Dangers to life and the public health lobby: adverse drug reactions kill more than smoking

Reader What the ... delivered a series of comments on the last blog piece. With the author's consent I have reproduced them below.

Tobacco makes a lot of people a lot of money

There’s quite a bit wrong with the Public Health position. The statement implies that the tobacco industry makes a lot of money. However, there are other groups that make far more money from tobacco. For example, the amount of tax on the retail price of tobacco is in the order of 85% in a number of countries. The government makes at least 10:1 the profit of tobacco companies. And the government doesn’t produce anything: It’s simply a bureaucracy raking in the loot. Then there are so-called Public Health groups that want their cut of the booty so that they can remain in comfortable employment and further “educate” the public. Then there are pharmaceutical companies that have positioned, through much manipulation, their products as the preferred method of treatment for smoking cessation. They price their next-to-useless and cheap-to-manufacture nicotine replacement products according to artificially highly-inflated tobacco prices. The bulk of this inflated price goes directly to pharmaceutical companies. This conduct of looting those who smoke can well be described as a racket.

Routinely overlooked by Public Health is that it, too, is part of an industry making a lot of money. The medical establishment and medically-dominated Public Health has become so large that it can well be described as the medical industrial complex. It dwarfs the tobacco industry. There is plenty of evidence that there is over-servicing, over-medicating, and other fraudulent practices within the medical industrial complex. But these are very rarely considered by participants in this industry. Rather, they have promoted themselves as benevolent, non-materialistic overseers of the public protecting it from “evil” money-making industries, e.g. tobacco. This is just another massive “con job” done on the public.

Consider how the medical establishment/Public Health portrays itself in the “battle” against “evil” Big Tobacco. Antismoking has been obscenely funded by the taxpayer and Pharma interests for the last few decades. The great “skill” of activists is in propaganda – how to make headlines, how to maintain a high media profile. There has essentially been no questioning of their conduct. They are used to getting their way. The more fanatics are accommodated, the more hysterical and inflammatory become their claims, and the more deranged, draconian, and inhumane become their demands. On the rare occasion that fanatics don’t get their way, they resort to “Plan B” which is occurring now concerning “plain packaging” – it’s all a tobacco industry “conspiracy”. “There’s that 'evil' tobacco industry thwarting our wonderful work”, screech the fanatics.

This entire “us vs them” framework was also contrived by the fanatics decades ago. This mythological good vs evil drama was suggested by Chapman at the 1983 [antismoking] World Conference on Smoking & Health. It was in the presentation of his paper, a manual on how to do propaganda, “The Lung Goodbye”:

Such a list could be added to considerably, but most entries would be characterized by being somehow cast in a mythological good versus evil battle in an arena observed by mass numbers of people. The good (health/clean air/children) versus evil (cancer/uncaring, callous industry) dimension is the ineluctable bottom line in the whole issue and a rich reservoir for spawning a great deal of useful social drama, metaphor, and symbolic politics that is the stuff of ‘news value’ and which is almost always to the detriment of the industry. (p. 11)

It’s all for manipulative, theatrical effect and has been quite successful – for decades – on an essentially gullible political class, media, and public. The zealots and their financial partners must have regular belly laughs at how all too easy the brainwashing has been.

 

1. The medical establishment also does much damage, medically.

Consider “iatrogenesis” which refers to any detrimental outcome produced by medical conduct (e.g., adverse drug reactions, medical errors, poor care of the bed-ridden resulting in infected bed sores). In America, from the very few studies that have been done, iatrogenic deaths are estimated at 750,000–1,000,000 per annum. It dwarfs the so-called tobacco “death toll” (400,000) and is approaching half of the total annual death toll in America (2,500,000). The medical establishment is by far the leading cause of preventable death and disability and associated costs.

