Facts and Figures

As evidence supporting the effectiveness of chiropractic continues to emerge, consumers are turning in record numbers to chiropractic care — a preventive, non-surgical, drug-free treatment option.

Just a few interesting facts on this increasingly popular form of health care:

       Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions.  (Meeker, Haldeman; 2002; Annals of Internal Medicine)

       There are more than 60,000 active chiropractic licenses in the United States.  All 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands officially recognize chiropractic as a health care profession.

        In 2002, approximately 7.4 percent of the population used chiropractic care – a higher percentage than yoga, massage, acupuncture or other diet-based therapies. (Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005 Jan-Feb;11(1):42-9.)

       Doctors of Chiropractic undergo at least four years of professional study at one of 16 chiropractic colleges accredited by the Council on Chiropractic Education (CCE), an agency recognized by the U.S. Secretary of Education.  In addition, Doctors of Chiropractic must pass national board examinations and become state-licensed prior to practicing.  In national surveys, patients favor chiropractic over medical care for back or neck pain.  Patients routinely rate Doctors of Chiropractic highly in skill, manner, and explanation of treatment.  Doctors of Chiropractic provide care in hospitals and other multidisciplinary health care facilities.  Chiropractic is the third largest doctoral-level health care profession after medicine and dentistry.  Back pain is the second leading cause of all physician visits in the U.S. In fact, half of all working Americans admit to having back pain each year.  According to a study conducted by the American Chiropractic Association in 2001, 43% of patients seen by a doctor of chiropractic were treated for low-back pain.  For more back pain statistics, click here.

American Prescription Drug Use

“The average number of prescriptions [drugs] per person, annually, in 1993 was seven.

The average number of prescriptions [drugs] per person, annually, in 2000 was eleven.

[The average number of prescriptions drugs per person], annually, in 2004 was twelve.

The total number of annual prescriptions [drugs] in the United States now stands at about 3 billion. The cost per year is about $180 billion, headed to an estimated $414 billion by 2011.

Pretty soon, you are talking real money.”

Generation Rx

How Prescription Drugs Are Altering American Lives, Minds, and Bodies

Greg Critser

Houghton Mifflin Company, 2005, Page 2

The enumerating of unnecessary medical events is very important in our analysis. Any medical procedure that is invasive and not necessary must be considered as part of the larger iatrogenic picture. Unfortunately, cause and effect go unmonitored. The figures on unnecessary events represent people ("patients") who are thrust into a dangerous health care system. They are helpless victims. Each one of these 16.4 million lives is being affected in a way that could have a fatal consequence. Simply entering a hospital could result in the following (out of 16. 4 million people):

2.1 percent chance of a serious adverse drug reaction (186,000) (1)

5 percent to 6 percent chance of acquiring a nosocomial [hospital] infection (489,500) (9)

4 percent to 36 percent chance of having an iatrogenic injury in hospital (medical error and adverse drug reactions) (1.78 million) (16)

17 percent chance of a procedure error (1.3 million) (40)

All the statistics above represent a one-year time span. Imagine the numbers over a 10-year period. Working with the most conservative figures from our statistics we project the following 10-year death rates.

The enumerating of unnecessary medical events is very important in our analysis. Any medical procedure that is invasive and not necessary must be considered as part of the larger iatrogenic picture. Unfortunately, cause and effect go unmonitored. The figures on unnecessary events represent people ("patients") who are thrust into a dangerous health care system. They are helpless victims. Each one of these 16.4 million lives is being affected in a way that could have a fatal consequence. Simply entering a hospital could result in the following (out of 16. 4 million people):

2.1 percent chance of a serious adverse drug reaction (186,000) (1)

5 percent to 6 percent chance of acquiring a nosocomial [hospital] infection (489,500) (9)

4 percent to 36 percent chance of having an iatrogenic injury in hospital (medical error and adverse drug reactions) (1.78 million) (16)

17 percent chance of a procedure error (1.3 million) (40)

All the statistics above represent a one-year time span. Imagine the numbers over a 10-year period. Working with the most conservative figures from our statistics we project the following 10-year death rates.

Our projected statistic of 7.8 million iatrogenic deaths is more than all the casualties from wars that America has fought in its entire history.

Projected figures for unnecessary medical events occurring over a 10-year period are also dramatic.

These projected figures show that a total of 164 million people, approximately 56 percent of the population of the United States, have been treated unnecessarily by the medical industry—in other words, nearly 50,000 people per day.

The American Medical System Is The Leading Cause Of Death And Injury In The United States
By Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD, Debora Rasio MD, Dorothy Smith PhD

A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million. (1) Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics. (2, 2a)

The number of unnecessary medical and surgical procedures performed annually is 7.5 million. (3) The number of people exposed to unnecessary hospitalization annually is 8.9 million. (4) The total number of iatrogenic [induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures] deaths is 783,936.

