Following today’s news about emergency admissions & hospitalisations a year in England due to medical error, we turn to iatrogenic disease and death

Up-to-date figures for iatrogenic disease and deaths (inadvertently caused by a surgeon or physician or by a medical or surgical treatment or a diagnostic procedure) are not readily available in UK or USA. the US Department of Health and Human Services Office of the Inspector General examining the health records of hospital inpatients in 2008, reported 180 000 deaths due to medical error a year among Medicare beneficiaries alone.

Paul Wearn from the Office for National Statistics – 9 June 2011 – finally answered a FOI request for information about the number of iatrogenic deaths each year: “ONS do not have a National Statistics definition for iatrogenic The causes most closely fitting this concept are ‘complications of medical and surgical care’, ICD 10 codes Y40-Y84. Table 5.19, from the annual ‘Mortality Statistics’ publication shows that there were 236 male deaths and 226 female deaths where the underlying cause was a complication of medical and surgical care, in England and Wales, for 2009”.

In the British Medical Journal (2016, sometinmes requires reader to login) Professor Martin A Makary, department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA explains that a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death so causes of death not associated with an ICD code, such as human and system factors, are not captured. can directly result in patient harm and death.

• communication breakdowns,
• diagnostic errors,
• poor judgment,
• and inadequate skill

Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums

Hospital committees undertake internal root cause analysis and departments hold morbidity and mortality conferences but these review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department.

Strategies to reduce death from medical error should include:

• making errors more visible when they occur so their effects can be intercepted;
• having remedies at hand to rescue patients
• and making errors less frequent by following principles that take human limitations into account
• death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.
• hospitals could carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of error.
• Standardized data collection and reporting processes are needed to build up an accurate national picture of the problem. 

World Health Organisation statistics show that strategies to reduce the rate of adverse events in the European Union alone would lead to the prevention – on average – of more than 750 000 harm-inflicting medical errors per year, leading in turn to over 3.2 million fewer days of hospitalization, 260 000 fewer incidents of permanent disability, and 95 000 fewer deaths per year.

 

 

 

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Weigh the value of new ‘tools’; apply the precautionary principle

There is mounting evidence of unintended harmful consequences in many sectors – including medicine, pharmacology, agriculture, energy generation, finance, engineering and transport. The most widely read post on this site in May reported the Lancet’s publication of the World Health Organisation’s finding that glyphosate, a widely used ingredient in weedkiller, is probably carcinogenic.

Michael J. Coren‘s article in Quartz magazine summarised the findings of Jameson Wetmore, an engineer turned social researcher at the Arizona State University’s School for the Future of Innovation in Society. Wetmore opened:

“The motto of the 1933 World Fair in Chicago was “Science Finds, Industry Applies, Man Conforms. Governments and companies were saying that technology can lead us out of this. It may not always be comfortable, but we have to ride it out. Household technologies were all the rage. When you hit the 1960s and 1970s, there is this shift.

“I think the hallmarks of that shift are the dropping of the atomic bomb, and then of course you have Ralph Nader’s Unsafe at Any Speed, and you also have Rachel Carson’s Silent Spring”.

“Whereas much of the contemporary world sees technological progress as inevitable, even a moral imperative, Wetmore finds that the Amish watch their neighbours and carefully consider how each one will change their culture before embracing it: “They . . . watch what happens when we adopt new technology, and then they decide whether that’s something they want to adopt themselves.”

We don’t think about the impact technology might have on our lives beyond the initial big idea.

“The automobile was sold to us with this idea of a freedom we never had before. With that freedom came a heavy toll of injury and death. So can we anticipate unintended consequences way the Amish do, or are these systems just too complex to go much beyond first-order effects?

A more rigorous application of the EU’s Article 191 (left) would help to do this.

“Less than a mile from where I’m standing [in Phoenix, Arizona], Elaine Herzberg was killed by an autonomous Uber vehicle. I fully recognize the only way we’re going to automated vehicles is running in this world is to test them on city streets. Now, if we were to sit back and think about the values of the society here, we might say that testing those vehicles at 10 PM at night outside of a concert hall where a huge amount of alcohol had been served was not the best place to be testing. Perhaps testing in a school zone when children are present is not the best place to test an autonomous vehicle. But those are decisions that local people did not have the chance to make.”

The idea that technology is an unmitigated good is beginning to be questioned

Wetmore thinks that today Americans have a much more nuanced view of things. The number of people who think technology is an unmitigated good is continuing to shrink, but most haven’t abandoned the idea that there are a lot of problems and technology will play a role in solving them.

The precautionary principle detailed in Article 191 of the Treaty on the Functioning of the European Union aims at ensuring a higher level of environmental protection through preventative decision-taking in the case of risk. It also covers consumer policy, European Union (EU) legislation concerning food, human, animal and plant health. It has been recognised by various international agreements, notably in the Sanitary and Phytosanitary Agreement (SPS) concluded in the framework of the World Trade Organisation (WTO).  

