The Iatrogenic Injury Page

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary.   If you want information about a specific disease, you can access the Merck Manual.   You can also search Pub Med for more abstracts on this, or any other health topic.

Iat·ro·gen·ic
Pronunciation:   I-a-tro-jen-ik
Function:   adjective
Meaning:   Induced inadvertently by a physician or surgeon, or by medical treatment or diagnostic procedures <an iat·ro·gen·ic rash>
- iat·ro·gen·i·cal·ly /-'jen-i-k(&-)lE/ adverb
- iat·ro·ge·nic·i·ty /-j&-'nis-&t-E/ noun, plural -ties

“Medicine is now a high risk industry, like aviation. But, the chance of dying in an aviation accident is one in 2 million, while the risk of dying from a medical accident is one in 200!” –– Dr. Lucian Leape, of the Harvard Medical School of Public Health

Iatrogenic Abstracts

	The Antibiotic Abuse Page A Chiro.Org article collection This new page explores the emergence of antibiotic resistant bacteria because of medical over-reliance on antibiotics as a cure-all, and due to use of antibiotics as a fattening agent in animal feed.
	Inappropriate Use of Skeletal Muscle Relaxants in Geriatric Patients U. S. Pharmacist 2020 (Jan 21); 45 (1): 25–29 ~ FULL TEXT Skeletal muscle relaxants are a sedating class of medications used to treat spasticity and pain. Their sedative properties can pose a risk for geriatric patients who are predisposed to falls. It is important for the pharmacist to assess the patient before dispensing medications. Short-term use of skeletal muscle relaxants may be appropriate for certain conditions but should not be used long-term, regardless of interaction. Alternative pharmacologic options exist, but most have drawbacks. Nonpharmacologic therapy may be a better option in both the short term and the long term. Nonpharmacologic education on fall prevention is essential in patients being given skeletal muscle relaxants, regardless of duration of therapy. Not only will appropriate use of skeletal muscle relaxants improve patient outcomes, it can also improve star ratings for both insurance providers and pharmacies.
	Guideline for Opioid Therapy and Chronic Noncancer Pain CMAJ. 2017 (May 8); 189 (18): E659–E666 A new Canadian guideline published today (May 8, 2017) in the Canadian Medical Association Journal (CMAJ) strongly recommends doctors to consider non-pharmacologic therapy, including chiropractic, in preference to opioid therapy for chronic non-cancer pain.
	Non-steroidal Anti-inflammatory Drugs for Spinal Pain: A Systematic Review and Meta-analysis Annals of the Rheumatic Diseases 2017 (Feb 2) [Epub] While it is now clear that paracetamol is ineffective for spinal pain, there is not consensus on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for this condition. We performed a systematic review with meta-analysis to determine the efficacy and safety of NSAIDs for spinal pain. We included 35 randomised placebo-controlled trials. NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo. Six participants (95% CI 4 to 10) needed to be treated with NSAIDs, rather than placebo, for one additional participant to achieve clinically important pain reduction. When looking at different types of spinal pain, outcomes or time points, in only 3 of the 14 analyses were the pooled treatment effects marginally above our threshold for clinical importance. NSAIDs increased the risk of gastrointestinal reactions by 2.5 times (95% CI 1.2 to 5.2), although the median duration of included trials was 7?days.
	FDA Asks Doctors to Limit Acetaminophen in Prescription Meds Medscape Medical News ~ January 15, 2014 The US Food and Drug Administration (FDA) is asking healthcare professionals to stop prescribing combination prescription pain relievers that contain more than 325 mg of acetaminophen per tablet, capsule, or other dosage unit, citing the risk for liver damage.
	Epidural Steroid Injections: Are long-term Risks Worth Short Term Benefits? ACA News ~ February 2014 While it is true that epidural steroid injections (ESI) are not FDA approved, Medicare, Medicaid, workers’ compensation and most other insurers continue to pay hundreds of millions of dollars per year for this controversial procedure.   Ironically, on every vial of Kenalog (a popular steroid used for epidural injections) there is actually a warning against its use for epidural injections, yet proceduralists continue to use it.
