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Death By Medicine

Critics of “conventional” medicine delight in pointing out how much harm it causes. Carolyn Dean, Gary Null, and others have written extensively about “death by medicine.” A typical statement (from Mercola.com) says:

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 deaths shown in the following table is 783,936. It’s evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251.

To show what’s wrong with this reasoning, let’s substitute “food” for “medicine.”

Death by Food

A definitive review and close reading of medical peer-review journals and government health statistics shows that food frequently causes more harm than good. The number of unnecessary calories ingested is astronomical. The number of overweight Americans is 100 million and continues to rise. Overweight is known to cause hypertension, heart disease and early death, as well as a huge number of other health problems. It is a major factor contributing to diabetes. Attempting to control weight (treating the symptoms instead of the cause) has led to a proliferation of dangerous diets and drugs such as the recent Fen/Phen scandal and the ephedra catastrophe. Unnecessary surgical procedures (again, treating the symptoms instead of the cause) mutilate the gastrointestinal tract of these unfortunate victims of food. Concerns about food lead to anorexia nervosa and bulimia. More money is spent on food than on any other class of products; just think how much more good that money could have done if it were spent instead on valuable research into things like homeopathy, acupuncture, and therapeutic touch! Frequent automobile trips to grocery stores and restaurants cause accidents, depletion of fossil fuels, and contamination of the atmosphere. Thousands suffer from indigestion, constipation, and diarrhea. Certain foods are deadly for those with allergies. Wheat is poison for those with celiac disease. Phenylalanine in foods causes mental retardation in children with undiagnosed PKU. Food may not contain all the vitamins and minerals and trace nutrients required for good health; people who depend on diet and refuse to take supplements can be seriously harmed. If you add up all the years of life lost due to overeating, obesity, allergic reactions, contaminants and toxic chemicals in food, deficiency syndromes, botulism, food-transmitted diseases like hepatitis, salmonella and E. coli, etc. etc. you will quickly come to the conclusion that food is the leading cause of death and injury in the United States. In fact, it is the ONLY cause: no illness has ever developed without previous food ingestion.

Yes, I’m being ridiculous, but I think this points out why you can’t take the doctor-bashers seriously. We don’t give up food just because it can harm people; we don’t give up scientific medicine just because effective treatments can have side effects and because errors can occur.

Fallacies

In the first place, how can they claim medicine does more harm than good by just listing harms? That’s like saying people buy more kumquats than artichokes and just presenting numbers for kumquat sales. You can’t say that’s “more” unless you also know what the artichoke sales figures are.

Most of their numbers are wrong. They are based on extrapolations. Even when they are more or less accurate they are misleading.

Drug reactions? All effective drugs also have side effects. It’s meaningless to count the side effects without counting the benefits. An insulin reaction counts as an adverse drug reaction, but if the patient weren’t taking insulin he probably wouldn’t be alive to have a reaction. Some of the counted drug reactions are transient minor annoyances like a rash. People have iatrogenic infections in the hospital, for instance post-op infections; but without hospitalization and surgery they might have been dead instead of infected.

Iatrogenic deaths? How many of those were of people who would have died many years earlier without modern medical care? How many of those iatrogenic causes were high-risk treatments in high-risk patients who had no other option?

Unnecessary antibiotics, procedures, hospitalizations? Sure, they happen, but judgment about what is necessary is open to debate, and these numbers are ridiculously inflated. Anyway, they’re arguing about death by medicine and they don’t even try to estimate how many of those “unnecessary” treatments led to deaths.

They even list bedsores and malnutrition in nursing homes as harms of modern medicine. I wonder how the incidence of those things compares between home care by untrained family members and science-based care in a well-run institution.

Doctor-bashers use their numbers to argue that alternative medicine is safer. Maybe it is. I suppose not treating at all would be safer still. It depends on how you define “safe.” To my mind, a treatment is not very “safe” if it causes no side effects but lets you die. Most of us don’t just want “safe:” we want “effective.” What we really want to know is the risk/benefit ratio of any treatment.

The ironic thing is that all the statistics these doctor-bashers have accumulated come from the medical literature that those bashed doctors have written themselves. Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.

When errors are identified, doctors take actions to prevent them. We are constantly trying to reduce the number of medication errors, the number of unnecessary surgeries, the overuse of antibiotics, etc. It’s one thing to say that more efforts are needed. It’s something else to condemn all of modern medicine because we imperfect humans have not managed to entirely eliminate all errors.

I’ll be the first to admit that there is a great deal wrong with modern medicine, but it makes more sense to fix what is wrong than to reject the whole shebang. Alternative medicine is not a rational alternative; it’s a belief system with a very poor track record.

If the doctor-bashers want to play statistics, how about comparing death rates with modern scientific medicine to death rates with alternative medicine and death rates with no medicine at all. That might really be interesting!

I think they’ve got it backwards. The biggest cause of death is not medicine, but a failure to use medicine. The blame is shared by patients who don’t follow preventive guidelines, by doctors who don’t practice the best science-based medicine, and by all those who reject science-based medicine in favor of belief-based alternatives.

Posted in: Science and Medicine

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69 thoughts on “Death By Medicine

  1. Stu says:

    Harriet, don’t you know I patented that form of parody after the first W^5? I’ll sue!

    Anyway, this line is sooo money:

    The biggest cause of death is not medicine, but a failure to use medicine.

    I think I’ll have to steal it.

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  3. TsuDhoNimh says:

    Hmmmm … 2.9 million people were injured and 42,636 people killed in automobile accidents in 2005. About 115 people die every day in vehicle crashes in the United States — one death every 13 minutes. There were nearly 6,420,000 auto accidents in the United States in 2005. The financial cost of these crashes is more than 230 Billion dollars.

    So let’s get rid of cars until they can be 100% safe!

  4. Zetetic says:

    There’s something that the detractors always leave out – the denominator! These numbers, if they are valid, are not compared to the millions and millions and millions (sorry, Carl) of patient visits and procedures that are successful.

  5. overshoot says:

    Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.