Further, the iatrogenic toll is far more plausible, causally, than the tobacco “toll”. The tobacco “toll” is based on lifetime use, involving millions of “puffs”, that also brings into play a veritable plethora of other factors over a lifetime. It is also argued from the population level that has very poor extrapolation to the individual level, i.e., it is a “statistical death toll”. Conversely, the iatrogenic toll is argued from the individual level and then estimated for the population level. For iatrogenesis, causation is typically demonstrable at the individual level. For example, with adverse drug reactions (these are properly prescribed, FDA approved drugs), it may take just one or a few pills to produce cardiac arrest in some patients that can be fatal or leave permanent injury. The patient is stable and within an hour of taking a pill goes into atypical catastrophic failure. The temporality of many of these associations is not over a lifetime, but involves hours or days. Of the two – the iatrogenic or tobacco tolls – it is the former that should attract very serious scrutiny. But, as will be seen, it has been the other way around, or upside-down, indicating who is running the show.

 

2. Concerning smoking, there have been thousands upon thousands of antismoking “studies” conducted/funded. Many do not break new ground but simply reinforce the agenda. World Conferences on Smoking and Health have been occurring since the 1960s. In the last few decades there are National Conferences on Smoking and Health. There are now even Conferences for Nonsmokers. Then there are Smoking Cessation Conferences run by the Pharma cartel peddling its useless/dangerous “smoking-cessation” wares. Additionally there are numerous antismoking lectures and colloquia and speeches and committees and campaigns. Specific institutes for the study of tobacco have been created as sub-centres of university Public Health Departments (which in turn are sub-centres of the medical faculty). There is a plethora of taxpayer/Pharma-funded antismoking organizations – referred to as “charities” – lobbying government for antismoking policies. There has been a frenzy of antismoking activity over the last three decades. A formidable, lucrative industry has been created that did not exist 30 years ago. And the bulk of it is all under medical direction. The medical establishment has wreaked social havoc, again, to tackle the tobacco “death toll”, and peddled essentially on the basis of the far smaller so-called tobacco “toll” in nonsmokers (SHS).

So we could then ask that if this has been the reaction to the tobacco “death toll”, then there must be an even greater industry addressing/correcting institution-wide iatrogenesis? In fact, there’s not. Compared with the many thousands of antismoking studies, there are but a handful (~20) concerning multi-source or institution-wide iatrogenesis, damning as they are. There are no conferences on iatrogenesis whatsoever. There are no specifically-created institutes addressing the issue. In fact, it attracts almost zero attention within the medical establishment itself. The medical administration doesn’t like talking about it or the public knowing about it. This is the same medical establishment that now wants to “fix-up” the world. Scrutinizing the medical establishment would reveal how unstable its framework is. It would mean a [reasonable] loss of profits and trust. While it tenaciously maintains the spotlight on its favourite social targets such as smoking, it avoids scrutiny like the plague. The contemporary medical establishment has been reduced to a production line, a medical industrial complex, where the tenets of the Hippocratic Oath (particularly the edict of "first do no harm") play little or no part. The medical establishment was out of control 30 years ago. It has since entered a sinister phase. And smokers are one of the first to notice the ugly side of the medical establishment in its world-fixing (eugenics) and financially-compromised aspirations.

 

3. References for iatrogenesis: from 'Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies', JAMA, April 1998 

We estimated that in 1994 overall 2,216,000 (1,721,000–2,711,000) hospitalized patients had serious ADRs [adverse drug reactions] and 106,000 (76,000–137,000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death.

Including more sources of iatrogenesis:

'Doctors are the third leading cause of death in the US: cause 250,000 deaths every year'

Starfield, B. (2000) 'Is US health really the best in the world?' Journal of the American Medical Association, 284 (4), 483–485. Including even more sources of iatrogenesis:

Null et al. (2003) 'Death by Medicine'

Classen et al. (2008) “'Global trigger tool' shows that adverse events in hospitals may be ten times greater than previously measured"

4. Some recent reports from other countries:

Huffington Post, 14 July 2013, 'NHS scandal report to expose thousands of 'excess' deaths at 14 Trusts'

Australian Broadcasting Corporation, 15 July 2013, 'Aged care crisis: A critical lack of staff and training in some nursing homes means that many elderly people are being left to die unnecessarily or are in great pain without proper palliative care.'