	Quantifying the Impact of NSAID-associated Adverse Events Am J Manag Care. 2013 (Nov); 19 (14 Suppl): s267–272 Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used among patients experiencing many different types of pain, including inflammatory, acute pain (eg, injury, low back pain, headache, postoperative pain), and chronic pain (eg, rheumatoid arthritis, osteoarthritis).   However, both traditional NSAIDs and second-generation NSAIDs (cyclooxygenase-2 inhibitors) can lead to very expensive and serious adverse events. Gastrointestinal, cardiovascular, and renal complications associated with NSAIDs have been shown to be dose-dependent. In 2005, to help minimize these risks, the US Food and Drug Administration issued a public health advisory stating that "NSAIDs should be administered at the lowest effective dose for the shortest duration consistent with individual patient treatment goals."
	Recent Report Highlights Growing Dangers of Anti-Inflammatory Medications Dynamic Chiropractic ~ January 29, 2012 “Non-steroidal anti-inflammation drugs (NSAIDs) are one of the most common causes of reported serious adverse reactions to drugs, with those involving the upper gastrointestinal tract (GIT), the cardiovascular system and the kidneys being the most common. Much of the focus on NSAID adverse effects has been on GIT consequences, with good reason. A U.S. study found the rate of deaths from NSAID-related GIT adverse effects is higher than that found from cervical cancer, asthma or malignant melanoma.”   [1]
	No-fault Compensation for Treatment Injury in New Zealand: Identifying Threats to Patient Safety in Primary Care British Medical Journal Quality & Safety 2011 (Jul); 20 (7): 587–591 New Zealand's no-fault treatment injury claims database provides information about primary care patient safety events from an unusual 'no-fault' perspective.   This analysis reinforces previous research identifying medication as a high-risk primary care activity and further identifies other primary care activities (dental care, injections, venepuncture, cryotherapy and ear syringing) as carrying important risks for patient harm.
	Money and Spinal Surgery: What Happened to the Patient? J American Medical Association 2010 (Apr 7); 303 (13): 1259–1265 ~ FULL TEXT There is a lack of evidence-based support for the efficacy of complex fusion surgeries over conservative surgical decompression for elderly stenosis patients. There is, however, a significant financial incentive to both hospitals and surgeons to perform the complex fusions. Spinal stenosis is the most frequent cause for spinal surgery in the elderly. There has been a slight decrease in these surgeries between 2002 and 2007. However, there has also been an overall 15 fold increase in the more complex spinal fusions (360 degree spine fusions). Deyo et. al. in yesterday’s issue (April 7, 2010) of the Journal of the American Medical Association concludes that “It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years. The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications…financial incentives to hospitals and surgeons for more complex procedures may play a role…” There is a significant difference in mean hospital costs for simple decompression versus complex surgical fusion. The cost of decompression is $23,724 compared to an average of $80,888 for complex fusion. Despite the much higher cost, there is no evidence of superior outcomes and there is greater morbidity associated with the complex fusion. The surgeon is typically reimbursed only $600 to $800 for simple decompression and approximately ten times more, $6,000 to $8,000 for the complex fusion.
	Widely Used Anti-Inflammatory Drug Risky Even in Small Doses MedPage Today ~ October 26, 2009 Even at low doses, naproxen (Aleve, Anaprox, Naprosyn, Naprelan) may increase the risk of upper gastrointestinal complications, researchers said here. Patients taking a 500-mg/day dose had a 2.5-fold increased risk of hospitalization from complicated gastric or duodenal ulcer, while those on the 750-mg/day dose had almost a threefold increased risk, Gurkirpal Singh, MD, of Stanford University, and colleagues reported at the American College of Gastroenterology meeting. [1]
	Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in US Children's Hospitals Pediatrics 2008 (Apr); 121 (4): e927–935 Adverse drug event rates in hospitalized children are substantially higher than previously described. Most adverse drug events resulted in temporary harm, and 22% were classified as preventable. Only 3.7% of these injuries were identified by using traditional voluntary reporting methods! Our pediatric-focused trigger tool is effective at identifying adverse drug events in inpatient pediatric populations. [Editorial Commentary: These findings (that only 3.7% of adverse events find their way into hospital error reports) is very alarming, and suggests that previous reports have only documented the tip of the iceberg.]