    A point often brought up by sectarians.

    Unfortunately, very few people appreciate the “you didn’t find any errors because you never looked” aspect. If in doubt, consider how much milage the “herbal supplement” business gets from comparing the reported rates of adverse reactions to their wares vs. effective medications (not mentioning that real meds have reporting mechanisms in place and the “herbal supplement” faction has successfully fought to prevent anything similar for themselves.)

  6. Calli Arcale says:

    “An insulin reaction counts as an adverse drug reaction, but if the patient weren’t taking insulin he probably wouldn’t be alive to have a reaction.”

    It’s amazing how few of them seem to consider this — especially considering that a great many alternative remedies not only have side effects of their own, but the practitioners themselves will say that the side effects are to be expected and are somehow evidence of the “remedy” (since they carefully do not call them drugs) working.

    In conversations along these lines, I often like to bring up my grandmother’s case. Yeah, it’s an anecdote, but although it’s not something you can make scientific conclusions on, it is illustrative, and anecdotes happen to speak well to alties. My grandmother has severe asthma. Has had it most of her life. For a long time, the gold standard for asthma care was oral steroid medications. (Nowdays, side effects are much lower because of modern inhaled steroid medications, a great example of how medicine is constantly improving itself.) She has taken a LOT of Prednisone in her life. The result is that she has skin as fragile as tissue paper, bruises astonishingly easily, has liver problems, and heals so poorly that even a minor scratch can require the attention of a plastic surgeon who knows about her skin. Band-Aids are an absolute no-no; stick one on her, and she will probably need a skin graft, because her skin will come off with it. (There are a few adhesive bandages that are safe for her, but they are very hard to find. Steri-Strips work, and she keeps a supply of those on hand.)

    So modern medicine has caused her a considerable amount of harm.

    But if it hadn’t, she would be dead.

    I think that’s a fair tradeoff. Sure, it’s better if you don’t have to deal with the side-effects, but she didn’t have that option at the time, and it’s given her *decades* of happy, productive life.

  7. Calli, that is a wonderful story. Of course you are correct. While it doesn’t prove anything scientifically, it does graphically illustrate a point which makes its value very great as an educational tool for both alties and the general public.

    I would like to add it to my bag of anecdotes, the ones I use to try to educate the general public. If you want me to attribute it to you personally, please email me privately. (rjstan@together.net)

    I find that with the general public using illustrations or stories often makes them conscious of knowledge they have but are unaware of. For instance, when the mantra “Natural is safe” was used to launch the supplement industry after DSHEA, I would respond. Cobra venom is natural. I don’t drink it for breakfast. I have orange juice. That got people thinking of all the natural substances they knew were toxic.

    When people tell me about the horrors of sciedntific medicine, I, like TsuDhoNimh, bring up cars and the alternatives like horse and buggies. The latter have also been known to injure and kill people, but they were no where near as efficient as motorized vehicles.

    Wim Betz, who some of you must know, used beds. Since the vast majority of people die in bed, beds must be lethal.

  8. DLC says:

    Clearly more research is needed into why people die of food, but, at the risk of seeming to be riding my hobby horse, I must bring your attention to the incredible dangers of Dihydrogen Monoxide.
    This dangerous chemical is often used as an industrial solvent, and yet people come in contact with it daily. Thousands of deaths are attributed to DHMO annually. I believe we should ban, or at least severely restrict public access to this harmful chemical until we can make it 100% safe! (add extra !s to taste).
    Of special note here is the fact that many so-called safe homeopathic drugs are manufactured with this dangerous chemical either as an adjuvant or as a primary ingredient!
    We must call on the Government to “Green Our Homeopathy” Immediately!

  9. Mark Crislip says:

    I don’t know.

    I find the numbers compelling. I bet when the data for complications and deaths are accurately reported because of CMS rather than kept internal for medical-legal reasons, that the numbers above are reasonable ballpark approximations.

    My practice depends in part on the harm we do.

    I have 20 years of infection control and quality improvement work under by enlarging belt.

    I know my local data, I know where it goes and how it is analyzed.

    I know the the harm that is done in health care (and am very proud of the excellent job my institutions have done over the last 20 years to eradicate these complications) and continue to do because we do not routinely follow evidence based practice.
    We have known about hand hygiene for 150 years, as one example. Docs rarely, when observed, get above 50% adherence in most studies. One of many failings that directly or indirectly kill or harm people. And I can rant for hours on inappropriate antibiotic use and its complications

    That doesn’t mean that alt med isn;t a worthless crock. It is.
    Medicine is dangerous, we usually do more good than harm, but I wouldn’t be so sanguine that those numbers are off. I am all to aware of areas for improvement, and I practice in institutions whose practice, when compared to others, is among the best best in the country.

  10. Harriet Hall says:

    Statistics are tricky and are only as good as the definitions used and the extrapolation methods. I’ve read some pretty lucid critiques of the numbers doctor-bashers use, but I can’t locate them at the moment.

    The precise numbers don’t really matter. There are way too many errors; we need to do better. We CAN do better.

    The doctor-bashers want to give away the car and walk just because the carburetor is out of adjustment.

  11. Chris Noble says:

    Sometimes the very success of modern medicine can fuel this anti-medicine quackery.

    Anti-retrovirals have dramatically extended the life expectancy of people infected with HIV. A greater proportion of these die from non-HIV related causes including side effects from the drugs.

    In effect HIV deniliasts use the very success of ARVs to argue that these drugs rather than HIV cause AIDS.

  12. AntiVax says:

    “Yes, I’m being ridiculous, but I think this points out why you can’t take the doctor-bashers seriously. We don’t give up food just because it can harm people; we don’t give up scientific medicine just because effective treatments can have side effects and because errors can occur.”

    Its allopath bashing actually. The cancer conspiracy is a good place to start http://whale.to/a/cancer_c.html

    and the 10 million or so addicted to benzos is another one, all completely unecessay, and millions of kids now on ritalin which is a fancy name for cocaine.

