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.
There is a Rhyme and a Reason
December 8, 2008 at 12:54 am | In Chinese Medicine, Herbal Medicine, Modern Research, Science | Leave a CommentTags: Chinese Medicine, Herbal Medicine, jargon, Skepticism, Theory
While I don’t like to go on about reductionism and its assumed evils and so forth, there are grains of truth in these criticisms.
There is a difference between a complex, open (interconnected) system and a small, (relatively) closed system – the former is like the weather, and the latter is like a motor vehicle. I believe we are all familiar with the viscissitudes of weather forecasting, and yet, on the other hand, how generally reliable and unperplexing our vehicles are.
In essence, the first system cannot be reduced without losing its essential complexity and interrelatedness, while the second one can (for a deeper discussion on the relative aspects of this idea, click here). This means that in order to understand a complex, open system, it must be met in its arena of effect. Reducing the arena changes the game and damages the data irretrievably.
In a previous post (Herb Comparable to Prednisone), I wrote about how the oversimplification of Chinese Medical principles tended to damage the effectiveness of the intervention, sometimes completely, and how it was important to understand that in Chinese Medicine we do things for a reason.
More careful research can illuminate some of these reasons, and I would like to provide you with a brief glimpse into one of these investigations:
Chinese Medicine almost always uses herbal combinations rather than single herbs, not only because a single herb has a weak effect, but because herbs can act in synergistic or antagonistic ways to each other (amongst other effects). Thus a properly constructed formula with the individual patient in mind provides a superior effect than the administration of a single herb, or of a non-individualised formula.
The following graph from the Biological and Pharmaceutical Bulletin (2003;26(7):911-919) dramatically illustrates this phenomenon:
The blood concentration of wagonoside from HuangQinTang was twice as high as that of HuangQin alone.
HuangQin Tang is a Chinese Herbal Combination, Huang Qin is merely the lead herb.
HuangQin Tang contains: huáng qín, huáng lián, gé gēn, and zhì gān cǎo.
This type of investigation makes two points:
1. There is a reason that herbal combinations are the standard of care in CM.
2. Deconstructing an open, complex system is fraught with dangers if the aim is to illuminate the true mechanisms or energetic dynamics of said system.
In the western world, and even the eastern world, too much effort has been spent on “identifying” the one herb in a formula which provides the effect, and then further “isolating” “active ingredients” in order to provide the end-user with a “real” medicinal in a “more potent” form for, ostensibly, superior clinical effect.
It’s as if a scientist wanted to provide us with a better vehicle, and decided the active ingredient was the piston, made us a big giant piston to use and acted all proud.
It is my hope that our understanding of the ancient and wise medical systems of this world becomes much more mature in the next short little while.
Incidentally, HuangQin Tang is primarily used for something called “Damp-Heat in the Lower Burner”, one manifestation of which is dysentery. Years ago, a chemical called “berberine” was isolated from another herb in this formula, huáng lián, and used in cases of dysentery. And yes, you guessed it, it doesn’t work as well as HuangQin Tang for the indicated condition.
Oh well.
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.
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