THE DR. STARFIELD INTERVIEW
MEDICALLY CAUSED DEATH IN AMERICA: AN EXCLUSIVE INTERVIEW WITH
DR. BARBARA STARFIELD
By Jon Rappoport
December 6-7, 2009
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I've had many requests for a reprint of this piece. Here it is.
As the national healthcare bill winds its way through the legislative process
(now passed), one explosive factor is being ignored: the American health system,
like clockwork, causes a mind-boggling number of deaths every year.
The figures have been known for ten years. The story was covered briefly when a
landmark study surfaced, and then it sank like a stone.
The truth was inconvenient for many interests. That has not changed. "Medical
coverage for all" is a banner that conceals ugly facts.
On July 26, 2000, the US medical community received a titanic shock to the
system, when one of its most respected public-health experts, Dr. Barbara
Starfield, revealed her findings on healthcare in America. Starfield was, and
still is, associated with the Johns Hopkins School of Public Health.
The Starfield study, "Is US health really the best in the world?", published in
the Journal of the American Medical Association, came to the following
conclusions:
Every year in the US there are:
12,000 deaths from unnecessary surgeries;
7,000 deaths from medication errors in hospitals;
20,000 deaths from other errors in hospitals;
80,000 deaths from infections acquired in hospitals;
106,000 deaths from FDA-approved correctly prescribed medicines.
The total of medically-caused deaths in the US every year is 225,000.
This makes the medical system the third leading cause of death in the US, behind
heart disease and cancer.
The Starfield study is the most disturbing revelation about modern healthcare in
America ever published. The credentials of its author and the journal in which
it appeared are, within the highest medical circles, impeccable.
On the heels of Starfield's astonishing findings, media reporting was extensive,
but it soon dwindled. No major newspaper or television network mounted an
ongoing "Medicalgate" investigation. Neither the US Department of Justice nor
federal health agencies undertook prolonged remedial action.
All in all, it seemed that those parties who could have taken effective steps to
correct this situation preferred to ignore it.
On December 6-7, 2009, I interviewed Dr. Starfield by email.
What has been the level and tenor of the response to your findings, since
2000?
My papers on the benefits of primary care have been widely used, including in
Congressional testimony and reports. However, the findings on the relatively
poor health in the US have received almost no attention. The American public
appears to have been hoodwinked into believing that more interventions lead to
better health, and most people that I meet are completely unaware that the US
does not have the 'best health in the world'.
In the medical research community, have your medically-caused mortality
statistics been debated, or have these figures been accepted, albeit with some
degree of shame?
The findings have been accepted by those who study them. There has been only one
detractor, a former medical school dean, who has received a lot of attention for
claiming that the US health system is the best there is and we need more of it.
He has a vested interest in medical schools and teaching hospitals (they are his
constituency). They, of course, would like an even greater share of the pie
than they now have, for training more specialists. (Of course, the problem is
that we train specialists-at great public cost-who then do not practice up to
their training-they spend half of their time doing work that should be done in
primary care and don't do it as well.)
Have health agencies of the federal government consulted with you on ways to
mitigate the effects of the US medical system?
NO.
Since the FDA approves every medical drug given to the American people, and
certifies it as safe and effective, how can that agency remain calm about the
fact that these medicines are causing 106,000 deaths per year?
Even though there will always be adverse events that cannot be anticipated, the
fact is that more and more unsafe drugs are being approved for use. Many people
attribute that to the fact that the pharmaceutical industry is (for the past ten
years or so) required to pay the FDA for reviews---which puts the FDA into an
untenable position of working for the industry it is regulating. There is a
large literature on this.
Aren't your 2000 findings a severe indictment of the FDA and its standard
practices?
They are an indictment of the US health care industry: insurance companies,
specialty and disease-oriented medical academia, the pharmaceutical and device
manufacturing industries, all of which contribute heavily to re-election
campaigns of members of Congress. The problem is that we do not have a
government that is free of influence of vested interests. Alas, [it] is a
general problem of our society-which clearly unbalances democracy.
Can you offer an opinion about how the FDA can be so mortally wrong about so
many drugs?
Yes, it cannot divest itself from vested interests. (Again, [there is] a large
literature about this, mostly unrecognized by the people because the
industry-supported media give it no attention.
Would it be correct to say that, when your JAMA study was published in 2000,
it caused a momentary stir and was thereafter ignored by the medical community
and by pharmaceutical companies?
Are you sure it was a momentary stir? I still get at least one email a day
asking for a reprint---ten years later! The problem is that its message is
obscured by those that do not want any change in the US health care system.
Do medical schools in the US, and intern/residency programs in hospitals,
offer significant "primary care" physician training and education?
NO. Some of the most prestigious medical teaching institutions do not even have
family physician training programs [or] family medicine departments. The federal
support for teaching institutions greatly favors specialist residencies, because
it is calculated on the basis of hospital beds.. [Dr. Starfield has done
extensive research showing that family doctors, who deliver primary care-as
opposed to armies of specialists-produce better outcomes for patients.]
Are you aware of any systematic efforts, since your 2000 JAMA study was
published, to remedy the main categories of medically caused deaths in the US?
