Modern Health Care System is the Leading Cause of Death, Part V

[Mrs. Sharon B. Hodge]

Modern Health Care System is the Leading Cause of Death, Part V

One of the most prominent articles on this site is Doctors are the Third Leading Cause of Death. Well that article was written in 2000 and now it appears that, based on a variety of references noted in the below article, some from prior to 2000 some after, doctors are in fact the LEADING cause of death in this country. Not heart disease, not cancer--doctors. In all fairness, doctors themselves are not to blame for all of this. The entire modern health care system, however, is to blame for allowing, even promoting, so many unnecessary procedures, drugs and mishaps. This illustrates precisely why the system is so desperately in need of change, and why facilitating this change is, and will continue to be, such a substantial portion of my vision.

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

Cesarean Section

In 1983, 809,000 cesarean sections (21 percent of live births) were performed, making it the most common obstetric and gynecologic (OB/GYN) surgical procedure. The second most common OB/GYN operation was hysterectomy (673,000), and diagnostic dilation and curettage of the uterus (632,000) was third. In 1983, OB/GYN operations represented 23 percent of all surgery completed in this country.104

In 2001, Cesarean section is still the most common OB/GYN surgical procedure. Approximately 4 million births occur annually, with a 24 percent C-Section rate, i.e., 960,000 operations. In the Netherlands only eight percent of babies are delivered by Cesarean section. Assuming human babies are similar in the United States and in the Netherlands, we are performing 640,000 unnecessary C-Sections in the United States with its three to four times higher mortality and 20 times greater morbidity than vaginal delivery.105

The cesarean section rate was only 4.5 percent in the United States in 1965. By 1986 it had climbed to 24.1 percent. The author states that obviously an "uncontrolled pandemic of medically unnecessary cesarean births is occurring."106 VanHam reported, in a high-risk population undergoing cesarean section, a:

Cesarean section postpartum hemorrhage rate of 7 percent
Hematoma formation rate of 3.5 percent
Urinary tract infection rate of 3 percent
Combined postoperative morbidity rate of 35.7 percent 107
Never Enough Studies

Scientists used the excuse that there were never enough studies revealing the dangers of DDT and other dangerous pesticides to ban them. They also used this excuse around the issue of 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 results of tobacco research. In 1964, the Surgeon General's report condemned smoking, however the AMA refused to endorse it. What was their reason? They needed more research. Actually what they really wanted was more money and they got it from a consortium of tobacco companies who 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 Chesterfield ads claiming that 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 they need more studies before they will lend their support to restrict the inordinate use of drugs.

Overview of Statistical Tables and Figures

Adverse Drug Reactions

The Lazarou study 1 was based on statistical analysis of 33 million U.S. hospital admissions in 1994. Hospital records for prescribed medications were analyzed with the following results:

The number of serious injuries due to prescribed drugs was 2.2 million
2.1 percent of in-patients experienced a serious adverse drug reaction
4.7 percent of all hospital admissions were due to a serious adverse drug reaction
Fatal adverse drug reactions occurred in 0.19 percent of in-patients and 0.13 percent of admissions.
The authors concluded that a projected 106,000 deaths occur annually due to adverse drug reactions.
We used a cost analysis from a 2000 study in which the increase in hospitalization costs per patient suffering an adverse drug reaction was $5,483. Therefore, costs for the Lazarou study's 2.2 million patients with serious drug reactions amounted $12 billion.1,49

Serious adverse drug reactions commonly emerge after Food and Drug Administration approval. The safety of new agents cannot be known with certainty until a drug has been on the market for many years.110

Bedsores

Over 1 million people develop bedsores in U.S. hospitals every year. It's a tremendous burden to patients and family, and a $55-billion health care burden.7 Bedsores are preventable with proper nursing care. It is true that 50 percent of those affected are in a vulnerable age group of over 70. In the elderly bedsores carry a four-fold increase in the rate of death.

The mortality rate in hospitals for patients with bedsores is between 23 percent and 37 percent.8 Even if we just take the 50 percent of people over 70 with bedsores and the lowest mortality at 23 percent, 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, gave citations to 20 percent 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 aren't able to manage a food tray by themselves.11 It is difficult to place a mortality rate on malnutrition and dehydration. This Coalition report states that malnourished residents, compared with well-nourished hospitalized nursing home residents, have a five-fold increase in mortality when they are admitted to hospital. So, if we take one-third of the 1.6 million nursing home residents who are malnourished and multiply that by a mortality rate of 20 percent,8,14 we find 108,800 premature deaths due to malnutrition in nursing homes.

Nosocomial Infections

The rate of nosocomial [originating or taking place in a hospital] infections per 1,000 patient days has increased 36 percent--from 7.2 in 1975 to 9.8 in 1995. Reports from more than 270 U.S. 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, which is a rate of 5 percent to 6 percent. However, because of progressively shorter inpatient stays and the increasing number of admissions, the actual number of infections increased.

It is estimated that in 1995, nosocomial infections cost $4.5 billion and contributed to more than 88,000 deaths--one death every six 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 This is a $0.5 billion increase in four years. The present cost of nosocomial infections might now be in the order of $5.5 billion.

Outpatient Iatrogenesis

Dr. Barbara Starfield in a 2000 JAMA paper presents us with well-documented facts that are both shocking and unassailable.12

The U.S. ranks twelfth out of 13 countries in a total of 16 health indicators. Japan, Sweden, and Canada were first, second, and third.
More than 40 million people have no health insurance.
20 percent to 30 percent of patients receive contraindicated care.
Dr. Starfield warns that one cause of medical mistakes is the overuse of technology, which may create a "cascade effect" leading to more treatment. She urges the use of ICD (International Classification of Diseases) codes that have designations called: "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 says that, at present, deaths actually due to medical error are likely to be coded according to some other cause of death.

She concludes that against the backdrop of our abysmal health report card compared to the rest of the 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" on outpatient iatrogenesis. And Weingart, in turn, cites several authors and provides statistics showing that between 4 percent to 18 percent of consecutive patients in outpatient settings suffer an iatrogenic event leading to 112:

116 million extra physician visits
77 million extra prescriptions
17 million emergency department visits
8 million hospitalizations
3 million long-term admissions
199,000 additional deaths
$77 billion in extra costs
Unnecessary Surgeries

There are 12,000 deaths per year from unnecessary surgeries. However, results from the few studies that have measured unnecessary surgery directly indicate that for some highly controversial operations, the fraction that are unwarranted could be as high as 30 percent.74

It's a Global Issue

A survey published in the Journal of Health Affairs pointed out that between 18 percent and 28 percent 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 in five different countries. The breakdown by country showed:

18 percent of those in Britain
25 percent in Canada
23 percent in Australia
23 percent in New Zealand
The highest number was in the U.S. at 28 percent 113
Health Insurance

A recent finding by the Institute of Medicine is that the 41 million Americans without health insurance have consistently worse clinical outcomes than those who are insured, and are at increased risk for dying prematurely.114

Insurance Fraud

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 U.S. General Accounting Office (GAO) gave a 1998 figure of $12 billion lost to fraudulent or unnecessary claims, 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

It is only fitting that we end this report with acknowledgement of our elders. The moral and ethical fiber of society can be judged by the way it treats its weakest and most vulnerable members. Some cultures honor and respect the wisdom of their elders, keeping them at home--the better to continue participation in their community. However, American nursing homes, where millions of our elders die, represent the pinnacle of social isolation and medical abuse.