HEALTH CARE QUALITY: BIG MEDICINE’S BIG LIE

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HEALTH CARE QUALITY: BIG MEDICINE’S BIG LIE

 

 

BY KATHLEEN B. DEOUL

 

The Medical Establishment likes to brag about the US healthcare system, claiming

it’s the best in the world. Considering that in 2003 Americans spent $1.6

Trillion on health care – 14% of Gross National Product – on health care, it

should be! The trouble is that despite the inflated claims of the Medical

Establishment and its allies in Big Pharma and Big Government, the facts tell a

far different story.

 

Just consider the following: adverse drug reactions and in-hospital medical

errors kill over 200,000 people every year and impose costs on the health care

system totaling over $14 billion!

 

But that’s just the tip of the iceberg.

 

Hospital acquired infections take another 88,000 lives at a cost of $5 billion,

and unnecessary procedures take over 37,000 lives at a cost of $122 billion!

 

What is perhaps most disturbing, though are the deaths that are clearly caused

by neglect. Some 115,000 people (many in nursing homes) die from complications

caused by bedsores – a problem easily avoided by proper care. Another 108,800

die as a result of malnutrition – that’s right, in a land of plenty people (most

elderly) are dying because their caregivers don’t care enough to make sure that

they eat!

 

This evidence of an unfeeling and callous health care delivery system that often

treats the elderly as “disposable” is perhaps the most damning indictment of the

Medical Establishment of all.

 

Could things really be that bad?

 

Other evidence says it is.

 

Take for example errors in outpatient medications prescribed to senior citizens.

According to a study by the Centers for Disease Control and Prevention, seniors

are prescribed the wrong medication eight percent of the time when they visit

outpatient facilities. The most frequent errors were for pain relievers and

central nervous system drugs, accounting for 65% of the mistakes. This is no

small concern. If, for example a senior with an ulcer, or who is taking a blood

thinner is given drugs such as Advil or even Celebrex, they could suffer a

serious bleeding incident. Most disturbing in at least 4% of the cases, the

patient was given a drug that they should NEVER take! Interestingly, women were

twice as likely to have an error made in their medication as men.

 

Mistaken prescriptions are a dangerous problem, but not the most dangerous. An

even more startling revelation comes from a French study of emergency room

diagnoses.

 

French researchers reviewed the autopsy results of 167 patients who were

autopsied after they died. The results of this study were, to say the least,

alarming.

 

According to the French researchers, in nearly a third of the cases the clinical

diagnosis made by the emergency room physician was either flat wrong, or

incomplete. Nor were the problems missed minor ones. They included 21 cases of

cancer, 12 strokes, 11 heart attacks, 10 cases of blood clots in the lungs and

nine cases of inflamed heart valves!

 

The emergency room is the first line of defense in health care. Patients come to

emergency rooms because they have urgent health problems that need attention

NOW. This fact alone should cause doctors to be especially careful in making a

complete examination to be sure that they know what the patient’s problem really

is. Yet the simple fact is that they clearly fail to do so nearly one-third of

the time. Is this really the best health care in the world as Big Medicine

claims?

 

A look at one common problem emergency room physicians must frequently deal

with, food allergies, illustrates the institutional failing.

 

More and more Americans are developing food allergies. According to the Food

Allergy and Anaphylaxis Network (FAAN), around five million people suffer from

food allergies in the United States. This figure includes around eight percent

of all children and from one to two percent of all adults.

 

The severity of the allergic reaction an individual suffers from a food can vary

from mild ones such as upset stomach or a slight rash to anaphylactic shock, a

severe, life-threatening condition.

 

When a person goes into anaphylactic shock, tissues in various parts of the body

release histamines and other substances causing airways to constrict and blood

vessels to dilate. Blood pressure drops causing the individual to go into shock

and pulmonary edema (fluid in the lungs) can occur. They can also suffer cardiac

arrhythmias.

 

Fortunately, there is a long-standing treatment of this sort of severe allergic

reaction: epinephrine, or as it is also called adrenalin.

 

The trouble is that if you show up at an emergency room with a severe allergic

reaction to food, there is no guarantee that epinephrine will be administered.

In fact, in most cases it won’t!