    “In effect HIV deniliasts use the very success of ARVs to argue that these drugs rather than HIV cause AIDS.”

    One word–AZT http://whale.to/a/azt_h.html

  13. David Gorski says:

    Please note that “AntiVax” is in reality John Scudamore, the creator and maintainer of one of the largest repositories of pseudoscience, quackery, and conspiracy theories on the entire Internet, namely the Whale.to site. Peruse it for yourself and see what I mean.

    Whale.to has it all, HIV/AIDS denialism, rabid antivaccinationism, claims for alternative cancer “cures,” New World Order conspiracy-mongering, and more. Here’s a small taste:

    1. Cloudbusters and black lines
    2. 6 TBs in a circle (Healing Black lines)
    3. Ghostly resident in Crieff shop
    4. Noxious earth energies and their influence on human beings
    5. Mind control hardware (Did you know that CPR equipment is part of the plot?)
    6. The vaccination hoax and Holocaust
    7. Genocide via vaccination
    8. Holy Hand Grenade (not of Antioch, I hasten to add).
    9. Crystal & water charging
    10. Cell phone/GSM/PCS (aka DEATH TOWERS), TETRA, HAARP, GWEN, & Power lines
    11. Asian tsunami was nuke
    12. Medical (Allopathic) Mind Control
    13. Mammography Hoax
    14. Atheism, Forbidden Archeology & The Darwinian Evolution Hoax

    Readers should be able to judge for themselves.

  14. Harriet Hall says:

    Antivax has provided a helpful example of exactly the kind of critiques of medicine that my article addresses.

    I urge anyone who has the time to examine some of the claims on his website and look for the logical fallacies and the missing evidence for the opposite viewpoints.

  15. AntiVax says:

    Nice distraction Gorski with ad hominem, no surprise there.

    The vaccine hoax, any 12 year old schoolkid could take that apart just with the statistics http://whale.to/a/smallpox_stats_h.htm

    “I urge anyone who has the time to examine some of the claims on his website and look for the logical fallacies and the missing evidence for the opposite viewpoints.”

    Please do but I can’t see any of you Pharma folk having the nerve to spend any time there except to collect ad hominem material as per Gorski above.

    I know all about the Allopathic viewpoint, I believed it for 35 years and you can get it 24/7 from the media and health dept. Here it is: http://whale.to/a/allopathy_h.html

  16. weing says:

    Antivax,
    Since you know so much, why not start your own Anti-Med school and hospital? You won’t need all the diagnostic and lab equipment. You won’t need ORs or drugs. You can make your own homeopathic drugs from distilled water and give them all Vitamin C. How much can it cost? You could advertise that you can cure hepatitis, etc. Let’s see how long you will last?

  17. vinny says:

    What motivates Antivax to write on this blog? Does he really have issues with doctors talking about unfounded claims and unscientific investigations? Maybe he is desperately trying to prove to himself, that his devotion to quackery is not as insane as he thinks. I had a patient with a simillar mindset who refused to treat her breast cancer. She was brought into the hospital because relatives found her sitting in a filthy apartment no longer being able to rise from bed. The stench was horrendous as the tumor mass had grown through her skin and part of it was necrotic and infected. Puss covered her clothing and the bed. After being brought into the hospital she refused examination, refused treatment, and insisted on only talking to a nutritionist about various supplementations. It was impossible to help her due to this insane behavior. Antivax, what motivates you?

  18. David Gorski says:

    Vinny,

    Your patient is not the only one. Here is an example of similar story:

    http://www.ariplex.com/ama/amamiche.htm

    I also have a patient that I heard about from my colleagues about whom I was thinking of posting sometime in the future. Her case was presented at a tumor board I attended, and it was, sadly, very memorable.

  19. Harriet Hall says:

    There’s a new website, What’s the Harm, that is collecting stories like these, not just about medicine but about the harm from irrational thinking in every area: http://www.whatstheharm.net/index.html

  20. For more information about the German cancer quack Ryke Geerd Hamer, go here: http://www.ariplex.com/nmwiki/index.php?title=Ryke_Geerd_Hamer_%28english%29
    If you would like to know how to contact Germans who have investigated Hamer, contact me privately, rjstan@together.net
    The victim Dr. Gorski linked to above http://www.ariplex.com/ama/amamiche.htm
    is one of many. I know of one “clinic” in the US that “practices” Hamer’s “New German Medicine” and one very vocal Canadian advocate.

  21. Pete07 says:

    You are undoubtedly correct that there will always be adverse events in medical care and that good outcomes outnumber bad ones. The issue, however, is not how many such events there are, but how many are preventable. From what I’ve read, a substantial proportion of them are preventable.

  22. Harriet Hall says:

    Pete07,

    I agree absolutely! We need to do everything within our power to prevent the preventable. We are trying, but we need to try ever harder.

    And that’s the real irony. The people who are criticizing scientific medicine for its errors are promoting a system that isn’t trying to correct its errors.

  23. nwtk2007 says:

    Harriet Hall – “And that’s the real irony. The people who are criticizing scientific medicine for its errors are promoting a system that isn’t trying to correct its errors.”

    Not true. I don’t know of a single chiropractor who would not support an informed consent about the risk of spinal manipulation.

    I see here all the familiar arguments defending medical related deaths and at least a smattering of the need to eliminate or try to reduce mistakes that take 500 lives per day. That is at least a start although still a little glossed over.

    I liked the analogies of water (dihydrogen monoxide) and the automobile industry as well as the story of the asthmatic grandmother and food. Defense of medical deaths due to errors and mistakes sounds just like defense of chiropractic. The big difference is that many here see chiropractic as quackery, which it is not, and the sheer numbers harmed by one group versus another.

    Thats really all. I don’t think the visionaries who see quackery in everything non-medical will ever be convinced and I don’t think the 500 or so deaths that occur everyday due to mistakes (not risks or side effects or clinically difficult cases, etc.) will be reduced either.