Jeremy Corbyn led the proposal (right) to retain Article 191’s environmental principles after exit day, narrowly defeated by 16 votes.

 

Time for change?

 

 

 

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Rising antibiotic resistance in E.coli on UK supermarket meat

Last December this site reported that Tracy Worcester is drawing attention to the subject of antibiotic resistance, which is growing – developing not in humans, but in bacteria that can then infect humans. Surgical and cancer chemotherapy patients rely on antibiotics to protect them from potentially life-threatening illnesses and declining efficacy could turn routine procedures into life-threatening ones.

The Organic Research Centre now reports that a new study carried out by scientists at Cambridge University, looked at 189 UK-origin pig and poultry meat samples from the seven largest supermarkets in the UK (ASDA, Aldi, Coop, Morrisons, Sainsbury’s, Tesco and Waitrose). It tested for the presence of E. coli which are resistant to the key antibiotics for treating E. coli urinary-tract and blood-poisoning infections in people. The highly resistant ESBL E. coli was found on meat from all of the supermarkets.

The research found rising levels of resistance in chicken meat, with 24% of samples testing positive for ESBL E. coli, a type of E. coli resistant to the ‘critically important’ modern cephalosporin antibiotics. This is four times higher than was found during a similar study in 2015, in which just 6% of chicken tested positive for ESBL E. coli. Modern cephalosporins are widely used for treating life-threatening E.coli blood poisoning in humans.

51% of the E. coli from pork and poultry samples were resistant to the antibiotic trimethoprim, which is used to treat over half of lower urinary-tract infections. In addition, 19% of the E. coli were resistant to gentamicin, a very important human antibiotic used to treat more serious upper urinary-tract infections.

The findings provide further evidence that the overuse of antibiotics used to mass medicate livestock on British farms is likely to be undermining the treatment of E. coli urinary-tract and blood-poisoning infections in humans. Some of the antibiotics tested are used in far greater quantities in livestock farming than in human medicine.

Dr Mark Holmes, from Cambridge University, who led the study said: “I’m concerned that insufficient resources are being put into the surveillance of antibiotic resistance in farm animals and retail meat. We don’t know if these levels are rising or falling in the absence of an effective monitoring system. These results highlight the need for improvements in antibiotic stewardship in veterinary medicine. While some progress has been made we must not be complacent as it may take many years before we see significant reductions in the numbers of antibiotic-resistant bacteria found in farms.”

E-coli is by far the most common cause of urinary-tract infections and of dangerous blood poisoning, and can also cause meningitis. These infections must be treated with antibiotics. Dr Ron Daniels BEM, CEO of the UK Sepsis Trust said: “This study highlights a worrying trend towards rising resistance in E.coli on UK retail meat. E.coli in people is the greatest cause of deaths from sepsis, and poor antimicrobial stewardship in intensive farming is undoubtedly contributing to this trend. It’s of paramount importance that we act decisively to reduce this immediate threat to human life.”

Two recommendations:

• Sign a letter to retailers.
• Sign Avaaz’ petition here

 Other proposals:

Tracy points out that we have the choice to buy meat with the high welfare labels RSPCA Assured, Outdoor Bred, Free Range or Organic – eat less meat as Anna advocates – or go meat-free. See the World Health Organisation on the health issues here.

Buy organic/local?

Organic farming is perceived as providing a better quality of life for farmed animals and an earlier article reports that a new financial report on organic farming in England and Wales for 2014/15, undertaken by the Organic Research Centre for the Welsh Government, shows organic farm profits increasing, with organic dairy farming outperforming conventional dairy farming in England and Wales. In particular, the organic dairy industry is now generating higher profits than conventional farms despite producing lower yields.

Animal welfare has been a key motivator to consumers who are increasingly choosing organic products with quality assurance standards, because they want to know the origins of their food, and are willing to pay more for products which are ‘friendly’ to wildlife and the environment.

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Professor Nic Lampkin from the Organic Research Centre in Newbury, was one of the co-authors of the report and the Cambridge study was commissioned by the Alliance to Save our Antibiotics, of which the Organic Research Centre is a member.

 

 

 

Monsanto asks the WHO, and California’s Office of Environmental Health Hazard Assessment, not to list glyphosate as a carcinogen

Glyphosate is the key ingredient in Monsanto’s branded Roundup line of herbicides, as well as hundreds of other products, but many scientific studies have raised questions about the health impacts of glyphosate and consumer and medical groups have expressed worries about glyphosate residues in food.

In October, Carey Gillam reported for Reuters that California’s Office of Environmental Health Hazard Assessment (OEHHA), has been accepting public comments about its intention to list glyphosate as a cause of cancer.