 

Dr. Carlos Camargo is an expert on allergies with the Emergency Department at

Massachusetts General Hospital. He recently published the results of a study of

emergency room treatment of food allergies in the Journal of Allergy and

Clinical immunology. His findings provide little confidence for patients

visiting emergency rooms with this condition. Dr. Camargo said flatly that “…

there is a tremendous gap between what the guidelines for managing a food

allergy are and what the actual practice is.”

 

Dr. Camargo’s concerns are echoed by Anne Munoz-Furlong of FAAN “There is a lot

of work to be done with allergists and emergency room physicians to ensure that

the patients get the care they need.”

 

The results of Dr. Camargo’s study certainly support this conclusion. His

research team reviewed the charts of some 678 patients who went to emergency

rooms with allergic reactions to food at 21 hospitals. He found that only 16

percent of the patients were given epinephrine, even though this is the drug

recommended for treatment of this type of allergic reaction. Instead, 72 percent

of the patients were given antihistamines and 48 percent were given steroids.

 

Dr. Camargo summed up his group’s results “The problem is that there clearly

were severe attacks that didn’t get the treatment that would have helped them

better.”

 

Of course epinephrine is a hormone that was first identified in 1902 and

synthesized in 1904. As a result it is not subject to patent and is available in

generic form. In contrast, most antihistamines are still under patent, and

potentially far more expensive.

 

But that wasn’t the only problem that Dr. Camargo’s study uncovered. He says

that anyone subject to severe allergic reactions should be given a prescription

for self-injectable epinephrine. The reason for this precaution is simple: there

might not be time to get to an emergency room and therefore having the ability

to administer the drug yourself could very well save your life. Yet, only

sixteen percent of the patients discharged following an allergic reaction were

given such a prescription. Indeed, only twelve percent were advised to see an

allergist!

 

The resistance to administering epinephrine is not limited to food allergies. It

is also the treatment of choice for a variety of other allergies including

allergies to bee stings. In a separate study, however, Dr. Camargo’s group found

the same pattern of under use.

 

It’s not just hospital emergency rooms or even hospitals themselves that are at

the core of America’s health care crisis. While they certainly are plagued with

problems, in a sense they represent a symptom of the underlying cause: greed --

specifically, the greed of the pharmaceutical industry. For decades Big Pharma

has put profits ahead of patients, often touting “cures” and treatments that are

eventually found to do more harm than good. No where is this more evident than

in regard to hormone replacement therapy (HRT).

 

In 2002, the U.S. government-sponsored Women’s Health Initiative Study, the

larges randomized clinical trial of hormone replacement therapy every conducted

took a startling step. It was abruptly halted because researchers conducting it

discovered that HRT increased the risks of heart disease, breast cancer and

stroke among participants. This was a stunning conclusion, especially since

prior to these results, HRT had been touted as a means of not only easing the

symptoms of menopause, but of helping to prevent cardiovascular disease as well.

 

The dramatic action of the Women’s Health Initiative has fueled a raging debate

over HRT and when or even if it should be used. To most doctors the news came as

a complete surprise, yet according to an article in the February 28 issue of the

British Medical Journal, the dangers of HRT should have been exposed years

earlier than they were.

 

Dr. Klim McPherson, a British Physician led a team of investigators who

researched the existing trials of HRT conducted in the 1990s and came to a

shocking conclusion. “We found 200 trials of efficacy, but most were useless

because they didn’t record any type of side effects and many of them didn’t have

proper controls.” Dr. Klim and his team did find that “There were 23 trials that

were useful.” Their analysis of those trials originally published in 1997 – five

years before the WHI action – were not well received to say the least. Indeed,

they were widely ignored as Big Pharma rushed to tout its latest cure-all. But

McPherson and his team were not about to give up.

 

His group found half a dozen more trials that were run by the drug companies

themselves, and attempted to gain access to the data. They hit a brick wall as

company after company refused to release the information claiming that they were

proprietary secrets. Undaunted, McPherson went to court and finally was able to

see the information. What he found made clear why the drug companies weren’t

anxious for anyone to see their results.

 

Put simply, the drug companies knew of the potential problems and were covering

up the truth.

 

But even the latest revelations were not the end of the HRT story. As data from

the WHI continues to undergo analysis, more and more adverse effects are

uncovered. The latest development is the finding that taking hormone replacement

therapy may result in an increased risk of dementia – something some doctors

were prescribing HRT to prevent! The FDA has announced that it will require drug

makers to update their labels to warn of the danger – the second label revision

in as many years! Undoubtedly more will be coming.

