Iatrogenic Illness: A Growing Threat

Iatrogenic Illness: A Growing Threat

© 2004 Dr. Dale Peterson, © 2006 drdalepeterson.com

My medical school biochemistry class was taught by Dr. Wally Armstrong, M.D., Ph.D. The fact that he had actually attended medical school and done a clinical internship before beginning his career as a biochemist made him unique among basic science professors. As we entered his classroom for the first time my classmates and I were anxious to hear what the first “real doctor” to instruct us had to say.

When he entered the auditorium Dr. Armstrong strode directly to the board and in big, bold letters wrote I A T R O G E N I C. Turning to face us he asked, “Who can tell me what that word means?”

I doubt that had anyone would have volunteered even had the answer been known. The figure of Dr. Armstrong with its muscular build and full head of pure white hair was as intimidating as it was distinguished.

Dr. Armstrong’s penetrating gaze moved slowly about the room. After what seemed like an eternity he continued, “That word is iatrogenic. It means doctor caused. That word means YOU DID IT!

“Students,” he admonished, “if you learn nothing else during your years at this institution remember this: Eighty-five percent of the people who come to you over the course of your careers will get better no matter what you do. Your job is never lower that percentage!”

Never lower that percentage! The thought was appalling. I was going to medical school to help people get well. The possibility that I might actually make someone worse had never crossed my mind prior to that moment. The concept that I could, by my actions, hasten someone’s death was an anathema. Emotions churned within me.

The emotional impact of Dr. Armstrong’s opening remarks cemented them into my memory. I remember that moment as vividly as I recall hearing that President Kennedy had been shot, or when I learned that the space shuttle, Challenger, had exploded. I can no sooner forget them than I can forget the morning of the Murrah Building bombing or watching planes fly into the World Trade Center.

So it is that I ask the question, “How are we doing, we young idealists who embarked upon careers in medicine bent upon improving the lot of those seeking our aid?” The answer I receive grieves and sickens me.

The Nutritional Institute of America released a paper in October 2003 entitled, “Death By Medicine.” Co-authored by 5 medical researchers, the paper documents the incidence of iatrogenic illness using articles from peer-reviewed medical journals and governmental health statistics. The findings are terrifying.

Using clearly documented statistics and using conservative figures, the authors found that nearly 800,000 people die each year as a direct result of injuries inflicted by diagnostic studies and medical treatment. The figure is undoubtedly higher. In 2001, the last year for which complete statistics are available, 699,697 people died from heart disease 553,251 from cancer.

Today more people in the United States are dying from the adverse affects of medical diagnosis and treatment than are dying from heart disease or cancer. The number of people dying from iatrogenic disease is the equivalent of seven fully occupied jumbo jets crashing and leaving no survivors every day of the year.

The prevailing attitude is that those deaths are inevitable – that they are the price paid for the lives that are saved by aggressive medical intervention and treatment. If there were no alternative the price might be acceptable, but there are options. There is a better way.

Several years ago a man asked me to lunch. He wanted to “pick my brain” about the direction he should go in his career. He wanted to know which cutting edge technologies were most likely to have a positive impact upon health. Being a caring person he hoped to develop a business that would help others obtain better health.

My response was not what he was seeking. I explained that the answer to improved health for the vast majority of individuals is not “high tech”, but rather what might be called “low tech”. It is educating people about the need to drink pure water, eat real food, take nutritional supplements, provide electromagnetic protection, and avoid toxic substances. It is possible to fight disease and promote wellness without causing harm to hurting people.

Why has the incidence of iatrogenic disease risen to such a high level? I believe that a lack of awareness is a major factor. Physicians simply are not being taught to recognize the risks inherent in the procedures and treatments they have learned to recommend.

Nearly every medical intervention carries a risk. When that risk is underestimated or unrecognized, the incidence of iatrogenic illness will inevitably increase. This is true of surgical procedures, it is true of invasive diagnostic techniques, and it is certainly true of prescription and non-prescription drugs.

I attend continuing medical education lectures to maintain my licensure. I have observed that when drug therapy is discussed the potential benefits are exaggerated and the possible side effects are downplayed or totally ignored. The same pattern occurs in direct-to-consumer pharmaceutical advertisements. The first 55 seconds of an ad are devoted to showing how tremendously one’s life can be improved by taking the drug and during the last five seconds the potential side effects are whispered with nearly unintelligible rapidity. As a result, the vast majority of adverse drug reactions go unrecognized and unreported. In many circumstances an individual’s quality of life is adversely affected. In some situations, people die.

