Iatrogenia - An Epidemic of Medical Incompetence

 

Epidemic of Harm

An epidemic has been sweeping western countries for several decades - it is an epidemic of medical incompetence. Iatrogenic disease – illness caused by doctors – kills between 760,000 and 1,000,000 people per year in the United States [Null-a],[Lazarou; Vilardo] with proportionately similar counts for Canada (see below). Note that the  number killed through medical incompetence is greater than deaths from cancer (553,251) or heart disease (699,697) [Vstat]. That is to say, the death of patients as a direct result of medical intervention is greater than from the reason for medical intervention.

Numbers abstracted and epidemiological evidence from the well known paper by Null et al [Null-b] with additional calculation and evidence in papers by [Kohn], [HCUP], [Lazarou], [Siu-a], [Siu-b], [Leape], [Brennan], [Bates] and many others, indicate that iatrogenia is not only the largest cause of death but is also the greatest cause of long term harm to those who survive its machinations.

During the ten years in which 300 people died in much-publicized accidents
involving Ford Broncos with Firestone tire blowouts, medical providers’
mistakes killed between 400,000 and 900,000 U.S. patients [Vilardo].

Medical Errors

A presidential task force in the United States labeled medical errors a “national problem of epidemic proportions.” Members estimated that the “cost associated with these errors in lost income, disability, and health care costs is as much as $29 billion annually.” More people in the USA die from medical mistakes each year than from highway accidents, breast cancer, or AIDS. In Canada the numbers are difficult to ascertain due to lobbying on the part of the Canadian Medical Association preventing government mandating the collection of appropriate statistics. However the numbers are thought to be proportionally higher. In other countries, epidemiological evidence is slowly being submitted to journals, indicating similar evidence of an epidemic of physician caused death and suffering. In Australia for example, 50, 000 Australians per year are permanently disabled and 18,000 die as a result of medical intervention [Wilson].

When physicians go on strike, patient mortality plummets: The 1960’s saw physicians in Canada go on strike and the mortality rate dropped. Los Angeles physicians associated with a USC hospital went on strike in the 1970’s and the mortality rate dropped. Physicians went on strike in South America later that same decade and the mortality rate dropped. Physicians have now gone on strike on 3 different occasions in Israel –in the 1950’s, again in the 1970’s or 80’s and now in the the year 2000. In all 3 occasions the mortality rate has dropped, on one or two occasions by 50%. [Siegel-Itzkovich; Mendelsohn; BritMed; CBC-a]

There is also the type of "error" that is simply due to mass ignorance and simple uncaring attitude on the part of an MD. This is most clearly shown on the subject of hand washing. Disease transfered by contamination from unclean physician hands is responsible for just tens of thousands of deaths every year in North America. A recent Canadian study showed that as few as 10-20% of hospital physicians wash their hands after visiting a patient [Garner]. The numbers are similar for the United States. There is some emerging evidence that MDs in general practice seldom if ever wash their hands when going between patients, thereby transferring disease from one to another. This is at best callous indifference to common sense and at worst apathetic ignorance of the literature on hand washing, the spread of infectious disease [Pittet], and the death toll preventable therefrom. Some researchers have even termed the average physician 'self-delusional' [Pritchard] (see also [Boyce]) in their disregard for so obvious a prophylactic measure. Indeed, ignorance, indifference, and self-delusion are common medical errors.

Hospitals

Hospitals - the sanctum sanctorum of the business of medicine - are particularly dangerous to health. For example, a British study found that just under 20% of patients suffer some adverse effect from hospital mistakes [Andrews]. The study followed 1047 consecutive patients admitted to three units of a large urban teaching hospital. It found that there were more adverse events the longer the patients were in the hospital. In fact the likelihood of experiencing a problem increased 6% for each day of hospitalization.

Furthermore, the manner in which deaths are encoded at hospitals serves to mask the true extent of iatrogenesis. ICD (International Classification of Diseases) usage allows deaths to be coded according to the immediate cause of death (such as organ failure), rather than to underlying cause (such as malpractice, drug interaction, etc.).

Here are a few additional statistics for the United States. Population proportion is largely consistent with other western countries (Health care in the United States is an almost $2 trillion per annum business. Yet U.S. health care ranks very poorly in the world - a mere 15th in the list of 25 industrialized countries tracked by the World Health Orginization [WHO(1)]):

• • 12,000 physician approved surgery later found to be unnecessary [Leape]
  • 195,000 U.S. deaths due to hospital error [HG] and are steadily rising [Shapiro] by a roughly 3% rate [ibid]. One can hypothesize that for the U.S. at least, in the intervening years since the IOM study pointing out the dangers of iatrogenia in hospitals, harm rates have actually increased and are continuing to do so.
  • 106,000 negative effects of drugs [Corrigan]

Is it any wonder that more and more people are doing everything possible to avoid the hospital when they are ill?

A majority of those seeking health solutions have left traditional allopathic medicine in favor of non-traditional medicine due to dissatisfaction with allopathic physicians [Eisenberg; Astin]. These numbers would be far higher if insurance companies would fund alternatives to allopathic medicine [Capell; Smith.]. The fact that naturopaths, who actually do help, are not funded in Canada serves as appauling testimony to the lobbying efforts of the iatrogenic horde.

Blaming the Patient

In part too this is due to the habitués of blame on the part of many physicians - a difficult to diagnose illness is often seen as the patient’s fault.

For example, if the diagnosis is not obvious and standard tests turn up negative, many physicians tend to assume there are psychological factors involved. It should go without saying that they have a complete lack of qualification to pursue these avenues, and worse often cause damage and misdiagnoses by so doing. Incidentally psychiatry - another area of allopathic medicine - has caused unimaginable suffering in many. There is a large literature debunking much of this pseudo-science. See for example [Levine; Regush; Kaiser; McGuiness; Morgan; Ross]. Of particular interest is Thomas Szasz work on the issue [Szasz].

