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I Get Mail – Medicine’s A Killer? Only if you don’t understand how it works

There are people who honestly think that medicine makes the world a worse place to live in. That if somehow we replace it with the holy grail of alternative medicine then all our ills will be cured and we will live long healthy lives bereft of any problems and die happy.

But the fact of the matter is that many people simply don’t get how medicine works.

According to a review of medical care provided in hospitals around the world, 43 million patients are harmed by medical care each year, with two-thirds of those cases occurring in mid to low income countries. To put that in perspective, there are 38 million people who live in the state of California.

There are 7 billion people on the planet. This is 0.6%. At least at some point in the next year you will fall sick and you will take real medicine. 0.6% isn’t that bad as failure rates go.

This argument works by trying to make it seem like the entire state of California regularly falls sick thanks to real medicine! Rather than a very very small number of people.

7 types of harm studiedData came from 4,000 articles published in the years since 1976 that have studied the quality of care provided in hospitals worldwide. The review authors focused on 7 types of poor care: harm from prescribed drugs, catheter-associated urinary tract infections, catheter-associated bloodstream infections, hospital-acquired pneumonia, blood clots, falls, and bedsores.

Yes these can happen as a product of medical treatment.

The issue however is that these are part and parcel of medical care. Some people are allergic to medications. Some people don’t take medications properly. Some people don’t mention the medications they take. Some people have side effects and indeed some people just don’t understand why they should tell us some things before we administer a drug.

UTIs from catheterisation assumes that catheters are inserted for “fun” rather than for clinical purposes (Such as keeping a bladder empty during a surgery). IV lines are vital for many drugs. Hospital acquired pneumonia is due to mechanical ventilation, blood clots due to prolonged immobility, falls due to patients slipping on stuff and bedsores are again due to immobility.

These are not products of medicine but a fact that sometimes a procedure doesn’t go precisely according to plan. None of these things are done pointlessly and in fact in a system aimed at the patient most patients are informed about these problems.

Rich countries’ harm comes from medicines

Yes, because everything else that causes harm has been eliminated.

The statistics show that 14 percent of hospital patients in high income countries receive substandard care, causing 17 million cases of harm. Meanwhile, 26 million cases of harm were caused by mid and low income countries. Most often in more affluent countries, harm comes from medicines. This happens in 5 percent of hospital visits. Blood clots were the most common issues in poorer countries, accounting for 3 percent of harm incurred by hospital stays.

Patient satisfaction is a terrible beast.

Blood Clots? Yes it’s a problem. The problem being that invalid patients think being invalid means lying in bed all day. That’s just a great way to get DVT.

Patients don’t have the same idea of ideal outcome as doctors. Many are satisfied by painless procedures. Many have weird notions on what is important.

Let’s take an example in Ziztur. For those who are unaware, Ziztur who blogs at WWJTD is an amputee. She broke her foot. A car fell on it. Now to you an amputation is a bad thing. To her?

Well her foot was pretty broken and honestly to fix  it would have taken longer than to simply cut it off and teach her to walk on a prosthesis and indeed the chance of repair was low so she wouldn’t have had a functioning foot. Her “real” foot would probably have not been as good as the prosthetic.

To her the ideal outcome was her choice. To you? Well that’s just some bloodthirsty ortho wanting to dismember someone and flog a prosthesis!

In poorer nations a couple more problems come into play. Hygiene is harder to maintain and patients often don’t understand or combine their traditional medicine resulting in complications. In addition? Patients tend to come in later requiring more drastic action and so more side effects.

Millions of years in lost life recorded

If we didn’t do these things the OP thinks that somehow we would not lose millions of years.

The study, published on Sept. 18 online in the journal, BMJ Quality & Safety, quantified the deaths in the following way: “Substandard hospital care resulted in 22.6 million years of life lost thato death or disability. Low and middle income countries had twice as many years lost to death or disability as high income families.” Most of these years come from premature loss of life, compared with how many years the person might have lived if medical harm had not occurred.

Yes and the notion is to improve and reduce the mistakes being made. For instance? Paperless drug prescribing. Prescriptions, safety testing, universal records…

Things that would help reduce these tragic cases where we don’t coordinate.

Nigeria has very little healthcare in the rural parts. Doctors live far away and are few and far between. Life expectancy? Around 45. The problem with the OP’s argument is that he forgets what hospitals exist for and all the things hospitals stop from killing us.

Dr. Ashish Jha, one of the study’s lead authors and faculty member at the Harvard School of Public Health said, “When patients are sick, they should not be further harmed by unsafe care. This should be a major policy emphasis for all nations.”

Yes, and that is what a lot of policy is aimed at. Trying to unify treatment plans, reduce red tape and increase communication systems.

Patients should be active in own health care

I agree and disagree.

You are not an expert. You are no more an expert of medicine than I am an expert in electronics. I cannot fix my laptop should it break and you are far more complex. We think patients should have a lot of say in their healthcare but are frustrated when what they choose is some quack flogging bullshit that doesn’t work. Herbal medicine? Morphine is pretty herbal you know. It’s just that we scientifically process it to get the active ingredient rather than making you smoke an opium pipe. Homeopathy? Magic Water. Magnets? How does it work?

The people who tend to argue for patient choice are a frightful group of people who flog alternative medicine because the choice they want is their pet quack being treated like a real doctor.

We can help you understand but that means realising that choice means choice within science rather than quackery.

In America, these results are significant because of the high number of problems related with adverse drug events. These events are, for the most part, preventable. However, they are even more unlikely when a patient takes an active role is his or her own care, according to Robin Diamond, chief patient safety officer at The Doctors Company. “Unless patients are engaged in their own health care, the likelihood of medical error . . . is much more significant,” Diamond explained.

Yes, and we accept that. We routinely tell patients to be more pro-active with their healthcare and indeed preventative. The errors that occur in this case are down to patient compliance. If a patient is more interested and understanding of his healthcare then he is more likely to stick to a treatment plan.

In India we have a problem called MDR TB. Multi Drug Resistant TB. This thing’s scary. It’s immune to many of the frontline TB Drugs. Why? Because TB has a long treatment time and people were prone to not taking their pills daily.

So the rules changed. We started DOTS. Directly Observed Therapy. You eat the pills in front of a person who comes and bugs you to take them. Compliance shoots up!

The harm being caused was by poor compliance. Trying to reduce that requires a lot of things. Doctors need to inform patients better but patients also have to listen to doctors more. You cannot simply change your own medications without intimating a doctor then get mad when the doctor’s treatments cause harm.

I had a case of a patient who replaced his normal anti-Rheumatic Arthritis medication with NSAIDs. He contracted an ulcer that got exacerbated by pre-surgical fasting and caused gastritits on the table. Why?

Because he changed his regimen and never thought about telling me when I asked.

Doctors and patients are human, they both make mistakes. But the mistakes they make are so varied.

If the USA wants to cut down  on mistakes? Unified health standards, reduced working hours for junior doctors and more logical shift systems along with electronic prescribing and a unified patient record. That reduces more deaths than simply  demonising medicine.

Comments

  1. dianne says

    Blood Clots? Yes it’s a problem. The problem being that invalid patients think being invalid means lying in bed all day. That’s just a great way to get DVT.

    VTE is a problem, especially in a hospitalized patient. This has been noted by people in medicine and protocols to reduce the incidence have been put in place. That’s why if you’re hospitalized, especially after surgery, you’re likely to get lovenox or heparin even if you’ve never had a clot: it’s being given to prevent clots.

    Same with line related infections and nosocomial infections. The problem has been noted and action taken. The reason people run around the hospital rubbing their hands isn’t because they’re plotting their evil schemes, but because they’re rubbing alcohol on their hands to prevent disease transmission. And there is at least some evidence that these interventions have decreased the rate of hospital acquired infection.

  2. dianne says

    reduced working hours for junior doctors

    It’s not clear that this is useful. It might make life better for residents and fellows, but the most recent study comparing the 2003 work rules with the 2011 showed better outcomes with the 2011 rules. I think we need more rational work rules and more logical shift systems, as you mentioned, but am not sure that simply reducing hours is going to be useful. (Also note that there are no work restrictions for doctors after completion of training. This may become an issue as hospitals attempt to replace one form of cheap labor with another form less cheap but at least already paid for…)

  3. A. Noyd says

    the choice they want is their pet quack being treated like a real doctor.

    More like they want their pet quack treated with the prestige of a real doctor but not with the limitations or accountability of a real doctor.

    If the USA wants to cut down on mistakes? Unified health standards…

    I wish that there were better ways of communicating issues with medications, especially in medical records. My records say that I’m allergic to vicodin and dilaudid, which isn’t right. The actual problem is that they make me high without blocking pain. (It was ever so much find finding that out the hard way.)