The continued widespread use of anti-inflammatory drugs known as NSAIDs (Non-Steroidal Anti-Inflammatory Drugs, which are really New Sorts of Aspirin In Disguise) is one example. These agents provide only marginal relief in the short term and many have been demonstrated to accelerate the loss of joint cartilage, worsening arthritic conditions over the long term. In an article published in the American Journal of Medicine in 1998, these drugs were responsible for 107,000 hospitalizations and 16,500 deaths each year. This number was derived only by evaluating people who were being treated for rheumatoid arthritis or osteoarthritis with prescription drugs. It did not include individuals taking them for non-arthritic reasons, nor did it consider those using over-the-counter medications such as aspirin or ibuprofen.

Newer non-steroidal agents called cox-2 inhibitors were introduced as the answer to NSAID toxicity and were quickly embraced by physicians. In 2001, two of them, Celebrex and Vioxx, generated $4.42 billion in sales in the United States. Unfortunately, these drugs also pose a significant risk. Among other adverse actions, the newer NSAIDS interfere with the function of the small intestines, decrease kidney function, elevate blood pressure, and increase the incidence of heart failure. Two large studies comparing the cox-2 drugs with other NSAIDs did not demonstrate any decrease in the death rate.

If there were no alternative to NSAIDs in the management of pain and inflammation perhaps the injuries and deaths associated with their use could be justified. Excellent alternatives do exist, however. Free of side effects, these options often provide better symptomatic relief in the short term while slowing or reversing joint deterioration over the long term. Some alternatives to NSAIDs include systemic enzymes, glucosamine, omega-3 fatty acids, mucopolysaccharides, and feverfew.

An open-ended metallic bracelet has been shown to bring significant pain relief to 75 % of those wearing it. Unfortunately, the company manufacturing the bracelet mistakenly believed that an ionizing process was responsible for its effectiveness. When studied, both the ionized bracelet and an identical, but un-ionized, version produced the improvement.

Since both versions of the bracelet were equally effective, reporters ignored the remarkable results achieved and led with headlines such as “A magic pain-killing bracelet that isn’t”. Researchers decried the results as a “placebo effect” and advised people not to waste their money on such a foolish device. Ironically, the “magic bracelet” that seems capable of providing ongoing relief with no side effects is sold for about a third the cost of a s ingle month’s supply of a potentially lethal medication.

Cholesterol lowering drugs carry a significant risk of doing harm. Despite the fact that an individual’s total cholesterol level is largely irrelevant to his or her risk of heart disease or stroke (an arterial wall must be injured and LDL cholesterol must be oxidized - damaged by a free radical - before plaque can begin to form), Lipitor has been the number one selling drug in the United States for the past three years. Its competitor, Zocor, is also consistently among the top ten prescription drugs sold in the United States. The 2001 combined sales volume of Lipitor and Zocor was $7.26 billion.

While these drugs have had a marginal impact upon the incidence of heart attack and stroke, the two main challenges they are intended to prevent, there has been little, if any, decrease in the overall death rate in people taking the drugs. It appears that any benefit obtained is negated by iatrogenic illnesses induced by the agents.

A number of studies have shown that cholesterol-lowering drugs significantly increase the risk of death from homicide or suicide. This is felt to be due to a decline in brain chemicals such as seratonin, which are dependent upon cholesterol for their production.

A large study of the effects of another cholesterol-lowering drug, Pravachol, which is a member of the same family, showed a highly significant increase in the incidence of breast cancer in women taking the drug. This is not surprising, since the drugs interfere with the body’s production of coenzyme Q-10. Low Q-10 levels are associated with an increased risk of breast cancer, colon cancer, gum disease, congestive heart failure, and muscular deficiencies.

In addition, the drugs cause muscle pain, sleep disturbances, and sexual dysfunction in a number of users. They are also the leading cause of idiopathic polyneuropathy, a condition characterized by numbness and tingling in the hands and feet. They can cause significant elevation of liver chemicals and can lead to a breakdown of muscle tissue leading to kidney failure and sometimes death.

