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Iatrogenesis, or The Curious Case of Andy Warhol

(Abstracted with permission from the RSCI Newsletter; March 2009 special edition)

A curious title for a serious article on why health care is considered by some to be the leading cause of death in America? Sure. But this is a curious subject.

Let me make this a bit more curious. I say “considered by some” only to keep us honest, to ensure that what follows sounds more informed than inflamed. But, truth be told – and that is our goal here – I know, and soon so will you, that health care is the leading cause of death in America.

Let’s go back in time a bit to, say, 400 B.C., when Hippocrates (aka, “the father of medicine”), the ancient Greek credited with making medicine a profession distinct from philosophy or theurgy (i.e., ritual and magic), may have first uttered the phrase primum non nocere – first do no harm.” We have all heard of the Hippocratic Oath taken by physicians promising their strict adherence to the ethical practice of medicine (you might want to Google the full text), which includes the following assurance: "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone."

(In 1964, Dr. Louis Lasagna, then Academic Dean of the School of Medicine at Tufts University, wrote a Modem Version of the oath, which is used in many schools today. See, http://en.wikipedia.org/wiki/Louis_Lasagna#Revision_of_Hippocratic_oath)  

OK. So far, so good. Now to the term Iatrogenesis, which derives from the Greek iadtros, meaning "healer." Iatrogenesis literally means "brought forth by a healer." In practical use, the term refers to any adverse effects or complications caused by or resulting from medical treatment or advice. It applies to actions taken not only by physicians, but by all healthcare professionals, including but not limited to, psychologists, pharmacists, therapists, nurses, dentists, et al. Iatrogenesis is equally applicable to conventional as well as complementary and alternative medicine.

The causes of Iatrogenesis include (but, again, are not limited to) error, negligence, the adverse effects or interactions of prescription drugs, overuse of drugs leading to antibiotic resistance, blood transfusions, poor prescription handwriting, and emotional distress from attributing transient personal problems to mental pathology.

The estimated number of annual deaths caused by Iatrogenesis in the U.S. varies from a low of about 240,000 to a high of nearly 784,000, making it either the # 3 or # 1 cause of death and injury in the U.S., behind or ahead of Heart Disease (about 700,000) and Cancer (about 554,000). Based on published research, most notably in the report "Death By Medicine'. (Life Extension Magazine, March 2004, Dr. Gary Null, PhD; Dr. Carolyn Dean, MD, ND; Dr. Martin Feldman, MD; Dr. Debora Rasio, MD ; and Dr. Dorothy Smith, MD) and Dr. Lucian L. Leape's 1994 paper, "Error in Medicine," published in the Journal of the American Medical Association (JAMA), we firmly believe Iatrogenesis is the #1 killer, propagated by Big Pharma, the FDA, hospital boards, and the traditional medical establishment to promote and protect their obscene profit margins at the expense of your health, and all too often, your life.

Now to Andy Warhol.

For the few people who don't know the name, Andy Warhol (aka, "the father of Pop Art") was one of the most influential artists of the 20th Century. At the tine of his death at age 58 in 1987, his estimated personal wealth was $150 million (or $350-400 million in 2009 dollars) –certainly enough to assure the best medical care possible. On February 20, 1981, Warhol entered the prestigious New York Hospital-Come11 Medical Center in New York City for a fairly routine removal of an inflamed gall bladder. On February 22, 1981, Warhol died of what Dr. Elliot M. Gross, the Chief Medical Examiner for New York City, termed "an unexplained death of a relatively young person in apparently good health." (quoted in The New York Times, Feb. 23, 1981).

The August 1, 1981 New York Times further reported that The New York State Health Department, in a report in April, was sharply critical of care Mr. Warhol was given from the time he was admitted to New York Hospital on Feb.20 until his death two days later. The department called Mr. Warhol's treatment "inadequate" and said it had found scores of "deficiencies," including failure to do proper tests before surgery and the failure to keep his medical chart accurately ...According to ...[a] letter to Dr. Gross from the Manhattan District Attorney, Robert M. Morgenthau, the inability to determine the underlying cause of Mr. Warhol's death was a result of several layers of uncertainty and ambiguity in the medical treatment that Mr. Warhol was given."

A January 24, 1981 New York Times article by its Medical Correspondent, Lawrence K. Altman, M.D., "A Great Hospital in Crisis," describes in depth a slew of other such cases as this "five-star" hospital, including the {ironic) 1986 death of Michael Gannon, a 39-year-old vice president of Empire Blue Cross and Blue Shield, who after being examined in the emergency room by a resident who took no blood tests and diagnosed Mr. Gannon's chest and left arm pains as muscular and bone problems, discharged him without consulting an attending physician. Gannon died of a heart attack that night at home.

