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Modern Health Care System is the Leading Cause of Death, Part VI
Modern Health Care System is the Leading Cause of Death, Part VI
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
Important Statistics about Nursing Homes
In America, at any one time, approximately 1.6 million elderly are confined to nursing homes. By 2050 that number could be 6.6 million.11,116
A total of 20 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
Congressman Waxman reminded us that "as a society we will be judged by how we treat the elderly" when he presented a report that he sponsored, "Abuse of Residents is a Major Problem in U.S. Nursing Homes," on July 30, 2001. The report uncovered that one-third--5,283 of the nation's 17,000 nursing homes--were cited for an abuse violation in the two-year period studied, January 1999 to January 2001.116 Waxman stated that "the people who cared for us, deserve better." He also made it very clear that this was only the tip of the iceberg and there is much more abuse occurring that we don't know about or ignore.116a
The major findings of "Abuse of Residents is a Major Problem in U.S. Nursing Homes," were:
Over 30 percent of nursing homes in the United States were cited for abuses, totaling more than 9,000 abuse violations.
10 percent of nursing homes had violations that caused actual physical harm to residents, or worse.
Over 40 percent, or 3,800, abuse violations were only discovered after a formal complaint was filed, 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. An exhaustive study of nurse-to-patient ratios in nursing homes was mandated by Congress in 1990. The study was finally begun in 1998 and took four years to complete.120 Commenting on the study, a spokesperson for The National Citizens' Coalition for Nursing Home Reform said:
"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
Bedsores occur three times more commonly in nursing homes than in acute care or veterans' hospitals.122 But we know that bedsores can be prevented with proper nursing care. It shouldn't take four years for someone to find out that proper care of bedsores requires proper staffing. In spite of such urgent need in nursing homes where additional staff could solve so many problems, we hear the familiar refrain "not enough research"--one that merely buys time for those in charge and relegates another smoldering crisis to the back burner.
Since many nursing home patients suffer from chronic debilitating conditions, their assumed cause of death is often unquestioned by physicians. Some studies show that as many as 50 percent of deaths due to restraints, falls, suicide, homicide, and choking in nursing homes may be covered up.123,124 It is quite possible that many nursing home deaths are attributed, instead, to heart disease, which, until our report, was the number one cause of death.
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 7.9 percent to 24.3 percent. In the elderly the over-reporting of heart disease as a cause of death is as much as two-fold.125
When elucidating iatrogenesis in nursing homes, some critics have asked, "To what extent did these elderly people already have life-threatening diseases that led to their premature deaths anyway?" Our response is that if a loved one dies one day, one week, one year, a decade, or two decades prematurely, thanks to some medical misadventure, that is still a premature, iatrogenic death. In a legalistic sense perhaps more weight is placed on the loss of many potential years compared to an additional few weeks, but this attitude is not justified in an ethical or moral sense.
The fact that there are very few statistics on malnutrition in acute-care hospitals and nursing homes shows the lack of concern in this area. A survey of the literature turns up very few American studies. Those that do appear are foreign studies in Italy, Spain, and Brazil. However, there is one very revealing American study conducted over a 14-month period that evaluated 837 patients in a 100-bed sub-acute-care hospital for their nutritional status. Only 8 percent of the patients were found to be well nourished.
Almost one-third (29 percent) were malnourished and almost two-thirds (63 percent) were at risk of malnutrition. The consequences of this state of deficiency were that 25 percent of the malnourished patients required readmission to an acute-care hospital compared to 11 percent of the well-nourished patients. The authors concluded that malnutrition reached epidemic proportions in patients admitted to this sub-acute-care facility.126
Many studies conclude that physical restraints are an underreported and preventable cause of death. Whereas administrators say they must use restraints to prevent falls, in fact, they cause more injury and death because people naturally fight against such imprisonment.
Studies show that compared to no restraints, the use of restraints carries a higher mortality rate and economic burden.127-129 Studies found that physical restraints, including bedrails, are the cause of at least one in every 1,000 nursing-home deaths.130-132
However, deaths caused by malnutrition, dehydration, and physical restraints are rarely recorded on death certificates. Several studies reveal that nearly half of the listed causes of death on death certificates for older persons with chronic or multi-system disease are inaccurate.133
Even though one in five people die in nursing homes, the autopsy rate is only 0.8 percent.134 Thus, we have no way of knowing the true causes of death.
Over-medicating Seniors
The CDC may be focused on reducing the number of prescriptions for children but a 2003 study finds over-medication of our elderly population.
Dr. Robert Epstein, chief medical officer of Medco Health Solutions Inc. (a unit of Merck & Co.), conducted the study on drug trends.135 He found that seniors are going to multiple physicians and getting multiple prescriptions and using multiple pharmacies. Medco oversees drug-benefit plans for more than 60 million Americans, including 6.3 million senior citizens who received more than 160 million prescriptions. According to the study, the average senior receives 25 prescriptions annually.
