In light of the current divisive debate about what passes for health-care reform, but is in reality little more than a health insurance mandate to enrich the medical and insurance industries, it’s important to consider just what it is that so many Americans want access to: the over-priced, high-tech, poorly-performing and often deadly medical industry.
In 1975, philosopher, priest and social critic Ivan Illich wrote Medical Nemesis: The Expropriation of Health, in which he argued (with hundreds of footnotes) that the medicalization in recent decades of so many of life’s vicissitudes – birth and death, for example – frequently caused more harm than good and rendered many people in effect lifelong patients. He marshaled a body of statistics to show what he considered the shocking extent of post-operative side-effects and drug-induced illness in advanced industrial society. He was the first to introduce to a wider public the notion of iatrogenic disease – illness or injury caused by medical intervention.
Illich goes on to dispel the self-serving mythology of the medical industry. “After a century of pursuit of medical Utopia, and contrary to current conventional wisdom, medical services have not been important in producing the changes in life expectancy that have occurred. A vast amount of contemporary clinical care is incidental to the curing of disease, but the damage done by medicine to the health of individuals and populations is very significant. These facts are obvious, well documented, and well repressed.”
Placing institutionalized medicine in the context of the technologizing and professionalization of all of life’s essential needs, Illich states “Increasing and irreparable damage accompanies present industrial expansion in all sectors. In medicine this damage appears as iatrogenesis. Iatrogenesis is clinical when pain, sickness, and death result from medical care; it is social when health policies reinforce an industrial organization that generates ill-health; it is cultural and symbolic when medically sponsored behavior and delusions restrict the vital autonomy of people by undermining their competence in growing up, caring for each other, and aging, or when medical intervention cripples personal responses to pain, disability, impairment, anguish, and death.”
His paradigm-shattering insights have been reinforced by a more recent meta-study of the actual outcomes of modern medical intervention.
The American Medical System Is The Leading Cause Of Death And Injury In The United States
By Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD, Debora Rasio MD, Dorothy Smith PhD, October 2003
A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million. Dr. Richard Besser, of the CDC , in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics.
The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. The total number of iatrogenic [induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures] deaths is 783,936.
The 2001 heart disease annual death rate is 699,697; the annual cancer death rate is 553,251. It is evident that the American medical system is the leading cause of death and injury in the United States.
On top of the fatalities, there is an annual total of 16.4 million unnecessary procedures and hospitalizations, resulting in 3.08 million non-fatal iatrogenic events.
A ten-year projection, using this understated number, of 7.8 million iatrogenic deaths, is more than all the casualties from wars that America has fought in its entire history.
Never before have the complete statistics on the multiple causes of iatrogenesis been combined in one paper. Medical science amasses tens of thousands of papers annually – each one a tiny fragment of the whole picture. To look at only one piece and try to understand the benefits and risks is to stand one inch away from an elephant and describe everything about it. You have to pull back to reveal the complete picture, such as we have done here. Each specialty, each division of medicine, keeps their own records and data on morbidity and mortality like pieces of a puzzle. But the numbers and statistics were always hiding in plain sight. We have now completed the painstaking work of reviewing thousands and thousands of studies. Finally putting the puzzle together we came up with some disturbing answers.
Is American Medicine Working?
At 14% of the Gross National Product, health care spending reached $1.6 trillion in 2003. Considering this enormous expenditure, we should have the best medicine in the world. We should be reversing disease, preventing disease, and doing minimal harm. However, careful and objective review shows the opposite. Because of the extraordinary narrow context of medical technology through which contemporary medicine examines the human condition, we are completely missing the full picture.
Medicine is not taking into consideration the following monumentally 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
(e) Exposure to tens of thousands of environmental toxins.
Instead of minimizing these disease-causing factors, we actually 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 appropriated for preventing disease.
Under-reporting of Iatrogenic Events
As few as 5% and only up to 20% of Iatrogenic acts are ever reported. This implies that if medical errors were completely and accurately reported, we would have a much higher annual Iatrogenic death rate than 783,936. Dr. Leape, in 1994, said his figure of 180,000 medical mistakes annually was equivalent to three jumbo-jet crashes every two days. Our report shows that six jumbo jets are falling out of the sky each and every day.
Correcting a Compromised System
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 quite obvious that we can’t 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 that what stands in the way of change are powerful pharmaceutical companies, medical technology companies, and special interest 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 a new therapy or drug.
You only have to look at the number of invested people on hospital, medical, and government health advisory boards to see conflict 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. The authors were concerned that such representation could cause potential conflicts of interest.