	Early Life Infections Improve the Function of the Immune System American Journal of Clinical Chiropractic 2006 (Apr); 16 (2): 22–25 This collection of medical citations presented by Dan Murphy, DC demonstrates that early exposure to antibiotic use and Pertussis vaccination contribute to the development of atopic disorders such as asthma, and hay fever, and may also be associated with the onset of pediatric lymphoblastic leukemia. Our thanks to the American Journal of Clinical Chiropractic for releasing this article exclusively at Chiro.Org!
	Diagnostic Error in Internal Medicine Archives of Internal Medicine 2005 (Jul 11); 165 (13): 1493–1499 Ninety cases involved injury, including 33 deaths. The underlying contributions to error fell into 3 natural categories: "no fault," system-related, and cognitive. Seven cases reflected no-fault errors alone. In the remaining 93 cases, we identified 548 different system-related or cognitive factors (5.9 per case). System-related factors contributed to the diagnostic error in 65% of the cases and cognitive factors in 74%. The most common system-related factors involved problems with policies and procedures, inefficient processes, teamwork, and communication. The most common cognitive problems involved faulty synthesis. Premature closure, ie, the failure to continue considering reasonable alternatives after an initial diagnosis was reached, was the single most common cause. Other common causes included faulty context generation, misjudging the salience of findings, faulty perception, and errors arising from the use of heuristics. Faulty or inadequate knowledge was uncommon.
	Prescription-related Illness--A Scandalous Pandemic J Eval Clin Pract 2004 (Nov); 10 (4): 491–497 Prescribed drugs are now a major cause of morbidity and mortality, particularly in the elderly. The extent of this pandemic is described and its likely causes in primary care are identified: unnecessary prescribing, imprecise diagnosis, inadequate undergraduate and postgraduate education in pharmacology and therapeutics, the uncritical application of evidence-based medicine, the outstanding development of new drugs and their sometimes unjustified promotion. Urgent action is recommended under seven headings, by health administration, epidemiologists, medical educators and prescribing doctors.
	Death by Medicine Life Extension Magazine ~ March 2004 No one had ever analyzed and combined ALL of the published literature dealing with injuries and deaths caused by government-protected medicine. That has now changed. A group of researchers meticulously reviewed the statistical evidence and their findings are absolutely shocking. This fully referenced report shows the number of people having in-hospital, adverse reactions to prescribed drugs to be 2.2 million per year. The number of unnecessary antibiotics prescribed annually for viral infections is 20 million per year. The number of unnecessary medical and surgical procedures performed annually is 7.5 million per year. The number of people exposed to unnecessary hospitalization annually is 8.9 million per year.   The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year!!!
	Adverse Side Effects from Medication Are Common LE Magazine 2003 (Dec) “This study is important because it showed that adverse drug events were found in 23% of ambulatory patients, a rate five times as high as that found in another recent study of the community-living elderly,” said Dr. Gandhi. “We probably found such a high rate because we called patients directly, while other studies have relied mainly on chart review.”
	Use Caution With Pain Relievers FDA Consumer Magazine ~ January 2003 The committee also recommended that labeling for aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen include warnings about the potential for gastrointestinal bleeding that may be associated with use of these products. Aspirin is sold under brand names such as Bayer and St. Joseph's. Ibuprofen is sold under names such as Advil and Motrin. Naproxen is sold under the name Aleve. There are generic versions available for all of these products, as well.
	Understanding NSAIDs: From Aspirin to COX-2 Clin Cornerstone 2001; 3 (5): 50–60 Nonsteroidal anti-inflammatory drugs (NSAIDs) annually account for 70 million prescriptions and 30 billion over-the-counter (OTC) medications sold in the United States alone. Some formulas are safe enough to be sold OTC for use in infants with fever, while others are available only as a prescription medication and are a leading cause of iatrogenic reactions, hospitalizations, and death.