    Hospitals are understandably not too keen on trusting what patients say about their narcotic needs, so the issue has to be in the records somehow. But I worry that inaccurately classifying my problem as an allergy might lead to confusion and unnecessary measures if, for instance, I’m given dilaudid before anyone checks the records (since it’s an emergency department go-to drug for pain). Apparently, though, there’s no system in place for keeping track of reactions other than allergies.

    I have to wonder, too, whether that oversight affects how and whether doctors give credence to complaints of idiosyncratic drug reactions.

  4. Ysanne says

    I’m amazed how you have the patience to go through such a load of BS in the first place.
    How on earth does it not occur to the author to compare the harm that can happen through medical treatment of a condition to the harm caused by not treating the condition at all? It’s not great to have a blood clot after surgery, but then it’s even less fun to walk around on a broken leg instead of getting it fixed.
    And this…

    Unless patients are engaged in their own health care, the likelihood of medical error . . . is much more significant,” Diamond explained.

    Well d’oh.
    Because the active involvement of the patient, i.e. a person with a vested interest in getting the treatment right, who is present pretty much throughout the whole medical episode, who has a bunch of first-hand information about the patient’s well-being, and who directly controls the patient’s actions, is obviously a quite a useful thing to have.
    Doesn’t mean the patient is competent to to make the detailed medical decisions.
    (Anecdotal: When I went to get the screws removed from my knee a year after getting a fracture set, I was almost passed out from the anaesthetic when I overheard someone read my file and say “ok, so this is a metal removal from the right shoulder”. Fortunately I managed to mumble loud enough “No! Left knee!” and they noticed that the file belonged to another patient. Not exactly a moment that built my trust in that hospital, but still beats asking a ghost healer to teleport out the screws instead.)

  5. Laila says

    SHOCK: COMPARING DEATHS FROM MEDICAL DRUGS, VITAMINS, ALL US WARS

    by Jon Rappoport
    October 7, 2013
    http://www.nomorefakenews.com

    People want to believe medical science gives us, at any given moment, the best of all possible worlds.

    And of course, the best of all possible worlds must have its enemies: the quacks who sell unproven snake oil.

    So let’s look at some facts.

    As I’ve been documenting in my last several articles, the medical cartel has been engaged in massive criminal fraud, presenting their drugs as safe and effective across the board—when, in fact, these drugs have been killing and maiming huge numbers of people, like clockwork.

    I’ve cited the review, “Is US Health Really the Best in the World?”, by Dr. Barbara Starfied (Journal of the American Medical Association, July 26, 2000), in which Starfield reveals the American medical system kills 225,000 people per year—106,000 as a direct result of pharmaceutical drugs.

    I’ve now found another study, published in the same Journal, two years earlier: April 15, 1998; “Incidence of Adverse Drug Reactions in Hospitalized Patients.” It, too, is mind-boggling.

    The authors, led by Jason Lazarou, culled 39 previous studies on patients in hospitals. These patients, who received drugs in hospitals, or were admitted to hospitals because they were suffering from the drugs doctors had given them, met the following fate:

    Every year, in the US, between 76,000 and 137,000 hospitalized patients die as a direct result of the drugs.

    Beyond that, every year 2.2 MILLION hospitalized patients experience serious adverse reactions to the drugs.

    The authors write: “…Our study on ADRs [Adverse Drug Reactions], which excludes medication errors, had a different objective: to show that there are a large number of ADRs even when the drugs are properly prescribed and and administered.”

    So this study had nothing to do with doctor errors, nurse errors, or improper combining of drugs. And it only counted people killed who were admitted to hospitals. It didn’t begin to tally all the people taking pharmaceuticals outside hospitals who died as consequence of the drugs.

    I found the link to this study at the Dr. Rath Health Foundation, in the middle of a very interesting article by Dr. Aleksandra Niedzwiecki: “Commentary on the Safety of Vitamins.”

    Here are two key quotes from her article:

    “In 2010, not one single person [in the US] died as a result of taking vitamins (Bronstein, et al, (2011) Clinical Toxical, 49 (10), 910-941).”

    “In 2004, the deaths of 3 people [in the US] were attributed to the intake of vitamins. Of these, 2 persons were said to have died as a result of megadoses of vitamins D and E, and one person as a result of an overdose of iron and fluoride. Data from: ‘Toxic Exposure Surveillance System 2004, Annual Report, Am. Assoc. of Poison Control Centers.'”

    Summing up:

    No deaths from vitamins (2011), and three deaths (2004) from vitamins (plus fluoride!).

    106,000 deaths every year from pharmaceutical drugs (Starfield).

    Between 76,000 and 137,000 deaths from pharmaceutical drugs every year in hospitalized patients (Lazerou).

    The FDA and its “quack-buster” allies go after vitamins, demean “unproven remedies,” and generally take every possible opportunity to warn people about “alternatives,” on the basis that they aren’t scientifically supported.

    Meanwhile, the very drugs these mobsters are promoting—and in the case of the FDA, CERTIFYING AS SAFE AND EFFECTIVE—are killing and maiming people at a staggering rate.

    The masses are treated to non-stop PR on the glories of the US medical system.

    In the Wikipedia entry, “US military casualties of war,” the grand total of all military deaths in the history of this country, starting with the Revolutionary War, is 1,312,612.

    In any given 10 years of modern medical treatment? 2,250,000 deaths.

    Consider how much suppression is necessary to keep the latter number under wraps.