Iatrogenic Deaths In the United States (deaths induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures)
|Adverse Drug Reactions||106,000||$12 billion|
|Medical error||98,000||$2 billion|
|Unnecessary Procedures||37,136||$122 billion|
Projected Ten-Year Statistics
|Unnecessary Events||10-Year Number||Iatrogenic Events|
|Hospitalization||89 million||17 million|
|Procedures||75 million||13 million|
|TOTAL||164 million||30 million|
These projected figures show that in the last decade a total of 164 million people, approximately 56 percent of the population of the United States, have been treated unnecessarily by the medical industry – in other words, nearly 50,000 people per day.
Ebola Raises Concerns Over Hospital Infection Controls
As public health authorities race to assess the U.S. medical system’s ability to contain Ebola, the track record of the nation’s hospitals in controlling other infections raises concern.
From small, rural hospitals to sprawling urban medical centers, infection control has been a persistent and vexing problem in U.S. health care for decades.
Many hospitals handle these cases without incident. But lapses in procedures to isolate contagious patients, to protect health care workers from dangerous bacteria and viruses, and to clean contaminated equipment consistently rank among the most common deficiencies cited in hospital inspections and accreditation reviews.
About one in every 25 patients get an infection while being treated in a U.S. hospital, which translates to more than 700,000 hospital-associated illnesses each year, according to data from the Centers for Disease Control and Prevention. In 2011, about 75,000 patients died from those infections, or more than twice the number killed in auto accidents. Virtually all those infections are transmitted via contaminated equipment, rooms or caregivers.
The 722,000 infections acquired in hospitals during 2011 represented a decline of 58% from a decade earlier, when the annual number stood at 1.7 million. The number of deaths linked to those infections dropped nearly 25% over the same period.
Hospital inspection records reviewed by USA TODAY show a wide range of problems.
Many violations involve health care workers failing to disinfect their hands or use protective gear properly – gloves, gowns, masks and other items that must be donned and removed in very precise ways. In one case, more than 60 personnel at a single hospital were cited for failing to use face masks properly.
In other instances, surveyors observed personnel tracking blood across floors, wiping down equipment with dirty rags, using blood-testing equipment on successive patients without proper disinfection and failing to change “high-touch” room curtains for more than a year.
More than 250 hospitals surveyed by state and federal regulators from January 2011 through June 2014 were cited for deficiencies in infection control, according to data obtained from the U.S. Centers for Medicare and Medicaid Services. Those hospitals accounted for nearly 15% of 1,815 that were cited for any sort of violation. The facilities cited for infection control lapses were in 44 states, with the highest number in Texas (23), California (16) and Florida (16).
Six Michigan hospitals were cited for a handful of violations that were relatively minor.
- In the first half of this year, infection control deficiencies were cited in about half of the hospital reviews conducted by the Joint Commission, which accredits more than 75% of the nation’s hospitals. Those deficiencies, among the top five issues cited in the commission’s reviews, related to hospitals’ failure to adequately reduce infection risks linked to medical equipment, devices and supplies, such as sterilization of surgical instruments and proper disinfection of endoscopes.
- In a 2013 Leapfrog survey of more than 1,400 hospitals, more than 30% reported that they did not meet the group’s standards for hand-washing education and compliance policies. Though hand hygiene is widely considered to be the most important component of infection-control programs, studies repeatedly have shown that compliance at many hospitals hovers below 70%.
- More than a third of all U.S. hospitals do not have a certified infection prevention specialist on staff, according to a study this year in the American Journal of Infection Control. The Association for Professionals in Infection Control recommends that every hospital have at least one certified infection specialist.
“I definitely worry” about most hospitals’ ability to handle Ebola cases safely, says William Jarvis, former head of the health care infection division at the CDC. “You can get away with breaks in (infection control) technique a lot of the time with other blood-borne pathogens that are not that readily transmittable; with something like Ebola, there’s no room for error.”
“We know that health care-associated infections are something that U.S. health care facilities continue to struggle with, and we know that things as simple as hand hygiene are not always adhered to,” says CDC spokeswoman Abbigail Tumpey. “So, when we’re talking about the complexities of caring for a patient with Ebola, we have to make sure facilities treating them are fully prepared, with practiced procedures and strict infection control protocols that they are going to adhere to.”
“It seems a bit shaky to base our defense against Ebola on an industry sector that frankly does not seem up to the challenge,” says John Santa, a physician and former health system administrator who now heads the Consumer Reports Health Ratings Center.