In 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 senior citizens, 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 said, "There are serious and systemic problems with poor continuity of care in the United States." He says this study shows "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 percent from 1999 to 2000--from 7.1 to 7.5 prescriptions. The average number dispensed for Medicare members increased 5.5 percent--from 18.1 to 19.1 prescriptions.136 The number of prescriptions in 2000 was 2.98 billion, with an average per person prescription amount of 10.4 annually.137
In a study of 818 residents of residential care facilities for the elderly, 94 percent 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
Unfortunately, seniors, and groups like the American Association for Retired Persons (AARP), appear to be dependent on prescription drugs and are demanding that coverage for drugs be a basic right.139 They have accepted the overriding assumption from allopathic medicine that aging and dying in America must be accompanied by drugs in nursing homes and eventual hospitalization with tubes coming out of every orifice.
Instead of choosing between drugs and a diet-lifestyle change, seniors are given the choiceless option of either high-cost patented drugs or low-cost generic drugs. Drug companies are attempting to keep the most expensive drugs on the shelves and to suppress access to generic drugs, in spite of stiff fines of hundreds of millions of dollars from the government.140,141
In 2001 some of the world's biggest drug companies, including Roche, were fined a record £523 million ($871 million) for conspiring to increase the price of vitamins.142
We would urge AARP, especially, to become more involved in prevention of disease and not to rely so heavily on drugs. At present, the AARP recommendations for diet and nutrition assume that seniors are getting all the nutrition they need in an average diet. At most, they suggest extra calcium and a multiple vitamin/mineral supplement.143 This is not enough, and in our next report we will show how to live a healthier life without unnecessary medical intervention.
We would like to send the same message to the Hemlock Society, which offers euthanasia options to chronically ill people, especially those in severe pain. What if some of these chronic diseases are really lifestyle diseases caused by deficiency of essential nutrients, lack of care, inappropriate medication, or lack of love? This question is extremely important to consider when you are depressed or in pain.
We must look to healing those conditions before offering up our lives.
Let's also look at the irony of under use of proper pain medication for patients that really need it. For example, in one particular study pain management was evaluated in a group of 13,625 cancer patients, aged 65 or over, living in nursing homes. Overall, almost 30 percent, or 4,003 patients, reported pain. However, more than 25 percent received absolutely no pain relief medication; 16 percent received a World Health Organization (WHO) level-one drug (mild analgesic); 32 percent a WHO level-two drug (moderate analgesic); and only 26 percent received adequate pain-relieving morphine. The authors concluded that older patients and minority patients were more likely to have their pain untreated.144
The time has come to set a standard for caring for the vulnerable among us--a standard that goes beyond making sure they are housed and fed, and not openly abused. We must stop looking the other way and we, as a society, must take responsibility for the way in which we deal with those who are unable to care for themselves.
What Remains to be Uncovered
Our ongoing research will continue to quantify the morbidity, mortality, and financial loss due to:
X-ray exposures: mammography, fluoroscopy, CT scans.
Overuse of antibiotics in all conditions.
Drugs that are carcinogenic: hormone replacement therapy (*see below), immunosuppressive drugs, prescription drugs.
Cancer chemotherapy: If it doesn't extend life, is it shortening life?70
Surgery and unnecessary surgery: Cesarean section, radical mastectomy, preventive mastectomy, radical hysterectomy, prostatectomy, cholecystectomies, cosmetic surgery, arthroscopy, etc.
Discredited medical procedures and therapies.
Unproven medical therapies.
Outpatient surgery.
Doctors themselves: when doctors go on strike, it appears the mortality rate goes down.
*Part of our ongoing research will be to quantify the mortality and morbidity caused by hormone replacement therapy (HRT) since the mid-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 million to 16 million women in the United States.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
Heart disease
... and little evidence of osteoporosis reduction or prevention of dementia. WHI researchers, who usually never give recommendations, other than demanding more studies, are advising 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 the Lancet, August 2003. Lead author, Professor Valerie Beral, director of the Cancer Research UK Epidemiology Unit, is very open about the damage HRT has caused. She said:
"We estimate that over the past decade, use of HRT by UK women aged 50 to 64 has resulted in an extra 20,000 breast cancers, oestrogen-progestagen (combination) therapy accounting for 15,000 of these."151
However, we were not able to find the statistics on breast cancer, stroke, uterine cancer, or heart disease due to HRT used by American women. The population of America is roughly six times that of the UK. Therefore, it is possible that 120,000 cases of breast cancer have been caused by HRT in the past decade.
Conclusion
When the number one killer in a society is the health care system, then that system has no excuse except to address its own urgent shortcomings. It's a failed system in need of immediate attention. What we have outlined in this paper are insupportable aspects of our contemporary medical system that need to be changed--beginning at its very foundations.
