The Price of Modern 'Miracles'
by
Gurli H. Bagnall
Patients' Rights Campaigner
New Zealand
May 22, 2001
"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.
Iatrogenic (doctor caused) death "... 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
Add to that, the World Health Organization's estimate that a third of diseases are the result of medical treatment and we all have cause to worry. No one is immune from such tragedy and when prestigious medical journals and the WHO are owning up to these horrendous statistics, society had better sit up and demand some answers.
New Zealand has a small population of 3.6 million people, so an article published in the New Zealand Herald of 14 September, 1990, was shocking to many. But it certainly sheds light on the preventable medical error epidemic. The article stated that in New Zealand, drug manufacturers spent "about $45 million a year" to "woo" doctors into prescribing their wares. Incentives included "...freebies such as river rafting weekends, ski trips, movie tickets, meals and alcohol". By 2001, we can assume that the amount of $45 million, will have increased significantly.
The average incentive offered by drug manufactures to prescribing practitioners, is equivalent to the annual income of some of the poorer members of our society. But it gets worse. Even as many of our doctors are cavorting about on the ski slopes, that $45 million plus, is added to the cost of pharmaceutical products and is another burden to be borne by the poor, the sick and the maimed through taxes and on-the-spot-payments. The final insult is that many of those people will become iatrogenic statistics.
The drugs belonging to the benzodiazepine (BZD) group have contributed largely to the international iatrogenic epidemic. Ironically, they are also known as minor tranquillizers – the 'minor' separating them from the major tranquillizers which were the anti-psychotics, now known as neuroleptics.
The first BZD appeared on the market in 1960, and it was recommended for anxiety, insomnia, as a muscle relaxant, an anti-epileptic and as a pre-operative medication. As more varieties were produced, and despite warnings from concerned professionals, the World Health Organization and the United Nations, their popularity with the medical profession sky rocketed and the health and lives of the majority of users, were seriously affected. Indeed, BZDs, were the most widely prescribed of any class of drugs for nearly three decades. They were so popular that doctors prescribed them, not only for their recommended uses, but seemingly for whatever ailed you.
While physical addiction had initially been denied, after a time it became clear that this stance was not credible and with huge profits at stake, the manufacturers conceded the addictive nature of their products – but, it was claimed, in less than ten percent of patients on high doses only, and even then, only in those who had 'addictive personalities'. The strategy was always to blame the patient.
The fact is, that it was very difficult to gauge how many were adversely affected. Some victims accepted their practitioners' explanations that these were symptoms of psychiatric disorder. Others did not. Nor did they accept accusations of lying, malingering, or being hypochondriacs, but at the same time, most were mentally confused and had no idea that they were drug addicts.
In 1989, Research Fellow, Claire Gudex, of the University of York, compiled a report entitled 'Adverse Effects of Benzodiazepines' and she stated: "Although the phenomenon of a BZD withdrawal syndrome is generally accepted, controversy remains regarding the incidence of dependency...The incidence is probably between 40 and 80%..." On May 13, 2001, BZDs were featured in a BBC Panorama documentary, and it reported that questionnaires filled out by 2000 BZD users, showed that 81% suffered adverse effects worse than the original problem for which the drug had initially been prescribed. These two reports into the incidence of adverse effects and addiction, present a very different picture from "the less than 10%" with the stipulations of 'high doses' and 'addictive personalities'.
As the years went by, complaints roller coasted and the medical profession, which often spoke on behalf of the drug companies, were vehement in their denials of wide spread addiction and iatrogenic illness. A favourite argument was that the alleged dangers had not been scientifically proven, but by the same reasoning, they had not been disproven either, so why were they on the market at all?
It was clearly assumed that a medical degree validated the common medical 'opinion' no matter how illogical and unintelligent it was. In his book "Power and Dependence – social audit on the safety of medicines", Charles Medawar believes that such behaviour occurs "partly because of the low opinion they [the doctors] held of their patients, and partly because of the high opinion they held of themselves..."