    Journal of the American Medical Association (JAMA)
    Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health describes how the US health care system may contribute to poor health.
    ALL THESE ARE DEATHS PER YEAR:
    12,000 —–unnecessary surgery (8)
    7,000 —–medication errors in hospitals (9)
    20,000 —–other errors in hospitals (10)
    80,000 —–infections in hospitals (10)
    106,000 —-non-error, negative effects of drugs (2)
    These total to 250,000 deaths per year from iatrogenic causes!!
    What does the word “iatrogenic” mean? This term is defined as induced in a patient by a physician’s activity, manner, or therapy. Used especially of a complication of treatment.
    Dr. Starfield offers several warnings in interpreting these numbers:
    First, most of the data are derived from studies in hospitalized patients.
    Second, these estimates are for deaths only and do not include negative effects that are associated with disability or discomfort. Third, the estimates of death due to error are lower than those in the IOM report.
    [Remember, only 60,000 Americans lost their life in the entire Vietnam war!- KSM]
    (1) If the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000. In any case, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Even if these figures are overestimated, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).
    Another analysis (11) concluded that between 4% and 18% of consecutive patients experience negative effects in outpatient settings, with:
    116 million extra physician visits
    77 million extra prescriptions
    17 million emergency department visits
    8 million hospitalizations
    3 million long-term admissions
    199,000 additional deaths
    $77 billion in extra costs
    The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care.
    However, evidence from a few studies indicates that as many as 20% to 30% of patients receive inappropriate care.
    An estimated 44,000 to 98,000 among them die each year as a result of medical errors. (2)
    This might be tolerated if it resulted in better health, but does it? Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators. More specifically, the ranking of the US on several indicators was:
    13th (last) for low-birth-weight percentages
    13th for neonatal mortality and infant mortality overall 14
    11th for post neonatal mortality
    13th for years of potential life lost (excluding external causes)
    11th for life expectancy at 1 year for females, 12th for males
    10th for life expectancy at 15 years for females, 12th for males
    10th for life expectancy at 40 years for females, 9th for males
    7th for life expectancy at 65 years for females, 7th for males
    3rd for life expectancy at 80 years for females, 3rd for males
    10th for age-adjusted mortality
    The poor performance of the US was recently confirmed by a World Health
    Organization study, which used different data and ranked the United States as 15th among 25 industrialized countries.
    There is a perception that the American public “behaves badly” by smoking, drinking, and perpetrating violence.” However the data does not support this assertion.
    The proportion of females who smoke ranges from 14% in Japan to 41% in Denmark; in the United States, it is 24% (fifth best). For males, the range is from 26% in Sweden to 61% in Japan; it is 28% in the United States (third best).
    The US ranks fifth best for alcoholic beverage consumption.
    The US has relatively low consumption of animal fats (fifth lowest in men aged 55-64 years in 20 industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among 13 industrialized countries.
    These estimates of death due to error are lower than those in a recent Institutes of Medicine report (and as said if higher estimates are used, deaths due to iatrogenic causes would range from 230,000 to 284,000).
    Even at the lower estimate of 225,000 deaths per year, this constitutes the third leading cause of death in the US, following heart disease and cancer.
    Lack of technology is certainly not a contributing factor to the US’s low ranking.
    Among 29 countries, the United States is second only to Japan in the availability of magnetic resonance imaging units and computed tomography scanners per million population. Japan, however, ranks highest on health, whereas the US ranks among the lowest.
    It is possible that the high use of technology in Japan is limited to diagnostic technology not matched by high rates of treatment, whereas in the US, high use of diagnostic technology may be linked to more treatment.
    Supporting this possibility are data showing that the number of employees per bed (full-time equivalents) in the United States is highest among the countries ranked, whereas they are very low in Japan, far lower than can be accounted for by the common practice of having family members rather than hospital staff provide the amenities of hospital care.
    Journal American Medical Association, (Vol. 284), July 26, 2000
    COMMENT: Folks, this is what they call a “Landmark Article”. Only several ones like this are published every year. One of the major reasons it is so huge is that it is published in JAMA which is the largest and one of the most respected medical journals in the entire world. I did find it most curious that the best wire service in the world, Reuter’s, did not pick up this article. I have no idea why they let it slip by.
    I would encourage you to bookmark this article and review it several times so you can use the statistics to counter the arguments of your friends and relatives who are so enthralled with the traditional medical paradigm.
    These statistics prove very clearly that the system is just not working. It is broken and is in desperate need of repair.
    I was previously fond of saying that drugs are the fourth leading cause of death in this country. However, this article makes it quite clear that the more powerful number is that doctors are the third leading cause of death in this country killing nearly a quarter million people a year. The only more common causes are cancer and heart disease. This statistic is likely to be seriously underestimated as much of the coding only describes the cause of organ failure and does not address iatrogenic causes at all.
    Japan seems to have benefited from recognizing that technology is wonderful, but just because you diagnose something with it, one should not be committed to undergoing treatment in the traditional paradigm. Their health statistics reflect this aspect of their philosophy as much of their treatment is not treatment at all, but loving care rendered in the home.
    Care, not treatment, is the answer. Drugs, surgery and hospitals are rarely the answer to chronic health problems. Facilitating the God-given healing capacity that all of us have is the key. Improving the diet, exercise, and lifestyle are basic. Effective interventions for the underlying emotional and spiritual wounding behind most chronic illness are also important clues to maximizing health and reducing disease.
    Related Articles:
    Medical Mistakes Kill 100,000 per year
    US Health Care System Most Expensive in the World
    Author/Article Information
    Author Affiliation: Department of Health Policy and Management, Johns
    Hopkins School of Hygiene and Public Health, Baltimore, Md.
    Corresponding Author and Reprints: Barbara Starfield, MD, MPH,
    Department of Health Policy and Management, Johns Hopkins School of
    Hygiene and Public Health, 624 N Broadway, Room 452, Baltimore, MD
    21205-1996 (e-mail: [email protected]).
    REFERENCES
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    care in the United States?” Milbank Q. 1998;76:517-563.
    2. Kohn L, ed, Corrigan J, ed, Donaldson M, ed. “To Err Is Human:
    Building a Safer Health System.” Washington, DC: National Academy Press; 1999.
    3. Starfield B. “Primary Care: Balancing Health Needs, Services, and
    Technology.” New York, NY: Oxford University Press; 1998.
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    http://www.who.int/whr/2000/en/report.htm.
    Accessed June 28, 2000.
    5. Kunst A. “Cross-national Comparisons of Socioeconomic Differences in
    Mortality.” Rotterdam, the Netherlands: Erasmus University; 1997.
    6. Law M, Wald N. “Why heart disease mortality is low in France: the
    time lag explanation.” BMJ. 1999;313:1471-1480.
    7. Starfield B. “Evaluating the State Children’s Health Insurance
    Program: critical considerations.” Annu Rev Public Health. 2000;21:569-585.
    8. Leape L. “Unecessarsary surgery.” Annu Rev Public Health.
    1992;13:363-383.
    9. Phillips D, Christenfeld N, Glynn L. “Increase in US medication-error
    deaths between 1983 and 1993.” Lancet. 1998;351:643-644.
    10. Lazarou J, Pomeranz B, Corey P. “Incidence of adverse drug reactions
    in hospitalized patients.” JAMA. 1998;279:1200-1205.
    11. Weingart SN, Wilson RM, Gibberd RW, Harrison B. “Epidemiology and
    medical error.” BMJ. 2000;320:774-777.
    12. Wilkinson R. “Unhealthy Societies: The Afflictions of Inequality.”
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    outcomes of care for generalists and specialists.” J Gen Intern Med.
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    Review | April 15, 1998
    Incidence of Adverse Drug Reactions in Hospitalized PatientsA Meta-analysis of Prospective Studies FREE
    Jason Lazarou, MSc; Bruce H. Pomeranz, MD, PhD; Paul N. Corey, PhD
    JAMA. 1998;279(15):1200-1205. doi:10.1001/jama.279.15.1200.
    ABSTRACT
    Objective.— To estimate the incidence of serious and fatal adverse drug reactions (ADR) in hospital patients.
    Data Sources.— Four electronic databases were searched from 1966 to 1996.
    Study Selection.— Of 153, we selected 39 prospective studies from US hospitals.
    Data Extraction.— Data extracted independently by 2 investigators were analyzed by a random-effects model. To obtain the overall incidence of ADRs in hospitalized patients, we combined the incidence of ADRs occurring while in the hospital plus the incidence of ADRs causing admission to hospital. We excluded errors in drug administration, noncompliance, overdose, drug abuse, therapeutic failures, and possible ADRs. Serious ADRs were defined as those that required hospitalization, were permanently disabling, or resulted in death.
    Data Synthesis.— The overall incidence of serious ADRs was 6.7% (95% confidence interval [CI], 5.2%-8.2%) and of fatal ADRs was 0.32% (95% CI, 0.23%-0.41%) of hospitalized patients. We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious ADRs and 106000 (76000-137000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death.
    Conclusions.— The incidence of serious and fatal ADRs in US hospitals was found to be extremely high. While our results must be viewed with circumspection because of heterogeneity among studies and small biases in the samples, these data nevertheless suggest that ADRs represent an important clinical issue.
    PUBLIC ATTENTION is currently focused on adverse drug reactions (ADR) as evidenced by a recent bill passed by the US Senate requiring pharmaceutical companies to provide ADR information to consumers.1 Heightened interest in ADRs was stimulated by the thalidomide tragedy in the 1960s.2 To obtain an accurate estimate of ADR incidence in hospital patients, prospective studies were done, beginning in the 1960s, in which a defined population could be kept under close observation by monitors who recorded all ADR occurrences.3- 5 These prospective studies have been done on 2 separate populations of patients; those admitted to the hospital due to an ADR (ADRAd),6 and those experiencing an ADR while in the hospital (ADRIn).7 We report here a meta-analysis of 39 of these prospective studies done in the United States over a period of 32 years from which we obtained ADR incidences for ADRIn and for ADRAd and an overall ADR incidence that combines these 2 groups. We focused mainly on serious and fatal ADRs since they represent the greatest impact of drug therapy. While recognizing the benefits of drug therapy, we chose not to compare benefits of drugs to the side effects of drugs.
    METHODS
    Definitions
    One step we took to reduce heterogeneity was to exclude any data that did not use the following specific definitions:
    Adverse Drug Reaction (ADR)
    According to the World Health Organization definition,8 this is any noxious, unintended, and undesired effect of a drug, which occurs at doses used in humans for prophylaxis, diagnosis, or therapy. This definition excludes therapeutic failures, intentional and accidental poisoning (ie, overdose), and drug abuse.8 Also, this does not include adverse events due to errors in drug administration or noncompliance (taking more or less of a drug than the prescribed amount).8 Using this conservative definition avoids overestimating the ADR incidence.
