From: email@example.com(Steven B. Harris)
Subject: Re: Alternative lies about Rx drugs (was: NEJM)
Date: 9 Oct 1998 07:05:10 GMT
In <firstname.lastname@example.org> email@example.com
>The 106,000 deaths per year is limited to deaths in hospitals and people
>who are taken to emergncy rooms and their cause of death is identified as
>being caused by a prescription drug reaction.
The 106,000 deaths a year is a number obtained by looking at a few
studies done at mostly academic hospitals, where very sick people go to
get stuff like chemotherapy, and deciding that you can just multiply
these figures by all the hospitalized patients in the country to get an
answer for the country (hint: wrong). And it isn't even all patients
in the study hospitals that are being looked at, but rather the
fraction in beds where monitoring is close, and statistics tend to be
kept. ICU's often, but rehab floors more rarely. Again, the really
ill patient bias. All of these problems are pointed out in the paper
itself, and in the JAMA editorial.
Desperate situations require desperate remedies. Some fraction of
people who are anesthetized for surgery die from the anaesthetic, but
this does not imply that surgery should be done without anaesthesia, or
that alternative medicine has a wonderful alternative for surgical
anaesthesia (You think so? You first). Some fraction of people who are
dying because of a clot in a coronary artery can be saved if given a
clot disolver. Some fraction of THEM will die of bleeding stroke, but
this does not imply that clot disolvers should not be used. Obviously
if they save more lives than they take, they are a good gamble. It's
hardly fair to count the deaths but not the lives saved. And we do
know that for appropriately chosen patients, such drugs save lives over
treating "conservatively" with the old standards of just morphine,
oxygen, lidocaine, aspirin, etc. Randomized studies show this.
Of course, at this point the alternative folks are always going to
come hopping up and say that even more lives could be saved if, instead
of clot busters, one treated people with cayanne pepper or bee pollen
or eye of newt, toe of frog. But these assertions are in the nature of
rumor, myth, and wishful thinking. One might as well assert that more
lives could be saved by Voodoo or Christian Science. Fantasy always
makes reality really look bad by comparison.
Unfortunately for fantasy, however, it's, well, fantasy.
Steve Harris, M.D.