No systematic efforts; however, there have been a lot of studies. Most of them
indicate higher rates [of death] than I calculated.
What was your personal reaction when you reached the conclusion that the US
medical system was the third leading cause of death in the US?
I had previously done studies on international comparisons and knew that there
were serious deficits in the US health care system, most notably in lack of
universal coverage and a very poor primary care infrastructure. So I wasn't
surprised.
Has anyone from the FDA, since 2000, contacted you about the statistical
findings in your JAMA paper?
NO. Please remember that the problem is not only that some drugs are dangerous
but that many drugs are overused or inappropriately used. The US public does
not seem to recognize that inappropriate care is dangerous---more does not mean
better. The problem is NOT mainly with the FDA but with population
expectations.
... Some drugs are downright dangerous; they may be prescribed according to
regulations but they are dangerous.
Concerning the national health plan before Congress-if the bill is passed,
and it is business as usual after that, and medical care continues to be
delivered in the same fashion, isn't it logical to assume that the 225,000
deaths per year will rise?
Probably---but the balance is not clear. Certainly, those who are not insured
now and will get help with financing will probably be marginally better off
overall.
Did your 2000 JAMA study sail through peer review, or was there some
opposition to publishing it?
It was rejected by the first journal that I sent it to, on the grounds that 'it
would not be interesting to readers'!
Do the 106,000 deaths from medical drugs only involve drugs prescribed to
patients in hospitals, or does this statistic also cover people prescribed drugs
who are not in-patients in hospitals?
I tried to include everything in my estimates. Since the commentary was
written, many more dangerous drugs have been added to the marketplace.
106,000 people die as a result of CORRECTLY prescribed medicines. I believe
that was your point in your 2000 study. Overuse of a drug or inappropriate use
of a drug would not fall under the category of "correctly prescribed."
Therefore, people who die after "overuse" or "inappropriate use" would be IN
ADDITION TO the 106,000 and would fall into another or other categories.
'Appropriate' means that it is not counter to regulations. That does not mean
that the drugs do not have adverse effects.
INTERVIEWER COMMENTS:
This interview with Dr. Starfield reveals that, even when an author has
unassailable credentials within the medical-research establishment, the findings
can result in no changes made to the system.
Yes, many persons and organizations within the medical system contribute to the
annual death totals of patients, and media silence and public ignorance are
certainly major factors, but the FDA is the assigned gatekeeper, when it comes
to the safety of medical drugs The buck stops there. If those drugs the FDA is
certifying as safe are killing, like clockwork, 106,000 people a year, the
Agency must be held accountable. The American people must understand that.
As for the other 119,000 people killed every year as a result of hospital
treatment, this horror has to be laid at the doors of those institutions.
Further, to the degree that hospitals are regulated and financed by state and
federal governments, the relevant health agencies assume culpability.
It is astounding, as well, that the US Department of Justice has failed to weigh
in on Starfield's findings. If 225,000 medically caused deaths per year is not
a crime by the Dept. of Justice's standards, then what is?
To my knowledge, not one person in America has been fired from a job or even
censured as result of these medically caused deaths.
Dr. Starfield's findings have been available for nine years. She has changed
the perception of the medical landscape forever. In a half-sane nation, she
would be accorded a degree of recognition that would, by comparison, make the
considerable list of her awards pale. And significant and swift action would
have been taken to punish the perpetrators of these crimes and reform the system
from its foundations.
In these times, medical schools continue turning out a preponderance of
specialists who then devote themselves to promoting the complexities of human
illness and massive drug treatment. Whatever the shortcomings of family
doctors, their tradition speaks to less treatment, more common sense, and a
proper reliance on the immune systems of patients.
The pharmaceutical giants stand back and carve up the populace into "promising
markets." They seek new disease labels and new profits from more and more toxic
drugs. They do whatever they can-legally or illegally-to influence doctors in
their prescribing habits. Some drug studies which show negative results are
buried. FDA panels are filled with doctors who have drug-company ties.
Legislators are incessantly lobbied and supported with pharma campaign monies.
Nutrition, the cornerstone of good health, is ignored or devalued by most
physicians. Meanwhile, the FDA continues to attack nutritional supplements,
even though the overall safety record of these nutrients is good, whereas, once
again, the medical drugs the FDA certifies as safe are killing 106,000 Americans
per year.
Physicians are trained to pay exclusive homage to peer-reviewed published drug
studies. These doctors unfailingly ignore the fact that, if medical drugs are
killing a million Americans per decade, the studies on which those drugs are
based must be fraudulent or, at the very least, massively incompetent. In other
words, the whole literature is suspect, unreliable, and impenetrable.
Jon Rappoport has worked as an independent investigative reporter since 1982.
The LA Weekly nominated him for a Pulitzer Prize, for a interview he did with
the president of El Salvador University, where the military had taken over the
campus and was disappearing students and burning books. He has written for In
These Tines, Village Voice, LA Weekly, Spin Magazine, CBS Healthwatch, Stern.
His work can be found at www.insolutions.info and wwwnomorefakenews.com
Jon is the author of a new course, LOGIC AND ANALYSIS. For inquiries:
qjrconsulting@gmail.com
By
Jon Rappoport
www.nomorefakenews.com
www.insolutions.info