MEDICAL INTER V E N T I O N

HIT OR MYTH?
PART ONE OF A SERIES OF ARTICLES EXAMINING THE SAFETY OF I M M U N I S A TION, AND VA C C I N AT I O N S .
THE MYTH OF MEDICAL ACHIEVEMENT
by Dr. Ronald S. Laura, Professor in Education, University of Newcastle & P.E.R.C. Fellow in Health Education, Harvard University
The first major challenge to the integrity of conventional medicine came in 1959 when Rene Dubos urged in his book Mirage of Health that the technological innovations of modern medicine, including the development of antibiotics, had far less to do with the improved health of the community than it might at first appear.1 Amassing an impressive array of statistics in support of his claim, Dubos argued that the most significant changes in the health of the population derived from social, economic, and nutritional advances. Environmental factors not clinical care factors, were applauded as the primary determinants of the improved state of general public health. Better housing, for example, meant less overcrowding, thereby reducing the facility with which infectious disease was previously spread. Similarly, the provision of safe drinking water in conjunction with the treatment of sewerage dealt a forceful blow to infectious disease. Other environmental factors such as improved sanitary conditions and the effective disposal of garbage also had a beneficial impact upon the virulence and incidence of infectious disease. Heralded by some writers as the single most important factor in the decline of infectious disease, better nutrition has been acclaimed to assist host-resistance, as well as host recovery.2 Indeed, by the time the etiology of infectious disease was sufficiently understood to develop and to administer vaccines, diseases such as cholera, typhoid fever, and dysentery had already been robbed of their virulence. In his presidential address in 1971 to the British Association for the Advancement of Science, R.R. Porter confirmed that between 1860 and 1965 almost 90% of the total decline in mortality among children up to fifteen suffering from diptheria, scarlet fever, measles and whooping cough had occurred prior to the introduction of antibiotics and immunisation on a systematic basis.3 The virulence of tuberculosis had also declined markedly prior to the introduction of antibiotics. In 1812 the death rate from tuberculosis in New York was estimated to be higher than 700 per 10,000. When Koch first isolated and succeeded in culturing the bacillus in 1882, the death rate had dropped to 370 per 10,000. By the time the first sanatorium was opened in 1910 the rate had further declined to 180 per 10,000, until shortly after World War II it had slipped from second to eleventh place with a rate of 48 per 10,000. Still before antibiotics were used routinely, tuberculosis had flourished and dwindled outside the control of medical science.4 This is not to say that drug treatment has been entirely incidental in the decline of certain infectious disease. Syphilis and malar-

WA R N I N G :
There are an alarming amount of people who have died or who have suffered serious adverse reactions to vaccinations. Does immunisation really work anyway? With strong moves now afoot to make immunisation compulsory, before children can attend school, these questions must be answered soon. The medical profession refuses to accept any responsibility for adverse reactions to vaccinations, to do so would raise questions of litigation and liability. This has meant that the only "tabs" being kept on just how many people die, or become 'retarded' suspiciously close to a vaccination - is being kept by a small bunch of dedicated parents in NSW.
If you would like to register such information, contact: PARENTS CONCERNED ABOUT VA C C I N AT I O N S P O BOX 900, KATOOMBA. NSW. 2780
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ia were both quickly cured by chemotherapy. On the other hand, malaria has reappeared despite the continued use of antimalarial drugs, largely because the use of pesticides was eventually superseded by the evolution of pesticide-resistant mosquitoes. Syphilis strains resistant to penicillin have also returned to remind medical science that the interlink between mores and medicine are of fundamental importance in understanding disease patterns.