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
Important Statistics about Nursing Homes
In America, at any one time, approximately 1.6 million elderly are confined to nursing homes. By 2050 that number could be 6.6 million.11,116
A total of 20 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
Congressman Waxman reminded us that "as a society we will be judged by how we treat the elderly" when he presented a report that he sponsored, "Abuse of Residents is a Major Problem in U.S. Nursing Homes," on July 30, 2001. The report uncovered that one-third--5,283 of the nation's 17,000 nursing homes--were cited for an abuse violation in the two-year period studied, January 1999 to January 2001.116 Waxman stated that "the people who cared for us, deserve better." He also made it very clear that this was only the tip of the iceberg and there is much more abuse occurring that we don't know about or ignore.116a
The major findings of "Abuse of Residents is a Major Problem in U.S. Nursing Homes," were:
Over 30 percent of nursing homes in the United States were cited for abuses, totaling more than 9,000 abuse violations.
10 percent of nursing homes had violations that caused actual physical harm to residents, or worse.
Over 40 percent, or 3,800, abuse violations were only discovered after a formal complaint was filed, 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. An exhaustive study of nurse-to-patient ratios in nursing homes was mandated by Congress in 1990. The study was finally begun in 1998 and took four years to complete.120 Commenting on the study, a spokesperson for The National Citizens' Coalition for Nursing Home Reform said:
"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
Bedsores occur three times more commonly in nursing homes than in acute care or veterans' hospitals.122 But we know that bedsores can be prevented with proper nursing care. It shouldn't take four years for someone to find out that proper care of bedsores requires proper staffing. In spite of such urgent need in nursing homes where additional staff could solve so many problems, we hear the familiar refrain "not enough research"--one that merely buys time for those in charge and relegates another smoldering crisis to the back burner.
Since many nursing home patients suffer from chronic debilitating conditions, their assumed cause of death is often unquestioned by physicians. Some studies show that as many as 50 percent of deaths due to restraints, falls, suicide, homicide, and choking in nursing homes may be covered up.123,124 It is quite possible that many nursing home deaths are attributed, instead, to heart disease, which, until our report, was the number one cause of death.
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 7.9 percent to 24.3 percent. In the elderly the over-reporting of heart disease as a cause of death is as much as two-fold.125
When elucidating iatrogenesis in nursing homes, some critics have asked, "To what extent did these elderly people already have life-threatening diseases that led to their premature deaths anyway?" Our response is that if a loved one dies one day, one week, one year, a decade, or two decades prematurely, thanks to some medical misadventure, that is still a premature, iatrogenic death. In a legalistic sense perhaps more weight is placed on the loss of many potential years compared to an additional few weeks, but this attitude is not justified in an ethical or moral sense.
The fact that there are very few statistics on malnutrition in acute-care hospitals and nursing homes shows the lack of concern in this area. A survey of the literature turns up very few American studies. Those that do appear are foreign studies in Italy, Spain, and Brazil. However, there is one very revealing American study conducted over a 14-month period that evaluated 837 patients in a 100-bed sub-acute-care hospital for their nutritional status. Only 8 percent of the patients were found to be well nourished.
Almost one-third (29 percent) were malnourished and almost two-thirds (63 percent) were at risk of malnutrition. The consequences of this state of deficiency were that 25 percent of the malnourished patients required readmission to an acute-care hospital compared to 11 percent of the well-nourished patients. The authors concluded that malnutrition reached epidemic proportions in patients admitted to this sub-acute-care facility.126
Many studies conclude that physical restraints are an underreported and preventable cause of death. Whereas administrators say they must use restraints to prevent falls, in fact, they cause more injury and death because people naturally fight against such imprisonment.
Studies show that compared to no restraints, the use of restraints carries a higher mortality rate and economic burden.127-129 Studies found that physical restraints, including bedrails, are the cause of at least one in every 1,000 nursing-home deaths.130-132
However, deaths caused by malnutrition, dehydration, and physical restraints are rarely recorded on death certificates. Several studies reveal that nearly half of the listed causes of death on death certificates for older persons with chronic or multi-system disease are inaccurate.133
Even though one in five people die in nursing homes, the autopsy rate is only 0.8 percent.134 Thus, we have no way of knowing the true causes of death.
Over-medicating Seniors
The CDC may be focused on reducing the number of prescriptions for children but a 2003 study finds over-medication of our elderly population.
Dr. Robert Epstein, chief medical officer of Medco Health Solutions Inc. (a unit of Merck & Co.), conducted the study on drug trends.135 He found that seniors are going to multiple physicians and getting multiple prescriptions and using multiple pharmacies. Medco oversees drug-benefit plans for more than 60 million Americans, including 6.3 million senior citizens who received more than 160 million prescriptions. According to the study, the average senior receives 25 prescriptions annually.
