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Will the accused please rise!
First of a two part article, published in the November 2001
issue of Healthy Options, New Zealand
"Adverse drug reactions...are common. They are responsible for 3.5% of hospital admissions, occur in 10 - 20% of hospital inpatients, and have recently been reported in 40% of patients receiving drugs in general practice." (M. Rawlins, Adverse reaction to drugs, British Medical Journal, 21 March 1981, 282, 974-976)
"Iatrogenic" is the word that describes doctor caused illnesses, disabilities and death. Embarking upon "learned" dissertations about the "etiology" of iatrogenesis, as one of the major journals has recently done, makes it sound as if it is an infectious disease beyond the control of the physician. Such language allows the medical profession to distance itself from responsibility yet again.
In New Zealand, Professor Peter Davis and his team have recently completed a study of preventable error in our hospitals. Such a study was long overdue, but I feel uneasy about the findings for two reasons.
The first reason is that the majority of those who suffer the effects of iatrogenesis in our community, never get as far as hospital; it is almost routine for their conditions to be misdiagnosed. The second reason is, that the drug injury statistics with which the researchers had to work, are incomplete due to those misdiagnoses, and because there is no legal obligation upon practitioners to report adverse reactions to the Centre for Adverse Reactions Monitoring.
On completion of the study, Professor Davis released a statement to the effect that our level of preventable medical error is on a par with the rest of the world. That may have been intended to be reassuring, but how reassured can one be when one knows the reported statistics in the two main international studies showed that: "In Australia medical error results in as many as 18,000 unnecessary deaths, and more than 50,000 patients become disabled every year" (British Medical Journal, 18 March 2000), and iatrogenesis "...constitutes the third leading cause of death in the United States after deaths from heart disease and cancer..." (The Journal of the American Medical Association, 26 July,2000.)
It would be humanly impossible to eliminate genuine mistakes entirely. Ideally these incidents should be regarded as a learning experience, and the injured party should not, as is usually the case, be traumatized a second time as he struggles with bureaucracy for the help that he now needs through no fault of his own.
The problem is that genuine mistakes are not the only cause of iatrogenesis.
Unethical "error" is an entirely different beast, and falling into this category are unreported and misdiagnosed iatrogenic conditions which occur for a variety of reasons.
Enticements from drug manufacturers in the form of gifts, expensive weekends at ski resorts, white water rafting, dinners at top class restaurants etc. are routine practice. The purpose is to persuade doctors to prescribe specific drugs and according to the New Zealand Herald (14 September 1990), the pharmaceutical industry in this country and at that time, spent $45 million a year on such incentives. Inflation adjusted, that figure would have increased considerably by 2001. It hardly seems necessary to mention that the pharmaceutical industry passes the cost on to consumers and according to the WHO, a third of them will suffer an iatrogenic illness. It is a game of Russian Roulette in which the practitioner points the pistol at the patient's head rather than at his own.
Political influence is also bought. In the United States, "Drug company lobbying for the first half of 2000 reached $US42.9million" and it was "predicted that the prescription drug industry would spend $US230 million during the election". Certainly the current most influential man on earth, George W. Bush, had no qualms about allowing the industry to contribute $US1.7 million towards his inauguration celebrations. (British Medical Journal 27.01.01) Multinational corporations do not part with such sums without a payback. It is not unusual for companies to manufacture a wide range of chemicals including pesticides that are known to cause cancer, but amongst its pharmaceutical range, is a very convenient treatment for that condition. Protected also by officialdom's blind eye, is the funding the company puts into cancer "research" - research that is designed to divert attention away from its own carcinogenic products.
You might be shocked if you could get your hands on a copy of a drug company's marketing strategy as I have done. Aggressive marketing and profits over-ride all other considerations and you would no doubt find wording such as: "The following specialists from the major centres, will recommend and endorse our new drug, X, and speak on behalf of the company." The specialist you last consulted, could very well be on one of those lists.
About thirty years ago, Roche had a plan to corner the market in addictive benzodiazepine drugs. They "...had been supplying hospitals with Valium and Librium free of charge. This not only blocked the competition, it also contributed to dependence... in response to the Monopolies Commission enquiry, Roche ceased this practice in 1972. In the same year, Dr. Anthony Clift published his seminal report on hypnotic drug dependence, in which he estimated that about one in five of his patients had started their hypnotic habit in hospital." ("Power and Dependence - social audit on the safety of medicines" by Charles Medawar)
Benzodiazepines, also known as tranquillisers, are a prime example of unethical "error" and it's worth having a brief look at their inglorious history.
In 1985, Dr. Vernon Coleman said this of them: "Increasing numbers of people have been turned into drug addicts through legal prescriptions which perhaps suits the politicians, and multi-national bureaucrats as well as the drug companies for it ensures an uncomplaining and docile community which is easy to administer, manage and manipulate..." Dr. Coleman was but one of many who had misgivings about the benzodiazepine drugs from the time they first appeared on the market in 1960.
The strange thing was, that for every professional article written expressing these concerns, several followed extolling the "virtues" of the drugs. This was and is, the function of ghost writers - a term employed when independent physicians sell their names to be used as the authors of such articles, when in fact they were written by the manufacturers of the drugs in question.
On the BBC Radio 4 programme, "Face the Facts" which was broadcast on March 16, 1999, Professor Malcolm Lader said: "It's more difficult to withdraw people from benzodiazepines than it is from heroin... Some of the tranquilliser groups can document people who still have symptoms 10 years after stopping."
In her "Evidence submitted to the House of Commons Health Committee 1999, sixth report" Professor C.H. Ashton, DM, FRCP, had this to say: "In some cases chronic prescribed benzodiazepine use has resulted in long-term, or possibly permanent disability."