    And just one more thing, I haven’t ever been warned of the risk of these errors happening when I have gone into any doctors office. Ever. I also don’t think the general public is aware of the magnitude of this either and they are not being educated about it either. As I said, not one single warning about mistakes and errors killing 500 people per day in the US alone from any medical provider.

  24. Blue Wode says:

    nwtk2007 said: “I don’t know of a single chiropractor who would not support an informed consent about the risk of spinal manipulation.”

    Perhaps you don’t know many chiropractors…

    Quote:

    “Consent: its practices and implications in United Kingdom and United States chiropractic practice

    Results from this survey suggest a patient’s autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk.”

    http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    Quote:

    “Consent or submission? The practice of consent within UK chiropractic

    Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.”

    http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15726031

  25. weing says:

    nwtk2007,
    Please clarify. Are you saying patients are killed by medical errors and MDs are doing nothing to prevent errors? And are you saying informed consent should include a statement saying that the MD can make a mistake? Wouldn’t it make a lawsuit impossible if the patient agreed to the possibility of negligence?

  26. Harriet Hall says:

    nwtk 2007,

    “defending medical related deaths” ???
    If you thought I was defending deaths, you need to read my article again.

    “I don’t know of a single chiropractor who would not support an informed consent about the risk of spinal manipulation.”

    Maybe you lead a charmed life. Apart from the issue of informed consent, how many chiropractors do you know who are actively trying to eliminate quackery from chiropractic? What chiropractic organization has spoken out against applied kinesiology, maintenance adjustments, full spine x-rays, discouraging vaccinations, etc. etc.

  27. Joe says:

    Harriet asked “What chiropractic organization has spoken out … maintenance adjustments, …?”

    I am sure you know this; but for the general reader-
    http://www.worldchiropracticalliance.org/positions/asymptomatic.htm
    “It is the position of the World Chiropractic Alliance that chiropractic care to detect and correct vertebral subluxations offers benefits for all people, including those who do not demonstrate symptoms of a disease or health condition. Therefore, the presence of symptoms and/or a medical diagnosis should not be a factor in determining the need for or appropriateness of chiropractic adjustments, nor should the presence of symptoms be required by any chiropractic board, insurance company or court of law to justify the rendering of chiropractic care to any patient.” [bold in the original]

    The WCA is still promoting maintenance adjustments (I checked the site today). This group was tapped to develop standards for the WHO!? That further erodes sources of good information on health care.

  28. nwtk2007 says:

    Previously on Death by Medicine – “Please clarify. Are you saying patients are killed by medical errors and MDs are doing nothing to prevent errors? And are you saying informed consent should include a statement saying that the MD can make a mistake? Wouldn’t it make a lawsuit impossible if the patient agreed to the possibility of negligence?”

    Response to question 1 – At the rate of 500 deaths per day, I would say they are doing little to prevent errors and mistakes. So, I give that one a prequalified yes and yes. Patients are being killed by medical errors and MD’s are doing little to prevent it.

    Response to question 2 – Yes and no. No they don’t have to say there is a good chance of the MD making a mistake that might harm the patient, but yes, they should tell their patients that there are many deaths (500 per day) associated with medical mistakes and that they (the patient) should be very allert to this fact.

    Response to question 3 – I don’t think so. It is merely a warning to the patient that medical mistakes occur (at an alarming rate I might add). Ultimately, I would think that no matter what a patient might agree to on paper, if the patient is harmed by the provider, then there would exist a cause of action by the harmed patient against the provider. I am not an attorney but the question of malpractice is harm to the patient. (Mistakes don’t result in malpractice, only harm to the patient.) Just as I don’t think an informed consent insolates a chiropractor from malpractice and litigation as well.

  29. weing says:

    I beg to differ. Malpractice requires deviation from the standard of care and this deviation results in harm to the patient. No matter how you feel about it, making a mistake is not the standard of care. I think a defense attorney would have a field day if the physician had an informed consent that included the risks and benefits of the procedure and the risk of negligence that the patient is willing to accept. Is that why the chiropractors would want an informed consent like that? Or is this your own idea.

    I also disagree that physicians are not trying to decrease the number of errors they make. We are actively trying to determine the causes of errors and find ways to prevent them. This is not a simple process by any means.

  30. weing says:

    BTW,
    The chiropractor will not be protected from litigation, as anyone can sue. He will be protected from successful litigation.

  31. Harriet Hall says:

    nwtk2007,

    Your comment that “At the rate of 500 deaths per day, I would say they are doing little to prevent errors and mistakes.” is illogical and ignorant.

    Stating a number of deaths tells us nothing about what efforts are being made to prevent them. That’s like listing the number of traffic deaths and assuming no one has tried to make cars safer. Just as there are seat belts and airbags and crash tests in the automotive industry, there are constant efforts to reduce medical errors. I read articles about that in the medical literature all the time. I used to chair committees for Risk Management and Quality Assurance. We have Infection Control committees, chart reviews, incident reports, Morbidity and Mortality conferences. The list goes on… Even if you don’t believe doctors are sincere about avoiding errors for the sake of their patients, you ought to at least accept that they want to protect themselves from malpractice lawsuits.

    Informed consent? I used to threaten to put a sign up in my office: “Visiting a doctor may be hazardous to your health.” But I was in the Air Force, and they would not have approved. :-)

  32. nwtk2007 says:

    “Is that why the chiropractors would want an informed consent like that? Or is this your own idea.”

    This question makes no sense if I am right about not being shielded from malpractice. But I could be wrong. I am not an attorney. And l do support the use of informed consent in chiro’s offices so patient’s can know that treatment procedures carry very real risks.

    I was told however, by an attorney who does malpractice litigation for injured patients, that any informed consent is the very first thing addressed and the very first thing that is removed as evidence which might be used to protect the provider.

    As I have never been in that situation, this is then 2nd hand info for me.

  33. weing says:

    It would be the first thing removed as evidence because if an adverse outcome occurred, even without negligence, but is not mentioned, then the physician loses. No informed consent lists physician negligence as an adverse outcome.

