Nearly 9 million (8,925,033) people were hospitalized unnecessarily in 2001.1-4 In a study of inappropriate hospitalization, two doctors reviewed 1,132 medical records. They concluded that 23% of all admissions were inappropriate and an additional 17% could have been handled in outpatient clinics. Thirty-four percent of all hospital days were deemed inappropriate and could have been avoided.2 The rate of inappropriate hospital admissions in 1990 was 23.5%.3 In 1999, another study also found an inappropriate admissions rate of 24%, indicating a consistent pattern from 1986 to 1999.4 The HCUP database indicates that the total number of patient discharges from US hospitals in 2001 was 37,187,641,22 meaning that almost 9 million people were exposed to unnecessary medical intervention in hospitals and therefore represent almost 9 million potential iatrogenic episodes.1-4
Women’s Experience in Medicine
Dr. Martin Charcot (1825-1893) was world renowned, the most celebrated doctor of his time. He practiced in the Paris hospital La Salpetriere. He became an expert in hysteria, diagnosing an average of 10 hysterical women each day, transforming them into “iatrogenic monsters” and turning simple “neurosis” into hysteria.99 The number of women diagnosed with hysteria and hospitalized rose from 1% in 1841 to 17% in 1883.
Hysteria is derived from the Latin “hystera,” meaning uterus. According to Dr. Adriane Fugh-Berman, US medicine has a tradition of excessive medical and surgical interventions on women. Only 100 years ago, male doctors believed that female psychological imbalance originated in the uterus. When surgery to remove the uterus was perfected, it became the “cure” for mental instability, effecting a physical and psychological castration. Fugh-Berman notes that US doctors eventually disabused themselves of that notion but have continued to treat women very differently than they treat men.100 She cites the following statistics:
- Thousands of prophylactic mastectomies are performed annually.
- One third of US women have had a hysterectomy before menopause.
- Women are prescribed drugs more frequently than are men.
- Women are given potent drugs for disease prevention, which results in disease substitution due to side effects.
- Fetal monitoring is unsupported by studies and not recommended by the CDC.101 It confines women to a hospital bed and may result in a higher incidence of cesarean section.102
- Normal processes such as menopause and childbirth have been heavily “medicalized.”
- Synthetic hormone replacement therapy (HRT) does not prevent heart disease or dementia, but does increase the risk of breast cancer, heart disease, stroke, and gall bladder attack.103
- As many as a third of postmenopausal women use HRT.104,105 This number is important in light of the much-publicized Women’s Health Initiative study, which was halted before its completion because of a higher death rate in the synthetic estrogen-progestin (HRT) group.106
In 1983, 809,000 cesarean sections (21% of live births) were performed in the US, making it the nation’s most common obstetric-gynecologic (OB-GYN) surgical procedure. The second most common OB-GYN operation was hysterectomy (673,000), followed by diagnostic dilation and curettage of the uterus (632,000). In 1983, OB-GYN procedures represented 23% of all surgeries completed in the US.107
In 2001, cesarean section was still the most common OB-GYN surgical procedure. Approximately 4 million births occur annually, with 24% (960,000) delivered by cesarean section. In the Netherlands, only 8% of births are delivered by cesarean section. This suggests 640,000 unnecessary cesarean sections—entailing three to four times higher mortality and 20 times greater morbidity than vaginal delivery108—are performed annually in the US.
The US cesarean rate rose from just 4.5% in 1965 to 24.1% in 1986. Sakala contends that an “uncontrolled pandemic of medically unnecessary cesarean births is occurring.”109 VanHam reported a cesarean section postpartum hemorrhage rate of 7%, a hematoma formation rate of 3.5%, a urinary tract infection rate of 3%, and a combined postoperative morbidity rate of 35.7% in a high-risk population undergoing cesarean section.110
Never Enough Studies
Scientists claimed there were never enough studies revealing the dangers of DDT and other dangerous pesticides to ban them. They also used this argument for tobacco, claiming that more studies were needed before they could be certain that tobacco really caused lung cancer. Even the American Medical Association (AMA) was complicit in suppressing the results of tobacco research. In 1964, when the Surgeon General’s report condemned smoking, the AMA refused to endorse it, claiming a need for more research. What they really wanted was more money, which they received from a consortium of tobacco companies that paid the AMA $18 million over the next nine years, during which the AMA said nothing about the dangers of smoking.111
The Journal of the American Medical Association (JAMA), “after careful consideration of the extent to which cigarettes were used by physicians in practice,” began accepting tobacco advertisements and money in 1933. State journals such as the New York State Journal of Medicine also began to run advertisements for Chesterfield cigarettes that claimed cigarettes are “Just as pure as the water you drink . . . and practically untouched by human hands.” In 1948, JAMA argued “more can be said in behalf of smoking as a form of escape from tension than against it . . . there does not seem to be any preponderance of evidence that would indicate the abolition of the use of tobacco as a substance contrary to the public health.’112 Today, scientists continue to use the excuse that more studies are needed before they will support restricting the inordinate use of drugs.
