The caption is a borrowed one! The medical world is full of uncertainties for the common man. Lay people believe that there is a pill for every ill and think that they need not bother about their health as long as the medical establishment, with its hi-tech gadgetry and heroic surgical feats, could overcome any human ill. This is a simple delusion. The fact still remains that the hi-tech medical science has been able to conquer but one single disease, smallpox, that too not with any hi-tech intervention but by the ancient vaccination. The truth is that while 59.4% of the improvement in health and fall in death rate has been due to change of mode of living of Americans, only a meager 3.4% has been due to hi-tech modern medical interventions. Americans have the best health habits in the world, despite the common perception that Americans behave badly by smoking, drinking and perpetrating violence.



Tobacco smoking has come down drastically in the US to 28% while 61% of men still smoke in Japan. For female smokers the corresponding figures are 24% in USA and 41% in Denmark. American average alcohol consumption is the 5th best among the thirteen countries studied. Average American cholesterol level is the third lowest. Well informed Americans eat very low animal fat. They eat fruits and vegetables in plenty. Notwithstanding all these the US ranks last but one among the thirteen countries studied for health status, Japan topping the list with Germany at the bottom. The fact that countries with the highest doctor patient ratio have the poorest health index is another amazing fact that came out of a separate five country study in Europe.



All these clearly point to one important truth. Americans have the highest medical interventions in the developed countries: they are overdosed. Every intervention has its good and bad fall outs; many times the bad overshadows the good. In a detailed commentary on the Institute of Medicine report for the year 2000, Barbara Starfield of the Johns Hopkins Medical College, shows how the US medical care is the worst among the developed countries studied. The brunt of this malady falls on the unknown side effects of known therapeutic agents. Adverse drug reactions are one of the leading causes of hospital admissions. Many of those drugs have had tests in small controlled human studies before being allowed to be marketed. Despite that new side effects come to light almost every day. In the last ten years the reporting of adverse drug reactions (ADRs) has been going up exponentially as shown in the figure 1 below. The reasons are not far to seek. While the drugs are tested by the “so called” controlled studies under ideal circumstances, the rules of the game change when the same drugs are let loose on the gullible public on a large scale.

Figure 1





Rate of increase of adverse and side effects







Whereas the controlled studies are done strictly on selected patients based on the entry criteria, in real life situations use of the drugs in patients can not follow those rules. In addition, every drug is studied in isolation in the controlled studies. One hardly sees a doctor’s prescription these days having a single drug. One sees large list of drugs given together to patients for various reasons in combinations. Drug interactions could throw up side effects unbeknownst to the medical establishment. The saving grace is that patient compliance, when large number of drugs is prescribed together, has been found to be very low. If patients had complied one hundred per cent, death and disability due to ADR would have been much more.



Despite all these checks and balances the fourth important cause of death in the US hospitals is adverse drug reactions (ADRs). On an average around 106,000 to 140,000 people meet their maker in heaven annually in the US hospitals due to ADR. If one takes the out-patients also into consideration the numbers are mind boggling. Annually nearly 116 million extra physician visits, 77 million extra prescriptions, 17 million emergency room visits, 8 million hospitalizations, 3 million long term admissions, and 199,000 additional deaths with $77 billion in extra costs occur because anywhere between 4-18% patients do experience adverse drug reactions. While it could be welcome news to the drug industry it is not good news to prospective patients.



Following healthy life style to avoid diseases would be the best bet to avoid adverse drug reactions (ADRs). One must also try and avoid pills for minor illness syndromes which are self curing. Whereas there is no pill for every ill, every pill is definitely followed by newer ills in the long run. Other avoidable areas of adverse drug reactions (ADRs) are the prolonged use of drugs to suppress asymptomatic stage of many diseases as also the prophylactic use of drugs in many situations resulting from routine screening mania. Studies have shown that routine screening of the apparently healthy population could be dangerous, to say the least. The very definition of “normality” in medicine is flawed! If every one goes through a total body scanner, there would no “well” person at all. Every citizen would need medical intervention.

Figure 2







Time evolution in the dynamic human system does not follow the linear rules of mathematics. Changing the initial state with drugs might or might not be associated with benefit in all cases, but the prolonged use of drugs is associated with side effects as most drugs are not tested before being permitted for human use on long term observation. Even drugs that have been in use for hundreds of years come up with newer side effects. Aspirin and digoxin are the two drugs that have been in use for more than two hundred years but at times they still baffle the medical world!



The pharmaceutical industry plays a vital role in this whole game. The former editor-in-chief of the prestigious New England Journal of Medicine and assistant professor of pathology at Harvard, Marcia Angell, in her latest book The Truth about Drug Companies: How They Deceive Us and What to do about it? (Random House), goes deep into this forbidden world of pharmaceutical business. If one observes the scatter of different drug producing side effects in the figure 2 above one quickly realizes that the main culprits are the anti-biotics and diagnostic drugs. Most of these could have been avoided if proper assessment of patients had been done on the bedside.





One of the main reasons for the poor state of American medical scenario brought out in the Institute of Medicine report is said to be the lack of a good primary family practitioner infrastructure in America. Countries with the robust family medicine systems have the best health care. Time honored bedside medicine has taken a back seat in this era of scanners and scopes and contrast studies. Time has come to go back to good doctoring-patient care truly is just caring for the patients. Common man also takes a share of the blame as many a time it is the patient that asks for more drugs and the obliging doctor might succumb to the pressure to cover his skin. Less drugging and better health care might bring America back to its pristine glory in the area of health care as well.