Unnecessary Surgical Procedures From:   Testimony to the Department of Veterans Affairs' Chiropractic Advisory Committee George B. McClelland, D.C., Foundation for Chiropractic Education and Research March 25, 2003 In 1974, the Congressional Committee on Interstate and Foreign Commerce held hearings on unnecessary surgery. Their findings from the first surgical second opinion program found that 17.6% of recommendations for surgery were not confirmed. The House Subcommittee on Oversight and Investigations extrapolated these figures to estimate that, on a nationwide basis, there were 2.4 million unnecessary surgeries performed annually resulting in 11,900 deaths at an annual cost of $3.9 billion. [1] With the total number of lower back surgeries having been estimated in 1995 to exceed 250,000 in the U.S. at a hospital cost of $11,000 per patient. [2] This would mean that the total number of unnecessary back surgeries each year in the U.S. could approach 44,000, costing as much as $484 million. 1. US Congressional House Subcommittee Oversight Investigation. Cost and Quality of Health Care: Unnecessary Surgery. Washington, DC: Government Printing Office, 1976 2. Herman R. Back Surgery. Washington Post [Health Section], April 18, 1995

	NSAIDs and Musculoskeletal Treatment: What Is the Clinical Evidence? PHYSICIAN AND SPORTSMEDICINE 2003 (Jan); 31 (1) ~ FULL TEXT Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for musculoskeletal injuries because the conditions are believed to be inflammatory in nature. However, because inflammation is a necessary component in the healing process, decreasing inflammation may prove counterproductive. Also, many tendon injuries called 'tendinitis' are, in fact, degenerative and not inflammatory conditions. An analysis of the pathophysiology and healing of musculoskeletal injuries questions the use of NSAIDs in many treatment protocols. Because NSAIDs have profound side effects, they should not automatically be the first choice for treating musculoskeletal injuries.
	Medication Errors Observed in 36 Health Care Facilities Arch Intern Med 2002 (Sept 9); 162 (16): 1897–1903 Answering 20% of the questions wrong on tests taken in school is generally considered better than average, earning a student a B or C letter grade. But when it comes to hospitals providing medication to patients, would you consider dosage mistakes made 20% of the time acceptable? In this study, one in five doses were incorrect; 7% of all dosages (or nearly 40% of errors) were deemed potentially harmful to the patient. In order of likelihood, the most frequent errors were: drugs given at the wrong time; omission of the correct medication; incorrect dosages; or unauthorized drugs given.
	Drug-induced Iatrogenic Intraparenchymal Hemorrhage Neurosurg Clin N Am 2002 (Jul); 13 (3): 299–312 Intracerebral hemorrhage is bleeding into the brain parenchyma with possible extension into the ventricles and subarachnoid space. Each year, approximately 37,000 to 52,400 people suffer from intraparenchymal hemorrhage (IPH) in the United States. This rate is expected to rise dramatically in the next few decades as a result of the increasing age of the population and a change in racial demographics. IPH accounts for 8% to 13% of all stroke cases and is associated with the highest mortality rate.
	Perioperative Deaths: A Further Comparative Review of Coroner's Autopsies with Particular Reference to the Occurrence of Fatal Iatrogenic Injury Ann Acad Med Singapore 2000 (Jul); 29 (4): 486–497 Another article finds that approximately 2% of those admitted to a hospital experience death, as revealed at autopsy. It goes on to say that “it is not clear why initial, supposedly elective, interventions should be associated with an apparently greater risk of iatrogenic injury than those classified as emergency procedures.”
	Severe Complication of a Commonly Prescribed Drug: Minocycline-Induced Lupus J Am Board Fam Pract 2002 (May); 15 (3): 239–241 This Adobe Acrobat article states: The constellation of symptoms that includes persistent fever, weight loss, general malaise with rash, myalgias, and arthritis brings a number of serious conditions into consideration: malignancies, connective tissue diseases, and systemic infections. Drug-induced complications also fall into this differential diagnosis. Drug-induced lupus is most commonly associated with procainamide (first described in 1962), hydralazine, chlorpromazine, isoniazid, a-methyldopa, and quinidine. From 46 to 70 drugs can cause drug-induced lupus.
	A Comparison of Iatrogenic Injury Studies in Australia and the USA. II: Reviewer Behaviour and Quality of Care Int J Qual Health Care 2000 (Oct); 12 (5): 379–388 This article found that approximately 2% of those admitted to a hospital experience major disability and/or death. WOW! A FULL-TEXT version is available.
	Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs New England Journal of Medicine 1999 (Jun 17); 340 (24): 1888–99 ~ FULL TEXT Starting in the early 1970s, numerous new NSAIDs were developed that were initially believed to be devoid of gastrointestinal toxicity, but few, if any, are entirely harmless. These agents constitute one of the most widely used classes of drugs, with more than 70 million prescriptions and more than 30 billion over-the-counter tablets sold annually in the United States. [9] Although NSAIDs are generally well tolerated, adverse gastrointestinal events occur in a small but important percentage of patients, resulting in substantial morbidity and mortality.
	Recent Considerations in Nonsteroidal Anti-inflammatory Drug Gastropathy American Journal of Medicine 1998 (Jul 27); 105 (1B): 31S–38S Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated. Analysis of these data indicates that: (1)   osteoarthritis (OA) and rheumatoid arthritis (RA) patients are 2.5—5.5 times more likely than the general population to be hospitalized for NSAID-related GI events; (2)   the absolute risk for serious NSAID-related GI toxicity remains constant and the cumulative risk increases over time; (3)   there are no reliable warning signals- >80% of patients with serious GI complications had no prior GI symptoms; (4)   independent risk factors for serious GI events were age, prednisone use, NSAID dose, disability level, and previous NSAID-induced GI symptoms; and (5)   antacids and H2 antagonists do not prevent NSAID-induced gastric ulcers, and high-risk NSAID users who take gastro-protective drugs are more likely to have serious GI complications than patients not taking such medications. Currently, limiting NSAID use is the only way to decrease the risk of NSAID-related GI events.
	Incidence of Adverse Drug Reactions in Hospitalized Patients JAMA 1998 (Apr 15); 279 (15): 1200–1205 ~ FULL TEXT Although the abstract quotes no numbers in the text, the body of the article states “that more than 2 million Americans become seriously ill every year from reactions to drugs that were correctly prescribed and taken, and that 106,000 Americans die annually from those side effects.” (emphasis added)   A related JAMA Editorial in the same issue also states that “ADRs may be the fourth to sixth leading cause of death, and that drug-related injuries occur in 6.7% of hospitalized patients.”   WOW! You may also want to read this AHRQ review titled: Incidence of Adverse Drug Reactions in Hospitalized Patients
	The Challenge of Antibiotic Resistance Scientific American March 1998 Last year an event doctors had been fearing finally occurred. In three geographically separate patients, an often deadly bacterium, Staphylococcus aureus, responded poorly to a once reliable antidote--the antibiotic vancomycin. Fortunately, in those patients, the staph microbe remained susceptible to other drugs and was eradicated. But the appearance of S. aureus not readily cleared by vancomycin foreshadows trouble.
	Therapeutic Misadventures With Acetaminophen: Hepatoxicity After Multiple Doses in Children J Pediatr 1998 (Jan); 132 (1): 22—27 Isn't that cute? A less threatening term to describe an accident.   Twenty-four of 43 patients (53%) died, with an additional three surviving after orthotopic liver transplantation. Parents should be advised about the potential hepatotoxicity of acetaminophen when given to ill children in doses exceeding weight-based recommendations.
	Prescribing of Nonsteroidal Anti-inflammatory Drugs in General Practice: Determinants and Consequences Aliment Pharmacol Ther 1997 (Apr); 11 (2): 293–298 The data are compatible with 1 hospital admission per 2823 NSAID prescriptions (95% confidence intervals 2098-8110) and they emphasize the need for strategies to reduce levels of NSAID prescribing.
	Emergency Admissions for Upper Gastrointestinal Disease and Their Relation to NSAID Use Aliment Pharmacol Ther 1997 (Apr); 11 (2): 283–291 There is a strong association between NSAID use and propensity for upper gastrointestinal emergency admission; NSAID use is associated with significant morbidity and mortality each year in UK.
	A Risk Assessment of Cervical Manipulation vs. NSAIDs for the Treatment of Neck Pain J Manipulative Physiol Ther 1995 (Oct); 18 (8): 530–536 As for comparative safety, the best available evidence indicates that NSAID use poses a significantly greater risk of serious complications and death than the use of cervical manipulation for comparable conditions. In conclusion, the best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain.
	Effect of Non–steroidal Anti–inflammatory Drugs on the Course of Osteoarthritis Lancet 1989 (Sep 2); 2 (8662): 519–522 To test the hypothesis that non–steroidal anti–inflammatory drugs (NSAIDs) accelerate the progression of osteoarthritis by reducing synthesis of vasodilator prostaglandins, thereby diminishing joint perfusion, 105 osteoarthritis patients awaiting hip arthroplasty were treated prospectively with a strong or weak prostaglandin synthesis inhibitor, indomethacin or azapropazone, respectively. In the indomethacin group the affected hips lost joint space more rapidly than did the contralateral hips, a difference not seen in the azapropazone group.

