Health

The Hazards Of Modern Medicine

Iatrogenic illness—disease produced as a result of medical treatment—is now recognized as a health hazard of global proportions. MEDLINE (the computerized medical research database of the United States National Library of Medicine) includes over 7,000 articles, reports, and scientific research papers since 1966 that show a substantial number of patients suffer treatment-caused disorders and adverse drug reactions. These harmful effects, which can be serious and even lethal, are associated with every facet of modern medicine including drugs, other medical therapies, diagnostic procedures, and surgery.

Massive Detrimental Effects

Detrimental effects have become so extensive as to prompt the use of the term ‘iatroepidemic’(2). Reporting in the Journal of the American Medical Association, Dr. Lucien Leape of Harvard School of Public Health, has calculated that ‘180,000 people die in the US each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jet crashes every two days’(3). In another issue, the Journal of the American Medical Association points out that injury from medical treatment in the US ‘dwarfs the annual automobile accident mortality of 45,000 and accounts for more deaths than all other accidents combined’(4).

An Economic Drain

Medication-caused disorders produce a substantial economic drain. For example, the Archives of Internal Medicine reported a cost to the US economy of $76 billion in 1995. This amount is nearly twice that spent on diabetes treatment and near the amount for cardiovascular disease(5). Iatrogenic disease can be due to many factors. These include: errors in prescribing or administering drugs and other treatments; accidents; inappropriate use of diagnostic or therapeutic measures; and the intrinsic potential for harm and side effects associated with medications, surgery, and other procedures.

Hazardous Hospital Environment

The hospital environment is especially conducive to medical hazards. Studies including those conducted at Harvard Medical School show that as many as 36 per cent of patients admitted to hospitals suffered iatrogenic injury with up to 25 per cent of those being serious or fatal. Up to half of these injuries were related to the use of medication(6).

The results of an analysis of cardiac arrests at a teaching hospital found that 64 per cent were preventable. Inappropriate use of drugs was the leading cause(7).

In addition to treatment-caused disorders, hospitals foster life-threatening nosocomial infections involving rare or drug-resistant micro-organisms, which are often difficult to treat.

Fifteen per cent of hospital days are devoted to the treatment of drug side effects(8). Every medication, including those that are sold over the counter without a prescription, has an associated side effect. Commonly used drugs have been found to affect every system. Frequent reactions include skin rashes, nausea, headaches, dizziness, lethargy, diarrhoea, and gastric bleeding in a significant number of people. More severe reactions that can be fatal or severely debilitating include deafness, depression, abnormal heart rhythms, angina, bronchospasm, electrolyte disturbances, immune system dysfunction, serious blood disorders such as aplastic anaemia, liver or kidney toxicity, Stevens-Johnson syndrome, or anaphylactic shock. These occur in a statistically significant proportion of the population. Despite what is known about adverse drug effects, Dr. David Kessler, Chief of the US Food and Drug Administration, believes that ‘only one per cent of all serious drug reactions are reported’(9).

Public Health in Jeopardy

The problem escalates to public health proportions when large numbers receive a treatment and experience its attendant side effect. The New England Journal of Medicine makes this point in discussing the link between breast cancer and menopausal hormone replacement therapy: ‘because of the high incidence of breast cancer even a slight increase in risk will yield a substantial increase in the number of cancers’(10). The scale of use causes drugs which are considered safe to end up producing significant damage. In this regard, the widely used non-steroidal anti-inflammatory drugs cause over 3,300 deaths per year and 41,000 hospitalizations.

Poisonous Drugs

Many drugs have side effects serious enough to cause a secondary disease warranting its own intensive therapy. An example is Parkinsonism caused by the neurological side effects of antidepressants or anti-psychotic medication. A Harvard Medical School study showed that drugs were the real cause of the original symptoms in 37 per cent of elderly patients who were treated for Parkinson’s disease. L-dopa, the medication used in treating these patients has its own severe side effects, that often require the use of additional drugs to control(11). Other examples of new diseases caused by medications include collagen vascular disease produced by blood pressure medications, and Cushing’s syndrome produced by prolonged cortico-steroid use. The New England Journal of Medicine has published several studies linking cancer chemotherapy to the later appearance of new malignancies(12). Many drugs are classified as teratogens and cause birth defects when taken during pregnancy. Others can cause diseases in offspring in later life.

Unfortunately, these effects may not become apparent until many thousands of women have taken a drug that had been enthusiastically introduced and promoted. The classic examples are the tragic epidemic of birth defects in Europe due to thalidomide, and the emergence of cancer in the children of mothers who took diethylstilbestrol.