In 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 senior citizens, 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 said, "There are serious and systemic problems with poor continuity of care in the United States." He says this study shows "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 percent from 1999 to 2000--from 7.1 to 7.5 prescriptions. The average number dispensed for Medicare members increased 5.5 percent--from 18.1 to 19.1 prescriptions.136 The number of prescriptions in 2000 was 2.98 billion, with an average per person prescription amount of 10.4 annually.137
In a study of 818 residents of residential care facilities for the elderly, 94 percent 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
Unfortunately, seniors, and groups like the American Association for Retired Persons (AARP), appear to be dependent on prescription drugs and are demanding that coverage for drugs be a basic right.139 They have accepted the overriding assumption from allopathic medicine that aging and dying in America must be accompanied by drugs in nursing homes and eventual hospitalization with tubes coming out of every orifice.
Instead of choosing between drugs and a diet-lifestyle change, seniors are given the choiceless option of either high-cost patented drugs or low-cost generic drugs. Drug companies are attempting to keep the most expensive drugs on the shelves and to suppress access to generic drugs, in spite of stiff fines of hundreds of millions of dollars from the government.140,141
In 2001 some of the world's biggest drug companies, including Roche, were fined a record £523 million ($871 million) for conspiring to increase the price of vitamins.142
We would urge AARP, especially, to become more involved in prevention of disease and not to rely so heavily on drugs. At present, the AARP recommendations for diet and nutrition assume that seniors are getting all the nutrition they need in an average diet. At most, they suggest extra calcium and a multiple vitamin/mineral supplement.143 This is not enough, and in our next report we will show how to live a healthier life without unnecessary medical intervention.
We would like to send the same message to the Hemlock Society, which offers euthanasia options to chronically ill people, especially those in severe pain. What if some of these chronic diseases are really lifestyle diseases caused by deficiency of essential nutrients, lack of care, inappropriate medication, or lack of love? This question is extremely important to consider when you are depressed or in pain.
We must look to healing those conditions before offering up our lives.
Let's also look at the irony of under use of proper pain medication for patients that really need it. For example, in one particular study pain management was evaluated in a group of 13,625 cancer patients, aged 65 or over, living in nursing homes. Overall, almost 30 percent, or 4,003 patients, reported pain. However, more than 25 percent received absolutely no pain relief medication; 16 percent received a World Health Organization (WHO) level-one drug (mild analgesic); 32 percent a WHO level-two drug (moderate analgesic); and only 26 percent received adequate pain-relieving morphine. The authors concluded that older patients and minority patients were more likely to have their pain untreated.144
The time has come to set a standard for caring for the vulnerable among us--a standard that goes beyond making sure they are housed and fed, and not openly abused. We must stop looking the other way and we, as a society, must take responsibility for the way in which we deal with those who are unable to care for themselves.
What Remains to be Uncovered
Our ongoing research will continue to quantify the morbidity, mortality, and financial loss due to:
X-ray exposures: mammography, fluoroscopy, CT scans.
Overuse of antibiotics in all conditions.
Drugs that are carcinogenic: hormone replacement therapy (*see below), immunosuppressive drugs, prescription drugs.
Cancer chemotherapy: If it doesn't extend life, is it shortening life?70
Surgery and unnecessary surgery: Cesarean section, radical mastectomy, preventive mastectomy, radical hysterectomy, prostatectomy, cholecystectomies, cosmetic surgery, arthroscopy, etc.
Discredited medical procedures and therapies.
Unproven medical therapies.
Outpatient surgery.
Doctors themselves: when doctors go on strike, it appears the mortality rate goes down.
*Part of our ongoing research will be to quantify the mortality and morbidity caused by hormone replacement therapy (HRT) since the mid-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 million to 16 million women in the United States.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
Heart disease
... and little evidence of osteoporosis reduction or prevention of dementia. WHI researchers, who usually never give recommendations, other than demanding more studies, are advising 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 the Lancet, August 2003. Lead author, Professor Valerie Beral, director of the Cancer Research UK Epidemiology Unit, is very open about the damage HRT has caused. She said:
"We estimate that over the past decade, use of HRT by UK women aged 50 to 64 has resulted in an extra 20,000 breast cancers, oestrogen-progestagen (combination) therapy accounting for 15,000 of these."151
However, we were not able to find the statistics on breast cancer, stroke, uterine cancer, or heart disease due to HRT used by American women. The population of America is roughly six times that of the UK. Therefore, it is possible that 120,000 cases of breast cancer have been caused by HRT in the past decade.
Conclusion
When the number one killer in a society is the health care system, then that system has no excuse except to address its own urgent shortcomings. It's a failed system in need of immediate attention. What we have outlined in this paper are insupportable aspects of our contemporary medical system that need to be changed--beginning at its very foundations.
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