 

This, of course won’t stop Big Pharma from pushing HRT or any other “new cure”

they think will fatten their bottom line – even when older, safer alternatives

exist. Any who doubt that this is the case need only look at what is going on

with blood pressure medication.

 

In 2002, Americans spent some $12 billion on drugs to treat high blood pressure.

The rise was fueled in part by a revision of the rules governing what

constituted high blood pressure. With a stroke of the pen bureaucrats lowered

the readings that indicate the disease and made millions of people whose blood

pressure was normal the day before “pre-hypertensive” the next day and suddenly

in need of medication. But it was not the change that caused the sharp increase

in what was being spent on medicine to treat high blood pressure. The real cause

was revealed in a recent study conducted by Stanford University professor Dr.

Randall Scott.

 

Dr. Scott compared information from 17,318 doctor visits in 1990 with

information from 21,885 visits in 2002 along with information from 20,000

pharmacies. What Scott concluded was that although higher drug prices accounted

for 29 percent of the cost increase between the two periods, fully one third of

the difference was the result of doctors prescribing high-priced, patented

prescription drugs when cheaper and often more effective generic alternatives

were available.

 

 

Specifically, doctors often prescribed one of two classes of expensive

brand-named drugs for their patients. The first class was comprised of the drugs

called ACE inhibitors (angiotensin-converting enzyme inhibitors). The second

were the drugs known as ARBs (angiotensin receptor blockers). A month’s supply

of ARBs runs around $56 and a month’s supply of ACE inhibitors around $44. The

trouble is that simple diuretics of the thiazide family that have been around

for decades can do as good or better a job for around $9 per month. Of course

these drugs are out of patent and therefore only sold in generic form.

 

As more and more doctors have recognized this fact, however, Big Pharma hasn’t

stood still. To test the waters, in Norway they stopped manufacturing thiazides

entirely despite widespread protests from physicians. Their argument was that

they couldn’t make money manufacturing the generic version – even though they

continued to do so everywhere else in the world! If they get away with it in

Norway, you can be certain that they will repeat the process elsewhere. As a

result, millions of patients with high blood pressure will be forced to pay

higher than necessary prices to line Big Pharma’s pockets.

 

Concern for patient’s welfare, of course, has never been very prominent on Big

Pharma’s agenda. The continuing revelations concerning the acne drug Accutane

are a case in point.

 

Virtually every teenager has to deal with some degree of acne during puberty.

For most it’s just a minor inconvenience as they go through the physical changes

that accompany becoming an adult. For some, however, it is much more than that.

They suffer from particularly severe acne that can leave them ostracized by

their peers and disfigured for life. For these young people, Accutane seemed

like a gift from heaven. Indeed, it was so effective that doctors began to

prescribe it for even mild to moderate cases – and why not? The manufacturer

said it was safe, and the FDA had approved it.

 

As the drug came into widespread use, however, disturbing reports began to

filter in. Some teenagers taking the acne medicine apparently were becoming

depressed – so depressed that they even contemplated or attempted suicide! At

first the manufacturer denied any connection, but after a time, the data were

beyond dispute. By December of 2000, the FDA had received reports of 66 suicides

and nearly 1,400 other cases of serious psychiatric problems among Accutane

users. As a result, the manufacturer was required to amend the label to indicate

it could cause “… depression, psychosis and, rarely, suicidal ideation, suicide

attempts and suicide.” That’s an awfully high price to pay for clear skin –

especially when depression and suicide are epidemic among America’s young

people.

 

Currently, suicide is the second leading cause of death among young people aged

15 to 19 years – the very population most likely to be prescribed Accutane.

Every day, 14 young people commit suicide – that’s equal to one every 100

minutes. Young women attempt suicide three times more frequently than young men.

 

But depression and suicidal tendencies were not the end of the problems Accutane

could cause.

 

On February 27th, an FDA advisory panel recommended that a national registry be

created for Accutane to help assure that young women using the drug do not

become pregnant. A similar registry was created for thalidomide when the drug

was reintroduced several years ago. The reason is quite simple, Accutane causes

birth defects. More important, this fact has been known for years.

 

Initially, the FDA allowed the manufacturer to create a “voluntary” registry to

assure users did not become pregnant – the only trouble was it didn’t work.

 

 

 

 

 

 

 

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