Top killers in U.S.
January 14, 2009 at 9:57 pm | In BioMedicine, Modern Research, Science, Social Medicine | 3 CommentsTags: Iatrogenic Disease
Tope three killers in the u.s. as reported in JAMA: 1 700000 2. 553000 3. 250000
(* Note: I made two errors when making my beautiful piechart – I cited 250,000 as the number of iatrogenic deaths, when the actual number is 280,000. I also mistakenly switched two sources for the deaths, ADRs and total injuries. Source below.)
Over a million patients are injured in U.S. hospitals each year, and approximately 280,000 die annually as a result of these injuries. Therefore, the iatrogenic death rate dwarfs the annual automobile accident mortality rate of 45,000 and accounts for more deaths than all other accidents combined.
Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, SheaBF, Hallisey R, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995 Jul 5;274(1):29-34.
When these numbers came out in 1995, Reuters didn’t pick them up. Why? These are shocking numbers.
It’s not the only piece of research that paints this shocking picture either: Gary Null paints a picture far more gruesome – total deaths due to conventional medical interventions and problems picked up in hospitals (such as infections) is 783,936 per year. Then, depending on the numbers for the other two top killers, Heart Disease and Cancer, Conventional medicine takes either the top or second spot.
Let’s look at another pie graph:
Top three killers in the u.s. as reported by G Null
The modern healthcare system is not supposed to do this. This is out of bounds. What now?
References:
Lazarou J, Pomeranz BH, Corey PN, Incidence of Adverse Drug Reactions in Hospitalized Patients, Journal of the American Medical Association (JAMA), Vol. 279. April 15, 1998, pp. 1200-05.
Bates, DW., Drugs and Adverse Drug Reactions: How Worried Should We Be? JAMA, Vol. 279. April 15, 1998, pp. 1216-17.
Leape L, Error in medicine, JAMA 1994;272:1851-7.
Schuster M, McGlynn E, Brook R. How good is the quality of health care in the United States? Milbank Q. 1998;76:517-563.
Starfield B. Evaluating the State Children’s Health Insurance Program: critical considerations. Annu Rev Public Health.
Phillips D, Christenfeld N, Glynn L. Increase in US medication-error deaths between 1983 and 1993. Lancet. 1998;351:643-644.
Leape L. Unnecessary surgery. Annu Rev Public Health. 1992;13:363-383.
Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology and medical error. BMJ. 2000;320:774-777.
Guyer B, Hoyert D, Martin J, Ventura S, MacDorman M, Strobino D. Annual summary of vital statistics 1998. Pediatrics. 1999;104:1229-1246.
HarHolland E, Degruy F. Drug-Induced Disorders – November 1, 1997 – American Family Physicianrold LR, Field TS,
Gurwitz JH. Knowledge, patterns of care, and outcomes of care for generalists and specialists. J Gen Intern Med. 1999;14:499-511.
World Health Report 2000. Available at: http://www.who.int/whr/2000/en/report.htm. 2000;21:569-585.
Sugar Proven Addiction
December 31, 2008 at 6:33 pm | In BioMedicine, Modern Research | Leave a CommentTags: Bias, Diabetes, perception, Sugar
From: http://tinyurl.com/a3bbja
It would be so nice to read a headline on a study like this that goes, “Scientists confirm what we all knew”. It would lead to such a different perception of the process.
As it stands, it seems to me that we give up our self-awareness to studies like this, simply by accepting that this kind of research “needs” to be done.
In all honesty, anyone with a smidgen of self-awareness knows that a human being can become addicted to anything.
Sugar? Well, absolutely.
So what’s the research for?
To find what particular pathways are affected.
To what end?
To help people come off their addiction. Ok, stop. Is sugar addiction really that strong? Are we so weak that we can no longer fight against pasta, bread, glucose-supplemented fruit juices and chocolate? There seems to be a slippery slope here somewhere… I am sure that someone, somewhere, has commented on the medicalisation of the human condition – “Why you’ve been hopelessly afflicted with the Human Condition? Egads, good thing we have a drug for that. Several actually…take a seat – they’re still experimental… but you’ll be helping us clear the path… good man”.
Maybe the benefits are in the spin-off research – if we study the pathways of sugar addiction we’ll find the cure to alzheimers. Or an anti-diabetes drug (or the solution for global warming!). All well and good when we put it that way…but isn’t a major issue for most diabetics “managing” sugar effectively? See my diabetes post for a discussion on this topic.
In any case, the idea is regarding the usefulness of research – something that is greatly critiqued in the bioethics community:
This is [...] to note that much of the scientific literature – perhaps especially the biomedical literature – is as much about waving arms as it is about communicating results. This is a vulgar glut that pollutes the scientific corpus. (Goodman 2003)
I hope that the next time we see a research article that seems to proclaim a re-invention of the wheel, we will stop and realise that in science, like in any other profession, there are factors at play which are very human in nature. See if the article says something really useful, and otherwise maintain a healthy skepticism – which, by the way, does not take a particular stance, other than to question until clarity occurs.
Do Breast Tumours Go Away On Their Own?
November 25, 2008 at 7:26 pm | In BioMedicine, Modern Health-Care, Modern Research | Leave a CommentTags: Anomalous Data Point, Fear, RCT
The Archives of Internal Medicine published an article this week which challenges the conventional wisdom regarding the early detection of breast cancer.