Overuse of antibiotics has produced resistant strains of formerly susceptible micro-organisms. Serious concern has been voiced about the potential for epidemics which cannot be effectively contained due to drug resistance. An example of this is the emergence of tuberculosis that is resistant to presently available drugs.

Unnecessary Surgery Epidemic

Studies also show substantial inappropriate and overuse of surgery, and continued use of outmoded operations. A US Congress Subcommittee on Oversight and Investigations into Unnecessary Surgery found that in one year, there were approximately two million unnecessary operations, responsible for more than 12,000 deaths, with an approximate cost wastage of $10 billion(13).

Injurious Technologies

Dependency on high technology both in diagnosis and treatment has been shown to be a source of injury with machine failure or misapplication of technology. For example, 36 per cent of iatrogenic problems in intensive care units were associated with equipment malfunction(14).

Unreliable Medical Care

In addition, medical care is often based on much less scientific evidence than assumed and undergoes radical reversals. The editor of the British Medical Journal revealed that only 15 per cent of all medical therapies have a scientific basis or have been demonstrated to be effective(15). Yet patients remain vulnerable. An example is the formerly common use of irradiation for enlargement of the thymus in infancy, a condition now recognized to be normal. This treatment has recently been shown to cause cancer in later life in those who received it(16).

Pushing Poisonous Drugs

Pharmaceutical marketing also puts great pressure on physicians to use new products. The medical journal Hospital Practice pointed out that pharmaceutical company competition ‘leads to very aggressive promotion and inundation of the physician with data supporting the use of each new drug’. Such marketing may dilute opposing scientific information that is not as well publicized. Ultimately drugs may be withdrawn, but only after substantial harm has been done. For example, benoxaprofen, a non-steroidal anti-inflammatory agent (NSAID) was introduced and heavily marketed in 1982, but then withdrawn after cases of fatal liver toxicity were reported in Great Britain. Zomepirac sodium was also ‘aggressively marketed as a safe analgesic’, but withdrawn after a year and numerous reports of fatal anaphylaxis(17). The cardiac drugs flecainide and encainide, heavily promoted to control abnormal heart rhythms, were then withdrawn years later after scientific studies showed they caused fatal arrythmias and that those treated with them were two-and-one-half times as likely to die as were those taking a placebo.

Developing countries, which have less stringent controls and means of surveillance, have had special problems with irrational drug marketing by multinational and indigenous pharmaceutical companies that have been carefully documented. These practices have been reviewed in the Journal of Clinical Epidemiology by several authors including Dr. Philip Lee, the United States Assistant Secretary of Health. According to Dr. Lee and his colleagues, ‘unjustified claims of efficacy or safety continue to proliferate’(18). In addition to side effects, the high cost of pharmaceuticals are a significant hazard to the economy of developing countries.

Urgent Need for New Knowledge

Physicians and patients have come to accept medical hazards as a necessary price to pay for modern diagnosis and therapy even though they may be seriously debilitating or lethal. The same is true with medical errors. Studies have shown errors to be so pervasive that mistakes are considered to be an inevitable part of the medical system, giving rise to the term ‘necessary fallibility’(19). The deplorable acceptance of disease or medical error as a consequence of treatment reflects a deviation from the most primary principle of medical ethics: primum non nocere ‘Above all do no harm.’ The wealth of data documenting the serious nature and extent of the hazards associated with modern medicine has made clear that fundamental deficiencies exist in the current medical approach and that new knowledge is urgently needed to effectively address this problem.

References

1. USA Today. September 13, 1995.
2. Review of Respiratory Diseases. 1987; 135: 1152-1156.
3. Journal of the American Medical Association. 1994; 272: 1851-1857.
4. Journal of the American Medical Association. 1995; 274: 29-34.
5. Archives of Internal Medicine. 1995; 155: 1949-1956.
6. Annals of Internal Medicine. 1964; 60: 100-110. New England Journal of Medicine. 1981; 304: 638-642. New England Journal of Medicine. 1991; 324: 370-376.
7. Journal of the American Medical Association. 1991; 265: 2815-2820.
8. Harrison’s Principles of Internal Medicine. 1994.
9. U.S. News and World Report. January 9, 1995: 49-54.
10. New England Journal of Medicine. 1994; 330: 1062-1071.
11. American Journal of Medicine. 1995; 99: 48-54.
12. New England Journal of Medicine. 1990; 322: 1-6
13. USA Today. October 31, 1983.
14. Nursing Clinics of North America. 1993; 28: 459-473.
15. British Medical Journal. 1991; 303: 798-799.
16. New England Journal of Medicine. 1989; 321: 1281-1284.
17. Hospital Practice. 1989; January 30: 89-94.
18. Journal of Clinical Epidemiology. 1991; 44: 49S-55S.
19. Journal of the American Medical Association. 1989; 261: 1610-1617.