UPI, 28 June 2013, 'Physician reveals the 'hidden agenda' of medical school'

***

The story that emerges from the last few decades is that the medical establishment in developed nations is dangerously out of control. And it’s not as if the above reports are anything new, and some of these reports only touch the tip of the iceberg. These sorts of reports emerge every few years. Nothing is typically done to address the problems, with more reports to emerge a few years down the track, etc. And the problem is set to worsen with the “boomers” coming into old age. Medical practice has been allowed to flourish into a medical industrial complex into which the patient is forced. There is a theme amongst medical practitioners of having the bedside manner and social graces of an oaf. They conduct themselves like “body mechanics” with a “god complex” – delusions of omniscience, infallibility, and benevolence. The medical establishment produces many detrimental outcomes, yet is highly self-serving and self-protecting, where one major constancy is the production of profit, seemingly at the expense of much else, even to the point of a culture of secrecy concerning highly significant iatrogenesis. The doctor/patient relationship has also taken a pounding. Particularly concerning smoking, many doctors adopt a dictatorial stance where patients should even be coerced into quitting. There is also a cruel theme emerging in the medical establishment – see nursing home abuses. And it doesn’t stop there. Is it also not cruel to force patients that want to smoke off the entire medical property – in any weather – to do so? And what about involuntary mental patients that want to smoke? They are restrained physically or chemically, or given multi-day solitary confinement, rather than allow them to have a cigarette – even outside.

There has been a terrible loss of compassion. Practitioners have become blinded by questionable ideological stances (e.g., antismoking) and profit pressures. There is a chilling inhumanity that has been allowed to flourish in the medical establishment.

The issue of iatrogenesis is occasionally put to Michael Siegel. Here’s his response of only a few days ago:

Sadly, the problem of medical errors and iatrogenic illness is one that has not received appropriate attention. You are correct that it causes a great deal of morbidity and mortality. Unfortunately, the medical and health care establishment has been quick to criticize others, but when it makes mistakes, it almost never acknowledges them. Many hospitals have opposed simple right-to-know laws that required them to report medical errors that are made. I experienced this on a personal level during my medical school training (I didn't make the mistake, I observed someone else doing so). 

It should also be noted that all of the detrimental consequences of the antismoking crusade – e.g. irrational fear/hate, social division/isolation, bigotry, economic fallout, contraband market – are also iatrogenic.

Land ownership and the Scottish effect

This is an interesting audio clip if the idea of rectifying some of Scotland's hugely imbalanced land ownership system where (last time I looked) it seemed that less than 10 per cent of the people own more than 80 per cent of the land. Lesley Riddoch is an advocate of land reform and also an advocate of renewable energy. She is concerned for example that any benefits from renewables at present will go straight to the pockets of large landowners (pointing out that around one-third of Tory MSPs currently benefit from them).

However it is what she says around eight minutes into the clip that explains why I am posting the link here. In the course of writing a book she cites an anti-poverty campaigner called Cathy McCormack who 'proved because she managed to team up with some academics to prove how dampness could be at the source of the Scottish effect, because it weakens all the organs of the body over a lifetime'.

Well! I learned something like that when I was at school in the 1970s – how dampness and bad housing were at the root of the public health crisis in Scotland. Somehow along the way, the explanation morphed into a public health crusade on people's habits, and immense pressure brought to bear on making people see themselves as the author of their own misfortunes, particularly when it comes to ill health. The fact that Scots are paying disproportionately high prices for fuel, when they need more of it to sustain living standards that are achieved without fuel expenditure in warmer climates, is a real cause of concern for public health, but will you catch ASH Scotland campaigning for Scots to have more influence in landownership and use decisions, or in any meaningful way to be in charge of their own destiny?