“It is likely a subset of hospitals can provide optimal care to an Ebola patient and optimal protection to their employees,” he adds. The challenge for the CDC is “to identify that subset and figure out mechanisms to get patients with Ebola or at risk of Ebola to those hospitals.”
US Healthcare to Blame for Poor Life Expectancy Rates
October 10, 2010
The US healthcare system is to blame for declines in the country’s life expectancy ranking, a study suggests.
A Columbia University report rejects claims that factors such as obesity have shortened life-spans for Americans relative to other wealthy nations.
The study blames reliance on costly and fragmented specialized care, and calls for systemic reform.
The study notes that in 1950, the US ranked fifth among leading industrialized nations for female life expectancy at birth, but only 46th in 2008.
It finds that US healthcare spending increased at nearly twice the rate of that in other wealthy nations between 1970 and 2002, with the increased spending corresponding with worsening survival rates relative to the other countries studied.
“In most cases, the relative US performance deteriorated from decade to decade,” wrote authors Peter Muennig and Sherry Glied of Columbia University’s Mailman School of Public Health.
They note the countries to which the US is compared – Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland and the UK – all provide universal healthcare coverage.
Factors such as differing obesity, smoking, road accident and murder rates were taken into account in the study.
The US spends far more on healthcare than any other country as a percentage of gross domestic product, the study finds.
“We speculate that the nature of our health care system – specifically, its reliance on unregulated fee-for-service and specialty care – may explain both the increased spending and the relative deterioration in survival that we observed,” the authors wrote.
“If so, meaningful reform may not only save money over the long term, it may also save lives.”
Antibiotic Resistance Could Bring End of Modern Medicine
As bacteria evolve to evade antibiotics, common infections could become deadly, according to Dr. Margaret Chan, director general of the World Health Organization.
[Yet she misstates the significance of the changes, which are not evolutionary but caused by real-time bacterial sharing of DNA, which transmits resistant genes almost instantaneously. In fact, human sewage effluent carries the resistant “bugs” from our guts into the environment where the antibiotic resistant traits are shared widely.]
Speaking at a conference in Copenhagen, Chan said antibiotic resistance could bring about “the end of modern medicine as we know it.”
“We are losing our first-line antimicrobials,” she said Wednesday in her keynote address at the conference on combating antimicrobial resistance. “Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units.”
Chan said hospitals have become “hotbeds for highly-resistant pathogens” like methicillin-resistant Staphylococcus aureus (MRSA), “increasing the risk that hospitalization kills instead of cures.”
Indeed, diseases that were once curable, such as tuberculosis, are becoming harder and more expensive to treat.
Chan said treatment of multi-drug-resistant tuberculosis was “extremely complicated, typically requiring two years of medication with toxic and expensive medicines, some of which are in constant short supply. Even with the best of care, only slightly more than 50 percent of these patients will be cured.”
Antibiotic-resistant strains of salmonella, E. coli, and gonorrhea have also been discovered.
“Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry,” said Chan. “A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”
[From the 1940s through the 1990s, we produced three new antibiotics per year. Since then, we create a new antibiotic once every second year – a six-fold reduction in discovery – while retiring old antibiotics at twice the rate of invention of new ones.]
The dearth of effective antibiotics could also make surgical procedures and certain cancer treatments risky or even impossible, Chan said.
“Some sophisticated interventions, like hip replacements, organ transplants, cancer chemotherapy and care of preterm infants, would become far more difficult or even too dangerous to undertake,” she said.
The development of new antibiotics now could help stave off catastrophe later. But few drug makers are willing to invest in drugs designed for short term use.
“It’s simply not profitable for them,” said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University Medical Center in Nashville. “If you create a new drug to reduce cholesterol, people will be taking that drug every day for the rest of their lives. But you only take antibiotics for a week or maybe 10 days.”
But there are ways to limit the potential for bacteria to develop antibiotic resistance: Use antibiotics appropriately and only when needed; follow treatment correctly; and restrict the use of antibiotics in food production to therapeutic purposes.
“At a time of multiple calamities in the world, we cannot allow the loss of essential antimicrobials, essential cures for many millions of people, to become the next global crisis,” said Chan.
2 BILLION Dementia Patients?
October 11, 2012
By 2050, the population at risk for the disease is expected to hit two billion, causing what experts say will be an unprecedented health care crisis that could cost $1 trillion a year in the U.S. alone.