  34. Excellent critique of the article Harriet. The real issue in healthcare is not whether avoidable accidents happen in hospitals but what is being done to engage in continuous quality improvement. Only science based medicine is self correcting in that way.

    In reviewing medicine’s “mistakes” they must be put in the context of what successes are evident as well. Clearly healthcare saves more lives than it takes by accident. Its not the number of incidents but the trend over time that is useful.

  35. Debbie-IQS says:

    Yes…you can substitute the word “food” for “medicine” all you want to, but you are forgetting one thing about Allopathic Medicine and those that make their money off the “treatment of disease”. The food…that the Allopathic Doctors do not refute…but, allow to be perpetuated is exactly what is harming us. Most MD’s do not get it…education (beginning with them) is necessary for change to happen. Or we can just wait for the uneducated people to literally die off…which WILL happen, given time. Our health care system as we now know and understand it cannot support what is coming down the pike.

    http://www.huffingtonpost.com/2008/11/11/fat-kids-have-the-arterie_n_143115.html “FAT KIDS HAVE THE ARTERIES OF 45-YEAR-OLDS, STUDY SHOWS”…November 11, 2008

    Only those who know and understand how to eliminate “white-trash food” from their diets will be left standing.
    It all started back in the 1960’s with processed foods. It’s been downhill ever since and 99.9999% of the time an Allopathic doctor will NEVER address nutrition with you before he prescribes pills…and I’m speaking from personal experience here. I’ve never personally ran across an MD who has ever looked at my diet when I’ve had a problem. But they have been quick to recommend a drug!! …I’ve had to literally remove my files from the office of my Allopathic doctor and educate myself on my own situation and the situation of my son. So, I AM speaking from experience with these people. Heck, just a month ago, my Mom had her thyroid removed and the doctor prescribed “TUMS” as the Calcium supplement she should be taking. I about flipped my lid!! They are clueless about nutrition!!!!! Thank God I was there to tell her not to listen to him. I was able to give her the correct information about calcium.

    Allopathic Medicine sees nothing wrong with peddling junk food to the masses…I see this when I take my kid to urgent care for injuries. Right there in the waiting room I see vending machines with Coke and Candy. Which is a known fact in Alternative/ Nutritional Medical Communities to suppress the immune system…not to mention so many other negative effects which are not understood by Conventional Medicine…such as how deadly Candida is to your health. Candida is fed by…GUESS WHAT??? SUGAR!!!…yet, there they are, those stupid vending machines!!

    http://www.naturalnews.com/024077.html
    “What the Drug Companies Really Want”

    The Allopathic World does not realize how sugar damages health…or they would not let this happen. But, they are driven by money and so there the vending machines sit.

    I guarantee, if you walked into a Naturopath’s office, you would not see junk food being peddled. It sets a bad example.

    And if you want to talk about food…look at the food pyramid, which is sanctioned by our Allopathic Gods of Medicine and the FDA. What a joke! The FDA is NO friend of yours if you want to maintain your health. They have pushed carbohydrates as the main source of calories for decades with their “Low Fat” recommendations. All the while people got fatter and fatter…”We are the Government and we’re here to help you”. What they fail to understand is that we need fats…just the right kind of fats. Not the junk “trans-fats” in all that junk food in the vending machines found in their office lobbies!!! I can tell you that in the Alternative World…the food pyramid looks entirely different.

    American’s are getting more educated on food and nutrition (leaving the doctors in the dust)…Jason’s Deli here in Phoenix is eliminating High Fructose Corn Syrup from its food and the people are ecstatic about it!!
    See their web-site: http://www.jasonsdeli.com/

    But, just this past September 2008, the corn industry got their underwear in a bunch because they are losing ground to an educated population and so they revamped a mass attempt to further “brainwash” us and they put some new commercials on the television: see them here:

    http://www.youtube.com/watch?v=EEbRxTOyGf0&feature=PlayList&p=62B534099931F869&playnext=1&index=2 HFCS Ad #1

    http://www.youtube.com/watch?v=KVsgXPt564Q&feature=PlayList&p=567403B25557696D&playnext=1&index=30 HFCS Ad #2

    Change is happening…but, it’s like eating an elephant…one bite at a time. I’m been tapping the pulse of this subject for about 12 years now and I’ve seen some pretty significant changes. The future of medicine is not our current sick care system of covering disease with a drug, it is true preventative medicine. Allopathic medicine is great for acute medical emergencies and yes, we need antibiotics sometimes. But, the chronic health issues of our day cannot be suppressed and covered up by a drug.

    The next thing to consider is helping the Allopathic Medical Community get a clear picture of exactly what that is. Right now, they think all preventative medicine is…is “vaccinations, cancer screenings and blood-pressure checks”, Ref. Time Magazine, December 2008 issue, “America’s Health Checkup”, pgs. 41-51. While those are very important and necessary, they are NOT PREVENTATIVE…THEY ARE DIAGNOSITC. If true PREVENTATIVE medicine is to be employed, insurance coverage will be granted for true nutritional counsel.

    “My people are DESTROYED for LACK of KNOWLEDGE…”
    Hosea 4:6

    Debbie, BS Cellular Biology/Physiology

  36. David Gorski says:

    Debbie:

    Two hints:

    1. Citing Mike Adams’ NaturalNews.com for any health- or science-related issue is akin to Scopie’s Law and Whale.to. So utterly unscientific and full of pseudoscientific and antiscientific misinformation are both Whale.to and NaturalNews.com that:

    In any discussion involving science or medicine, citing Whale.to as a credible source loses you the argument immediately …and gets you laughed out of the room.

    Personally, I’d add the Mike Adams corollary to Scopie’s Law and add:

    The same applies to citing NaturalNews.com as a credible source of health- or science-related information.

    2. The whole dichotomy between “allopathy” and “naturopathy” or “alternative medicine” is a false one and reveals you to be clueless about what scientific medicine actually involves. Nor does it demonstrate that your favored “alternative” medicine does any better of a job at preventative medicine. And vaccinations, cancer screenings and blood pressure checks are preventative in the sense that they monitor health and allow intervention early. Indeed, vaccinations are the very essence of preventative medicine in that they prevent infectious diseases in the population. No other medical intervention has saved more lives and prevented more disease than vaccination.