A man born in a poor area of Washington can have a life expectancy that is 40 years less than a one in a prosperous neighborhood only a few blocks away [Jacobs]. The true cause of a plethora of illness and disease is poverty (as Foucault’s and others’ research so clearly shows). And poverty in the United States and Canada is large scale and worsening – the U.S. for example is the 3^rd worst on income inequality of all industrialized nations [Starfied]. Update: Now according to [Evans] and [Seeley], the the U.S. is the worst in terms of income inequality of all industrialized nations.

The vast majority of the citizenry of North America have incomes far lower than those of the doctors they visit. The majority of these latter both come from and move into, a socio-economic class unreachable by the majority of their patients. Hence there is little or no experience of poverty and its role in illness. The doxa of blame rendered by so many physicians is exacerbated by their inability to understand (more than in an abstract, off hand, intellectual manner), the true effects of such poverty and the inability of those entrapped therein. Escape from the pernicious health effects is unlikely for those little able to afford food, and insufficiently educated to judge the deleterious effects of advice from an MD blaming the patient for being too poor to be well.

Drug Culture and Profit

Adverse drug reactions (ADR) to prescription and over-the-counter drugs and medicines kill roughly 110,000 in the U.S. alone each year, and cause serious injury (blindness, paralysis, etc.) to 2.2 million in the U.S. per annum [Starfield; Bates; Lazarou]. This number has been steadily rising. Hence at least one person dies every 3-5 minutes from causes traceable to side effects of approved pharmaceutical drugs prescribed by physicians. This is roughly five times the number who die each year from illicit drugs [Hoyert].

The medical establishment works closely with the drug multinationals (see for example [Fraser]) whose main objective is profit , and whose worst nightmare would be an epidemic of good health. A Harvard Medical Practice Study found evidence that in the United States as many as 180,000 die each year as a result of adverse reactions to prescription [Leape]. (See also [Tamblyn].) This and similar studies however did not address the morphology of off-label drug prescription. Here drugs are prescribed for uses for which they are neither recommended or approved. This is a practice extremely common in North America [Stafford; Chen]. Yet off-label treatment success is largely unsupported by strong evidence [Radley]. What there is strong evidence for however, is drug company marketing to physicians of off-label use [Steinman; Sanghavi]. A Pfizer subsidiary to give but a single well-known example, was allegedly found guilty of so doing [Henney] and allegedly required to pay roughly $410M USD for so doing [USDJ(2)].

Lots of drugs must be sold. In order to achieve this drug companies have been caught in lies about test results, fraudulent activities, off-label marketing, and kickbacks to both politicians and the medical profession. One such company for example has been found guilty of a five billion dollar conspiracy of price fixing [USDJ(1)].

Sadly doctors have become the principal salespeople of the drug companies. They are rewarded with research gifts, and many perks, as well as research grants ( in Canada [Argene], the United States [US-3], and Britain [Mendal] senior drug company executives sit on the boards of  government granting agencies, deciding on how to distribute taxpayer funded research grants). The principal buyers  of these drugs are the public - from infants to the elderly - who are thoroughly medicated and vaccinated (media hyped pandemics, real or not, are a drug company's dream). The bottom line is that drug companies have come to dominate medicine.

Drug companies advertise to the tune of several billion per year. The result of this advertising? A susceptible health care system contributing to iatrogenia. For example, in a randomized control trial research [Kravitz] showed that actors posing as patients complaining of stress and fatigue were five times more likely be prescribed a particular antidepressant – Paxil - if they mentioned having seen an advertisement for same. The study concluded that “direct-to-consumer advertising may have competing effects of quality, potentially averting under use ... while also promoting overuse”.

Gunpoint Medicine

This domination extends to new laws requiring drug treatment of healthy patients: The Attorney General for the U.S. state of Maryland announced that parents refusing to have their young children vaccinated would face jail terms and fines, and their children would be forcibly injected with vaccines [Manning; Aizenman]. Students were literally hearded like cattle to injection sites in courtrooms where armed guards and attack dogs made certain no interference with the forced vaccinations were possible. No health emergency was in progress – the state had simply decided that mass forced vaccination was appropriate. The vaccines in question contained thimerosal, preservative made in part with toxic methyl mercury. Methyl mercury – a known nerve toxin which has frequently been linked to increased numbers of autistic children. Its use in vaccines has been banned for decades in most civilized countries.

Similarly the governor of the U.S. state of Texas passed a law requiring all young girls entering 6th grade (I.e. 11 and 12 year old girls) be vaccinated against some of the viruses believed by some to cause cervical cancer. The vaccine in question – Gardasil – was made only the the Merck drug conglomerate. Note that Gardasil was said to be only sometimes effective against some of strains of human papilloma virus (HPV) believed to causes some forms of cervical cancer. Yet there are >100 types of HPV of which only 15 are associated with cervical cancer. Gardasil has been said to protect against only 70% percent of these latter. Note that regular Pap tests and associated normal treatment would do the job better, and more inexpensively [Saslow]. And without the side effects of Gardasil which have been alleged to be: neurological symptoms, joint pain, fever and Guillain-Barre syndrome in 82 girls within six months of their forced treatment, with neurological symptoms being common [FDA]. Use of Gardasil with other vaccines had not been studied at this time, although common practice with girls this age was multiple vaccinations [Merck]. When news of this emerged, 20 other U.S. states immediately began ordering forced injections of all young girls.

Another example: In Virginia the courts ordered a young teen, Abraham Cherrix, to undergo chemotherapy for his Hodgkin's disease, Hodgkin's disease, despite the fact that neither he nor his family wished the treatment [Cherrix]. Chad Jessop, of California was diagnosed with a malignant mole, similarly wished to forego traditional treatments. For the horrific crime of supporting her son in his refusal of chemotherapy, his mother was she was arrested and placed in maximum security solitary confinement. Things became much worse for the family after that as the full power of the state was brought to bear to force her son to be injected with drugs he neither wanted, nor needed – since his melanoma had vanished [Jessop].

