Medically-caused deaths and medically-caused suffering (continued)

Re my post earlier today, another friend from the UK responds as follows:

"First, big numbers always impress but I wanted to put them in context.

"In a western industrial society like the US or the UK you can expect 1% of your populate to die each year – for the US (the context of the paper) this means about 3 million deaths a year, of which 39,000 were estimated as being a result of errors (given the inadequacies of coding acknowledged by the author). This is just over 1% of deaths – too many perhaps, but at least its a number in context!

"The next group was Hospital Acquired Infections, which has then been a major focus in the UK for well over a decade, so perhaps the policy makers took note of this type of research and evidence early on.

"Then finally, adverse effects of medicines – which comes down to both the professionalism of medical practitioners and pharmacists, compliance by the patient and, perhaps most significantly, the growing complexity of patient need due to survival from previously deadly conditions and therefore significant rises in comorbidity in older age.

"The latter point requires new approaches to meeting the needs of people with complex/multiple conditions, something we are closely involved in through both our work with strategic workforce planners and others. We have also done extensive work in the area of end of life care services and continue to liaise with national policy makers in this area.

"There is therefore now significant emphasis, and some progress in the UK, on maintaining low levels of hospital acquired infections, training a workforce to meet complex multi-morbid needs amongst patients, and redesigning pathways and services so as to provide far more care outside of hospital.

"Scandals still happen though, and the Mid-Staffs review, which was born out of evidence of ‘excess hospital deaths’, is testimony to this.

"In my own mind this is in part due to an ‘over-industrialisation’ of the healthcare system, coupled with over-specialisation in the workforce and competition between NHS organisations driven by a silo approach to performance and target setting.

"All these are things that a healthy dose of Relational Thinking could address.

"Finally I was struck by the evidence and reference to inequalities being associated with poor health outcomes.

"There is a question about the adequacy of Rawlsian political philosophy to address health inequalities.

"I’m following up the reference in the paper you sent that suggests that more inequality, irrespective of the levels of wealth, leads to poorer health – that’s very interesting if competition drives inequality whilst collaboration creates a more mutually advantageous world-view and lifestyle."

Medically-caused Deaths (Iatrogenesis) - or how much evidence is there actually for so-called "Evidence-based Medicine"?

Dr Gunter Frank is a dear friend of mine, and his books are best-sellers in the German-speaking world (www.gunterfrank.de AND DO NOTE THAT GOOGLE TRANSLATE WILL TRANSLATE, AFTER A FASHION, THE WHOLE OF THE WEBSITE FOR YOU) though his work is unfortunately known only in the German-speaking world.

On my mentioning The Relational Thinking Network to him, he sent me the doc at www.drug-education.info/documents/iatrogenic.pdf

This shows that the health system in the USA is not the best in the world by a long shot.

However, that article was published 14 years ago - and, on my enquiring what the reaction to that had been, Dr Frank sent me the following link: http://jonrappoport.wordpress.com/2009/12/09/an-exclusive-interview-with-dr-barbara-starfield-medically-caused-death-in-America

Thankfully, I may never have to experience the American health system, but it is increasingly analogous to health systems in other parts of the developed world, so the information in these materials was shocking me to me as a potential patient as I grow older.

I said to Dr Frank that if 225,000 patients each year in the USA die from mis-diagnosis, improper medication, or the "side-effects of *correctly-prescribed* medicines", that is unfortunate of course, but not as unfortunate with living for the rest of one's life with the consequences of mis-diagnosis and improper medication for the rest of one's life - or at least for a very long time (it is now some 5 years that a relative in the USA has been suffering from this...).

If so-called "evidence-based medicine" is mostly now sponsored by pharma companies in order to enhance their own profitability, what can we do to move medicine more in the direction of "responsible medicine" (or "strengthening the ability of patients to take an objective view of the medical interventions being offered")?

That is Dr Frank's concern and I will be happy to have my attention drawn to others who are concerned about this.

Meanwhile, I raised such matters with a British colleague who is active in the UK's National Health Service.

He responded: "Sadly the papers were not surprising to me. Iatrogenics is a topic I have discussed with medical professional over the years. There is a strong mental defence mechanism amongst many professionals about this topic. It is very emotive. I would liken it to the introduction of asepsis: existing practitioners had to come to terms with the fact that their whole medical practice was dangerous (in a culture of “first do no harm”) in order to adopt a different approach. The admission was psychologically hard in the case of asepsis when there was a clear solution. It is a lot harder when there is no clear solution. Also in a litigious environment, it is safer to act (based on studies approving action) than to stand by. There is significant evidence that defensive medicine in the US causes more interventions than are necessary and that at best those extra interventions have no impact on mortality or morbidity. The BMJ and other UK journals have covered this for over 20 years to my knowledge".

On the issue of so-called "Evidence-Based Medicine", this colleague says "XXX & I have previously discussed the irony that there has been inadequate evidence in favour of Evidence-Based Medicine itself as a methodology. Apart from the issues with pharmaceutical/economic drivers in the approach, there are studies that a) the evidence generally used is skewed & b) the approach ignores the evidence in favour of the primacy of the clinician-patient relationship in the efficacy of treatment".

He then draws my attention to Michael Porter's article in The Harvard Business Review last October, which includes critiques of previous magic bullets for improving healthcare (including "Evidence-Based Medicine") before proposing one of his own.

BTW, Porter's solution unfortunately ignores the cheapest ways of encouraging people to take responsibility for their own health - exercise, proper diet, adequate sleep (and then using complementary efforts such as homeopathy and Chinese medicine as a first line of defence for everything non-urgent).

