not
always been specifically authorized by the copyright owner. We are
making such material available to our readers under the provisions of “fair use”
in an effort to advance a better understanding of political, health,
economic and social issues. The material on this site is distributed
without profit to those who have expressed a prior interest in receiving
it for research and educational purposes. If you wish to use
copyrighted material for purposes other than “fair use” you must request permission from the copyright owner.
••••
Disclaimer:
The information and opinions shared are for informational purposes only
including, but not limited to, text, graphics, images and other
material are not intended as medical advice or instruction. Nothing
mentioned is intended to be a substitute for professional medical
advice, diagnosis or treatment.
Dead Newborn Infant Lies In Gutter Like Trash In China
Source: Marie Claire magazine, June 2001
A
morning in the Chinese province of Hunan brings an unimaginable sight
of cruelty and horror. Lying in the gutter of a bustling main road is
the tiny, twisted body of a dead baby girl. She is naked, surrounded by
only dirty pieces of hospital gauze. Buses and bicycles speed past the
corpse, spraying it with mud.
Nameless
and unwanted, the newborn’s been dumped by the roadside during winter.
Few of the locals hurrying by give her a second glance. To them, she is
just one of thousands of baby girls abandoned each year as a result of
China’s ruthless one-child policy. “I think the baby had just died,”
says a woman who was the only person to attempt to rescue the infant. “I
touched her skin, and it was warm. Blood was still coming out of her
nose.”
Under
China’s strict family-planning laws, couples in urban areas are allowed
only one child; couples in most rural regions can try for a second if
their first-born is a girl. Those who have an illegal baby are subject
to crippling fines, sterilization, and other severe penalties. To avoid
punishment, many parents go to the desperate measure of deserting their
illegal offspring. If their child is a girl--considered less valuable
than boys in rural, traditional parts of China, like Hunan--the chances
of this heartbreaking fate are immeasurably higher.
To
the Chinese authorities, abandoned girls are merely worthless trash. “I
called the emergency services, but nobody came,” says the woman who
found this latest little victim. (For fear of official reprisal, she
wishes to remain anonymous.) “The baby was lying right near the
government tax office, so many people in government just walked past.”
Eventually, an old man picked up the child, put her in a box, and
dropped her in a garbage bin. When the police finally arrived, they
showed no interest in investigating her death. They instead arrested the
woman who’d tried to save her. “I took some photographs, because it was
so terrible; the police were more worried about my pictures than the
baby,” she says. The police only released the woman once she handed over
her film.
The
chilling death of this baby, and countless others like her, reveals the
gross inhumanity behind the enforcement of China’s one-child policy.
The world’s most populous country with 1.3 billion people, China
introduced the policy in 1979 in response to a rapid increase in the
birth rate under former leader Mao Tse-tung, and a fear that the
exploding population couldn’t be fed. Today, China’s leaders claim that
the policy has been a great success, preventing an extra 300 million
births.
Most
Chinese recognize the need to keep the birth rate down, but the
government’s methods continue to cause untold misery. “What’s happening
since the one-child policy was introduced as a national catastrophe,”
says Wu Hongli a woman’s aid worker in Shanghai who does outreach work
in rural communities. “So many families have lost their children and had
their lives destroyed.”
While
abandonment is shockingly common, say Wu, some parents who give birth
“outside the plan” are so terrified of being caught, they even kill
their child. “One father dropped his daughter down an old well so no one
would ever know she existed.”
Each
region in China has a target “birth quota” for the number of babies
allowed to be born per year. Local government offices and state-owned
factories appoint female staff to monitor every woman’s menstrual cycle.
Before conceiving a baby, women must have a “birth permit”; those who
don’t, or who’ve already given birth have their contraceptive usage
monitored. Though condoms and the Pill are available, the most common
form of birth control is the metal IUD; it’s inserted at government
clinics and detectable by X-ray to ensure it hasn’t been removed without
authorization.
Click to enlarge
Officially,
the state condemns the use of force or cruelty in enforcing quotas. But
in practice, officials feel pressure to achieve low birth rates or face
disgrace and demotion, causing many to resort to brutal tactics.
Population officials, “abortion squads” regularly conduct midnight raids
into the homes of women suspected of becoming pregnant illegally. These
squads drag offenders into custody and detain them until they submit to
an abortion, even if they’re eight to nine months pregnant.
Gao
Xio Duan, a former population-control official who fled to America
three years ago, spoke out about the methods used to terminate illegal
pregnancies. Describing herself as a “monster”, she told a U.S.
Congressional committee how she had helped doctors inject lethal
formaldehyde into babies’ skulls during forced abortions. “I saw how the
baby’s lips were sucking and how its limbs were stretching,” she said
of one such instance. “Then the doctor injected the poison into its
head, and the child died and was thrown in the trash.”
Some
pregnant women try to avoid capture by going into hiding. But often,
they return after the birth to find their homes burned to the ground and
their other family members beaten or persecuted. In an extreme case
last year, a man in Changsha, a Hunan province, died after being
tortured for refusing to reveal the whereabouts of his pregnant wife. If
couple successfully give birth to an illegal baby, the face further
punishment, including fines of around 10,000 yuan ($1500)--seven times
more than the average peasant’s annual income--compulsory sterilization,
forced confiscations of property. Children born this way are denied
schooling, medical care, and other social benefits.
Many
peasants believe only sons can carry on the family line. “They think it
greatly dishonors their ancestors if they don’t produce a male heir,”
says outreach worker Wu Hongli. Also, daughters usually live with their
husband’s family after marriage and are, therefore, considered a wasted
investment. “Although the one-child policy allows many rural couples to
have another baby if their first is a girl, it spells disaster if their
second child is also female,” says Wu. Such unwanted girls are often
dubbed “maggots in the rice”. In northeast China, one man was so
distraught when his second-born was a girl that he smothered bother her
and his other healthy daughter. “It is a sin not to have a boy. I will
try again for a son when I get out of prison,” he told police.
In
China’s modern cities, the traditional desire for boys has all but
disappeared. But coupled with the one-child policy, its endurance in the
country side is having devastating social consequences. An estimated 17
million girls are “missing” from the population nationwide. Infanticide
and abandonment account for some of these lost females, with those who
survive ending up in bleak state orphanages--if they’re lucky. Other
factors include sex-selective abortion, which are technically outlawed,
but are still readily available through the use of ultrasound for a
small bribe. According to official figures, 97.5 percent of all aborted
fetuses in China are female. Failure to register the birth of girl
babies is another factor; it’s believed many parents hide their
daughters, or sell them to infertile couples, thereby making them
invisible to authorities.
The
result is a chronic imbalance in the male and female populations.
Already, millions of rural Chinese men are unable to find a wife. To
overcome this, young girls who leave their villages to look for work are
often tricked and drugged by traffickers and then sold to older single
men in distant provinces, where they don’t even speak the same dialect.
This imbalance is set to worsen, too. A decade ago, the birth records of
boys versus girls in some countryside areas where two to one. Today,
the ratio is often as high as an alarming six to one.
Still,
the Chinese government remains committed to its one-child policy. Wu
Hongli despairs over this situation. “Of course, population is a serious
issue,” she says, “but so are human rights. The authorities are making
no attempt to implement more humane family planning.” She also laments
official apathy toward teaching the population about the equal value of
baby girls. “Educational programs have had a lot of success in rural
areas, but there is still a vast amount to be done. So many tragedies
are ignored every day that it makes me want to cry. ”Looking at the
anonymous baby girl whose brief life ended on a roadside only a few
weeks ago, it’s impossible not to feel the same way.