There are many, many other examples. Systems which combine legislation, forced drugs, and forced medical intervention are known as 'gunpoint medicine'. Gunpoint medicine has served to criminalize those who eschew Big Pharma and Big Medicine in favor of alternate health strategies. Strategies which the patient wishes... but which have the potential to lower profit, power, and social status of those involved in so-called traditional medicine. Gunpoint medicine is iatrogenia taken to its logical extension.

Finally, a quick word about evidence based medicine (EBM). This current fad was originally proposed at Oxford to help a lagging department achieve some newly announced government grants. It is yet another example of gunpoint medicine, albeit from a different vantage. In any case history the evidence record is necessarily incomplete. Real patients have real-world experience, needs, learning backgrounds and so on which have little in common with the artificialities statistically averaged, carefully screened and selected patients of randomized clinical trials from which EBMs are abstracted. Such trials can be and are easily skewed through statistical collapse, endpoints matching, study design, and a plethora of other artifices as the citations supra indicate. Whilst the ostensible goals of EBM may be laudable, the foundation echoes the fallacious reasoning of the early 20th century researcher Wundt who become one of the doyens of psychology and psychiatry. His reductio ad absurdum of the organism to appercetption, and stimulus objects to sensation – became a cornerstone of 'scientific' psychology. Yet like EBM rests on nothing more than spiritualistic presuppositions about the nature of the organism and indeed, the rejection of much of that which can be observed for its 'irrelevancy'. In the field, basing practice upon the dual processes of statistical averaging and spiritual presupposition guised as objectivity, adds to the harm so many patients experience. When EBM is taken as objective science, holding the patient, physician, and testing process to an artificially derived 'standard' the harm can be considerable. 

Ghosting

Many articles in medical journals are ghost written. Sometimes they are authored by people with scientific backgrounds who are paid to stay in the shadows and generate results favorable to particular points of view. Or to falsely represent clinical trial results in favor of a procedure or corporation [Johnson].

Some doctors at leading hospitals are paid large fees for simply signing their names to a ghostwritten journal article promoting a particular medical device, procedure, or drug whose favorable review may eventually lead to profit [Boseley]. Further, many medical journals and publications do not disclose their authors’ financial ties to drug and biotechnology companies. The argument that the extensive and familial ties between academic research and industry allow for necessary technology transfer is overinflated. This is especially so for clinical research where the technologies involved have usually long since been developed and tested.

This intrusion was well exemplified by the Oliveri case [ Oliveri; Nat. Rep.] which made it clear that medical faculty who protested corporate intrusion, control of pedagogy, or control of research could lose their reputations and their careers. For the majority, it was and is easier to play along.

The majority of publications relating to randomized drug trials have been ghost written, frequently in ways favorable to commercialization [Gotzsche]. Ghost authorship in industry-initiated trials is very common throughout the entire medical literature [ibid].

Often ghosted articles in medical journals are written on behalf of pharmaceutical companies. They are then published under the name of medical researchers who were paid for the use of their names yet had little or no involvement with the research or writing [Brophy; Antonuccio; Berenson; Elliott; Jones; Mathews; Ngai; Fugh-Bernam; and many others]. This is clear violation of the ICMJE guidelines [ICMJE] particularly section II.A.I, II.D, and III.A.

To give but one of many possible examples: A multi-billion dollar pharmaceutical company recently hired a medical education and communications company. They wished the company to produce a 'scientific' paper favorable to a particular drug. The company then hired famous medical doctor and academic who agreed to allow the paper to be published under their name without disclosing the paper's true origins [Moffatt]. In general pharmaceutical companies fund the majority of clinical trials and related research [Bodenheimer; Fielder] - little wonder that the results of many papers, particularly those ghosted by pharmaceutical hires, are favorable to the drug in question.

During the discovery phase of a recent lawsuit, one of the world's largest drug companies was allegedly influencing as many as 85 manuscripts on a single drug – sertraline. The company was allegedly using a 'front' medical education company to coordinate authors and ghostwriters to ensure favorable results were published. The end results was a medical literature allegedly largely ghostwritten which made up the body of published work on sertraline – the majority favorable to the drug company involved [Healy(a); Healy(b); Healy(c)].

Further, such funding of research, writing of papers, the popular practice of 'gifting' and other such practices by pharmaceutical and similar companies strongly biases published results favorable to the funders' products [Wood; Lexchin; Bekelman; Lesser; Warren]. The boundaries between corporate interests and academic medicine are indeed blurred (see Science is in Trouble). Regarding this, a small example: Elsevier publishes more than 1,800 journals and 2,200 new books per year [Elsevier (a)], amongst which number is the Australasian Journal of Bone and Joint Medicine.   Not listed on the journal's masthead however was the the fact that Merck (creator of the drug Vioxx discussed previously) had allegedly paid Elsevier an undisclosed sum to publish this allegedly fake academic journal [Grant]. Said journal does not appear to be listed in Medline, unlike almost every other reputable medical journal. The Australasian Journal of Bone and Joint Medicine was filled with articles allegedly favourable to Merck's alleged products. Yet nowhere was Merck's alleged funding of the work declared. The articles were also allegedly free of normal sourcing and citation. Dr. Jelinek - a member of the World Association of Medical Editors testified during a court case in which Merck was being sued for allegedly producing drugs with allegedly known dangerous side effects  [Rout]. After reviewing several issues of this journal during the trial Dr. Jelinek  indicated that the purpose of the primary purpose of the articles therein was to reassure the medical profession about the safety of  Merck products.  And further that a typical reader (ie. a physician) could easily mistake the publication for a real peer reviewed medical journal  [Grant (b)]. With allegedly potential dire consequences for that physicians patients. Elsevier, which allegedly accepted Merck's money to publish the “journal”, has argued in the past against open-access journals stating that such would undermine public trust in the integrity of journal data from reputable publishing houses such as itself [Elsevier (b)]. Yet it seems to me that Elsevier's alleged activities regarding Merck may be a clear argument in favour of community based open-access journals.