My friend concludes: "As with reform of the audit regulatory system, I think we need to either lobby at the highest level with a cogent alternative or create counter-cultural subsystems which will influence the wider system".

Any takers?

So when should you seek a different hospital than your nearest - or your usual?

Here's research from Germany suggesting its when occupancy touches 92.5%:http://www.health.jbs.cam.ac.uk/research/current/downloads/120806_stress_on_the_ward.pdf

Any research into what the exact figure is for the USA or UK or India or any other country?

If so, I'm unaware of it.

But occupancy rates are one thing to keep in mind anyway....

Do you suffer from "dry eyes" and spend more than 5 hours a day at a computer screen?

You may find it helpful to:

- deliberately blink more often

- place the terminal at a lower height, with the screen tilted upward

- use a humidifier, and

- avoid being in the direct path of the wind from any air conditioner.

At least that is what Japanese researchers recommend: http://www.reuters.com/article/2014/06/16/us-screens-dry-eye-idUSKBN0ER2HG20140616?

The debate among UK parliamentarians regarding the merits and limitations of homeopathy

Someone I know draws my attention to a blog post on the debate among UK parliamentarians regarding the merits and limitations of homeopathy: http://www.theguardian.com/science/blog/2010/feb/22/mps-verdict-homeopathy-useless-unethical item saying that

My response

"I am well aware of such arguments on the part of the Western medical establishment which, among other things, wishes to push the interests of the Western pharmaceutical industries.

"The facts are that:

" (a) Western "evidence-based" medicine keeps changing its mind on whether even ordinary food (such as coconuts) are healthy or unhealthy (there is an interesting debate on what constitutes "evidence" and in relation to what - e.g. the Japanese claim that Western medicine affects the Japanese differently (because of their different genetics and diet) - so if your test sample includes Japanese-origin people, how valid is that sample and for whom? In any case, Western medicine focuses only on symptoms not on the whole person and the idea that you need to establish exactly how vigorously to shake homeopathic medicine is simply idiotic - at those levels of dilution a vigorous shake is just a vigorous shake - one could no doubt establish the degree and duration of shake that is most effective, but one always has to ask how much time and energy to invest in establishing something - if homeopathic medicine was extremely expensive it might be worth doing, but homeopathic medicine is extremely cheap

"and

" (b) there is a huge amount of subjective evidence such as that my allergy is helped by NO Western medicine but responds to homeopathic treatment (it could be argued, of course, that I am so deeply suggestible or brainwashed that my system does not respond to Western medicine but does respond to homeopathy - but such an argument would be tantamount to saying that neither Western medicine nor homeopathic medicine "really works" while suggestibility and brainwashing does - in which case of course we should not be spending so much money on Western medicine (and the little that is required for homeopathic medicine), we should instead be focusing on suggestibility and brainwashing as by far cheaper routes to health).

"I have maintained for a very long time that Western medicine is unbeatable when it comes to infection or to situations needing surgical intervention, but Western medicine has no clue at all when it comes to age-related or genetics-related or disposition-related or chronic or mild illnesses, and that is where other medical systems (e.g. Ayurveda or Homeopathy) help.

"There are then further facts, which no one talks about:

" 1. the side-effects of the very powerful Western medicines (sometimes "the cure is worse than the disease")

"and

" 2. the effects of mis-diagnosis and, moreover, of mis-prescription.... I don't know of any research that has been sponsored by these folk who are so interested in "evidence" regarding how often mis-diagnosis happens and what is the impact of the wrong prescriptions.

"Conclusion: let us continue taking Western medicine for clear, identifiable diseases for which Western medicine has effective cures; and, where Western medicine has no clear diagnosis and treatment, it is ALWAYS common sense to at least try complementary medicines.

"For example, if X's indigestion were to be shown to be due to some specific disease in the Western lexicon, then it would certainly be silly to avoid using Western medicine; but where Western medicine has no clear diagnosis and treatment, we would be stupid to not try alternative medicines. Of course nothing has worked over the last decade or whatever, but that is simply the reality of the fallen world in which we all grow older and sicken and must die some day regardless of all the illusions as well as all the undoubted wonders of Western medicine (such as fixing Y's ankle-ligaments problem).

So calories may have nothing to do with the obesity epidemic: if so, what does?

So my earlier intuition, based on mere observation, that calories had nothing (or very little) to do with the obesity epidemic, has now been shown to have been correct:

"Despite obesity rise, U.S. calories trending downward March 06, 2013 01:32 PM ET NEW YORK (Reuters Health) - U.S. adults have been eating steadily fewer calories for almost a decade, despite the continued increase in obesity rates, according to survey data from the Centers for Disease Control and Prevention (CDC)." http://links.reuters.com/r/CRB2Q/7HA2Q/08U5ZC/V11JD5/3C632Q/YT/t

That leaves unanswered the question: so what IS responsible for the obesity epidemic?

As earlier, I suggest that food modification may have something to do with it...as well as the kinds of fertilisers used.

Mobile Phones threat

I see that the US Government Accountability Office has called for a rather overdue review of the impact of radio-waves: http://www.reuters.com/article/2012/08/08/us-usa-phone-radiation-idUSBRE8761CG20120808?feedType=RSS&feedName=healthNews 

In an age when technology changes every 18 months on average, mobile 'phone radiofrequency energy standards are 15 years old - and are therefore probably at least a dozen years out of date.