  37. Fifi says:

    “The food…that the Allopathic Doctors do not refute…but, allow to be perpetuated is exactly what is harming us.”

    This is just silly – doctors don’t control the food industry or the massive corporations that are the food industry. Nor do they control the advertising industry or the goverment that regulates food. Nor do they control what individuals eat (nor should they). If anyone is busy selling lies about nutrition and food for profit, it’s the SCAM industry that bases their whole sales pitch on denigrating food and promoting supplements based on pseudoscience.

  38. pmoran says:

    Debbie, you are a little off the pace aren’t you? “Candida” was the “alternative” illness-du-jour a few years back. Is your naturopath keeping up with the times?

  39. khan says:

    I always wonder what ‘food’ or ‘supplement’ or ‘energy medicine’ that ‘naturopaths’ would have recommended when I had septicemia (red line running up the vein) from a cat bite.

  40. Jurjen S. says:

    Quoth nwtk2007 (back in July): “I haven’t ever been warned of the risk of these errors happening when I have gone into any doctors office. Ever.”

    I have psoriasis, and have have darkened the doorway of my dermatologist’s office many a time over the past four years. Every single time my dermatologist or his PA-C has suggested a procedure or course of treatment (corticosteroids, UV treatment, a biopsy on my toe), they have have made sure to warn me in detail of the potential adverse side-effects of said interventions, and to give me the option to back out.

    Have they advised me that X number of iatrogenic deaths occur in the US every day, month, year, whatever? Well, no. But there’s really no reason they should, because all those people died as a result of different procedures than the ones I was undergoing. Ergo, the numbers were irrelevant to my situation. Why should it matter to me, as a patient, how many people die from errors in administering a general anaesthetic when the procedure I’m about to undergo requires no anaesthetic (general or otherwise) at all? Why should it matter to me how may people die from surgery-related complications when I’m not undergoing surgery? Why should a travel agent be required to warn you of crime, wars and diseases that may harm tourists in developing countries in Africa and Asia when you’re going to Whistler, BC for a week?

  41. HCN says:

    Jurgen, funny you should mention Whistler, BC. It has avalanches:
    http://www.vancouversun.com/Sports/RCMP+press+release+Whistler+avalanche+deaths/1132616/story.html

    oh, and in mid-December a ski gondola broke, injuring several people:
    http://www.canada.com/topics/news/story.html?id=1089039

  42. HCN says:

    oops, I did not spell you name right! Sorry, Jurjen!

  43. Jurjen S. says:

    Don’t sweat it, HCN; it’s an unusual spelling.

    I named Whistler as a resort that happens to be popular where I live (greater Seattle), but the mishaps you mention actually serve to illustrate my point. What’s the point of your travel agent warning you about kidnappings in Sri Lanka, ebola in sub-Saharan Africa, pollution in Mexico City, etc. instead of warning you about risks that actually affect you, namely avalanches and malfunctioning cable cars?

    Similarly, what’s the point of your dermatologist warning you about the risks of general anaesthetic and surgery when what matters to you is that the biopsy she’s about to perform on your toe may affect nail growth (to give a real-life example of a warning I’ve been given)?

  44. freetorun says:

    I going to jump in here and post, even though I realize that you all are probably going to rip me to shreds…and that is partly what is wrong with our whole medical system…You all will debunk any evidence you personally don’t agree with because it threatens your current dogma (and ego)…

    “Common” people like me are being totally disillusioned with the whole medical system because of the same attitude that I see on here…the pride, egotism and the refusal to consider (and the harsh rhetoric applied to)alternative methods that “common” people like me have benefited from.

    Personally, I have experienced our health problems deteriorating due to what conventional doctors have prescribed, and improving drastically with alternative methods…so when you all knock the alternative methods it just makes me feel that you are arrogant and close-minded.

  45. Harriet Hall says:

    freetorun,

    You have offered opinion but no evidence. Do you understand that the scientific method is the only practical way to determine whether a treatment is effective or non-effective? If not, you have nothing to contribute to this discussion. This is a science-based medicine blog.

    If you have any evidence (other than testimonial) that some method of alternative medicine is more effective than placebo, we would be happy to look at it. We don’t knock methods because they are alternative, but only because they are not supported by good evidence.

    Science has no dogma; it follows the evidence wherever it leads. We would even accept the Tooth Fairy if the evidence was overwhelmingly robust. I can’t begin to count the changes in medical practice just during my professional lifetime. We have demonstrated that we are willing to give up time-honored, apparently effective practices as soon as evidence shows they don’t work.

  46. thissiteisajoke says:

    Harriet, the scientific method used in allopathic medicine might be adequate, but is utterly irrelevant in many cases. Consider the cancer industry. It considers a patient “cured” (well in fact it does not, the patient is actually considered “in remission”) from cancer when his tumor/s have been removed. So in allopathic terms, you are basically “cured” from cancer when your tumors are gone. This is where the problem starts. Allopathic doctors use the scientific method to find effective treatments for the cure, defined as the elimination of the tumors. This is a very important logical fallacy.

    They believe that the cure is to get rid of the lumps, when in fact the lumps are mere symptoms of the cancer. The tumors are manifestations of your immune system’s inaptness to eliminate cancerous cells in time for a tumor never to emerge. There is much evidence on this.

    The scientific method in allopathic medicine is used FOR THE WRONG REASONS. It is used to find a treatment for mere symptoms or manifestations of the disease, but never for the true cause of the disease.

  47. Harriet Hall says:

    We’ve discussed this before. The failure of immune surveillance contributes to cancer in some cases, but that is only a small part of the story. You need to learn more about the complexities and the realities of oncology.

    You can criticize conventional treatment of cancer all you want, but there is no evidence that any other methods get better results.