MEDICAL INTERVENTION AND IATROGENESIS

Iatrogenic illness refers to those illnesses which result from professional medical treatment, and which could presumably have been avoided had such treatment not been administered. Ivan Illich has done much to consolidate and bring into bold relief studies concerning this category of physician or hospital-caused injuries. He writes that "the pain, dysfunction, disability, and anguish resulting from technical medial intervention now rival the morbidity due to traffic and industrial accidents and even war-related activities, and make the impact of medicine one of the most rapidly spreading epidemics of our time. 5 Illich claims that one out of every five persons entering a typical research hospital will acquire an iatrogenic disease. Given that every twenty-four to thirty six hours, from 50 to 80% of all Americans will swallow a medically prescribed drug, it is perhaps unsurprising to find that one half of iatrogenic episodes arise from complications of drug therapy.6 Some patients are given the wrong drugs, others are given drugs which are contaminated. Some patients receive injections with improperly sterilised syringes, while others are given combinations of drugs which in their chemical reactions to each other prove to be harmful. The main problem here, however, is not simply one of negligence. Although the well considered and circumspect use of drugs may have a role to play in health care, chemotherapy is an interventionist technique whose importance and use has been greatly exaggerated. As Mendelsohn has put it: "Unfortunately, doctors have seeded the entire population with these powerful drugs. Every year, from 8 to 10 million Americans go to the doctor when they have a cold. About 95% of them come away with a prescription - half of which are for antibiotics ... The doctor, once the agent of cure, has become the agent of disease. By going too far and diffusing the power of the extreme on the mean, Modern Medicine has weakened and corrupted even the management of extreme cases. The miracle I and other doctors were once proud to take part in has become a miracle of mayhem.7" While there has during the past decade been a growing awareness of the limitations of drug therapy, the extent of the use and abuse of drugs in conventional medicine is still staggering. As a consequence of negative reactions to drugs, more than a million people every year, or 3 - 5% of hospital admissions, are treated for drug complications. It is also reported that 30% of these patients will experience a second drug reaction during the course of their hospital stay. The cost of health care associated with drug toxicity

and make the impact of medicine one of the most rapidly spreading epidemics of our time.

in the United States is estimated at US$3 billion yearly, and reflects the fact that 1/7th of all hospital days are required to attend to patients suffering drug reactions.8 Despite the growing use of street drugs, deaths attributable to medically prescribed drugs still exceed the number of deaths caused by the use of illegal drugs. It has been estimated that approximately 30,000 deaths per year are the consequence of adverse reactions to drugs prescribed by doctors. Serious reactions to drugs as common as penicillin, for example, occur in 5% of those individuals who are administered the drug. The anaphylactic shock which results from severe penicillin allergy is often more debilitating than the medical condition that the penicillin was used to treat. Clammy skin, profuse sweating, fallen blood pressure, cardiovascular collapse, and even unconsciousness are just a few of the side-effects of acute reaction to penicillin. During the 1960's the drug tetracycline was administered so frequently that it came to be called the "housecall" antibiotic, and a generation of children in America and elsewhere has suffered its adverse effects. In 1970 the U.S. Food and Drug Administration finally required that a warning be affixed to all packages of the drug, admonishing of the tendency of tetracycline to accumulate in bones and teeth.9 One of the more visible side effects of this chemical deposition has been to cause the permanent discoloration of developing teeth (ie stages of tooth development ranging from the last half of pregnancy to approximately 8 years of age). Countless adults now bear their "tetracycline scars" on their teeth in shades of discolored enamel ranging from yellow to yellow-green to gray brown. Illich's study showed that one in every thirty cases of iatrogenic illness leads to death, and that the frequency of reported accidents in hospitals exceeds the accident rates in all industries with the exceptions of mining and high-rise construction.10 Of all children admitted to hospitals, one in fifty will suffer an accident for which specific treatment will be required.11 In a study of medical malpractice conduced by the United States Department of Health, Education, and Welfare, it is reported that 7% of all patients suffer compensable injuries while hospitalised, though few of them take legal action. Nonetheless, it is estimated that in 1971 from 12,000 to 15,000 medical malpractice suits were lodged in courts throughout the United States. In as study by berman and Stamm on misdiagnosis, it was calculated that the number of children who suffer disability as a consequence of medical treatment for what turned out to be cardiac nondisease exceeds the number of children under effective treatment for genuine cardiac disease.12 In other cases it has been shown that specific forms of treatment actually exacerbate the specific condition they are intended to alleviate. The epidemic of asthma deaths in the mid-1960s provides a useful illustration. In England and Wales between 1959 and 1966 mortality due to asthma trebled in the age group 5-24 and increased seven-fold in the 10-14 age group.13 Up to this time mortality rates from this cause had remained relatively constant for more than half a century. Although the epidemic was shared by Scotland, Ireland, Australia, and New Zealand, asthma mortality in Europe, Japan and North America remained virtually stable. Once it was ascertained that the prevalence of asthma was not on