In the early 1980s, Canadian authorities acknowledged the problems associated with BZDs and in 1982, the Minister of National Health and Welfare authorized the publication of a 67 page book which outlined the dangers of the drugs and the role of the pharmaceutical industry in promoting them. It also said, "The major indication of [physical] dependence is the development of withdrawal symptoms, which have now been clearly established at therapeutic levels." In the same year, the Public Citizen's Health Research Group of the USA, published a detailed book designed to help people get off BZDs.
New Zealand, however, was somewhat tardy. While private individuals such as Hazel McIzaac, founder of TRANX (Tranquillizer Recovery and New Existence Inc.) and Anna de Jonge of the Patients' Rights Advocacy, ran support clinics, it was not until 1989, that the Department of Health issued Therapeutic Notes 207. Aimed at doctors, it was a small leaflet of seven (half A4 size) pages and compared to the Canadian and American publications, it was but scant information. On the last page, there was a note to say that these opinions did not necessarily reflect the views of the Health Department.
While the two voluntary organizations offered withdrawal advice and support to those in the Auckland and Hamilton regions, it is ironic that by the middle of the 1980s, as the medical profession continued to churn out more and more addicts, the alcohol and drug dependency units attached to public hospitals, were also picking up some casualties. The only thing that can be said as far the hospital system is concerned, was that it kept people employed, but that was far outweighed by the expense of supporting victims on state benefits.
The subject of BZDs was included as a separate issue to be considered by the National Advisory Committee on Core Health and Disability Support Service in 1991/1992. The resultant report recommended, amongst other things, that the prescribing habits of practitioners should be better monitored. The following comment was of particular interest, "Evidence suggests that some general practitioners who over-prescribe minor tranquillizers [BZD] may be experiencing their own addiction problems." To my knowledge, none of the recommendations were acted upon.
But nothing focuses medical minds quite as much as a few good law suits, and in the UK, legal representatives of a class action, prepared to sue two of the major manufacturers, Roche and Wyeth. In 1988, several hundred claimants were involved and legal aid had been granted. By 1992, the numbers had swelled to 12,000 claimants and legal aid was withdrawn. With no more funds, the case collapsed and the medical profession heaved a sigh of relief, shrugged its shoulders and continued its old prescribing habits. Australia too, initiated a class action, but due to a deficit in the country's legal aid kitty, that also foundered. In the United States, individuals have successfully sued manufactures or reached settlements out of court, while the ACC in New Zealand has paid compensation to a number of victims during the past 10 to 15 years.
The specific effect of BZDs is upon the central nervous system which makes them mind altering. A normally cheerful, outgoing person can become a cringing, fearful individual, or a surly, violent one. Cognitive functions and intellect are frequently impaired and the toxic nature of the chemical, has the potential to cause lasting damage. Where the adverse effects and addiction had been misdiagnosed as a psychiatric disorder, more mind altering drugs were prescribed and some of those unfortunates, were admitted to mental institutions where electric shock treatment was administered in some cases.
Unlike the withdrawal syndrome associated with other addictive substances, in this instance, it can continue for long after a person is drug free for the chemical is stored in the tissues of the body. It is estimated that there will be about thirty days of post withdrawal syndrome for every year the drugs were taken. For those who have used BZDs for ten, twenty or thirty years, this is not a happy time. Some simply never recover.
The overall result, has rendered many victims unable to work. Some families have been torn asunder. Mothers complained that they could not recall the growing years of their children or how to do basic household chores. The careers, assets, financial status, hopes, relationships and health of vast numbers worldwide, have been destroyed thanks to these 'miracle' drugs.
In the previously mentioned book, Charles Medawar stated, "Severe withdrawal symptoms from any of these drugs may be dangerous, and may feel almost unbearable at their most intense..." Typical withdrawal symptoms are: sensations such as that of a tight band around the head, earth 'tremors', 'electric' shocks, and 'crawling' of the skin. There may be abnormal temperature, sweating, numbness, trembling, muscle pains, stiffness, weakness, muscle twitching, irregular and jerky movements, staggering, shortness of breath, flushing, blurred or doubled vision, hypersensitivity to light, sound, taste and smell, headache, tinnitus, impotence (sometimes swinging to a dramatic increase in sexual feelings), tingling of mouth/hands/feet, major convulsions, temporal lobe seizures, palpitations, flushing, chest pain, influenza-like symptoms, nausea, vomiting, constipation or diarrhoea, anxiety, insomnia, nightmares, hyperactivity, panic attacks, agoraphobia, rage, aggression, acute psychotic episodes, mental confusion, hallucinations, depersonalisation and, hardly to be wondered at, depression and the feeling of going mad.