The 2001 heart disease annual death rate is 699,697; the annual cancer death rate is 553,251. (5) It is evident that the American medical system is the leading cause of death and injury in the United States.

Introduction
Never before have the complete statistics on the multiple causes of iatrogenesis been combined in one paper. Medical science amasses tens of thousands of papers annually—each one a tiny fragment of the whole picture. To look at only one piece and try to understand the benefits and risks is to stand one inch away from an elephant and describe everything about it. You have to pull back to reveal the complete picture, such as we have done here. Each specialty, each division of medicine, keeps their own records and data on morbidity and mortality like pieces of a puzzle. But the numbers and statistics were always hiding in plain sight. We have now completed the painstaking work of reviewing thousands and thousands of studies. Finally putting the puzzle together we came up with some disturbing answers.

Is American Medicine Working?
At 14 percent of the Gross National Product, health care spending reached $1.6 trillion in 2003. (15) Considering this enormous expenditure, we should have the best medicine in the world. We should be reversing disease, preventing disease, and doing minimal harm. However, careful and objective review shows the opposite. Because of the extraordinary narrow context of medical technology through which contemporary medicine examines the human condition, we are completely missing the full picture.

Medicine is not taking into consideration the following monumentally important aspects of a healthy human organism:
(a) Stress and how it adversely affects the immune system and life processes
(b) Insufficient exercise
(c) Excessive caloric intake
(d) Highly processed and denatured foods grown in denatured and chemically damaged soil
(e) Exposure to tens of thousands of environmental toxins.

Instead of minimizing these disease-causing factors, we actually cause more illness through medical technology, diagnostic testing, overuse of medical and surgical procedures, and overuse of pharmaceutical drugs. The huge disservice of this therapeutic strategy is the result of little effort or money being appropriated for preventing disease.

Under-reporting of Iatrogenic Events
As few as 5 percent and only up to 20 percent of iatrogenic acts are ever reported. (16, 24, 25, 33,34) This implies that if medical errors were completely and accurately reported, we would have a much higher annual iatrogenic death rate than 783,936. Dr. Leape, in 1994, said his figure of 180,000 medical mistakes annually was equivalent to three jumbo-jet crashes every two days.16 Our report shows that six jumbo jets are falling out of the sky each and every day.

Correcting a Compromised System
What we must deduce from this report is that medicine is in need of complete and total reform: from the curriculum in medical schools to protecting patients from excessive medical intervention. It is quite obvious that we can't change anything if we are not honest about what needs to be changed. This report simply shows the degree to which change is required.

We are fully aware that what stands in the way of change are powerful pharmaceutical companies, medical technology companies, and special interest groups with enormous vested interests in the business of medicine. They fund medical research, support medical schools and hospitals, and advertise in medical journals. With deep pockets they entice scientists and academics to support their efforts. Such funding can sway the balance of opinion from professional caution to uncritical acceptance of a new therapy or drug.

You only have to look at the number of invested people on hospital, medical, and government health advisory boards to see conflict of interest. The public is mostly unaware of these interlocking interests. For example, a 2003 study found that nearly half of medical school faculty, who serve on Institutional Review Boards (IRB) to advice on clinical trial research, also serve as consultants to the pharmaceutical industry. (17) The authors were concerned that such representation could cause potential conflicts of interest.

A news release by Dr. Erik Campbell, the lead author, said, "Our previous research with faculty has shown us that ties to industry can affect scientific behavior, leading to such things as trade secrecy and delays in publishing research. It's possible that similar relationships with companies could affect IRB members' activities and attitudes." (18)

Medical Ethics and Conflict of Interest in Scientific Medicine
Jonathan Quick, director of Essential Drugs and Medicines Policy for the World Health Organization (WHO) wrote in a recent WHO Bulletin:

"If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken." (19)

Former editor of the New England Journal of Medicine (NEJM), Dr. Marcia Angell, struggled to bring the attention of the world to the problem of commercializing scientific research in her outgoing editorial titled "Is Academic Medicine for Sale?" (20) Angell called for stronger restrictions on pharmaceutical stock ownership and other financial incentives for researchers. She said that growing conflicts of interest are tainting science.

She warned that, "When the boundaries between industry and academic medicine become as blurred as they are now, the business goals of industry influence the mission of medical schools in multiple ways." She did not discount the benefits of research but said a Faustian bargain now existed between medical schools and the pharmaceutical industry.