    Recently, some authors prefer the term adverse drug event (ADE), which is an injury resulting from administration of a drug. In contrast to the World Health Organization definition of ADR, the definition of ADE includes errors in administration.9 However, we have chosen the World Health Organization definition for ADR because of its frequent use in the studies that we analyzed, and because of our goal to estimate injuries incurred by drugs that were properly prescribed and administered. In those articles that did not use the World Health Organization definition (eg, ADE was used), we examined the raw data and removed adverse events due to errors in administration. However, this was not always feasible since a few articles may have included errors in administration but did not report them separately. Therefore, unfortunately, these latter articles added to the heterogeneity of our data.
    Possible ADR
    This is an ADR that follows a reasonable temporal sequence and for which the ADR is a known response to the drug, although the response may also be explained by the patient’s clinical state.10 Possible ADRs were excluded from our study.
    Serious ADR
    This is an ADR that requires hospitalization, prolongs hospitalization, is permanently disabling, or results in death. Serious ADRs include fatal ADRs, which were also analyzed separately.
    Prospective Studies
    Patients were present during the study, and monitors were able to interview physicians, nurses, or patients at least once per week. All ADRs were confirmed prior to patient’s discharge from the hospital.
    Retrospective Studies
    Chart reviews were performed after the patient had left the hospital. These studies were excluded from our analysis.
    Literature Search
    Electronic databases were searched using the following key word strategy: adverse drug or adverse reaction or drug-related or drug-induced and hospital. Three MeSH (Medical Subject Headings) terms were also used where appropriate (ie, hospitalization, drugs, drug therapy/adverse effects) in combination with key words. Databases that we used were MEDLINE (1966-1996), Excerpta Medica (1980-1996), International Pharmaceutical Abstracts (1970-1996), and Science Citation Index (1989-1996). The reference sections of all retrieved articles were manually searched for additional studies. In addition, we sent letters to researchers in the field to request unpublished data in order to reduce publication bias.
    Selection Criteria
    The following criteria were used:
    1. The patients studied were not selected for particular conditions or specific drug exposures.
    2. Sufficient information was reported in the published study to calculate the incidence of ADRs.
    3. English translations of the papers were available.
    4. Prospective monitoring was used to identify ADRs.
    5. Definitions used in the studies coincided with ours (see “Definitions” subsection for our definitions).
    Quality of the Data
    Rather than merely assessing the quality of each study,11 we chose instead to improve the quality of our database. First, we used prospective monitoring as an inclusion criterion to exclude the lowest-quality studies (ie, the retrospective studies). Second, ADRs classified as “possible” were excluded. Attributing causality is always a problem with ADR detection12 and, by excluding possible ADRs, we reduced the number of false positives in the data.
    Heterogeneity
    We dealt with heterogeneity among the studies in numerous ways: (1) we placed considerable emphasis on the 95% confidence intervals (CIs) to draw attention to the heterogeneity,13 (2) we used a random-effects model to do the analysis because it takes into account the heterogeneity of the various studies,13- 14 (3) to reduce heterogeneity, we excluded ADRs caused by errors in administration, noncompliance, overdose, drug abuse, or therapeutic failures, (4) for additional ways to reduce heterogeneity, we excluded ADRs not fitting our strict definitions, possible ADRs, and retrospective data.
    Data Extraction
    We determined the incidence of ADRs in the hospital by extracting the total number of hospital patients in each study experiencing at least 1 ADR and dividing this value by the total number of hospital patients in each study. The ADR incidence was expressed as the percent of patients with an ADR. A data collection form was developed prior to the study for this purpose. Information on nonserious, serious, and fatal reactions was extracted. Other data extracted included the year of the study, ward and hospital type in which the study was performed, mean age, average length of hospital stay, average number of drug exposures for the patients included in the study, and the number of men and women in each study. To test for reliability of our extraction procedures a randomly selected subset of the data was extracted independently by 2 of us (J.L. and B.H.P.) and was found to be very consistent for the published ADR incidence for serious, fatal, and all severities (intraclass correlation coefficient ranging from 0.89 to 0.92).
    Analysis of ADR Incidence
    We separately analyzed the incidence of ADRIn and the incidence of ADRAd and then combined the 2 groups to obtain an overall ADR incidence. We analyzed ADRs of all severities (which included nonserious and serious), ADRs that were serious (which included fatal), and ADRs that were fatal; however, we focused mainly on the serious and fatal ADRs. For each category, we analyzed the ADR incidences obtained from the different studies to determine the mean incidence and the 95% CIs. For this purpose we used a random-effects model for meta-analysis15 similar to the method used in the only previous meta-analysis of ADRAds.16 This is the method of choice because it takes into account the heterogeneity of the various studies.14
    When combining the incidence of ADRIn and ADRAd to obtain the overall incidence of ADRs, we avoided double counting patients who were admitted for an ADR and who then also experienced an ADR while in the hospital by assuming the 2 types of events to be independent and deriving an adjusted estimate using the following formula:
    This provided a slightly smaller estimate of the ADR incidence. For example, the mean estimate for the overall number of serious ADRs per year (see “Results” section) would change by 33000 patients, dropping from 2249000 (no adjustment) to 2216000 (our estimate using the adjustment).
    When comparing groups, we used both parametric and nonparametric methods. The results were always the same for the 2 methods. Hence, for group comparisons, whenever possible, we reported the results of the more robust nonparametric Wilcoxon rank sum test.17 All statistical analyses were performed using the SAS statistical software package, version 6.11 (Statistical Analysis System, Cary, NC).
    Number of Patients With ADRs
    We estimated the number of hospital patients with ADRs in the United States by using the incidence of ADRs in US hospitals derived from our data and multiplying this value by the number of hospital admissions in 1994 in the United States, obtained from published statistics.18 In 1994, there were 33125492 hospital admissions in the United States. We calculated the 1994 fatal ADRIns as follows:
    Number of Fatal ADRIns in US Hospitals in 1994 (63000)=Incidence of Fatal ADRIns in Hospitals in the United States (0.0019)×Number of Hospital Admissions in the United States (33125492).
    This estimate is based on the assumption that our sample is representative of the hospital population, and, hence, we examined representativeness at some length (see “Results” section).
    RESULTS
    Using our 5 selection criteria, 39 of the 153 studies found in the literature were included in our meta-analysis. Features of these 39 studies are given in Table 1 and Table 2.4- 7,9,19- 43 Fifty-seven studies were excluded from our meta-analysis by the 2 blinded investigators because they did not meet our criteria. In addition 57 of the remaining 96 studies were performed in countries other than the United States and were excluded from our meta-analysis because one of our major goals was to determine representativeness of our sample in order to establish the accuracy of our summary statistics. Since we only had a sufficient number of studies from the United States to allow us to perform these tasks, we decided to exclude the remaining countries from our meta-analysis since a proper analysis for representativeness for any other country would be impossible to perform.
    Table 1.—Studies on ADRs in Patients While in the Hospital (ADRIn)*
    Incidence of ADRs
    As shown in Table 3, the incidence of serious ADRIn was 2.1% (95% CI, 1.9%-2.3%) of hospital patients, while the incidence of serious ADRAd was 4.7% (95% CI, 3.1%-6.2%). The incidence of fatal ADRIn was 0.19% (95% CI, 0.13%-0.26%) of hospital patients and the incidence of fatal ADRAds was 0.13% (95% CI, 0.04%-0.21%). Combining ADRIn and ADRAd, the overall incidence of serious ADR was 6.7% (95% CI, 5.2%-8.2%) of hospital patients and the overall incidence of fatal ADRs was 0.32% (95% CI, 0.23%-0.41%). The incidence of ADRIn of all severities (including nonserious and serious) was 10.9% (95% CI, 7.9%-13.9%) of hospital patients. The overall incidence of ADRIn plus ADRAd for ADRs of all severities was 15.1% (95% CI, 12.0%-18.1%) of hospital patients.
    Eight ADRIn articles included the proportion of type A44 (dose-dependent ADRs) and type B44 (idiosyncratic and/or allergic ADRs). Of the “all severities” ADRIn, 76.2% (95% CI, 71.0%-81.4%) were type A reactions and 23.8% (95% CI, 18.6%-29.0%) were type B reactions. Unfortunately, none of these studies reported the proportion of type A and type B reactions for serious and fatal ADRs.
    Number of Hospital Patients With ADRs
    As shown in Table 4, we estimated that 702000 (95% CI, 635000-770000) hospital patients in the United States experienced a serious ADRIn in 1994. We calculated that 1547000 (95% CI, 1033000-2060000) hospital patients experienced a serious ADRAd. Combining these values, overall 2216000 (95% CI, 1721000-2711000) hospital patients experienced a serious ADR in the United States in 1994. We calculated that there were 63000 (95% CI, 41000-85000) fatalities due to ADRIn and another 43000 (95% CI, 15000-71000) deaths occurred in association with ADRAd in the United States. Overall in 1994, we estimated that 106000 (95% CI, 76000-137000) deaths were caused by ADRs in the United States, which could account for 4.6% (95% CI, 3.3%-6.0%) of the 2286000 recorded deaths from all causes during 1994 in the United States.18 Using the mean ADR incidence (106000) or the more conservative lower 95% CI (76000), we found that fatal ADRs ranked between the fourth and sixth leading cause of death in the United States in 1994.
    Representativeness of Our Sample
    Among the many factors possibly influencing ADR incidence, considerable research has identified average length of stay,45- 46 age,45,47 gender,48- 49 and drug exposure.45- 46 Therefore, as shown in Table 5, we checked to see whether the population that we sampled was representative of the US hospital population50 vis-à-vis these 4 factors. We determined that the differences were significant for length of stay and gender but not for age. Unfortunately, we were unable to find values for the average number of drug exposures from national statistics. Possible biases in our ADR incidence that may have been caused by the differences in length of stay or gender are estimated in the “Comment” section.
    Another possible source of sampling bias might be the year of study, as our meta-analysis spans 4 decades. Hence, we studied the relationship between ADR incidence and year of study using a random-effects linear regression model and found no significant correlation for ADRIn (r=0.27, P=.14, n=18) or for ADRAd (r=0.23, P=.34, n=21). Figure 1 shows these results graphically and indicates that no change in ADR incidence occurred over the span of our study. This result seems surprising since great changes have occurred over the last 4 decades in US hospitals that should have affected the incidence of ADRs. Perhaps, while length of hospital stay is decreasing,51 the number of drugs per day may be rising to compensate. Therefore, while the actual incidence of ADRs has not changed over the last 32 years, the pattern of their occurrence has, undoubtedly, changed.
    Incidence of adverse drug reactions (ADRs) in 39 studies distributed over 32 years. All 39 points are not visible as several are superimposed on each other. Linear regression, using a random-effects model, showed no significant correlation for either those experiencing an ADR while in the hospital (ADRIn) (r=0.27, P=.14) or those admitted to the hospital due to an ADR (ADRAd) (r=0.23, P=.34).
    It should be noted that additional factors have been proposed to have an effect on ADR rate: renal function, hepatic function, alcoholism, drug abuse, and severity of illness.44,52 Unfortunately, these factors were rarely reported in our sample of studies and, thus, could not be used to determine representativeness.
    Medical wards are overrepresented in our database, and some articles in the literature suggest that ward type might have an effect on ADR incidence.9,40,53- 54 Unfortunately, there is insufficient power in the 39 studies to calculate the incidence of ADRs for each ward type individually. Without these data, we cannot determine the possible effect that ward-type distribution might have on our ADR incidence. Nevertheless, in the “Comment” section, we estimate the possible bias due to ward type.