Adverse Drug Reactions
The Lazarou study6 analyzed records for prescribed medications for 33 million US hospital admissions in 1994. It discovered 2.2 million serious injuries due to prescribed drugs; 2.1% of inpatients experienced a serious adverse drug reaction, 4.7% of all hospital admissions were due to a serious adverse drug reaction, and fatal adverse drug reactions occurred in 0.19% of inpatients and 0.13% of admissions. The authors estimated that 106,000 deaths occur annually due to adverse drug reactions.
Using a cost analysis from a 2000 study in which the increase in hospitalization costs per patient suffering an adverse drug reaction was $5,483, costs for the Lazarou study’s 2.2 million patients with serious drug reactions amounted to $12 billion.6,57
Serious adverse drug reactions commonly emerge after FDA approval of the drugs involved. The safety of new agents cannot be known with certainty until a drug has been on the market for many years.113
Over 1 million people develop bedsores in US hospitals every year. It is a tremendous burden to patients and family, and a $55 billion health care burden.14 Bedsores are preventable with proper nursing care. It is true that 50% of those affected are in a vulnerable age group of over 70. In the elderly, bedsores carry a fourfold increase in the rate of death. The mortality rate in hospitals for patients with bedsores is between 23% and 37%.15 Even if we just take the 50% of people over 70 with bedsores and the lowest mortality at 23%, that gives us a death rate due to bedsores of 115,000. Critics will say that it was the disease or advanced age that killed the patient, not the bedsore, but our argument is that an early death, by denying proper care, deserves to be counted. It is only after counting these unnecessary deaths that we can then turn our attention to fixing the problem.
Malnutrition in Nursing Homes
The General Accounting Office (GAO), a special investigative branch of Congress, cited 20% of the nation’s 17,000 nursing homes for violations between July 2000 and January 2002. Many violations involved serious physical injury and death.114
A report from the Coalition for Nursing Home Reform states that at least one third of the nation’s 1.6 million nursing home residents may suffer from malnutrition and dehydration, which hastens their death. The report calls for adequate nursing staff to help feed patients who are not able to manage a food tray by themselves.18 It is difficult to place a mortality rate on malnutrition and dehydration. The coalition report states that compared with well-nourished hospitalized nursing home residents, malnourished residents have a fivefold increase in mortality when they are admitted to a hospital. Multiplying the one third of 1.6 million nursing home residents who are malnourished by a mortality rate of 20%15,24 results in 108,800 premature deaths due to malnutrition in nursing homes.
The rate of nosocomial (in-hospital) infections per 1,000 patient days rose from 7.2 in 1975 to 9.8 in 1995, a 36% jump in 20 years. Reports from more than 270 US hospitals showed that the nosocomial infection rate itself had remained stable over the previous 20 years, with approximately 5-6 hospital-acquired infections occurring per 100 admissions. Due to progressively shorter inpatient stays and the increasing number of admissions, however, the number of infections has increased. It is estimated that in 1995, nosocomial infections cost $4.5 billion and contributed to more than 88,000 deaths, or one death every six minutes.16 The 2003 incidence of nosocomial mortality is probably higher than in 1995 because of the tremendous increase in antibiotic-resistant organisms. Morbidity and Mortality Report found that nosocomial infections cost $5 billion annually in 1999,17 representing a $0.5 billion increase in just four years. At this rate of increase, the current cost of nosocomial infections would be close to $6 billion.