British Medical Journal 2000;320:1561 ( 10 June )

Industrial action by doctors in Israel seems to be good for their patients' health. Death rates have dropped considerably in most of the country since physicians in public hospitals implemented a programme of sanctions three months ago, according to a survey of burial societies.

The Israel Medical Association began the action on 9 March to protest against the treasury's proposed imposition of a new four year wage contract for doctors. Since then, hundreds of thousands of visits to outpatient clinics have been cancelled or postponed along with tens of thousands of elective operations. Public hospitals, which provide the vast majority of secondary and tertiary medical care, have kept their emergency rooms, dialysis units, oncology departments, obstetric and neonatal departments, and other vital facilities working normally during the industrial action.

In the absence of official figures, the Jerusalem Post surveyed non-profit making Jewish burial societies, which perform funerals for the vast majority of Israelis, to find out whether the industrial action was affecting deaths in the country.

"The number of funerals we have performed has fallen drastically," said Hananya Shahor, the veteran director of Jerusalem's Kehilat Yerushalayim burial society. "This month, there were only 93 funerals compared with 153 in May 1999, 133 in the same month in 1998, and 139 in May 1997," he said. The society handles 55% of all deaths in the Jerusalem metropolitan area. Last April, there were only 130 deaths compared with 150 or more in previous Aprils. "I can't explain why," said Mr Shahor.

Meir Adler, manager of the Shamgar Funeral Parlour, which buries most other residents of Jerusalem, declared with much more certainty: "There definitely is a connection between the doctors' sanctions and fewer deaths. We saw the same thing in 1983 [when the Israel Medical Association applied sanctions for four and a half months]."

Motti Yeshuvayov of Tel Aviv's only burial society said that he had noticed the same trend in the Tel Aviv metropolitan area in the past two months. The only exception to the trend of decreasing deaths has been in the Haifa area.

The coastal city of Netanya has only one hospital, and it has been spared the industrial action because staff have to sign a no strike clause with their contract. Netanya's burial society, headed by Shlomo Stieglitz, reported 87 funerals last month, the same number as in May 1999. It reported 97 in April compared with 122 in April 1999, and 99 in March as compared with 119 in March 1999. Mr Stieglitz said that his burial society services not only Netanya but also other cities, including Hadera and Kfar Sava, where hospital doctors have joined the sanctions.

Avi Yisraeli, director general of the Hadassah Medical Organization, which owns two university hospitals in the capital, offered his own explanation. "Mortality is not the only measure of harm to health. Lack of medical intervention can lead to disability, pain, and reduced functioning. Elective surgery can bring about a great improvement in a patient's condition, but it can also mean disability and death in the weakest patients. And patients who do not undergo diagnosis or surgery now could decline or die in a few months due to the postponement."

During the months of the strike, patients "have been going more to their family doctor and to hospital emergency rooms, which have not been affected by sanctions," Professor Yisraeli said.

*************************************************************************************************************************

(Note: By "Church" he is referring to the medical establishment, which he says is far more a religion than a science)

"How truly deadly the Church is comes into stark relief whenever there’s a doctor’s strike. In 1976 in Bogota, Columbia, there was a fifty-two day period in which doctors disappeared altogether except for emergency care. The "National Catholic Reporter" described "a string of unusual side-effects" from the strike. The death rate went down 35%. A spokesman for the National Morticians Association said, "It might be a coincidence but it is a fact." An 18% drop in the death rate occurred in Los Angeles County in 1976 when doctors there went on strike [note: it was a work slowdown] to protest soaring malpractice insurance premiums…. When the strike ended and the medical machines started grinding again, the death rate went right back up to where it had been before the strike.

"The same thing happened in Israel in 1973 when the doctors reduced their daily patient contact from 65,000 to 7,000. The strike lasted a month. According to the Jerusalem Burial Society, the Israeli death rate dropped 50% during that month. There had not been such a profound decrease in mortality since the last doctors’ strike twenty years before!

"I’ve been saying right along that what we need is a perpetual doctors’ "strike." If doctors reduced their involvement with people by ninety percent and attended only emergencies, there’s no doubt in my mind that we’d be better off."

*************************************************************************************************************************

Extract from: Medical Journal of Australia 1999; 170: 404-405

Editorial

The human element of adverse events

Is a certain level of error inevitable in healthcare?

Quality in Australian Health Care Study (QAHCS) (1) together with the Harvard study on which it was based (2), were groundbreaking studies that for the first time systematically revealed the nature and scale of iatrogenic injury in healthcare.

Morbidity due to healthcare appears to be a major public health problem, and it is very unlikely that this problem is confined to Australia and the United States. The QAHCS revealed particularly high levels of adverse events (AEs), in part because it took a broader, quality-of-care approach rather than one focused on negligence and compensation…..