    Similar to ward type, hospital type may also introduce bias into our results. It is thought that teaching hospitals contain more seriously ill patients than nonteaching hospitals, which may lead to a higher incidence of ADRs in teaching hospitals, but this has never been proven.35,55 Teaching hospitals are overrepresented in our sample. However, when we compared ADR incidences for teaching and nonteaching hospitals in our study, we found no significant differences. Thus, despite an overrepresentation of teaching hospitals in our sample, there may not be a major bias.
    Finally, our letters to researchers in the field produced no evidence of publication bias.
    COMMENT
    We have found that serious ADRs are frequent and more so than generally recognized. Fatal ADRs appear to be between the fourth and sixth leading cause of death. Their incidence has remained stable over the last 30 years.
    There has been only one previous meta-analysis of ADR hospital studies,16 and it focused only on ADRAd. Our article differs from this report in many respects: (1) we studied incidence of ADRIn as well as ADRAd, (2) we combined ADRAd and ADRIn to obtain the overall incidence of ADRs, (3) we gave special emphasis to serious and fatal ADRs, (4) we improved the quality of the data by excluding retrospective studies and by excluding ADRs that were classified as “possible,” (5) we examined the representativeness of our sample, and (6) we estimated the total number of patients in US hospitals experiencing ADRs.
    Recent studies have focused on ADEs, which include errors in administration.9,19- 20 One of the goals of ADE research is to alert physicians about the preventability of many ADEs.20 In contrast, our study on ADRs, which excludes medication errors, had a different objective: to show that there are a large number of serious ADRs even when the drugs are properly prescribed and administered.
    We found that a high proportion of ADRs (76.2%) were type A reactions. This may suggest that many ADRs are due to the use of drugs with unavoidably high toxicity. For example, warfarin often results in bleeding. It has been shown that careful drug monitoring in hospitals leads to a reduction of many of these ADRs, suggesting that some type A and type B ADRs may be due to inadequate monitoring of therapies and doses.56
    Recent studies have shown that the costs associated with ADRs may be very high. Research to determine the hospital costs directly attributable to an ADR estimated that ADRs may lead to an additional $1.56 to $4 billion in direct hospital costs per year in the United States.57- 58
    Heterogeneity
    As outlined in the “Methods” section, we dealt with heterogeneity in numerous ways. After taking these measures, we examined the remaining heterogeneity. We determined whether 4 factors thought to affect ADR incidence (age, gender, drug exposure, and length of stay) contributed to the remaining heterogeneity in our data using a linear regression version of the random-effects model.15 For ADRIn, we found that number of drug exposures and length of hospital stay jointly accounted for 43% of the variance (r=0.65, P=.009, n=18). For the rate of ADRAd, when age was included in the model, the variance was reduced by 27% (r=0.52, P=.04, n=14). Gender did not contribute to the variance. Thus, a great deal of the heterogeneity could be attributed to factors well known to affect ADR rates: number of drug exposures per patient, length of hospital stay, and the age of patients. This result indicates that much of the heterogeneity is due to variation in the populations examined in the various articles and, hence, only a portion of the variation could merely be attributed to inconsistent methods among the individual studies. For example, if the different investigators use different methods of ascertainment regarding what represents an ADR, they will find different rates. Another example of inconsistent methodology is the problem that some articles did not separate out administration errors. Methodological variation such as this is a limitation of meta-analysis.
    Representativeness of Our Sample
    In the “Results” section, we found that for the 5 factors examined 3 were possible sources of bias: length of stay, gender, and ward type. Thus, we have attempted to estimate the size of the sampling bias due to these 3 factors as follows. As seen in Table 5, we had a higher average length of hospital stay than the US national average (10.6 days vs 7.6 days).18 While the literature qualitatively reports a relationship between the incidence of ADRIn and length of stay,21,45- 46 there are no quantitative estimates. Therefore, we performed a linear regression analysis on our own data using a random-effects model15 regressing the incidence of ADRIn of all severities on average length of stay to obtain a slope of 0.007 (P=.008) and deduced that increasing the length of hospital stay from 7.6 to 10.6 days would possibly cause the incidence of ADRIn of all severities to rise from the adjusted value of 8.7% to our value of 10.9%.
    Also, as shown in Table 5, the proportion of female patients in our sample was lower than the national average (50% vs 60%). Using several studies reporting an increased incidence of ADRs among females, we were able to determine that, at most, the risk ratio for women vs men could be as high as 1.5 for both ADRIn and ADRAd. Assuming the worst-case scenario, the adjusted value for the overall incidence of ADRs of all severities in the United States becomes 15.7% (95% CI, 12.7%-18.8%) compared with our value of 15.1% (95% CI, 12.0%-18.1%).
    Finally, with regard to ward type, there was insufficient power in 39 studies to determine precisely the effect of ward-type discrepancies. Instead, we made a crude determination of the worst-case scenario of ward bias. If we assumed (1) that obstetrical wards have zero ADRs and (2) that we sampled zero obstetrical patients, and, since there are about 4 million obstetrical ward patients each year in the United States59 of 33 million total hospital admissions,18 then the total number of ADRs occurring in the United States would be 4/33 lower than our estimates. Thus the overall number of fatal ADRs in the United States would drop from 106000 (95% CI, 76000-137000) to 93000 (95% CI, 67000-121000), which would make ADRs between the fourth and seventh leading cause of death in the United States rather than between the fourth and sixth leading cause as reported above. Regarding other ward types, psychiatric wards tend to have a higher ADR incidence and pediatric wards a lower ADR incidence than medical wards,53- 54 so these 2 biases might cancel out. Thus, altogether, there probably is a small net upward bias in our ADR incidence due to our overrepresentation of medical wards.
    It is important to note that we have taken a conservative approach, and this keeps the ADR estimates low by excluding errors in administration, overdose, drug abuse, therapeutic failures, and possible ADRs. Hence, we are probably not overestimating the incidence of ADRs despite the 3 small sampling biases discussed earlier.
    CONCLUSIONS
    Perhaps, our most surprising result was the large number of fatal ADRs. We estimated that in 1994 in the United States 106000 (95% CI, 76000-137000) hospital patients died from an ADR. Thus, we deduced that ADRs may rank from the fourth to sixth leading cause of death. Even if the lower confidence limit of 76000 fatalities was used to be conservative, we estimated that ADRs could still constitute the sixth leading cause of death in the United States, after heart disease (743460), cancer (529904), stroke (150108), pulmonary disease (101077), and accidents (90523); this would rank ADRs ahead of pneumonia (75719) and diabetes (53894).18 Moreover, when we used the mean value of 106000 fatalities, we estimated that ADRs could rank fourth, after heart disease, cancer, and stroke as a leading cause of death. While our results must be viewed with some circumspection because of the heterogeneity among the studies and small biases in the sample, these data suggest that ADRs represent an important clinical issue.
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    Doctors Are The Third Leading Cause of Death in the US, Causing 225,000 Deaths Every Year
    This article was published in the
    Journal of the American Medical Association (JAMA)
    July 26, 2000
    This information is a followup of the Institute of Medicine report which hit the papers in December of last year, but the data was hard to reference as it was not in peer-reviewed journal. Now it is published in JAMA which is the most widely circulated medical periodical in the world.
    The author is Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health and she desribes how the US health care system may contribute to poor health.
    ALL THESE ARE DEATHS PER YEAR:
    • 12,000 — unnecessary surgery
    • 7,000 — medication errors in hospitals
    • 20,000 — other errors in hospitals
    • 80,000 — infections in hospitals
    • 106,000 — non-error, negative effects of drugs
    These total to 225,000 deaths per year from iatrogenic causes!!
    What does the word iatrogenic mean? This term is defined as induced in a patient by a physician’s activity, manner, or therapy. Used especially of a complication of treatment.
    Dr. Starfield offers several warnings in interpreting these numbers:
    • First, most of the data are derived from studies in hospitalized patients.
    • Second, these estimates are for deaths only and do not include negative effects that are associated with disability or discomfort.
    • Third, the estimates of death due to error are lower than those in the IOM report.
    If the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000. In any case, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Even if these figures are overestimated, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).
    Another analysis concluded that between 4% and 18% of consecutive patients experience negative effects in outpatient settings,with:
    • 116 million extra physician visits
    • 77 million extra prescriptions
    • 17 million emergency department visits
    • 8 million hospitalizations
    • 3 million long-term admissions
    • 199,000 additional deaths
    • $77 billion in extra costs
    The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care.
    However, evidence from a few studies indicates that as many as 20% to 30% of patients receive inappropriate care.
    An estimated 44,000 to 98,000 among them die each year as a result of medical errors.
    This might be tolerated if it resulted in better health, but does it? Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators. More specifically, the ranking of the US on several indicators was:
    • 13th (last) for low-birth-weight percentages
    • 13th for neonatal mortality and infant mortality overall
    • 11th for postneonatal mortality
    • 13th for years of potential life lost (excluding external causes)
    • 11th for life expectancy at 1 year for females, 12th for males
    • 10th for life expectancy at 15 years for females, 12th for males
    • 10th for life expectancy at 40 years for females, 9th for males
    • 7th for life expectancy at 65 years for females, 7th for males
    • 3rd for life expectancy at 80 years for females, 3rd for males
    • 10th for age-adjusted mortality
    The poor performance of the US was recently confirmed by a World Health Organization study, which used different data and ranked the United States as 15th among 25 industrialized countries.
    There is a perception that the American public “behaves badly” by smoking, drinking, and perpetrating violence.” However the data does not support this assertion.
    • The proportion of females who smoke ranges from 14% in Japan to 41% in Denmark; in the United States, it is 24% (fifth best). For males, the range is from 26% in Sweden to 61% in Japan; it is 28% in the United States (third best).
    • The US ranks fifth best for alcoholic beverage consumption.
    • The US has relatively low consumption of animal fats (fifth lowest in men aged 55-64 years in 20 industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among 13 industrialized countries.
    These estimates of death due to error are lower than those in a recent Institutes of Medicine report, and if the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000.
    Even at the lower estimate of 225,000 deaths per year, this constitutes the third leading cause of death in the US, following heart disease and cancer.
    Lack of technology is certainly not a contributing factor to the US’s low ranking.
    • Among 29 countries, the United States is second only to Japan in the availability of magnetic resonance imaging units and computed tomography scanners per million population. 17
    • Japan, however, ranks highest on health, whereas the US ranks among the lowest.
    • It is possible that the high use of technology in Japan is limited to diagnostic technology not matched by high rates of treatment, whereas in the US, high use of diagnostic technology may be linked to more treatment.
    • Supporting this possibility are data showing that the number of employees per bed (full-time equivalents) in the United States is highest among the countries ranked, whereas they are very low in Japan, far lower than can be accounted for by the common practice of having family members rather than hospital staff provide the amenities of hospital care.