Subvert The Dominant Paradigm

Film Review - "The Corporation"

'The Corporation's' power comes through in its personalities

The rise of the corporation as the dominant institution in the modern world is perhaps the most important story of our time. Few people on this planet are not affected by its incursions into spheres formerly considered too public to be controlled by private interests.

Taking their cue from Joel Bakan's concept of the pathology of commerce, developed in his book "The Corporation: The Pathological Pursuit of Profit and Power," directors Mark Achbar and Jennifer Abbott have constructed a film as multifaceted and monolithic as its subject.

With the corporation recently accorded the rights of a person, Bakan uses the personality diagnostic checklist of the World Health Organization's Manual of Mental Disorders to define the corporation's personality. Not surprisingly, it scores as a criminal psychopath.

Editor/co-director Abbott has constructed a convincing labyrinth of interviews and archival materials to support the diagnosis.

The 40 subjects interviewed by Achbar cover a span from cool intellectualism of Noam Chomsky to Michael Moore's underclass rabble-rousing. The most intriguing subject is Ray Anderson, Interface CEO, whose recent epiphany has led to a turnaround in his company's policies.

If Interface is the film's hero, then Fox is its villain. A "60 Minutes"-styled exposé on the network's suppression of a story about the health dangers of Monsanto's bovine growth hormone is a chilling example of the corporate control of media. Reporters Jane Akre and Steve Wilson, who ultimately were fired as a result of their story, offer first-hand accounts of their experiences.

Recent films like "Spellbound," "Winged Migration" and "Standing in the Shadows of Motown" have brought a new popularity to the documentary. With this has come a pressure for the films to be as entertaining as they are educational. As a result, the charisma of the interviewees is sometimes as important as what they have to say.

An extreme example of this is Mark Barry, whose flamboyant style makes him come across, not as the corporate spy that he is, but as an actor playing the part. Michael Moore, bellowing about orange Fanta being a conspiracy between the Coca-Cola company and Nazi Germany, is even worse. He speaks in headlines, rarely bothering to explain the facts of his stories.

Like them or not, all these voices are part of a great untold tale. At 2 1/2 hours, "The Corporation" is too short to tell the whole story. It is, however, a fast-paced, highly enjoyable and provocative introduction.

Boo

Film Review - "The Garden Of The Finzi Continis"

Vittorio de Sica, known commonly for The Bicycle Thief and other neo-realist classics of the 40s and 50s also made this lesser known, yet exquisite film in the 70s. It has the ambience of a dream. In the NYT review of the time:

"The garden of the Finzi Continis, owned by a rich, intellectual Jewish-Italian family, is a sylvan sanctuary in the ducal town of Ferrara in 1938. Outside its walls, the good gentile citizens of Ferrara parade Fascist banners and slogans and prepare for war, but these things are barely acknowledged by the Finzi Continis, who have their gardens and woods, a huge main house, a smaller but still imposing summer lodge, and a private tennis court.

When the tennis club, observing Mussolini's new anti-Semitic laws, drops the Finzi Continis from its rolls, Micol Finzi Contini (Dominique Sanda) and her brother, Alberto (Helmut Berger), make a tentative gesture towards ending their aristocratic isolation. They invite friends—gentiles as well as Jewish—into their sanctuary to play tennis on long, lovely, hot summer afternoons. Micol is paid romantic court by Giorgio (Lino Capolicchio), the narrator of the film, a nice young Jewish boy, but she has midnight assignations with Malnate, a gentile whom she can never marry.

There are no commitments in such liaisons, and although Micol and Alberto are fond of their friends, they are different from them, even from their Jewish friends. They are aware of something that is apparent to no one else. They are dying but will do nothing about it................."

Really hope you can get your hands on this one.

Big Picture

Impossible?

If you find the following extract tantalizing, definitely follow the link "Final Empire" on the side column of this blog:

"The consensus assumption of civilization is that an exponentially expanding human population with exponentially expanding consumption of material resources can continue, based on dwindling resources and a dying ecosystem. This is simply absurd. Nonetheless, civilization continues on with no memory of its history and no vision of its future.