This bit of research is an excellent example of what RCTs are good for: examination of apparently homogeneous populations to find indications of non-homogeneity.
Two groups were studied – women with frequent screening (and their cancer rates), and women with infrequent screening (and their cancer rates). The researchers were astounded to discover that, in these two large groups of people (approx 100,000 each), there was a twenty two percent greater incidence of cancer in the women who were screened frequently[1].
There are many explanations for this phenomena – the one that the authors advance is that a certain proportion of tumors go away “on their own” (although this author is certain it is not quite that random or mysterious).
If we read the USA Today article, we can find an interesting statement by the cancer society’s Robert Smith: “It’s important that people not wonder if women lost their breasts for no reason. That’s a reprehensible conjecture.”
Mr. Smith, medicine is not about feel-good. It’s about finding the correct way to maintain health and the correct way to resolve disease. Avoiding a conjecture because of a bad feeling is bad medicine. Conjectures should be based on the best available data and followed accordingly.
And, yes, unfortunately, human life does seem to have quite a bit of uncertainty and ignorance built-in.
From the study:
Conclusions Because the cumulative incidence among controls never reached that of the screened group, it appears that some breast cancers detected by repeated mammographic screening would not persist to be detectable by a single mammogram at the end of 6 years. This raises the possibility that the natural course of some screen-detected invasive breast cancers is to spontaneously regress.
Why the fear that cancer can be cured? Why not just write that the evidence indicates that the body is able to heal some cancers on its own some of the time?
The fear, in this case, doesn’t help us.
There is another possibility, which is the one that the spokesman for the cancer society immediately assailed: is it possible that the search and treatment for cancer causes more cancer?
It would seem that, if this is the case, the fear definitely doesn’t help us.
1.The natural history of invasive breast cancers detected by screening mammography. Arch Intern Med. 2008 Nov 24;168(21):2302-3.
Diagnosis
November 13, 2008 at 4:45 pm | In BioMedicine, Chinese Medicine | Leave a CommentTags: jargon, Terminology
Question: Does anyone know what Trichotillomania is? My daughter was diagnosed with this recently. Any help is appreciated.
Response: Oh gosh. Trichotillomania. How obscenely stupid. I wonder if this syndrome is further differentiated based on whether it is the left or right hand that’s doing the pulling, or if there is a naming convention that takes into account how many strands of hair are in each fistful, and how many, thereof, are dyed, split-ended or glossy?
There is one good thing about this obsessive compulsion to give long, stupid names to diseases, and that is that the name for fear of long names is Hippopotomonstrosesquippedaliophobia.
Anyway, on to something useful, I hope:
Apart from being all technically technicacious about our patients, we shouldn’t forget to be human. While we must be very careful to mind our manners, ethics, scope of practice and personal limitations, be not afraid to be human. If someone is pulling their hair out, ask yourself, what in god’s dreaming heaven would cause ME to pull out my mane. Start from there, and you may find a way to delicately tease out (part, just enough) of a painful story to inform your pattern diagnosis, and perhaps give the girl and her family a better result than something who blindly, meaninglessly tries to treat for liver qi, or phlegm misting the heart.
In a case like this, it might be most important to find out what started it. I just had a patient in the other week with bad chest pain who responded not at all to western medicine, a very competent naturopath or a very heartfelt osteopath, and yet responded in my clinic (with a 100% reduction in pain after 20 minutes), in my humble opinion, because I asked her what was going on when this started (thirty years ago when she was 17). And when she said “nothing”, I gently said, “something”. And eventually she “mentioned”, by the by, that her boyfriend, when she was 16, had tried to kill her. I gently, over the course of our conversation, explained about some possible connections, placed some needles in her, and she seemed to relax, cry, and begin a new stage in her life. Not my credit, I credit it to being human, and trying to keep the old sages in mind.
(excerpted from an online forum conversation)
I Love Chinese Medicine
September 25, 2008 at 3:04 pm | In BioMedicine, Chinese Medicine | Leave a CommentTags: Diagnosis, Narcissism, Theory
A topic that I expect to touch upon often in this blog is the problem of loving systems more than people. I recall that while I was in school my teacher would often say, “but just remember, this is theory!”. He meant many things by this, but the fundamental meaning always had to do with mental constructs and their limitations. It is a wisdom that runs throughout Chinese culture (and, I wager, traditional cultures in general) that a system is no more than a bridge, and that, when it has been crossed, that bridge will lose its usefulness as the journey continues on the other side.
I have witnessed, so many times, medical Doctors loving their diagnosis more than the patient. Because of technical reasons which I will explore in another post on CM diagnosis, this is more difficult to do in CM, but yet I have still seen it happen. I too have found myself loving my system more than my patient at times.
This is dangerous because when we do this our patient loses their voice, and we, as therapists, lose our life-line to the truth of their condition.
Therapists must always stand on the side of the patient, not the theory, and yet both people must simultaneously retain a healthy respect for the guidance and context which the theory brings. Only in this way can we be sure to remain therapists and not cross the line into mental narcissism.
Blog at WordPress.com. | Theme: Pool by Borja Fernandez.
Entries and comments feeds.