“The scope of the looming medical-care disaster is beyond comparison with anything that has been faced during the entire history of humanity,” said Dr. Barry Greenberg, the director of strategy for the Toronto Dementia Research Alliance, in a recent talk in Canada.
If Descartes’ proposition, “I think, therefore I am” is accepted as what it means to be human – at least in the Western world – then what about the projected two billion people who will soon become living, breathing entities without the capacity to remember their own thoughts?
Ebola Threatens the World while Vaccine Sat on Shelf for Ten Years
Almost a decade ago, scientists from Canada and the United States reported that they had created a vaccine that was 100% effective in protecting monkeys against the Ebola virus. The results were published in a respected journal (Nature Medicine 2005, “Live attenuated recombinant vaccine protects nonhuman primates against Ebola and Marburg viruses”). The researchers said tests in people might start within two years, and a product could potentially be ready for licensing by 2010 or 2011.
It never happened. The vaccine sat on a shelf. Only now is it undergoing the most basic safety tests in humans – with nearly 5,000 people dead from Ebola and an epidemic raging out of control in West Africa.
Its development stalled in part because Ebola is rare, and until now, outbreaks had infected only a few hundred people at a time. But experts also acknowledge that the absence of follow-up on such a promising candidate reflects a broader failure to produce medicines and vaccines for diseases that afflict poor countries. Most drug companies have resisted spending the enormous sums needed to develop products useful mostly to countries with little ability to pay.
Now, as the growing epidemic devastates West Africa and is seen as a potential threat to other regions as well, governments and aid groups have begun to open their wallets. A flurry of research to test drugs and vaccines is underway, with studies starting for several candidates, including the vaccine produced nearly a decade ago.
The Director-General of the World Health Organization (WHO), Dr. Margaret Chan, said “Ebola emerged nearly four decades ago. Why are clinicians still empty-handed, with no vaccines and no cure? Because Ebola has historically been confined to poor African nations. The R&D incentive is virtually non-existent. A profit-driven industry does not invest in products for markets that cannot pay. WHO has been trying to make this issue visible for ages. Now people can see for themselves.”
We Americans only started worrying about it when a Liberian man whose compassion killed him arrived on our shores. And then we suddenly noticed that 5,000 West Africans have died from a virus with a vaccine sitting untested on the shelves for years. Even then, the nation primarily cared about whether we might catch the virus ourselves. Our paranoia has led to irrational behavior that threatens our ability to help West Africa fight the disease. As every epidemiologist and public health expert warns us, the only way to prevent an epidemic at home is to fight it at the source.
African health-care systems are medieval and minimal. In some countries there is one pediatrician for a million residents. But the West has ignored Africa’s health needs unless and until it affects our own security. As Chan said, “Without fundamental public health infrastructures in place, no country is stable. No society is secure.”
Another way to put it is, until health care and preventative services are considered a universal human right for all peoples, rather than a commodity to be sold to those with the resources to afford it and by those corporations who can profit from it, then none of us will be safe.
Little Cuba Leads in International Medical Care
In contrast to the profit-driven medical systems of the US and much of the “advanced” world, tiny Cuba, an isolated nation of just 11 million, has sent more doctors and nurses to West Africa to fight the Ebola epidemic than any other country.
Cuba has offered more than 460 Cuban doctors and nurses to West Africa, and currently, 256 are working in the three hard hit nations under the direction of the World Health Organization (WHO). More than 50,000 health care workers from Cuba are working in 66 countries around the world (they have deployed 135,000 since 1960), and 15,000 eagerly volunteered for the African Ebola mission.
Cuba’s global health crisis response system is a Doctors Without Borders-like program, but instituted by the government. When Cuban doctors graduate medical school, they are given the opportunity to volunteer to be called upon for medical missions. Often, these are one- or two-year commitments. To prepare for something like Ebola, health care workers not only undergo aggressive training for the specific disease they are treating, but they also take courses on the region’s culture and history.
In 1998, Cuban medical teams discovered that they were treating a lot people who had never before had access to doctors, so Cuba founded the Latin American Medical School (ELAM), which offers scholarships to low-income students from around the world with the expectation that they will graduate and return to their home countries as health workers.
More than 23,000 physicians from low-income communities in 83 countries (even the US) have graduated from ELAM, and nearly 10,000 are currently enrolled.
While WHO struggles to get commitments from Western nations to staff the 50 Ebola treatment units due to be rolled out in Liberia, Sierra Leone and Guinea, the little socialist nation of Cuba is the only one to jump into service to this global crisis.