Possibly the most important source of life on this planet is the thin film of topsoil. The life of the planet is essentially a closed, balanced system with elements of sun, water, soil and air as the basic elements. These elements work in concert to produce life and they function according to patterns that are based in the laws of physics, which we refer to as Natural Law.

The soil depth and its richness are a basic standard of health of the living planet. As a general statement we may say that when soil is lost, imbalance and injury to the planet’s life occurs. In the geologic time-span of the planet’s life, this is a swift progression toward death. Even if only one per cent of the soil is lost per thousand years, eventually the planet dies. If one per cent is gained, then the living wealth, the richness, of the planet increases. The central fact must be held in mind of how slowly soil builds up. Soil scientists estimate that three hundred to one thousand years are required for the build up of each inch of topsoil.

The nourishment of the soil depends upon the photosynthetic production of the vegetative cover that it carries. There are wide differences in the Net Photosynthetic Production of many possible vegetative covers. As a rule it is the climax ecosystem of any particular region of the earth that is the most productive in translating the energy of the sun into the growth of plants and in turn into organic debris which revitalizes the soil.

A climax ecosystem is the Equilibrium State of the "flesh" of the earth. After a severe forest fire, or to recover from the injury of clearcut logging, the forest organism slowly heals the wound by inhabiting the area with a succession of plant communities. Each succeeding community prepares the area for the next community. In general terms, an evergreen forest wound will be covered by tough small plants, popularly called "weeds" and the grasses which hold down the topsoil and prepare the way for other grasses and woody shrubs to grow up on the wound. ("Weeds" are the "first aid crew" on open ground.) As a general rule, the "first aid crew" - the first community of plants to get in and cover the bare soil and hold it down - is the more simple plant community with the smallest number of species of plants, animals, insects, micro-organisms and so forth. As the succession proceeds, the diversity, the number of species, increases as does the NPP, until the climax system is reached again, and equilibrium is established. The system drives toward complexity of form, maximum ability to translate incoming energy (NPP) and diversity of energy pathways (food chains and other services that plants and animals perform for one another). The plants will hold the soil so that it may be built back up. They will shade the soil to prevent its oxidation (the heating and drying of soil promotes chemical changes that cause sterility) and conserve moisture. Each plant takes up different combinations of nutrients from the soil so that specific succession communities prepare specific soil nutrients for specific plant communities that will succeed them. Following the preparation of the site by these plants, larger plants, alders and other broadleaf trees will come in and their lives and deaths will further prepare the micro-climate and soil for the evergreens. These trees function as "nurse" trees for the final climax community, which will be conifers. Seedling Douglas Fir for example, cannot grow in sunlight and must have shade provided by these forerunner communities.

The ecosystems of this earth receive injury from tornado, fire, or other events and then cycle back to the balanced state, the climax system. This is similar to the wound on a human arm that first bleeds, scabs over and then begins to build new replacement skin to reach its equilibrium state. The climax system then is a basic standard of health of the living earth, its dynamic equilibrium state. The climax system is the system that produces the greatest photosynthetic production. Anything that detracts from this detracts from the health of the ecosystem.

Climax ecosystems are the most productive because they are the most diverse. Each organism feeds back some portion of energy to producers of energy that support it (as well as providing energy to other pathways) and as these support systems grow, the mass and variety of green plants and animals increases, taking advantage of every possible niche. What might be looked at as a whole unitary organ of the planet’s living body- a forest or grassland- experiences increased health because of its diversity within.

On a large scale, the bioregions and continental soils substantially support sea life by the wash-off (natural and unnatural) of organic fertility into aquatic and ocean environments. This is a further service that these whole ecosystems perform for other whole ecosystems.

A few basic principles of the earth’s life in the cosmos have now been established. Balance is cosmic law. The earth revolves around the sun in a finely tuned balance. The heat budget of the planet is a finely tuned balance. If the incoming heat declined, we would freeze or if the planet did not dissipate heat properly we would burn up. The climax ecosystem maintains a balance and stability century after century as the diverse flows of energies constantly move and cycle within it. In the same manner the human body maintains balance (homeostasis) while motion of blood, digestion and cell creation, flow within it.

The life of the earth is fundamentally predicated upon the soil. If there is no soil, there is no life, as we know it. (Some micro-organisms and some other forms might still exist). Its vegetative cover maintains the soil and in optimal, balanced health, this cover is the natural climax ecosystem.

If one can accept these few simple principles then we have established a basis of communication upon which we may proceed. Anyone who cannot accept these principles must demonstrate that the world works in some other way. This must be done quickly because the life of the planet earth hangs in the balance."