  6. dianne says

    What do all of Laila’s legitimate, peer reviewed references have in common? They’re all from 2000 or earlier. I admit I haven’t gone through them to see if they actually support what xe said or not, but they are definitively out of date.

  7. smrnda says

    “• The US has relatively low consumption of animal fats (fifth lowest in men aged 55-64 years in 20 industrialized countries)”

    This seems a bit strange to me. I thought the US was noteworthy for high levels of meat consumption, but without a footnote, that’s not helping me.

    You know Laila, I have chronic health conditions. I do my best with diet,exercise and the like but my health problems are totally unrelated to any choices I could make.

    The other problem is that overall stats aren’t very useful in the US since health care access is hardly uniform.

  8. Laila says

    COCONUT OIL & REBOUNDING

    Coconut Oil Benefits

    Why is it So Wonderful?

    Most people are afraid to believe all the wonderful coconut oil benefits because it’s one of those “dreaded” saturated fats with lots of bad press.
    Where did all that bad press come from? I’ll address that below. But first, let’s look at how this oil can improve your health.

    Health Benefits of Coconut Oil

    Here are some of the main coconut oil benefits…
    Boosts Immune System Health – To say that it enhances your immune system seems like such an understatement.

    Coconut oil is antifungal, antibacterial, and antiviral when applied topically or taken internally.
    It has found to be particularly effective against influenza viruses and bacteria that cause urinary tract infections, ulcers, pneumonia, even cavities.
    It also treats fungal infections like athlete’s foot, thrush, and diaper rash.
    And we can’t forget that it kills off excess candida, which can seriously weaken the immune system and lower your body pH.
    Cardiovascular Health – The high amounts of lauric acid in coconut oil reduces high blood pressure and improves cholesterol levels.
    Helps with Digestive Disorders – Specifically, Crohn’s Disease and Irritable Bowel Syndrome (IBS). The medium chain triglycerides (MCTs) in coconut oil are absorbed quickly and easily in the digestive tract.
    Longer chain triglycerides, like those found in polyunsaturated fats, stay in the digestive tract longer and can cause inflammation.
    Increased Energy and Weight Loss – How can a fat help you lose weight and boost your energy? When it contains high amounts of those MCTs I just mentioned.
    MCTs support your thyroid and rev up you metabolism. They are not stored as fat, but burned quickly by the liver as an energy source.
    Improves Skin and Hair – These benefits can be gotten from both consuming the oil and applying it topically.
    Put in on a cut or scrape to prevent infections. Use it as a moisturizer to relieve dry, itchy skin and rashes. Use it as a hair conditioner for shiny, strong hair and a dandruff-free scalp.
    These are All Coconut Oil Facts – So Why All the Bad Press?
    If you follow the trail, it ends up at the back door of the vegetable oil manufacturers. Not exactly what I would call an unbiased source.
    It makes sense that they would want to discredit all these wonderful coconut oil benefits.
    But there IS data out there saying that coconut oil will wreck your health. How can that be?
    There is a simple explanation – the experiments used hydrogenated coconut oil – also known as trans fatty acids!
    Any kind of oil that is hydrogenated or partially hydrogenated will wreck your health – guaranteed.
    So if you buy coconut oil, you need to make sure that it isn’t the highly processed, deodorized garbage that is more commonly available (also known as RBD – which stands for Refined, Bleached, and Deodorized).
    So I hope you can see that it really is an amazing oil. To get the most health benefits of coconut oil, replace your polyunsaturated fats with it.
    I personally only use organic virgin coconut oil, extra virgin olive oil, and butter for all my cooking and baking. All are very healthy fats that will keep your immune system strong.
    REBOUNDING

    What is rebound exercise?

    Why choose rebounding as an exercise?

    Why is rebounding the best exercise according to NASA & Albert Einstein?
    NASA states that “rebounding is the best exercise ever devised by man”, not to be confused with a mini trampoline.

    Just 10 minutes a day for a whole body cellular health and fitness program and only 2 minutes a day to give your immune system a boost.
    What is rebounding? Rebounding is a unique form of exercise, for all types of people; any age, size or shape including pregnant women, paraplegics, and senior citizens. Just 10 minutes of rebounding on a quality rebounder is equal to 30 minutes of jogging.
    Rebounding is a therapeutic exercise and is one of the most effective ways to stimulate and detoxify your lymphatic system, boost your immune system while keeping you and your body healthy and in harmony. Your body can be compared to an intricate plumbing system. Fluids need to continuously flow. Rebounding ensures that the toxins in your body are eliminated while bringing critical nutrients to your entire body. It is proven to miraculously rejuvenate your body, giving you more energy and looking younger.

    It strengthens every bone, organ, vein, capillary, joint, tissue and skin. It reduces body fat.

    According to Dr Paul E. Devore, from the American Society of Bariatric Physicians (doctors dealing with weight loss), rebounding on a quality rebounder burns 11 times more calories than walking, 5 times more than swimming and 3 times more than jogging or aerobics.

    A very important aspect is that it returns trapped blood proteins. Rebounding is a whole cellular exercise, because it works all 100 trillion cells in your body.
    In 1911, Albert Einstein stated that the cells of the body will adapt to gravity, acceleration and deceleration, but can not tell the difference between these natural forces. Our physiologists have not yet developped exercise systems using these natural forces. To use these three forces in the most effective way, we need only to line them up vertically on the same plane. No exercises fitted in this definition until rebound exercise making it the best exercise on the planet.

    naturalnews.com printable article
    Originally published January 31 2011
    A rebounder is the best exercise for the immune system
    by Melissa Makris

    (NaturalNews) Not many people have heard of a rebounder, but bouncing on this simple contraption has an amazing number of health benefits. One such benefit is how it strengthens the immune system by quickly and efficiently flushing out the lymphatic system.