    You are repeating the thoroughly debunked myth that scientific medicine treats the symptoms rather than the cause of disease. If you believe that, you are out of contact with reality.

  48. pmoran says:

    “Harriet, the scientific method used in allopathic medicine might be adequate, but is utterly irrelevant in many cases. Consider the cancer industry. It considers a patient “cured” (well in fact it does not, the patient is actually considered “in remission”) from cancer when his tumor/s have been removed. So in allopathic terms, you are basically “cured” from cancer when your tumors are gone. ”

    No, journalists commonly, and doctors occasionally use the word “cure” loosely, but cure means being cancer-free long-term, whereas remission can be partial and involve a period of no more than a few months.

    Also defining cancer as a disease of the immune system, just one of the many factors that can be permissive of cancer development (rarely even the main cause), is just plain silly. It is like worrying about the quarantine lapses while a nigh-on invincible alien is already loose within the space ship.

    It ignores the fact that there is a whole other set of known factors that can favor the production of mutant cancer cells, before the immune system even has an opportunity to react. Gene monitoring and repair mechanisms, and apoptosis activation are probably more important, immediate defenses against cancer than antigen-activated immune responses..

  49. thissiteisajoke says:

    The reason for there not being evidence of alternative treatments to any disease is because there is a monopoly on the testing and legalization of these treatments. No competition is allowed to test medications or treatments. There are serious conflicts of interest that arise from this reality. Science-based medicine is irrelevant if it is regulated and authorized by one monopolistic body such as the FDA.

  50. Harriet Hall says:

    thissiteisajoke? No, yourcommentsareajoke.

    Monopoly on testing? What about the NCCAM and all the other published studies on alternative treatments? There is obviously no monopoly preventing testing of alternative treatments. Surely you don’t think the FDA has any control over what is tested or who does the testing. The FDA can only approve things after they have been tested – it has no other power to “regulate” or “authorize” science-based medicine. No competition is allowed? Of course it is: drug companies are in competition with each other.

  51. David Gorski says:

    And let’s not forget that drug companies are increasingly getting in on these “natural cures” and supplements. They know a good profit opportunity when they see one. After all, supplements are cheap to manufacture, highly profitable, and, thanks to the DSHEA of 1994, don’t even have to be tested for efficacy. No need to invest hundreds of millions of dollars to bring a product to market there!

  52. Fifi says:

    “drug companies are in competition with each other.”

    No offense Dr Hall but that can be more in theory than practice, price fixing is not unknown (ironically enough, a big case in the EU about six years ago was over the price fixing of vitamins).

    http://www.guardian.co.uk/money/2001/nov/21/personalfinancenews.europeanunion

    Big Pharma is not a noble corporate entity or particularly ethical and, in the US, drugs are more expensive than elsewhere (which indicates just how well “competition” works in the patient’s favor).

    Drug companies may use science to produce their product and employ scientists but they’re hardly considered to be ethical or responsible in the way academic scientists are. All the researchers I know see a very distinct difference between working in academia or working for Big Pharma and are willing to work for less in academia because of the difference. This doesn’t mean pharmaceuticals aren’t useful, it just means that the people who make them are business people first and foremost.

  53. Fifi says:

    “Alternative” drug companies who make “natural” drugs, and vitamins and herbal supplements, are even less ethical than Big Pharma because they’re much less regulated so can get away with more. The idea that “competition” keeps corporations in line or behaving ethically is absurd, this doesn’t just apply to Big Pharma or Big SCAM.

  54. Harriet Hall says:

    Fifi,

    First, I was responding to the allegation that competition “is not alllowed.” It most certainly is.
    Second, the example you gave of price fixing is an example of competition: competitors occasionally cooperate for mutual benefit.
    Third, you are changing the subject by raising other issues (ethics and pricing) that are valid but that say nothing about the relevance of the scientific method to the testing and authorization of new treatments.

  55. qetzal says:

    Harriett Hall wrote to thissiteisajoke:

    Surely you don’t think the FDA has any control over what is tested or who does the testing. The FDA can only approve things after they have been tested – it has no other power to “regulate” or “authorize” science-based medicine.

    Without meaning to endorse thissiteisajoke’s conspiracy theories, FDA has quite substantial power over what is tested and who does the testing.

    It is illegal in the US to test investigational new drugs in humans unless one first submits an Investigational New Drug Application (IND) to the FDA. If FDA determines that your plans pose an unacceptable safety risk to human subjects, they can indeed prevent you from conducting the test.

    Of course, this only applies to investigational new drugs. If someone wants to test whether oral echinacea capsules or megavitamin regimens or coffee enemas cure cancer, I don’t think FDA has any say (though IRBs might object). OTOH, if someone wanted to test IV injection of echinacea extract, that would be a new drug and would require an IND.

  56. Joe says:

    @Fifi,

    Sales of existing drugs aside, drug companies are in fierce competition to produce the next blockbuster drug. Your argument about sales may be valid; but the big picture is otherwise.

    You also seem to imply that drug company salaries are higher because they are buying the ethics of the scientists (academic scientists work for less in order to have ethical freedom). No. An organic chemist going to work for a pharmaceutical co. may be handed a list of 40 compounds (suggested by someone else) that they are expected to synthesize in their first year. In other words, imagination, not ethics, is squelched.

    @qetzal, you wrote “… FDA has quite substantial power over what is tested and who does the testing.” I may be wrong; but I think that is only true for applications to the FDA. It seems you acknowledge as much in your last paragraph. I don’t see how an IV product is different.

  57. pmoran says:

    No one is asking elaborate controlled studies of those pretending to have cancer cures. Cancer is an objective and mostly predictable state that can be easily demonstrated and quantified with present technology. There is no difficulty confronting alternative cancer “cures” that cannot be overcome by the regular production of well-documented, cured (or even remitted) patients.

    None of them can do this, even when directly challenged, as they have been by the existence of the OAM/NCCAM and their call for “best cases” over the past decade.

    They rely upon low quality, low detail cases wherein there is usually no clear knowledge as to the state of the cancer at crucial times. Or, the cases are too short term to have any meaning at all.