Iatrogenic Articles

	The Antibiotic Abuse Page A Chiro.Org article collection This new page explores the emergence of antibiotic resistant bacteria because of medical over-reliance on antibiotics as a cure-all, and due to use of antibiotics as a fattening agent in animal feed.
	Public Citizen Petitions FDA to Take Celebrex and Bextra Off the Market Public Citizen ~ January 24, 2005 Public Citizen today petitioned the U.S. Food and Drug Administration (FDA) to immediately remove two widely prescribed pain relievers, Celebrex and Bextra, from the market because they increase the risk of heart attacks in patients. The group also urged the FDA to cancel plans to approve two other drugs in the same class.
	Medicare Patients Dying at Rate of 195,000 a Year Due to Medical Errors HealthGrades Quality Study. Patient Safety in American Hospitals ~ July 2004 An average of 195,000 Medicare patients in the U.S. died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a new study of 37 million patient records that was released in July by HealthGrades, the healthcare quality company. That's 534 people killed every day!
	Free Drugs For Grandma! Todays Chiropractic ~ March 2004 Uncle Sam now proposes giving senior Americans free prescription drugs. While this ploy may help many cash-strapped seniors financially, it will definitely be a windfall for the drug companies—as if they needed more profits. The drug industry last year was the most profitable industry on Wall Street, with earnings of over 40 percent. Considering the fact that Americans are the most over-medicated society in the history of the world, or the fact that the American Medical Asociation estimates 2.2 million adverse drug reactions occur every year resulting in over 100,000 deaths, people are nonetheless sold on “wonder” drugs as their quick-fix salvation to serious health problems. I recall one article that mentioned the average senior already takes 28 prescriptions.
	Don’t Chase Aspirin With Ibuprofen: It Can Block the Heart-protecting Effects of Aspirin The popular pain reliever ibuprofen blocks the heart-protecting effects of aspirin, according to a new study (NEJM 2001 (Dec 20): 345 (25): 1809-1817). The results, if confirmed, would have major implications for millions of people who take a small dose of aspirin every day for their hearts, but who also take ibuprofen, widely known in North America under the brand names Advil and Motrin, to cope with conditions such as arthritis.
	The True Cost of Drugs Rush Limbaugh Online and Anne Boone Did you ever wonder how much it costs a drug company for the active ingredient in prescription medications? Some people think it must cost a lot, since many drugs sell for more than $2.00 per tablet. In reality, the markup on many popularly used drugs ranges from 2000% to 224,973%. WOW. No wonder there's a Walgreens on every corner!
	Does the Pharmaceutical Model Still Hold Water? Functional Foods & Nutraceuticals (January 2003) After several years as an executive in the pharmaceutical industry, Jean Nordström questioned that approach to human health, so he started his own natural ingredients company. Here he considers the role of both paradigms in improving human health.
	Death by Medicine Life Extension Magazine ~ March 2004 No one had ever analyzed and combined ALL of the published literature dealing with injuries and deaths caused by government-protected medicine. That has now changed. A group of researchers meticulously reviewed the statistical evidence and their findings are absolutely shocking. This fully referenced report shows the number of people having in-hospital, adverse reactions to prescribed drugs to be 2.2 million per year. The number of unnecessary antibiotics prescribed annually for viral infections is 20 million per year. The number of unnecessary medical and surgical procedures performed annually is 7.5 million per year. The number of people exposed to unnecessary hospitalization annually is 8.9 million per year. The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year!!!
	Natural COX-2 Inhibitors The Future of Pain Relief Nutrition Science News (August 2000) While COX-2 inhibition may seem to clearly describe one pharmacological effect of several common and widely recognized natural products, such a benefit cannot be confirmed until each is systematically tested for such activity. However, the odds seem in favor of the following compounds serving as natural modulators of pain.