Sadly this is by no means an isolated example of a complicity of the willing. Physicians lend their names to mastheads, boards, and articles which they have neither read, penned, or reviewed; publishers offer their presses and their reputations; and large corporations perform revisionist manipulation of data. Collusion on all sides to the detriment of the patient, the profession, and society as a whole. 

Everyone who has conducted legitimate science, or expanded their medical knowledge, based upon reading and/or referencing the fake journals, has been disserviced. The false information has been passed along and may continue since not all readers/users could ever be located. Science and medicine have been poisoned by this, and the damage can multiply. The publisher should print a final edition of each, containing only one article, saying that all previous work printed there is suspect at best. The problem could be somewhat mitigated if the editors of every other journal reviewed the articles they've printed to see if they contain references to those journals, and request the author(s) examine them for possible revision removing same. When the authors are no longer reachable the editors should do it.

Medical schools are influenced by several means. Medical students are under the constant tutelage of industry representatives. Hence they learn to rely upon drugs and medical devices, rather than less invasive and more patient-oriented approaches. They come to believe there is a pill for every symptom. The come to believe it is natural and normative to receive 'gifts' from industry. They attend 'conferences' free of charge, never wondering why industry sponsors their meetings. Academic medical centers have become laboratories testing industry hypotheses, drug applicabilities; faculty perform extensive 'consults' for industry carrying their 'research findings' into the lecture hall imbibing the next generation with the same modus operandi. Medical graduates have been acculturated to this normative practice to the point were they are largely oblivious to its consequences throughout their profession, and in their own practices.

Ethics

The field of bioethics and medical ethics are rife with examples of the horrific. And of ethical departures by physicians and clinicians of all stripes. Similarly journals devoted to privacy ethics wax eloquent on the lack of such in the medical profession. Rather than cite these however, a real world example of what goes on may penetrate the blasé acceptance so common of ethical departures by so many in the business of medicine:

“I am all gloved up, fifth in line. At Tufts University in Boston, medical students, particularly male students, practice pelvic exams on anesthetized women without their consent and without their knowledge. Women come in for surgery and, once they are asleep, we all gather around; line forms to the left. We learn more than examination skills. Taking advantage of the woman’s vulnerability, as she lay naked on a table unconscious, we learn that patients are tools to exploit for our education. It all started on the first day when the clerkship director described that we were to gain valuable experience doing pelvic exams on women in the operating room. I asked him if the women knew what we were doing. Are the women asked permission? “No,” he said. And not only no, he described that he was “ethically comfortable with that.” [Greger].

Patients are regularly mocked and made fun of during surgery; MDs write shorthand notes on patient charts for view only by other MDs to belittle and degrade patients: the acronym GPO on a chart means “Good for Parts Only”; there is the term DBI, for “Dirtbag Index” where your friendly MD writes on a chart a rating of his personal opinion of you (remember, you are paying for this); 'LOBNH' - Lights On But Nobody Home referring to their opinion of their paying customer in need of medical help, and so on.

If more people demanded copies of their MDs’ notes – as is their legal right in most western countries - litigation for libel against MDs would sky rocket. And perhaps iatrogenic incidents would decrease as MDs learned to respect their customers rather than embracing the classism and cognitively dissonant questionable ethical practices which the label 'patient' has come to represent to the system.

In Canada MDs regularly screen new patients. Not as one might hope, to see how best to help them. But rather they are screened to see if the patient would be too much bother. If a patient has a complex illness, a long term illness, or a difficult to diagnose illness, they are rejected. Despite the fact that this is illegal, it is done everywhere. What an MD wants is a quick turnover - more patients usually mean more money. If a patient can be in and out in ten minutes, so much the better. So why take on more patients and spend more time with them, even though that might be the ethical thing to do? So-called 'high maintenance' patients can be sent to someone else. If there is no 'someone else', so be it.

Finally, it would be remiss in any discussion of medical ethics to fail in mentioning the well documented legions of MDs standing at the bedsides of torture victims ensuring that they stayed conscious for more agony, or did not die before their interrogators wished. You may wish to read Miles' well document research [Miles] for an introduction to this issue and then consider the ethics of the AMA's travesty of a response.  Or consider the thousands of MDs who have performed routine lobotomies on schizophrenics, gays, and others whom that egregeous manual of harm - the DSM - abhors. You may also enjoy Foucault's The Clinic for a brief history of purposeful and appalling harm cause by those who called themselves 'healers' working on behalf of the state.

Triage for Profit

“America's children must also have a healthy start in life. In a new term, we will lead an aggressive effort
to enroll millions of poor children who are eligible but not signed up for the government's health insurance programs.”
-- G.W. Bush [Bush-a] 

“I believe government cannot provide affordable health care.”
-- G.W. Bush [Bush-b] ignoring hard data from most other western countries

"... they've brought in private services covered by public health insurance... Why do I care and why do we
care as a federal government how they're managed?" -- Stephan Harper [Harper-a] 

“The package included ... some that would just horrify you, putting universal Medicare in our
constitution ... and a whole bunch of other things." -- Stephan Harper [Harper-b] decrying the human 
right to health care enshrined in the UN Charter to which his country was a signatory

In the United States the medical business (American Medical Association, American Hospital Association, Pharmaceutical Manufacturers of America, etc.) spends approximately $60,000,000 per annum [LD-1] into the purchase lobbying of U.S. politicians. The United States is the only industrialized country lacking a public health care system. Perhaps there is a relationship?