The risk of fatal reactions is increased when they are combined with other drugs, including other lipid lowering agents such as fibric acid derivatives. Baycol, a member of this class of drugs was removed from the market due to the number of deaths that occurred when it was used in combination with fibric acid drugs like Tricor or Lopid. The closely guarded secret is that all drugs in the statin class cause deaths when combined with fibric acid drugs. Baycol’s sin was not that it caused deaths; it was that it caused relatively more deaths than its competitors. The incidence of myopathy is currently estimated at 0.12 %, a little over 1 in 1000. The percentage of individuals who die as a result is currently unknown.

I am amazed at the number of individuals I see who are on these potentially lethal combinations. The prevailing attitude among physicians, pharmacists, and patients seems to be, “This is an uncommon complication, and therefore it won’t happen to me.” Statistics, however, can never be applied to individuals. If you are one of the people who develop the fatal reaction your incidence is 100%!

If there was no alternative and the only way to decrease the risk of heart attacks and strokes was to take these drugs, the risks could be justified. As in the case of the NSAIDs, however, there are safe, effective alternatives. In fact, the alternatives appear to be more effective than the cholesterol-lowering drugs in preventing disease.

Lowering homocysteine levels with B vitamins, N-acetyl cysteine, or trimethylglycine will dramatically lower your risk of heart attack or stroke. Preventing oxidation of LDL cholesterol with antioxidant supplements will lower the risk to an even greater extent. Individuals who take comprehensive antioxidant regimens and who maintain homocysteine levels below 7 mmol/L almost never experience heart attacks or strokes. This cannot be said of people who rely upon cholesterol-lowering medications, as even the most optimistic studies have failed to lower the risk of heart attack by more than 35 %.

Challenges with proton pump inhibiting drugs for acid reflux disease were enumerated in the March issue of this publication. Two of them, Prilosec and Prevacid were the second and third best selling drugs in 2001 totaling 7.2 billion in sales. Like the other classes of drugs, safe, effective, alternatives exist.

The top ten list is rounded out by antidepressant medications, primarily seratoin reuptake inhibitor drugs. Zoloft, Paxil, and Prozac all made the top ten list and produced $6.26 billion in 2001 sales. Since then Effexor XR and Celexa have edged out Zoloft and Prozac, but three antidepressants remain among the top ten best selling prescription drugs in the United States.

Controversy has surrounded these drugs since their introduction. Common side effects include sleep disturbances, weight gain, and sexual dysfunction. It is an apparent increase in violent behavior leading to homicide or suicide, however, that has caused the most concern. Studies have shown that the risk of suicide doubles in children given the drugs. British regulators issued a recommendation in 2003 that the drugs not be prescribed to children. The FDA recently agreed to issue a warning about the dangers of the drugs, but stopped short of recommended that physicians stop prescribing them to children.

Once again, safe and effective alternatives are available. A comprehensive nutritional supplement is effective in clearing depressive symptoms in a large number of individuals. Regular physical activity and exposure to sunlight will bring improvement to many others. During the winter months, when daylight hours are diminished, light box therapy can prevent or improve depression in a large percentage of individuals.

When basic supplementation, light exposure, and exercise are ineffective I have seen excellent response to the addition of a supplement called 5-HTP. 5-HTP is the last building block necessary for the body to manufacture seratonin. It will not work alone, but the addition of 5-HTP to a comprehensive vitamin, mineral, and amino acid supplement is often like turning on a switch. I have seen depression resolve overnight in some instances.

Studies have demonstrated that St. John’s wort can be as effective as prescriptive antidepressants with far fewer side effects. I have not needed to have people take St. John’s wort since I have been recommending 5-HTP, however.

Never lower that percentage! Those words have echoed within me since that first afternoon in medical school. They are actually a restatement of one of the most basic principles handed down from Hippocrates, the Father of Medicine. He taught, “First, and above all else, do no harm!”

Do no harm. Never lower that percentage. The principle those words represent is as important today as when they were first spoken, perhaps more so, as ever more potent pharmaceutical agents are being marketed and prescribed and a greater number of invasive diagnostic and surgical procedures are being performed.

Some signs suggest that the desire for self-preservation is gaining ground in our society. One-third of people interviewed report using some form of alternative medicine each year and approximately two-thirds report using an alternative medicine approach at some time during their lifetime. Young adults report being more open to alternative approaches to illness than their elders.

The increasing popularity of alternative practices should not be surprising. After all, if you were planning to travel and knew that, on average, seven airliners crash each day wouldn’t you consider an alternative means of transportation to get to your destination?

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