	Even Small Amounts of Tylenol May Be Dangerous for Infants and Small Children In a paper published in Contemporary Pediatrics, Dr. James E. Heubi states that in infants and small children, studies have indicated that the toxic dose is less than twice the recommended dose. Studies have also shown that it is very easy to mistakenly give children too much acetaminophen and, as a result, endanger their lives and health.
	Child Acetaminophen Deaths Reported At least 24 children in the United States have died and three have required liver transplants after receiving accidental overdoses of acetaminophen –– the most widely used medication for relief of pain and fever in children and infants, according to a report in the Journal of Pediatrics.
	Will More Doctors Increase or Decrease Death Rates? An Econometric Analysis of Australian Mortality Rates The Center for Health Program Evaluation This unsettling Adobe Acrobat report (134 KB ~ 31 pages) clearly documents the increase in death rates in Australia as the density of medical doctors increased in the studied regions.
	HMOs Not Protecting Patients: Managed Care Fails to Report Doctors The Associated Press May 29, 2001 Health maintenance organizations reported only 715 such actions from 1990 to 1999, at a time when the insurance plans became the dominant form of health care in the United States, the May report by the inspector general of the Department of Health and Human Service said. Nearly 100 million Americans are enrolled in such plans. Eight-four percent of the 1,401 HMOs in the study didn't report a single action to the National Practitioners Data Bank, the report found.
	36 Percent of Acute Liver Failures Are Linked to Acetaminophen U.S. News & World Report July 2, 2001 Mixing the pain reliever acetaminophen with alcohol can be hard on the liver; but so can taking it while fasting. Yet, surprisingly, many doctors don't tell you that.
	CDC Reports: Hospital Infections and Drug-resistance Rise in U.S. The rate at which patients pick up an infection while being treated in a U.S. hospital has increased 36 percent in the past 20 years, U.S. health researchers said Wednesday.
	FDA Warns Against New Painkiller February 11, 1998 -- Patients who take a potent new painkiller for longer than 10 days can suffer potentially fatal liver damage, the Food and Drug Administration said in a stern warning Tuesday to doctors who prescribe the drug Duract.
	“More drug rules needed in nursing homes” USA Today Ten years after Congress attacked improper drug use by nursing homes in a sweeping set of reforms, federal investigators say tougher rules are needed to combat lingering problems.
	MDs Employ Spinal Manipulation After a Short Training Course: The Ensuing Study Then Reveals Limited Benefit for the Patients Timothy Carey, MD's trial involved teaching MD's manipulation in two one-day sessions, and a refresher session, adding up to a grand total of 18 hours of training. When it yielded “poor” patient outcomes (what a shock, eh?), he stated that: “Overall, the results do not support training primary care physicians in manipulative techniques” said Carey.
	Accuracy of Data in Medical Abstracts of Published Research Articles Researchers randomly selected 44 articles from each of five medical journals, including Lancet and The New England Journal of Medicine. The results, published in JAMA. 1999 (Mar 24); 281 (12): 1110–1111, showed that between 18 and 68 percent of the 264 abstracts evaluated were inaccurate, meaning there were omissions or inconsistencies between the data in the abstract and the data in the body, tables and figures of the main article. The results are especially troubling because abstracts are widely used, often separate from their text, as in MEDLINE and other databases, and data taken from the abstracts may be reported and disseminated in other works, in other formats and in the media.

REPORT TO THE PRESIDENT

Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact Report of the Quality Interagency Coordination Task Force (QuIC) to the President February 2000 To Err Is Human: Building a Safer Health System, a report released late last year by the Institute of Medicine (IOM), shocked the Nation by estimating that up to 98,000 Americans die each year as a result of preventable medical errors (According to JAMA that figure is actually 106,000 deaths). The report concludes that the majority of these errors are the result of systemic problems rather than poor performance by individual providers, and outlined a four-pronged approach to prevent medical mistakes and improve patient safety.

Reference Tools

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