Roughly 8,000 comments were filed regarding the state action, according to officials, including those from Monsanto. Several farming, public health and environmental groups sent a letter to OEHHA supporting the listing, and said that rising use of glyphosate presents a danger to people and animals.

The OEHHA gave notice in September that it intended to list glyphosate under proposition 65, a state initiative enacted in 1986 to inform residents about cancer-causing chemicals. State officials said the action is required after the World Health Organization’s (WHO) cancer research committee in March classified glyphosate as a probable human carcinogen.

As we reported in March, the Wall Street Journal and Financial Times reported Monsanto’s call for the World Health Organisation’s cancer agency to retract a report published in the journal Lancet Oncology by researchers for WHO’s International Agency for Research on Cancer.

The WHO’s research unit, however, said it had reviewed many scientific studies, including two out of Sweden, one out of Canada and at least three in the United States before making its classification.

Since the WHO classification, the New York-based mass-tort firm of Weitz & Luxenberg, and other firms representing U.S. farm workers, have filed lawsuits against Monsanto, accusing the company of knowing of the dangers of glyphosate for decades. Monsanto has said the claims are without merit

Monsanto has now urged California not to list herbicide glyphosate as carcinogenic.

It added, in its formal comment, that California’s actions could be considered illegal because they are not considering valid scientific evidence.

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Wheat and other cereals – 2. glyphosate pesticides

In October plant biologist Dr. Jonathan Latham who began his doctoral research by creating GMO foods, published an article saying that commercial interests are beginning to ‘run ahead’ of scientific knowledge.

17 leading cancer experts on the World Health Organization’s (WHO) cancer research committee in March agreed to classify glyphosate as a probable human carcinogen. As we reported in March, the Wall Street Journal and Financial Times published Monsanto’s call for the World Health Organisation’s cancer agency to retract a report published in the journal Lancet Oncology by researchers for WHO’s International Agency for Research on Cancer.

An earlier study published in the journal Toxicology supports the findings of the WHO scientists that pesticides, such as Roundup, also contain additives (adjuvants), which increase the pest or weed-killing activity of the pesticide and do not have to be tested in medium and long-term tests.

This appears to have been known as far back as 1996, according to a Pesticides Action Network factsheet: It said that in pure chemical terms glyphosate is an organophosphate in that it contains carbon and phosphorous. However, it does not affect the nervous system in the same way as organophosphate insecticides, and is not a cholinesterase inhibitor:

“While glyphosate itself may be relatively harmless, some of the products with which it is formulated have a rather less benign reputation. Marketed formulations of glyphosate generally contain a surfactant. The purpose of this is to prevent the chemical from forming into droplets and rolling off leaves which are sprayed. Some of these surfactants are serious irritants, toxic to fish, and can themselves contain contaminants which are carcinogenic to humans”.

Alternet summarises: glyphosate by itself doesn’t cause cancer but it is likely that, in products which contain glyphosate and other additives and chemicals, the genotoxic effects observed in some glyphosate-based formulations are related to the other constituents or “co-formulants.

However, this year, scientists who compiled the European Food Safety Authority’s peer review report – with only one exception – found that the weed killer glyphosate, present in the widely used product ‘Round Up’, is not likely to be carcinogenic.

An Open Letter was sent to Commissioner Andriukaitis, European Commissioner for Health and Food Safety, on 29th October 2015. Campaigners called on him to ensure an open, scientifically robust process – and to immediately restrict the herbicide. In addition, an expert task force, which was set up to illuminate similar differences between two WHO bodies, the IARC and the Joint Meeting on Pesticide Residues (JMPR), concluded that the Joint FAO/WHO Meeting on Pesticide Residues (JMPR) which assessed glyphosate as non-carcinogenic, had to redo its work, properly taking into account published peer-reviewed literature.

The WHO then created an “ad hoc expert task force“ to consider possible reasons for the different assessments of the data by IARC and the JMPR. It was scheduled to report back to in September 2015 for further discussion and action but no news of its findings has been found by the writer. This process is known as a scientific divergence procedure within the WHO.

Though the World Health Organisation’s lead scientist disputes EFSA’s findings, new, lower EU safe limits for exposure to glyphosate will be recommended for those using it and for residues in food.

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COMMENT from Devon farmer

Yes, when we got the standard stuff for killing the weevils in our grain store, we were a bit shaken. I think it had a “warning – keep away from foodstuffs”. It then went on to tell you how to apply it to the grain! We only used it on the empty bin, and it is only barley for cattle feed. The cattle have never shown any ill effects.

When people say to me how much it is used in America – to prove it is harmless – my reply is “yes, and look at the Americans!”

