by Carolyn Dean, M.D., N.D.
“Death by Medicine” is a paper on medical iatrogenesis—44 pages in length. The definition of iatrogenic is “a
symptom or illness brought on unintentionally by something that a doctor does or says.” Much like conventional
medicine itself, my dictionary is in denial about iatrogenic deaths. Iatrogenesis is not just about symptoms or
illness—incredibly, I found that in the U.S. there are 783,936 deaths annually due to medicine’s effects.
I wrote “Death by Medicine” in late fall 2003 while my
mother was dying of acute leukemia. She was 82 and sharp as
a tack and lively to boot, just a few months before she was
diagnosed. It’s a rare disease in the elderly but while I was
reading hundreds of studies on drug side effects, I was confronted
with the fact that the two medications she was
taking—one for high blood pressure and one for cholesterol—were both found to cause acute leukemia.
In 1998 a Canadian team of researchers, led by a friend, Dr.
Bruce Pomeranz, found that 106,000 people die annually in the
U.S. from properly prescribed medications. No “mistakes” were
made here—these drugs were the right amounts, given to the
right people, at the right time—and still ended up killing 106,000.
In “Death by Medicine” I went beyond “adverse drug reactions,”
adding up the death toll for medical errors, surgical
errors, outpatient adverse drug reactions, drug-resistant hospital
infections, unnecessary medical and surgical procedures,
malnutrition and bedsores in hospitals and nursing homes.
The statistics that I did not add include deaths due to:
- X-ray exposures: mammography, fluoroscopy, CT scans
- Overuse of antibiotics in all conditions
- Drugs that are carcinogenic: hormone replacement therapy, immunosuppressive drugs and prescription drugs
- Cancer chemotherapy
- Unnecessary surgery: Caesarean section, radical mastectomy, preventive mastectomy, radical hysterectomy, prostatectomy, cholecystectomies, cosmetic surgery, arthroscopy, etc.
- Medical procedures and therapies
- Discredited, unnecessary and unproven medical procedures and therapies
- Missed diagnoses.
Another important area not included in “Death by Medicine”
are deaths due to “something a doctor says.” Because I am a
naturopath as well as a medical doctor, I realize that many
deaths are caused by doctors giving their patients bad advice.
Every patient I have ever seen has told me s/he was given some
combination of the following advice by a “trusted” doctor:
- Vitamins are not necessary and you get all you need from your diet
- Chinese medicine won’t help you
- Acupuncture is worthless
- Don’t waste your money on vitamins
- It’s perfectly OK to eat sugar, aspartame, fast food, coffee
- Doctors who tell you to take high doses of vitamin C are quacks.
By not keeping up with the current knowledge of therapeutic
nutrients, doctors are ensuring that their patients do not get
proper care and they are treating nutrient-deficient conditions
with harmful drugs. A PubMed search of 50 known nutrients
finds almost half a million studies on these nutrients. A very
brief overview of the existing literature on nutrient therapy
finds the following:
- Homocysteine disease can be treated with B6, B12, folic acid and magnesium
- Niacin treats high cholesterol
- Vitamin E treats heart disease
- Vitamin C treats infectious diseases and prevents cancer
- Niacinamide treats some forms of arthritis
- Antioxidants, in general, delay the onset and severity of Alzheimer’s disease
- Antioxidants, in general, prevent some forms of cancer
- Magnesium prevents heart disease and 22 other conditions
- St.-John’s-wort is a treatment for mild to moderate depression
- Red clover and black cohosh treat menopausal symptoms
- Echinacea, garlic and astragalus are used to boost the immune system.
Because they are not keeping up with nutrient research, many
conventional doctors are rapidly losing the trust that they once
had. Since they have become entrenched in drug-based medicine,
bonded with their pharmaceutical reps, and are receiving
consideration from drug companies to prescribe their products,
many doctors are losing an adoring public. A 2004 survey
of complementary alternative medicine found that 25 percent
of people who use CAM do so because they no longer trust
conventional medicine.
I was shocked by many things while researching and writing
this paper. Shocked that no one had ever done this compilation
of statistics before; shocked at the incredible number of
lives cut short; shocked that nothing was being done to stop
this insanity; shocked that only 5–20 percent of iatrogenic incidents ever see the light of day. That’s right! I couldn’t believe
my eyes when I first found that statistic. However, another four
journal articles confirmed it, making the 750,000 death rate
pale when you think it could be doubled or tripled!
In 1994, Dr. Lucien Leape produced a major report,
focusing on medical error alone. He equated his findings of
180,000 deaths annually to three jumbo jet crashes every two
days. “Death by Medicine” shows that six jumbo jets are falling
out of the sky each and every day—and no one seems to
notice. What contributes to this denial? Unlike a jumbo jet
crash, which gets instant media coverage, hospital errors are
spread out over the country in thousands of different locations.