In Canada lobbying amounts from the health sector are so masked and tertiary sourced as to make exact determination impossible - but are thought to be proportionately similar [Ed.J.]. However lobbying efforts appear to be successful. For example, a 1994 clause agreed to by Canadian negotiators private health insurance in Canada subject to the World Trade Organization’s trade-in-services agreement (the GATS). As a result of this completely unnecessary clause U.S. groups are now able to stop expansion of Canadian public health insurance into new areas, such as pharmacare or homecare by invoking the GATS. They can do this, and are doing this, by complaining that their private insurers (almost entirely U.S. based) are being denied promised markets in Canada under the GATS provisions.

Lobbying by the medical business has also had its effects on the NAFTA agreements as negotiated by the Canadian government. The government has agreed under NAFTA to allow foreign health-care insurers and companies to use the expropriation-compensation rules to oppose reforms that harm their investments. That is to say, to oppose any move by the public health care system in Canada to expand or to exclude private providers. Canada's negotiators did not allow for any exception or exemption for health care to the expropriation-compensation provisions. Or said another way, appear to have purposefully paved the way for privatization of the Canadian system. Canadian governments, particularly Conservative governments, have been made fully aware of this fact but appear unwilling to protect the public system. Rather than enforcing the CHA (Canada Health Act) they have allowed NAFTA and GATS to lock in commercial for-profit commercialization of the industry.

The Romanow Commission on the future of Canadian Health Care found that greater privatization of health services would not deliver better or cheaper care, or reduce wait times [Romanow-b]. Privatization would negatively impact the poor, the elderly, and those in need while most likely exacerbating delays and negatively impacting quality. Privatization would not only destroy the public system, but introduce two tier – one for those with the wealth to afford proper care, and one for everyone else.

There are basically two arguments put forth in favor of privatization: (1) There are insufficient funds to maintain a public system and (2) there are insufficient numbers of MDs to fill the need. Both are faux arguments.

As to the money issue, most governments in Canada – federal and provincial – has had increasingly large and record high surpluses. Take British Columbia for example. There the Premier has stated many times that there were insufficient funds to maintain the public health care system. Yet this same person proudly announced a $4.1 billion dollar surplus in the Province – six times that predicted by the budget and in fact, the highest in history [Kemp]. Overall, federal budget surpluses in Canada had been in the multiple billions for many years [CanSoc-a]. There is more than enough money to maintain a properly managed public system.

The second argument is also incorrect. Certain medical (and highly litigious and so unnamed here) groups had purchased lobbied politicians in a successful effort to keep experienced doctors from other countries from practicing in Canada. Doctors trained in India, Britain, China, Brazil, and so on have been denied a license to practice without first jumping through complex, expensive, and belittling hoops. This same group has for decades ensured too that alternative practitioners are not covered by the public system, which would further reduce the need for MDs. They have also vigorously lobbied to keep RNs out of the loop – which again would further reduce the need for as many MDs. Finally, much of the so-called physician shortage is largely in rural areas, areas where Canadian physicians in general prefer not to practice (less money, fewer local resources, fewer perks, and less opportunity to refuse 'high-maintenance' patients as described in the previous section).

Notwithstanding this, the Romanow Commission and a host of papers in the literature indicating the deleterious nature of privatization [CanSrv] the Canadian Medical Association (CMA) through their president appear to want privatization. At a conference held by insurance brokers, the head of the associate claimed that there were long wait lists in Canada [Day] . He also claimed levels of health care spending were unsustainable - "Health care is approaching 50 per cent of all spending in the provinces" [Day]. These two claims were questionable: Tax cuts to provinces had reduced government revenue, hence public health care spending only appeared to rise as a percentage of provincial budgets. This did not in any way mean that they were rising as a percentage of the economy. The inference that they were somehow not sustainable by the economy therefore is incorrect. Similarly government in the thrall of privatization craze cut budgets to hospitals, then blithely say the system is in crisis and their friends in the private hospital business must be allowed to compensate. Bate and switch has a long tradition in politics.

Companies running private for-profit clinics generally sought profit centers similar to that which had occurred in the U.S. Such profit centers, in the words of the CMA president "...will create a massive new industry and enable the Canadian health industry and its workers to enter the international health market and participate in the $2 trillion American health economy. On the basis of extrapolations from other countries, we may see $40 billion a year added to the Canadian health system" [Day].

What were these profit centers? In large part they came from private clinics and private hospitals that did not accept emergency or complex cases. Rather such private for-profit institutions concentrated upon well-reimbursed and simple procedures. They refused patients, regardless of need, who lacked complete insurance coverage. Hence the huge profit margins. In testimony before the United States Senate Committee on Finance [Hosp.] it was shown that the profit from such enterprises came as a result of careful pre-screening based not upon patient need, but solely upon the patient's ability to pay and a relatively low expense (to the clinic) of the administered treatment.

That is to say, triage not by need of the patient, but by their ability to profit from the patient's illness. That is the type of system praised above for its $40 billion per annum increased profit.

As Commissioner Romanow said:

“... it is a far greater perversion of Canadian values to accept a system were money, rather than need, determines who gets access to care" [Romanow-a].

Yet that is precisely the direction that well lobbied politicians and an ontology of avarice amongst certain sectors of the medical community are taking Canada. 

There may be too, efforts by politicians to ensure private medical for-profit corporations continue to be profitable.  Consider the United States for example: There the health care system  forces people to purchase private health insurance should they fail to receive same from an employer [Fanchild]. This in effect mandates that money be paid to private medical interests. Indeed 30,000,000 citizens formerly free to choose other forms of medical coverage have been forced by law to purchace coverage from privately held for-profit corporations. At time of writing this privatization initiative is being mimicked in Canada, Germany, and many other states where Medicare is under severe attack. It is of course mere coincidence that so many for-profit medical corporations and others pushing for such schemes have been primary contributers to campaign funds  and other cash  'gifts' to the various politicians working to ensure such laws are passed [Fanchild], [Able], [Schwatzman].