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MEDICAL INTERVENTION the increase, investigators hypothesised that the epidemic of asthDES is not the only hormone which - despite detrimental sidema deaths could be associated with the new forms of treatment effects - doctors prescribe for women. While it is to be admitted whose introduction roughly coincided with the steady increase in that there has in recent years been a greater awareness of the drugmortality rates. associated victimisation of patients to which we have been alludEvidence of the excessive use of pressurised aerosols containing ing, the fact that some 20 million women in the United States alone bronchiodilator drugs correlated with asthma patient deaths. Other are under prescription for the birth control pill or menopausal investigations confirmed that the increase in asthma mortality corestrogens gives cause for reflection. Concern about the side-effects related with the increased sales of aerosol bronchiodilators, particof the pill led the U.S. Food and Drug Administration to issue a ularly those containing the drug isoprenaline. Additional evidence warning bulletin to doctors in 1975 exhorting that women beyond in favour of the causal connecthe age of forty be taken off the Pill tion between the epidemic in and provided other means of conasthma mortality and the traception. This first admoniDespite the growing use of street excessive use of bronchiodilation was followed by a second drugs, deaths attributable to tor drugs came in 1968 when from the FDA in 1977 requirthe sales of these aerosols were ing the provision of a warning medically prescribed drugs still regulated in the United brochure stressing the inordiexceed the number of deaths Kingdom by prescription. nately high risk of cardiovasWithin a year asthma mortality cular disease among women rates declined and levelled off caused by the use of illegal drugs. over forty taking the Pill.17 to almost pre-epidemic rates. The mortality risk from carIsoprenaline came under immediate diovascular disease for suspicion since it was in any case women over forty taking the the drug mainly used as a bronchiodilator in the 1960s, though Pill is increased by a factor of five; for women between the ages of considerable debate ensured as to whether the fluorocarbon prothirty to forty the risk of dying from a heart attack is multiplied by pellant could be cast as the true culprit. Although both isoprenaline a factor of three. Increased risk of cardiovascular disease is not the and the fluorocarbon propellants were demonstrated to produce only health hazard associated with the Pill. The risk of high blood heart irregularities, it has more recently been shown that asthma pressure is six times greater for women taking the Pill than for mortality correlates particularly well with the sale of bronthose who are not. Women taking the Pill run a risk of thromchiodilators capable of delivering up to five times the concentraboembolism which is more than five times that for women not taktion of the normal spray of isoprenaline. It is estimated that in ing it and the risk of stroke is four times greater.18 Other risks assoEngland and Wales the asthma epidemic claimed a total of 3,500 ciated with the Pill are liver tumors, headaches, depression, and lives in excess of the expected rate over the same period calculatcancer. ed on the basis of the pre-epidemic rate in 1959-1960. It has been Similarly, antihypertension drugs have in recent years soared in remarked by Taylor that, "even if some asthmatics were saved by popularity as an easy way to lower blood pressure. Although medmedical treatment, more were lost." 14 ical journals carry advertisements for drugs intended to counteract The use of other medically prescribed drugs has led to the the adverse effects of antihypertension drugs, sufficient awareness increased risk of other diseases worse than the ones that they are of their dangers seems decidedly not to be reflected by the astrodesigned to treat. Reserpine, for example, is one of the drugs nomical number of medical prescriptions still written for them. which has been used to control high blood pressure. Despite the Among the multitude of side effects associated with high blood fact that studies undertaken in the mid-'70s have established that pressure drugs are rash, hives, sensitivity to light, vertigo, muscle reserpine triples the risk of breast cancer, already ranked as the cramps, weakness, inflammation of the blood vessels, joint aches, number-one cause of death in women, it is still prescribed. There muscle spasms, nausea, psychological disorientation, reduced are now indications that insulin, heralded as one of the miracles of libido, and impotency (affecting women as well as men).19 modern medicine, is implicated as one of the causes of diabetic Medical intervention utilising the tools of high technology has blindness.15 Investigations undertaken in the 1970s have revealed also given rise to its own peculiar forms of iatrogenic diseases. that daughters of women treated with a synthetic oestrogen, DiBetween the years 1942 and 1954 the problem of retrolental fibroethylstilbestrol (DES), during the early stages of pregnancy for the plasia, disease of the eye leading to blindness, came to figure purported prevention of miscarriage are developing vaginal cancer prominently in the management of premature infants in the United at an alarming rate. It has also been confirmed more recently that States. Despite being possessed of some of the most advanced an alarmingly high incidence of genital malformations can be cormedical technology available, hospital nurseries especially related with the male offspring of women treated with DES, not to equipped to accommodate premature babies were finding that mention that the cancer mortality rate of the women themselves is around 90% of all low-weight infants suffered either partial or also statistically significant. Studies of DES have since established total blindness. Indeed by 1954 retrolental fibroplasia ranked first that it does not prevent miscarriage; indeed, it is in fact currently in the United States among the causes of blindness in children.20 used as a "morning-after" contraceptive pill and in some cases to Investigations eventually showed that the increasing incidence of dry up milk. In the case of DES it is particularly ironic that here the disease paralleled the introduction of plastic incubators into we have a drug that not only caused vaginal cancer and other which high concentrations of oxygen were pumped to the premaabnormalities, but did not even work for the purpose for which it ture infants on the assumption that oxygen therapy was beneficial, was originally administered. 16 an assumption which, during the time high-concentration oxygen