The piece in general talks about how Scots seem resigned to the fact that their land is there to be milked for value by 'absentee landlords', and whatever form of fuel we rely on, the people enriched by it are the owners of big companies and corporations or (in the case of renewables) large amounts of land. Lesley Riddoch's co-presenter points out that no change in the fuel regime will be achieved without both independence and withdrawal from Europe (where corporations appear to rule).

I haven't done the sums on renewables, but it seems that choice of fuel is a smaller consideration than who controls the prices that people pay for fuel, and how much is charged. All decisions that will sway the independence referendum, if campaigners can persuade the Scottish people that they will be more relevant to political processes by voting yes than they are at present. Time will tell.

Tobacco, other vested corporate interests and democracy

I've often wondered why opposition to the smoking ban is not more vociferous, and felt that had it been tried in the 1970s it would not have worked in the UK. I have wondered if other processes in society have isolated people from each other in ways that have made mass protests more difficult, or seem more pointless.

I found a copy of George Monbiot's 2000 book Captive State, which describes 'the corporate takeover of Britain'. His book tells of how a wide range of projects, including the Skye Bridge, has been achieved by big business interests crowding out the protests of local inhabitants. Corporations have paid for the planning and public presentation of building projects on behalf of local councils. Support for local development projects has been made conditional on accepting the Private Finance Initiative. This meant that building projects, including the upgrading of NHS hospitals, had to be planned so as to make money for the builders, rather than to save money for the people and the local council. The book is quite clear that New Labour from 1997 did nothing to stop the corporate takeover of Britain and much to encourage it – the PFI was, after all, their brainchild.

A chapter entitled 'Silent Science' talks about how corporate funding has affected the scientific research agenda. Of particular interest is the following:

As big business infiltrates the research agenda, ever wider zones of public enquiry are placed off limits. In 1999, the government published a White Paper on public health called Saving Lives: Our Healthier Nation. The only atmospheric pollution named in the report is radon. It also happens to be one of the only pollutants in Britain which does not result from the activities of large corporations: it is naturally occurring. The report warns us about the dangers of cancer resulting from 'exposure to radon gas in certain homes or excessive sunlight', but nuclear power stations are not mentioned, and nor are any other chemicals, even though the paper concedes that 'Pollutants in the atmosphere may cause cancer if inhaled or swallowed'. The language in which this warning is given is interesting: it creates the impression that breathing or ingesting pollution is something we can avoid. The paper informs us that the government hosted 'the largest ever Ministerial conference on environment and health in 1999. It fails to tell us that the links between cancer and industrial pollution were dropped from the agenda soon after the meeting began. [link added]

Isn't that interesting: although Monbiot does not mention smoking, he does point out that industrial pollutants are factored out of this discussion. The appendix of this document talks about tackling lifestyle factors, radon control and improved responses from the health service, as the way to improve public health – it is a clear prelude to present policies.

A few pages earlier we have this:

In December 1988, the Committee of Vice-Chancellors and Principals announced that the universities they ran would no longer take money for cancer research from the tobacco industry. The companies' backing, they had decided, 'is not likely to be viewed as disinterested and will consequently damage the university's standing and reputation'. It seems astonishing that they had been taking this money in the first place. But while this, the most controversial source of industrial funding, was discontinued, the business sponsorship of other areas of research has expanded. Why funding from the corporate sectors should be 'viewed as disinterested' and not likely to 'damage the university's standing and reputation' has never been satisfactorily explained by the vice-chancellors. But I have been unable to find a university anywhere in the United Kingdom which does not accept corporate money for research in which the companies involved have an immediate interest.