Oncology

A case in point regarding triage for profit concerns the business of cancer treatment. Ocology is a business as well as an attempt to extend life. Sadly sometimes the former aspect obfuscates or even obliterates the latter.

It was known as early as 1939 that cigarette smoke was carcinogenic [Müller; Schairer]. Yet it took many decades to launch massive public education campaigns and class action suits against the perpetrators. It has been hypothesized by many that the delay was in large part been due to long standing conflicts of interest between donor corporate entities and cancer agencies purported to be working in the public good. It has been further argued that there has been and continues to be a systematic discrediting of evidence of avoidable causes of cancer by these agencies [Davis-3; Epstein; Rampton; etc.]. Should the reverse have been the case it is argued, a lucrative revenue stream would likely have been cut off. For example, the highly toxic mix of chemicals which are used in chemotherapy are reputed to be very profitable for the pharmaceutical companies involved in their manufacture. It would really be injurious were papers to be accepted for publication or research for funding, which indicated that deaths are frequently due to this mix rather than to the cancer they are supposed to treat. Cancer treatments are multi-billion dollar businesses. Cancer prevention, is not. Yet perhaps the emphasis should not be upon diagnosis and treatment, but rather upon research into prevention, alternatives, and most of all, science rather than politics and profit.

Since the 1800's carcinogens as collateral damage resulting from industrial and factory farming pollution, have been flooding the ecosystem. Commonly used pesticides, pulp-mill effluent, plastics in re-constructive surgery, building materials in homes, paints, oestrogen based insecticides ... in every aspect of large industry, farming, and manufacturing massive carcinogen leakage into the environment is common. To say nothing of the massive increase in radiation from the communications infrastructure (such as finding on neural damage/tumour growth with cellphone usage [Schuz; Lai-1; Lai-2; Lai-3;  Arnetz]). As both Epstein [Epstein-3] and Davis [Davis-2] point out, there is strong evidence that such lead to  increased the risk of cancer. For example, there are 28 chemicals produced in excess of 1,000,000 lbs/annum which have been shown in peer reviewed, double-blind studies to even in small amounts cause mammary gland tumours in animals [Rudel]. Yet none of these chemicals have been limited by government agencies, nor lobbied to do so by the ACS or similar groups. It should come as no surprise then that the directors of the American Cancer Society, FDA, National Cancer Institute, and similar bodies are primarily business people, many with ties to the pharmaceutical industry [Davis-1] who allegedly fund treatment venues vastly in excess of research into these effluent causes. In the US alone there are hundreds of millions of dollars in rebates for those proscribing so-called blood-boosting drugs [Berenson]. For which it should be pointed out, there is no independent system of evaluation the efficacy of so doing [Davis-4].

Similarly research into nontoxic alternatives to traditional for-profit drug treatment has continued to be dismissed by the FDA (United States Federal Drug Administration) [Epstein].  Consider for example the case of B17 for which there is considerable, well documented, peer-reviewed academic research indicating its efficacy as a treatment alternative [Griffin-2]. The various agencies whose board members or governing bodies stand to profit from the status quo have however virulently dismissed such inexpensive and perhaps far more effective, alternatives. For example the FDA which oversees this activity itself allegedly owns stocks in many of the  companies providing the very profitable service of drug cocktails [Feuer; Davis-2]. The American Cancer Society (ACS) allegedly devotes a mere 10% of its money toward independent research [ACS-a; ACS-b]. Research for prevention of the disease allegedly takes a (distant) second to use and prescription of  drugs, chemotherapy, and radiation [Davis-3]. All of which are very expensive. But more importantly, can themselves be as toxic as the disease.

“The chief qualification for a lay leader of the ACS was often check size, not a grasp of cancer” – [ibid, pp. 130]

The American Cancer Society (ACS) allegedly accepts millions in contributions from the very corporations which it is alleged, create this carcinogenic pollution [Epstein; Davis-2; Rampton].  One of three people in the United States is struck by cancer, one of two in Canada (note that more accurate statistics are available for Canada than the U.S.) [Mesley]. Of 57 known cancer-causing toxins, on average 45 are present in the bloodstream of every North American [Mesley]. Yet the Cancer Society and US National Cancer Institute allegedly do little in the pursuit of class action against polluting corporations, provide instead little more than a modicum of prevention or pollution research. The FDA and various advocacy agencies largely fail to pursue other avenues to prevent these toxins from entering the environment in the first place. The corporations producing the contaminates from oil companies using MTBE to pulp mills releasing dioxins into air and water, continue largely unabated and unhampered by the agencies who focus instead upon the billion-dollar business of cancer treatment and cure. And which continue to accept promotional deals [Epstein; Davis1; Davis-2; Rampton; Griffin] with the pollutors.

One may be forgiven for the suspicion that research by and for some of these agencies as well as the associated training of medical and oncology students, may show some bias toward perpetuating an industry. And that this is in large part due to the manner in which corporate funding for such research is made. The modus operandi of Big Science and its kin, Public Relations in medicine is not necessarily one of magnanimity.

“It is clear that the American Cancer Society - or at least someone very high within it - is trying to give the American people a good old-fashioned snow job. The truth of the matter is - ACS statistics notwithstanding - orthodox medicine does not have 'proven cancer cures,' and what it does have is pitifully inadequate considering the prestige it enjoys, the money it collects, and the snobbish scorn it heaps upon those who do not wish to subscribe to its treatments” [Griffin].
 

How to sue your doctor:

Again consider Canada, which as mentioned above is praised by the UN for its medical system. In that country all MDs are protected by the Canadian Medical Protective Association (CMPA). Monies from the CMPA, legal help, and a number of other services are available to any physician. Not so for the individual patient who believes herself grievously harmed by her physician and seeks respite through the courts. She foot the entirety of the cost of lawyers, expert witnesses, travel costs, time away from work, and the like herself. While her physician can draw upon relatively bottomless pit of resources available through the CMPA, the patient can seldom afford the costs involved.