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HIT OR MYTH?
therapy was used, was in fact untested. Oxygen therapy did make hospital between 1979 and 1988, 218 women attended for mamthe babies look pink, but definitive evidence was provided in 1954 mography, in 95 of which cases the mammogram failed to detect by Lanman et. al. that it also made them go blind.21 breast cancer. For 47 of these delayed treatment had tragic Another example of the extent to which high-technology mediresults.27 cine can be debilitating is amply demonstrated by the controversy Specific iatrogenic diseases resulting from surgical intervention surrounding coronary arteriography, a test technique whereby a are astronomical in number and kind. Complications arise from dye is injected into the coronary arteries by way of a small catheter lack of surgical expertise, the degree of difficulty involved in perthreaded from one of the blood vessels in the limbs and back forming the surgery, the unique constitution of the patient, anaestowards the heart. The technique is designed to assist in the diagthetic accidents, laceration of large blood vessels, and misplace nosis and evaluation of coronary ligatures disrupting nerve heart disease by providing an outresponses, blood flow, etc. line of the interior of the coronary Taylor reports that an untold the frequency of reported arteries through the medium of variety of surgical instruaccidents in hospitals exceeds the the passage of the dye which is ments, swabs, etc. have been visible on X-ray film. In support left and sutured to cause seriaccident rates in all industries of the procedure, mortality rates ous infection. Even the talc with the exceptions of mining and of 0.1% or one per thousand are commonly used by surgeons cited to indicate the technique to to lubricate their hands so high-rise construction. be relatively innocuous. Taylor that their surgical gloves can has commented, however, that the be more easily fitted is now statistics belie the true state of affairs. known to cause inflammatoThe mortality rate of one per thousand is accurate, he says, if the ry reactions in patients on whom they operate. Uncontrollable statistical analysis is restricted to results of the procedure deriving internal bleeding, shock, coma, and death are not uncommon side from only "very competent" and "experienced" units which pereffects of surgical intervention.28 form it. Surveys of the technique which reflect a regional and more References: comprehensive base reveal practice of coronary arteriography was 1: R. Dubos, The Mirage of Health , 1959, Harper & Row, New York, pp.88-89 carried out, it showed that the mortality rate was not one per thou2: See, I. Illich, Limits to Medicine, 1976, Penguin Books, Harmandsworth, pp. 23-30; see also T. McKeown, The Role of Medicine , 1979, Princeton University sand, but virtually one in every hundred, ten times the rate regardPress, Princeton, pp. 29-44. ed as innocuous. The death rate for patients undergoing the proce3: R.R. Porter, "The Contribution of the Biological and Medical Sciences to dure in some institutions was as high as 8%. The incidence of carHuman Welfare," Presidential Address to the British Association for the diac arrest during the procedure, is in respect of which defibrillaAdvancement of Science , Swansea Meeting, 1971 (London: The Association, tion was required to resuscitate the heart, ranged from 1-10%. 