A headline in the British paper, the Sunday Express, 13 May, 2001, read: "1.5 million patients at risk from danger pills. Tranquillisers are linked to brain damage." The Sunday Telegraph of 5 January, 1997, stated: "A survey of more than 1,000 women is to be carried out, following reports of physical and mental disorders among children born to women who took tranquillisers while pregnant. The survey comes weeks after The Telegraph revealed a generation of children suffering cleft palates, wasted bodies and dyslexia. The children - now in their teens and twenties - were born to women who took tranquillisers during pregnancy. All suffered withdrawal symptoms at birth." The floppy baby syndrome is the term used to describe those babies.
Successive New Zealand governments have known about the addictive qualities of the drugs since at least 1971. That was the year in which the World Health Organization required that they be restricted internationally in an effort to stop illicit trafficking. Those elected to take care of our interests, simply ignored the WHO along with the burgeoning numbers of casualties on sickness benefits, in prisons (for crimes carried out while under the influence of the drugs), and on ACC compensation.
The WHO document was not signed until 1990, but even then, it took a certain amount of arm twisting by the International Narcotics Control Board before the government of the day was shamed into passing the necessary legislation in January 1999.
Was Dr. Coleman right when he suggested that these drugs were used to control and manipulate the population? It was hardly necessary for the politicians to make it mandatory to take a benzodiazepine every morning before reading the political section of the newspaper since, for decades, they were the most widely prescribed drugs for just about anything that ailed you.
But Dr. Coleman was wrong in one respect. Not all users become docile and easily manipulated, as the police know only too well. The results of a study of the effects of benzodiazepines prescribed in a Canadian prison were published in Canadian Family Physician, November 1975. The study took place over a six months period and all participants were males ranging in age from 18 - 50. The report stated: "...3.6 times as many acts of aggression occurred when inmates were on these drugs. Crimes committed by those inmates... included: murder, attempted rape, rape, attempted murder, indecent assault, assault, armed robbery, robbery with violence, assault or wounding with intent."
The authorities are aware that many of the perpetrators who committed senseless, violent acts such as schoolyard and workplace massacres, were under the influence of medication, yet nothing has been done to stop it. Even as people are dying, the drugs companies are raking in the profits and writing out their cheques for political protection and physician incentives.
In her article "The big tranquilliser cover-up" published in "What doctors don't tell you", June 2001, Margaret Bell described how her friend and benzodiazepine victim, died. "My friend Simon died last year at the age of 36 after 15 years of painful [post] withdrawals. Over six feet tall, he weighed only six stone. His post mortem showed swelling and marked pallor of the entire brain... an atrophied heart, artherosclerosis, oedema, congestion of the lungs, liver damage, stomach bleeding and multiple gastric erosions. The pathologist diagnosed death due to multiorgan failure..." In life, Simon's GP had diagnosed anxiety. A cover-up, indeed.
In 1988, the Committee on Safety of Medicines in the UK warned against prescribing benzodiazepines for more than four weeks, yet a Panorama documentary shown on BBC television in May 2001, found that some patients for whom the drugs were first prescribed after that date, have been kept on them for ten years and more. With its population of 50.4 million, 17.5 million prescriptions are still issued annually in the UK. 1.5 million patients are still on long-term prescriptions. (Official 1999 figures).
In New Zealand we are following the same pattern but our ratio is much higher. Even though the drugs were restricted in January 1999, the number of prescriptions issued since then, has changed little. In the year 2000, 463,312 prescriptions were written and we only have a population of 3.7 million.
Between 1982 and 2000, only two practitioners in New Zealand reported addiction as an adverse reaction to the Centre for Adverse Reactions Monitoring. Given the several million prescriptions issued during that period and the fact the most people become addicted, someone somewhere has a lot of explaining to do about the system.
Deaths attributed to addictive drugs in the UK between 1990 and 1995, are as follows: benzodiazepines 1,810; methadone (prescribed as a "treatment" for addiction), 676: and heroin 291. What a picture that paints! Two legal prescription drugs cause more deaths than heroin.
So here's something else that needs explaining. When our government finally and reluctantly restricted benzodiazepines, why were they listed in the least restricted category, rather than the most stringently restricted category under which heroin is listed - a drug which the statistics show, is less dangerous?
The cost of unethical "error" to the victims and their families in suffering and financial terms, is horrendous, but how much does it cost society in terms of health services, state benefits, ACC, and the justice system? Where the ACC is concerned, one cannot include the medical profession as part of "society", because its members do not pay ACC levies associated with their work. This is not because the law says they don't have to, it is because they have said, "Sod the law! We're not going to!" And all the politicians do, and have done for many years, is to shrug their shoulders. That leaves the rest of us to pick up the tab for the profession's botches.
I recently approached the ACC and asked the following three questions about benzodiazepines:
How many claims were made during the past 20 years?
How many of those were successful? And
what was the average duration of ACC support given?
I received a reply from Dr. David Rankin who was concerned about who I was and what the information was to be used for. He then said: "...It is unlikely that there will be much information... benzodiazepines are pretty safe and seldom give rise to injury. For them to be covered by mishap, you must die, have to stay in hospital for 14 days or be disabled for 28 days. These are most unlikely to be the results of benzodiazepines."
It is true of course, that the profession, the government and the drug companies are keeping close lipped and wish we would all shut up and go away, but in the year 2001, nobody in the medical profession can be as naive as Dr. Rankin. And certainly not now that the drugs are restricted with the recommendation that they be prescribed for no more than four weeks.
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