Unlike the patient's meager financial resources for malpractice lawsuits, the   CMPA's war chest is allegedly in the three billion dollar range [Bratstein].

Further, the CMPA can draw upon an army of medical experts such as amongst their own members. Such "experts" can and do claim fees of $300-500/hour [Watcht] plus travel and accommodation fees for their testimony. Should the testimony favor the plaintiff, the CMPA allegedly will never use it. Further, all such testimony is largely opinion, since there is seldom incontrovertible fact in proving malpractice - only an opinion that standards of practice had been or had not been followed. For the patient finding expert whinesses willing to provide supportive testimony against their colleagues is a non-trival - and very expensive - task. Much more so in the United States and Britain.

In effect suing a physician is akin to suing a police officer. Proof well beyond that required in normal court cases is required. And as with alleged impropriety from the police, evidence sans videotaped or similarly strong evidence is unlikely to hold sway in the courts. In effect, whilst there are some legal wins against physician, malpractice suits to all intents and purposes stack the odds very firmly against the patient.

Alternatives

Of course some allopathic physicians do much good - setting broken bones, treating traumatic injury, aiding in difficult births, etc. And some are decent human beings, caring and concerned about the welfare of their customers. Some are very well intentioned, and to be praised for their work. t is important to remember this. But one must remember too that other health professionals are similarly dedicated, can do the tasks done by physicians, and aid patients as much if not more. Midwives, osteopaths, physiotherapists, speech language pathologists, etc. all have a significant and useful role to play. And yes, certainly some drugs can be very beneficial. But so can many herbal and alternative treatments.

But as cited in the section in oncology, the medical industry like any multibillion dollar business adverse to competition, has mercilessly sought out and destroyed alternative and successful methodologies. Working hand in hand with insurance companies, the drug industry, and lobbyists the multibillion dollar business of medicine seeks to protect its monopolistic power and profit. Medicine in North America is operated as a virtual monopoly. Any alternative approach is marginalized by the traditional medical profession, which fears above all things encroachment upon their profits - even if the encroaching alternatives are superior.

The point is that like any monopoly the business of medicine eschews other methodologies and equality-based funding mechanisms unless they prove profitable to the monopoly itself. Note that the fact that since alternative or non-allopathic are not offered and indeed have been virulently marginalized, there is no way to tell if other methods might in fact be more successful if they were allowed to flourish. Certainly with the number of deaths and injuries per year resulting from medical incompetence  indicates that it may be time to start looking seriously at the profession for what it is - a money making business monopoly. It is time to overhall a failed system.

Education

An MD is a trade school diploma. Some medical schools do not require even a three year BA. For those that do, it should be noted that a baccalaureate qualifies its holder for very little. For it neither certifies a knowledge of science or an ability therein. It is at most a starting place only. And it most certainly does not make one capable of understanding any but the most rudimentary science, its interpretation, or application. Yet this or its surrogate is the only actual true academic training the average MD will likely ever possess.

Once accepted into a medical school, it is difficult to fail - approximately 96% of medical students complete [Garrison]. This is higher than for PhDs at 62% [ibid], and significantly higher than good PhDs in the hard sciences, which can be lower than 10% for some of the more esoteric (i.e. interesting) disciplines. It is in fact on a par with the redoubtable MBA “degree” which can be had for a simple payment of tuition and a one month “intensive” at many institutions. That is to say, a farce of scholarship. Much of this high graduation rate for MDs has to do with socio-economic background, which is generally higher for the MD candidate [Dhalla; NASTOR-1; Baum] and the massive grade inflation present in most medical schools [Rosevensky].

No wonder so many errors are made, and so little cognizance of research methodologies, how to evaluate journal articles or the swave assurance of drug company "research" and salesforce. And no wonder that the well documented incompetence of the medical business as a whole goes unacknowledged by the average MD. Within the egregious Weltanschauung inculcated in the boot camp of medical training,  there is little room for science or competence. How different from PhD students (again, I am not speaking of the grade inflated degree here, but of one wherein true scholarship is required), particularly in the sciences, who must already have a Bachelors degree, a Masters degree, good grades, good references, hopefully several publications, and the money and energy to last the average of 10 years post Masters degree [Michigan State University study]  that it takes to complete a good degree. And unlike potential MDs, the failure rate is very high: >60% of PhD candidates (again here I speak of a true academic PhD, not the grade inflated fluff of nth tier institutions) do not finish [Statistics Canada; University Affairs reports].

You may enjoy the book The Medical Mafia by Dr. Guylaine Lanctot, or Confessions of a Medical Heretic by Dr. Robert Mendelsohn, or The Theology of Medicine by Dr.  Thomas Szasz. Medicine is BIG business, with a questionably educated, elite pseudo-scientific class perpetuating the myth of their own expertise in order to maintain status, money, and societal prestige.

But what of a physician's continued training after leaving medical school?  Consider Canada, which the UN considers a center of medical expertise [Huffman]. In that country Continued Medical Training (CME) requires no review and no testing. Certificates of attendance are given before the course(s) begin, leaving no requirement to attend. Overall real CME for MDs is largely non-existent.  Reading the occasional journal article or attending a drug-company sponsored seminar is not continued education. Under pressure from public lawsuits, there has recently been some sporadic attempt at correcting this, but sadly the efforts are little more than theatre security. In North America there few mandatory assessment programs, and certainly none of proven quality which ensure the MD injecting drugs or recommending treatment is even remotely current... or  competent. In Britain and Germany physicans are rated on-line in a number of ways - one of which is currency and recent formal education. But not in North America it has been alleged that the political power of the union (ie. the CMA and AMA) is far too entrenched to allow for meaningful, mandatory, high quality continued education.