….The findings from the QAHCS (5 years ago) suggested that each year 50 000 Australians suffer permanent disability and 18 000 die at least in part as a result of their healthcare. Further evidence emerged in 1997 with the publication of AE rates in Victorian hospitals (3). Since then, thousands more Australians have presumably been injured or died through deficiencies in the healthcare system. Furthermore, the QAHCS found that AEs lost Australia over three million bed-days per annum. In its interim report, the National Expert Advisory Group pointed out that the extrapolated potential saving from preventable AEs in 1995-96 would be $4.17 billion (4). AEs also lead to increased disability benefits and time lost off work, which all impact on the Australian economy.

1. Wilson RM, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471.
2. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. N Engl J Med 1991; 324: 370-376.
3. O'Hara D, Carson NJ. Reporting of adverse events in hospitals in Victoria 1994-1995. Med J Aust 1997; 166: 460-463.
4. National Expert Advisory Group on Safety and Quality in Australian Health Care. Interim report - Commitment to quality enhancement. July 1998.

*************************************************************************************************************************

Metro, May 11, 2005

Prescription Drugs 'kill 15,000 a year'

Thousands of people are killed each year by common prescription drugs, scientists revealed yesterday.

They suffer heart attacks because the medication disrupts the electrical activity controlling their heartbeat.

Seven drugs are said to present a danger, including the antibiotics erythromycin and clarithromycin.

The others are domperidone and cisapride, for gastro-intestinal disorders, and anti-psychotic drugs pimozide, haloperidol and chlorpromazine.

Dr Bruno Stricker said: 'Sudden cardiac death can be attributed to these drugs in around 9,000 people in Europe and 6,000 in the US.'

Researchers studied 775 cases of sudden heart deaths and found the seven drugs were responsible for 320.

They calculated this worked out to about 15,000 deaths each year across Europe and America.

The chances of someone in the West dying from sudden cardiac arrest is normally one or two in a thousand.

The risk for those taking the drugs was found to be up to three times higher - about three in a thousand. Patients who had been on the drugs for less than about 90 days were said to be in the greatest danger…"

*************************************************************************************************************************

By BRENDA C. COLEMAN

April 15, 1998

Associated Press

CHICAGO _¯ Bad reactions to prescription and over-the-counter medicines kill more than 100,000 Americans and seriously injure an additional 2.1 million every year _¯ far more than most people realize, researchers say.

Such reactions, which do not include prescribing errors or drug abuse, rank at least sixth among U.S. causes of death _¯ behind heart disease, cancer, lung disease, strokes and accidents, says a report based on an analysis of existing studies.

"We're not saying, 'Don't take drugs.' They have wonderful benefits," said Dr. Bruce H. Pomeranz, principal investigator and a neuroscience professor at the University of Toronto.

"But what we're arguing is that there should be increased awareness also of side effects, which until now have not been too well understood."

The harm may range from an allergic reaction to an antibiotic to stomach bleeding from frequent doses of aspirin, Pomeranz said. The study, by Pomeranz and two colleagues at his school, Jason Lazarou and Paul N. Corey, did not explore which medications or illnesses were involved.

The authors analyzed 39 studies of hospital patients from 1966 to 1996. Serious drug reactions affected 6.7 percent of patients overall and fatal drug reactions 0.32 percent, the authors reported in Wednesday's Journal of the American Medical Association.

In the study, serious injury was defined as being hospitalized, having to extend a hospital stay or suffering permanent disability.

The most surprising result was the large number of deaths, the authors said. They found adverse drug reactions ranked between fourth and sixth among leading causes of death, depending on whether they used their most conservative or a more liberal estimate.

In 1994, between 76,000 and 137,000 U.S. hospital patients died, and the "ballpark estimate" is 106,000, Pomeranz said. The low estimate, 76,000 deaths, would put drug reactions sixth. The ballpark estimate would put them fourth, he said.

An additional 1.6 million to 2.6 million patients were seriously injured, with the ballpark estimate 2.1 million, he said.

More than two-thirds of the cases involved reactions outside hospitals rather than in hospitals, the authors reported.

Experts commended the study but disagreed whether the estimates are on target.

Dr. David W. Bates of Partners Healthcare Systems and Brigham and Women's Hospital in Boston said the estimates may be high. One reason, he said, is that they may overrepresent large medical centers, which treat sicker than average patients, who are more prone to reactions.

"Nonetheless, these data are important, and even if the true incidence of adverse drug reactions is somewhat lower than that reported ... it is still high, and much higher than generally recognized," he said.

Dr. Sidney M. Wolfe, director of the consumer advocacy Public Citizen Health Research Group, said he believes the numbers are on target.

"I've read most of these studies, and they represent large hospitals, small hospitals ... a heterogeneous sample of the kinds of hospitals in this country, and include a whole range," Wolfe said by telephone Tuesday from Washington.

**************************************************************************************************************************