1972) p.95 4: Ibid., pp. 95-97 Some studies report that in addition to the threat of mortality, seri5: Illich, p. 35. ous complications resulting for coronary arteriography are of the 6: Ibid. , pp. 36-37 order of 1.5%. 22 7: R.S. Mendelsohn, Confessions of a Medical Heretic , 1979, Warner Books, X-rays represent another dimension of high-technology mediNew York, p. 56. cine whose unbridled use has led to untold iatrogenic illness and 8: Ibid., p. 38 9: Ibid., p. 54. disease. Mendelsohn reports that thyroid lesions, a considerable 10: Illich, op. cit., pp. 37-40. number of which are proving to be cancerous, "are turning up by 11: See, for example, U.S.House of Representatives, Committee on Interstate the thousands in people who were exposed to head, neck, and and Foreign Commerce, "An Overview of Medical Malpractice," 94th upper chest radiation twenty to thirty years ago."23 The amount of Congress, 1st Session, 17 March 1975. radiation required to cause thyroid cancer, he asserts, is "less than 12: A.B. Bergman, and S.J. Stamm, "The Morbidity of Cardiac Nondisease that produced by ten lite-wing dental X-rays."24 It is sobering to in School Children," New England Journal of Medicine , vol. 276, 1967, pp. 1008-13. hear that every year some 4,000 people die from radioactive 13: R.Taylor, Medicine Out of Control , 1979, Sun Books, Melbourne, p. 21. dental and medical interventionist techniques, and there are 14: Ibid., p. 53 those who urge that the estimate is conservative.25 The use of X15: R.S. Mendelsohn, op. cit., pp. 57-58. rays to diagnose and assess the female breast is - despite the iatro16: Ibid., pp. 61-63. genic problems associated with them -widely recommended as as 17: Ibid., p. 63. 18: Ibid., p. 65. effective means of detecting breast cancer in its early stages. 19: Ibid., p. 66-67. Setting aside the fact that studies have shown that disagreement 20: R.Taylor, op. cit., pp. 53-54. among radiologists is considerable in respect of their interpretation 21: J. Lanman et. al., "Retrolental Fibroplasia and Oxygen Therapy," Journal of of the same film, it is even more distressing to find other studies the American Medical Association , 1954, vol. 155, p. 223. reporting that mammography will in fact cause more breast cancer 22: R. Taylor, op. cit., pp. 63-64. 23: R.S. Mendelsohn, op. cit., p. 27. than it will detect and that the number of deaths from breast can24: Ibid. cer caused by mammography may in fact "balance the number of 25: Ibid. patients who may be cured by early diagnosis and treatment of the 26: R. Taylor, op. cit., p.64. naturally occurring disease." 26 Putting aside the cancer-causing 27: S. Rice, Some Doctors Make You Sick, 1988, Angus and Robertson effects of mammography, the efficacy of the procedure in correct Publishers, North Ryde, Australia, p. 15. 28: R. Taylor, op. cit ., p. 64. ly diagnosing cancer can be questioned. At on Australian teaching

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