    For more detail as to what I mean see –

    http://www.users.on.net/~pmoran/cancer/Brenneranecdote.htm

    and –

    http://www.users.on.net/~pmoran/cancer/how_to_read_a_testimonial.htm

  58. qetzal says:

    @Joe,

    Echinacea capsules for oral admin are considered supplements and covered under DSHEA. Oral ingestion is required to be considered a supplement (see here).

    If you reformulate echinacea extract for IV injection to treat cancer, it’s no longer a supplement. It’s now a drug within the meaning of the law, and any clinical testing becomes subject to FDA’s IND requirements.

  59. Joe says:

    @qetzal,

    I agree, that IV products do not come under DSHEA; but I doubt clinical studies of such must be FDA approved. IV EDTA (for heart disease) was studied, clinically, without FDA approval. Clinical, intercessory prayer was studied without FDA approval. The Gonzalez anti-cancer protocol did not have FDA approval.

    It continues to be my understanding that the FDA only weighs-in if one applies for official recognition of a drug.

  60. qetzal says:

    Joe,

    EDTA (in different forms) has been an approved drug for decades, for use in treating hypercalcinemia and heavy metal poisoning. As such, it is not a new drug. Clinical studies where an approved drug is tested for a new indication don’t require an IND. However, if a sponsor wants FDA approval to market the existing drug for a new indication, then they would need an IND. That’s probably the situation you’re thinking of.

    Intercessory prayer is not a drug, nor is the Gonzalez protocol. The latter involves diet, vitamins, supplements, and coffee enemas. Since these are not legally new drugs, no IND is required to test them.

    IV echinacea extract would be a new drug. It’s not taken by ingestion, so it’s not a supplement, and it’s not already approved in the US for any indication. Anyone wishing to test IV echinacea extract in a clinical study would legally have to submit an IND to FDA in advance, and FDA would have 30 days to put a hold on the study. If a study is put on hold, the study may not proceed until FDA’s concerns have been addressed to their satisfaction.

    See here for the statutory language on the requirment for an IND.

    To my knowledge, the only caveat to this revolves around interstate commerce. I have heard it argued that in reality, if you want to test a new drug without an IND, FDA can only prevent you from shipping the drug across state lines. Some of the language in the regulations seems to support this. Other parts seem more absolute that an IND is always required.

    There was a fairly well known case of Dr. Burzynski a while back. He was treating patients with “antineoplastons” without an IND. FDA tried to shut him down. He and his lawyers argued he didn’t need an IND because he made the antineoplastons himself, and did all the treatments in his own clinic. Since there was no shipment of a new drug across state lines, he argued FDA had no jurisdiction. FDA fought him aggressively in court. I don’t know if there was ever a clear ruling about whether FDA truly had jurisdiction. (Apparently, what constitutes interstate commerce can be almost anything the gov’t wants it to be.) I do recall there was ultimately some kind of settlement in which Burzynski agreed he would submit and IND before continuing his clinical testing.

  61. Joe says:

    @qetzal,

    Perhaps I chose poor examples. However, Atwood et al>/i> have observed that the chelation study does not meet FDA standards http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18596934 That makes it hard to argue that the FDA controls (and stifles) clinical studies.

    Moreover, “supplements” are not allowed to make medical claims (and there is a “wink, wink, nudge, nudge, say no more” character to that). Trials of echinacea to prevent or treat colds, and of saw palmetto to treat benign prostatic hyperplasia (failed) funded by NCCAM fly in the face of the “supplement” exclusion that you claim.

    My understanding remains that if you want to market an FDA-approved drug, they control what you do. But, you are free to “study” and promote snake oil with impunity. (There are high hurdles to FDA action on snake oil, see “Natural Causes” by Dan Hurley (Broadway Books, 2006)).

    Do you still think the FDA prevents clinical studies of quackery?

  62. qetzal says:

    I apologize for being unclear. I do not think FDA does much if anything to prevent clinical studies of quackery. Many types of quackery don’t fall under FDA’s jurisdiction at all. That includes quack uses of approved drugs, quack uses of legal supplements (as long as they’re still taken orally), and quack uses of stuff like reiki or prayer or other nonmaterial intervention.

    My point was only to correct Dr. Hall’s statement that FDA has no control of what gets tested. FDA does control testing of things that meet the legal definition of new drugs.

    The chelation trial was testing sodium edetate (aka disodium EDTA). That’s an approved drug. Therefore, it’s not a new drug even though it was being tested for an unapproved indication. AFAIK, FDA has no jurisdiction in that case. An IND is not required, unless the sponsors are working towards FDA approval of EDTA for CAD.

    Legally, it’s no different from taking some chemotherapy that’s approved for say, lung cancer, and testing against colon cancer. If the drug company is doing the testing and they want to put colon cancer on the drug label, they’ll need to submit to FDA. If a group of oncologists is doing the testing, and they just want to know if that’s a good off-label use for the drug, no IND is required. All of that is true only because the drug has already been approved for at least one other indication in the US.

    Re snake oil: people are free to promote snake oil as long as it meets the legal definition of a supplement, and as long as they don’t claim it treats illness. In that case, FDA can only stop them if FDA can show that their snake oil is dangerous.

    The bottom line is that FDA has little opportunity to stop clinical trials of quackery, simply because most quackery deliberately uses ‘interventions’ that are outside the legal definition of a new drug. IF someone wanted to test quacker that did meet the definition of a new drug (as in my example of IV echinacea extract), they would need FDA’s buy in. Even then, as long as they performed the proper safety testing, had proper manufacturing controls, and showed the likely risk to human subjects was low, FDA would probably let them go ahead. IIRC, FDA is not supposed to block an IND for the sole reason that FDA doesn’t think the treatment will work. However, if they did want to block an IND, they could certainly do so, just by nit-picking the safety testing and manufacturing controls.

    FWIW, I’ve personally been involved with clinical testing of about 10 investigational new drugs, so I have a fair familiarity of the regs.

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