This view is reflected today, with much corporate funding going largely unnoticed, while the idea that tobacco should be allowed to fund cancer treatments gives rise to hysteria. I am no apologist for the tobacco industry but I feel bound to point out that their donations to cancer research, other than giving them corporate responsibility brownie points, cannot be said to contribute directly to their own commercial advancement. On the other hand, Monbiot describes the Biotechnology and Biological Science Research Council's influence in university science, and in particular its aggressive stand in favour of genetic engineering. Its funding allows the recruitment of researchers  in biotechnology for major companies such as Glaxo and Unilever. Researchers are gagged, but effectively only if they want to rock the boat. The upshot is that the public interest becomes corporate interest, because the mega-corporations have the means to purchase it.

I am still not sure about Monbiot. He understands the dilemma that you can't control big business without running the risk of oppressing the powerless, but he is still trying to work out how it can be done. I feel that tobacco control bears many of the hallmarks of corporate influence on local life, including the contempt for local democracy implicit in arrangements like the Framework Convention on Tobacco and Health. One of the most important of these is blaming people for their health problems, when corporate interests are able to buy their way out of public scrutiny.

Air pollution and the public health agenda

You will have seen discussion boards where somebody points out that exhaust emissions are worse for you than passive smoking, and someone else says 'ah, but we need cars'! as if this were a good enough reason to ban something that we supposedly don't need, without any proof that it's damaging.

When I was growing up in the 1970s word had reached us in East Yorkshire that Glasgow had a poor health record. We were told that much of this was because of poverty, substandard housing and a damp climate. No one in those days told us that drinking and smoking was the cause or gave us that pearl of twenty-first century wisdom – that smoking causes health inequalities.

But in the corridors of power there is evidence of change going back twenty more years. (H/tip to Rose for the link.) Published in 2002, this link reports attempts to disguise the impact of air pollution on the London smog of 1952:

Delegates attending an international conference in London today to commemorate the 50th anniversary of the Great London Smog of 1952, which caused an estimated 12,000 deaths, will hear how governments from the late 50s onwards deliberately downplayed the huge threat to public health caused by air pollution, and sought to shift the blame firmly onto cigarette smoking instead.  

In 1953, Dr Guy Scadding, speaking on the television programme Matters of Medicine, had expressed a belief that air pollution was as much a factor in whether someone developed lung cancer as smoking, citing the significantly higher number of deaths from the disease among those living in polluted cities, as opposed to the countryside, and assuming that rates of smoking were likely to be similar in both populations. 

A few years later, in 1957, the Medical Research Council was planning to issue a statement saying although smoking was a significant cause of lung cancer, up to 30% of cases might be caused by air pollution. But the Cabinet committee on cancer of the lung, fearful of another political embarrassment which could be caused by stressing the air pollution connection, asked the MRC to reconsider its statement. On 31 May 1957 a modified version was published, which asserted that although it was likely that atmospheric pollution did play a role in lung cancer, it was 'a relatively minor one in comparison with cigarette smoking'.

 The clear conclusion?

'What was happening in this committee was a shift away from a concept of health and wellbeing related to an individual¹s environment, occupation, class or work, towards one focused strongly on that individual's responsibility for his or her health, which smoking came to symbolise. After the 1962 report, it was smoking and the type of public health which it epitomised which was to become the central public health issue. Smoking was something which the individual could do something about; air pollution was not,' explains Professor Berridge.

Public health, as far back as 1957, was to become judgemental. The medical establishment was already prepared to take an attitude on the issue, and suppress data that would inconvenience the public health message: 'take responsibility'. (Was this an early revolt against universal health provision free at the point of need?)

The medical establishment has appealed to corporations to take note that poor employee health is costing money. Hell, someone has to support them, and why not have a crack at those who support smokers, drinkers and the obese by offering them a livelihood?

Sometimes this smacks less of altruism than of a deliberate attempt to disenfranchise people. Usually, in fact.  Any health problem can be resolved by addressing personal issues (smoking, drinking ...). People are not expected to protest about the extent of air pollution (or any other health issue) because health politics is no longer the domain of those most affected by health inequalities. Their duty is to look after themselves so that their employers can make more money from them.