    Blood and lymph are the two types of fluid that flow through the circulatory system. This consists of the cardiovascular system (heart, blood, and blood vessels) and the lymphatic system (lymph, lymph nodes, and lymph vessels).

    It is common knowledge that the cardiovascular system relies on the heart to pump blood, but the lymphatic system has no such pump. It relies solely on the body’s physical movement to move lymph fluid around.

    When the lymphatic fluid moves along freely, cells are able to get the oxygen and other nutrients they need. The lymphatic system is also responsible for removing metabolic waste, toxins, abnormal cells, bacteria, and viruses from the body. When a person is relatively inactive, the lymph fluid becomes congested, stagnant, and toxic. A sluggish lymphatic system causes a suppressed immune system and paves the way for many common diseases.

    It is important to note that any kind of exercise will keep the lymphatic system flushed, but the rebounder is the most efficient way to move lymph fluid around. This is because bouncing, a vertical motion exercise, smoothly opens and closes the one-way valves that make up the lymphatic system. Most other exercises, like walking or jogging, are dominated by horizontal movements that are not as effective at moving lymph.

    Jumping on a rebounder, even gently, increases lymph flow by as much as 15-30 times. This means that bouncing just a few minutes several times a day will fully flush your lymphatic system and invigorate your immune system. Rebounding is also a low impact exercise, meaning just about anyone can benefit. Stabilizer bars are available for those unsure of their balance.

    Despite the lack of attention rebounders receive, bouncing on a high quality unit is one of the healthiest exercises around. The benefits go well beyond a stronger immune system, but it is undeniably one of the most important ways we can benefit from this fun and easy activity.

    Sources:

    http://www.how-to-boost-your-immune-system.com/rebounder-exercise.htm
    http:/www.wellbeingjournal.com/index.php?option=com_content&task=view&id=92
    http://www.healingdaily.com/exercise/rebounding-for-detoxification-an

    About the author
    Melissa Makris is a researcher with a technical background in immunology. She is passionate about holistic and alternative methods of healing. Her website How to Boost Your Immune System shares information on how to improve immune system health using simple, natural methods

    American Society of Beriatric (Physicians weight loss) March 1979
    By Dr Paul E. Devore
    1) It tones up the glandular system to increase the output of the thyroid gland, the pituitary gland, and the adrenals. The thyroid’s hormonal production stimulates or affects almost every important body process, including the body’s use of oxygen. The pituitary stimulates, regulates, and coordinates the functions of the other endocrines. For this reason, the pituitary gland is called the master gland of the body. The two main functions of the hormones of the adrenal cortex are the control of the proper salt and water content of the body; and the regulation of carbohydrate, fat, and protein metabolism. In addition, the adrenal cortex secretes sex hormones, mainly androgens, similar to those produced by the testicles.
    2) It strengthens the heart and any other muscle being used in the body so that the muscle works more efficiently. Muscle tissue is made up of elastic cells and fibers that can repeatedly contract and relax. Whenever we move, we do so by contraction of some particular set of muscles attached to the skeleton. When we hold our-selves erect against gravity we are using muscles in opposing groups, some held in a contracted state in order to maintain our balance. Increase the G force, and you will cause greater contraction – the involved muscles work harder and get stronger. Rebounding increases the G force at the bottom of each bounce.
    3) By strengthening the heart muscle, it allows the resting heart to beat less often. Each beat becomes more powerful and sends out a greater surge of blood around the body to nourish its 60 trillion cells.
    4) It encourages collateral circulation, the formation of new branch blood vessels that distribute blood to the heart muscle and to other body parts by alternate routes. This indirect, subsidiary or accessory influx of new blood supply is valuable when there is a lack of nutrition to the tissues as the result of impairment of the main blood flow.
    5) It tends to reduce the height to which the arterial pressure rises during exertion. The same kind of training effect that occurs from aerobics performance with external muscles, takes place in the media, or middle muscle layer of the arteries. The training effect gives the media greater muscle tone, and elevation of the blood pressure becomes less great in time of stress.
    6) Furthermore, the blood pressure won’t remain elevated quite so long because of this training effect, and it lessens the time during which the blood pressure remains below normal after severe activity. The blood pressure drops suddenly after the need for its elevation is removed; the training effect from rebounding aerobics brings up the dropped pressure to its normal level more quickly.
    7) It lowers elevated cholesterol and triglyceride levels. As indicated in chapter two, L. Howard Hartley, M.D., Director of Exercise at Beth Israel Hospital and Associate Professor of Medicine, Harvard Medical School, discussed the relationship between physical activity and other risk factors for heart disease at a symposium sponsored by The American Heart Association, October 18, 1978. Dr. Hartley said, “Exercise can have a direct effect on blood Iipids,” and studies have shown that “people who exercise regularly reduce their levels of serum cholesterol and serum triglycerides.” Results of studies have also shown that exercise increases levels of high density lipoprotein fraction of cholesterol and “all of these effects of exercise are expected to have a favorable effect on cardiovascular health maintenance,” said the exercise physiologist.
    8) It holds off the incidence of cardiovascular disease. This is evident by acknowledging the risk factors of high blood pressure, high cholesterol, high triglycerides, high LDL (Iow density Iipoprotein) and realizing that rebounding exercises reduce all of these elevated readings that have your heart at risk.
    9) It increases the functional activity of the red bone marrow in the production of red blood cells. The red blood cells carry oxygen and nutrients to the tissues of the body and also help remove carbon dioxide from them. They are formed in the cancellous portion of the bone, the red marrow of which consists largely of blood corpuscles in all stages of development. About five million mature red blood cells are produced and released into the bloodstream every second. The blood platelets, which are essential for blood clot formation, and the white blood cells, which protect the body against infection, are also formed in the red marrow.
    10) It establishes a better equilibrium between the oxygen required by the tissues and the oxygen made available. This equilibrium is established by the red cells in the blood that carry oxygen to the organs and tissues and removes the carbon dioxide from them.
    11) It circulates more oxygen to the tissues. The different oxygen and carbon dioxide concentrations in the blood in the capillaries, and in the air in the alveoli cause the two to exchange gases. Carbon dioxide, at a higher concentration in the blood, leaves it and enters the lungs. Oxygen, which initially has a higher concentration in the lungs, leaves them and enters the blood. ln the blood, oxygen combines with the red coloring matter, hemoglobin, which transports it, pumped by the heart, to all the organs and tissues in the body.
    12) It increases the capacity for respiration. Breathing is controlled by changes in the volume of the chest cavity, brought about mainly by muscular movements of the diaphragm. Expansion and contraction of the lungs to fill the cavity result in lower and higher air pressures within them, which are equalized with the atmospheric pressure as air is forced into and out of the lungs. Repeated rebounding aerobics accomplishes more muscular movements of the diaphragm with the consequent chest expansion.
    13) It causes muscles to perform work in moving fluids through the body – which lightens the load on the heart. With two-thirds of the body comprised of liquids, the ability to send fluid to areas where it is needed such as to sites of inflammation, becomes vital. The amount of fluid in the body remains constant, con-trolled by the workings of the kidneys, and the surplus is disposed of through the bladder, lungs, intestines, and skin. The muscles also help in this disposal effort.
    14) It aids Iymphatic circulation, as well as the flowing the veins of the circulatory system. Lymph is pushed through the Iymphatic system by contractions of the vessel walls, by differences in pressure, and by the movements of muscles in surrounding parts of the body. At the base of the neck, the two main branches of the Iymphatic system merge with two veins, and the Iymph becomes part of the bloodstream.
    15) It promotes body growth and repair. Growth of the long bones is especially stimulated by rebounding; this is true because of the simulative effect on the pituitary gland. The gland’s frontal lobe produces at least six necessary hormones, one of which is the growth-stimulating hormone.
    16) It stimulates metabolism, which is a complex and continuous process that begins in the digestive tract and the lungs and goes on in every cell of the body. It consists of breaking down substances into simpler parts that are then recombined into countless new substances that compose the body. Every one of these chemical changes either uses up or releases energy, and rebounding conditions ail the body’s systems to handle energy more efficiently.
    17) It enhances digestion and elimination processes. The .beginning of metabolism is digestion, where food is broken down into simpler elements so that it may be absorbed into the bloodstream and used for energy, repair of tissues, and growth. The end products of digestion are eliminated from the body and regular muscular activity carries the entire process forward effectively.
    18) It expands the capacity for fuel storage, causing extra endurance. But the storage will be as deposits of protein rather than fat because of the extra muscular motion from rebounding.
    19 It reduces the likelihood of obesity, for exercise is vital in taking off excess weight. A daily program of rebounding aerobics may not cause the pounds to melt away overnight, but it will diminish body fat, improve muscle tone, improve the efficiency with which your body burns carbohydrates, and lower your pulse rate and blood pressure. Remember, there are 150 calories in a glass of beer. If your body does not need the energy these calories provide, and if you don’t want the beer to end up as fatty tissue, you will have to rebound for two minutes,” run for six minutes, swim for 10 minutes, .or walk for 22 minutes in order to burn up the extra calories.
    20) It provides an addition to the alkaline reserve of the body which may be of significance in an emergency requiring prolonged effort. The principal acid neutralizer, or base, in the body is sodium bicarbonate which is manufactured from carbon dioxide and from sodium obtained from dietary salt. Sodium bicarbonate helps to maintain the delicate balance between acidity and alkalinity that is necessary for the normal chemical activity in the body. By stimulating metabolism, rebounding enhances this whole alkaline mechanism.
    21) It more nearly attains absolute potential of the cells through chemical function. Cells respond to stimuli from the environment outside their walls. They perform the special task designed for them in the total economy of the living body. Thus, they will live up to their potential and function at peak performance if the environment is ideal. Oxygenation by muscular movement to increase respiration and circulation permit this potential.
    22) It improves coordination through the transmission of more impulses and responsiveness of the muscle fibers. Impulses travel along a nerve by a series of reactions that are partly chemical, partly electrical. Motor or efferent neurons carry impulses from the central nervous system to the various parts of the body where they are translated into action. At the outer end of motor neuron, the frayed end of an axon spreads out to form an end plate, which connects with muscle fibers. Similar structures at the ends of sensory nerves are concentrated in the sense organs and irregularly dispersed in the skin. The more coordinated procedures are carried out, the finer becomes future coordination efforts. Rebounding is a coordinative process.
    23) It affords a feeling of muscular vigor from increased muscle tone. Healthy muscles are important to our sense of well-being, our grace, coordination, and energy. But only properly exercised muscles stay in good condition; the reduced muscle tone that goes with a sedentary Iife can lead to poor circulation and a sense of physical depression. If muscles are not used at all because of prolonged bed rest or other immobilization, they become weak and atrophied.
    24) It supplies a reserve of bodily strength and physical efficiency. Even when we stand perfectly still, muscles are at work supporting our weight and maintaining our balance. While we sleep the muscles of our internal organs continue their motions. Stored within the belly of a muscle is protein and sometimes fat that comes forth when called upon to provide hidden quantities of strength and energy.
    25) It offers relief from neck and back pains, from headaches, and from other pains caused by lack of use of the various joints and muscles of the body. Almost everyone has experienced a charley horse that results from too violent use of a muscle. The muscle protests against an unaccustomed activity by becoming sore, stiff, and painful. By rebounding regularly, it’s not likely you’ll ever again have a charley horse.
    26) It curtails the occurrence of fatigue and menstrual discomforts for women. Muscles are affected by a great variety of disorders. They also are the underlying cause of many health problems. Fatigue, overwork of a group of muscles, nervousness, or insomnia, for example, bring on muscle twitches and spasms. The same is true of muscle cramps, especially those in the lower abdomen which may be related to dysmenorrhea or other female trouble.
    27) It results in better mental performance, within keener learning processes. You can help your brain to stay healthy and work at top efficiency by providing It with the necessary version through exercise and the sufficient amount of sleep.
    28) It allows for better and easier relaxation and sleep. The amount of sleep needed differs with individuals, but generally the body and mind tell you they are tired. If anxiety or discomfort are interfering with your sleep, a good session of rebounding aerobics does wonders to give you the necessary relaxation diversion.
    29) It minimizes the number of colds, allergies, digestive disturbances, and abdominal problems. Simply rebounding keeps the entire body with all its variable systems in tune. They work coordinately to provide optimum metabolism.
    30) It tends to stop premature aging. The effects of hardening of the arteries are reversed, prevented, or diminished. By conquering this ultimate pathology of the main degenerative diseases, you will keep your mind alert, skin smooth, skeleton flexible, libido intact, kidneys functioning, blood circulating, Iiver detoxifying, enzyme systems alive, hold onto your memory, and avoid different symptoms of the aging process. Rebounding aerobics will do it all for you. It offers limberness, pliability, strength, and stretch, for all parts of the body. It does away with “desk¬bound flabbiness” and executive stress which sometimes is the fate of many business executives and other persons.