Iatrgenesis strikes again... and again... and again...and again... and again

The above stories are by no means to suggest that the pandemic of "Death By Medicine" is limited to, or more important for, the rich and famous. They stress that in America, even money cannot buy adequate or life-preserving medical care. On the contrary, we quite possibly don't have sufficient bandwidth to point out how this completely unnecessary plague, fueled by unmitigated greed and disregard for basic human life, touches the lives and financial well-being of every man, woman, and child in America -and increasingly worldwide.

Here are but a few of the myriad of horrifying annual statistics and estimates:

bullet2.2 million adverse reactions to in-hospital prescribed drugs
bullet7.5 million unnecessary medical and surgical procedures
bullet8.9 million unnecessary hospitalizations
bulletBy some estimates, 783,936 deaths caused by conventional medicine
bullet20 million unnecessary antibiotics prescribed for viral infections

In 1994, Dr. Lucian L. Leape published what has become the seminal Iatrogenic study,

"Error in Medicine," in the Journal of the American Medical Association (JAMA). With its publication, he opened medicine's Pandora's box and ensured that the problem could no longer be ignored. In it, he cited autopsy studies that showed 35-40% rates of misdiagnoses leading to death. He also calculated a 1% failure rate in intensive care units. To put that seemingly small number in perspective, a 0.1% failure rate in aviation would translate to 2 unsafe landings a day at Chicago's O'Hare Airport; in the U.S. Postal Service, it would equal 16,000 pieces of lost mail every hour; and in the banking industry, would mean 32,000 bank checks deducted from the wrong bank accounts.

At a 1997 press conference. Leape released a nationwide survey on Iatrogenesis conducted by the National Patient Safety Foundation (NPSF}, which is sponsored by the American Medical Association (AMA). The survey concluded that more than 100 million Americans have been affected directly and 84% knew of someone who had experienced medical mistake. At the same press conference, Dr. Leape updated his 1994 statistics, noting that as of 1997, inpatient medical errors nationwide could be as high as 3 million at a cost of $200 billion annually.

Let's step back for a moment and digest these anecdotes and numbers.

It's insane, isn't it?

It's completely insane that according to the "National Scorecard on U.S. Health System performance, 2008" prepared by the respected Commonwealth Fund Commission, “Performance on measures of health system efficiency remains especially low, with the U.S. scoring 53 out of 100 on measures gauging inappropriate, wasteful, or fragmented care; avoidable hospitalizations; variation in quality and costs; administrative costs; and use of information technology." In addition, the report concludes that "The U.S. fell to last place among 19 industrialized nations on mortalityamenable to health care -deaths that might have been prevented with timely and effective care." (For the full report, horrifying as it is, go to www.commonwealthfund.org )


Perhaps in a future article we will delve into the many, many causes behind the terrible reality of U.S. health care, but for right now, the causes can be summed up as follows:

bulletPROFIT (the desired result)
bulletGREED (the driving force)
bulletCONTEMPT (the life blood)

The nexus of Big Pharma, health management (HMO) business, insurance carriers, and increasingly medical practitioners has so much opportunity to make such outlandish profit that unmitigated greed, rather than ethics (remember our friend Hippocrates), has become the engine of the health industry. With that has come a culture of contempt -contempt for the very life which this nexus is supposed to preserve and enhance –and acceptability of implicit or explicit error.

We know we are in big trouble when

bulletthe pharmaceutical industry now provides about half the FDA's budget (this unholy alliance has substantially undermined one of the most significant accomplishments of Dr. Louis Lasagna (who wrote the Modem Hippocratic Oath) - that is, the requirement for controlled clinical trials as necessary for proving drug effectiveness as a condition for regulatory approval of a new drug which resulted in major improvements in the evidentiary standard in the Food and Drug Administration (FDA) and the pharmaceutical industry.");
bulletthe prestigious New England Journal of Medicine accepts articles from journalists who acept money from drug companies (as of June 202, because it was "too difficult" to find ones hat did not);
bulletthe amount of (reported) money given by the rug industry to colleges and universities for research spiked from $292 million in 1981 to $2.1 billion in 1991;
bulletBig Pharma spends over $2 billion annually on more than 314,000 events attended by doctors; and .Americans are bombarded by print, radio, television, and internet ads urging them to medicate their emotions, self-prescribe by mail order, or run to their doctors to demand medication for conditions they never knew existed.

As Dr. Marcia Angell, former editor of the New England Journal of Medicine, stated in her outgoing editorial, "When the boundaries between industry and academic medicine become as blurred as they are now, the business goals of industry influence the mission."