I have known physicians who left medicine in disgust feeling abused by the system themselves, and believing that that the profession had lost compassion, competence, and most particularly, all vestige of academic quality or excellence.  Medical doctors are not scientists. Most have never done real research (the clinical trials occupying so many pages of so many medical journals do not constitute scientific research). Very few have any training in how to assess journal articles, and virtually no knowledge of advanced statistics or the rigours of proper hypothesis testing. Of course there are some excellent and knowledgeable practitioner’s of medicine, since competence can exist in any field. In essence, an MD is a trade school 'degree'. Like an automotive mechanic or other graduate of a trade school,  a certain level of memorization and doxal acquisition has taken place. But to equate this with deep learning is merely illustrative of inculcated belief systems by a union jealously protecting its revenue stream.

I would suggest that a typical MD involves surface learning; a good PhD on the other hand requires deep learning. By these terms I mean the formal definitions in the literature - particularly as found in work by Abrams, Levi-Strauss, Brouwer, Ramsden, Biggs, Entwistle, and others. As you may know from this literature, those who become expert in surface learning seldom if ever comprehend or even acknowledge deep learning, particularly in the Chomsky/morphological sense. The ability to memorize and survive the boot camp of medical training is the ability to survive and acculturate to the dogma of a trade school; it is emphatically not the same as the ability to reason, despite what the political clout of one’s business and propaganda may inculcate the public as well as its own practitioners to believe. 

False and Falsified Results

Perhaps in part because of this lack scientific training in medical schools (despite strident objections to the contrary from practitioners), there is a dearth of replicable, statistically sound research in the entire field.

The practice of medicine is not science. Syndrome disclosed to an MD are not met as objects of empirical study. Instead a little more than a general hypothesis on etiology and treatment is formed. And treatment rather than objective evidence determines the diagnosis. Yet even the simplistic hypotheses so formed are usually incorrect:

Consider: A finding touted by the medical community is that risk of disease between the genders is a function of genetic differences. Sex differences have ostensibly been found for hypertension, schizophrenia, multiple sclerosis, lung cancer, heart attacks, strokes, and the like. Publications recording these genetic gender differences are legion in the medical literature. Yet for all the claims of such association, there has been little replication in support. Of 600 reported positive associations between gene variants and common diseases, only six received consistent replication [Hirsch-a]. Bias, population stratification, Type I errors, and similarly poor research [Hirsch-b] has rendered the majority of the claimed results at best questionable and at worst, complete erroneous .

A team at Tufts and Ionnina Schools of Medicine looked at 432 peer reviewed publications concerning this link between gender and genetics [Ioan-a]. There was none. That is to say, only one of the publications had been replicated, and all of the publications did not properly account for statistical bias, a priori assumptions, false positive report probability [Wacht], testing by independent teams, and so on.

Ioannidis also found [Ioan-b] that when research first begins to be published, there is a back and forth of contradictory findings – the so-called 'Proteus Effect'. Initially some of the literature may for example support a relation between gender and disease type, and some may not. But in his review [Ioan-a], this effect subsided after time. He found that the probability of a research finding being correct appeared inversely related to the the number of studies finding statistically significant results. That is to say bias unconscious or not strongly effects results as more and more researchers hop on the current bandwagon – in this example molecular genetics and the relationship between disease and gender. Or more simply put – the more medical researchers studying and publishing concerning a phenomenon, the less likely the results are to be an accurate reflection of the data.

In contrast to Kuhn's highly questionable arguments regarding paradigm change, it seems to me that this is basically a 'Bandwagon Effect'. That is, the simple weight of medical publications in a particular direction forces conformity. If the data does not fit the current model, the data – not the model - is rejected. Although there is no question that medical care can and does help, it does not do so with the frequency of success its practitioners suggest, nor is it the only or even best means of providing curative aid. Bandwagon, not paradigm, is the overwhelming force behind traditional western medicine.

Postscript

Of the emails I have received over the years concerning this little page, the only writers who were in disagreement were those who indicated that they were physicians or medical students. All other have been overwhelmingly in agreement. Here is one of the earliest emails I received:

Comment received: … you are DEAD WRONG when it comes to medical school entrance and the “expertise” of a physician vs. a research PhD but you are very ignorant about what a doctor is. A doctor is a clinician of the human body and NO PHD could come even remotely close to being a clinician of the PHD. YOU need histology, pathology, Anatomy, medical history courses, EKG clinicals, hands on experience, etc need I go on. Do your research before you write such blatant false information for public consumption

My reply: Thanks for your note. It is always interesting when someone with ideas contrary to the mainstream is accused of ignorance simply because of his dissent from orthodoxy. In this little article I purposefully strove to write for a lay audience and so eschewed a more detailed or formal analysis. Here is a bit of background which may be relevant: As a professor I have taught medical students at a major first-tier university, I have worked in a research hospital as an epidemiologist, my research has been published in major peer reviewed journals including medical journals,  I am a researcher in the mathematical modeling of certain cortical functions, have had personal friends who are MDs, and finally have read extensively on the history of medicine in acculturation whilst working on my second doctorate. But far more importantly, the maleficence of iatrogenic incompetence from several demonstrably scientifically illiterate but highly placed physicians and 'specialists' have harmed those close to me.

It is often the case that those who have been pedagogically acculturated to the mythos of medical truth evidence bold belief in its (and their) superiority. If you have not already done so, you may enjoy reading Bourdieu and Foucault, and perhaps Ellul and a host of others pertaining to acculturation, habitus acquisition, and normative behavior, particularly in medical training and the belief systems inherent therein. At the least, you may enjoy a peek at Foucault’s history of the clinic. Finally, perhaps some research into the studies on surface learning (such that acquired by an MBA, MD, or similar) and deep learning (viz that acquired by true scholars) may be in order? Levi-Strauss' 'Structural Anthropology' may be a good place to start. I did not wish in this little page to present academic or theoretical justifications for my comments. But these can be had from those citations mentioned supra, as well as a plethora of others both within and without the multi-billion dollar medical business.

References

147 references cited. Please see here for detailed bibliography.