This makes it more likely that they are perceived as isolated
and unusual events. However, the most important
reason that medical error is unrecognized and growing,
according to Leape, is that doctors and nurses are unequipped
to deal with human error due to the culture of medical training
and practice.
Doctors are taught that mistakes are unacceptable, medical
mistakes are therefore viewed as a failure of character and any
error equals negligence. We can see how a great deal of
sweeping under the rug takes place since nobody is taught
what to do when medical error does occur. Leape said the
“infallibility model” of medicine leads to intellectual dishonesty
with a need to cover up mistakes rather than admit them.
There are no Grand Rounds on medical errors, no sharing of
failures among doctors and no one to support them, emotionally,
when their error harms a patient.
To most people who read “Death by Medicine,” these
excuses are just that—excuses. What can we do about it? I even
tackled this question when I reported on a survey about preventing
medical errors (see sidebar).
Whether any of these measures are being implemented is
unknown; whether anything will ever be done to decrease the
rate of iatrogenesis is also unknown. A recent report from
Pennsylvania makes me wonder if there will ever be a change
from within the system. On July 8, 2004 the Philadelphia Daily
News published a report of a lawsuit filed by a prominent psychiatrist,
Dr. Stefan Kruszewski. He had been hired by the
state’s Department of Public Welfare to “root out fraud, abuse
and waste” within the department. Apparently he found out
too much, uncovering several fatalities due to lethal combinations
of medications; use of unprescribed, dangerous and
unnecessary drugs; use of bizarre combinations of drugs;
overmedicating of patients in government facilities; illegally
committing of people and putting them on drugs. Dr.
Kruszewski told his supervisor that “These medications are
killing people; something’s wrong here.” That’s when Dr.
Kruszewski, a 53-year-old Harvard Medical School graduate,
was fired.
Fortunately, the good doctor has enough chutzpah to file
suit against the state, the only way this information will come
to light. You can see how difficult it will be to “root out fraud,
abuse and waste” when the very people who hire you to do
so—can just as easily fire you. Countless doctors have lost
their medical licenses for much less. Doctors who prescribe
nutrients and do not follow the “standard practice of medicine,”
which means they don’t prescribe as many drugs or recommend
By telephone, 1,207 adults were asked to indicate how
effective they thought the following would be in reducing
preventable medical errors that resulted in serious harm:
- Giving doctors more time to spend with patients: very effective 78 percent
- Requiring hospitals to develop systems to avoid medical errors: very effective 74 percent
- Better training of health professionals: very effective 73 percent
- Using only doctors specially trained in intensive care medicine on intensive care units: very effective 73 percent
- Requiring hospitals to report all serious medical errors to a state agency: very effective 71 percent
- Increasing the number of hospital nurses: very effective 69 percent
- Reducing the work hours of doctors-in-training to avoid fatigue: very effective 66 percent
- Encouraging hospitals to voluntarily report serious medical errors to a state agency: very effective 62 percent.
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as much surgery, regularly have their licenses
revoked. They are usually turned in by jealous or disgruntled
conventional doctors or even drug reps who abuse pharmacists’
data bases and alert state medical boards if a doctor falls
below the “standard” number of drug prescriptions for his or
her city. It’s a wonder that alternative medicine is practiced at
all because an investigation by the state licensing board usually
results in loss of license—unless you have a few million
tucked away to pay for your defense.
That leaves you, the health consumer, as the only person
outside the system who can possibly turn the tide on medical
iatrogenesis. You can do that simply by continuing to be a
health consumer and by encouraging more people to follow
your lead. If medicine has become all about making money, the
power of the purse still speaks loud and clear. Keep buying
organic food, supplements and health books; keep visiting
alternative health practitioners and keep attending natural
health seminars.
It all adds up and lets the “bean counters” know that more
and more Americans are turning away from drug-based medicine.
That’s the message conventional medicine and the pharmaceutical
industry needs to hear. Once they realize their
profits are dropping and they are losing customers, we might
see a change in the way medicine is practiced. Of course, we
also have to be wary of the takeover of nutrients by pharmaceutical
companies that will try to patent synthetic supplements
—making them into drugs with side effects. Also, be
aware of the Codex Alimentarus, the World Trade
Organization’s attempt to “harmonize” us out of being able to
get nutrients over the counter but available only by prescriptions.
But that’s another story!
Carolyn Dean is a medical doctor and a naturopathic doctor, graduating from
Dalhousie Medical School in Nova Scotia and the Ontario Naturopathic
College. She serves on the board of the Canadian College of Naturopathic
Medicine in Toronto. Dr. Dean began practicing integrative medicine almost
25 years ago, long before the term was invented. She’s also a writer, researcher
and an outspoken advocate of natural healing options and choices. Her widely
acclaimed paper, “Death by Medicine,” released December 2003, revealed that
nearly 784,000 people die annually due to medical interventions. Click “contact”
at carolyndean.com and find a link to “Death by Medicine.”
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