Given that the drugs are now restricted with the recommendation that they be prescribed for no more than two to four weeks continuous use, and that addicts should withdraw under specialist supervision, the addictive properties of BZDs can no longer be denied. Yet many professional papers still brush the aftermath aside as a minor, short term inconvenience, rather than a devastating long term and sometimes, permanent illness.
At the beginning of the twenty-first century, one does not expect any doctor to place BZD addiction into the same category as addiction to shopping, but I had occasion to deliver a short lecture to someone for that very thing about eighteen months ago. More recently, in trying to obtain statistics from the Accident Compensation Corporation, one of their medical advisers, Dr. David Rankin, replied: "Can you let me know who you are and what the information is to be used for...It is unlikely that there will be much information, as you have to have personal injury by accident and 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 result of benzodiazepines." He too, received a short lecture.
But culpability does not end with pharmaceutical manufactures and the medical profession.
In 1964, the World Health Organization warned of the potential for addiction, and some years later, even as the drug industry and the medical establishment defended BZDs, the UN had a different view. It was in 1971 when the UN took steps to reduce illicit supply and use of BZDs. To this end, a Convention was instituted which obliged signatory countries to place restrictions upon some psychotropic substances which included the BZDs. The New Zealand Government did not sign that Convention until 1990.
In 1994, even as victims battled with the rejections, the obstructions and accusations of psychiatric disorder at the hands of the Accident Compensation Corporation and their medical advisers, the International Narcotics Control Board (INCB) named New Zealand as one of only three countries that had not met its obligations under the Convention to control BZDs. In 1996, officials of that organization visited New Zealand to discuss the Government's negligence in not doing so.
That visit prompted the Ministry of Health to issue a discussion paper which listed options for the proposed control. One option was to create a new division within the Class C group in the Schedules to the Misuse of Drugs Act 1975, that "...would ensure New Zealand's compliance with its treaty obligations under the 1971 Convention, as well as being localised to best suit any specific features of the New Zealand BZD use environment." The question is, what unique use did the Ministry envisage that New Zealand had for these highly toxic and destructive drugs?
After studying the submissions received, the Ministry set out recommendations which were addressed to the Minister of Health. The twelve page document can be summed up thus: The recommended method of control should be the one which "...represents the least restrictive alternative..."
It was not until January 1999, that the drugs were finally restricted under Part V of the Third Schedule of the Misuse of Drugs Act 1975, Class C, Part 5. The Ministry got its way for this does indeed represent "the least restrictive alternative..."
The questions victims and their families would like answered by the government are these:
Why did successive governments ignore the WHO, the UN, and the overwhelming evidence of addiction and iatrogenic illness?
Why did they turn their backs on the chemical torture of thousands of New Zealand citizens?
Why did they ignore basic human rights?
And why have the huge costs associated with subsidized BZD prescriptions, state benefits and other services never been questioned during the past four decades?
One can only speculate on the influence exerted by the two powerful lobby groups – the drug industry and the medical profession.
The final irony is that, as with every other citizen and business in New Zealand, members of the medical profession are legally obliged to pay Accident Compensation Corporation levies, but en masse and for many years, they have steadfastly refused to do so. Once again, the Government has turned a blind eye.
Whatever the game, the name of it is not 'Accountability'.
*****
The above article was first published as "Prescription for Addiction – The Benzodiazepine Dilemma" in Healthy Options, May 1999, New Zealand and is republished here with extensive revisions.
Gurli Bagnall is a Patient's Rights Campaigner and lives in New Zealand. Her online novel "The Bounty Hunters" was recently published by London Circle Publishing. You can read more of Gurli's articles under Australia & New Zealand Information.