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WHO: Glyphosate is “probably carcinogenic to humans”

Glyphosate, the world’s most widely-used herbicide, the key ingredient in Monsanto’s Roundup weedkiller, is “probably carcinogenic to humans”

The Wall Street Journal and Financial Times focus on Monsanto’s call for the World Health Organisation’s cancer agency to retract a report published on Friday in the journal Lancet Oncology by researchers for WHO’s International Agency for Research on Cancer.

The report found that glyphosate, the world’s most widely-used herbicide and the key ingredient in Monsanto’s Roundup weedkiller, is “probably carcinogenic to humans”.

This review of existing studies includes reports on the effects of glyphosate on farming and forestry workers. The people exposed to glyphosate experienced a higher incidence of non-Hodgkin’s lymphoma than those who were not exposed, according to the review.

The IARC report points out that 750 products used in agriculture, forestry and domestic gardening contain glyphosate and its use has increased sharply with the development of GM glyphosate-resistant crop varieties.

Monsanto’s current generation of herbicide-resistant genetically modified crops depends on farmers spraying their fields with glyphosate to kill weeds. Glyphosate had been detected in air during spraying, in water and in food.

But the company has consistently argued that its seeds and weedkillers are safe, and has fought efforts to label foods made with genetically-modified crops.

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A pharmaceuticals market of 800,000 – and growing

“Drug companies got out of antibiotics as their attention switched to much more lucrative daily medicines for chronic diseases”

In March, at the World Health Organisation’s first Ministerial Conference on Global Action Against Dementia in Geneva, Jeremy Hunt, the UK’s health secretary, announced plans to boost early-stage research into Alzheimer’s disease and other forms of dementia in order to find an effective treatment. Just three new drugs for the condition have reached market in the past 15 years and these only alleviate symptoms.

The WHO conference was supported by the Department of Health of the United Kingdom of Great Britain and Northern Ireland, and the Organization for Economic Cooperation and Development (OECD). Both days were webcast.

Ongoing lifelong drug treatment is very profitable – not so pre-emption

The $100m venture capital fund will be backed by the UK government and several of the world’s biggest pharmaceuticals companies, amongst them US investment bank JPMorgan, GlaxoSmithKline, Johnson & Johnson, Pfizer, Eli Lilly and Biogen.

Drug companies had lost billions of dollars in many failed trials and Patrick Vallance, president of research and development at GlaxoSmithKline, said the venture fund was a good way to spread risk and share expertise.

He added that there are rewarding economic incentives for research. “Nobody doubts that if you find an effective medicine for dementia it will be very profitable.”

True – and discovering and addressing the causes would remove this market opportunity.

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Today’s broadcast theme:

Infectious bacteria are becoming resistant to the drugs that used to kill them. The last new class of antibiotics was discovered in the 1980s. There is little in the development pipelines of the world’s pharmaceutical industry. Drug companies got out of antibiotics as their attention switched to much more lucrative daily medicines for chronic diseases. Public funding on antibiotic research has also withered.

Suppression of UN reports on the use of depleted uranium weapons

Richard Bruce draws our attention to a Global Research article written this month by Denis Halliday, who resigned from his position as UN Humanitarian Coordinator for Iraq because of the economic sanctions imposed on Iraq, characterizing them as “genocide”.

It summarises the repeated refusal of the World Health Organisation (WHO) to publish evidence uncovered in Iraq that US military use of depleted uranium and other weapons have not only killed many civilians, but continue to result in the birth of deformed babies.

2004: a WHO expert report by three leading radiation scientists “on the long-term health of Iraq’s civilian population resulting from depleted uranium (DU) weapons” was “held secret”. The study cautioned that children and adults could contract cancer after breathing in dust containing DU, which is radioactive and chemically toxic.

In November 2012, a joint WHO- Iraqi Ministry of Health Report on cancers and birth defect in Iraq was to be released. “It has been delayed repeatedly and now has no release date whatsoever.” To this date the WHO study remains “classified”.

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According to Hans von Sponeck, former Assistant Secretary General of the United Nations, who took over from Halliday in Iraq: “The US government sought to prevent the WHO from surveying areas in southern Iraq where depleted uranium had been used and caused serious health and environmental dangers,” (quoted in Mozhgan Savabieasfahani’s Rise of Cancers and Birth Defects in Iraq: World Health Organization Refuses to Release Data,

Is the Anglo Saxon alliance exerting pressure on the United Nations? Are they protecting companies who manufacture these weapons, including:

Aerojet, US
Alliant Techsystems (ATK), US
BAE Systems, UK
General Dynamics, US

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Halliday ends with a reference to the millions of gallons of Agent Orange used in rural Vietnam which were manufactured and sold to the Pentagon by companies Dupont and Monsanto for huge profits:

“This tragedy in Iraq reminds one of US chemical weapons used in Vietnam. And that the US has failed to acknowledge or pay compensation or provide medical assistance to thousands of deformed children born and still being born due to American military use of Agent Orange throughout the country.

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