  9. Holms says

    I’ve cited the review, “Is US Health Really the Best in the World?”, by Dr. Barbara Starfied (Journal of the American Medical Association, July 26, 2000), in which Starfield reveals the American medical system kills 225,000 people per year—106,000 as a direct result of pharmaceutical drugs.HAH you jest I hope? It is widely known that the US health system is a shambles.

    “In 2010, not one single person [in the US] died as a result of taking vitamins (Bronstein, et al, (2011) Clinical Toxical, 49 (10), 910-941).”

    “In 2004, the deaths of 3 people [in the US] were attributed to the intake of vitamins. Of these, 2 persons were said to have died as a result of megadoses of vitamins D and E, and one person as a result of an overdose of iron and fluoride. Data from: ‘Toxic Exposure Surveillance System 2004, Annual Report, Am. Assoc. of Poison Control Centers.’”

    To my knowledge, vitamins aren’t considered a problem per se by medical science provided they are used in a supplementary fashion. Rather, the problem arises when people replace proper medicine with these alternatives.

    In the Wikipedia entry, “US military casualties of war,” the grand total of all military deaths in the history of this country, starting with the Revolutionary War, is 1,312,612.

    In any given 10 years of modern medical treatment? 2,250,000 deaths.

    What an utterly ludicrous and dishonest comparison. Even setting aside my scepticism of those numbers, you are comparing completely different populations as if they are the same and hence implying that we can use these to calculate incidence rates.

    Let’s take America as it stands in 2013. How many people Americans are exposed to ‘death by war’? Wikipedia gives a figure of ‘about 63,000′ personnel deployed to the active combat zone of Afghanistan. How many people are exposed to ‘death by hospital visit’? I couldn’t find 2013 data, but for 2009 there were 128,885,040 emergency admissions to hospital.

    These then are the at-risk populations being compared: 63,000 to 128,885,040. Notice something? The death-by-war risk pool is less than 0.05% of the death-by-hospital pool.

    In other words, no shit Sherlock of course the hospital deaths are vastly higher.

  10. says

    I remember at my school, in various classes, the report “To Err is Human” was mentioned and discussed, in order to emphasize the harm that can be done by medical errors and to teach about steps that are being taken to prevent them. Nothing in this world is perfect, but it showed that there are people who are dedicated to making medical care better than it is.

    People conveniently forget what it was like before certain treatments were invented. Greta Christina’s essay “Short Memories: AIDS Denialism and Vaccine Resistance” comes to mind.

    Also: Siddhartha Mukherjee’s “The Emperor of All Maladies”. Not specifically about this topic, but there are passages which show how progress is made with lots of effort over time, etc.

  11. says

    There are different factors in harm by medicine and we should look at all of them.
    Patient compliance and information is one of them.
    We need to give them better information and we need to minimize their chances of making mistakes. Honestly, just printing damn days of the week of the stupid blister for daily medication helps (I’m speaking from experience). Better records are another thing.

    And doctors? They’re not above mistakes either, especially GPs who haven’t seen any formation and education not sponsored by the pharmaceutical industry in 2 decades. Recently my husband had a bad, bad cold, which looked a lot like an actual influenza. His GP just gave him antibiotics. Well, they didn’t do any good, but he got the full load of side-effects. Now, he’s a good boy and took them, but many people would have just stopped. And what did that GP do when he came back 2 weeks later because he still wasn’t really well? Gave him another, broad band antibiotic without ever actually looking whether he had a bacterial infection and if yes which one. This time he didn’t take them, but by now he’s well again.

    Last part is systematic problems like lack of personel. It’s not just “people who lie in hospital bed all day voluntarily. ” Some people need help and if they don’t get them, things get bad. After my grandma broke her arm it took us a few days to realize that not only nobody helped her getting uo, but also that nobody helped her eating or drinking. They simply put the stuff on the right hand side of the bed, the side where her arm was broken and bound against the body and after half an hour they would just remove everything again.
    By the time we found out the damage was done. Pneumonia, total loss of bladder control, heavy loss of body weight. A mostly independent elderly woman had been turned into somebody who needed assistance 24/7. And her arm? Well, she never got surgery because with everything it would have been life-threatening, so yes, in her case the hospital only did her bad. Had we known that we would have kept her at home.
    But the point is that we didn’t know so taking her to the hospital was the right decision.

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