Angell left the NEMJ in June 2000. Two years later, in June 2002, the NEJM announced that it would now accept biased journalists (those who accept money from drug companies) because it is too difficult to find ones who have no ties. Another former editor of the journal, Dr. Jerome Kassirer, said that was just not the case, that there are plenty of researchers who don't work for drug companies. (21) The ABC report said that one measurable tie between pharmaceutical companies and doctors amounts to over $2 billion a year spent for over 314,000 events that doctors attend.

The ABC report also noted that a survey of clinical trials revealed that when a drug company funds a study, there is a 90 percent chance that the drug will be perceived as effective whereas a non-drug company-funded study will show favorable results 50 percent of the time.

It appears that money can't buy you love but it can buy you any "scientific" result you want.

The only safeguard to reporting these studies was if the journal writers remained unbiased. That is no longer the case.

Cynthia Crossen, writer for the Wall Street Journal in 1996, published "Tainted Truth: The Manipulation of Fact in America," a book about the widespread practice of lying with statistics. (22) Commenting on the state of scientific research she said that:

"The road to hell was paved with the flood of corporate research dollars that eagerly filled gaps left by slashed government research funding."

Her data on financial involvement showed that in l981 the drug industry "gave" $292 million to colleges and universities for research. In l991 it "gave" $2.1 billion.

The First Iatrogenic Study Dr. Lucian L. Leape opened medicine's Pandora's box in his 1994 JAMA paper, "Error in Medicine." (16) He began the paper by reminiscing about Florence Nightingale's maxim—"first do no harm." But he found evidence of the opposite happening in medicine. He found that Schimmel reported in 1964 that 20 percent of hospital patients suffered iatrogenic injury, with a 20 percent fatality rate. Steel in 1981 reported that 36 percent of hospitalized patients experienced iatrogenesis with a 25 percent fatality rate and adverse drug reactions were involved in 50 percent of the injuries. Bedell in 1991 reported that 64 percent of acute heart attacks in one hospital were preventable and were mostly due to adverse drug reactions.

However, Leape focused on his and Brennan's "Harvard Medical Practice Study" published in 1991.16a They found that in 1984, in New YorkState, there was a 4 percent iatrogenic injury rate for patients with a 14 percent fatality rate. From the 98,609 patients injured and the 14 percent fatality rate, he estimated that in the whole of the United States 180,000 people die each year, partly as a result of iatrogenic injury. Leape compared these deaths to the equivalent of three jumbo-jet crashes every two days.

Why Leape chose to use the much lower figure of four percent injury for his analysis remains in question. Perhaps he wanted to tread lightly. If Leape had, instead, calculated the average rate among the three studies he cites (36 percent, 20 percent, and 4 percent), he would have come up with a 20 percent medical error rate. The number of fatalities that he could have presented, using an average rate of injury and his 14 percent fatality, is an annual 1,189,576 iatrogenic deaths, or over ten jumbo jets crashing every day.

Leape acknowledged that the literature on medical error is sparse and we are only seeing the tip of the iceberg. He said that when errors are specifically sought out, reported rates are "distressingly high." He cited several autopsy studies with rates as high as 35 percent to 40 percent of missed diagnoses causing death. He also commented that an intensive care unit reported an average of 1.7 errors per day per patient, and 29 percent of those errors were potentially serious or fatal.

We wonder: what is the effect on someone who daily gets the wrong medication, the wrong dose, the wrong procedure; how do we measure the accumulated burden of injury; and when the patient finally succumbs after the tenth error that week, what is entered on the death certificate?

Leape calculated the rate of error in the intensive care unit. First, he found that each patient had an average of 178 "activities" (staff/procedure/medical interactions) a day, of which 1.7 were errors, which means a 1 percent failure rate. To some this may not seem like much, but putting this into perspective, Leape cited industry standards where in aviation a 0.1 percent failure rate would mean:

Two unsafe plane landings per day at O'Hare airport In the U.S. mail, 16,000 pieces of lost mail every hour. In banking, 32,000 bank checks deducted from the wrong bank account every hour

Analyzing why there is so much medical error Leape acknowledged the lack of reporting. Unlike a jumbo-jet crash, which gets instant media coverage, hospital errors are spread out over the country in thousands of different locations. They are also perceived as isolated and unusual events. However, the most important reason that medical error is unrecognized and growing, according to Leape, was, and still is, that doctors and nurses are unequipped to deal with human error, due to the culture of medical training and practice.

Doctors are taught that mistakes are unacceptable. Medical mistakes are therefore viewed as a failure of character and any error equals negligence. We can see how a great deal of sweeping under the rug takes place since nobody is taught what to do when medical error does occur. Leape cited McIntyre and Popper who said the "infallibility model" of medicine leads to intellectual dishonesty with a need to cover up mistakes rather than admit them. There are no Grand Rounds on medical errors, no sharing of failures among doctors and no one to support them emotionally when their error harms a patient. Leape hoped his paper wo